Severe Mood Disorders Research Articles

Effects of Neurodevelopmental Disorders on the Clinical Presentations and Therapeutic Outcomes of Children and Adolescents with Severe Mood Disorders: A Multicenter Observational Study.

Individuals with neurodevelopmental disorders (NDDs) are more susceptible to developing severe or resistant mood disorders. However, they often face challenges in accessing specific treatments. To understand the barriers to treatment in this group, we conducted a secondary analysis of a multicenter observational study on 305 adolescents referred to specialized care (mean age 14.38 ± 0.13 years, 57% girls, 9% bipolar disorder, 91% depressive disorders). NDDs were categorized based on the number of co-occurring NDDs for each subject (none: 67%, one: 18%, two: 7%, three: 5%, four and more: 2%). We explored the predictive value of the number of NDDs on various clinical and therapeutic factors. The analysis revealed significant associations between the number of NDDs and the duration of mood symptoms, persistent irritability, associated disruptive behavioral disorders, lower scores on the Children's Global Assessment Scale (CGAS) at baseline, and polypharmacy. The number of NDDs did not correlate with the use of antidepressants, the Clinical Global Impression-Improvement scale (CGI-I) at discharge, or changes in the CGAS score during the stay. The challenges in distinguishing mood disorders from chronic emotional and behavioral difficulties may contribute to the difficulties in accessing specific care for mood disorders. These results suggest that treatments for mood disorders demonstrate comparable effectiveness when provided regardless of the associations with NDDs.

Exploring Effective Interventions for Postpartum Blues: A Review of Current Literature

Postpartum blues, or "baby blues," is a common condition affecting 50-80% of new mothers, marked by mood swings, tearfulness, anxiety, and fatigue. It typically emerges within the first two weeks postpartum and can impact mother-infant bonding and maternal well-being. Left untreated, it may escalate into more severe postpartum mood disorders. This review aims to assess the efficacy, accessibility, and feasibility of various interventions for postpartum blues, synthesizing current research to inform clinical practices and future studies. A systematic review of peer-reviewed articles from 2010 to 2024 was conducted using PubMed, CINAHL, and PsycINFO databases. Articles were selected based on relevance, methodological rigor, and focus on postpartum blues interventions. After screening, 72 articles met the inclusion criteria and were included in the final analysis. The review identified several effective interventions across different domains: Psychosocial intervention particularly peer support programs and cognitive-behavioral therapy (CBT) were most effective in reducing postpartum blues symptoms; Hormonal and pharmacological interventions, including neuroactive steroids and selective serotonin reuptake inhibitors (SSRIs), showed mixed but promising results; Nutritional interventions, particularly omega-3 supplementation, demonstrated significant preventive effects; Mind-body interventions, such as mindfulness-based therapies, were effective in improving mood stability; Technology-based interventions, including mobile health applications and AI-driven support, showed potential for scalable and accessible solutions. Psychosocial interventions provide the strongest evidence for managing postpartum blues, while emerging research on hormonal, nutritional, and technology-based interventions offers promising new directions. A personalized, multimodal approach integrating these strategies is recommended for improving maternal mental health during the postpartum period.

CircRNAs as a novel class of potential diagnostic biomarkers in bipolar disorders.

Bipolar disorder (BD) is a severe mood disorder with uncertain causes and debilitating signs and symptoms. Gene expression is crucial to the pathophysiology of BD and could be influenced by genetic or epigenetic factors, by either direct modification of mRNA templates or by regulation of post-transcriptional translation. Recent evidence has shown that several critical processes in psychiatric diseases, such as neuronal activity or plasticity, synaptic transmission, and neuronal depolarization, have all been linked to circular RNAs (circRNAs). The circRNA profile of neuronal cells, which may be easily ascertained by a liquid biopsy, may shed light on the molecular pathophysiology of psychiatric disorders, including BD. This approach could aid in future development in diagnosis and treatment. In this review, we provide an in-depth understanding of the roles of circRNAs in the pathophysiology of BD and offer new insight into their potential as emerging diagnostic tools and therapeutic targets.

Positive vaccine beliefs linked to reduced mental stress in healthcare professionals during COVID-19: a retrospective study.

The COVID-19 pandemic has led to a significant adverse effect on the mental health of healthcare professionals. This study aims to assess the effects of the prolonged pandemic on burnout and mood disorders and to evaluate the influence of positive vaccination beliefs on these factors at a medical center during the extended COVID-19 pandemic. This retrospective study analyzed the results of an online questionnaire survey including burnout status and mood disorders from 2020 to 2022. The factors related to mood moderate/severe disorders and the impact of the positive vaccine belief were also explored. The initial analysis revealed that healthcare professionals continued to experience significant levels of personal and work-related burnout, along with mood disorders. However, the scores and the percentage of moderate to severe burnout gradually decreased. Notably, the percentage of individuals with moderate to severe mood disorders also gradually declined (2020: 13.4%, 2021: 12.3%, 2022: 11.1%). The number of participants who need professional interventions decreased from 56.2% in 2020 to 45.9% in 2021, and 46% in 2022. Multivariate analysis revealed a positive vaccine belief was associated with a lower risk of moderate/severe mood disorders, with odd ratios (OR) and 95% confidence intervals (95% CI) of 0.38 (0.28 - 0.52) and 0.41 (0.30 - 0.52) in the 2021 and 2022 cohorts, respectively. Further investigation revealed that age over 50 was linked to a positive vaccine belief in 2021 and 2022. Within the 2022 cohort, working as nurses was identified as the independent factor associated with a less positive belief, with the OR and 95% CI of 0.49 (0.27 - 0.90). The findings of the present study suggest burnout and mood disorders are still significant during the pandemic. A positive vaccine belief may mitigate pandemic-related mental distress. Further interventions to enhance the belief combined with other supporting measures are important in a long fight against the pandemic.

The Role of Spiritual Well-Being and Religious Coping in Psychiatric Morbidities Associated with Breast Cancer Patients: A Cross-Sectional Analysis

Background: Spirituality and religious resources support and enhance both overall and emotional well-being during adversity such as diagnosis of breast cancer. Breast cancer patients are at higher risk of developing severe anxiety, depression, and potential mood disorders. Aim: The aim is to assess, compare, and correlate spiritual well-being and religious coping in patients with breast cancer with and without psychiatric disorders (anxiety and depression). Materials and Methodology: Recently diagnosed 90 treatment-naïve breast cancer patients were selected in adherence to the inclusion and exclusion criteria. Hospital Anxiety and Depression Scale (HADS), Spiritual Assessment Scale, and Brief Religious Coping Scale were applied to the sample population. The study population was divided into two groups depending on scores of HADS, those having psychiatric disorders, and those who did not have. The data were analyzed using Mann‒Whitney test and Pearson’s correlation coefficient in the SPSS version 21. Results: More than half (61.1%) of the females suffered from psychiatric disorders after diagnosis of breast cancer. About 50% and 38.9% of the study population developed significant emotional distress, leading to the diagnosis of cases of anxiety and depression, respectively. Females suffering from psychiatric disorders have significantly lower spirituality, positive religious coping, and significantly higher negative religious coping than females without any psychiatric disorder. Total spirituality score (P = 0.034) is making a significant contribution toward predicting depression. Negative religious coping is making a significant contribution toward predicting both anxiety (P = 0.008) and depression (P = 0.045). Conclusion: The study suggests that spirituality and religion-based coping facilitates adaptive psychological adjustment to cancer and decreases the prevalence of anxiety and depression.

Mood Disorder and Oral Health

Mood disorders collectively represent one of the most common mental illnesses. Patients with mood disorders are more likely to have various physical illnesses compared to the general population. Of these diverse physical illnesses, poor oral health conditions are common, but they are often neglected in the care of mood disorders. This review examines the currently available evidence that altogether shows that oral disease both is common in patients with mood disorders and affects the course of mood disorders. In particular, oral disease is found to be common in patients with mood disorders, and patients with mood disorders put less effort toward oral hygiene than the general population. Symptoms of mood episodes, comorbid tobacco, alcohol, and substance use, diet, and pharmacological agents for mood disorder are all factors that could worsen oral health by worsening oral hygiene care. Etiological associations have also been suggested. Severe mood disorders can worsen oral health, and poor oral health could worsen mood disorder by increasing chronic low-grade inflammation. Mental health professionals should remain aware of the importance of oral hygiene in the clinical course of mood disorders and they should advise their patients to do regular dental checkups. [ Psychiatr Ann. 2024;54(8):e226–e229.]

Risk of severe mood and anxiety disorders in the adult children of parents with alcohol use disorder: a nationwide cohort study

BackgroundGrowing up with parental alcohol use disorder (AUD) is a risk factor for psychiatric disorders. This study investigated the risk of mood disorders and of anxiety disorders in the adult...

Beyond the Window of Risk? The Dutch Bipolar Offspring Study: 22-Year Follow-up

Adolescent offspring of parents with bipolar disorder (BD) are at high risk to develop BD and other psychopathology, yet how this risk continues into middle adulthood remains unknown. This study aimed to determine the window of risk for BD and other psychopathology in offspring of parents with BD followed from adolescence into adulthood. This study reported on the 22-year follow-up assessment of the Dutch Bipolar Offspring Study, a fixed cohort study of 140 participants established in 1997. Offspring (n= 100; mean [SD] age= 38.28 [2.74] years) of parents with bipolar I disorder or bipolar II disorder were assessed at baseline and 1-, 5-, 12-, and 22-year follow-up. No new BD onsets occurred since the 12-year follow-up (lifetime prevalence= 11%-13%; bipolar I disorder= 4%; bipolar II disorder= 7%). Lifetime prevalence of any mood disorder was 65%; for major depressive disorder, prevalence was 36%; and for recurrent mood episodes, prevalence was 37%. Prevalence of major depressive disorder more than doubled in the past decade. Point prevalence of any psychopathology peaked between 20 and 25 years (38%-46%), subsiding to 29% to 35% per year after age 30. Overall, 71% of offspring contacted mental health services since the last assessment. The risk for homotypic transmission of BD in offspring of parents with BD is highest during adolescence. The heterotypic risk for mood disorder onset and recurrences continues over the life course. Severe mood disorders are often preceded by milder psychopathology, emphasizing the need for early identification and interventions. This study allows for better understanding of the onset and course of mood disorders and specific windows of risk in a familial high-risk population.

Mechanisms Involved in the Link between Depression, Antidepressant Treatment, and Associated Weight Change.

Major depressive disorder is a severe mood disorder associated with a marked decrease in quality of life and social functioning, accompanied by a risk of suicidal behavior. Therefore, seeking out and adhering to effective treatment is of great personal and society-wide importance. Weight changes associated with antidepressant therapy are often cited as the reason for treatment withdrawal and thus are an important topic of interest. There indeed exists a significant mechanistic overlap between depression, antidepressant treatment, and the regulation of appetite and body weight. The suggested pathomechanisms include the abnormal functioning of the homeostatic (mostly humoral) and hedonic (mostly dopaminergic) circuits of appetite regulation, as well as causing neuromorphological and neurophysiological changes underlying the development of depressive disorder. However, this issue is still extensively discussed. This review aims to summarize mechanisms linked to depression and antidepressant therapy in the context of weight change.

Development of a Patient-Centred Care Plan for Patients Requiring Maintenance Electroconvulsive Therapy Long-Term

IntroductionMaintenance electroconvulsive therapy (ECT) can be effective and necessary in the long-term for patients with severe and recurrent mood or psychotic disorders that are not amenable to any other forms of treatment. Patients with such treatment resistance affecting their ability to maintain minimal daily activities may eventually fall within the palliative psychiatric care domain in which advanced medical directives become an important beacon to direct care. There are Psychiatric Advance Directives which allow people with severe mental health conditions to consent to or refuse to consent to hospital admission and psychiatric treatment in the event they lose decision-making capacity and this can be especially important for a potentially controversial treatment such as ECT. However, the focus tends to be on enforcing involuntary treatment and less about a comprehensive long-term care plan. To our knowledge, there is no available framework to structure maintenance ECT as a patient-centred care plan.ObjectivesOur aim is to share the process of development of a patient-centred care plan for patients requiring maintenance ECT. Our objectives are: 1.Constant engagement with patients and family or caregivers2.Regular reviews of clinical and consent aspects of treatment3.Advocating for the welfare of patients and respect of values4.Focus on dignity especially for patients who require treatment well into old age5.Being prepared for termination of treatment if necessary MethodsWe reviewed our management of previous and existing patients on maintenance ECT and incorporated diligent consent-taking practices. Adopting good practices from known palliative approaches and involving the patient voice helped to form a framework for a patient-centred care plan.ResultsOur patient-centred care plan features half-yearly discussions about the risks and benefits of treatment, as well as an assessment of the patient’s cognition and ability to consent which may change over time. Opportunities for them to share their values and expectations of care and engagement with their caregivers about their quality of life guide the continued treatment. A framework for discussing the disruption or eventual termination of ECT prepares for scenarios where older-aged patients may develop frailty or present with acute, prolonged or devastating medical concerns. This end-of-life care approach manages anticipated psychiatric-specific behavioural concerns and prepares for the possibility of death following the planned termination of ECT for patients who required long-term treatment throughout their life. Lastly, issues of grief amongst caregivers and ethical concerns from medical staff are addressed.Conclusions We hope that our patient-centred care plan provides a well-considered conversation and structure for the initiation, continuation and termination of maintenance ECT in the long-term.Disclosure of InterestNone Declared

Prescription of Opioid Analgesics for Chronic Non-Cancer Pain in Germany despite Contraindications: Administrative Claims Data Analysis.

In Germany, long-term opioid treatment (L-TOT) for chronic non-tumor pain (CNTP) is discussed as not being performed according to the German guideline on L-TOT for CNTP. In the present analysis, the occurrence and predictors of inappropriate care/overuse in a cohort of German insureds with L-TOT for CNTP by the presence of a contraindication with concurrent opioid analgesic (OA) therapy were investigated. We also analyzed whether prescribing physicians themselves diagnosed a contraindication. The retrospective cohort study was based on administrative claims data from a German statutory health insurance. Eight contraindication groups were defined based on the German guideline. Logistic regressions were performed in order to identify predictors for OA prescriptions despite contraindications. The possible knowledge of the prescribing physician about the contraindication was approximated by analyzing concordant unique physician identification numbers of OA prescriptions and contraindication diagnoses. A total of 113,476 individuals (75% female) with a mean age of 72 years were included. The most common documented contraindications were primary headaches (8.7%), severe mood disorders (7.7%) and pain in somatoform disorders (4.5%). The logistic regressions identified a younger age, longer history of OA therapy, opioid related psychological problems, and outpatient psychosomatic primary care as positive predictors for all contraindication groups.

Psychosis Recovery Orientation in Malawi by Improving Services and Engagement (PROMISE) protocol.

Malawi has a population of around 20 million people and is one of the world's most economically deprived nations. Severe mental illness (largely comprising psychoses and severe mood disorders) is managed by a very small number of staff in four tertiary facilities, aided by clinical officers and nurses in general hospitals and clinics. Given these constraints, psychosis is largely undetected and untreated, with a median duration of untreated psychosis (DUP) of around six years. Our aim is to work with people with lived experience (PWLE), caregivers, local communities and health leaders to develop acceptable and sustainable psychosis detection and management systems to increase psychosis awareness, reduce DUP, and to improve the health and lives of people with psychosis in Malawi. We will use the UK Medical Research Council guidance for developing and evaluating complex interventions, including qualitative work to explore diverse perspectives around psychosis detection, management, and outcomes, augmented by co-design with PWLE, and underpinned by a Theory of Change. Planned deliverables include a readily usable management blueprint encompassing education and community supports, with an integrated care pathway that includes Primary Health Centre clinics and District Mental Health Teams. PWLE and caregivers will be closely involved throughout to ensure that the interventions are shaped by the communities concerned. The effect of the interventions will be assessed with a quasi-experimental sequential implementation in three regions, in terms of DUP reduction, symptom remission, functional recovery and PWLE / caregiver impact, with quality of life as the primary outcome. As the study team is focused on long-term impact, we recognise the importance of having embedded, robust evaluation of the programme as a whole. We will therefore evaluate implementation processes and outcomes, and cost-effectiveness, to demonstrate the value of this approach to the Ministry of Health, and to encourage longer-term adoption across Malawi.

Methyleugenol Has an Antidepressant Effect in a Neuroendocrine Model: In Silico and In Vivo Evidence.

Major depressive disorder is a severe mood disorder characterized by different emotions and feelings. This study investigated the antidepressant activity of the phenylpropanoid methyleugenol (ME) in adult female mice exposed to a stress model induced by dexamethasone. The animals were randomly divided into groups containing eight animals and were pre-administered with dexamethasone (64 μg/kg subcutaneously). After 165 and 180 min, they were treated with ME (25, 50 and 100 mg/kg intraperitoneally) or imipramine (10 mg/kg intraperitoneally) after 45 min and 30 min, respectively; they were then submitted to tests which were filmed. The videos were analyzed blindly. In the tail suspension test, ME (50 mg/kg) increased latency and reduced immobility time. In the splash test, ME (50 mg/kg) decreased grooming latency and increased grooming time. In the open field, there was no statistical difference for the ME groups regarding the number of crosses, and ME (50 mg/kg) increased the number of rearing and time spent in the center. Regarding in silico studies, ME interacted with dopaminergic D1 and α1 adrenergic pathway receptors and with tryptophan hydroxylase inhibitor. In the in vivo evaluation of the pathways of action, the antidepressant potential of ME (50 mg/kg) was reversed by SCH23390 (4 mg/kg intraperitoneally) dopaminergic D1 receptor, Prazosin (1 mg/kg intraperitoneally) α1 adrenergic receptor, and PCPA (4 mg/kg intraperitoneally) tryptophan hydroxylase inhibitor. Our findings indicate that ME did not alter with the locomotor activity of the animals and shows antidepressant activity in female mice with the participation of the D1, α1 and serotonergic systems.

Using Kernel Density Estimation in Knowledge Distillation to Construct the Prediction Model for Bipolar Disorder Patients

Bipolar disorder is a severe mood disorder and is one of the top 20 causes of disability in the world. Although there have been numerous studies based on machine learning models for the detection of bipolar disorder patients, these works have limitations. This study used a kernel density estimation algorithm to generate distributions of the input data, which can make knowledge distillation work and can improve prediction performances of the machine learning models for bipolar disorder. To the best of our knowledge, this is the first attempt to apply kernel density estimation to knowledge distillation. Another main contribution is that we used medical history information that was readily available from the electronic health record system, trying to improve the limitation of previous studies that needed to use special instruments to collect input data. Furthermore, in view of the fact that most previous studies have sample sizes of less than 1000, we collected tens of thousands of data samples to improve the representativeness of the constructed prediction models. Finally, the generated data distributions helped the decision tree algorithm to select the appropriate branching attributes to construct the prediction models. These branching attributes can be mapped back to specific diseases that are all associated with bipolar disorder.

Trastornos afectivos, trastornos depresivos y trastorno bipolar

Mood disorders are a set of psychiatric illnesses in which abnormal moods are observed. Most mood disorders are chronic and recurrent in nature, entailing a deterioration in the subject's functioning and thus hindering the person's adaptation to their daily life. Together with anxiety disorders, they are among the most common psychiatric disorders. This update aims to provide an overview of the symptoms, diagnosis, and treatment of the most severe and relevant mood disorders.

Advocacy and Lactation Support for Patient With Bipolar Disorder: A Case Report

Introduction:Bipolar disorder (BD) is a severe affective mood disorder with medication management as the backbone of treatment; however, medication use during pregnancy and lactation impacts a patient’s decision and ability to breastfeed. Disparate recommendations from healthcare providers may further undermine a patient’s ability to achieve their lactation goals.Methods:This case reviews the role of the lactation consultant in facilitating interprofessional collaboration to help meet the breastfeeding goals of the patient with BD.Results:Interdisciplinary collaboration with several providers through pregnancy, postpartum, and the community setting helped this mother achieve her goal to breastfeed her infant for 5 months.Conclusion:The IBCLC is perfectly positioned to represent the patient’s interests and facilitate interprofessional collaboration to achieve breastfeeding goals.

Mental Health Assessment and Risk Characterization in Puerto Rico’s Homeless Post-Hurricane Maria

ABSTRACT This study provides a mental health assessment of the homeless of Puerto Rico, compared to a non-homeless sample, in the aftermath of Hurricane Maria. Multi-stage sampling was used to assess risk of anxiety, depression, and PTSD, as well as provide a demographic profile of the homeless and non-homeless of Puerto Rico. The homeless, compared to non-homeless, had a significantly higher risk for all tested mental disorders. Pre-hurricane homeless had significantly higher risk for Major Depressive Disorder and severe mood and anxiety disorders compared to post. This study highlights the need for disaster preparedness strategies specific to this disproportionately affected population.

Bipolar disorder longitudinal study in Nigeria – Preliminary data on demographic and clinical findings of the study cohort

BackgroundBipolar disorder, severe mood disorder characterised by its ability to swing between two contrasting poles of low and elated mood with a return to relatively normal level of functioning, has a lifetime prevalence of up to 2.4%, a heterogenous clinical picture, significant burden of disease, and a high co-morbidity rate. With significant lack of data from the African continent on bipolar disorder, this study was started with an aim to provide insight into the sociodemographic, biological, clinical, and cultural picture of bipolar disorder in Nigeria. MethodsPhase I of the study required the development of a bipolar registry and collection of data in a retrospective manner from patient clinically diagnosed with bipolar disorder at the department of neuropsychiatry, University of Port Harcourt Teaching Hospital in Nigeria. Data collection on demography, illness onset, duration to bipolar diagnosis, mood polarity etc., were extracted manually from patient case files using a data form developed by the research team. ResultBipolar disorder has a mean age at onset of 27.43±10.56 years, with younger age at onset in males. There is a relatively high misdiagnosis rate of bipolar disorder with delay in making a bipolar diagnosis of 19.39 months. The data also show the presence of singular mood polarity in bipolar disorder. ConclusionPreliminary findings from the bipolar disorder longitudinal study in Nigeria has provided much needed data for bipolar disorder in Nigeria. It also makes evident the need for a prospective, multicentre study of the life course of bipolar disorder as intended in the second phase of the study.

Neuroimaging study of electroconvulsive therapy for depression.

Electroconvulsive therapy (ECT) is an important treatment for depression. Although it is known as the most effective acute treatment for severe mood disorders, its therapeutic mechanism is still unclear. With the rapid development of neuroimaging technology, various neuroimaging techniques have been available to explore the alterations of the brain by ECT, such as structural magnetic resonance imaging, functional magnetic resonance imaging, magnetic resonance spectroscopy, positron emission tomography, single photon emission computed tomography, arterial spin labeling, etc. This article reviews studies in neuroimaging on ECT for depression. These findings suggest that the neurobiological mechanism of ECT may regulate the brain functional activity, and neural structural plasticity, as well as balance the brain's neurotransmitters, which finally achieves a therapeutic effect.

Ferulic acid as a therapeutic agent in depression: Evidence from preclinical studies.

Depression is a common but severe mood disorder with a very high prevalence across the general population. Depression is of global concern and poses a threat to human physical and mental health. Ferulic acid (FA) is a natural active ingredient that has antioxidative, anti-inflammatory, and free radical scavenging properties. Furthermore, studies have shown that FA can exert antidepressant effects through a variety of mechanisms. The aim of the review was to comprehensively elucidate the mechanisms in FA that alleviate depression using animal models. The in vivo (animal) studies on the mechanism of FA treatment of depression were searched in PubMed, Chinese National Knowledge Infrastructure, Baidu academic, and Wan fang databases. Thereafter, the literature conclusions were summarized accordingly. Ferulic acid was found to significantly improve the depressive-like behaviors of animal models, suggesting that FA is a potential natural product in the treatment of depression. The mechanisms are achieved by enhancing monoamine oxidase A (MOA) activity, inhibiting microglia activation and inflammatory factor release, anti-oxidative stress, promoting hippocampal nerve regeneration, increasing brain-derived neurotrophic factor secretion, regulating gut microbiome, and activating protein kinase B/collapsin response mediator protein 2 (AKT/CRMP2) signaling pathway. Ferulic acid produces significant antidepressant effects in animal depression models through various mechanisms, suggesting its potential value as a treatment of depression. However, clinical research trials involving FA are required further to provide a solid foundation for its clinical application.