Mood Disorders

I. Overview, History, and Classification of Mood Disorders.- 1. Mood Disorders: An Introduction.- Two Case Histories.- Melancholia.- Mania.- The Semantics of Mood and Its Disorder.- The Clinical Manifestations of Mood Disorder.- Who Suffers Mood Disorders?.- The Distinction between Mood Change and Clinical Episode.- The Subjective Experience of Depressed Mood.- The Affective Experience: Teleological and Literary Reflections.- References.- 2. Mood Disorders: Historical Perspective and Current Models of Explanation.- Early Struggles: The Empirical and the Supernatural.- Introspection and the Comfort of Metaphysics.- The Cartesian Dualism of Mind and Body.- The Rise of Humanism and Objective Observation.- The Progenitors of Current Understanding: Freud, Kraepelin, and Meyer.- The Common-Sense Psychobiology of Adolf Meyer.- Current Concepts of Mood Disorder.- Intrapsychic Models of Depression.- Behavioral Models of Depression.- Biological Models of Affective Disorder.- In Conclusion.- References.- 3. Clinical and Familial Subtypes of Mood Disorders: Observation, Opinion, and Purpose.- Why Classify?.- Phenomenology and Pathogenesis: Confusion and Debate.- Symptomatology and the Classification of Mood Disorders.- The Need to Be Practical.- A Primary-Secondary Distinction.- Classifying Primary Mood Disorder: Dimensional and Axial Techniques.- Family Studies and the Unipolar/Bipolar Distinction.- Other Specific Disorders: Variants of the Major Affective Disorders.- Toward a Practical Nosology: DSM-III.- Outcome Studies of the Diagnostic Criteria.- References.- II. Elements of Present Knowledge.- 4. Attachment and Loss.- The Experience of Grief.- Bereavement and Its Sequelae.- Attachment and Its Formation.- Attachment as a Primary Drive.- Failure to Develop Primary Attachment.- Behavior following Separation in Human and Monkey Infants.- Separation and the Precipitation of Mood Disorders.- Sensitization to Adult Depression by Loss in Childhood.- Some Conclusions and Comment.- References.- 5. The Meaning of Loss: Psychoanalytic Explorations.- The Roots of Psychoanalysis.- Early Psychoanalytic Concepts of Melancholia.- Structural Analytic Approaches.- The Mother-Child Relationship and the Depressive Position.- The Evolution of Analytic Concepts.- Self-Esteem, the Ego, and Depression.- Theories of Manic-Depressive Oscillation.- Reality Distortion in Depression.- Some Conclusions and Comment.- References.- 6. The Neurobiological Foundations of Behavior: Environmental Challenge and Response.- Illustrations from Endocrinology.- Chemical Signaling Systems.- Homeostatic Control Mechanisms.- Orchestrated and Dual Systems of Control.- Marking Time with Neurophysiology.- A Neuroanatomy of Function.- Neurochemical Mapping.- The Neuroanatomic Chemistry of Emotion.- The Importance of Technology.- The Life Cycle of the Biogenic Amines.- Manufacture.- Events at the Synapse.- Subsequent Metabolism.- The Interface between Neurochemical and Neuroendocrine Mechanisms.- The Neuroendocrine Response to Environmental Challenge.- Early Studies.- Individual Differences in Response.- Some Conclusions and Comment.- References.- 7. The Emerging Neurobiology of Mood Disorder.- The Nature of the Evidence.- Serendipity: New Drug Treatments and the Pharmacological Bridge.- Biochemical Correlates of the Affective Syndromes.- Studies of Urinary Metabolites.- Investigation of the Cerebrospinal Fluid.- Studies of Brains of Suicide Victims and Postmortem Material.- Neuropsychopharmacology and Biogenic Amine Metabolism.- Influencing the Manufacture of Biogenic Amines.- Influencing the Dynamics of Release of Biogenic Amines.- Influencing the Receptor Site at the Postsynaptic Neuron.- Decreasing the Destruction of Monoamines.- The Evidence in Summary.- The Prediction of Pharmacological Response.- The Affective Syndromes and Hypotheses of Amine Interdependence.- Neurophysiological Arousal States in Melancholia and Mania.- Electrolyte Studies.- Sleep Studies.- Changes in Endocrine Function and Physiological Mechanisms of Defense.- The Brain-Corticosteroid Axis.- The Brain-Thyroid Axis: An Adaptive Mechanism?.- The Role of Receptor Sensitivity in Affective Illness and the “Switch Mechanism” of Bipolar Illness.- Some Conclusions and Comment.- References.- III. Toward a Synthesis.- 8. Theoretical Aspects of Living Systems: Philosophical Pitfalls and Dynamic Constructs.- The Philosophical Pitfall of the Mind-Body Dichotomy.- Living Organisms as Open Systems: Dynamic Stability through Regulation and Control.- Analogy with the Mechanical World.- Rhythmic Behavior and Temporal Organization in Biology.- Human Biological Clocks.- Light as a Zeitgeber in Human Beings.- The Changing Photoperiod and Seasonal Depressions.- Evidence for Temporal Disorder in the Final Common Path of Affective Illness.- Dynamic Mechanisms Which Serve Stability and Flexibility.- Dynamic Systems and Subsystems: Some Definitions.- Describing the Behavior of Complex Systems: Mathematics as a Potential Common Language.- Conclusion and a Review of Dynamic Constructs.- References.- 9. Toward a Psychobiological Integration: Affective Illness as a Final Common Path to Adaptive Failure.- The Evidence for a Final Common Path to Disorder.- The Predisposition to Disorder.- Genetic Vulnerability.- Predisposing Temperament.- The Modulating Influence of Age and Sex.- Physical Illness and Its Treatment.- Loss of Attachment in Childhood.- Predisposing Character Traits.- Precipitating Factors That Initiate the Path to Dysfunction.- Psychosocial Variables as Precipitants.- Precipitating Factors in Mania and Hypomania.- Intermediary Mechanisms to Adaptive Dysfunction.- Appraisal, Response, and Pathway Initiation.- Biological Mediation of the Arousal Response.- The Importance of the Diencephalon.- An Integrative Model of Depression.- Conclusions.- References.- 10. Implications for Clinical Practice, Training, and Research.- Implications for Clinical Practice.- The Importance of Diagnosis.- Principles of Comprehensive Clinical Care.- Mood Clinics and Affective Disorder Units.- Implications for Training.- In General.- Post-Residency Fellowships.- Implications for Research.- Epilogue: The Case for Optimism.- References.- Author Index.