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Tijdschrift Voor Psychiatrie 2014The DSM-5 was published in May, 2013. (Review)
Review
BACKGROUND
The DSM-5 was published in May, 2013.
AIM
To discuss and comment on the important changes that appear in the sections of DSM-5 dealing with mood disorders.
METHOD
The DSM-5 chapters on mood disorders are reviewed.
RESULTS
Bipolar disorders and depressive disorders are now dealt with in separate categories. Some new diagnoses have been added to depressive disorders, namely 'disruptive mood dysregulation disorder', 'premenstrual dysphoric disorder' and 'persistent depressive disorder'. With regard to depression, some changes have been made in the specifiers, and new specifiers such as 'with anxious distress' have been added. There were only minor changes in the section on bipolar disorder; these stem from changes made in the section on depressive disorders.
CONCLUSION
The alterations in the section on mood disorders are unlikely to lead to major changes in clinical practice. Psychiatrists are advised to be very wary about using the new DSM-5 terms 'disruptive mood dysregulation disorder' and 'premenstrual dysphoric disorder' as diagnoses for their patients.
Topics: Bipolar Disorder; Depressive Disorder; Diagnostic and Statistical Manual of Mental Disorders; Humans; Practice Guidelines as Topic; Psychiatric Status Rating Scales
PubMed: 24643826
DOI: No ID Found -
Journal of the American Academy of... Apr 2014Disruptive mood dysregulation disorder (DMDD) is a new diagnosis in the DSM-5. Youth with a family history of bipolar disorder (BD) are at increased risk for BD and...
OBJECTIVE
Disruptive mood dysregulation disorder (DMDD) is a new diagnosis in the DSM-5. Youth with a family history of bipolar disorder (BD) are at increased risk for BD and non-bipolar psychopathology. No studies to date have examined rates of DMDD among offspring of parents with BD. This study examines the risk for DMDD in offspring of parents with BD compared to community controls and considers rates of chronic irritability (independent of a DMDD diagnosis) across diagnoses in youth with parents with BD.
METHOD
Modified DMDD criteria were applied post hoc to 375 offspring of parents with BD and 241 offspring, aged 6 to 17 years, of community control parents. We calculated odds ratios using generalized linear mixed models. In addition, we explored associations with a severe chronic irritability phenotype and various diagnoses in the high-risk cohort.
RESULTS
Offspring of parents with BD were more likely to meet criteria for DMDD than were the offspring of community control parents (Odds ratio [OR] = 8.3, 6.7% vs. 0.8%), even when controlling for demographic variables and comorbid parental diagnoses (OR = 5.4). They also had higher rates of chronic irritability compared to community controls (12.5% vs. 2.5%, χ(2) = 18.8, p < .005). Within the offspring of parents with BD, the chronic irritability phenotype was frequently present in offspring with diagnoses of BD, depression, attention-deficit/hyperactivity disorder, and disruptive behavior disorders.
CONCLUSIONS
Like other non-BD diagnoses, family history of BD increases the risk for DMDD. Severe chronic irritability and temper tantrums are the core features of DMDD, and are associated with mood and behavioral disorders in youth at risk for BD.
Topics: Adolescent; Adult; Bipolar Disorder; Child; Female; Genetic Predisposition to Disease; Humans; Irritable Mood; Male; Mood Disorders; Phenotype
PubMed: 24655650
DOI: 10.1016/j.jaac.2013.12.026 -
The Journal of Clinical Psychiatry 2009Generalized anxiety disorder (GAD) has a high rate of comorbidity with other psychiatric disorders, including major depressive disorder (MDD), bipolar disorder, other... (Review)
Review
Generalized anxiety disorder (GAD) has a high rate of comorbidity with other psychiatric disorders, including major depressive disorder (MDD), bipolar disorder, other anxiety disorders, and substance use disorders. The similarities between GAD and MDD have led some to suggest that GAD should be reclassified as a mood disorder. The concurrence of GAD with another disorder heightens a patient's risk for impairment, disability, and suicidality. Clinical trials for GAD and disorders that are most likely to occur with GAD have generally not taken comorbidity into account, and there is a paucity of data guiding how comorbidity should inform treatment selection. Research into the biology and psychopathology underlying the high rate of comorbidity of GAD and into efficacious interventions for GAD with comorbidity is needed.
Topics: Anti-Anxiety Agents; Anxiety Disorders; Bipolar Disorder; Comorbidity; Depressive Disorder, Major; Disabled Persons; Humans; Mood Disorders; Quality of Life; Role; Substance-Related Disorders
PubMed: 19371501
DOI: 10.4088/jcp.s.7002.02 -
CJEM Jan 2022Frequent emergency department (ED) use is a growing problem that is associated with poor patient outcomes and increased health care costs. Our objective was to analyze...
OBJECTIVES
Frequent emergency department (ED) use is a growing problem that is associated with poor patient outcomes and increased health care costs. Our objective was to analyze the association between mood disorders and the incidence of frequent ED use.
METHODS
We used the Canadian Community Health Survey conducted by Statistics Canada, 2015-2016. Mood disorder was defined as depression, bipolar disorder, mania, or dysthymia. Frequent ED use was defined as 4 or more visits in the year preceding the interview. Multivariable log-binomial regression models were used to determine the associations between mood disorders and frequent ED use.
RESULTS
Among the 99,009 participants, 8.4% had mood disorders, 80.3% were younger than 65, and 2.2% were frequent ED users. Mood disorders were significantly associated with the 1-year cumulative incidence of frequent ED use (RR = 2.5, 95% CI 2.2-2.7), after adjusting for several potential confounders.
CONCLUSIONS
This national survey showed that people with a mood disorder had a three-fold risk of frequent ED use, compared to people without mood disorder. These results can inform the development of policies and targeted interventions aimed at identifying and supporting ED patients with mood disorder.
Topics: Canada; Cross-Sectional Studies; Emergency Service, Hospital; Humans; Mood Disorders; Surveys and Questionnaires
PubMed: 34669174
DOI: 10.1007/s43678-021-00204-w -
Journal of Affective Disorders Aug 2019Mood disorders (MDs) are pervasive and debilitating psychiatric conditions. Many helpful psychological and psychopharmacological treatments exist, but MD's prevalence...
BACKGROUND
Mood disorders (MDs) are pervasive and debilitating psychiatric conditions. Many helpful psychological and psychopharmacological treatments exist, but MD's prevalence and chronicity often means relying purely on professional care can create financial strain on individuals and healthcare systems. Also, many individuals respond only partially to professionally-delivered medical/pharmacological interventions or are unable to tolerate or adhere to them. Peer-led mutual-help organizations (MHOs) have emerged and grown in the U.S. to extend and potentiate professional efforts or otherwise address needs unmet by professional care. The Depression and Bipolar Support Alliance (DBSA) is the largest of these, but beyond observational evidence, little is known about participation or benefits. Greater knowledge could inform the field regarding clinical and public health utility of peer-driven efforts.
METHOD
Community-based cross-sectional comparative investigation of MD individuals attending (N = 202) or not attending (N = 105) DBSA. Measures included demographics, clinical characteristics and clinical service use, and indices of symptomatology, functioning, quality of life (QOL), and psychological well-being.
RESULTS
Compared to non-DBSA participants, DBSA participants were more likely to be male and white and trended toward greater religious affiliation (p = 0.05). DBSA participants attended meetings about twice per month with two-thirds attending for more than one year. The DBSA cohort had a much higher proportion with bipolar I disorder and reported more lifetime and past 90-day use of acute, intensive, medical services and medications. There were no between-group differences on indices of QOL or psychological well-being, but within the DBSA group, greater DBSA attendance and involvement was associated with greater QOL and well-being, and less functional impairment.
LIMITATIONS
Cross-sectional design and regional sampling frame with unknown generalizability to national DBSA membership.
CONCLUSION
Given the grave impact of MDs and that DBSA is freely available it may fill an important clinical and public health need by attracting and engaging MD individuals with greater functional instability and impairment. The positive association found between greater active DBSA participation and improvements in functioning and well-being, while promising, requires longitudinal investigation to formally establish the causal direction of effects.
Topics: Adult; Bipolar Disorder; Counseling; Cross-Sectional Studies; Depression; Female; Humans; Male; Mood Disorders; Quality of Life; Self-Help Groups
PubMed: 31150942
DOI: 10.1016/j.jad.2019.05.039 -
Canadian Journal of Public Health =... Oct 2020The inflammatory biomarker C-reactive protein (CRP) measures systemic inflammation and has been shown to be increased in patients with mood disorders such as depression....
OBJECTIVES
The inflammatory biomarker C-reactive protein (CRP) measures systemic inflammation and has been shown to be increased in patients with mood disorders such as depression. The objective of this study was to determine the association between self-reported mood disorders with CRP levels in a representative sample of the Canadian population using the Canadian Health Measures Survey (CHMS) data 2013-2014.
METHODS
The CHMS is an ongoing national cross-sectional survey of Canadians about their general health. The current study used the data collected from Cycle 3 (2012/13) and was limited to adults aged 18 and older. Survey weights were assigned to adjust for non-response and non-random sample selection of the responding sample.
RESULTS
Data were analyzed from 5782 respondents (400 (6.9%) self-reported mood disorders and 5382 (93.1%) reported no mood disorders). The CRP level was significantly higher among those with mood disorders than among those without (3.22 (0.17) vs. 2.34 (0.04) mg/L, p = 0.003). Respondents with CRP levels > 10.00 mg/L had 2.69 greater odds of reporting a mood disorder compared with those with CRP levels ≤ 1.00 mg/L (p = 0.02). Higher proportions of respondents with mood disorders were older, had lower BMI, had secondary education, had weak sense of community, had higher proportion of asthma or arthritis, were current/past smokers, had daily consumption of 3+ drinks of alcohol, and used prescription drugs, cannabis/hashish, or other drugs compared with those without mood disorders (all p's < 0.05).
CONCLUSION
This study supported the association of CRP and mood disorder, specifically in a representative sample of the Canadian population. Targeting inflammation in depression and mood disorder warrants further study.
Topics: Adult; C-Reactive Protein; Canada; Cross-Sectional Studies; Female; Health Surveys; Humans; Male; Middle Aged; Mood Disorders
PubMed: 32130717
DOI: 10.17269/s41997-020-00297-3 -
The American Journal of Psychiatry Feb 2011In recent years, increasing numbers of children have been diagnosed with bipolar disorder. In some cases, children with unstable mood clearly meet current diagnostic...
In recent years, increasing numbers of children have been diagnosed with bipolar disorder. In some cases, children with unstable mood clearly meet current diagnostic criteria for bipolar disorder, and in others, the diagnosis is unclear. Severe mood dysregulation is a syndrome defined to capture the symptomatology of children whose diagnostic status with respect to bipolar disorder is uncertain, that is, those who have severe, nonepisodic irritability and the hyperarousal symptoms characteristic of mania but who lack the well-demarcated periods of elevated or irritable mood characteristic of bipolar disorder. Levels of impairment are comparable between youths with bipolar disorder and those with severe mood dysregulation. An emerging literature compares children with severe mood dysregulation and those with bipolar disorder in longitudinal course, family history, and pathophysiology. Longitudinal data in both clinical and community samples indicate that nonepisodic irritability in youths is common and is associated with an elevated risk for anxiety and unipolar depressive disorders, but not bipolar disorder, in adulthood. Data also suggest that youths with severe mood dysregulation have lower familial rates of bipolar disorder than do those with bipolar disorder. While youths in both patient groups have deficits in face emotion labeling and experience more frustration than do normally developing children, the brain mechanisms mediating these pathophysiologic abnormalities appear to differ between the two patient groups. No specific treatment for severe mood dysregulation currently exists, but verification of its identity as a syndrome distinct from bipolar disorder by further research should include treatment trials.
Topics: Anxiety Disorders; Attention Deficit Disorder with Hyperactivity; Bipolar Disorder; Brain; Cross-Sectional Studies; Depressive Disorder; Diagnosis, Differential; Diagnostic and Statistical Manual of Mental Disorders; Humans; Irritable Mood; Longitudinal Studies; Mood Disorders; Neural Pathways; Phenotype; Psychotropic Drugs; Risk Factors
PubMed: 21123313
DOI: 10.1176/appi.ajp.2010.10050766 -
Turkish Journal of Medical Sciences Dec 2021To investigate the correlation between depressive-anxiety symptoms, mixed features, disease activity, and functional status in patients with rheumatoid arthritis (RA) in...
BACKGROUND/AIM
To investigate the correlation between depressive-anxiety symptoms, mixed features, disease activity, and functional status in patients with rheumatoid arthritis (RA) in the light of the shared underlying etiology in both disorders.
MATERIALS AND METHODS
The study included 556 patients with RA. RA disease activity was measured using the Disease Activity Score 28-joint count C reactive protein (DAS28-CRP), and the patients were evaluated by a Health Assessment Questionnaire (HAQ). The Hospital Anxiety and Depression Scale (HADS), Mood Disorder Questionnaire (MDQ), and Modified Hypomania Checklist (mHCL) were used to evaluate the mixed depression and bipolarity status of the patients.
RESULTS
Of the patients, 430 (77.3%) were female and 126 (22.7%) were male. The median age was 57 years, the median HAQ score was 0.55 points, and the median DAS28-CRP score was 4.1 points. The evaluation of the patients by DAS28-CRP revealed that 58.5% of the patients had moderate and severe disease activity, while only 23.4% of them were in remission. The group using the combination of synthetic disease-modifying anti-rheumatic drugs (sDMARD) and steroid therapy had significantly higher HAD-depression, HAD-anxiety, mHCL, DAS28-CRP, HAQ, and MDQ scores than the group using sDMARD alone. The grouping of the patients based on the DAS28-CRP cut-off scores showed that the patients with moderate and severe disease activity had significantly higher HADS, mHCL, MDQ scores than those in remission and those with mild disease activity (p < 0.001).
CONCLUSION
Disease severity and functional status in RA can be affected by comorbid anxiety-depressive and mixed symptoms. Therefore, clinicians should consider screening the depressive-anxiety and mixed mood symptoms of RA patients. Moreover, patients who use steroid therapy are more susceptible to mood symptoms (anxiety, depression, bipolarity), which should also be considered during the follow-up of patients.
Topics: Adult; Aged; Aged, 80 and over; Antirheumatic Agents; Anxiety; Arthritis, Rheumatoid; Bipolar Disorder; C-Reactive Protein; Depression; Female; Functional Status; Humans; Male; Middle Aged; Mood Disorders; Prevalence; Severity of Illness Index; Steroids
PubMed: 34773692
DOI: 10.3906/sag-2107-283 -
Molecules and Cells Jul 2017Mammalian physiology and behavior are regulated by an internal time-keeping system, referred to as circadian rhythm. The circadian timing system has a hierarchical... (Review)
Review
Mammalian physiology and behavior are regulated by an internal time-keeping system, referred to as circadian rhythm. The circadian timing system has a hierarchical organization composed of the master clock in the suprachiasmatic nucleus (SCN) and local clocks in extra-SCN brain regions and peripheral organs. The circadian clock molecular mechanism involves a network of transcription-translation feedback loops. In addition to the clinical association between circadian rhythm disruption and mood disorders, recent studies have suggested a molecular link between mood regulation and circadian rhythm. Specifically, genetic deletion of the circadian nuclear receptor induces mania-like behavior caused by increased midbrain dopaminergic (DAergic) tone at dusk. The association between circadian rhythm and emotion-related behaviors can be applied to pathological conditions, including neurodegenerative diseases. In Parkinson's disease (PD), DAergic neurons in the substantia nigra pars compacta progressively degenerate leading to motor dysfunction. Patients with PD also exhibit non-motor symptoms, including sleep disorder and neuropsychiatric disorders. Thus, it is important to understand the mechanisms that link the molecular circadian clock and brain machinery in the regulation of emotional behaviors and related midbrain DAergic neuronal circuits in healthy and pathological states. This review summarizes the current literature regarding the association between circadian rhythm and mood regulation from a chronobiological perspective, and may provide insight into therapeutic approaches to target psychiatric symptoms in neurodegenerative diseases involving circadian rhythm dysfunction.
Topics: Affect; Animals; Circadian Rhythm; Dopamine; Humans; Models, Biological; Mood Disorders; Parkinson Disease
PubMed: 28780783
DOI: 10.14348/molcells.2017.0065 -
Molecular Psychiatry Oct 2022Mood disorders and suicidal behavior have moderate heritability and are associated with altered corticolimbic serotonin 1A receptor (5-HT) brain binding. However, it is...
Mood disorders and suicidal behavior have moderate heritability and are associated with altered corticolimbic serotonin 1A receptor (5-HT) brain binding. However, it is unclear whether this reflects genetic effects or epigenetic effects of childhood adversity, compensatory mechanisms, or illness stress-related changes. We sought to separate such effects on 5-HT binding by examining high familial risk individuals (HR) who have passed through the age of greatest risk for psychopathology onset with and without developing mood disorder or suicidal behavior. PET imaging quantified 5-HT binding potential BP using [C]CUMI-101 in healthy volunteers (HV, N = 23) and three groups with one or more relatives manifesting early-onset mood disorder and suicide attempt: 1. unaffected HR (N = 23); 2. HR with lifetime mood disorder and no suicide attempt (HR-MOOD, N = 26); and 3. HR-MOOD with previous suicide attempt (HR-MOOD + SA, N = 20). Findings were tested in an independent cohort not selected for family history (HV, MOOD, and MOOD + SA, total N = 185). We tested for regional BP differences and whether brain-wide patterns distinguished between groups. Low ventral prefrontal 5-HT BP was associated with lifetime mood disorder diagnosis and suicide attempt, but only in subjects with a family history of mood disorder and suicide attempt. Brain-wide 5-HT BP patterns including low ventral prefrontal and mesiotemporal cortical binding distinguished HR-MOOD + SA from HV. A biological endophenotype associated with resilience was not observed. Low ventral prefrontal 5-HT BP may reflect familial mood disorder and suicide-related pathology. Further studies are needed to determine if higher ventral prefrontal 5-HT BP confers resilience, reducing risk of suicidal behavior in the context of familial risk, and thereby offer a potential prevention target.
Topics: Humans; Suicidal Ideation; Receptor, Serotonin, 5-HT1A; Genetic Predisposition to Disease; Serotonin; Mood Disorders
PubMed: 35760877
DOI: 10.1038/s41380-022-01671-y