4 topics with concise reviews: definitions, key facts, and class questions.
In this chapter, we examine mood disorders—conditions where emotions spin out of control and completely dominate the patient's thinking and behavior. Affective disorders are a staple of psychiatry exams and one of the most common reasons for seeking help in clinical practice.
This section covers both poles of affective pathology. You will study bipolar affective disorder (BAD) and isolated manic episodes in detail, as well as severe recurrent depressive disorder. Special attention is paid to chronic yet milder forms of mood fluctuations—cyclothymia and dysthymia.
In practical classes, instructors most frequently demand a clear differentiation between BAD and classic recurrent depression, a solid grasp of strict diagnostic criteria for manic syndrome, and the ability to justify the choice between mood stabilizers and antidepressants. Pay special attention to ICD diagnostic criteria—these are precisely what examiners will use to "catch" you during bedside clinical case discussions.
Can endogenous depression be distinguished from reactive depression?
In practice, this is difficult. Reactive depression occurs exclusively in response to severe psychological trauma and typically does not recur. In endogenous depression, the first episode may also be triggered by stress, but the subsequent course becomes cyclical and autochthonous.
Does mania occur without depressive episodes?
Yes, but this is an extremely rare phenomenon (a casuistry). Most commonly, mania alternates with depressive phases within the framework of bipolar affective disorder.
What is the difference between depression in schizophrenia and recurrent depressive disorder?
In schizophrenia, the structure of affect is dominated by apathy and abulia (indifference and lack of will) rather than sadness. Pseudohallucinations and symptoms of psychic automatism are also frequently present.
Does manic-depressive psychosis lead to dementia?
No, the disease progresses without the development of pronounced personality or cognitive deficits. Memory impairment, apathy, and increasing egocentrism and suspiciousness are not observed as an outcome.
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