Chapter 5 — Mood Disturbances

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Last Updated on March 27, 2021 by Atif

Mood Disorders: Definitions and Diagnosis (Chapter 5) The word mood refers to a pervasive and long-lasting emotional state that can here by influence any aspect of a person’s life and perceptions. Mood disorders include full or partial periods of depression or mania, as well as pathologically elevated or depressed mood disturbances. Severe depression, dysthymia (dysthymic disorder), bipolar disorder, mood disorder attributable to a general medical condition, and substance-induced mood disorder are the most common forms of mood disorders. Mood disturbances have no obvious cause. A mood episode (for example, major depression) is a set of symptoms that appear at the same time and last for a certain amount of time. A major depressive episode is characterized by a depressed mood, as well as a lack of pleasure or indifference to most or all activities, that lasts for at least two weeks straight. Significant changes in energy, sleep habits, concentration, and weight can almost always accompany these mood shifts. Psychomotor agitation or retardation, persistent feelings of worthlessness or inappropriate guilt, and recurring thoughts of death or suicide are all possible symptoms. Evidence of one or more major depressive episodes occurring without specifically being linked to another psychological, AOD use, or medical condition is necessary for the diagnosis of major depression. Serious depression is divided into three categories: major depressive disorder, single episode depression, and chronic depression. The DSM-IV draft lists nine signs of a major depressive episode, and at least five of them must be present for two weeks to be diagnosed with this condition.

Dysthymia is a chronic mood disturbance characterized by a loss of interest or pleasure in most activities of daily life but not meeting the full criteria for a major depressive episode. The diagnosis of dysthymia requires mild to moderate mood depression most of the time for a duration of at least 2 years.

A manic episode is a phase of persistently high, euphoric, irritable, or expansive mood lasting at least one week. Hyperactivity, grandiosity, flight of thoughts, talkativeness, a reduced need for sleep, and distractibility are all possible symptoms. Manic episodes are characterized by a rapid onset and symptom development within a few days, and they often affect occupational or social functioning, necessitating hospitalization to avoid harm to themselves or others. People suffering from mania often experience psychotic hallucinations or delusions. It may be difficult to tell the difference between this form of mania and schizophrenia or stimulant intoxication.

A hypomanic episode is a phase of pathologically elevated mood that resembles but is not as severe as a manic episode (weeks or months). Hypomanic episodes do not cause substantial deterioration in social or occupational functioning, nor do they necessitate hospitalization.

Evidence of one or more manic episodes, sometimes in a person with a history of one or more major depressive episodes, is used to diagnose bipolar disorder. Depending on the clinical characteristics of the present or most recent episodes, bipolar disorder is categorized as manic, depressive, or mixed. A major manic or depressive episode can be accompanied by a brief episode of the opposite.

Cyclothymia is a moderate type of bipolar disorder characterized by more severe and recurrent mood swings. Multiple hypomanic episodes and cycles of depressed mood inadequate to fulfill the criterion for a psychotic or major depressive disorder characterize cyclothymia. According to the updated third edition of the Diagnostic and Statistical Manual of Psychiatric Disorders (DSM-III-R), cyclothymia must be diagnosed after a two-year period in which the patient is never without hypomanic or dysthymic symptoms for more than two months.

Substance-induced mood disorder is described in the DSM-IV draft according to the following criteria:

  1. A mood disturbance that is apparent and lasts for a long time and is characterized by either (or both) of the following:
  2. Elevated, expansive, or irritable mood; depressed mood or markedly reduced involvement or enjoyment in all, or nearly all, activities.
  3. There is proof of drug intoxication or withdrawal from the past, physical examination, or laboratory findings, and the symptoms in criterion A formed during, or within a month of, severe substance intoxication or withdrawal.
  4. A mood condition that is not caused by drugs or alcohol does not account for the disruption. Evidence that the signs are best explained by a mood condition that is not caused by drugs or alcohol may include: The signs appear before the onset of drug abuse or dependency, and they last for a long time. (e.g., about a month) They are significantly greater than what would be expected given the character, length, or amount of the substance used; or there is other evidence indicating the presence of an independent non-substance-induced mood disorder after the cessation of acute withdrawal or serious intoxication; or they are substantially greater than what would be expected given the character, duration, or amount of the substance used (e.g., a history of recurrent non-substance-related major depressive episodes) .
  5. Clinically serious distress or disability in social, educational, or other critical areas of functioning is almost always triggered by the symptoms.
  6. The disruption does not only happen when someone is delirious.
  7. In general, nearly everyone with a mood disorder has ongoing feelings of sadness from within, and may feel helpless, hopeless, and irritable. Without treatment, symptoms can last for weeks, months, or years, and can impact quality of life.

Substance-induced mood disorders may be classified as 1) psychotic, 2) depressive, or 3) mixed mood disorders. It can also be defined as starting during intoxication or withdrawal. The DSM-IV draft contains the possibility of a substance-induced condition among most of the main mental illnesses.

Incidence

The Epidemiologic Catchment Area (ECA) research showed that approximately 40% of people with an alcohol problem often had a psychological problem, based on standardized interviews. More than half of people with other opioid addictions said they had psychological symptoms (Regier et al., 1990).

Anxiety and mood disturbances are the most common clinical diagnosis for patients with an AOD condition. A large number of people with a mood disorder suffer from severe depression. Mood problems may be more common in methadone and heroin addicts than in other drug users. The percentage of patients diagnosed with major depression in an alcohol care environment is smaller than in a mental health setting.

The findings of the ECA research can be used to estimate the prevalence rates of mood disorders in the general population (Regier et al., 1988; Robins et al., 1988). According to these reports,

  • In the ECA sample of New Haven, Baltimore, and St. Louis, the lifetime prevalence rates for any mood disorder ranged from 6.1 to 9.5 percent.
  • In the ECA sample of New Haven, Baltimore, and St. Louis, the lifetime prevalence rates for any mood disorder ranged from 6.1 to 9.5 percent.
  • Dysthymia prevalence rates ranged from 2.1 to 3.8 percent over a lifetime.
  • Manic episode prevalence rates ranged from 0.6 to 1.1 percent over a lifetime.

According to some research, the prevalence of mood and anxiety disorders in AOD users is no higher than in the general population. Other studies also shown that people with AOD disorders have higher prevalence of these disorders. While several patients in drug care appear depressed, only a small percentage of them receive a formal diagnosis of major depression as a co-occurring disorder.

Many AOD offenders can experience depressive symptoms that diminish with time and are linked to acute withdrawal within the first months of sobriety. As a result, depressive symptoms during withdrawal and early recovery could be caused by AOD disorders rather than an underlying depression. Until a diagnosis of depression is made, a period of time should pass.

The prevalence of mood disorders may be high among women with an AOD condition. The prevalence of depression among alcoholic women is higher than that of alcoholic men. Counselors should be mindful that women are more likely than men to be clinically depressed in both addiction and non addiction care environments.

Other classes, in addition to women, need special attention. Native Americans, HIV patients, methadone patients, and the elderly may all be at an elevated risk of depression. The elderly may be at the greatest risk for co-occurring mood disorders and AOD issues. Mood swings begin to rise in frequency as people grow older. Also when their AOD use is under control, elderly people with combined mood and AOD disorders have more mood episodes as they grow older.

Who is at risk for mood disorders?

Anyone can feel sad or depressed at times. However, mood disorders are more intense and harder to manage than normal feelings of sadness. Children, teens, or adults who have a parent with a mood disorder have a greater chance of also having a mood disorder. However, life events and stress can expose or worsen feelings of sadness or depression. This makes the feelings harder to manage.

Sometimes, life’s problems can trigger depression. Being fired from a job, getting divorced, losing a loved one, death in the family, and financial trouble, to name a few, all can be difficult and coping with the pressure may be troublesome. These life events and stress can bring on feelings of sadness or depression or make a mood disorder harder to manage.

The risk of depression in women is nearly twice as high as it is for men. Once a person in the family has this diagnosis, their brothers, sisters, or children have a higher chance of the same diagnosis. In addition, relatives of people with depression are also at increased risk for bipolar disorder .

Once a person in the family has a diagnosis of bipolar disorder, the chance for their brothers, sisters, or children to have the same diagnosis is increased. Relatives of people with bipolar are also at increased risk for depression.

Differential Diagnosis is a concept used to describe the process of distinguishing between two

Phase of Diagnosis

Diagnoses of psychiatric disorders should be provisional and constantly reevaluated. In addiction treatment populations, many psychiatric disorders are substance-induced disorders that are caused by AOD use. Treatment of the AOD disorder and an abstinent period of weeks or months may be required for a definitive diagnosis of an independent psychiatric disorder. Unfortunately, the severely depressed person may drop out of treatment or even commit suicide while the clinician is trying to sort things out (see section on “Assessing Danger to Self or Others.”)

Intoxication with stimulants, hormones, hallucinogens, or polydrug combinations may cause or imitate acute manic symptoms. They can also be brought about by the removal of depressants like alcohol, as well as medical conditions like AIDS and thyroid disorders. Acute mania, which is characterized by hyperactivity, psychosis, and often violent and impulsive behavior, is a medical emergency that should be referred to emergency mental health practitioners. This is so regardless of the underlying causes.

Mood disorders may be confused with other mental disorders. Addiction is the most common disease that mimics a mood disorder, and it is often undiagnosed or misdiagnosed. Schizophrenia, brief reactive insanity, and anxiety disorders are all disorders that can make diagnosis difficult.

Patients with personality disorders, especially borderline, narcissistic, and antisocial styles, often exhibit mood disorder symptoms. These signs are often intermittent and do not satisfy the diagnostic criteria of long-term persistence. Furthermore, all of the psychiatric conditions listed here can occur alongside AOD and mood disorders.

EXAMPLES OF CASE STUDIES: GEORGE AND MARY

George, a divorced 37-year-old man, was taken to the emergency room inebriated. His blood alcohol level was 152, and he tested positive for cocaine on a toxicology sample. He was also on the verge of committing suicide ( “This time, I’m going to get it right! I’ve got a weapon “(Imaginative+ paraphrase). He has three psychiatric hospitalizations and two inpatient AOD services on his record. AOD usage followed each psychiatric admission. George has never completed his medical therapy. He has gone to AA on occasion, but not lately.

Mary is a divorced 37-year-old woman who was admitted to a detoxification unit with a blood alcohol level of 150 and was described as depressed and withdrawn. She has never used drugs (other than alcohol) and has only been drinking for three years. She has, however, had some alcohol-related issues since then. At the ages of 19, 23, and 32, she had three medical hospitalizations for depression. She claims that antidepressants have helped her. She is not undergoing AOD or medical care at this time.

Case cases of differential diagnosis problems.

When making initial diagnosis and treatment decisions, several considerations must be considered. What if George’s psychiatric admissions lasted two to three days, with discharges typically linked to leaving against medical advice? If two of his clinical admissions were 4 to 6 weeks long, with well established manic and psychotic symptoms persisting during the course despite intensive psychiatric care and medication, decisions about diagnosis and treatment would be very different.

What if Mary had abstained from alcohol for six months “on her own,” but had become steadily depressed, exhausted, and withdrawn over the previous three months, with disturbed sleep and poor concentration, as well as suicidal thoughts? She also relapsed last night, while trying to kill herself. If Mary had been taking antidepressants for a year and had intensified her heavy drinking in the last month, she would have a different diagnosis, and she would have lost her job yesterday as a result of her drinking.

What methods are used to treat mood disorders?

Mood disturbances are often successfully treated. The following treatments can be used:

  • Antidepressant and mood-stabilizing drugs have been shown to be effective in the treatment of depression, particularly when combined with psychotherapy. Psychotherapy—The most popular forms of counseling are cognitive-behavioral and/or interpersonal therapy. The aim of this therapy is to change the person’s skewed perceptions of himself and the world around him. It also assists in the growth of interpersonal relationship skills and the detection of environmental stressors and how to prevent them.
  • Family therapy
  • Other therapies, such as electroconvulsive therapy and transcranial stimulation

In every recovery process, families play a crucial supporting role.

People with mood disorders will live happy, prosperous, and healthy lives if they are properly diagnosed and treated.

Mood Disturbances Caused by AOD

It’s crucial to differentiate between mood disorders and the symptoms of AOD intoxication, withdrawal, and/or chronic use. These distinctions are particularly crucial after long-term usage of drugs that cause physiologic dependency.

Any psychoactive agent changes one’s natural mood. Preexisting mood states, form and volume of substance used, chronicity of drug use, path of drug administration, current medical status, and history of mood disorders all affect the severity and manner of these changes.

AOD-induced mood changes may occur as a result of short-term and long-term drug use, as well as drug withdrawal. Sedative-hypnotic intoxication can cause AOD-induced mood disorders, most commonly acute depression lasting hours to days. In the same way, chronic or subacute withdrawal, which can last anywhere from weeks to months, can lead to depressive symptoms, which are often followed by suicidal ideation or attempts.

Also, particularly after long-term, high-dose stimulant use, stimulant withdrawal may trigger depressive symptoms that last from hours to days. Symptoms of hysteria can last anywhere from hours to days during stimulant-induced mania. Overall, addiction can cause biopsychosocial disintegration, which can lead to chronic dysthymia or depression that can last months or years.

Since the symptoms of mood disorders that follow acute withdrawal syndromes are often the product of the withdrawal, enough time should pass before a definitive diagnosis of a separate mood disorder is made.

AOD-induced conditions must be distinguished from conditions that often cause and imitate mood disturbances and symptoms. When symptoms continue or worsen, they may be signs of AOD-related psychiatric illnesses. Transient dysphoria after stopping stimulants may be mistaken for a depressive episode. A depressive episode can be diagnosed, according to the DSM-IV draft, if symptoms are severe and last more than a month after acute withdrawal. A substance-induced mood disturbance may be diagnosed if the symptoms last for less than a week.

Generalizations about particular medications causing specific behavioral syndromes are difficult to make. There is a lot of variety, as seen in Multiple substance use complicates the differential diagnosis even further. If at all practicable, diagnostic procedures such as urinalysis and toxicology screens should be used. It’s also worth noting that addicted patients may experience withdrawal symptoms from one medication even though they’re taking another.

ADDITIVES

Cocaine and amphetamines are stimulants that cause intense psychomotor stimulation. Increased mental and physical capacity, feelings of well-being and grandiosity, and rapid pressured expression are all symptoms of stimulant intoxication. Chronic, high-dose stimulant intoxication can lead to mania, particularly when combined with sleep deprivation. Symptoms involve a euphoric, expansive, or irritable mood, often accompanied by flight of ideas, extreme impairment of social functioning, and insomnia.

Depressed mood, anxiety, exhaustion, voracious appetite, and insomnia or hypersomnia are typical signs of acute stimulant withdrawal, which may last anywhere from a few hours to a week. Depression induced by stimulant withdrawal can be intense, and it can be compounded by a person’s knowledge of addiction’s negative consequences. Symptoms of stimulant addiction are likely, and suicide is a possibility.

Anhedonia and lethargy are common symptoms of long-term stimulant withdrawal, as are repeated ruminations and dreams about stimulant use. Following the removal of stimulants, there may be bursts of dysphoria, acute depression, insomnia, and anxiety for many months. The quality of the patient’s treatment program can intensify or relieve these symptoms.

DEPRESSANTS are sad individuals.

Depressants of the central nervous system, such as alcohol, benzodiazepines, and opioids, slow down an individual’s psychomotor functions in general. Acute alcohol and opioid overdose, on the other hand, often includes two phases: euphoria at first, accompanied by a longer period of relaxation, sedation, lethargy, apathy, and drowsiness.

Sedative-hypnotic intoxication can be caused by alcohol, barbiturates, and benzodiazepines, particularly when taken in high doses. Mood swings, mental dysfunction, poor memory and concentration, lack of balance, unsteady gait, slurred expression, and confusion are all examples of psychomotor symptoms.

PCP, HALLUCINOGENS, AND MARIJUANA

Hallucinosis is a state of intoxication caused by hallucinogens that shares many characteristics with psychotic disorders and a few with mood disorders. LSD and other hallucinogens, as well as drugs like MDMA (methylenedioxy-methamphetamine, or Ecstasy) and MDA (methylenedioxyamphetamine), may cause extreme emotional experiences that the user can interpret as positive or negative mood states.

Personality, preexisting mood state, personal expectations, medication dosage, and environmental surroundings all have an effect on these interactions. While many users will encounter sensory and visual distortions, others will have euphoric religious or philosophical experiences comparable to those associated with a manic or psychotic episode. Others may have a highly distressing introspective experience that leads to depressive symptoms.

Marijuana may have a range of mood-altering effects due to its sedative and psychedelic properties. High doses of marijuana can cause acute marijuana overdose with euphoria or anxiety, grandiosity, and “profound thoughts” in people who have not built a tolerance for the drug’s effects. These signs and symptoms may be mistaken for mania. Chronic drug use results in relatively constant marijuana levels because marijuana is only slowly removed from the body. As a result, daily marijuana use will result in chronic marijuana intoxication. Symptoms of chronic, low-grade lethargy and depression, possibly followed by anxiety and memory loss, may be present. Intoxication with phencyclidine (PCP) can cause euphoria, mania, depression, sensory dissociation, hallucinations, paranoia, delusional thought, distorted body image, and disorientation, among other items.

Mood Disturbances As A Result Of A Medical Condition

Diagnostic criteria for mood disorders caused by a general medical condition are defined in the DSM-IV draft. The following are the five criteria:

  1. One (or both) of the following characteristics describe a prominent and recurrent mood disturbance:
  2. 1) a depressed mood or a major decline in interest or enjoyment in all, or nearly all, activities
  3. 2) A mood that is elevated, expansive, or irritable.
  4. There is evidence of a general medical disorder that is etiologically linked to the disruption based on the history, physical examination, or laboratory results.
  5. Another psychiatric illness does not account for the disruption (e.g., adjustment disorder with depressed mood, in response to the stress of having a general medical condition).
  6. Clinically serious distress or disability in social, educational, or other critical areas of functioning is triggered by the symptoms.
  7. The disturbance does not only occur in the case of delirium or dementia.

A mood disorder caused by a general medical condition can be classified as 1) manic, 2) depressed, or 3) mixed, with signs of both mania and depression present but none of them predominating.

The following are medical conditions that can either cause or imitate mood disorders:

Malnutrition is a problem that many people face.
Anemia is a condition in which a person
Thyroid hyperthyroidism and hypothyroidism

Dementia is a form of dementia.

Ailment of the brain

Lupus is a disease that affects the immune

AIDS/HIV

Condition following a heart attack

Stroke, especially in the elderly.

Medications for hypertension and hypotension, such as reserpine and other blood pressure medications, may trigger symptoms that are similar to psychological or AOD disorders. Prescription and over-the-counter (OTC) drugs both have the ability to induce depression. Mania may be caused by diet pills and other over-the-counter drugs. A pronounced constriction of affect in patients treated with neuroleptic (antipsychotic) medications may be misinterpreted as a symptom of depression.

Assessment Processes

When a patient has coexisting AOD and mood disorders, both disorders must be diagnosed and treated. The evaluation process can be broken down into three stages: acute, subacute, and long-term.

In certain clinical settings, acute and subacute assessment may not be appropriate for some patients. Outpatient AOD treatment program staff, for example, can see fewer patients with acute psychiatric symptoms than detoxification program staff.

Acute Assessment

ESTIMATING THE Risk TO ONESELF OR OTHERS

It’s important to decide whether or not patients are a risk to themselves or others. This assessment will help decide whether there is a responsibility to protect patients from self-harm, disrupt violent intentions toward others, and/or alert intended victims of patients’ stated violent intent.

With regard to AOD addiction, confidentiality laws do not mitigate the obligation to shield any patients from suicide or violence related to mental illness. Many states’ laws justify and warrant the dedication of patients or the alert of possible victims when there is an immediate danger.

AOD confidentiality rules are generally rather strict. Although some states prohibit involuntary commitment for AOD violence, they do not prohibit commitment for AOD-induced psychiatric states that put oneself or others in risk.

Suicidal thoughts should be assessed by screening staff to see whether they are temporary or indicative of a chronic illness. Consider this: Do patients have any plans to commit suicide or have serious intentions? Have they attempted this before? It is important to assess whether the patients have already been committed to a psychiatric institution or are currently undergoing care. If patients are extremely dangerous to themselves or others, local services should be used to follow either voluntary or involuntary interventions such as commitment. Prior to and in anticipation of emergencies, AOD workers should have a clear understanding of local resources.

Patients with AOD issues and apparent suicidal thoughts can benefit from being put in a secure holding area. If an admission facility is unable to handle such patients, a referral to another facility is suggested. If someone comes into a facility on Monday at 8:00 a.m. and says he wants to kill himself, there should be enough time to talk him down, evaluate his treatment needs, and initiate treatment or make evaluation referrals. A rapid triage should be included in an assessment if it is required. See the sections on determining high-risk conditions in and Chapter 8 for more detail (Psychotic Disorders).

AOD use and major depression are among the top related factors in almost every recent report of active or attempted suicide. Having these factors at the same time increases the risk of suicide.

Patients with manic symptoms that are reaching psychotic levels need immediate assessment and treatment. Mania should be assessed as soon as possible, and it should be tracked during subacute evaluations.

AOD and mental conditions are often minimized in patients with manic and hypomanic symptoms. Manic patients may have poor insight into their AOD condition, mania, and social situation due to the symptom of grandiosity. Patients who are manic do not recognize themselves as sick. They are typically hyperactive and irritable, and their impulsivity, irritability, and bad judgement make them a threat to themselves and others. Most of these individuals would need involuntary commitment if they are not inebriated. A discussion of psychosis evaluation can be found in Chapter 8.

MEDICAL Examination

Patients with mood disorders, especially the elderly, are at risk for life-threatening medical conditions such as hypoglycemia (insulin overdose), stroke, or infections. These symptoms, as well as withdrawal and adverse drug reactions, must be taken into account at all times and necessitate a thorough physical examination and laboratory evaluation. Referrals for medical examination and care should be provided by assessment staff. Assessment personnel in non-medical facilities should be qualified in triage and referral.

A strategy for identifying and treating medical conditions that cause or intensify mood disorders should be formulated. Endocrine conditions (like thyroid problems), neurological disorders (like multiple sclerosis), and HIV infection should all be taken into account. In addition to apparent medical concerns, it’s fair to say that patients with dual disorders’ basic medical needs aren’t being met, and a strategy for resolving these shortcomings should be formulated.

AN INITIAL ADDICTION EVALUATION WITH THE CAGE QUESTIONS

The CAGE questions are easy to use for screening (see Chapter 3) and to adjust for use with patients who may have mood disorders. Consider the following questions, which were adapted from the CAGE questionnaire. “Have you ever diminished or increased your AOD use as a result of being seriously depressed (or psychotic, for example)?” “When you use AODs, do you ever get more irritable, frustrated, depressed, or annoyed?” “Do you use alcohol or other medications to cope with guilt?” “Are you moodier in the morning or evening?” “Have you ever attempted suicide while inebriated?”

The emphasis of an initial AOD evaluation should be on recent alcohol and other substance use as well as a behavioral background. The assessor wants to know what medication was used, how much of it was used, how frequently it was used, and how recently it was used. Previous medications, delirium tremens, hallucinations, blackouts, and disruptive behaviour should all be recorded.

ASSESSMENT OF SOCIAL CONDITIONS

The patient’s social environment should be evaluated, particularly in relation to AOD and psychiatric disorders. It’s vital to find out whether the patient is experiencing housing insecurity or homelessness. What is the location of the patient’s residence? Is the patient a resident of a nursing home? Who does the patient live with? Who does the patient socialize with on a daily basis? Is it possible to maintain a healthy social and domestic environment?

Is there a possibility for a social problem in the patient’s life? What is the patient’s current support system at home and in the community? What part do others play? Are there any AODs in your house? Is it possible to go home and socialize in a non-violent environment? Is it possible to sustain an abstinent lifestyle in your home and social environment? If not, it should be determined if the patient has the requisite resources to resolve the negative effects of non-supportive home and social environments on abstinence and rehabilitation.

OTHERS’ Abuse

It is important to determine if the patient’s family members are physically violent during the screening interview. If the patient is in risk, it must be decided. Observation of physical and behavioral attributes may be an important part of the assessment process. Previous violence is the best indicator of potential violence.

SYMPTOMATOLOGY OF MOOD ASSESSMENT

Patients with AOD disorders can overemphasize or underemphasize their psychiatric symptoms during AOD use history taking and psychiatric screening and evaluation sessions. Patients who are depressed during the evaluation, for example, can inadvertently misinterpret their past psychological experiences by exaggerating the severity or frequency of previous depressive episodes.

Patients who are severely depressed during the evaluation, on the other hand, can downplay their depressive disorder because they believe it is a normal state. Indeed, some people may feel that they “deserve” to be depressed, rather than realizing that depression is a mood condition that varies from normal.

Excessive and unnecessary guilt feelings are experienced by some patients. Some patients do not correctly mark their depression and do not recall having been depressed previously. Since patients often associate depression with sadness and other feelings, it’s important to ask questions like “Have you ever seen a psychiatrist or therapist?” during the evaluation. (If you answered yes, ask why.) “Are you able to get out of bed in the morning or are you exhausted all of the time?” “Have you noticed any recent changes in your sleeping or eating habits?”

Patients may choose information from their medical background that are important to their present state of mind. Depressed people are more likely to give a negative self-report. Psychiatric symptoms are frequently overemphasized in addicted patients, although they are often underemphasized in psychiatric patients. Unhappy addicted patients who are experiencing a temporary mood disturbance will often rationalize their past as lifelong depression. As a result, obtaining additional information from other individuals and documentation such as medical and psychological reports is important. It is important to continue the evaluation process after the opioid withdrawal phase has finished.

Assessment Advice

The following are some examples of questions to ask during the evaluation.

To help with depression, try:

  • “Have there been a moment in the last month that you felt down for the majority of the day almost every day?”
  • “Have you gained or lost any weight during this time?”
  • “Did you have any trouble focusing?”
  • “Did you have trouble sleeping, or did you oversleep?”
  • “Did you make an attempt to injure yourself?”

Mania treatment:

  • “Have you had moments in the last month that you felt so hyperactive that you got into trouble or were told by someone that your conduct was out of character for you?”
  • “Have you recently had episodes of irritability where you screamed or fought with others?”
  • “Did you feel more self-assured than normal during this time?”