Phenomenology of Affective Disorders

The clinical syndrome of all affective disorders is a persistent and pervasive disturbance in mood, selfattitude, vital sense, and neurovegetative functioning. In depression, the varieties of mood disturbance include not only melancholia or sadness, but also apathy, anxiety, and irritability. Some patients describe depression as the absence of any feeling. The mood of a manic patient may be elated, but also irascible to the point of belligerence, expansive without a sense of euphoria, or simply excitable.

Self-attitude, the feeling of personal worth, is insidiously disturbed in affective disorders. The disturbance in self-valuation often impedes treatment. Depressed patients may delay treatment because the suffering they experience seems somehow deserved; ultimately suicide may be desired because the patient feels that he or she is such a burden on others. Manic patients may feel smarter than the doctor and others, and may feel misunderstood or insulted by the suggestion they are ill.

Affectively ill patients have a disturbance in the sense of physical well-being, or vital sense. In depressed patients, physical well-being is lacking; patients feel tired, weak, slow, and inept; cognition is halting or uncertain. Manic patients tend to feel energized, quick, tireless, and powerful. Thoughts move swiftly; the patient may have the sense that he or she is thinking circles around others, while others may find the patient’s ideas loose, connected by the thinnest of associations - clanging speech, riddled with puns and rhymes, is seen in severe cases - or at the most severe, incomprehensible.

Neurovegetative functioning - the body’s internal regulation of activity and metabolism - is typically disturbed in both syndromes. Depressed patients may have insomnia or may sleep to excess without feeling rested. Manic patients may feel little to no need to sleep and may arise rested after a few hours and carry on in this manner to the marvel (or annoyance) of others. Appetites tend to diminish with depression (though some will overeat or binge); in mania the drive for food is less often disturbed, but the drives for sex, acquisition, and excitement are enhanced.

Affective disorders are diagnosed from clinical history and observation of the patient’s demeanor and behavior. The clinician is more certain of the diagnosis upon hearing the patient’s own description of troubling mental phenomena and personally observing signs (e.g., emaciation, lethargy, agitation, rapid speech) consistent with the clinical syndrome. There are no laboratory tests to reveal affective disorder.