| disease | Affective Disorder |
Affective mental disorders (mood disorders) are characterized by significant and persistent elevation or depression of mood, accompanied by corresponding changes in thinking and behavior, with recurrent episodes and complete remission during intervals. In slower-progressing cases, symptoms may not reach the severity of psychosis. The prognosis is generally favorable, though a minority of patients may experience prolonged and persistent illness. The disorder can manifest as manic or depressive episodes.
bubble_chart Diagnosis
1. Medical History and Symptoms:
(1) Clinical Manifestations
Primarily characterized by elevated or depressed mood, accompanied by flight of ideas or psychomotor retardation, and psychomotor agitation or inhibition. In a manic state, the patient's mood is excessively elevated, incongruent with their circumstances, manifesting as euphoria, irritability, agitation, anger, or anxiety. In severe cases, mood-congruent or incongruent delusions, hallucinations, and other psychotic symptoms may occur. In a depressive state, seasonal disease leads to poor mood, distress, sadness to pessimism, despair, inability to feel joy, loss of interest, and low self-esteem. Severe cases may exhibit suicidal ideation and behavior, with symptoms showing a diurnal variation (worse in the morning and improving at night).
(2) Course Characteristics
Most cases follow a recurrent course, with intermittent periods of relatively normal mental state, and often a high positive family history.
2. Physical Examination Findings
Generally, no positive findings are observed in physical, neurological, or laboratory examinations.
bubble_chart Treatment Measures
I. Management of Mania(1) Antipsychotic Medications:
Various antipsychotic drugs can be selected, such as chlorpromazine with strong sedative effects at 200–600 mg/d. For acute mania, administer chlorpromazine 50–100 mg IM 2–3 times/d, or combine chlorpromazine with promethazine 50 mg, or chlorpromazine with scopolamine 0.3 mg IM. Haloperidol 8–32 mg/d orally may also be used. For acute cases, administer haloperidol 5–10 mg IM 2–3 times/d and switch to oral administration after symptom control.
(2) Lithium Therapy:
Commonly used preparations include lithium carbonate, with a therapeutic dose of 500–2000 mg/d and a maintenance dose of 400–1000 mg/d. The therapeutic dose is close to the toxic dose, so careful monitoring is required to prevent side effects.
(3) Electroconvulsive Therapy (ECT):
It has certain therapeutic effects in controlling patients' excitement and agitation.
II. Management of Depression
(1) Antidepressants:
There are numerous types of antidepressants, providing ample options. Traditional tricyclic antidepressants (TCAs) such as amitriptyline, imipramine, and doxepin have proven efficacy. For amitriptyline, start with 25 mg 1–2 times/d and gradually increase the dose to around 200 mg/d within 1–2 weeks; some cases may require up to 200 mg/d. If no improvement is observed after 3–4 weeks, switch medications. Selective serotonin reuptake inhibitors (SSRIs) have definite efficacy for this condition, with fewer side effects than TCAs and convenient administration. Examples include fluoxetine, paroxetine hydrochloride, and sertraline. Fluoxetine and paroxetine are typically dosed at 20 mg/d, with severe cases requiring up to 40 mg/d, once daily.
ECT is indicated for severely ill patients with strong suicidal ideation, as it acts quickly and effectively. After symptom relief, switch to antidepressant maintenance therapy.
