Mood

Disorders
 MOOD
I.
II.
DISORDERS
Overview
Depressive Disorders
III. Bipolar Disorders
IV. Suicide
V. Prevalence of Mood
Disorders
VI. Cause of Mood Disorders
VII. Treatment
 OVERVIEW
Mood is the predominant feeling state of the individual. (Pervasive and
Sustained)
✓ more persistent period of affect or emotionality.
Mood disorders involves disabling disturbances in emotion. The fundamental
experiences of depression and mania contribute, either singly or together, to
all the
mood disorders.
✓ Unipolar – refers to a singular mood. (Either or)
o Major Depressive Disorder
o Dysthymic Disorder
o Depressive Disorders Not Otherwise Specified
✓ Bipolar – encompasses two opposite moods. (Depression and Mania)

o Bipolar I Disorder
o Bipolar II Disorder
o Cyclothymia.
 UNIPOLAR
1. Major Depressive Disorder (MDD)
2. Persistent Depressive Disorder (Dysthymia)
3. Premenstrual Dysphoric Disorder
4. Disruptive Mood Dysregulation Disorder
5. Substance/Medication-induced Depressive Disorder
6. Depressive Disorder due to medical condition
 BIPOLAR
1. BIPOLAR I
2. BIPOLAR II
3. Cyclothymic
4. Substance/ Medication-induced Bipolar Disorder
Depression is a low, sad state in which life seems dark and its challenges
overwhelming. It is usually characterized by:
o Feelings of worthlessness
o Guilt
o Sadness
o Changes in sleep and appetite

Mania is a state of breathless euphoria, or at least frenzied energy, in which people

may have an exaggerated belief that the world is theirs or the taking. It is usually
characterized by:

o Intense elation or irritability

o Hyperactivity, talkativeness, distractibility
o Symptoms typically lasts for 1 week
DEPRESSIVE DISORDER BIPOLAR DISORDER

Major Depressive Disorder (MDD) Bipolar I

Persistent Depressive Disorder Bipolar II

(Dysthymia)
Premenstrual Dysphoric Disorder Cyclothymic

Disruptive Mood Dysregulation Substance/Medication Induced

Disorder
Substance/ Medication-induced
Depressive Disorder
Depressive Disorder due to medical
condition
 II. DEPRESSIVE DISORDERS
A. Major Depressive Disorder (MDD)
An extremely depressed mood state that lasts at least 2 weeks and includes
cognitive symptoms (such as feelings of worthlessness and indecisiveness) and
disturbed physical functions (such as altered sleeping patterns, significant changes
in appetite and weight, or a notable loss of energy) to the point that even the
slightest activity or movement requires an overwhelming effort.
 DSM CRITERIA FOR MAJOR
DEPRESSIVE DISORDER
✓ For at least 2 weeks, the depressed person must have a depressed mood
and/or a loss of interest or pleasure.
And in the same 2 weeks, the person must experience 5 or more of the following
symptoms:
✓ Significant appetite or weight changes
✓ Insomnia or hypersomnia
✓ Psychomotor agitation or retardation
✓ Fatigue or loss of energy
✓ Feelings of worthlessness or excessive, inappropriate guilt
✓ Difficulties in thinking, concentrating, or decision-making
✓ Recurrent thoughts about death, suicidal ideation or suicidal behavior
✓ Depressed children are particularly likely to exhibit somatic complaints,
irritability, and social withdrawal.
PERSISTENT DEPRESSIVE DISORDER
(Dysthymia)
A depressed mood that continues at least 2 years, during which the patient
cannot be symptom free for more than 2 months at a time even though they may not
experience all of the symptoms of a major depressive episode.

✓ This disorder differs from a major depressive disorder (1) number of

symptoms and (2) chronicity.
✓ More severe since patients with this present with higher rates of
comorbidity with other mental disorders, are less responsive to
treatment, and show a slower rate of improvement over time.
✓ Double Depression – individuals who suffer from both major
depressive episodes and persistent depression with fewer symptoms.
PERSISTENT DEPRESSIVE DISORDER
 2 years; 2 months; 2 or more symptoms
 Depressed mood OR loss of interest (children and adolescents – 1 year)
 Appetite/ weight change
 Low self-esteem OR energy
 Insomnia/Hypersomnia
 Feelings of hopelessness
 Difficulties in thinking, concentrating
PERSISTENT DEPRESSIVE DISORDER
 Never symptom free for more than 2 months
 No manic, hypomanic or cyclothymia
 NOT BECAUSE OF
- Schizoaffective disorder, schizophrenia, delusional disorder, or other psychotic disorder
- Substance medication/medical condition
PERSISTENT DEPRESSIVE DISORDER
 More severe:
- higher rates of comorbidity with other disorders
-less responsive to treatment
- slower rate of improvement over time.
Double Depression
- Individuals who suffer from both
major depressive episodes and
persistent depression with fewer
symptoms
 Other Depressive Disorders
1. Premenstrual Dysphoric Disorder - a combination of physical symptoms,
severe mood swings and anxiety are associated with incapacitation in the week
before menses.

2. Disruptive Mood Dysregulation Disorder - Severe recurrent temper

outburst manifested verbally (e.g., verbal rages) and/or behaviorally (e.g., physical
aggression toward people or property) and persistent negative mood for at least 1
year beginning before age 10.

3. Seasonal Affective Disorder (SAD) – These episodes must have occurred at least 2 years
with no evidence of nonseasonal major depressive episodes occurring during that period of
time.
 GRIEF
Grief – is characterized by a number of depressive symptoms as well as anxiety,
emotional numbness, and denial due to death of loved one. It can be considered
normal as an initial reaction to the loss of a loved one.

o Integrated Grief - the finality of death and its consequences are

acknowledged and the individual adjusts to the loss. (normal and
positive reaction)
o Complicated Grief - When grief lasts beyond typical time; after 6
months to a year or so, the chance of recovering from severe grief
without treatment is considerably reduced. (Persistent acute grief)
 SPECIFIERS
1. Psychotic features specifiers - Some individuals in the midst of a major
depressive (or manic) episode may experience psychotic symptoms, specifically
hallucinations (seeing or hearing things that aren’t there) and delusions (strongly
held but inaccurate beliefs).

a. Mood-incongruent - other types of hallucinations that do not

seem consistent with the depressed mood.

2. Anxious distress specifier - the presence and severity of accompanying anxiety

3. Mixed features specifier. Predominantly depressive episode that have several (at
least three) symptoms of mania
4. Melancholic specifiers include some of the more severe somatic (physical)
symptoms, such as early-morning awakenings or weight loss.
 SPECIFIERS
5. Catatonic features specifier. This serious condition involves an absence of
movement (a stuporous state) or catalepsy, in which the muscles are waxy and
semirigid, so a patient’s arms or legs remain in any position in which they are
placed. Catatonic symptoms may also involve excessive but random or purposeless
movement.
6. Atypical features specifier. While most people with depression sleep less and lose
their appetite, individuals with this specifier consistently oversleep and overeat
during their depression.
7. Peripartum onset specifier. Peri means “surrounding”, in this case the period of
time just before and just after the birth.
8. Seasonal pattern specifier - It accompanies episodes that occur during certain
seasons (for example, winter depression).

o Seasonal affective disorder (SAD) - These episodes must have

occurred for at least two years with no evidence of nonseasonal major
depressive episodes occurring during that period of time.
 OTHER KEY FACTS
✓ Women are 2–3 times more likely than men to get this diagnosis.
✓ Biologically, it is caused by a neurotransmitter imbalance, genetic
transmission, or even medical illnesses.
✓ Psychosocially, it can be caused by loss of a loved one, loss of health, or low
self-esteem, or learned helplessness.
✓ The mean age of onset for major depressive disorder is 30 years.
✓ onset before 21 years of age, and often much earlier, is associated with three
characteristics: (1) greater chronicity (it lasts longer), (2) relatively poor
prognosis (response to treatment), and (3) stronger likelihood of the disorder
running in the family of the affected individual.
 BIPOLAR DISORDERS
✓ The key identifying feature of bipolar disorders is the tendency of manic
episodes to alternate with major depressive episodes.
✓ For the manic episodes to be considered separate, there must be a symptom-
free period of at least 2 months between them. Otherwise, one episode is seen as a
continuation of the last.
✓ There are 3 forms of Bipolar disorder: Bipolar I disorder, Bipolar II disorder,
and Cyclothymic disorder.
✓ Manic symptoms are the defining feature of each of these disorders.
o Bipolar I – at least 1 episode of mania
o Bipolar II – 1 Major depressive episode and at least 1
hypomania
o Cyclothymic disorder – a chronic form of bipolar disorder.
Defining feature: MANIC SYMTPOMS
- For manic episodes to be considered separate,
there must be a symptom-free period of at least 2
months between them. Otherwise, one episode is
seen as a continuation of the last.
DSM Criteria for Bipolar Disorder (enumerates the symptoms of following
symptoms mania):
✓ For one week or more, there is the presence of an abnormal and persistent
elevated, expansive, or irritable mood.
✓ Expansive mood is an expression of one’s feelings without restraint, with an
overestimation of one’s significance or self-worth.
✓ ELEVATED MOOD – cheerful air of confidence and enjoyment, being more
cheerful than usual
✓ IRRITABLE MOOD - easily annoyed and provoked to anger.
There should also be at least 3 of the following symptoms:
 Elevated, expansive or grandiose
✓ Inflated self-esteem or grandiosity
✓ Decreased need for sleep
✓ More talkative than usual (pressured speech)
✓ Flight of ideas/ racing thoughts
✓ Distractibility
✓ Increased goal-directed activities or psychomotor agitation
✓ Excessive involvement in pleasurable activities buying sprees,
foolish business investments, and sexual indiscretions
A. Bipolar I B. Bipolar II
✓ Major depressive episodes alternate ✓ Major depressive episodes alternate
with a full manic episode. with hypomanic episodes.
✓ Average age onset is from 15 – 18 ✓ Hypomania – characterized by less
years old. severe symptoms of mania which lasts
for at least 4 days.
✓ Average age onset is from 19 – 22
years old.
C. Cyclothymic Disorder
✓ A milder but more chronic version of bipolar disorder.
✓ A chronic alternation of mood elevation and depression
that does not reach
the severity of manic or major depressive episodes.
 2 years; 2 months
Rapid-Cycling Specifier
✓ An individual with bipolar disorder who experiences at least four manic or
depressive episodes within a year is considered to have a rapid-cycling
pattern.
✓ A severe variety of bipolar disorder.
✓ Rapid switching or rapid mood switching - rapid cycling tends to increase
in
frequency over time and can reach severe states in which patients cycle
between mania and depression without any break.
✓ Women are more likely than men to experience rapid cycling.
D. Other important facts
✓ No sex difference for bipolar disorder.
✓ A manic period usually follows after a depressive
episode.
✓ Prevalence rates lower than MDD.
✓ Tends to be recurrent.
 SUICIDE
✓ Suicide is death from deliberate self-injury.
✓ Suicide ideation – thoughts of killing oneself.
✓ Suicide attempt – behavior intended to kill oneself.
✓ Non-suicidal self-injury – behaviors intended to injure oneself without intent
to kill oneself.
✓ Suicide is the third leading cause of death in people 15–24, often via drug
overdose.
✓ Up to 70% of all suicides result from a mood disorder.
✓ Men are 4x more likely than women to kill themselves.
✓ Women are more likely than men to make suicide attempts that do not result
in death.
✓ Main interventions for those at high risk:
medication, crisis intervention,
hospitalization, psychotherapy.
✓ WARNING SIGNS:
o social withdrawal
o decline in school functioning
o loss of appetite
o sleep problems
Three types of suicide
✓ ANOMIC: people who feel let down by society
and/or have experienced major
Change
✓ EGOISTIC: people who are alienated and are
unconcerned with societal
norms
✓ ALTRUISTIC: believe it will benefit society.
PREVALENCE OF MOOD DISORDERS
✓ Depressive disorders occur less often in prepubertal children than in adults
but rise dramatically in adolescence.
✓ Adolescents experience major depressive disorder about as often as adults.
✓ Infants of depressed mothers display marked depressive behaviors.
✓ Mood disorders are fundamentally similar in children and in adults. Unlike the
anxiety disorders in which a number of conditions occur only early in
development.
✓ The earlier gender imbalance in depression lessens considerably after the
age of 65.
 CAUSES OF MOOD DISORDERS
1. GENETIC PREDISPOSITION
✓ Stronger for bipolar disorders
✓ Genetic contribution determined by twin and adoption studies.
✓ Feeling of disappointment in depression has been linked to the hyperactivity
in lateral habenula.
✓ People who experienced depression had hyper-connectivity in areas of the
brain which have been associated with rumination.
2. NEUROTRANSMITTER DYSREGULATION
✓ Catecholamine Hypothesis: MDD results from low levels of norepinephrine.
✓ In mania, high level of norepinephrine and dopamine; low levels of serotonin.
✓ Indoleamine Hypothesis: Depression results from decreased levels of
serotonin.
✓ Antidepressants act to reduce the reuptake of these neurotransmitters.
✓ New models focus on sensitivity of postsynaptic receptors.
B. Cognitive
✓ Depression - Negative Triad: negative view of self, others, and future.
✓ Negative schemata – underlying tendency to see the world negatively. It
causes cognitive biases.
✓ Schemas (mindset consisting of beliefs, rules, and assumptions about oneself
and the world) are rigid, negative, dysfunctional.
✓ Schemas show indications of: overgeneralization, excessive sense of
responsibility, all-or-nothing thinking.
✓ Negative automatic thoughts and cognitive distortions promote and maintain
depression
✓ In Mania, individual denies certain aspects of reality in order to promote or
preserve an unrealistic set of self-perceptions.
✓ A superficial set that serves to cover up underlying depressed thinking.
C. Behavioral
Life stress => social withdrawal => reduction in positive
reinforcements =>
depression
Seligman’s Learned helplessness theory: derived from dogs’
reactions to
inescapable electric shock. States that one gives up after learning
that one’s efforts
are futile in avoiding pain and frustration.
D. Psychodynamic
1. Depression
✓ Differentiates normal process of grieving from depression.
✓ Both processes involve loss; key symptom in depression is self-reproach,
and in depression anger is turned against the self.
✓ Combination of poor self-esteem, unconscious self-punishment, and
sense of loss and abandonment make one vulnerable to depression.
✓ Rigid superego serves to punish oneself.
✓ Socio-cultural explanations believe that depression may be caused by
o An individual’s vulnerability to depression (diathesis),
o Exposure to cultural/ environmental stressors,
o Cultural expectations on how emotions are handled.
o The unavailability of social support.
2. Mania
✓ Viewed as self-defense against underlying depression.
✓ Feelings of worthlessness are converted by means of denial, reaction
formation and projection to grandiose delusions.
E. Emotional factors
Affect
✓ High negative affect
✓ Low positive affect
In response to positive stimuli, depressed individuals experience:

✓ Lesser motivation
✓ Lesser psychophysiological activity
✓ Fewer positive facial expressions
✓ Less pleasant emotions
F. Personality factors
Neuroticism

✓ Predicts onset of depression

✓ Tendency to react with higher levels of negative affect

Extraversion

✓ Associated with high levels of positive affect

Those who suppressed their anger has a greater tendency for depression.
VIII. Treatment of Mood Disorder
A. Psychological
Interpersonal Psychotherapy (IPT)

✓ Short-term psychodynamic therapy

✓ Focuses on current relationships
Behavior therapy (increase positive reinforcers)
Cognitive-Behavioral Therapy

✓ Teaches the patient to identify, examine, and replace distorted

negative thoughts with more realistic ones.
✓ Monitor and identify automatic thoughts
Mindfulness based cognitive therapy (MBCT)
✓ Strategies that aims to prevent relapse.
B. Biological
The principal medications used to treat depression are:

o Tricyclic antidepressants: block the reuptake of norepinephrine but

cause side effects-drowsiness, insomnia, and agitation.
o Heterocyclic antidepressants,
o Monoamine oxidase (MAO) inhibitors. However, MAO inhibitors have a
serious interaction with tyramine, found in many cheeses and other
fermented products.
o SSRIs such as fluoxetine (Prozac) block the reuptake of serotonin.
o Electroconvulsive therapy (ECT) usually reserved for severe
depressives who do not respond to medications, works rapidly but can
cause memory loss and so is controversial.
o Light therapy for SAD
o Lithium for bipolar disorders.
 INFORGRAPHIC

1. Create an infographic about an assigned disorder

2. The infographic should inform the public about this disorder.
Facts should be accurate and presented in a creative way.
3. The infographic should also include how we should deal with
patients with this disorder or how should we take care of them.