Analysis of information sources in references of the Wikipedia article "Mood swing" in English language version.
Moods differ from emotions in lacking an object; for example, the emotion of anger can be aroused by an insult, but an angry mood may arise when one does not know what one is angry about or what elicited the anger.
a nonspecific term for any oscillation in mood, particularly between feelings of happiness and sadness.
Mental illnesses are highly complex, temporally dynamic phenomena (1). Variables across a vast range of timescales – from milliseconds to generations – and levels – from subcellular to societal – interact in complex manners to result in the dynamic, rich and extraordinarily heterogeneous temporal trajectories that are characteristic of the personal and psychiatric histories evident in mental health services across the world.
The results showed that less than 50% of PTSD cases presented with anxiety as the primary emotion, with the remainder showing primary emotions of sadness, anger, or disgust rather than anxiety
This pattern is consistent with the pattern of dysregulation demonstrated by the ADHD-EDr child in the present study, as he demonstrated generally low positive affect along with 10 single time-point ratings of mild to moderate irritability over the 4 weeks.
Electronic self-monitoring of mood was considered valid compared to clinical rating scales for depression in six out of six studies, and in two out of seven studies compared to clinical rating scales for mania.
Measuring and characterizing the experience of affective instability have proved challenging, however. Traditional measures of affective instability rely on respondents' retrospective recall and subjective assess-ment of affective variability or reactivity on interview or questionnaire items.
A self-report measure of changeable affect was developed, with a goal of identification of patterns of instability in mood. Scales measuring lability in anxiety, depression, anger, and hypomania, and labile shifts between anxiety and depression and hypomania and depression were constructed. These scales were then evaluated for internal consistency, retest reliability, score stability ...
To measure affect lability, Harvey et al. (1989) developed the Affective Lability Scales (ALS), a 58-item questionnaire measuring changeability among euthymia and four affect states (i.e., depression, elation, anger, and anxiety).
...the use and definitions of the terms "affect," "mood," "emotion," and "feeling" in some classical and contemporary works of psychiatry and psychology. He concludes that these words refer to distinct pscychological phenomena and suggests that they be used clearly and carefully to facilitate communication about emotions.
The literature spans psychiatry, psychology and neuroscience, and multiple terms are used to describe the same, or related phenomena, including affective instability, emotional dysregulation, mood swings, emotional impulsiveness and affective lability. Collating the main overlapping dimensions, definitions, and their measurement scales, a recent systematic review proposed that mood instability is 'rapid oscillations of intense affect, with a difficulty in regulating these oscillations or their behavioural consequences'.
One would conclude from the above italic sentences of Fish that affect is a sudden exacerbation of emotion, and mood is also the emotional state prevailing at any given time, in other words, both mood and affect are short-term emotional tone (However, these confusing lines are deleted in the new edition of Fish's clinical psychopathology).
Four of 5 normal controls displayed a circadian mood pattern with chaotic dynamics.
When a patient, in the longitudinal course of mood disturbances, no longer meets the threshold of a disorder such as depression or mania, as assessed by categorical methods resulting in diagnostic criteria or by cutoff points in the dimensional measurement of rating scales, he or she is often labeled as euthymic.
Complexity of symptoms or behaviors in an individual is often characterized by the dynamics of the individual's longitudinal patterns. While periodic/linear temporal patterns are predictable in both trajectory and pattern, chaotic patterns are predictable in pattern only. Random dynamics are predictable in neither trajectory nor pattern.
The visual analog scale can capture patterns of mood and mood variability thought to be typical of these diagnostic groups. Mood disorders differ not only in the degree of abnormal mood but also in the pattern of mood variability, suggesting that mechanisms regulating mood stability may differ from those regulating overall mood state.
We typically have little control over fluctuations between episodes of good and bad mood. In most cases, we also have little understanding of the causal factors driving our mood fluctuations, contrary to emotional reactions that are circumscribed to a specific trigger and limited to a short duration.
The main conclusion of the study was that happiness depends not on how well things are going (in terms of cumulative earnings) but whether they are going better than expected.
The bipolar II spectrum represents the most common phenotype of bipolarity. Numerous studies indicate that in clinical settings this soft spectrum might be as common--if not more common than--major depressive disorders.
Difficulties with measurement, and unclear definitions for terms like cyclothymia, rapid cycling, mixed states, short episodes, and soft spectrum have contributed to the uncertainty (Akiskal et al., 2000, Blacker and Tsuang, 1992, Cassano et al., 1999, Ghaemi et al., 2001).
DSM-5 introduced the "with mixed features" specifier, which could apply to any type of episode of BD and major depressive disorder (MDD).
Patients with bipolar disorder spend about half of their time in depression, mania or mixed states22. The remaining periods are defined as euthymic23, 24, 25, 26, 27. However, considerable fluctuations in psychological distress were recorded in studies with longitudinal designs, suggesting that the illness is still active in those latter periods, even though its intensity may vary28. It is thus questionable whether subthreshold symptomatic periods truly represent euthymia28....This definition of euthymia, because of its intertwining with mood stability, is substantially different from the concept of eudaimonic well‐being, that has become increasingly popular in positive psychology
Though mixed feelings may be uncommon, they might often have important consequences (e.g., for health).
Indeed, college students are more likely to report mixed emotions of happiness and sadness on the day that they move out of their freshmen dorm and on their graduation day than on typical days.
The findings confirm that adolescents experience wider and quicker mood swings, but do not show that this variability is related to stress, lack of personal control, psychological maladjustment, or social maladjustment within individual teenagers.
Mental illnesses are highly complex, temporally dynamic phenomena (1). Variables across a vast range of timescales – from milliseconds to generations – and levels – from subcellular to societal – interact in complex manners to result in the dynamic, rich and extraordinarily heterogeneous temporal trajectories that are characteristic of the personal and psychiatric histories evident in mental health services across the world.
Cyclothymia is characterized by early onset, persistent, spontaneous and reactive mood fluctuations, associated with a variety of anxious and impulsive behaviors, resulting in a very rich and complex clinical presentation. Current diagnostic criteria for cyclothymic disorder (DSM-5 and ICD-10), emphasizing only episodic mood symptoms, may be misleading both from diagnostic and therapeutic point of views.
A time-series approach allows comparison of mood instability pre- and post-treatment. Figure 1
As expected, episodes of depressions were much longer than manias, but episode-duration did not differ among BD diagnostic types: I, II, with mainly mixed-episodes (BD-Mx), or with psychotic features (BD-P)...A total of 56.8% of subjects could be characterized for major course-patterns as either DMI or MDI, which occurred in similar proportions for each type. As expected, depressive episodes averaged 5.2 months
These studies indicate that mood in patients with bipolar disorder is not truly cyclic for extended periods. Nonetheless, self-rated mood in bipolar disorder is significantly more organized than self-rated mood in normal subjects and can be characterized as a low-dimensional chaotic process. This characterization of the dynamics of bipolar disorder provides a unitary theoretical framework that can accommodate neurobiologic and psychosocial data and can reconcile existing models for the pathogenesis of the disorder. Furthermore, consideration of the dynamical structure of bipolar disorder may lead to new methods for predicting and controlling pathologic mood.
The median duration of major depressive episodes was 14 weeks, and over 70% recovered within 12 months of onset of the episode. The median duration of minor depressive episodes was 8 weeks, and approximately 90% recovered within 6 months of onset of the episode...An early report from this study examined 66 participants with bipolar I followed for up to 5 years, and found that the median time to recovery from the first two prospectively observed episodes of major depression was 20 weeks and 24 weeks.16 A subsequent report described 82 participants with bipolar I followed for 10 years; the median duration of major and minor depressive episodes were 12 and 5 weeks, respectively.17
(graph PMS pattern)...Key characteristics of PMS include a lack of symptoms during the follicular phase, a peak of symptoms during the late luteal or premenstrual phase, and a sudden decrease of symptoms with the onset of menses.
The ACOG definition involves the presence of at least one of the six affective symptoms (angry outbursts, depression, anxiety, confusion, irritability and social withdrawal) and one of the four somatic…
It consists of a heightened emotional reactivity to environmental stimuli, including emotions of others. Emotion sensitivity in BPD has primarily been associated with negative mood states (e.g., anger, fear, sadness) and not positive emotions (although see [9, 10]).
...but in BPD, symptoms are usually associated with mood instability rather than with the extended and continuous periods of lower mood seen in classic mood disorders.19 Also, because of characteristic mood swings, BPD is often mistaken for bipolar disorder.30 However, patients with BPD do not show continuously elevated mood but instead exhibit a pattern of rapid shifts in affect related to environmental events, with "high" periods that last for hours rather than for days or weeks.
Individuals with BPD report more negative emotions and a greater intensity of negative emotions than healthy individuals throughout the day (9). However, recent data suggest a particular relevance of anger, a negative emotion that is closely related to reactive aggression, in BPD. Using e-diaries, Kockler et al. (10) found that individuals with BPD exhibit anger more frequently in their daily life than healthy as well as clinical control groups and feelings of anger accounted for more distress than pure emotional intensity.
The results of this study suggest that the presence of greater lability in terms of anger, anxiety, and depression/anxiety oscillation characterizes borderline personality disorder, while suggesting that the subjective sense of high affective intensity is present in this population but does not explain these other affective phenomena.
Depressive symptoms that occur as part of BPD are usually transient and related to interpersonal stress (eg, after an event arousing feelings of rejection). Such "depression" usually lifts dramatically when the relationship is restored. Depressive symptoms in BPD may also serve to express feelings (eg, anger, frustration, hatred, helplessness, powerlessness, disappointment) that the patient is not able to express in more adaptive ways.
Moderator analyses revealed lower depression severity in BPD patients without comorbid DeDs, but higher severity in BPD patients with comorbid DeDs compared to depressed controls...some authors labeled the depression experienced in BPD "borderline-depression", characterized by distinct feelings of loneliness and isolation (Adler and Buie, 1979, Grinker et al., 1968), emptiness or boredom (Gunderson, 1996), high dependency and fears of abandonment (Masterson, 1976), as well as intense anger and hate toward the self and others (Hartocollis, 1977, Kernberg, 1975, Kernberg, 1992).
This study replicates research showing that adults with ADHD report heighted emotional lability (EL), which contributes to impairments in their daily life.
However, common themes include decreased inhibitory control, intolerance of delay to rewards and quick decision-making due to lack of consideration, as well as more universal deficits such as poor attentional ability.
Kraepelin1 and Bleuler2 had already mainly focused on "flat" or "inappropriate" emotions as core features of the illness.
There were no statistically significant differences between individuals with BD-I and SZ for any ALS-SF dimension and these two groups had very similar score patterns throughout. This suggests that despite the overlap in core affective symptom profiles of BD-I and BD-II, the BD-I group is more similar to SZ than it is to BD-II concerning levels of affective lability.
Evidence from multiple domains indicates that affective dysregulation is strongly associated with reality distortion.1,2 Genetic epidemiological studies have demonstrated that the liabilities for bipolar disorder and schizophrenia are correlated.
Blunted affect, also referred to as emotional blunting, is a prominent symptom of schizophrenia. Patients with blunted affect have difficulty in expressing their emotions [1], characterized by diminished facial expression, expressive gestures and vocal expressions in reaction to emotion provoking stimuli [1–3]. However, patients' reduced outward emotional expression may not mirror subjective internal emotional experiences [4] suggesting a disconnect in what patients experience, perceive and express when interpreting emotional stimuli [5] due to problems associated with emotional processing [6–7].
There is evidence that the occurrence of stressful life events3,6–8 or the presence of social relationship stressors such as high levels of familial "expressed emotion9–11" are associated with subsequent exacerbation of psychotic symptoms in patients as a group.
Whether depressed individuals and healthy controls will differ in their instability of PA is less clear. As we noted above, depressed individuals have been found to have blunted emotional responses to valenced stimuli in the laboratory (Bylsma, et al., 2008) and decreased responsivity to reward (e.g., Pizzagalli, Iosifescu, Hallett, Ratner, & Fava, 2009)...
He noted that people with melancholia could become over-talkative and manic but did not adequately explain why this is so." & "On the VAS ratings, the depressed group experienced more severe low moods and less severe high moods than the non-depressed group, as would be expected given the selection criteria. This is consistent with reports of more severe negative emotions and variable positive emotions in ecological momentary assessment studies of patients with major depression (12, 33, 53).
Emotional effects of depression and treatment vary, but may include, for example, feeling emotionally "numbed" or "blunted" in some way; lacking positive emotions or negative emotions; feeling detached from the world around you...
Major depressive disorder is characterized by high mean NA and low mean PA (e.g., Watson et al., 1988).... Note that major depressive disorder generally is unassociated with instability of NA or PA (Köhling et al., 2016; Koval et al., 2013).
Diurnal variation in mood is a prominent symptom of depression, and is typically experienced as positive mood variation (PMV — mood being worse upon waking and better in the evening).
The depressives are more sensitive to displeasure and more anhedonic than controls.
The mixed depressive syndrome is not a transitory state but a state of long duration, which may last weeks or several months. The clinical picture is characterized by dysphoric mood, emotional lability, psychic and/or motor agitation, talkativeness, crowded and/or racing thoughts, rumination, initial or middle insomnia.
Emotional abuse was associated with average daily mood and mood lability.
The results showed that less than 50% of PTSD cases presented with anxiety as the primary emotion, with the remainder showing primary emotions of sadness, anger, or disgust rather than anxiety
Taken together, these results indicate that PTSD development is a dynamic process in which symptoms interact over time (Gelkopf et al., 2017). As hypothesized, intrusions and AAR symptoms may be more important early on and lead to other symptoms in the disorder.
Chronic PTSD most often co-occurs with mood, anxiety and substance use disorders. It is highly reactive to environmental reminders of the traumatic event and to renewed life-stressors, and thus may have a fluctuating course (23).
Posttraumatic stress symptom severity was uniquely correlated with greater intensity and variability, but not occurrence, of certain negative emotions, and with less frequent occurrence but greater variability of joy/happiness. Intrusive reexperiencing was uniquely associated with greater variability of both anxiety and joy/happiness. Results suggest that women with more severe posttraumatic stress symptoms do not experience more episodes of negative emotion but, once emotion occurs, they have difficulty modulating its intensity.
Reexperiencing symptoms describe spontaneous, often insuppressible intrusions of the traumatic memory in the form of images or nightmares that are accompanied by intense physiological distress...Hyperarousal symptoms reflect more overt physiological manifestations, such as insomnia, irritability, impaired concentration, hypervigilance, and increased startle responses.
Kleim, Graham, Bryant, and Ehlers (2013) asked a sample of trauma-exposed individuals to report state levels of various unpleasant emotions (i.e., fear, helplessness, anger, guilt, and shame) following naturally occurring intrusive memories over the course of a week.
{{cite journal}}: CS1 maint: DOI inactive as of September 2024 (link)Findings and future directions from the ENIGMA Bipolar Disorder Working Group. Hum Brain Mapp. 2022 Jan;43(1):56-82."Initial BD Working Group studies reveal widespread patterns of lower cortical thickness, subcortical volume and disrupted white matter integrity associated with BD. Findings also include mapping brain alterations of
mesial limbic system (nucleus accumbens, amygdala, and hippocampus) and the entire prefrontal cortex. They play a determining role in emotional expression and motivation. For example, a reduction in the activity of the mesocortical pathway will result in a paucity of affect and loss of motivation and planning
Anabolic steroids are used to accelerate the growth of normal boys with constitutional, delay of growth and puberty
The anabolic effects are considered to be those promoting protein synthesis, muscle growth and crythopoiesis
Anabolic steroids and other agents are fast becoming part of the standard of care for HIV disease, gaining acceptance in reversing loss of lean body mass...
High doses of AASs can lead to serious physical and psychological complications, such as hypertension, atherosclerosis, myocardial hypertrophy and infarction, abnormal blood clotting, hepatotoxicity and hepatic tumors, tendon damage, reduced libido, and psychiatric/behavioral symptoms like aggressiveness and irritability
AAS users who fulfilled the criteria for AAS‐dependence had significantly thinner cortex in frontal, temporal, parietal, occipital and pre‐frontal regions compared to non‐dependent users
ADHD is a neurodevelopmental disorder defined by impairing levels of inattention, disorganization, and/or hyperactivity-impulsivity. Inattention and disorganization entail inability to stay on task, seeming not to listen, and losing materials necessary for tasks, at levels that are inconsistent with age or developmental level.
Ozel-Kizil et al. (2013; also see Ozel-Kizil et al., 2014) defined hyperfocusing as being "characterized by intensive concentration on interesting and non-routine activities accompanied by temporarily diminished perception of the environment".
Shifting attention was more significantly associated with trait anger and anger out than response inhibition, which was significantly related to anger control
Studies have found that ADHD is associated with weaker function and structure of prefrontal cortex (PFC) circuits, especially in the right hemisphere.
ADHD subjects indeed showed a performance deficit in the tasks, supporting OFC dysfunction in ADHD. Furthermore, a discriminat analysis using the task performance variables correctly classified 89.7% of the participants among ADHD patients and normal controls.
The prefrontal association cortex plays a crucial role in regulating attention, behavior, and emotion, with the right hemisphere specialized for behavioral inhibition.
Table 1 :Changes in ASD criteria from the DSM-IV to DSM-5
Difficulties with sensory input was described to impact mood, causing stress and agitation:
The authors found that youth with ASDs had overactivation in limbic areas, primary sensory cortices, and orbitofrontal cortex (OFC) compared with typically developing (TD) control subjects in response to mildly aversive visual and auditory stimuli." & "Finally, Green et al10 found that SOR symptoms correlated with hyperactivity in the amygdala and OFC.
Children with ASD and disruptive behavior showed reduced amygdala–vlPFC connectivity compared with children with ASD without disruptive behavior.
In BPD, the appraisal mechanisms are at fault, in large part because of mentalizing difficulties (e.g. in the mistaken appraisal of threat at the moment of its presentation) or a breakdown in epistemic trust, which damages the capacity to relearn different ways of mentalizing – or appraising – situations (i.e. the inability to change our understanding of the threat after the event).
Core symptoms that comprise the disorder are often explicitly interpersonal in nature (e.g., tumultuous romantic relationships and frantic efforts to avoid abandonment) or are expressed in reaction to interpersonal stressors (e.g., affective instability, paranoid ideation, suicidal behavior
Individuals with a diagnosis of BPD have difficulty making appropriate social judgements about others from their faces. Judging more faces as unapproachable and untrustworthy indicates that this group may have a heightened sensitivity to perceiving potential threat, and this should be considered in clinical management and treatment
Individuals with BPD features often have distorted cognitions. Specifically, they often make simplified judgments about people and situations.
Following Linehan's biosocial model, we conceptualize emotion dysregulation in borderline personality disorder (BPD) as consisting of four components: emotion sensitivity, heightened and labile negative affect, a deficit of appropriate regulation strategies, and a surplus of maladaptive regulation strategies.
In comparison to a healthy control group, BPD patients show deficits in the following areas: mindfulness, self-compassion and adaptive emotion-regulation strategies.
BPD features are also associated with self-criticism, thought suppression, avoidance, and alcohol use as strategies for regulating emotions (Aldao & Dixon-Gordon, 2014).
Studies of the general population indicate that attempts to suppress thoughts typically result in a heightened accessibility of suppressed thoughts (e.g., a rebound effect) together with increases in emotional and physiological arousal [27].
...NPSs based on neurobiological dimensions and behaviors rather than clinical syndromes, grouping them into five domains: (1) negative valence; (2) positive valence; (3) cognitive systems; (4) processes for social systems; and (5) arousal or regulatory systems [13]. Yet here, too, there is tremendous overlap. For example, impairment of cognitive systems may manifest in delusions, hallucinations, agitation, aggression, depression or dysphoria, anxiety, elation or euphoria, apathy, disinhibition, irritability, motor disturbance, sleep disorder, appetite disorder, aberrant vocalization, and ruminative, repetitive, and somatoform behaviors.
(d) impairment in social or occupational functioning: fights, violent behaviour, loss of friends, absence from work, loss of job, legal difficulties, arguments or difficulties with family; (e) development of hypomaniac, maniac, or cyclothymic affective syndrome in relation to DRT; (f) development of a withdrawal state characterized by dysphoria, depression, irritability, and anxiety on reducing the level of DRT; (g) duration of disturbance of at least 6 months." & "Patients with DDS develop an addictive pattern of DRT use, self-administering doses of dopaminergic drugs in excess of those required to control their motor symptoms.
However, the findings argue against a simple relationship between dopamine level and reward sensitivity. Many PD+ICD patients were also found to experience behavioural apathy and impulsivity comorbidly, suggesting that aberrant reward sensitivity is just one component of a dysfunctional system which may incorporate functional changes in other neurotransmitter systems.
Hyperexcitability of neurons and hypersynchrony of neural networks are the hallmarks of seizures." & "Seizures have been known to cause abnormal neurogenesis in the hippocampus and form faulty circuits that disrupt its function (11).
Mood disorder may represent the most common, and likely the most worrisome, psychiatric manifestation associated with epilepsy. Depression is frequently associated, although anxiety and bipolar disorder may also co-occur with epilepsy
Today, it is well recognized that disturbances in thyroid function may significantly affect mental status including emotion and cognition. Both excess and insufficient thyroid hormones can cause mood abnormalities including depression...
Variations in normal-range TSH and FT4 levels have no effects on the risk of MDD and its subtypes, and neither on minor depressive symptoms. This indicates that depressive symptoms should not be attributed to minor variations in thyroid function
These data indicate that inter-outburst anger in those with IED is relatively brief and that such individuals do not generally display the kind of persistent anger that is a diagnostic feature of DMDD.
A prominent bimodal conceptualisation of aggression classifies it as either: (i) spontaneous (referred to as reactive or impulsive aggression), or (ii) planned (referred to as proactive, premediated or instrumental aggression) (Babcock et al., 2014; Wrangham, 2018)." & "...DSM-5 is the occurrence of repeated episodes of impulsive aggression resulting in verbal or physical assaults or property destruction." & "DSM-IV criterion B for IED requires that the aggressiveness is 'grossly out of proportion to any precipitating psychosocial stressor'.
Results suggest that shame and CSB converge into a common construct, significantly related to depressive symptoms and cognitions. Convergence of guilt and BSB, however, was limited to particular pairs of measures.
We found hyperreactivity in brain regions involved in both, emotional expression, and regulation.
Transition to menopause and its changing hormonal milieu are strongly associated with new onset of depressed mood among women with no history of depression.
Sex steroids are able to modify several functions including behavior, cognition and memory, sleep, mood, pain and coordination, amongst others.
Major depressive disorder (MDD) also referred to as depression, is one of the most severe and common psychiatric disorders across the world. It is characterized by persistent sadness, loss of interest or pleasure, low energy, worse appetite and sleep, and even suicide, disrupting daily activities and psychosocial functions.
The most common DSM-IV-TR manic/hypomanic symptoms of mixed depression are irritability, mental overactivity (flight of ideas, racing thoughts, crowded thoughts), and behavioral overactivity (psychomotor agitation, overtalkativeness). Different frequencies of mixed depression have been reported, which may be related to treated versus untreated samples...
Anger in people with depression often stems from narcissistic vulnerability, a sensitivity to perceived or actual loss or rejection. These angry reactions cause intrapsychic conflicts through the onset of guilt and the fear that angry feelings will disrupt relationships
Recurring thoughts of death and suicide (27) and aggression (28, 29) are common features of OCD. The most prevalent obsession was the fear of harming oneself in the DSM-IV field trials of 431 patients diagnosed with OCD (30, 31).
These thoughts can include horrific flashes of violence involving one's baby and frequently lead to shame and fear on the mother's part, but rarely result in real-world violence.
The DSM-TV Field Trial8 demonstrated that it was not the prevalence of PTSD symptoms themselves, but depression, outbursts of anger, self-destructive behaviors, and feelings of shame, self-blame, and distrust that distinguished a treatment-seeking...
Marital discord, stressful life events, and ambivalence about the pregnancy are risk factors not only for depression during pregnancy but also for postpartum depression
The length of symptom expression varies between a few days and 2 weeks (figure 1). Symptoms often worsen substantially 6 days before, and peak at about 2 days before, menses start. " & "Such an enhanced tendency to have disphoria as a result of the effects of sex steroids on the brain might be heritable, as suggested by twin studies.56–58 Other possible risk factors for PMS are high body-mass index,59 stress,7 and traumatic events.60" " & "…various indices of serotonergic trans mission are reported to be aberrant in women with PMS.75,80–89" & "Another neurotransmitter that has been linked to PMS is the inhibitory aminoacid GABA. This theory gains support from an imaging study,90"
...phenomenology of depression in schizophrenia, however, has not often been interrogated in phenomenological terms. Some of our recent evidence suggests self-stigma, shame, difficulty in regaining trust in ones own thoughts after recovery from delusional beliefs, and poor motivation are core features rather than other more "biological" symptoms such as early morning wakening, diurnal variation in mood or loss of appetite.14
Studying anger is important for schizophrenia because this disease is often associated with angry and hostile behavior (Volavka, 1999)
Paranoia is the most commonly reported delusion among individuals diagnosed with schizophrenia spectrum illnesses (Bentall et al., 2009)
Both the schizophrenia and depression groups exhibited higher levels of external shame, or seeing others as shaming, than the medical group
SAD patients were also more likely to report a larger number of accompanying symptoms during the anger attacks, suggesting that they experience the anger attacks as particularly intense.
48,XXYY is one of the most under-studied and rare types of sex chromosome aneuploidies (SCAs). In male births, 48,XXYY incidence occurs with an estimated prevalence of 1 in 18,000–40,000 (1). The SCAs can influence the neurodevelopment of an individual and are associated with impairment in executive function, verbal skills, working memory, sustained attention, mental flexibility, and inhibition by altering the basic differentiation process of the neurons, encoding proteins, and synaptic transmission (2).
Behavioral and psychiatric symptoms including hyperactivity, attention problems, impulsivity, aggression, mood instability, and "autistic-like" behaviors have also been described [Schlegel et al., 1965; Sorensen et al., 1978; Fryns et al., 1995; Hagerman, 1999].
A retrospective web-based study of 2087 adults found small but reliable associations between a history of physical illness and the character strengths of appreciation of beauty, bravery, curiosity, fairness, forgiveness, gratitude, humor, kindness, love of learning, and spirituality.
Personal recovery involves developing the skills to live well and is a very individual process that the consumer can undertake on their own, with peers and family or through disorder-specific psychotherapies. Personal recovery can be contrasted with clinical and functional recovery and refers to the process of individual psychological adaptation to the disorder rather than the reduction of psychiatric symptoms, relapse prevention and addressing functional impairment (Tse et al., 2014)
Our findings indicate that people with mental illness who receive greater support from the family are better able to have self-caring attitudes...They may also have more positive experiences and perceptions of recovery and attain greater levels of life satisfaction and enjoyment.
It encompasses various elements, such as spirituality, empowerment, embracing the illness actively, finding hope, restoring a positive identity, creating meaning in life, combating stigma, taking charge of one's own life, and cultivating supportive relationships [4]. PR concerns the individuals' perceived capacity to manage mental illness, their sense of purpose, and their confidence in their ability to lead a fulfilling life, irrespective of the disorder's severity [5]
For many, recovery is their preferred term to describe the continuing experience of living with, managing, or overcoming mental health difficulties [5].
It is the unfortunate result of the bidirectional relationship between depression and inactivity: depression leads to a reduced activity level, and depressive symptoms then become more severe. Berlin, et al.
By intentional activity, the authors meant discrete actions or practices that individuals must choose to engage in and that require some effort to enact. This might include adopting new behaviors such as an exercise program, changing one's cognitive attitudes or practices such as practicing forgiveness, or volitional activity such as pursuing personal goals.
Irritability describes proneness to anger... Irritability is a mood in the sense that young people can remain in states of proneness to anger for very long times and sometimes for no apparent reason, as discussed below... irritability shares a negative valence with anxiety and depression but denotes approach and is therefore linked to elation in mania.
The first session provided an overview of the training goals and an explanation of the differences between the three states of mind (i.e., emotional mind, rational mind and wise mind)...In DBT, ER skills training is oriented to encouraging behavioral activation (BA) by training patients in "opposite action" (OA) to depressive symptoms.
DBT was designed to treat emotional dysregulation (i.e., mood disturbance, affective liability, uncontrolled anger) and the behavioral difficulties..." & "Research has shown that there are potentially clinically significant results when using DBT to treat anger and aggression in various samples. Findings from this review suggest that treatments, even when modified show a positive impact on the reduction of anger and aggressive behaviors.
While they also experienced more improvement in depressive symptoms and in their ability to control emotional states, the difference between the two groups did not reach statistical significance.
...first phase of treatment focusing on increasing momentary clarity of motivational responses during emotional episodes and the cultivation of mindful emotion regulation skills with the goal of promoting counteractive responding to intense emotional experiences. Skills are presented in a specific order focusing on less cognitively elaborative skills (e.g., attention regulation skills) followed by more cognitively elaborative skills (e.g., metacognitive regulation skills).
Interpersonal and social rhythm therapy is a manual-based psychotherapy (E. Frank et al, unpublished data, 1999) focusing on 1) the link between mood and life events, 2) the importance of maintaining regular daily rhythms as elucidated by the SRM, 3) the identification and management of potential precipitants of rhythm dysregulation with special attention to interpersonal triggers, 4).
Shen, Alloy, Abramson, and Sylvia provided further evidence of social rhythm irregularities in bipolar spectrum disorder (2008). In a sample of 414 undergraduates, those diagnosed with either cyclothymia or bipolar II disorder reported significantly fewer regular activities than normal controls.
As well as being strongly associated with the clinical manifestation of BD, reduced social rhythmicity has also been demonstrated in some populations with increased risk for BD.
More than 30 years ago, it was observed that major life events associated with mood disorder (divorce, loss of job, life transitions) are not just psychologically challenging but also cause significant change to daily routines.10 Unemployment, for example, may be associated not just with challenges to self-esteem but also with less regular bed-, wake- and mealtimes. This instability of daily routines, in turn, may have circadian impact through weakened zeitgeber information.
...To foster psychological flexibility, according to Grégoire et al. (2017), ACT relies on six interrelated and overlapping processes: acceptance (i.e., willingness to open fully to unwanted experiences such as difficult thoughts, memories, or emotions), contact with the present moment (i.e., being mindful and aware of one's experiences), self as context (i.e., maintaining perspective about oneself within one's experiences), cognitive defusion (i.e., being able to step back from unwanted experiences without getting stuck in them), committed action (i.e., engaging in actions that move toward important aspects of life), and values (i.e., staying connected to personal values or areas of life that are important).
A time-series approach allows comparison of mood instability pre- and post-treatment. Figure 1
Major depressive disorder is characterized by high mean NA and low mean PA (e.g., Watson et al., 1988).... Note that major depressive disorder generally is unassociated with instability of NA or PA (Köhling et al., 2016; Koval et al., 2013).
The depressives are more sensitive to displeasure and more anhedonic than controls.
mesial limbic system (nucleus accumbens, amygdala, and hippocampus) and the entire prefrontal cortex. They play a determining role in emotional expression and motivation. For example, a reduction in the activity of the mesocortical pathway will result in a paucity of affect and loss of motivation and planning
Children with ASD and disruptive behavior showed reduced amygdala–vlPFC connectivity compared with children with ASD without disruptive behavior.
These data indicate that inter-outburst anger in those with IED is relatively brief and that such individuals do not generally display the kind of persistent anger that is a diagnostic feature of DMDD.
Results suggest that shame and CSB converge into a common construct, significantly related to depressive symptoms and cognitions. Convergence of guilt and BSB, however, was limited to particular pairs of measures.
Major depressive disorder (MDD) also referred to as depression, is one of the most severe and common psychiatric disorders across the world. It is characterized by persistent sadness, loss of interest or pleasure, low energy, worse appetite and sleep, and even suicide, disrupting daily activities and psychosocial functions.
The most common DSM-IV-TR manic/hypomanic symptoms of mixed depression are irritability, mental overactivity (flight of ideas, racing thoughts, crowded thoughts), and behavioral overactivity (psychomotor agitation, overtalkativeness). Different frequencies of mixed depression have been reported, which may be related to treated versus untreated samples...
Paranoia is the most commonly reported delusion among individuals diagnosed with schizophrenia spectrum illnesses (Bentall et al., 2009)
Both the schizophrenia and depression groups exhibited higher levels of external shame, or seeing others as shaming, than the medical group
For many, recovery is their preferred term to describe the continuing experience of living with, managing, or overcoming mental health difficulties [5].
DBT was designed to treat emotional dysregulation (i.e., mood disturbance, affective liability, uncontrolled anger) and the behavioral difficulties..." & "Research has shown that there are potentially clinically significant results when using DBT to treat anger and aggression in various samples. Findings from this review suggest that treatments, even when modified show a positive impact on the reduction of anger and aggressive behaviors.
As well as being strongly associated with the clinical manifestation of BD, reduced social rhythmicity has also been demonstrated in some populations with increased risk for BD.
...To foster psychological flexibility, according to Grégoire et al. (2017), ACT relies on six interrelated and overlapping processes: acceptance (i.e., willingness to open fully to unwanted experiences such as difficult thoughts, memories, or emotions), contact with the present moment (i.e., being mindful and aware of one's experiences), self as context (i.e., maintaining perspective about oneself within one's experiences), cognitive defusion (i.e., being able to step back from unwanted experiences without getting stuck in them), committed action (i.e., engaging in actions that move toward important aspects of life), and values (i.e., staying connected to personal values or areas of life that are important).
Mental illnesses are highly complex, temporally dynamic phenomena (1). Variables across a vast range of timescales – from milliseconds to generations – and levels – from subcellular to societal – interact in complex manners to result in the dynamic, rich and extraordinarily heterogeneous temporal trajectories that are characteristic of the personal and psychiatric histories evident in mental health services across the world.
Hyperexcitability of neurons and hypersynchrony of neural networks are the hallmarks of seizures." & "Seizures have been known to cause abnormal neurogenesis in the hippocampus and form faulty circuits that disrupt its function (11).
Blunted affect, also referred to as emotional blunting, is a prominent symptom of schizophrenia. Patients with blunted affect have difficulty in expressing their emotions [1], characterized by diminished facial expression, expressive gestures and vocal expressions in reaction to emotion provoking stimuli [1–3]. However, patients' reduced outward emotional expression may not mirror subjective internal emotional experiences [4] suggesting a disconnect in what patients experience, perceive and express when interpreting emotional stimuli [5] due to problems associated with emotional processing [6–7].
Individuals with a diagnosis of BPD have difficulty making appropriate social judgements about others from their faces. Judging more faces as unapproachable and untrustworthy indicates that this group may have a heightened sensitivity to perceiving potential threat, and this should be considered in clinical management and treatment
In comparison to a healthy control group, BPD patients show deficits in the following areas: mindfulness, self-compassion and adaptive emotion-regulation strategies.
Studies of the general population indicate that attempts to suppress thoughts typically result in a heightened accessibility of suppressed thoughts (e.g., a rebound effect) together with increases in emotional and physiological arousal [27].
As a result, it was observed that at NS, these stimulants actuate through a complex signaling systems that include the neuroendocrine alteration of the hypothalamic pituitary-gonadal axis, modification of neurotransmitters and their receptors, as well as the induction of neuronal death by apoptosis in several pathways
Depressive symptoms that occur as part of BPD are usually transient and related to interpersonal stress (eg, after an event arousing feelings of rejection). Such "depression" usually lifts dramatically when the relationship is restored. Depressive symptoms in BPD may also serve to express feelings (eg, anger, frustration, hatred, helplessness, powerlessness, disappointment) that the patient is not able to express in more adaptive ways.
Electronic self-monitoring of mood was considered valid compared to clinical rating scales for depression in six out of six studies, and in two out of seven studies compared to clinical rating scales for mania.
Measuring and characterizing the experience of affective instability have proved challenging, however. Traditional measures of affective instability rely on respondents' retrospective recall and subjective assess-ment of affective variability or reactivity on interview or questionnaire items.
A self-report measure of changeable affect was developed, with a goal of identification of patterns of instability in mood. Scales measuring lability in anxiety, depression, anger, and hypomania, and labile shifts between anxiety and depression and hypomania and depression were constructed. These scales were then evaluated for internal consistency, retest reliability, score stability ...
To measure affect lability, Harvey et al. (1989) developed the Affective Lability Scales (ALS), a 58-item questionnaire measuring changeability among euthymia and four affect states (i.e., depression, elation, anger, and anxiety).
...the use and definitions of the terms "affect," "mood," "emotion," and "feeling" in some classical and contemporary works of psychiatry and psychology. He concludes that these words refer to distinct pscychological phenomena and suggests that they be used clearly and carefully to facilitate communication about emotions.
The literature spans psychiatry, psychology and neuroscience, and multiple terms are used to describe the same, or related phenomena, including affective instability, emotional dysregulation, mood swings, emotional impulsiveness and affective lability. Collating the main overlapping dimensions, definitions, and their measurement scales, a recent systematic review proposed that mood instability is 'rapid oscillations of intense affect, with a difficulty in regulating these oscillations or their behavioural consequences'.
One would conclude from the above italic sentences of Fish that affect is a sudden exacerbation of emotion, and mood is also the emotional state prevailing at any given time, in other words, both mood and affect are short-term emotional tone (However, these confusing lines are deleted in the new edition of Fish's clinical psychopathology).
Four of 5 normal controls displayed a circadian mood pattern with chaotic dynamics.
When a patient, in the longitudinal course of mood disturbances, no longer meets the threshold of a disorder such as depression or mania, as assessed by categorical methods resulting in diagnostic criteria or by cutoff points in the dimensional measurement of rating scales, he or she is often labeled as euthymic.
Complexity of symptoms or behaviors in an individual is often characterized by the dynamics of the individual's longitudinal patterns. While periodic/linear temporal patterns are predictable in both trajectory and pattern, chaotic patterns are predictable in pattern only. Random dynamics are predictable in neither trajectory nor pattern.
The visual analog scale can capture patterns of mood and mood variability thought to be typical of these diagnostic groups. Mood disorders differ not only in the degree of abnormal mood but also in the pattern of mood variability, suggesting that mechanisms regulating mood stability may differ from those regulating overall mood state.
We typically have little control over fluctuations between episodes of good and bad mood. In most cases, we also have little understanding of the causal factors driving our mood fluctuations, contrary to emotional reactions that are circumscribed to a specific trigger and limited to a short duration.
The main conclusion of the study was that happiness depends not on how well things are going (in terms of cumulative earnings) but whether they are going better than expected.
The bipolar II spectrum represents the most common phenotype of bipolarity. Numerous studies indicate that in clinical settings this soft spectrum might be as common--if not more common than--major depressive disorders.
Difficulties with measurement, and unclear definitions for terms like cyclothymia, rapid cycling, mixed states, short episodes, and soft spectrum have contributed to the uncertainty (Akiskal et al., 2000, Blacker and Tsuang, 1992, Cassano et al., 1999, Ghaemi et al., 2001).
DSM-5 introduced the "with mixed features" specifier, which could apply to any type of episode of BD and major depressive disorder (MDD).
Patients with bipolar disorder spend about half of their time in depression, mania or mixed states22. The remaining periods are defined as euthymic23, 24, 25, 26, 27. However, considerable fluctuations in psychological distress were recorded in studies with longitudinal designs, suggesting that the illness is still active in those latter periods, even though its intensity may vary28. It is thus questionable whether subthreshold symptomatic periods truly represent euthymia28....This definition of euthymia, because of its intertwining with mood stability, is substantially different from the concept of eudaimonic well‐being, that has become increasingly popular in positive psychology
Though mixed feelings may be uncommon, they might often have important consequences (e.g., for health).
Indeed, college students are more likely to report mixed emotions of happiness and sadness on the day that they move out of their freshmen dorm and on their graduation day than on typical days.
The findings confirm that adolescents experience wider and quicker mood swings, but do not show that this variability is related to stress, lack of personal control, psychological maladjustment, or social maladjustment within individual teenagers.
Mental illnesses are highly complex, temporally dynamic phenomena (1). Variables across a vast range of timescales – from milliseconds to generations – and levels – from subcellular to societal – interact in complex manners to result in the dynamic, rich and extraordinarily heterogeneous temporal trajectories that are characteristic of the personal and psychiatric histories evident in mental health services across the world.
Cyclothymia is characterized by early onset, persistent, spontaneous and reactive mood fluctuations, associated with a variety of anxious and impulsive behaviors, resulting in a very rich and complex clinical presentation. Current diagnostic criteria for cyclothymic disorder (DSM-5 and ICD-10), emphasizing only episodic mood symptoms, may be misleading both from diagnostic and therapeutic point of views.
A time-series approach allows comparison of mood instability pre- and post-treatment. Figure 1
As expected, episodes of depressions were much longer than manias, but episode-duration did not differ among BD diagnostic types: I, II, with mainly mixed-episodes (BD-Mx), or with psychotic features (BD-P)...A total of 56.8% of subjects could be characterized for major course-patterns as either DMI or MDI, which occurred in similar proportions for each type. As expected, depressive episodes averaged 5.2 months
These studies indicate that mood in patients with bipolar disorder is not truly cyclic for extended periods. Nonetheless, self-rated mood in bipolar disorder is significantly more organized than self-rated mood in normal subjects and can be characterized as a low-dimensional chaotic process. This characterization of the dynamics of bipolar disorder provides a unitary theoretical framework that can accommodate neurobiologic and psychosocial data and can reconcile existing models for the pathogenesis of the disorder. Furthermore, consideration of the dynamical structure of bipolar disorder may lead to new methods for predicting and controlling pathologic mood.
The median duration of major depressive episodes was 14 weeks, and over 70% recovered within 12 months of onset of the episode. The median duration of minor depressive episodes was 8 weeks, and approximately 90% recovered within 6 months of onset of the episode...An early report from this study examined 66 participants with bipolar I followed for up to 5 years, and found that the median time to recovery from the first two prospectively observed episodes of major depression was 20 weeks and 24 weeks.16 A subsequent report described 82 participants with bipolar I followed for 10 years; the median duration of major and minor depressive episodes were 12 and 5 weeks, respectively.17
(graph PMS pattern)...Key characteristics of PMS include a lack of symptoms during the follicular phase, a peak of symptoms during the late luteal or premenstrual phase, and a sudden decrease of symptoms with the onset of menses.
The ACOG definition involves the presence of at least one of the six affective symptoms (angry outbursts, depression, anxiety, confusion, irritability and social withdrawal) and one of the four somatic…
It consists of a heightened emotional reactivity to environmental stimuli, including emotions of others. Emotion sensitivity in BPD has primarily been associated with negative mood states (e.g., anger, fear, sadness) and not positive emotions (although see [9, 10]).
...but in BPD, symptoms are usually associated with mood instability rather than with the extended and continuous periods of lower mood seen in classic mood disorders.19 Also, because of characteristic mood swings, BPD is often mistaken for bipolar disorder.30 However, patients with BPD do not show continuously elevated mood but instead exhibit a pattern of rapid shifts in affect related to environmental events, with "high" periods that last for hours rather than for days or weeks.
Individuals with BPD report more negative emotions and a greater intensity of negative emotions than healthy individuals throughout the day (9). However, recent data suggest a particular relevance of anger, a negative emotion that is closely related to reactive aggression, in BPD. Using e-diaries, Kockler et al. (10) found that individuals with BPD exhibit anger more frequently in their daily life than healthy as well as clinical control groups and feelings of anger accounted for more distress than pure emotional intensity.
The results of this study suggest that the presence of greater lability in terms of anger, anxiety, and depression/anxiety oscillation characterizes borderline personality disorder, while suggesting that the subjective sense of high affective intensity is present in this population but does not explain these other affective phenomena.
Depressive symptoms that occur as part of BPD are usually transient and related to interpersonal stress (eg, after an event arousing feelings of rejection). Such "depression" usually lifts dramatically when the relationship is restored. Depressive symptoms in BPD may also serve to express feelings (eg, anger, frustration, hatred, helplessness, powerlessness, disappointment) that the patient is not able to express in more adaptive ways.
Moderator analyses revealed lower depression severity in BPD patients without comorbid DeDs, but higher severity in BPD patients with comorbid DeDs compared to depressed controls...some authors labeled the depression experienced in BPD "borderline-depression", characterized by distinct feelings of loneliness and isolation (Adler and Buie, 1979, Grinker et al., 1968), emptiness or boredom (Gunderson, 1996), high dependency and fears of abandonment (Masterson, 1976), as well as intense anger and hate toward the self and others (Hartocollis, 1977, Kernberg, 1975, Kernberg, 1992).
This study replicates research showing that adults with ADHD report heighted emotional lability (EL), which contributes to impairments in their daily life.
However, common themes include decreased inhibitory control, intolerance of delay to rewards and quick decision-making due to lack of consideration, as well as more universal deficits such as poor attentional ability.
Kraepelin1 and Bleuler2 had already mainly focused on "flat" or "inappropriate" emotions as core features of the illness.
There were no statistically significant differences between individuals with BD-I and SZ for any ALS-SF dimension and these two groups had very similar score patterns throughout. This suggests that despite the overlap in core affective symptom profiles of BD-I and BD-II, the BD-I group is more similar to SZ than it is to BD-II concerning levels of affective lability.
Evidence from multiple domains indicates that affective dysregulation is strongly associated with reality distortion.1,2 Genetic epidemiological studies have demonstrated that the liabilities for bipolar disorder and schizophrenia are correlated.
Blunted affect, also referred to as emotional blunting, is a prominent symptom of schizophrenia. Patients with blunted affect have difficulty in expressing their emotions [1], characterized by diminished facial expression, expressive gestures and vocal expressions in reaction to emotion provoking stimuli [1–3]. However, patients' reduced outward emotional expression may not mirror subjective internal emotional experiences [4] suggesting a disconnect in what patients experience, perceive and express when interpreting emotional stimuli [5] due to problems associated with emotional processing [6–7].
There is evidence that the occurrence of stressful life events3,6–8 or the presence of social relationship stressors such as high levels of familial "expressed emotion9–11" are associated with subsequent exacerbation of psychotic symptoms in patients as a group.
Whether depressed individuals and healthy controls will differ in their instability of PA is less clear. As we noted above, depressed individuals have been found to have blunted emotional responses to valenced stimuli in the laboratory (Bylsma, et al., 2008) and decreased responsivity to reward (e.g., Pizzagalli, Iosifescu, Hallett, Ratner, & Fava, 2009)...
He noted that people with melancholia could become over-talkative and manic but did not adequately explain why this is so." & "On the VAS ratings, the depressed group experienced more severe low moods and less severe high moods than the non-depressed group, as would be expected given the selection criteria. This is consistent with reports of more severe negative emotions and variable positive emotions in ecological momentary assessment studies of patients with major depression (12, 33, 53).
Emotional effects of depression and treatment vary, but may include, for example, feeling emotionally "numbed" or "blunted" in some way; lacking positive emotions or negative emotions; feeling detached from the world around you...
Major depressive disorder is characterized by high mean NA and low mean PA (e.g., Watson et al., 1988).... Note that major depressive disorder generally is unassociated with instability of NA or PA (Köhling et al., 2016; Koval et al., 2013).
Diurnal variation in mood is a prominent symptom of depression, and is typically experienced as positive mood variation (PMV — mood being worse upon waking and better in the evening).
The depressives are more sensitive to displeasure and more anhedonic than controls.
The mixed depressive syndrome is not a transitory state but a state of long duration, which may last weeks or several months. The clinical picture is characterized by dysphoric mood, emotional lability, psychic and/or motor agitation, talkativeness, crowded and/or racing thoughts, rumination, initial or middle insomnia.
Emotional abuse was associated with average daily mood and mood lability.
The results showed that less than 50% of PTSD cases presented with anxiety as the primary emotion, with the remainder showing primary emotions of sadness, anger, or disgust rather than anxiety
Taken together, these results indicate that PTSD development is a dynamic process in which symptoms interact over time (Gelkopf et al., 2017). As hypothesized, intrusions and AAR symptoms may be more important early on and lead to other symptoms in the disorder.
Chronic PTSD most often co-occurs with mood, anxiety and substance use disorders. It is highly reactive to environmental reminders of the traumatic event and to renewed life-stressors, and thus may have a fluctuating course (23).
Reexperiencing symptoms describe spontaneous, often insuppressible intrusions of the traumatic memory in the form of images or nightmares that are accompanied by intense physiological distress...Hyperarousal symptoms reflect more overt physiological manifestations, such as insomnia, irritability, impaired concentration, hypervigilance, and increased startle responses.
Kleim, Graham, Bryant, and Ehlers (2013) asked a sample of trauma-exposed individuals to report state levels of various unpleasant emotions (i.e., fear, helplessness, anger, guilt, and shame) following naturally occurring intrusive memories over the course of a week.
{{cite journal}}: CS1 maint: DOI inactive as of September 2024 (link)Findings and future directions from the ENIGMA Bipolar Disorder Working Group. Hum Brain Mapp. 2022 Jan;43(1):56-82."Initial BD Working Group studies reveal widespread patterns of lower cortical thickness, subcortical volume and disrupted white matter integrity associated with BD. Findings also include mapping brain alterations of
Currently, the etiology of BD is unknown but appears to be due to an interaction of genetic, epigenetic, neurochemical, and environmental factors. Heritability is well established.[3][4][5] Numerous genetic loci have been implicated as increasing the risk of BD; the first was noted in 1987 with "DNA markers" on the short arm of chromosome 11. Since then, an association has been made between at least 30 genes and an increased risk of the condition.[6]
The anabolic effects are considered to be those promoting protein synthesis, muscle growth and crythopoiesis
Anabolic steroids and other agents are fast becoming part of the standard of care for HIV disease, gaining acceptance in reversing loss of lean body mass...
High doses of AASs can lead to serious physical and psychological complications, such as hypertension, atherosclerosis, myocardial hypertrophy and infarction, abnormal blood clotting, hepatotoxicity and hepatic tumors, tendon damage, reduced libido, and psychiatric/behavioral symptoms like aggressiveness and irritability
AAS users who fulfilled the criteria for AAS‐dependence had significantly thinner cortex in frontal, temporal, parietal, occipital and pre‐frontal regions compared to non‐dependent users
ADHD is a neurodevelopmental disorder defined by impairing levels of inattention, disorganization, and/or hyperactivity-impulsivity. Inattention and disorganization entail inability to stay on task, seeming not to listen, and losing materials necessary for tasks, at levels that are inconsistent with age or developmental level.
Ozel-Kizil et al. (2013; also see Ozel-Kizil et al., 2014) defined hyperfocusing as being "characterized by intensive concentration on interesting and non-routine activities accompanied by temporarily diminished perception of the environment".
Studies have found that ADHD is associated with weaker function and structure of prefrontal cortex (PFC) circuits, especially in the right hemisphere.
ADHD subjects indeed showed a performance deficit in the tasks, supporting OFC dysfunction in ADHD. Furthermore, a discriminat analysis using the task performance variables correctly classified 89.7% of the participants among ADHD patients and normal controls.
We conclude that the findings of interest (i.e., hippocampus enlargement and amygdala volume loss) are not very stable across different samples of patients with ADHD and that the different and contradictory findings may be related to the different locations of alterations along the complex circuits responsible for the different symptoms of ADHD.
The prefrontal association cortex plays a crucial role in regulating attention, behavior, and emotion, with the right hemisphere specialized for behavioral inhibition.
Table 1 :Changes in ASD criteria from the DSM-IV to DSM-5
Difficulties with sensory input was described to impact mood, causing stress and agitation:
The authors found that youth with ASDs had overactivation in limbic areas, primary sensory cortices, and orbitofrontal cortex (OFC) compared with typically developing (TD) control subjects in response to mildly aversive visual and auditory stimuli." & "Finally, Green et al10 found that SOR symptoms correlated with hyperactivity in the amygdala and OFC.
Children with ASD and disruptive behavior showed reduced amygdala–vlPFC connectivity compared with children with ASD without disruptive behavior.
In BPD, the appraisal mechanisms are at fault, in large part because of mentalizing difficulties (e.g. in the mistaken appraisal of threat at the moment of its presentation) or a breakdown in epistemic trust, which damages the capacity to relearn different ways of mentalizing – or appraising – situations (i.e. the inability to change our understanding of the threat after the event).
There are many theories about the development of borderline personality disorder. In the mentalizing model of Peter Fonagy and Anthony Bateman, borderline personality disorder is the result of a lack of resilience against psychological stressors. In this framework, Fonagy and Bateman define resilience as the ability to generate adaptive re-appraisal of negative events or stressors;...
Core symptoms that comprise the disorder are often explicitly interpersonal in nature (e.g., tumultuous romantic relationships and frantic efforts to avoid abandonment) or are expressed in reaction to interpersonal stressors (e.g., affective instability, paranoid ideation, suicidal behavior
Individuals with a diagnosis of BPD have difficulty making appropriate social judgements about others from their faces. Judging more faces as unapproachable and untrustworthy indicates that this group may have a heightened sensitivity to perceiving potential threat, and this should be considered in clinical management and treatment
Individuals with BPD features often have distorted cognitions. Specifically, they often make simplified judgments about people and situations.
Following Linehan's biosocial model, we conceptualize emotion dysregulation in borderline personality disorder (BPD) as consisting of four components: emotion sensitivity, heightened and labile negative affect, a deficit of appropriate regulation strategies, and a surplus of maladaptive regulation strategies.
In comparison to a healthy control group, BPD patients show deficits in the following areas: mindfulness, self-compassion and adaptive emotion-regulation strategies.
BPD features are also associated with self-criticism, thought suppression, avoidance, and alcohol use as strategies for regulating emotions (Aldao & Dixon-Gordon, 2014).
Studies of the general population indicate that attempts to suppress thoughts typically result in a heightened accessibility of suppressed thoughts (e.g., a rebound effect) together with increases in emotional and physiological arousal [27].
...NPSs based on neurobiological dimensions and behaviors rather than clinical syndromes, grouping them into five domains: (1) negative valence; (2) positive valence; (3) cognitive systems; (4) processes for social systems; and (5) arousal or regulatory systems [13]. Yet here, too, there is tremendous overlap. For example, impairment of cognitive systems may manifest in delusions, hallucinations, agitation, aggression, depression or dysphoria, anxiety, elation or euphoria, apathy, disinhibition, irritability, motor disturbance, sleep disorder, appetite disorder, aberrant vocalization, and ruminative, repetitive, and somatoform behaviors.
(d) impairment in social or occupational functioning: fights, violent behaviour, loss of friends, absence from work, loss of job, legal difficulties, arguments or difficulties with family; (e) development of hypomaniac, maniac, or cyclothymic affective syndrome in relation to DRT; (f) development of a withdrawal state characterized by dysphoria, depression, irritability, and anxiety on reducing the level of DRT; (g) duration of disturbance of at least 6 months." & "Patients with DDS develop an addictive pattern of DRT use, self-administering doses of dopaminergic drugs in excess of those required to control their motor symptoms.
However, the findings argue against a simple relationship between dopamine level and reward sensitivity. Many PD+ICD patients were also found to experience behavioural apathy and impulsivity comorbidly, suggesting that aberrant reward sensitivity is just one component of a dysfunctional system which may incorporate functional changes in other neurotransmitter systems.
Hyperexcitability of neurons and hypersynchrony of neural networks are the hallmarks of seizures." & "Seizures have been known to cause abnormal neurogenesis in the hippocampus and form faulty circuits that disrupt its function (11).
Mood disorder may represent the most common, and likely the most worrisome, psychiatric manifestation associated with epilepsy. Depression is frequently associated, although anxiety and bipolar disorder may also co-occur with epilepsy
Today, it is well recognized that disturbances in thyroid function may significantly affect mental status including emotion and cognition. Both excess and insufficient thyroid hormones can cause mood abnormalities including depression...
Variations in normal-range TSH and FT4 levels have no effects on the risk of MDD and its subtypes, and neither on minor depressive symptoms. This indicates that depressive symptoms should not be attributed to minor variations in thyroid function
These data indicate that inter-outburst anger in those with IED is relatively brief and that such individuals do not generally display the kind of persistent anger that is a diagnostic feature of DMDD.
A prominent bimodal conceptualisation of aggression classifies it as either: (i) spontaneous (referred to as reactive or impulsive aggression), or (ii) planned (referred to as proactive, premediated or instrumental aggression) (Babcock et al., 2014; Wrangham, 2018)." & "...DSM-5 is the occurrence of repeated episodes of impulsive aggression resulting in verbal or physical assaults or property destruction." & "DSM-IV criterion B for IED requires that the aggressiveness is 'grossly out of proportion to any precipitating psychosocial stressor'.
Results suggest that shame and CSB converge into a common construct, significantly related to depressive symptoms and cognitions. Convergence of guilt and BSB, however, was limited to particular pairs of measures.
We found hyperreactivity in brain regions involved in both, emotional expression, and regulation.
Transition to menopause and its changing hormonal milieu are strongly associated with new onset of depressed mood among women with no history of depression.
Sex steroids are able to modify several functions including behavior, cognition and memory, sleep, mood, pain and coordination, amongst others.
Major depressive disorder (MDD) also referred to as depression, is one of the most severe and common psychiatric disorders across the world. It is characterized by persistent sadness, loss of interest or pleasure, low energy, worse appetite and sleep, and even suicide, disrupting daily activities and psychosocial functions.
The most common DSM-IV-TR manic/hypomanic symptoms of mixed depression are irritability, mental overactivity (flight of ideas, racing thoughts, crowded thoughts), and behavioral overactivity (psychomotor agitation, overtalkativeness). Different frequencies of mixed depression have been reported, which may be related to treated versus untreated samples...
Obsessive compulsive disorder (OCD) involves obsessions, compulsions, or both, that are not caused by drugs or by a physical disorder, and which cause significant personal distress or social dysfunction.
Recurring thoughts of death and suicide (27) and aggression (28, 29) are common features of OCD. The most prevalent obsession was the fear of harming oneself in the DSM-IV field trials of 431 patients diagnosed with OCD (30, 31).
These thoughts can include horrific flashes of violence involving one's baby and frequently lead to shame and fear on the mother's part, but rarely result in real-world violence.
The DSM-TV Field Trial8 demonstrated that it was not the prevalence of PTSD symptoms themselves, but depression, outbursts of anger, self-destructive behaviors, and feelings of shame, self-blame, and distrust that distinguished a treatment-seeking...
Marital discord, stressful life events, and ambivalence about the pregnancy are risk factors not only for depression during pregnancy but also for postpartum depression
Psychological symptoms of PMS include irritability, depression, crying/tearfulness, and anxiety. Physical symptoms of PMS include abdominal bloating, breast tenderness, and headaches.
The length of symptom expression varies between a few days and 2 weeks (figure 1). Symptoms often worsen substantially 6 days before, and peak at about 2 days before, menses start. " & "Such an enhanced tendency to have disphoria as a result of the effects of sex steroids on the brain might be heritable, as suggested by twin studies.56–58 Other possible risk factors for PMS are high body-mass index,59 stress,7 and traumatic events.60" " & "…various indices of serotonergic trans mission are reported to be aberrant in women with PMS.75,80–89" & "Another neurotransmitter that has been linked to PMS is the inhibitory aminoacid GABA. This theory gains support from an imaging study,90"
Premenstrual syndrome (PMS) is characterized by a cluster of mild to severe physical or emotional symptoms that mainly begin during the luteal phase of the menstrual cycle. Symptoms should disappear within 4 days of the onset of menses and be severe enough to interfere with normal and daily function. The severe form of PMS is the Premenstrual Dysphoric Disorder (PMDD), which differs from PMS in respect to intensity of symptoms, predominance of mood symptoms, and the significant function impairment. (1, 2, 3). The most common symptoms are tension, irritability, hostility, depression, anxiety, mood swings, sleep changes, breast tenderness, and abdominal bloating (4).
Schizophrenia is a complex, chronic mental health disorder characterized by an array of symptoms, including delusions, hallucinations, disorganized speech or behavior, and impaired cognitive ability.
...phenomenology of depression in schizophrenia, however, has not often been interrogated in phenomenological terms. Some of our recent evidence suggests self-stigma, shame, difficulty in regaining trust in ones own thoughts after recovery from delusional beliefs, and poor motivation are core features rather than other more "biological" symptoms such as early morning wakening, diurnal variation in mood or loss of appetite.14
Studying anger is important for schizophrenia because this disease is often associated with angry and hostile behavior (Volavka, 1999)
Paranoia is the most commonly reported delusion among individuals diagnosed with schizophrenia spectrum illnesses (Bentall et al., 2009)
Both the schizophrenia and depression groups exhibited higher levels of external shame, or seeing others as shaming, than the medical group
SAD patients were also more likely to report a larger number of accompanying symptoms during the anger attacks, suggesting that they experience the anger attacks as particularly intense.
48,XXYY is one of the most under-studied and rare types of sex chromosome aneuploidies (SCAs). In male births, 48,XXYY incidence occurs with an estimated prevalence of 1 in 18,000–40,000 (1). The SCAs can influence the neurodevelopment of an individual and are associated with impairment in executive function, verbal skills, working memory, sustained attention, mental flexibility, and inhibition by altering the basic differentiation process of the neurons, encoding proteins, and synaptic transmission (2).
Behavioral and psychiatric symptoms including hyperactivity, attention problems, impulsivity, aggression, mood instability, and "autistic-like" behaviors have also been described [Schlegel et al., 1965; Sorensen et al., 1978; Fryns et al., 1995; Hagerman, 1999].
Neurotransmitters that play an important function in mood disorders are serotonin and...." & "Stressful life changes (death of significant other, parents, siblings, etc.) traumatic events and childhood abuse have been found to be major risk factors for the development of mood disorder later on in life....
Personal recovery involves developing the skills to live well and is a very individual process that the consumer can undertake on their own, with peers and family or through disorder-specific psychotherapies. Personal recovery can be contrasted with clinical and functional recovery and refers to the process of individual psychological adaptation to the disorder rather than the reduction of psychiatric symptoms, relapse prevention and addressing functional impairment (Tse et al., 2014)
It encompasses various elements, such as spirituality, empowerment, embracing the illness actively, finding hope, restoring a positive identity, creating meaning in life, combating stigma, taking charge of one's own life, and cultivating supportive relationships [4]. PR concerns the individuals' perceived capacity to manage mental illness, their sense of purpose, and their confidence in their ability to lead a fulfilling life, irrespective of the disorder's severity [5]
For many, recovery is their preferred term to describe the continuing experience of living with, managing, or overcoming mental health difficulties [5].
It is the unfortunate result of the bidirectional relationship between depression and inactivity: depression leads to a reduced activity level, and depressive symptoms then become more severe. Berlin, et al.
By intentional activity, the authors meant discrete actions or practices that individuals must choose to engage in and that require some effort to enact. This might include adopting new behaviors such as an exercise program, changing one's cognitive attitudes or practices such as practicing forgiveness, or volitional activity such as pursuing personal goals.
Irritability describes proneness to anger... Irritability is a mood in the sense that young people can remain in states of proneness to anger for very long times and sometimes for no apparent reason, as discussed below... irritability shares a negative valence with anxiety and depression but denotes approach and is therefore linked to elation in mania.
The first session provided an overview of the training goals and an explanation of the differences between the three states of mind (i.e., emotional mind, rational mind and wise mind)...In DBT, ER skills training is oriented to encouraging behavioral activation (BA) by training patients in "opposite action" (OA) to depressive symptoms.
While they also experienced more improvement in depressive symptoms and in their ability to control emotional states, the difference between the two groups did not reach statistical significance.
...first phase of treatment focusing on increasing momentary clarity of motivational responses during emotional episodes and the cultivation of mindful emotion regulation skills with the goal of promoting counteractive responding to intense emotional experiences. Skills are presented in a specific order focusing on less cognitively elaborative skills (e.g., attention regulation skills) followed by more cognitively elaborative skills (e.g., metacognitive regulation skills).
Interpersonal and social rhythm therapy is a manual-based psychotherapy (E. Frank et al, unpublished data, 1999) focusing on 1) the link between mood and life events, 2) the importance of maintaining regular daily rhythms as elucidated by the SRM, 3) the identification and management of potential precipitants of rhythm dysregulation with special attention to interpersonal triggers, 4).
Shen, Alloy, Abramson, and Sylvia provided further evidence of social rhythm irregularities in bipolar spectrum disorder (2008). In a sample of 414 undergraduates, those diagnosed with either cyclothymia or bipolar II disorder reported significantly fewer regular activities than normal controls.
As well as being strongly associated with the clinical manifestation of BD, reduced social rhythmicity has also been demonstrated in some populations with increased risk for BD.
More than 30 years ago, it was observed that major life events associated with mood disorder (divorce, loss of job, life transitions) are not just psychologically challenging but also cause significant change to daily routines.10 Unemployment, for example, may be associated not just with challenges to self-esteem but also with less regular bed-, wake- and mealtimes. This instability of daily routines, in turn, may have circadian impact through weakened zeitgeber information.
...To foster psychological flexibility, according to Grégoire et al. (2017), ACT relies on six interrelated and overlapping processes: acceptance (i.e., willingness to open fully to unwanted experiences such as difficult thoughts, memories, or emotions), contact with the present moment (i.e., being mindful and aware of one's experiences), self as context (i.e., maintaining perspective about oneself within one's experiences), cognitive defusion (i.e., being able to step back from unwanted experiences without getting stuck in them), committed action (i.e., engaging in actions that move toward important aspects of life), and values (i.e., staying connected to personal values or areas of life that are important).
Electronic self-monitoring of mood was considered valid compared to clinical rating scales for depression in six out of six studies, and in two out of seven studies compared to clinical rating scales for mania.
To measure affect lability, Harvey et al. (1989) developed the Affective Lability Scales (ALS), a 58-item questionnaire measuring changeability among euthymia and four affect states (i.e., depression, elation, anger, and anxiety).
The literature spans psychiatry, psychology and neuroscience, and multiple terms are used to describe the same, or related phenomena, including affective instability, emotional dysregulation, mood swings, emotional impulsiveness and affective lability. Collating the main overlapping dimensions, definitions, and their measurement scales, a recent systematic review proposed that mood instability is 'rapid oscillations of intense affect, with a difficulty in regulating these oscillations or their behavioural consequences'.
One would conclude from the above italic sentences of Fish that affect is a sudden exacerbation of emotion, and mood is also the emotional state prevailing at any given time, in other words, both mood and affect are short-term emotional tone (However, these confusing lines are deleted in the new edition of Fish's clinical psychopathology).
Four of 5 normal controls displayed a circadian mood pattern with chaotic dynamics.
Complexity of symptoms or behaviors in an individual is often characterized by the dynamics of the individual's longitudinal patterns. While periodic/linear temporal patterns are predictable in both trajectory and pattern, chaotic patterns are predictable in pattern only. Random dynamics are predictable in neither trajectory nor pattern.
The main conclusion of the study was that happiness depends not on how well things are going (in terms of cumulative earnings) but whether they are going better than expected.
DSM-5 introduced the "with mixed features" specifier, which could apply to any type of episode of BD and major depressive disorder (MDD).
Patients with bipolar disorder spend about half of their time in depression, mania or mixed states22. The remaining periods are defined as euthymic23, 24, 25, 26, 27. However, considerable fluctuations in psychological distress were recorded in studies with longitudinal designs, suggesting that the illness is still active in those latter periods, even though its intensity may vary28. It is thus questionable whether subthreshold symptomatic periods truly represent euthymia28....This definition of euthymia, because of its intertwining with mood stability, is substantially different from the concept of eudaimonic well‐being, that has become increasingly popular in positive psychology
Indeed, college students are more likely to report mixed emotions of happiness and sadness on the day that they move out of their freshmen dorm and on their graduation day than on typical days.
Cyclothymia is characterized by early onset, persistent, spontaneous and reactive mood fluctuations, associated with a variety of anxious and impulsive behaviors, resulting in a very rich and complex clinical presentation. Current diagnostic criteria for cyclothymic disorder (DSM-5 and ICD-10), emphasizing only episodic mood symptoms, may be misleading both from diagnostic and therapeutic point of views.
A time-series approach allows comparison of mood instability pre- and post-treatment. Figure 1
As expected, episodes of depressions were much longer than manias, but episode-duration did not differ among BD diagnostic types: I, II, with mainly mixed-episodes (BD-Mx), or with psychotic features (BD-P)...A total of 56.8% of subjects could be characterized for major course-patterns as either DMI or MDI, which occurred in similar proportions for each type. As expected, depressive episodes averaged 5.2 months
The median duration of major depressive episodes was 14 weeks, and over 70% recovered within 12 months of onset of the episode. The median duration of minor depressive episodes was 8 weeks, and approximately 90% recovered within 6 months of onset of the episode...An early report from this study examined 66 participants with bipolar I followed for up to 5 years, and found that the median time to recovery from the first two prospectively observed episodes of major depression was 20 weeks and 24 weeks.16 A subsequent report described 82 participants with bipolar I followed for 10 years; the median duration of major and minor depressive episodes were 12 and 5 weeks, respectively.17
The ACOG definition involves the presence of at least one of the six affective symptoms (angry outbursts, depression, anxiety, confusion, irritability and social withdrawal) and one of the four somatic…
It consists of a heightened emotional reactivity to environmental stimuli, including emotions of others. Emotion sensitivity in BPD has primarily been associated with negative mood states (e.g., anger, fear, sadness) and not positive emotions (although see [9, 10]).
...but in BPD, symptoms are usually associated with mood instability rather than with the extended and continuous periods of lower mood seen in classic mood disorders.19 Also, because of characteristic mood swings, BPD is often mistaken for bipolar disorder.30 However, patients with BPD do not show continuously elevated mood but instead exhibit a pattern of rapid shifts in affect related to environmental events, with "high" periods that last for hours rather than for days or weeks.
Individuals with BPD report more negative emotions and a greater intensity of negative emotions than healthy individuals throughout the day (9). However, recent data suggest a particular relevance of anger, a negative emotion that is closely related to reactive aggression, in BPD. Using e-diaries, Kockler et al. (10) found that individuals with BPD exhibit anger more frequently in their daily life than healthy as well as clinical control groups and feelings of anger accounted for more distress than pure emotional intensity.
However, common themes include decreased inhibitory control, intolerance of delay to rewards and quick decision-making due to lack of consideration, as well as more universal deficits such as poor attentional ability.
Kraepelin1 and Bleuler2 had already mainly focused on "flat" or "inappropriate" emotions as core features of the illness.
There were no statistically significant differences between individuals with BD-I and SZ for any ALS-SF dimension and these two groups had very similar score patterns throughout. This suggests that despite the overlap in core affective symptom profiles of BD-I and BD-II, the BD-I group is more similar to SZ than it is to BD-II concerning levels of affective lability.
Evidence from multiple domains indicates that affective dysregulation is strongly associated with reality distortion.1,2 Genetic epidemiological studies have demonstrated that the liabilities for bipolar disorder and schizophrenia are correlated.
Blunted affect, also referred to as emotional blunting, is a prominent symptom of schizophrenia. Patients with blunted affect have difficulty in expressing their emotions [1], characterized by diminished facial expression, expressive gestures and vocal expressions in reaction to emotion provoking stimuli [1–3]. However, patients' reduced outward emotional expression may not mirror subjective internal emotional experiences [4] suggesting a disconnect in what patients experience, perceive and express when interpreting emotional stimuli [5] due to problems associated with emotional processing [6–7].
There is evidence that the occurrence of stressful life events3,6–8 or the presence of social relationship stressors such as high levels of familial "expressed emotion9–11" are associated with subsequent exacerbation of psychotic symptoms in patients as a group.
Whether depressed individuals and healthy controls will differ in their instability of PA is less clear. As we noted above, depressed individuals have been found to have blunted emotional responses to valenced stimuli in the laboratory (Bylsma, et al., 2008) and decreased responsivity to reward (e.g., Pizzagalli, Iosifescu, Hallett, Ratner, & Fava, 2009)...
He noted that people with melancholia could become over-talkative and manic but did not adequately explain why this is so." & "On the VAS ratings, the depressed group experienced more severe low moods and less severe high moods than the non-depressed group, as would be expected given the selection criteria. This is consistent with reports of more severe negative emotions and variable positive emotions in ecological momentary assessment studies of patients with major depression (12, 33, 53).
Emotional effects of depression and treatment vary, but may include, for example, feeling emotionally "numbed" or "blunted" in some way; lacking positive emotions or negative emotions; feeling detached from the world around you...
Taken together, these results indicate that PTSD development is a dynamic process in which symptoms interact over time (Gelkopf et al., 2017). As hypothesized, intrusions and AAR symptoms may be more important early on and lead to other symptoms in the disorder.
Chronic PTSD most often co-occurs with mood, anxiety and substance use disorders. It is highly reactive to environmental reminders of the traumatic event and to renewed life-stressors, and thus may have a fluctuating course (23).
Kleim, Graham, Bryant, and Ehlers (2013) asked a sample of trauma-exposed individuals to report state levels of various unpleasant emotions (i.e., fear, helplessness, anger, guilt, and shame) following naturally occurring intrusive memories over the course of a week.
Findings and future directions from the ENIGMA Bipolar Disorder Working Group. Hum Brain Mapp. 2022 Jan;43(1):56-82."Initial BD Working Group studies reveal widespread patterns of lower cortical thickness, subcortical volume and disrupted white matter integrity associated with BD. Findings also include mapping brain alterations of
Currently, the etiology of BD is unknown but appears to be due to an interaction of genetic, epigenetic, neurochemical, and environmental factors. Heritability is well established.[3][4][5] Numerous genetic loci have been implicated as increasing the risk of BD; the first was noted in 1987 with "DNA markers" on the short arm of chromosome 11. Since then, an association has been made between at least 30 genes and an increased risk of the condition.[6]
High doses of AASs can lead to serious physical and psychological complications, such as hypertension, atherosclerosis, myocardial hypertrophy and infarction, abnormal blood clotting, hepatotoxicity and hepatic tumors, tendon damage, reduced libido, and psychiatric/behavioral symptoms like aggressiveness and irritability
AAS users who fulfilled the criteria for AAS‐dependence had significantly thinner cortex in frontal, temporal, parietal, occipital and pre‐frontal regions compared to non‐dependent users
ADHD is a neurodevelopmental disorder defined by impairing levels of inattention, disorganization, and/or hyperactivity-impulsivity. Inattention and disorganization entail inability to stay on task, seeming not to listen, and losing materials necessary for tasks, at levels that are inconsistent with age or developmental level.
Ozel-Kizil et al. (2013; also see Ozel-Kizil et al., 2014) defined hyperfocusing as being "characterized by intensive concentration on interesting and non-routine activities accompanied by temporarily diminished perception of the environment".
Studies have found that ADHD is associated with weaker function and structure of prefrontal cortex (PFC) circuits, especially in the right hemisphere.
We conclude that the findings of interest (i.e., hippocampus enlargement and amygdala volume loss) are not very stable across different samples of patients with ADHD and that the different and contradictory findings may be related to the different locations of alterations along the complex circuits responsible for the different symptoms of ADHD.
The prefrontal association cortex plays a crucial role in regulating attention, behavior, and emotion, with the right hemisphere specialized for behavioral inhibition.
Table 1 :Changes in ASD criteria from the DSM-IV to DSM-5
Difficulties with sensory input was described to impact mood, causing stress and agitation:
The authors found that youth with ASDs had overactivation in limbic areas, primary sensory cortices, and orbitofrontal cortex (OFC) compared with typically developing (TD) control subjects in response to mildly aversive visual and auditory stimuli." & "Finally, Green et al10 found that SOR symptoms correlated with hyperactivity in the amygdala and OFC.
Children with ASD and disruptive behavior showed reduced amygdala–vlPFC connectivity compared with children with ASD without disruptive behavior.
In BPD, the appraisal mechanisms are at fault, in large part because of mentalizing difficulties (e.g. in the mistaken appraisal of threat at the moment of its presentation) or a breakdown in epistemic trust, which damages the capacity to relearn different ways of mentalizing – or appraising – situations (i.e. the inability to change our understanding of the threat after the event).
There are many theories about the development of borderline personality disorder. In the mentalizing model of Peter Fonagy and Anthony Bateman, borderline personality disorder is the result of a lack of resilience against psychological stressors. In this framework, Fonagy and Bateman define resilience as the ability to generate adaptive re-appraisal of negative events or stressors;...
Core symptoms that comprise the disorder are often explicitly interpersonal in nature (e.g., tumultuous romantic relationships and frantic efforts to avoid abandonment) or are expressed in reaction to interpersonal stressors (e.g., affective instability, paranoid ideation, suicidal behavior
Individuals with a diagnosis of BPD have difficulty making appropriate social judgements about others from their faces. Judging more faces as unapproachable and untrustworthy indicates that this group may have a heightened sensitivity to perceiving potential threat, and this should be considered in clinical management and treatment
Individuals with BPD features often have distorted cognitions. Specifically, they often make simplified judgments about people and situations.
Following Linehan's biosocial model, we conceptualize emotion dysregulation in borderline personality disorder (BPD) as consisting of four components: emotion sensitivity, heightened and labile negative affect, a deficit of appropriate regulation strategies, and a surplus of maladaptive regulation strategies.
In comparison to a healthy control group, BPD patients show deficits in the following areas: mindfulness, self-compassion and adaptive emotion-regulation strategies.
BPD features are also associated with self-criticism, thought suppression, avoidance, and alcohol use as strategies for regulating emotions (Aldao & Dixon-Gordon, 2014).
Studies of the general population indicate that attempts to suppress thoughts typically result in a heightened accessibility of suppressed thoughts (e.g., a rebound effect) together with increases in emotional and physiological arousal [27].
...NPSs based on neurobiological dimensions and behaviors rather than clinical syndromes, grouping them into five domains: (1) negative valence; (2) positive valence; (3) cognitive systems; (4) processes for social systems; and (5) arousal or regulatory systems [13]. Yet here, too, there is tremendous overlap. For example, impairment of cognitive systems may manifest in delusions, hallucinations, agitation, aggression, depression or dysphoria, anxiety, elation or euphoria, apathy, disinhibition, irritability, motor disturbance, sleep disorder, appetite disorder, aberrant vocalization, and ruminative, repetitive, and somatoform behaviors.
(d) impairment in social or occupational functioning: fights, violent behaviour, loss of friends, absence from work, loss of job, legal difficulties, arguments or difficulties with family; (e) development of hypomaniac, maniac, or cyclothymic affective syndrome in relation to DRT; (f) development of a withdrawal state characterized by dysphoria, depression, irritability, and anxiety on reducing the level of DRT; (g) duration of disturbance of at least 6 months." & "Patients with DDS develop an addictive pattern of DRT use, self-administering doses of dopaminergic drugs in excess of those required to control their motor symptoms.
However, the findings argue against a simple relationship between dopamine level and reward sensitivity. Many PD+ICD patients were also found to experience behavioural apathy and impulsivity comorbidly, suggesting that aberrant reward sensitivity is just one component of a dysfunctional system which may incorporate functional changes in other neurotransmitter systems.
Mood disorder may represent the most common, and likely the most worrisome, psychiatric manifestation associated with epilepsy. Depression is frequently associated, although anxiety and bipolar disorder may also co-occur with epilepsy
Today, it is well recognized that disturbances in thyroid function may significantly affect mental status including emotion and cognition. Both excess and insufficient thyroid hormones can cause mood abnormalities including depression...
Variations in normal-range TSH and FT4 levels have no effects on the risk of MDD and its subtypes, and neither on minor depressive symptoms. This indicates that depressive symptoms should not be attributed to minor variations in thyroid function
A prominent bimodal conceptualisation of aggression classifies it as either: (i) spontaneous (referred to as reactive or impulsive aggression), or (ii) planned (referred to as proactive, premediated or instrumental aggression) (Babcock et al., 2014; Wrangham, 2018)." & "...DSM-5 is the occurrence of repeated episodes of impulsive aggression resulting in verbal or physical assaults or property destruction." & "DSM-IV criterion B for IED requires that the aggressiveness is 'grossly out of proportion to any precipitating psychosocial stressor'.
Results suggest that shame and CSB converge into a common construct, significantly related to depressive symptoms and cognitions. Convergence of guilt and BSB, however, was limited to particular pairs of measures.
We found hyperreactivity in brain regions involved in both, emotional expression, and regulation.
Sex steroids are able to modify several functions including behavior, cognition and memory, sleep, mood, pain and coordination, amongst others.
Major depressive disorder (MDD) also referred to as depression, is one of the most severe and common psychiatric disorders across the world. It is characterized by persistent sadness, loss of interest or pleasure, low energy, worse appetite and sleep, and even suicide, disrupting daily activities and psychosocial functions.
The most common DSM-IV-TR manic/hypomanic symptoms of mixed depression are irritability, mental overactivity (flight of ideas, racing thoughts, crowded thoughts), and behavioral overactivity (psychomotor agitation, overtalkativeness). Different frequencies of mixed depression have been reported, which may be related to treated versus untreated samples...
Obsessive compulsive disorder (OCD) involves obsessions, compulsions, or both, that are not caused by drugs or by a physical disorder, and which cause significant personal distress or social dysfunction.
Recurring thoughts of death and suicide (27) and aggression (28, 29) are common features of OCD. The most prevalent obsession was the fear of harming oneself in the DSM-IV field trials of 431 patients diagnosed with OCD (30, 31).
These thoughts can include horrific flashes of violence involving one's baby and frequently lead to shame and fear on the mother's part, but rarely result in real-world violence.
The DSM-TV Field Trial8 demonstrated that it was not the prevalence of PTSD symptoms themselves, but depression, outbursts of anger, self-destructive behaviors, and feelings of shame, self-blame, and distrust that distinguished a treatment-seeking...
Marital discord, stressful life events, and ambivalence about the pregnancy are risk factors not only for depression during pregnancy but also for postpartum depression
Psychological symptoms of PMS include irritability, depression, crying/tearfulness, and anxiety. Physical symptoms of PMS include abdominal bloating, breast tenderness, and headaches.
The length of symptom expression varies between a few days and 2 weeks (figure 1). Symptoms often worsen substantially 6 days before, and peak at about 2 days before, menses start. " & "Such an enhanced tendency to have disphoria as a result of the effects of sex steroids on the brain might be heritable, as suggested by twin studies.56–58 Other possible risk factors for PMS are high body-mass index,59 stress,7 and traumatic events.60" " & "…various indices of serotonergic trans mission are reported to be aberrant in women with PMS.75,80–89" & "Another neurotransmitter that has been linked to PMS is the inhibitory aminoacid GABA. This theory gains support from an imaging study,90"
Premenstrual syndrome (PMS) is characterized by a cluster of mild to severe physical or emotional symptoms that mainly begin during the luteal phase of the menstrual cycle. Symptoms should disappear within 4 days of the onset of menses and be severe enough to interfere with normal and daily function. The severe form of PMS is the Premenstrual Dysphoric Disorder (PMDD), which differs from PMS in respect to intensity of symptoms, predominance of mood symptoms, and the significant function impairment. (1, 2, 3). The most common symptoms are tension, irritability, hostility, depression, anxiety, mood swings, sleep changes, breast tenderness, and abdominal bloating (4).
Schizophrenia is a complex, chronic mental health disorder characterized by an array of symptoms, including delusions, hallucinations, disorganized speech or behavior, and impaired cognitive ability.
...phenomenology of depression in schizophrenia, however, has not often been interrogated in phenomenological terms. Some of our recent evidence suggests self-stigma, shame, difficulty in regaining trust in ones own thoughts after recovery from delusional beliefs, and poor motivation are core features rather than other more "biological" symptoms such as early morning wakening, diurnal variation in mood or loss of appetite.14
Studying anger is important for schizophrenia because this disease is often associated with angry and hostile behavior (Volavka, 1999)
Paranoia is the most commonly reported delusion among individuals diagnosed with schizophrenia spectrum illnesses (Bentall et al., 2009)
48,XXYY is one of the most under-studied and rare types of sex chromosome aneuploidies (SCAs). In male births, 48,XXYY incidence occurs with an estimated prevalence of 1 in 18,000–40,000 (1). The SCAs can influence the neurodevelopment of an individual and are associated with impairment in executive function, verbal skills, working memory, sustained attention, mental flexibility, and inhibition by altering the basic differentiation process of the neurons, encoding proteins, and synaptic transmission (2).
Behavioral and psychiatric symptoms including hyperactivity, attention problems, impulsivity, aggression, mood instability, and "autistic-like" behaviors have also been described [Schlegel et al., 1965; Sorensen et al., 1978; Fryns et al., 1995; Hagerman, 1999].
Neurotransmitters that play an important function in mood disorders are serotonin and...." & "Stressful life changes (death of significant other, parents, siblings, etc.) traumatic events and childhood abuse have been found to be major risk factors for the development of mood disorder later on in life....
It encompasses various elements, such as spirituality, empowerment, embracing the illness actively, finding hope, restoring a positive identity, creating meaning in life, combating stigma, taking charge of one's own life, and cultivating supportive relationships [4]. PR concerns the individuals' perceived capacity to manage mental illness, their sense of purpose, and their confidence in their ability to lead a fulfilling life, irrespective of the disorder's severity [5]
For many, recovery is their preferred term to describe the continuing experience of living with, managing, or overcoming mental health difficulties [5].
It is the unfortunate result of the bidirectional relationship between depression and inactivity: depression leads to a reduced activity level, and depressive symptoms then become more severe. Berlin, et al.
By intentional activity, the authors meant discrete actions or practices that individuals must choose to engage in and that require some effort to enact. This might include adopting new behaviors such as an exercise program, changing one's cognitive attitudes or practices such as practicing forgiveness, or volitional activity such as pursuing personal goals.
Irritability describes proneness to anger... Irritability is a mood in the sense that young people can remain in states of proneness to anger for very long times and sometimes for no apparent reason, as discussed below... irritability shares a negative valence with anxiety and depression but denotes approach and is therefore linked to elation in mania.
The first session provided an overview of the training goals and an explanation of the differences between the three states of mind (i.e., emotional mind, rational mind and wise mind)...In DBT, ER skills training is oriented to encouraging behavioral activation (BA) by training patients in "opposite action" (OA) to depressive symptoms.
While they also experienced more improvement in depressive symptoms and in their ability to control emotional states, the difference between the two groups did not reach statistical significance.
...first phase of treatment focusing on increasing momentary clarity of motivational responses during emotional episodes and the cultivation of mindful emotion regulation skills with the goal of promoting counteractive responding to intense emotional experiences. Skills are presented in a specific order focusing on less cognitively elaborative skills (e.g., attention regulation skills) followed by more cognitively elaborative skills (e.g., metacognitive regulation skills).
Shen, Alloy, Abramson, and Sylvia provided further evidence of social rhythm irregularities in bipolar spectrum disorder (2008). In a sample of 414 undergraduates, those diagnosed with either cyclothymia or bipolar II disorder reported significantly fewer regular activities than normal controls.
More than 30 years ago, it was observed that major life events associated with mood disorder (divorce, loss of job, life transitions) are not just psychologically challenging but also cause significant change to daily routines.10 Unemployment, for example, may be associated not just with challenges to self-esteem but also with less regular bed-, wake- and mealtimes. This instability of daily routines, in turn, may have circadian impact through weakened zeitgeber information.
...phenomenology of depression in schizophrenia, however, has not often been interrogated in phenomenological terms. Some of our recent evidence suggests self-stigma, shame, difficulty in regaining trust in ones own thoughts after recovery from delusional beliefs, and poor motivation are core features rather than other more "biological" symptoms such as early morning wakening, diurnal variation in mood or loss of appetite.14
Only about 36% of people in the world are emotionally Intelligent... 54% of the U.S. population are emotionally aware.
ADHD-induced mood shifts may be a result of being distracted, comorbid conditions like depression or bipolar disorder, or a side effect of certain medications.
Although the neurobiological aspects of aggression in patients with schizophrenia are still not well understood, impulsivity and aggression may correlate with frontal and temporal brain abnormalities.2 Psychotic symptoms, such as delusions and hallucinations, with subsequent suspiciousness and hostility, may result in aggressive behavior. Or, aggression may be impulsive and caused by an environmental frustrating event. Patients may be more aggressive and violent during acute episodes.3
...the use and definitions of the terms "affect," "mood," "emotion," and "feeling" in some classical and contemporary works of psychiatry and psychology. He concludes that these words refer to distinct pscychological phenomena and suggests that they be used clearly and carefully to facilitate communication about emotions.
The visual analog scale can capture patterns of mood and mood variability thought to be typical of these diagnostic groups. Mood disorders differ not only in the degree of abnormal mood but also in the pattern of mood variability, suggesting that mechanisms regulating mood stability may differ from those regulating overall mood state.
The results of this study suggest that the presence of greater lability in terms of anger, anxiety, and depression/anxiety oscillation characterizes borderline personality disorder, while suggesting that the subjective sense of high affective intensity is present in this population but does not explain these other affective phenomena.
Measuring and characterizing the experience of affective instability have proved challenging, however. Traditional measures of affective instability rely on respondents' retrospective recall and subjective assess-ment of affective variability or reactivity on interview or questionnaire items.
Though mixed feelings may be uncommon, they might often have important consequences (e.g., for health).
(graph PMS pattern)...Key characteristics of PMS include a lack of symptoms during the follicular phase, a peak of symptoms during the late luteal or premenstrual phase, and a sudden decrease of symptoms with the onset of menses.
Anabolic steroids and other agents are fast becoming part of the standard of care for HIV disease, gaining acceptance in reversing loss of lean body mass...
Difficulties with measurement, and unclear definitions for terms like cyclothymia, rapid cycling, mixed states, short episodes, and soft spectrum have contributed to the uncertainty (Akiskal et al., 2000, Blacker and Tsuang, 1992, Cassano et al., 1999, Ghaemi et al., 2001).
Moderator analyses revealed lower depression severity in BPD patients without comorbid DeDs, but higher severity in BPD patients with comorbid DeDs compared to depressed controls...some authors labeled the depression experienced in BPD "borderline-depression", characterized by distinct feelings of loneliness and isolation (Adler and Buie, 1979, Grinker et al., 1968), emptiness or boredom (Gunderson, 1996), high dependency and fears of abandonment (Masterson, 1976), as well as intense anger and hate toward the self and others (Hartocollis, 1977, Kernberg, 1975, Kernberg, 1992).
This study replicates research showing that adults with ADHD report heighted emotional lability (EL), which contributes to impairments in their daily life.
Diurnal variation in mood is a prominent symptom of depression, and is typically experienced as positive mood variation (PMV — mood being worse upon waking and better in the evening).
The mixed depressive syndrome is not a transitory state but a state of long duration, which may last weeks or several months. The clinical picture is characterized by dysphoric mood, emotional lability, psychic and/or motor agitation, talkativeness, crowded and/or racing thoughts, rumination, initial or middle insomnia.
The anabolic effects are considered to be those promoting protein synthesis, muscle growth and crythopoiesis
Interpersonal and social rhythm therapy is a manual-based psychotherapy (E. Frank et al, unpublished data, 1999) focusing on 1) the link between mood and life events, 2) the importance of maintaining regular daily rhythms as elucidated by the SRM, 3) the identification and management of potential precipitants of rhythm dysregulation with special attention to interpersonal triggers, 4).
When a patient, in the longitudinal course of mood disturbances, no longer meets the threshold of a disorder such as depression or mania, as assessed by categorical methods resulting in diagnostic criteria or by cutoff points in the dimensional measurement of rating scales, he or she is often labeled as euthymic.
We typically have little control over fluctuations between episodes of good and bad mood. In most cases, we also have little understanding of the causal factors driving our mood fluctuations, contrary to emotional reactions that are circumscribed to a specific trigger and limited to a short duration.
The findings confirm that adolescents experience wider and quicker mood swings, but do not show that this variability is related to stress, lack of personal control, psychological maladjustment, or social maladjustment within individual teenagers.
Mental illnesses are highly complex, temporally dynamic phenomena (1). Variables across a vast range of timescales – from milliseconds to generations – and levels – from subcellular to societal – interact in complex manners to result in the dynamic, rich and extraordinarily heterogeneous temporal trajectories that are characteristic of the personal and psychiatric histories evident in mental health services across the world.
Depressive symptoms that occur as part of BPD are usually transient and related to interpersonal stress (eg, after an event arousing feelings of rejection). Such "depression" usually lifts dramatically when the relationship is restored. Depressive symptoms in BPD may also serve to express feelings (eg, anger, frustration, hatred, helplessness, powerlessness, disappointment) that the patient is not able to express in more adaptive ways.
Major depressive disorder is characterized by high mean NA and low mean PA (e.g., Watson et al., 1988).... Note that major depressive disorder generally is unassociated with instability of NA or PA (Köhling et al., 2016; Koval et al., 2013).
The results showed that less than 50% of PTSD cases presented with anxiety as the primary emotion, with the remainder showing primary emotions of sadness, anger, or disgust rather than anxiety
Posttraumatic stress symptom severity was uniquely correlated with greater intensity and variability, but not occurrence, of certain negative emotions, and with less frequent occurrence but greater variability of joy/happiness. Intrusive reexperiencing was uniquely associated with greater variability of both anxiety and joy/happiness. Results suggest that women with more severe posttraumatic stress symptoms do not experience more episodes of negative emotion but, once emotion occurs, they have difficulty modulating its intensity.
Reexperiencing symptoms describe spontaneous, often insuppressible intrusions of the traumatic memory in the form of images or nightmares that are accompanied by intense physiological distress...Hyperarousal symptoms reflect more overt physiological manifestations, such as insomnia, irritability, impaired concentration, hypervigilance, and increased startle responses.
Anabolic steroids are used to accelerate the growth of normal boys with constitutional, delay of growth and puberty
Anabolic steroids and other agents are fast becoming part of the standard of care for HIV disease, gaining acceptance in reversing loss of lean body mass...
Shifting attention was more significantly associated with trait anger and anger out than response inhibition, which was significantly related to anger control
ADHD subjects indeed showed a performance deficit in the tasks, supporting OFC dysfunction in ADHD. Furthermore, a discriminat analysis using the task performance variables correctly classified 89.7% of the participants among ADHD patients and normal controls.
These data indicate that inter-outburst anger in those with IED is relatively brief and that such individuals do not generally display the kind of persistent anger that is a diagnostic feature of DMDD.
Both the schizophrenia and depression groups exhibited higher levels of external shame, or seeing others as shaming, than the medical group
A retrospective web-based study of 2087 adults found small but reliable associations between a history of physical illness and the character strengths of appreciation of beauty, bravery, curiosity, fairness, forgiveness, gratitude, humor, kindness, love of learning, and spirituality.
Our findings indicate that people with mental illness who receive greater support from the family are better able to have self-caring attitudes...They may also have more positive experiences and perceptions of recovery and attain greater levels of life satisfaction and enjoyment.
Interpersonal and social rhythm therapy is a manual-based psychotherapy (E. Frank et al, unpublished data, 1999) focusing on 1) the link between mood and life events, 2) the importance of maintaining regular daily rhythms as elucidated by the SRM, 3) the identification and management of potential precipitants of rhythm dysregulation with special attention to interpersonal triggers, 4).
...To foster psychological flexibility, according to Grégoire et al. (2017), ACT relies on six interrelated and overlapping processes: acceptance (i.e., willingness to open fully to unwanted experiences such as difficult thoughts, memories, or emotions), contact with the present moment (i.e., being mindful and aware of one's experiences), self as context (i.e., maintaining perspective about oneself within one's experiences), cognitive defusion (i.e., being able to step back from unwanted experiences without getting stuck in them), committed action (i.e., engaging in actions that move toward important aspects of life), and values (i.e., staying connected to personal values or areas of life that are important).
Posttraumatic stress symptom severity was uniquely correlated with greater intensity and variability, but not occurrence, of certain negative emotions, and with less frequent occurrence but greater variability of joy/happiness. Intrusive reexperiencing was uniquely associated with greater variability of both anxiety and joy/happiness. Results suggest that women with more severe posttraumatic stress symptoms do not experience more episodes of negative emotion but, once emotion occurs, they have difficulty modulating its intensity.
Shifting attention was more significantly associated with trait anger and anger out than response inhibition, which was significantly related to anger control
A retrospective web-based study of 2087 adults found small but reliable associations between a history of physical illness and the character strengths of appreciation of beauty, bravery, curiosity, fairness, forgiveness, gratitude, humor, kindness, love of learning, and spirituality.
Emotional abuse was associated with average daily mood and mood lability.
In PMS: Solving the Puzzle, Linaya Hahn identifies five patterns of symptoms, occurring primarily within the luteal phase but varying in timing and intensity (see Patterns of PMS Symptoms)
Electronic self-monitoring of mood was considered valid compared to clinical rating scales for depression in six out of six studies, and in two out of seven studies compared to clinical rating scales for mania.
Measuring and characterizing the experience of affective instability have proved challenging, however. Traditional measures of affective instability rely on respondents' retrospective recall and subjective assess-ment of affective variability or reactivity on interview or questionnaire items.
To measure affect lability, Harvey et al. (1989) developed the Affective Lability Scales (ALS), a 58-item questionnaire measuring changeability among euthymia and four affect states (i.e., depression, elation, anger, and anxiety).
...the use and definitions of the terms "affect," "mood," "emotion," and "feeling" in some classical and contemporary works of psychiatry and psychology. He concludes that these words refer to distinct pscychological phenomena and suggests that they be used clearly and carefully to facilitate communication about emotions.
The literature spans psychiatry, psychology and neuroscience, and multiple terms are used to describe the same, or related phenomena, including affective instability, emotional dysregulation, mood swings, emotional impulsiveness and affective lability. Collating the main overlapping dimensions, definitions, and their measurement scales, a recent systematic review proposed that mood instability is 'rapid oscillations of intense affect, with a difficulty in regulating these oscillations or their behavioural consequences'.
One would conclude from the above italic sentences of Fish that affect is a sudden exacerbation of emotion, and mood is also the emotional state prevailing at any given time, in other words, both mood and affect are short-term emotional tone (However, these confusing lines are deleted in the new edition of Fish's clinical psychopathology).
Four of 5 normal controls displayed a circadian mood pattern with chaotic dynamics.
When a patient, in the longitudinal course of mood disturbances, no longer meets the threshold of a disorder such as depression or mania, as assessed by categorical methods resulting in diagnostic criteria or by cutoff points in the dimensional measurement of rating scales, he or she is often labeled as euthymic.
Complexity of symptoms or behaviors in an individual is often characterized by the dynamics of the individual's longitudinal patterns. While periodic/linear temporal patterns are predictable in both trajectory and pattern, chaotic patterns are predictable in pattern only. Random dynamics are predictable in neither trajectory nor pattern.
The visual analog scale can capture patterns of mood and mood variability thought to be typical of these diagnostic groups. Mood disorders differ not only in the degree of abnormal mood but also in the pattern of mood variability, suggesting that mechanisms regulating mood stability may differ from those regulating overall mood state.
We typically have little control over fluctuations between episodes of good and bad mood. In most cases, we also have little understanding of the causal factors driving our mood fluctuations, contrary to emotional reactions that are circumscribed to a specific trigger and limited to a short duration.
The main conclusion of the study was that happiness depends not on how well things are going (in terms of cumulative earnings) but whether they are going better than expected.
The bipolar II spectrum represents the most common phenotype of bipolarity. Numerous studies indicate that in clinical settings this soft spectrum might be as common--if not more common than--major depressive disorders.
Difficulties with measurement, and unclear definitions for terms like cyclothymia, rapid cycling, mixed states, short episodes, and soft spectrum have contributed to the uncertainty (Akiskal et al., 2000, Blacker and Tsuang, 1992, Cassano et al., 1999, Ghaemi et al., 2001).
DSM-5 introduced the "with mixed features" specifier, which could apply to any type of episode of BD and major depressive disorder (MDD).
Patients with bipolar disorder spend about half of their time in depression, mania or mixed states22. The remaining periods are defined as euthymic23, 24, 25, 26, 27. However, considerable fluctuations in psychological distress were recorded in studies with longitudinal designs, suggesting that the illness is still active in those latter periods, even though its intensity may vary28. It is thus questionable whether subthreshold symptomatic periods truly represent euthymia28....This definition of euthymia, because of its intertwining with mood stability, is substantially different from the concept of eudaimonic well‐being, that has become increasingly popular in positive psychology
Though mixed feelings may be uncommon, they might often have important consequences (e.g., for health).
Indeed, college students are more likely to report mixed emotions of happiness and sadness on the day that they move out of their freshmen dorm and on their graduation day than on typical days.
The findings confirm that adolescents experience wider and quicker mood swings, but do not show that this variability is related to stress, lack of personal control, psychological maladjustment, or social maladjustment within individual teenagers.
Cyclothymia is characterized by early onset, persistent, spontaneous and reactive mood fluctuations, associated with a variety of anxious and impulsive behaviors, resulting in a very rich and complex clinical presentation. Current diagnostic criteria for cyclothymic disorder (DSM-5 and ICD-10), emphasizing only episodic mood symptoms, may be misleading both from diagnostic and therapeutic point of views.
A time-series approach allows comparison of mood instability pre- and post-treatment. Figure 1
As expected, episodes of depressions were much longer than manias, but episode-duration did not differ among BD diagnostic types: I, II, with mainly mixed-episodes (BD-Mx), or with psychotic features (BD-P)...A total of 56.8% of subjects could be characterized for major course-patterns as either DMI or MDI, which occurred in similar proportions for each type. As expected, depressive episodes averaged 5.2 months
These studies indicate that mood in patients with bipolar disorder is not truly cyclic for extended periods. Nonetheless, self-rated mood in bipolar disorder is significantly more organized than self-rated mood in normal subjects and can be characterized as a low-dimensional chaotic process. This characterization of the dynamics of bipolar disorder provides a unitary theoretical framework that can accommodate neurobiologic and psychosocial data and can reconcile existing models for the pathogenesis of the disorder. Furthermore, consideration of the dynamical structure of bipolar disorder may lead to new methods for predicting and controlling pathologic mood.
The median duration of major depressive episodes was 14 weeks, and over 70% recovered within 12 months of onset of the episode. The median duration of minor depressive episodes was 8 weeks, and approximately 90% recovered within 6 months of onset of the episode...An early report from this study examined 66 participants with bipolar I followed for up to 5 years, and found that the median time to recovery from the first two prospectively observed episodes of major depression was 20 weeks and 24 weeks.16 A subsequent report described 82 participants with bipolar I followed for 10 years; the median duration of major and minor depressive episodes were 12 and 5 weeks, respectively.17
(graph PMS pattern)...Key characteristics of PMS include a lack of symptoms during the follicular phase, a peak of symptoms during the late luteal or premenstrual phase, and a sudden decrease of symptoms with the onset of menses.
The ACOG definition involves the presence of at least one of the six affective symptoms (angry outbursts, depression, anxiety, confusion, irritability and social withdrawal) and one of the four somatic…
It consists of a heightened emotional reactivity to environmental stimuli, including emotions of others. Emotion sensitivity in BPD has primarily been associated with negative mood states (e.g., anger, fear, sadness) and not positive emotions (although see [9, 10]).
...but in BPD, symptoms are usually associated with mood instability rather than with the extended and continuous periods of lower mood seen in classic mood disorders.19 Also, because of characteristic mood swings, BPD is often mistaken for bipolar disorder.30 However, patients with BPD do not show continuously elevated mood but instead exhibit a pattern of rapid shifts in affect related to environmental events, with "high" periods that last for hours rather than for days or weeks.
Individuals with BPD report more negative emotions and a greater intensity of negative emotions than healthy individuals throughout the day (9). However, recent data suggest a particular relevance of anger, a negative emotion that is closely related to reactive aggression, in BPD. Using e-diaries, Kockler et al. (10) found that individuals with BPD exhibit anger more frequently in their daily life than healthy as well as clinical control groups and feelings of anger accounted for more distress than pure emotional intensity.
The results of this study suggest that the presence of greater lability in terms of anger, anxiety, and depression/anxiety oscillation characterizes borderline personality disorder, while suggesting that the subjective sense of high affective intensity is present in this population but does not explain these other affective phenomena.
Depressive symptoms that occur as part of BPD are usually transient and related to interpersonal stress (eg, after an event arousing feelings of rejection). Such "depression" usually lifts dramatically when the relationship is restored. Depressive symptoms in BPD may also serve to express feelings (eg, anger, frustration, hatred, helplessness, powerlessness, disappointment) that the patient is not able to express in more adaptive ways.
Moderator analyses revealed lower depression severity in BPD patients without comorbid DeDs, but higher severity in BPD patients with comorbid DeDs compared to depressed controls...some authors labeled the depression experienced in BPD "borderline-depression", characterized by distinct feelings of loneliness and isolation (Adler and Buie, 1979, Grinker et al., 1968), emptiness or boredom (Gunderson, 1996), high dependency and fears of abandonment (Masterson, 1976), as well as intense anger and hate toward the self and others (Hartocollis, 1977, Kernberg, 1975, Kernberg, 1992).
This study replicates research showing that adults with ADHD report heighted emotional lability (EL), which contributes to impairments in their daily life.
However, common themes include decreased inhibitory control, intolerance of delay to rewards and quick decision-making due to lack of consideration, as well as more universal deficits such as poor attentional ability.
Kraepelin1 and Bleuler2 had already mainly focused on "flat" or "inappropriate" emotions as core features of the illness.
There were no statistically significant differences between individuals with BD-I and SZ for any ALS-SF dimension and these two groups had very similar score patterns throughout. This suggests that despite the overlap in core affective symptom profiles of BD-I and BD-II, the BD-I group is more similar to SZ than it is to BD-II concerning levels of affective lability.
Evidence from multiple domains indicates that affective dysregulation is strongly associated with reality distortion.1,2 Genetic epidemiological studies have demonstrated that the liabilities for bipolar disorder and schizophrenia are correlated.
Blunted affect, also referred to as emotional blunting, is a prominent symptom of schizophrenia. Patients with blunted affect have difficulty in expressing their emotions [1], characterized by diminished facial expression, expressive gestures and vocal expressions in reaction to emotion provoking stimuli [1–3]. However, patients' reduced outward emotional expression may not mirror subjective internal emotional experiences [4] suggesting a disconnect in what patients experience, perceive and express when interpreting emotional stimuli [5] due to problems associated with emotional processing [6–7].
There is evidence that the occurrence of stressful life events3,6–8 or the presence of social relationship stressors such as high levels of familial "expressed emotion9–11" are associated with subsequent exacerbation of psychotic symptoms in patients as a group.
Whether depressed individuals and healthy controls will differ in their instability of PA is less clear. As we noted above, depressed individuals have been found to have blunted emotional responses to valenced stimuli in the laboratory (Bylsma, et al., 2008) and decreased responsivity to reward (e.g., Pizzagalli, Iosifescu, Hallett, Ratner, & Fava, 2009)...
He noted that people with melancholia could become over-talkative and manic but did not adequately explain why this is so." & "On the VAS ratings, the depressed group experienced more severe low moods and less severe high moods than the non-depressed group, as would be expected given the selection criteria. This is consistent with reports of more severe negative emotions and variable positive emotions in ecological momentary assessment studies of patients with major depression (12, 33, 53).
Emotional effects of depression and treatment vary, but may include, for example, feeling emotionally "numbed" or "blunted" in some way; lacking positive emotions or negative emotions; feeling detached from the world around you...
Diurnal variation in mood is a prominent symptom of depression, and is typically experienced as positive mood variation (PMV — mood being worse upon waking and better in the evening).
The depressives are more sensitive to displeasure and more anhedonic than controls.
The mixed depressive syndrome is not a transitory state but a state of long duration, which may last weeks or several months. The clinical picture is characterized by dysphoric mood, emotional lability, psychic and/or motor agitation, talkativeness, crowded and/or racing thoughts, rumination, initial or middle insomnia.
The results showed that less than 50% of PTSD cases presented with anxiety as the primary emotion, with the remainder showing primary emotions of sadness, anger, or disgust rather than anxiety
Taken together, these results indicate that PTSD development is a dynamic process in which symptoms interact over time (Gelkopf et al., 2017). As hypothesized, intrusions and AAR symptoms may be more important early on and lead to other symptoms in the disorder.
Chronic PTSD most often co-occurs with mood, anxiety and substance use disorders. It is highly reactive to environmental reminders of the traumatic event and to renewed life-stressors, and thus may have a fluctuating course (23).
Posttraumatic stress symptom severity was uniquely correlated with greater intensity and variability, but not occurrence, of certain negative emotions, and with less frequent occurrence but greater variability of joy/happiness. Intrusive reexperiencing was uniquely associated with greater variability of both anxiety and joy/happiness. Results suggest that women with more severe posttraumatic stress symptoms do not experience more episodes of negative emotion but, once emotion occurs, they have difficulty modulating its intensity.
Reexperiencing symptoms describe spontaneous, often insuppressible intrusions of the traumatic memory in the form of images or nightmares that are accompanied by intense physiological distress...Hyperarousal symptoms reflect more overt physiological manifestations, such as insomnia, irritability, impaired concentration, hypervigilance, and increased startle responses.
Kleim, Graham, Bryant, and Ehlers (2013) asked a sample of trauma-exposed individuals to report state levels of various unpleasant emotions (i.e., fear, helplessness, anger, guilt, and shame) following naturally occurring intrusive memories over the course of a week.
Findings and future directions from the ENIGMA Bipolar Disorder Working Group. Hum Brain Mapp. 2022 Jan;43(1):56-82."Initial BD Working Group studies reveal widespread patterns of lower cortical thickness, subcortical volume and disrupted white matter integrity associated with BD. Findings also include mapping brain alterations of
Anabolic steroids are used to accelerate the growth of normal boys with constitutional, delay of growth and puberty
The anabolic effects are considered to be those promoting protein synthesis, muscle growth and crythopoiesis
Anabolic steroids and other agents are fast becoming part of the standard of care for HIV disease, gaining acceptance in reversing loss of lean body mass...
High doses of AASs can lead to serious physical and psychological complications, such as hypertension, atherosclerosis, myocardial hypertrophy and infarction, abnormal blood clotting, hepatotoxicity and hepatic tumors, tendon damage, reduced libido, and psychiatric/behavioral symptoms like aggressiveness and irritability
AAS users who fulfilled the criteria for AAS‐dependence had significantly thinner cortex in frontal, temporal, parietal, occipital and pre‐frontal regions compared to non‐dependent users
As a result, it was observed that at NS, these stimulants actuate through a complex signaling systems that include the neuroendocrine alteration of the hypothalamic pituitary-gonadal axis, modification of neurotransmitters and their receptors, as well as the induction of neuronal death by apoptosis in several pathways
ADHD is a neurodevelopmental disorder defined by impairing levels of inattention, disorganization, and/or hyperactivity-impulsivity. Inattention and disorganization entail inability to stay on task, seeming not to listen, and losing materials necessary for tasks, at levels that are inconsistent with age or developmental level.
Ozel-Kizil et al. (2013; also see Ozel-Kizil et al., 2014) defined hyperfocusing as being "characterized by intensive concentration on interesting and non-routine activities accompanied by temporarily diminished perception of the environment".
Shifting attention was more significantly associated with trait anger and anger out than response inhibition, which was significantly related to anger control
ADHD subjects indeed showed a performance deficit in the tasks, supporting OFC dysfunction in ADHD. Furthermore, a discriminat analysis using the task performance variables correctly classified 89.7% of the participants among ADHD patients and normal controls.
We conclude that the findings of interest (i.e., hippocampus enlargement and amygdala volume loss) are not very stable across different samples of patients with ADHD and that the different and contradictory findings may be related to the different locations of alterations along the complex circuits responsible for the different symptoms of ADHD.
Table 1 :Changes in ASD criteria from the DSM-IV to DSM-5
Difficulties with sensory input was described to impact mood, causing stress and agitation:
The authors found that youth with ASDs had overactivation in limbic areas, primary sensory cortices, and orbitofrontal cortex (OFC) compared with typically developing (TD) control subjects in response to mildly aversive visual and auditory stimuli." & "Finally, Green et al10 found that SOR symptoms correlated with hyperactivity in the amygdala and OFC.
Children with ASD and disruptive behavior showed reduced amygdala–vlPFC connectivity compared with children with ASD without disruptive behavior.
In BPD, the appraisal mechanisms are at fault, in large part because of mentalizing difficulties (e.g. in the mistaken appraisal of threat at the moment of its presentation) or a breakdown in epistemic trust, which damages the capacity to relearn different ways of mentalizing – or appraising – situations (i.e. the inability to change our understanding of the threat after the event).
Core symptoms that comprise the disorder are often explicitly interpersonal in nature (e.g., tumultuous romantic relationships and frantic efforts to avoid abandonment) or are expressed in reaction to interpersonal stressors (e.g., affective instability, paranoid ideation, suicidal behavior
Individuals with a diagnosis of BPD have difficulty making appropriate social judgements about others from their faces. Judging more faces as unapproachable and untrustworthy indicates that this group may have a heightened sensitivity to perceiving potential threat, and this should be considered in clinical management and treatment
Individuals with BPD features often have distorted cognitions. Specifically, they often make simplified judgments about people and situations.
Following Linehan's biosocial model, we conceptualize emotion dysregulation in borderline personality disorder (BPD) as consisting of four components: emotion sensitivity, heightened and labile negative affect, a deficit of appropriate regulation strategies, and a surplus of maladaptive regulation strategies.
In comparison to a healthy control group, BPD patients show deficits in the following areas: mindfulness, self-compassion and adaptive emotion-regulation strategies.
BPD features are also associated with self-criticism, thought suppression, avoidance, and alcohol use as strategies for regulating emotions (Aldao & Dixon-Gordon, 2014).
Studies of the general population indicate that attempts to suppress thoughts typically result in a heightened accessibility of suppressed thoughts (e.g., a rebound effect) together with increases in emotional and physiological arousal [27].
(d) impairment in social or occupational functioning: fights, violent behaviour, loss of friends, absence from work, loss of job, legal difficulties, arguments or difficulties with family; (e) development of hypomaniac, maniac, or cyclothymic affective syndrome in relation to DRT; (f) development of a withdrawal state characterized by dysphoria, depression, irritability, and anxiety on reducing the level of DRT; (g) duration of disturbance of at least 6 months." & "Patients with DDS develop an addictive pattern of DRT use, self-administering doses of dopaminergic drugs in excess of those required to control their motor symptoms.
However, the findings argue against a simple relationship between dopamine level and reward sensitivity. Many PD+ICD patients were also found to experience behavioural apathy and impulsivity comorbidly, suggesting that aberrant reward sensitivity is just one component of a dysfunctional system which may incorporate functional changes in other neurotransmitter systems.
Mood disorder may represent the most common, and likely the most worrisome, psychiatric manifestation associated with epilepsy. Depression is frequently associated, although anxiety and bipolar disorder may also co-occur with epilepsy
Today, it is well recognized that disturbances in thyroid function may significantly affect mental status including emotion and cognition. Both excess and insufficient thyroid hormones can cause mood abnormalities including depression...
Variations in normal-range TSH and FT4 levels have no effects on the risk of MDD and its subtypes, and neither on minor depressive symptoms. This indicates that depressive symptoms should not be attributed to minor variations in thyroid function
These data indicate that inter-outburst anger in those with IED is relatively brief and that such individuals do not generally display the kind of persistent anger that is a diagnostic feature of DMDD.
A prominent bimodal conceptualisation of aggression classifies it as either: (i) spontaneous (referred to as reactive or impulsive aggression), or (ii) planned (referred to as proactive, premediated or instrumental aggression) (Babcock et al., 2014; Wrangham, 2018)." & "...DSM-5 is the occurrence of repeated episodes of impulsive aggression resulting in verbal or physical assaults or property destruction." & "DSM-IV criterion B for IED requires that the aggressiveness is 'grossly out of proportion to any precipitating psychosocial stressor'.
Results suggest that shame and CSB converge into a common construct, significantly related to depressive symptoms and cognitions. Convergence of guilt and BSB, however, was limited to particular pairs of measures.
We found hyperreactivity in brain regions involved in both, emotional expression, and regulation.
Transition to menopause and its changing hormonal milieu are strongly associated with new onset of depressed mood among women with no history of depression.
Sex steroids are able to modify several functions including behavior, cognition and memory, sleep, mood, pain and coordination, amongst others.
Major depressive disorder (MDD) also referred to as depression, is one of the most severe and common psychiatric disorders across the world. It is characterized by persistent sadness, loss of interest or pleasure, low energy, worse appetite and sleep, and even suicide, disrupting daily activities and psychosocial functions.
The most common DSM-IV-TR manic/hypomanic symptoms of mixed depression are irritability, mental overactivity (flight of ideas, racing thoughts, crowded thoughts), and behavioral overactivity (psychomotor agitation, overtalkativeness). Different frequencies of mixed depression have been reported, which may be related to treated versus untreated samples...
Anger in people with depression often stems from narcissistic vulnerability, a sensitivity to perceived or actual loss or rejection. These angry reactions cause intrapsychic conflicts through the onset of guilt and the fear that angry feelings will disrupt relationships
Obsessive compulsive disorder (OCD) involves obsessions, compulsions, or both, that are not caused by drugs or by a physical disorder, and which cause significant personal distress or social dysfunction.
Recurring thoughts of death and suicide (27) and aggression (28, 29) are common features of OCD. The most prevalent obsession was the fear of harming oneself in the DSM-IV field trials of 431 patients diagnosed with OCD (30, 31).
These thoughts can include horrific flashes of violence involving one's baby and frequently lead to shame and fear on the mother's part, but rarely result in real-world violence.
The DSM-TV Field Trial8 demonstrated that it was not the prevalence of PTSD symptoms themselves, but depression, outbursts of anger, self-destructive behaviors, and feelings of shame, self-blame, and distrust that distinguished a treatment-seeking...
Marital discord, stressful life events, and ambivalence about the pregnancy are risk factors not only for depression during pregnancy but also for postpartum depression
Psychological symptoms of PMS include irritability, depression, crying/tearfulness, and anxiety. Physical symptoms of PMS include abdominal bloating, breast tenderness, and headaches.
The length of symptom expression varies between a few days and 2 weeks (figure 1). Symptoms often worsen substantially 6 days before, and peak at about 2 days before, menses start. " & "Such an enhanced tendency to have disphoria as a result of the effects of sex steroids on the brain might be heritable, as suggested by twin studies.56–58 Other possible risk factors for PMS are high body-mass index,59 stress,7 and traumatic events.60" " & "…various indices of serotonergic trans mission are reported to be aberrant in women with PMS.75,80–89" & "Another neurotransmitter that has been linked to PMS is the inhibitory aminoacid GABA. This theory gains support from an imaging study,90"
Premenstrual syndrome (PMS) is characterized by a cluster of mild to severe physical or emotional symptoms that mainly begin during the luteal phase of the menstrual cycle. Symptoms should disappear within 4 days of the onset of menses and be severe enough to interfere with normal and daily function. The severe form of PMS is the Premenstrual Dysphoric Disorder (PMDD), which differs from PMS in respect to intensity of symptoms, predominance of mood symptoms, and the significant function impairment. (1, 2, 3). The most common symptoms are tension, irritability, hostility, depression, anxiety, mood swings, sleep changes, breast tenderness, and abdominal bloating (4).
Schizophrenia is a complex, chronic mental health disorder characterized by an array of symptoms, including delusions, hallucinations, disorganized speech or behavior, and impaired cognitive ability.
...phenomenology of depression in schizophrenia, however, has not often been interrogated in phenomenological terms. Some of our recent evidence suggests self-stigma, shame, difficulty in regaining trust in ones own thoughts after recovery from delusional beliefs, and poor motivation are core features rather than other more "biological" symptoms such as early morning wakening, diurnal variation in mood or loss of appetite.14
Studying anger is important for schizophrenia because this disease is often associated with angry and hostile behavior (Volavka, 1999)
Paranoia is the most commonly reported delusion among individuals diagnosed with schizophrenia spectrum illnesses (Bentall et al., 2009)
Both the schizophrenia and depression groups exhibited higher levels of external shame, or seeing others as shaming, than the medical group
SAD patients were also more likely to report a larger number of accompanying symptoms during the anger attacks, suggesting that they experience the anger attacks as particularly intense.
48,XXYY is one of the most under-studied and rare types of sex chromosome aneuploidies (SCAs). In male births, 48,XXYY incidence occurs with an estimated prevalence of 1 in 18,000–40,000 (1). The SCAs can influence the neurodevelopment of an individual and are associated with impairment in executive function, verbal skills, working memory, sustained attention, mental flexibility, and inhibition by altering the basic differentiation process of the neurons, encoding proteins, and synaptic transmission (2).
Behavioral and psychiatric symptoms including hyperactivity, attention problems, impulsivity, aggression, mood instability, and "autistic-like" behaviors have also been described [Schlegel et al., 1965; Sorensen et al., 1978; Fryns et al., 1995; Hagerman, 1999].
A retrospective web-based study of 2087 adults found small but reliable associations between a history of physical illness and the character strengths of appreciation of beauty, bravery, curiosity, fairness, forgiveness, gratitude, humor, kindness, love of learning, and spirituality.
Our findings indicate that people with mental illness who receive greater support from the family are better able to have self-caring attitudes...They may also have more positive experiences and perceptions of recovery and attain greater levels of life satisfaction and enjoyment.
It encompasses various elements, such as spirituality, empowerment, embracing the illness actively, finding hope, restoring a positive identity, creating meaning in life, combating stigma, taking charge of one's own life, and cultivating supportive relationships [4]. PR concerns the individuals' perceived capacity to manage mental illness, their sense of purpose, and their confidence in their ability to lead a fulfilling life, irrespective of the disorder's severity [5]
For many, recovery is their preferred term to describe the continuing experience of living with, managing, or overcoming mental health difficulties [5].
It is the unfortunate result of the bidirectional relationship between depression and inactivity: depression leads to a reduced activity level, and depressive symptoms then become more severe. Berlin, et al.
By intentional activity, the authors meant discrete actions or practices that individuals must choose to engage in and that require some effort to enact. This might include adopting new behaviors such as an exercise program, changing one's cognitive attitudes or practices such as practicing forgiveness, or volitional activity such as pursuing personal goals.
Irritability describes proneness to anger... Irritability is a mood in the sense that young people can remain in states of proneness to anger for very long times and sometimes for no apparent reason, as discussed below... irritability shares a negative valence with anxiety and depression but denotes approach and is therefore linked to elation in mania.
The first session provided an overview of the training goals and an explanation of the differences between the three states of mind (i.e., emotional mind, rational mind and wise mind)...In DBT, ER skills training is oriented to encouraging behavioral activation (BA) by training patients in "opposite action" (OA) to depressive symptoms.
DBT was designed to treat emotional dysregulation (i.e., mood disturbance, affective liability, uncontrolled anger) and the behavioral difficulties..." & "Research has shown that there are potentially clinically significant results when using DBT to treat anger and aggression in various samples. Findings from this review suggest that treatments, even when modified show a positive impact on the reduction of anger and aggressive behaviors.
While they also experienced more improvement in depressive symptoms and in their ability to control emotional states, the difference between the two groups did not reach statistical significance.
...first phase of treatment focusing on increasing momentary clarity of motivational responses during emotional episodes and the cultivation of mindful emotion regulation skills with the goal of promoting counteractive responding to intense emotional experiences. Skills are presented in a specific order focusing on less cognitively elaborative skills (e.g., attention regulation skills) followed by more cognitively elaborative skills (e.g., metacognitive regulation skills).
Interpersonal and social rhythm therapy is a manual-based psychotherapy (E. Frank et al, unpublished data, 1999) focusing on 1) the link between mood and life events, 2) the importance of maintaining regular daily rhythms as elucidated by the SRM, 3) the identification and management of potential precipitants of rhythm dysregulation with special attention to interpersonal triggers, 4).
Shen, Alloy, Abramson, and Sylvia provided further evidence of social rhythm irregularities in bipolar spectrum disorder (2008). In a sample of 414 undergraduates, those diagnosed with either cyclothymia or bipolar II disorder reported significantly fewer regular activities than normal controls.
As well as being strongly associated with the clinical manifestation of BD, reduced social rhythmicity has also been demonstrated in some populations with increased risk for BD.
More than 30 years ago, it was observed that major life events associated with mood disorder (divorce, loss of job, life transitions) are not just psychologically challenging but also cause significant change to daily routines.10 Unemployment, for example, may be associated not just with challenges to self-esteem but also with less regular bed-, wake- and mealtimes. This instability of daily routines, in turn, may have circadian impact through weakened zeitgeber information.
...To foster psychological flexibility, according to Grégoire et al. (2017), ACT relies on six interrelated and overlapping processes: acceptance (i.e., willingness to open fully to unwanted experiences such as difficult thoughts, memories, or emotions), contact with the present moment (i.e., being mindful and aware of one's experiences), self as context (i.e., maintaining perspective about oneself within one's experiences), cognitive defusion (i.e., being able to step back from unwanted experiences without getting stuck in them), committed action (i.e., engaging in actions that move toward important aspects of life), and values (i.e., staying connected to personal values or areas of life that are important).