I. Definition and Characteristics of Affective Disorders
Emotions are people's subjective attitudes toward objective things and corresponding inner experiences.
Emotional activity is closely linked to the limbic system of the brain and the vegetative nervous system. The cerebral cortex regulates the conduct of emotions and feelings and controls the activities of subcortical centers. This includes the functions of the thalamus, hypothalamus, limbic system and reticular formation. The reticular formation plays an activating role in the composition of emotions, the arousal it produces is necessary for active emotions, it can reduce or increase the brain's positivity, strengthen or inhibit the answer response to the stimulus, the emotional color and emotional response of a person is largely dependent on the state of the reticular formation. Animal experiments have shown that the limbic system contains the highest levels of 5-hydroxytryptamine and norepinephrine. And has an important role in the regulation of emotional activity.
The Pavlovian school believes that emotional disorders are based on disorders of cortical and subcortical neural processes, and that changes in emotion are associated with metabolic disorders, especially with disorders of carbohydrate metabolism. Emotional inversion and expression inversion in schizophrenic patients are the result of diffuse inhibition of their cerebral cortex, which causes disorders in the regulation of emotion; emotional indifference is the result of cortical and subcortical decline, or inhibition of the cerebral cortex and subcortex. Emotional vulnerability, compulsive crying and laughing, and irritability in patients with organic brain disorders and dysthymia are associated with disruption or diminution of cortical activity. Depressive episodes in bipolar disorder may be the result of a lack of central catecholamines, primarily norepinephrine, and diminished activity; manic episodes may be the result of excess catecholamines and increased norepinephrine activity at receptor sites.
Second, the classification of affective disorders
Affective disorders are usually divided into three main categories: pathologically dominant emotions; emotionally induced disorders; and emotional degeneration.
1. Pathologically dominant emotion
Pathologically dominant emotion refers to the emotion that is significantly dominant in pathological mental activity, which is not related to the intensity and nature of objective stimuli, but has some connection with the patient's inner experience.
(1) Etiology
Elevated emotion: common in mania in affective disorders; if the degree of heightened emotion ranges from mild pleasantness and delight to the highest degree of extreme joy and ecstasy with an uncanny mystical quality, i.e., the state of pins and needles, it is seen in cerebral organic psychiatric disorders such as epilepsy.
Elation: seen in cerebral organic mental disorders, schizophrenia youthful type.
Low mood or depression: depression, reactive depression, depressive neurosis, anxiety neurosis, obsessive-compulsive disorder, menopausal mental disorder, post-schizophrenic depression.
Anxiety, panic attacks: can be seen in anxiety disorders, depression, obsessive-compulsive disorder, agoraphobia, disease, mental disorders due to organic and somatic brain diseases.
Horror: prominent in phobic neurosis, also seen in the early stages of schizophrenia.
(2) Characteristics
Emotional exaltation: refers to the patient's emotional activity in a long period of time continued to increase in height, the performance of joy and happiness, relaxed and happy, feel good about themselves, appear busy, energetic, talk with their hands, smiling, vivid expression, rich associations, more words, exaggeration, high pitch, a wide range of interests, and optimistic about everything, as if there is never any sadness and Worries. However, the patient is easily provoked at this time, a little less than desired, that is, bursting into a rage, or in the event of sadness immediately cry tears, can be recovered in an instant as before. It is often with the thought of running away and increased activity at the same time, constitute a manic state.
The degree of emotional elevation increases from mildly pleasant, happy to the highest degree of extreme joy, ecstasy or ecstasy, the state of extreme joy is good, if there is a great joy, and there is no thought running away or increase in movement, there may be mild consciousness disorder.
High emotion includes the following three symptoms:
Manic high. The main clinical symptom is persistent high emotion or irritability, accompanied by running thoughts, self-conceit and exaggeration, increased movement, rash behavior, inattention, hypersexuality and other symptoms. The heightened emotions are infectious and ****ing, and harmonize with the inner experience. The disease has a tendency to recur, and the intervals are mentally normal.
Epileptic psychosis. Such patients may have symptoms of emotional exaltation, emotional increase in the expression of pleasantness to the state of extreme happiness and dissipation of soul, self-consciousness of good meet great joy, but the inner experience and not in line with the surrounding environment, speech, although the increase, but incoherent, not infectious, there is a mild impairment of consciousness. Previous patients have a long history of recurrent epilepsy.
Psychotic disorders due to psychoactive substances. Such patients often have a long history of using psychoactive substances, and experience psychomotor arousal and abnormal moods ranging from fearfulness to a state of pins and needles during or after the use of psychoactive substances. They are also often accompanied by a wealth of vivid and vivid hallucinations, as well as symptoms of somatic and psychiatric dependence.
Elation: usually refers to a happy mood on the basis of organic brain disease, the patient is self-conscious of good, happy, facial stupidity, stupidity, childishness, no rich inner experience, appear monotonous stereotypes, can not attract normal people's **** song.
Emotional depression or depression: refers to the negative mood continues to increase in a longer period of time. It is the opposite of emotional high, the patient's state of mind depression, pessimism, pessimism, worry all day, no interest, low self-evaluation, have a sense of life is like years, often self-blame, suicidal thoughts and attempts. Low mood is often accompanied by slow thinking, reduced speech and movement, decreased will and slow reaction. This mood is closely related to the surrounding environment. There are two kinds of symptoms:
Mental disorders caused by organic brain and physical diseases: in organic brain diseases, such as mental disorders caused by cerebral arteriosclerosis, hepatic encephalopathy, etc., euphoria is a common symptom of affective disorders, and the patients are self-conscious of being good and happy, with shallow witty and playful behaviors because of the impaired memory intelligence, which gives a feeling of stupid childishness and drollness, and their mental symptoms often have a reversible, disappear with the improvement of the primary disease.
Schizophrenia youth type: the organic pathological basis of youth type schizophrenia is not obvious, the mental symptoms of thinking, emotion and behavioral incongruity as the main clinical features, expression, emotional euphoria, childish movements, excitement, impulsive, fragmentary hallucinations and delusions. These patients have a long course of illness and a poor prognosis.
Anxiety, panic attacks: anxiety (anxiety) refers to the lack of sufficient basis or obvious objective factors, excessively serious estimate of their own state or the surrounding environment, fear of their own health and life is threatened. Patients feel restless, nervous and fearful, worried, so that rubbing hands and feet, sighing, such as a big trouble, panic. It can also be accompanied by palpitations, sweating, cold limbs and symptoms of gastrointestinal dysfunction.
The symptoms are as follows:
Depressive phase of bipolar disorder. Persistent emotional depression, slowed thinking, reduced activity and diminished will are the main features of this disease. Expressed disinterest, sad face, pessimism, self-consciousness of life is worse than death, reduced energy, often self-blame and self-guilt, passive suicide, etc., with the characteristics of daytime and nighttime light. The patient has no self-awareness of the pathology, and the symptoms do not improve due to changes in the environment.
Menopausal depression. The onset of the disease is slow, preceded by the manifestations of menopausal syndrome, generalized malaise, early awakening, endocrine decline and vegetative nerve dysfunction; anxiety and depression, nervousness and fear may occur, but thinking and motor inhibition is not obvious. Some patients have self-guilt, hypochondriasis, nihilistic delusions and severe negative behavior.
Reactive mental disorder. Reactive psychiatric disorders, there is a class of reactive depressive states characterized by depressed mood, frustration, decreased interest, guilt or depression, which may be accompanied by anxiety, tension or agitation, for about a month under the trauma. The patient's entire mental activity is focused on the traumatic experience, as long as the scenario related to mental factors, are easy to cause the patient's emotional response, even if the time has changed, there is still a sense of "reminiscence". The symptoms often improve as a result of changes in the environment.
Post-schizophrenic depression: the residual period of schizophrenia, because of psychological factors, psychotropic drugs and endogenous factors, depression can occur. The main manifestations are severe dullness, debility, passivity and suicide attempts, feeling lonely, bewildered, scattered and blocked thoughts, often entangled with some empty and vain ideas, and emotion is not coordinated with thinking, behavior and environment, and will not improve due to changes in the environment.
Psychiatric disorders due to organic brain and somatic diseases, inhibitory symptoms often occur after organic brain or somatic diseases, manifested as anxious depression, no obvious thought inhibition, often have suspicious thoughts, the symptoms are fluctuating, usually disappear with the improvement of somatic diseases.
Panic attack: sudden, spontaneous, incomprehensible experience of panic, terror, anxiety, accompanied by dyspnea, dizziness, palpitations, near-death feeling and other physical symptoms.
Anxiety Disorders. Anxiety disorders are categorized into acute anxiety (i.e., panic attacks) and generalized anxiety. Panic attack is defined as sudden tension, fear, near-death of unknown cause, accompanied by severe vegetative nervous function disorders, such as palpitations, dyspnea, chest pain, tremor, etc. The duration of the attack is relatively short, mostly not more than 60 minutes, and the attack is normal after the attack. Generalized anxiety is a longer duration, unknown cause or object unknown and content of fear, tension, and accompanied by vegetative symptoms.
Depression. Depression is often accompanied by anxiety or panic attacks, but its anxiety and its severe depressive symptoms coexist with depression, self-guilt, pessimism, despair, low interest, decreased competence, and negativity, and antidepressants are effective.
Obsessive-compulsive disorder. This disease can be accompanied by anxiety and panic attacks, but in the case of obsessive-compulsive symptoms, i.e., conscious self-compulsion and conscious self-counter-compulsion coexist, the patient feels distressed and anxious, fearful, and tense, etc., which usually disappears with the improvement of obsessive-compulsive symptoms.
Horror: the patient encounters a specific situation or a certain thing, a kind of tension and horror mood. Knowing that this feeling of terror is abnormal, but can not get rid of. Terror has the following contents: such as fear of being dirty, fear of empty squares, fear of meeting people, fear of blushing, fear of going to school and so on.
Phobia. Neurosis with terror symptoms as the main clinical manifestations. Fear of fear of the object is a single or a variety of common people are animals, high places, squares, closed rooms and social activities, etc., with avoidance behavior, accompanied by vegetative symptoms. Knowing that the terror is irrational, it is repeatedly presented and difficult to control.
Schizophrenia. Schizophrenia under the domination of delusions and hallucinations, may present fear, dread, etc., but the object is not clear, no self-awareness.
2. Emotionally evoked disorder
Emotionally evoked disorder is a dysfunction of emotion initiation, where emotions are easily evoked or difficult to evoke when stimulated.
(1) etiology
Easily provoked: the patient's emotions are easily provoked, anger, the slightest stimulus burst of anger, irritation, easy to conflict with others. Commonly found in mania, cerebral organic mental disorders, mental disorders caused by somatic diseases, neurosis.
Pathological passion: the patient's causative factors are not obvious or on the background of the poor state of mind, a sudden onset, very strong, for a short period of time of anger; and the resulting brutal impulsive behavior and serious injury to others, the onset of the seizure is often accompanied by a certain degree of impaired consciousness, and there may be amnesia after the incident. It is often seen in mental disorders caused by organic and somatic brain diseases, schizophrenia, and reactive mental disorders.
Emotional fragility: refers to the patient's susceptibility to sadness, crying or excitement and agitation due to minor trivialities, and inability to exercise self-restraint. It is seen in cerebral arteriosclerotic mental disorders, hysteria, neurasthenia.
Emotional instability: refers to the patient's mood is very easy to change, from one kind of emotion quickly changed to another kind of emotion. Emotional instability, not lasting, can be no external triggers, sometimes sad, sometimes happy, sometimes self-blame or sometimes complaining, etc., sometimes rage, noise, roaming or suicide, and hit and scold people for no reason. Seen in cerebral organic mental disorder, alcoholism, personality disorder.
Compulsory crying and laughing: sudden outbursts of uncontrollable or compulsive crying and laughing without external triggers, and the patient's expression is stupid, peculiar, and lack of inner experience. Most often seen in cerebral organic mental disorder.
Emotional retardation: the patient's expression of the stimuli that can usually cause distinct emotional response is bland, and the corresponding inner experience is also lacking. Most of them are characterized by a gradual loss of subtle emotions. Such as not considerate relatives, do not care about comrades, do not work seriously, the expression is not vivid and vivid. Mostly seen in schizophrenia, early cerebral organic mental disorder and dementia early.
Emotional numbness: in a state of long-term emotional repression (such as long-term detention) or suddenly encountered an emergency when the corresponding lack of emotional experience. Expression of neither fear nor pain, numbness. Most often seen in reactive mental disorders, hysteria.
(2) Symptoms
Mania. Manic patients have obvious irritability, anger and hostility due to the instability of mood, the patient may burst into a rage because of small things or because of unfulfilled demands, even hurt people and destroy things, and the rage is unbearable; but usually the piece of time passes away, and the anger is turned into a smile as if nothing has happened, and the patient is still happy and satisfied afterward.
Psychiatric disorders caused by organic brain and physical diseases: organic brain psychiatric disorders, such as hypertension, can appear in the early stage of cerebral debility syndrome, the performance of emotional instability, the factors are not obvious emotional irritability, but at the same time can be accompanied by vegetative symptoms, such as rapid heartbeat, precordial discomfort, and sleep disorders. Mental disorders caused by somatic diseases, such as hyperthyroidism associated with mental disorders can manifest mood instability, impatience, agitation, irritability, and so on, its irritability is not specific, but often with increased metabolic rate of somatic symptoms and goiter.
Nervousness: decreased mental activity, mood swings and worries, and increased somatic complaints; its irritability is due to mental excitability and easy mental fatigue, but there is self-awareness.
Pathological passions. Brain organic and somatic diseases caused by mental disorders. Such as epilepsy caused by mental disorders can appear pathologically bad state of mind, unknown reasons for the sudden emergence of depressed mood, irritability, agitation, nervousness, restlessness, fear, dissatisfaction with the surrounding all sorts of, complaining that other people are not good for themselves. Sometimes there is a violent rage and a brutal attack on others. The attacks usually last for days or hours.
Reactive mental disorder. As a result of sudden and intense mental stimulation, and the emergence of acute cardiac cause reaction, in a mild consciousness disorder, showing disorganized and purposeless movements, impulsive hurtful behavior, emotional tension, fear, can appear fragmentary hallucinations and delusions. However, the duration is short, and if the degree of impaired consciousness fluctuates, the clinical manifestations also change.
Emotional vulnerability. Cerebral arteriosclerosis mental disorder. Emotional vulnerability is the most typical symptom of early cerebral arteriosclerosis, the patient performance control of emotions weakened, very easy to hurt feelings and irritation, or worry about depression, bitterness or remorse for no reason. The disease progresses gradually, and in the stage of obvious intellectual disorder, the above emotional disorder is also aggravated accordingly, which is obviously manifested as emotional fragility, instability, euphoria or stagnation, or the emergence of obligatory crying and laughing.
Hysteria. Hysterical patients often show crying, laughing, shouting, noisy, etc. because of small things, and the emotional transformation is rapid and suggestive.
Neurasthenia. Patients due to increased excitability, easily agitated, often due to small things can cause strong emotional reaction. Easily provoked, easy to feel sad, often for some trivial things and tears of grief, sadness and frustration. There may also be fatigue or exhaustion, accompanied by physical and neuropsychiatric symptoms.
Emotional instability. Cerebral organic mental disorder. Early patients often show low mood, depression, sometimes anxiety, shock or fear, sometimes indifference to the surrounding, reduced interest, but usually are superficial, easy to change. At the same time such patients also have a cerebral organic pathology basis and organic somatic symptoms and signs.
Alcoholism. In patients with acute alcohol intoxication, due to the one-time excessive drinking, the patient shows a special state of excitement, emotional irritability and instability, increased speech, repetition, with exaggerated elements, loud insults to the usual dissatisfaction, aggressive behavior; at this time, slurred speech, tremor of the hands and lips, walking unsteadily, facial flushing, increased heart rate.
Personality disorders. Personality disorder patients may have severe emotional disorders, emotional instability, easily provoked, easily enhanced or depressed, and some are emotionally shallow or even callous toward others. Personality disorders usually begin early in life, with a personality that is seriously deviated from normal and incongruous; the purpose and motivation of the behavior are unclear, and the behavior is mostly influenced by emotional impulses; there is no self-awareness of the personality, and it is not possible to learn from past life experiences, making correction difficult and the prognosis is poor.
Compulsory crying and laughing. Cerebral functional sclerosis mental disorder. Such patients in the early stage of more than obvious triggers gradually appeared symptoms of neurasthenia-like, accompanied by emotional instability; with the development of the disease, intelligence may be impaired, emotional symptoms aggravated, the emergence of mandatory crying and laughing. The symptoms of this disease are fluctuating, and physical examination shows signs of cerebral atherosclerosis, while blood cholesterol and blood lipids are higher than normal.
Hepatomegaly. Hepatomegaly is an autosomal recessive copper metabolism disease, the age of onset is mostly in children or adolescents, neuropsychiatric symptoms can appear, early that is, obvious personality and emotional changes and extra-vascular motor disorders. There are obvious personality and emotional changes as well as extra-dimensional movement disorders in the early stage. The manifestations include tremor, dystonia, "mask face", and obligatory crying and laughing. Physical examination of the color membrane pigment damage, liver damage and serum steel oxidase activity is reduced.
Paralytic dementia. It is a type of chronic meningitis caused by the invasion of the brain by syphilitic spirochetes, and may present with neurologic, somatic, and psychiatric symptoms. In the developmental stage of the disease mood is much unstable, some show emotional vulnerability and obligatory crying and laughing. Schizophrenia. Emotional retardation and indifference, emotional reactions that do not correspond to the content of thinking, as well as external stimuli, are important features of schizophrenia. The patient also has thought association disorder. Hallucinations, delusions, diminished volition and behavioral withdrawal. The disease is frequent in young adults, with a prolonged course and without organic brain symptoms and signs.
Cerebral organic mental disorders. Affective disorder is one of the common symptoms in patients with cerebral organic mental disorder. Some patients may show emotional retardation and indifference to anything, which may also be accompanied by intellectual decline and personality changes. These patients can be diagnosed with organic brain disorders through physical and laboratory tests.
Emotional numbness. Reactive mental disorder. The patient suffered a severe mental trauma and the acute mind reaction, some patients show rigid immobility, motor inhibition, emotional unresponsiveness, dullness, and even to the pain stimulus is not responsive. The course of the disease, a recurrence of less.
Hysteria. Some patients with hysteria due to exaggeration and artifice, the performance of closed eyes, call not wake up, push not move, it seems that the corresponding lack of emotional experience, there is no sense of fear and pain. However, such patients have a history of hysterical episodes in the past, and will have similar episodes when they encounter stimuli.
3. Emotional degradation
The patient's emotions become very childish or decay is called emotional degradation.
(1) Etiology
Emotional childishness: it means that the patient's emotion lacks restraint, and it is very easy to show it, just like a child's general behavior. The patient's reaction to external stimuli is rapid and strong, the slightest stimulus will howl or storm, and a little appeasement will break into laughter. Due to the weakened control of the cerebral cortex, the patient's emotional activity is easily influenced by instinct or intuition, and lacks restraint and comprehension, and is easily revealed. Common in schizophrenia adolescent type, hysteria, dementia patients.
Emotional decay: refers to the patient to all kinds of things gradually lose their own inner experience, with a silly smile face or no expression, usually external stimuli is difficult to cause emotional reaction, for heavy external interference can be some anger or avoidance reaction. It is part of the overall decline in mental activity. It is common in patients with schizophrenic decline or dementia.
(2) Differential diagnosis
①Emotional naivety.
Schizophrenia. Schizophrenia adolescent patients, there can be emotional childish performance, temperamental expression, suddenly crying and laughing, easily disturbed by external stimuli, sometimes impulsive excitement, beating and destroying things, sometimes running, learning chickens and dogs, as three-year-old children; at the same time, with fragmented thinking, rupture, behavior stupidity, peculiar, with fragmentary hallucinations, delusions, but also hypersexuality intention reversal, the course of the disease progresses more quickly, the gradual decline of the personality.
Plague. This kind of patient's own character has a strong emotional life and emotional variability, emotionally active, vivid, superficial, childish, emotional reaction is easy to shift from one extreme to another. Part of the hysteria patients can show child-like dementia symptoms, patients call themselves children, the tone of their conversation. Content, expression, action are the same as children, performance is very childish, mischievous. It seems as if the state of dementia, but the patient actually has no intellectual disability.
Cerebral organic mental disorder. Long-term organic lesions of the brain, dementia syndrome can occur, manifested as a comprehensive intelligence, memory decline and personality changes, intelligence and memory impairment is the prominent manifestation of dementia; personality changes are mainly manifested in the temperament of irritability, suspiciousness, ethical and moral concepts of the diminished behavior stupidity, emotional indifference, childishness, euphoria, and daily life can not be self-care.
②Emotional decay.
Schizophrenic decline type. Patients with schizophrenia, due to the progressive course of the disease, the mental symptoms are getting worse and worse, with the negative symptoms of schizophrenia predominantly, manifesting withdrawn temperament, low volitional activity, emotional indifference to decay, giggling all day long, indifferent to any stimulus, impoverished thinking, and loss of social functioning.
Cerebral organic mental disorder. Cerebral organic mental disorder dementia patients, due to intellectual decline, personality changes, performance of social function decline, withdrawn, withdrawn, self-talk, giggling, lack of internal experience of external stimuli. Such patients have signs and symptoms of organic brain lesions.