affective disorders. Mood disorders. Treatment of phobic anxiety disorders

Mood is an emotional state characterized by a change of joy and sadness depending on the circumstances. Mood disorders are characterized by excessive hypo- or hyperthymia. Major mood disorders include depressive disorders and bipolar affective disorder.

Depression is characterized by an experience of deep sadness, disappointment, and despondency that persists most day and almost every day. A depressed person does not respond to the external circumstances of life, does not show interest in performing all or almost all types of activities, does not enjoy what he used to like. He moves away from his friends, family, preferring to spend time alone and thinking. His thoughts are often associated with ideas or actions aimed at self-harm, self-deprecation. The future is perceived gloomy and pessimistic. A person with depression does not feel the strength to do anything, tends to consider any action meaningless.

Any normal person experiencing depression when faced with unhappiness or a hopeless situation, disappointment in someone or something. However, in some people, including children, this condition persists for a long time: from three months to a year. Unfortunately, parents and educators often “cheat” Bad mood children to lack of sleep or "weather" and not always see a mental disorder in long-term depression. Recognition of depression is often hindered by the fact that it is often accompanied by increased irritability, capriciousness, hysterical outbursts, psychomotor agitation, destructive behavior, screams, caustic malicious remarks (especially if they try to somehow activate or force the child to do something, violate his loneliness, etc.). With the help of excitement, the child is just trying to cope with depression. Therefore, depressive disorders do not necessarily make a person sad and dull. A depressive disorder can also manifest itself in sleep disturbances (a person often wakes up at night, wakes up very early in the morning for no reason, and during the day experiences drowsiness, various unreasonable pains, loss of strength), eating disorders (too high or, conversely, decreased appetite). specific feature depressive disorder is that in the morning a person's mood is much worse than in the evening.

Children experience depression differently depending on their age. In preschoolers, depressive disorder often manifests itself in the form of dull, passive-indifferent, autistic (closed in itself), inhibited behavior. They experience excessive affection, tearfulness. They lack imagination in games, liveliness and enthusiasm in the game. Adolescents are more pronounced aggressiveness and conflict, despair and suicidal tendencies, self-deprecating thoughts. They often quarrel with their parents about the choice of friends or late return home, experience strong feeling guilt and suffer from loneliness (including - from loneliness "in the crowd" when the existing social circle does not satisfy them). Precisely because destructive behavior draws more attention to itself than internal state child, depressive disorder often goes unnoticed. Against the background of a depressive disorder, concomitant mental disorders often occur: anxiety disorders, obsessions, attention deficit hyperactivity disorder, substance abuse.

Depressive disorders are very misleading because they often go away on their own. However, spontaneously resolving depressive disorders subsequently increase the risk of recurrent depression and other psychiatric disorders.

Depression has many causes. Each factor - biological, personal, socio-psychological - can contribute to their occurrence.

People who are prone to developing depressive disorders have an imbalance electrical activity frontal lobes brain. The main neurobiological correlates of depression are focused on the hypothalamic-pituitary-adrenal axis - the endocrine system that regulates brain activity during the reaction to stressful events: in depression, there is a reduced activity of biogenic amines (serotonin, norepinephrine, dopamine) and increased secretion of cortisol. With this functioning of the body, the psyche becomes extremely sensitive to stressful psychosocial factors - life crises.

Crisis life events (moving to a new place of residence, changing school, death loved one, economic need, etc.) should be recognized as the main provoking factor of depressive disorder. The role of this factor is enhanced when combined with the factors of "social vulnerability" - insufficient social support personality, peculiarities of upbringing and hostile social environment.

In families where a child suffers from depression, a more critical attitude is manifested towards him, more control, a lack of emotional communication /30/. There is a strong link between childhood depression and family disorders.

Personal factors also play a predisposing role. First of all - dysfunction of cognitive processes. A. Beck considered changes in the system of a person's attitude to himself, to others and to his future as a personality basis of depressive disorder /53/. Negative cognitive schemas arise in adverse experiences of interpersonal relationships (especially in early childhood) and are activated in similar stressful situations. The relationship of hypercontrol between parents and the child provokes in the latter a feeling of insufficient control over adverse effects from the outside, the desire to receive positive reinforcement only from other (referential) people and the tendency to attribute all failures to one's own life incompetence (pessimistic attribution style).

Bipolar affective disorder is characterized by abrupt, cyclic mood swings between the hyperthymic and hypothymic poles. A cheerful mood, increased energy and activity are suddenly replaced by a decrease in mood, a decrease in energy and activity. Depending on the severity of the manic or depressive pole in mood swings, two types of bipolar affective disorder are distinguished. In the case of the severity of the manic characteristics of hyperthymia we are talking about bipolar disorder type 1. If the disorder occurs within the framework of the hypomanic form of hyperthymia, we are talking about bipolar disorder of the second type.

Manic (hypomanic) episodes usually start suddenly and last from 2 weeks to 4-5 months. At this time, a person shows strong irritability and outbursts of anger, or simply behaves unreasonably, frivolously. In communication, he is extremely talkative and persistent. Can overspend money just for fun, over-indulge in gambling, strive for multiple sexual relationships and flirting, take on a large amount of work and easily take on extreme responsibility, easily get excited if even minor obstacles come in their way. May not feel the need to sleep. In statements, there is an inadequately high self-esteem, an exaggeration of one's own significance and power, and in intentions it is full of grandiose plans. He takes on many ideas at once, without working through any of them to the end, but visibly and in detail discussing the particular aspects of his thoughts. At the same time, there is also absent-mindedness and constant switching from one thought to another.

Criticality in relation to their capabilities and abilities in a manic episode is sharply reduced. AT extreme cases there are delusional and hallucinatory disorders, the subject matter of which is associated with incredible self-importance and power. At the same time, a person cannot present any logical explanations for his significance and power. For example, a teenager with bipolar disorder in a manic episode may claim to be a famous scientist in the future, while ignoring his school failures as the incompetence of teachers and the adolescent's right to choose his own subject areas worthy of study.

After some time, the episode of extreme excitement is replaced by a state of depression or calm. Mood depressive episodes in bipolar disorder may precede, accompany, or follow a manic episode. Depression in this disorder tends to last longer - an average of about six months. If a manic episode has a clearly defined beginning and end, then depression is a constant background of mood disturbance. Despite the fact that in a manic episode the teenager looks vigorous and cheerful, excessively mobile and active, as a rule, with more careful attention to him, one can notice that the high spirits contrast with what is happening in this moment troubles, conflicts and problems at school or at home.

Changing the poles of mood, as a rule, is associated with the experience of stressful situations or mental trauma.

The first episode of the disorder can occur at any age, from childhood to old age. But most often the onset occurs at the age of 15-19 years. For most people, bipolar disorder begins with severe depression, followed by flare-ups of manic mood swings.

Bipolar disorder has a pronounced hereditary character: if one of the parents suffers from bipolar disorder, the probability of this disorder in a child is 25%; if both parents have bipolar disorder, the child has a 50-75% chance of developing the disorder /19/. However, psychosocial factors play important role in how it appears genetic predisposition.

Recognition of any disease, including mental, begins with a symptom (a sign that reflects certain disorders of one or another function). However, the symptom-sign has many meanings and it is impossible to diagnose the disease on its basis. An individual symptom acquires diagnostic value only in the aggregate and in interrelation with other symptoms, that is, in a syndrome (symptom complex). A syndrome is a set of symptoms united by a single pathogenesis. From the syndromes and their successive changes, the clinical picture of the disease and its development are formed.

Neurotic (neurosis-like) syndromes

Neurotic syndromes are observed in neurasthenia, hysterical neurosis, obsessive-compulsive disorder; neurosis-like - in diseases of an organic and endogenous nature and correspond to the mildest level of mental disorders. Common to all neurotic syndromes is the presence of criticism of their condition, the absence of pronounced phenomena of maladaptation to normal conditions life, the concentration of pathology in the emotional-volitional sphere.

Asthenic syndrome - characterized by a noticeable decrease in mental activity, increased sensitivity to common stimuli (mental hyperesthesia), rapid fatigue, difficulty in the flow of mental processes, incontinence of affect with rapidly onset fatigue (irritating weakness). There are a number of somatic functional disorders with vegetative disorders.

obsessive-compulsive disorder (anancastic syndrome) - manifested by obsessive doubts, ideas, memories, various phobias, obsessive actions, rituals.

hysterical syndrome - a combination of egocentrism, excessive self-suggestion with increased affectation and instability emotional sphere. Actively seeking recognition from others by demonstrating one's own superiority or seeking sympathy or self-pity. The experiences of patients and behavioral reactions are characterized by exaggeration, hyperbolization (of the merits or severity of their condition), increased fixation on painful sensations, demonstrativeness, mannerisms, exaggerations. This symptomatology is accompanied by elementary functional somato-neurological reactions, which are easily fixed in psychogenic situations; functional disorders of the motor apparatus (paresis, astasia-abasia), sensitivity, activity of internal organs, analyzers (deafness, aphonia).

Mood Disorder Syndromes

Dysphoria - Grumpy-irritable, angry and gloomy mood with increased sensitivity to any external stimulus, aggressiveness and explosiveness. Accompanied by unfounded accusations of others, scandalousness, cruelty. There are no disturbances of consciousness. The equivalents of dysphoria can be binge drinking (dipsomania) or aimless wandering (dromomania).

Depression - melancholy, depressive syndrome- a suicidal state, which is characterized by an oppressed, depressed mood, deep sadness, despondency, melancholy, ideational and motor retardation, agitation (agitated depression). In the structure of depression, there are possible depressive delusional or overvalued ideas (of low value, worthlessness, self-accusation, self-destruction), a decrease in attraction, a vital oppression of self-perceptions. Subdepression is a mild depressive affect.

Cotard's syndrome - nihilistic-hypochondriac nonsense combined with ideas of enormity. It is most common in involutional melancholia, much less often in recurrent depression. There are two variants of the syndrome: hypochondriacal - characterized by a combination of anxious-melancholic affect with nihilistic-hypochondriac delirium; depressive - characterized by anxious melancholy with predominantly depressive delusions and ideas of denial of the outside world of a megalomaniac nature.

Masked (larvated) depression - characterized by a feeling of general indefinite diffuse somatic discomfort, vital senestopathic, algic, vegetodistonic, agripnic disorders, anxiety, indecision, pessimism without clear depressive changes in affect. Often found in somatic practice.

Mania (manic syndrome) - a painfully elevated joyful mood with increased drives and tireless activity, acceleration of thinking and speech, inadequate joy, cheerfulness and optimism. The manic state is characterized by distractibility of attention, verbosity, superficiality of judgments, incompleteness of thoughts, hypermnesia, overvalued ideas of overestimation of one's own personality, lack of fatigue. Hypomania is a mildly expressed manic state.

Affective syndromes (depression and mania) are the most common mental disorders and are noted in the onset of mental illness, may remain the predominant disorders throughout the course of the disease.

When diagnosing depression, it is necessary to focus not only on the complaints of patients: sometimes there may be no complaints about a decrease in mood, and only a targeted questioning reveals depression, loss of interest in life (“satisfaction with life” - taedium vitae), a decrease in overall vitality, boredom, sadness, anxiety, etc. In addition to targeted questioning about mood changes proper, it is important to actively identify somatic complaints that can mask depressive symptoms, signs of sympathicotonia (dry mucous membranes, skin, a tendency to constipation, tachycardia - the so-called "Protopopov's sympathicotonic symptom complex"), characteristic of endogenous depression. depressive "omega" (fold between the eyebrows in the form of the Greek letter "omega"), Veraguta fold (oblique fold on the upper eyelid). Physical and neurological examination reveals objective signs of sympathicotonia. Paraclinically to clarify the nature of depression allow such biological tests as therapy with tricyclic antidepressants, dexamethasone test. Clinical and psychopathological examination using standardized scales (Zung's scale, Spielberger's scale) allows to quantify the severity of depression, anxiety.

Chronic (affective) mood disorders (F34)

These disorders are chronic and usually intermittent. Individual episodes are not deep enough to qualify as hypomania or mild depression. Last for years, and sometimes throughout the life of the patient. Due to this, they resemble special personality disorders such as constitutional cycloids or constitutionally depressive ones. Life events and stresses can deepen these conditions.
Etiology and pathogenesis
Etiology chronic disorders mood is both constitutional and genetic, and is due to a special affective background in the family, for example, its orientation towards hedonism and optimism or a pessimistic perception of life. When confronted with life events that none of us manage to avoid, the personality reacts with a typical affective state, which initially seems quite adequate and psychologically understandable. This affective state, although it causes the reaction of others, but it seems to them adaptive.

Cyclothymia (F34.0).

Often since childhood or adolescence, mood swings of a seasonal type are noted. However, this diagnosis is considered adequate only in post-puberty, when unstable mood with periods of subdepression and hypomania lasts at least two years. The clinic itself is endogenously perceived only as a period of inspiration, rash acts or blues. Moderate and severe depressive and manic episodes are absent, but are sometimes described in the anamnesis.
The period of depressed mood grows gradually and is perceived as a decrease in energy or activity, the disappearance of the usual inspiration and creativity. This in turn leads to a decrease in self-confidence and feelings of inferiority, as well as social isolation, isolation is also manifested in reduced talkativeness. Insomnia appears, pessimism is a stable property of character. The past and the future are evaluated negatively or ambivalently. Patients sometimes complain about increased drowsiness and impaired attention, which prevents them from absorbing new information.
An important symptom is anhedonia to previously pleasurable instinctual discharges (eating, sex, travel) or pleasurable activities. A decrease in activity is especially noticeable if it followed an elevated mood. However, there are no suicidal thoughts. The episode can be perceived as a period of idleness, existential emptiness, and when long duration evaluated as a trait.
The opposite state can be stimulated by endogenous and external events and also be tied to the season. With an elevated mood, energy and activity increase, and the need for sleep decreases. Creative thinking increases or sharpens, this leads to an increase in self-esteem. The patient tries to demonstrate intelligence, wit, sarcasm, speed of association. If the patient's profession coincides with self-demonstration (actor, lecturer, scientist), then his results are assessed as "brilliant", but with a low mind, increased self-esteem is perceived as inadequate and ridiculous.
Increased interest in sex and increases sexual activity, interest in other types of instinctive activity increases (food, travel, there is an over-involvement in the interests of one's own children, relatives, an increased interest in outfits and jewelry). The future is perceived optimistically, past achievements are overestimated. The psychological analogue of cyclothymia is the creative productivity of A.S. Pushkin, which, as you know, was characterized by significant productivity in the fall and a decrease in the activity of inspiration in the spring. The same periods of creative productivity, covering a longer period, were characteristic of P. Picasso. Cyclic mood rhythms clearly depend on the length daylight hours, latitude of the area, this is intuitively captured by patients in their desire for migration and travel.
Diagnostics
1. More than two years of unstable mood, including alternating periods of both subdepression and hypomania, with or without intervening periods of normal mood.
2. Two years of absence of moderate and severe manifestations affective episodes. Observed affective episodes are lower in level than mild ones.
3. In depression, at least three of the following symptoms must be present:

- insomnia;

- difficulty concentrating;
- social isolation;
- decreased interest or pleasure in sex or pleasant views activities;
- decreased talkativeness;
- a pessimistic attitude towards the future and a negative assessment of the past.
4. An increase in mood is accompanied by at least three of the following symptoms:
- increased energy or activity;
- reduced need for sleep;
- increased self-esteem;
- heightened or unusual creative thinking;
- increased sociability;
- increased talkativeness or demonstration of the mind;
- increased interest in sex and an increase in sexual relations, other types of activities that give pleasure;
- over-optimism and reassessment of past achievements.
Individual anti-disciplinary actions are possible, usually in a state of alcohol intoxication, which are rated as "excessive fun".

Should be differentiated from mild depressive and manic episodes, bipolar affective disorders flowing with moderate and light affective attacks, hypomanic states should also be distinguished from the onset of Pick's disease.
In relation to mild depressive and manic episodes, this can usually be done on the basis of anamnesis data, since unstable mood in cyclothymia should be determined for up to two years, suicidal thoughts are also not characteristic of cyclothymics, and periods of elevated mood are socially more harmonious. Cyclothymic episodes do not reach the psychotic level, which distinguishes them from affective bipolar disorders, in addition, cyclothymics have a unique anamnestic history, episodes of mood disturbances are noted very early in puberty.
Mood changes in Pick's disease occur late in life and are associated with more severe impairments to social functioning.
Therapy
Prevention of episodes of disturbed mood in cyclothymia is carried out with lithium, carbamazepine or sodium valproate. These same drugs can be used in the treatment of elevated mood, although in cases where it is accompanied by increased productivity, this is hardly advisable. For depressed mood, Prozac, sleep deprivation treatment, and enotherapy are indicated. Sometimes the effect is given by 2-3 sessions of nitrous oxide, amytal-caffeine disinhibition and intravenous administration novocaine.

Dysthymia (F34.1).

Etiology
The types of individuals who develop dysthymia would be correct to call constitutionally depressive. These traits manifest themselves in childhood and puberty as a reaction to any difficulty, and later endogenously.
Clinic
They are whiny, thoughtful and not too sociable, pessimistic. Under the influence of minor stresses in post-puberty, for at least two years, they experience periods of constant or intermittent depressive mood. Intermediate periods of normal mood rarely last more than a few weeks, the whole mood of the individual is colored by subdepression. However, the level of depression is lower than in mild recurrent disorder. It is possible to identify the following symptoms of subdepression:
- decreased energy or activity;
- sleep disturbance and insomnia;
- Decreased self-confidence or feelings of inadequacy;
- Difficulties in concentrating, and hence subjectively perceived memory loss;
- frequent tearfulness and hypersensitivity;
- Decreased interest or pleasure in sex, other previously pleasurable and instinctive forms of activity;
- feeling of hopelessness or despair in connection with the realization of helplessness;
- inability to cope with the routine responsibilities of everyday life;
- a pessimistic attitude towards the future and a negative assessment of the past;
- social isolation;
- decreased talkativeness and secondary deprivation.
Diagnostics
1. At least two years of persistent or recurring depressed mood. Periods of normal mood rarely last more than a few weeks.
2. The criteria do not meet a mild depressive episode because there are no suicidal thoughts.
3. During periods of depression, at least three of the the following symptoms: decreased energy or activity; insomnia; decreased self-confidence or feelings of inferiority; difficulty concentrating; frequent tearfulness; decreased interest or pleasure in sex or other pleasurable activities; feelings of hopelessness or despair; inability to cope with the routine responsibilities of daily life; pessimistic attitude towards the future and negative assessment of the past; social isolation; reduced need for communication.
Differential Diagnosis
It should be differentiated from a mild depressive episode, the initial stage of Alzheimer's disease. In a mild depressive episode, suicidal thoughts and ideas are present. AT initial stages Alzheimer's disease and others organic disorders depressions become protracted, organics can be detected neuropsychologically and with the help of other objective research methods.
Therapy
For depressed mood, Prozac, sleep deprivation treatment, and enotherapy are indicated. Sometimes 2-3 sessions give the effect nitrous oxide, amytal-caffeine disinhibition and intravenous administration of novocaine, as well as nootropic therapy.

Other chronic (affective) mood disorders F34.8.

A category for chronic affective disorders that are not severe or long enough to meet the criteria for cyclothymia or dysthymia, mild or moderate depressive episode. Some types of depression formerly called "neurotic" are included. These types of depression are closely related to stress and, together with dysthymia, organize a circle of endoreactive dysthymia.

Mixed affective episode (F38.00).

1. The episode is characterized by mixed clinical picture or rapid succession (within hours) of hypomanic, manic, and depressive symptoms.
2. Both manic and depressive symptoms should be expressed most of the time, during, at least, a two-week period.
3. No previous hypomanic, depressive, or mixed episodes.
Clinical example: Patient E., 32 years old, artist by profession. The disease starts after mental trauma. Only a few close friends come to the opening of the solo exhibition, the rest are not at all interested in her, she is going through a “personal crisis”. He thinks about his future all night long, pessimistically evaluates his past work, destroying most of the work. We believe that the result of this action should be his suicide. However, in the morning the state changes, half-asleep he sees his future works and begins to work feverishly, creating several things in a completely different style. Lively, tells everyone about his plans, cheerful and carefree. By evening, the state again becomes gloomy, destroys everything that he created during the day, "it's all wrong." Does not understand the origins of the former optimism. In the morning, the hypomanic state resumes. As a result of the phase change, sleep is completely desynchronized, sleeps for an hour with interruptions up to 3-4 hours of wakefulness, forgets to eat. He tries to be treated with alcohol, but as a result, one day, phases of depression and hypomania follow already in the afternoon, each for 5-6 hours.

Many of us have experienced ups and downs in mood. The reason for this can be pleasant emotions, events, or overtaken by grief, conflict, etc. But there are conditions in which the problem occurs without previous factors that can change the emotional state. These are affective disorders. mental symptom requiring study and treatment.

Affective disorder - a mental disorder associated with disorders in the emotional sphere

to certain types mental disorders, in which the dynamic development of a person's emotional sensations changes, leads to sharp mood swings. An affective disorder is quite common, but it is not always possible to immediately determine the disease. It can be hidden behind various types of diseases, including somatic ones. According to research, approximately 25% of the world's population are prone to such problems, that is, every fourth person. But, unfortunately, only a quarter of those suffering from mood swings turn to a specialist for adequate treatment.

Behavioral disorders have been observed in humans since ancient times. It was only in the 20th century that leading experts began to closely study the condition. It should be noted right away that the field of medicine dealing with affective disorder is psychiatry. Scientists divide this disease into several types:

• bipolar disorder;
• depression;
• anxiety is mania.

These points still excite the minds of scientists who do not stop arguing about the correctness of the selected types. The problem lies in the versatility of conduct disorders, the variety of symptoms, precipitating factors, and the insufficient level of research into the disease.

Scientists divide this disorder into several types: bipolar disorder, depression, anxiety-mania

Affective mood disorders: causes

Specialists have not identified certain factors leading to mood disorders. Most tend to think that there is a violation in the cerebral cortex, a malfunction in the functions of the epiphysis, limbic, hypothalamus, etc. Due to the release of substances such as melatonin, liberins, there is a failure in cyclicity. Sleep is disturbed, energy is lost, libido and appetite are reduced.

genetic predisposition.

According to statistics, in every second patient, one of the parents or both also suffered from this problem. Therefore, geneticists hypothesized that the disorders occur due to a mutated gene on the 11th chromosome, which is responsible for the synthesis of an enzyme that produces catecholamines - adrenal hormones.

psychosocial factor.

Disorders can be caused prolonged depressions, stress, important event in life, which causes failure or destruction of the central nervous system. These include:

• loss of a loved one;
• lowering social status;
• family conflicts, divorce.

Important: mood disorders, affective disorders are not a mild ailment or a short-term problem. Ailment drains nervous system of a person, destroys his psyche, because of which families break up, loneliness sets in, complete apathy for life.

Affective disorders can be caused by conflicts in the family, the loss of a loved one, and other factors.

Psychological models of affective disorders

Violation in the emotional state of a person may be evidence of the following models.

• Depression as an affective disorder. AT this case characterized by prolonged despondency, a feeling of hopelessness. The state should not be confused with the banal lack of mood observed in short period time. Depressive disorder is caused by dysfunction of certain parts of the brain. Feelings can last for weeks, months, and every next day for the sufferer is another portion of torment. Some time ago, this person was enjoying life, spending time in a positive way and thinking only about good things. But certain processes in the brain force it to think only in negative direction, contemplate suicide. In most cases, patients visit a therapist for a long time, and only by a lucky chance, a few get to a psychiatrist.
• Dysthymia - depression, expressed in milder manifestations. A lowered mood haunts from several weeks to many years, feelings and sensations are dulled, which creates conditions for an inferior existence.
• Mania. This type is characterized by a triad: a feeling of euphoria, excited movements, high intelligence, fast speech.
• Hypomania is a milder form of conduct disorder and a complex form of mania.
• bipolar type. In this case, there is an alternation of outbreaks of mania and depression.
• Anxiety. The patient feels groundless worries, anxieties, fears, which is accompanied by constant tension and the expectation of negative events. In advanced stages, restless actions, movements join the state, it is difficult for patients to find a place for themselves, fears, anxieties grow and turn into panic attacks.

Anxiety and fear is one of the psychological models of affective disorders.

Symptoms and syndromes of affective disorders

Signs of affectivity in the mood are varied and in each case, the doctor applies individual approach. The problem may arise due to stress, head injury, cardiovascular diseases, late age etc. Let's briefly consider each type separately.

Specificity of affective disorders in psychopathy

With psychopathy, specific deviations in human behavior are observed.

• Attractions and habits. The patient performs actions that are contrary to his personal interests and the interests of others:

Gambling - gambling

For the patient, there is a passion for gambling, and even with failure, interest does not disappear. This fact negatively affects relationships with family, colleagues, friends.

Pyromania

Inclination to set fire, play with fire. The patient has a desire to set fire to his or someone else's property, objects, without having any motives.

Theft (kleptomania)

Without any need, there is a desire to steal someone else's thing, up to trinkets.

Kleptomania manifests itself in the desire to steal something without having to do it.

Hair pulling - trichotillomania

Patients tear their hair, due to which a noticeable loss is noticeable. After the shreds are torn out, the patient feels relief.

Transsexualism

Internally, a person feels like a representative of the opposite sex, feels discomfort and seeks to change through surgical operations.

Transvestism

In this case, there is a desire to use hygiene items and wear clothes of the opposite sex, while there is no desire to change sex surgically.

Also, the list of disorders in psychopathy includes fetishism, homosexuality, exhibitionism, voyeurism, sadomasochism, pedophilia, uncontrolled reception medicines non addictive.

Affective disorders in cardiovascular disease

Approximately 30% of patients suffering from disorders, the condition "masquerades" as a somatic disease. A specialized specialist can identify an ailment that truly torments a person. Doctors point out that depression can occur against the background of diseases of the heart, blood vessels, which is called neurocirculatory dystonia. For example, endogenous depression, manifested by heaviness "in the soul", "precordial longing" is difficult to distinguish from a banal attack of angina pectoris due to the similarity of symptoms:

• tingling;
• aching, sharp pain with return to the shoulder blade, left hand.

These points are quite inherent in depression of the endogenous type. Also with the affect of anxiety, there are problems such as arrhythmia, tremor of the limbs, rapid pulse, interruptions in the work of the heart muscle, and suffocation.

This type of disorder can occur against the background of cardiovascular diseases.

Affective disorders in traumatic brain lesions

Head injury, and as a result, the brain is a common pathology. The complexity of mental disorders depends on the severity of the injury, complications. There are three stages of disorders caused by brain damage:

• initial;
• acute;
• late;
• encephalopathy.

At the initial stage, stupor, coma occurs, the skin becomes pale, swollen, moist. There is a rapid heartbeat, bradycardia, arrhythmia, the pupils are dilated.

If the stem part is affected, blood circulation, respiration, and the swallowing reflex are disturbed.

The acute stage is characterized by the revival of the patient's consciousness, which is often disturbed by slight stunning, which causes antero-, retro-, retroanterograde amnesia. It is also possible delirium, clouding of mind, hallucinosis, psychosis.

Important: the patient must be observed in the hospital. Only an experienced specialist will be able to detect moriya - a state of pleasure, euphoria, in which the patient does not feel the severity of his situation.

At a late stage, the processes increase, asthenia, exhaustion, mental instability appear, vegetation is disturbed.

Asthenia of traumatic type. The patient has headaches, heaviness, fast fatiguability, loss of attention, coordination, weight loss, sleep disturbance, etc. Periodically, the state is supplemented by mental disorders, manifested in inadequate ideas, hypochondria, and explosiveness.

Traumatic encephalopathy. The problem is accompanied by a violation of the function of the brain center, damage to areas. Affective disorders are manifested, expressed in sadness, melancholy, anxiety, anxiety, aggression, fits of anger, suicidal thoughts.

Traumatic encephalopathy is accompanied by anxiety, attacks of aggression, constant thoughts of suicide

Affective disorders of late age

Psychiatrists rarely deal with conduct disorder in the elderly, which can lead to advanced stage, in which it will be almost impossible to fight the disease.

Due to chronic, somatic diseases "accumulated" over the past years, brain cell death, hormonal, sexual dysfunction and other pathologies, people suffer from depression. The condition may be accompanied by hallucinations, delusions, suicidal thoughts, and other behavioral disturbances. There are features in the character of an elderly person that differ from behavior with other provoking factors:

• Anxiety reaches a level at which unconscious movements arise, a state of numbness, despair, pretentiousness, demonstrativeness.
• Delusional hallucinations, reduced to feelings of guilt, the irresistibility of punishment. The patient suffers from hypochondriacal delirium, as a result, there are lesions of internal organs: atrophy, decay, poisoning.
• Over time, clinical manifestations become monotonous, anxiety is monotonous, accompanied by the same movements, mental activity decreases, constant depression, a minimum of emotions.

After episodes of disorders, there is a periodic decline in the background, but there may be insomnia, loss of appetite.

Important: the elderly are characterized by the syndrome of "double depression" - a drooping mood is accompanied by phases of depression.

organic affective disorder

Behavioral disturbance is often observed in diseases of the endocrine system. Those who take hormonal preparations. After the end of the reception, there are disorders. The cause of violations of organic nature are:

• thyrotoxicosis;
• Cushing's syndrome;
• menopause;
• poisoning with antihypertensive drugs;
• neoplasms of the brain, etc.

After elimination causal factors, the condition is normalized, but requires periodic monitoring by a doctor.

Organic affective disorder most often occurs in those who take hormonal drugs for a long time.

Children and adolescents: affective disorders

After a long debate, leading scientists who did not recognize such a diagnosis as affective behavior in children, nevertheless managed to stop on the fact that the emerging psyche can be accompanied by a behavior disorder. Symptoms of pathology in adolescence and young age are:

• frequent mood swings, outbursts of aggression, turning into calmness;
• visual hallucinations that accompany babies under the age of 3 years;
• affective disorders in children occur in phases - only one attack for a long time or a repetition every few hours.

Important: the most critical period is from 12 to 20 months of a baby's life. Observing his behavior, you can pay attention to the features that "give out" the disorder.

Diagnostics of affective disorders in drug addiction and alcoholism

Bipolar disorder is one of the main companions of alcohol abusers and drug addicts. They experience both depression and mania. Even if an alcoholic, an experienced drug addict reduce the dose or completely give up a bad habit, the phases mental disorder haunt them for a long time or a lifetime.

According to statistics, about 50% of abusers are subject to mental problems. In this state, the patient feels: worthlessness, uselessness, hopelessness, dead end. They consider their entire existence a mistake, a series of troubles, failures, tragedies and lost chances.

Important: heavy thoughts often lead to suicidal attempts or again driven into an alcohol, heroin trap. Arises " vicious circle”and without adequate medical intervention, it is almost impossible to get out of it.

Bipolar disorder is common in people who abuse alcohol

Relationship between socially dangerous acts and affective disorders

According to criminal law, an act committed in an affective disorder is called a crime committed in a state of passion. There are two types of status:

Physiological - a short-term emotional failure that arose suddenly, disturbing psyche. In this case, there is an understanding of what is being done, but it is impossible to subordinate the actions to one's own control.

Pathological - an attack is accompanied by clouding of consciousness, short-term or complete loss of memory. Rarely seen in forensic medicine accurate diagnosis an examination with the participation of psychiatrists, psychologists, etc. is necessary. When performing an action, a sick person pronounces incoherent words, gesticulates brightly. After attacks, there is weakness, drowsiness.

If the crime is committed with pathological affect, the perpetrator is considered insane and is relieved of responsibility. But at the same time, he must be kept in a special institution of a psychiatric type.

A person declared insane for affective disorders must be treated in a psychiatric hospital

Mood disorders are a condition that anyone can be exposed to if there is a genetic predisposition, there are bad habits, there were injuries, diseases, etc. To mental pathology has not passed into a life-threatening phase - it is necessary to contact a specialized specialist in time to eliminate provoking factors and treat the psyche. To avoid mood disorders in old age, try to monitor your health from an early age, develop fine motor skills and protect your head from injury.

Various emotional processes are an integral part of the human psyche. We rejoice in pleasant moments, we are sad when we lose something, we yearn after parting with our loved ones. Emotions and feelings are an important component of our personality, which has a huge impact on thinking, behavior, perception, decision-making and motivation. Periodic mood swings different situations- it `s naturally. Man is not a machine to smile around the clock. However, it is our emotionality that makes the psyche more vulnerable, so the aggravation of a stressful situation, changes in internal biochemical processes and other factors can cause all kinds of mood disorders. What are emotional disorders? How to recognize them? What are the most characteristic symptoms?

What is meant by affective disorder?

Far from always, the expression of emotions that are not characteristic of a person or their too vivid manifestation can be called a mood disorder. Anyone is capable in certain circumstances to show rage, anxiety or despondency. The concept is based on emotional spectrum disorders that occur in the absence of a visible stimulus and are observed certain period. For example, stormy joy and enthusiastic mood because your favorite team scored a goal is natural, but a high degree of euphoria for several days in a row for no reason at all is a sign of illness. In addition, only disturbed mood is not enough to make a diagnosis; other symptoms characteristic of an affective disorder (cognitive, somatic, etc.) must also be present. Although the main violations relate specifically to the emotional sphere and affect the overall level of human activity. Mood disorder, as an intense manifestation of inappropriate emotions, is often observed in other mental illness e.g. schizophrenia, delusional states, personality disorders.

The main causes and mechanisms of affective disorders

Mood disorders can occur due to many factors. The most significant of them are endogenous, in particular, genetic predisposition. Heredity has a particularly strong effect on severe variants of depression, the manifestation of mania, bipolar and anxiety-depressive disorder. The main internal biological factors are endocrine disruptions, seasonal fluctuations in the level of neurotransmitters, their chronic deficiency and other changes in biochemical processes. However, the presence of a predisposition does not guarantee the development of a mood disorder. This can happen under the influence of certain environmental influences. There are many, here are the main ones:

• long stay in a stressful environment;
• loss of one of the relatives in childhood;
• sexual problems;
• breaking up with a loved one or divorce;
• postpartum stress, loss of a child during pregnancy;
• psychological problems at the stage of growing up in adolescents;
• child's absence warm relationship with parents.

An increased risk of developing affective diseases is also associated with certain personality traits: constancy, conservatism, responsibility, the desire for orderliness, schizoid and psychasthenic features, a tendency to mood swings and anxious and suspicious experiences. Some sociologists, on the basis of theoretical developments, argue that the main causes of affective disorders, especially the depressive spectrum, lie in the contradictions between the structure of a person's personality and society.

Characteristic symptoms of a mood disorder

Emotional disturbance (recurrent, episodic or chronic) can be unipolar depressive or manic in nature, as well as bipolar, with alternating manifestations of mania and depression. The main symptoms of mania are high spirits, which is accompanied by accelerated speech and thinking, as well as motor excitement. Affective mood disorders, in which there are such emotional symptoms like melancholy, despondency, irritability, indifference, feeling of apathy, are categorized as depressive. Some affective syndromes may be accompanied by phobic anxiety and cognitive impairment. Cognitive and anxiety symptoms are secondary to the main emotional ones. Mood disorders are distinguished by the fact that they lead to a violation of people's daily activities and their social functions. Often, patients also have such additional symptoms as feelings of guilt, psychosensory manifestations, a change in the mental pace, an inadequate assessment of reality, sleep and appetite disorders, and a lack of motivation. Similar diseases don't go unnoticed physical condition body, weight, hair and skin condition suffer the most. Severe lingering forms often lead to irreversible changes in personality and behavior patterns.

AT International classification Tenth Revision Diseases Mood disorders are classified as a separate category and are coded F30 to F39. All of their types can be divided into the following main groups:

1. manic episodes. This includes hypomania (lungs manic manifestations without psychotic symptoms), mania without psychosis and mania with their various variants (including manic-delusional states in paroxysmal schizophrenia).
2. Bipolar affective disorder. It can occur both with psychoses and with their absence. Changes between manic and depressive states can be varying degrees expression. Current episodes vary in severity.
3. depressive states. This includes single episodes of varying severity, from mild to severe with psychoses. Included are reactive, psychogenic, psychotic, atypical, masked depressions, and anxiety-depressive episodes.
4. recurrent depressive disorder. It proceeds with recurring episodes of depression of varying severity without manifestations of mania. A recurrent disorder can be both endogenous and psychogenic, it can occur with or without psychoses. Seasonal affective disorder is also positioned as recurrent.
5. Chronic affective syndromes. This group includes cyclothymia (multiple mood swings from mild euphoria to mild depression), dysthymia (chronic low mood, which is not a recurrent disorder), and other persistent forms.
6. All other types of diseases, including mixed and short-term recurrent disorder, are separated into a separate category.

Features of seasonal mood disorders

Seasonal affective disorder is a form of recurrent depression that is quite common. It retains all major depressive symptoms, however, differs in that the exacerbation occurs in the autumn-winter or spring seasons of the year. Various theoretical and practical studies show that seasonal affective disorder occurs due to cyclic changes biochemical processes in the body in connection with daily rhythms. " The biological clock» people work on the principle: it's dark - it's time to sleep. But if in winter time darker around 5 pm, then the working day can last until 20:00. The discrepancy between natural changes in the level of neurotransmitters and the period of forced activity in some people can provoke seasonal affective disorder with all the ensuing consequences for the individual. The depressive periods of such a recurrent disorder may be different duration their degree of severity is also different. Symptocomplex can be of an anxious-suspicious or apathetic bias with impaired cognitive functions. Seasonal affective disorder is rare in teenagers, and quite uncommon in a child under 10 years of age.

Differences in affective disorders in children and adolescents

It seems, well, what kind of emotional disorder can a child have? His whole life is games and entertainment! Periodic mood swings are not particularly dangerous for the development of a child's personality. Indeed, affective disorders in children do not correspond to clinical criteria fully. The child may be more likely to have some kind of depressive state with mild cognitive impairment than major depression. The main symptoms of childhood mood disorders differ from those of adults. The child is characterized by more somatic disorders: bad dream, complaints of discomfort, lack of appetite, constipation, weakness, pale skin. A child or teenager may have an atypical pattern of behavior, he refuses to play and communicate, keeps aloof, becomes slow. Mood disorders in children, as well as in adolescents, can cause cognitive symptoms such as decreased concentration, difficulty remembering, and poor academic performance. Anxiety-manic manifestations in adolescents and children are more pronounced, as they are most reflected in the behavioral model. The child becomes unreasonably lively, uncontrollable, tireless, poorly measures his abilities, adolescents sometimes have tantrums.

What could be the consequences?

To some, emotional problems and mood swings may not seem particularly important to seek help from psychologists. Of course, there are situations when an affective disorder can go away on its own, for example, if it is a seasonal recurrent malaise. But in some cases, the consequences for the individual and human health can be extremely negative. First of all, this applies to anxiety-affective disorders and deep depression with psychosis, which can cause irreparable damage to a person's personality, especially the personality of a teenager. Serious cognitive impairment affects professional and daily activities, anxiety-manic psychoses of one of the parents can harm the child, depression in adolescents often causes suicidal attempts, prolonged affective disorders can change a person's behavior pattern. Negative consequences for the psyche in general and for the personality structure in particular can become irreversible, in order to minimize them, it is necessary to contact a psychotherapist in a timely manner. Treatment of affective disorders is usually prescribed complex, with the use of drugs and psychotherapy methods.