Mood Disorders

Terms to ponder

Mood – sustained feeling tone or enduring

period of emotionality
Emotion – A psychological and physiological
reaction to a stimulus
Affect – An outward manifestation of emotion
 Mood Episodes
 Major Depressive Episode
 Manic Episode
 Mixed Episode
 Hypomanic Episode
 Major Depressive Episode
 Extreme depression
 2 weeks
 Cognitive symptoms
 Physical dysfunction
 Anhedonia
 Duration—4 to 9 months, untreated
 Manic Episode

Exaggerated elation, joy, euphoria

1 week, or less
Cognitive symptoms
Duration—3 to 4 months, untreated
 Mixed Episode
and
Hypomanic Episode

Mixed Episode
 Presence of Manic Episode and Major Depressive Episode
nearly every day during at least a 1–week period.
Hypomanic Episode
 4 days symptoms similar to manic episode but not does not
require hospitalization
Structure of Mood Disorders

Unipolar disorders
 Depression or mania alone
 Typically depression

Bipolar disorders
 Depression and mania
 Dysphoric manic episode
 Mixed manic episode
 BIPOLAR I DISORDER
Manic

Hypoma
nic CYCLOTHYMIC
M
O
O
D
DYSTHYMIA
Minor
depression

Major depression BIPOLAR II DISORDER

 Depressive Disorders
 Major depressive disorder, single episode
 No mania/hypomania
 Single episode
 Major depressive disorder, recurrent
 4 – 7 episodes (lifetime)
 Duration—4 to 5 months

Persistent Depressive Disorder (Dysthymia)

 Milder symptoms
 2+ years
 Chronic
 Persistent
 Double Depression
 Major depressive episodes and dysthymic disorder
 Dysthymia first
 Severe psychopathology
 Poor course
Additional Defining Criteria for Depressive
Disorders - Specifiers
 Psychotic features
 Anxious distress
 Mixed features
 Melancholic
 Atypical features
 Catatonic features
 Peripartum onset
 Seasonal pattern
 From Grief to Depression

Integrated grief
 Grief that evolves from acute grief into a condition in which the
individual accepts the finality of a death and adjusts to the loss.

Complicated grief
 Persistent intense symptoms of acute grief
 Presence of thoughts, feelings, or behaviours reflecting excessive
or distracting concerns about the circumstances or consequences
of the death
 Pathological or impacted grief reaction
 Extreme reaction to the death of a loved one that involves psychotic features,
suicidal ideation, or severe loss of weight or energy or that persists more than 2
months

 Note: DSM IV- TR does not qualify individuals under bereavement as clinically
depressed. DSM 5 does.
 Premenstrual Dysphoric Disorder
 In the majority of menstrual cycles, at least five
symptoms must be present in the final week
before the onset of menses, start to improve
Disruptive Mood within a few days after the onset of menses,
and become minimal or absent in the week
Dysregulation Disorder post menses
 Severe recurrent temper  Affective lability
outbursts, at least three times
 Increased interpersonal conflict or irritability or
per week, in response to anger
common stressors
 Depressed mood, feelings of hopelessness, or
 Persistent negative mood self-deprecating thoughts
between temper outbursts most
 Anxiety, tension, and/or feelings of being keyed
days, and the negative mood is up or on edge
observable to others.
 Decreased interest in usual activities; subjective
 Age 6 or higher (or equivalent difficulty in concentration; lethargy, easy
developmental level). Onset fatigability, or marked lack of energy;
before age 10 hypersomnia or insomnia; sense of being
overwhelmed or out of control; physical
 Temper outbursts or negative symptoms such as breast tenderness or
mood are present in at least two swelling, joint or muscle pain, sensation of
settings (at home, at school, or bloating or weight gain
with peers) and are severe in at
least one setting.
Depression in numbers:

Worldwide:
 Lifetime prevalence = 20% to 25% in women and 7% to 12% in
men
 Incidence= around 300million people around the
world(WHO)

Philippines:
 Incidence= 3.3 million Filipinos suffered from depression(2015)
 Suicide rates = 2.5% in males and 1.7% in females in every
100,000 Filipino population
 Bipolar Disorder
Bipolar I Bipolar II
 Alternating major depressive and  Alternating major depressive and
manic episodes hypomanic episodes
 Single manic episode
 Recurrent
 Symptom-free for 2 months

Cyclothymic Disorder
Alternating manic and
depressive episodes
Persists longer
Less severe

Rapid- cycling Specifier

- unique to bipolar I and II
- rapid transition of manic and depressive
episodes
- treatment-resistant form
 Etiology of Mood Disorders

 Biological factors
 Neurobiological Factors
 Social Factors and cultural factors
 Psychological Factors
 Neurobiological Factors
Neurotransmitters
Depression – Low norepinephrine, dopamine, SEROTONIN LEVELS
Mania – Low serotonin, high norepinephrine and DOPAMINE LEVELS
 Dopamine plays a major role in the sensitivity of the reward system in the
brain, which is believed to guide pleasure, motivation, and energy in the
context of opportunities to obtain rewards. Some research suggests that
diminished function of the dopamine system could help explain the deficits in
pleasure, motivation, and energy in major depressive disorder.
 Mania is also linked to hypersensitive dopamine receptors.
Permissive hypothesis
 when serotonin levels are low, other neurotransmitters are permitted to
range more widely, become dysregulated, and contribute to mood
irregularities, specifically depression
 Brain-Imaging Studies
 Amygdala - The amygdala helps a person to assess how emotionally
important a stimulus is. Functional brain activation studies show
elevated activity of the amygdala among people with MDD.
 Subgenual Anterior cingulate – greater activation for MDD
 Hippocampus – MDD has diminished activity of the hippocampus
 Dorsolateral prefrontal cortex – diminished activity
 Striatum – responsible for
reactions to reward, is
overly active for Mania
 Other Biological Factors:

a. thyroid hormones – it promotes neurogenesis specifically in

the hippocampus region of the brain
b. estrogen involvement – low estrogen level among women
during menstrual cycle, postpartum, and onset of
menopausal period makes women more susceptible to
experience depression
c. Vasopressine – a hormone secreted by hypothalamus and
stored in the pituitary gland, elevated level of vasopressine is
associated with major depressive disorder
d. Melatonin – a hormone secreted by pineal gland,
responsible for regulating sleep and wake cycle. Lower level
of melatonergic signalling in the brain causes delayed
circadian rhythm in patients with major depressive disorder
Socio - Cultural factors of Depression

 Poverty/socio-economic status
 Language barriers
 Cultural syndrome
-ataque de nervios - cultural concept of distress and
syndrome in Hispanic and Latin cultures
- Shenjing shuairuo - or “weakness of the nervous
syndrome” is a concept of cultural syndrome in Chinese
population
- nasusuban or nabibinat – extreme sadness after giving
birth, cultural belief of Filipinos
 Politics
 Social media
Psychological Factors in
Depression
 Neuroticism - a personality trait that involves the
tendency to react to events with greater-than-
average negative affect, predicts the onset of
depression.
 As you would expect, neuroticism is associated with
anxiety as well as dysthymia.

 Stressful Life Events

 Cognitive Theories
 Beck’s Theory
 Cognitive Bias - tendencies to process information in certain negative ways.
 Negative/Cognitive Triad – negative views about:
 Self
 World
 Future
 Hopelessness Theory
 desirable outcomes will not occur and that
 the person has no responses available to change this situation.

 Rumination Theory
 Rumination is defined as a tendency to repetitively dwell on sad
experiences and thoughts, or to chew on material again and again. The
most detrimental form of rumination may be a tendency to worry or to
regretfully ponder why an episode happened.
Treatment of Mood Disorders

Changing the chemistry of the brain

 Medications
 ECT
 Psychological treatment
 Antidepressant Medications
Tricyclics (Tofranil, Elavil) Monoamine Oxidase (MAO) Inhibitors
 Frequently used for severe depression  Block MAO
 Block reuptake/down regulate  Higher efficacy
Norepinephrine  Fewer side effects
Serotonin  Interactions
 2 to 8 weeks to work  Foods
 Many negative side effects  Medicines
Lethality  Selective MAO-Is

Selective Serotonin Reuptake Inhibitors Lithium

(SSRI)  Mood-stabilizing drug
 Fluoxetine (Prozac)  Common salt
 First treatment choice  Primary treatment for bipolar
 Block presynaptic reuptake disorders
 No unique risks  Unsure of mechanism of action
 Suicide or violence  Narrow therapeutic window
 Many negative side effects Too little—ineffective
Mixed reuptake inhibitors Too much—toxic, lethal
 Blocking reuptake of norepinephrine as well as
serotonin
 Electroconvulsive Therapy
 Electroconvulsive Therapy (ECT)
 Brief electrical current
 Temporary seizures
 6 to 10 treatments
 High efficacy
 Severe depression
 Few side effects
 Relapse is common

Transcranial Magnetic Stimulation

 Transcranial magnetic stimulation (TMS)
 Localized electromagnetic pulse
 Fewer side effects
 Efficacy is likely good
 More studies needed

 Vagus nerve stimulation

 Psychological Treatment for Depression

 Cognitive Therapy  Interpersonal

 Identify errors in Psychotherapy (IPT)  CBT and IPT
thinking
 Address interpersonal Outcomes
 Correct cognitive
errors
issues in relationships
 Comparable
 Substitute more Role disputes to medications
adaptive thoughts  More effective
Loss
 Correct negative than:
cognitive schemas New relationships  Placebo
Social skill deficits  Brief
psychodyna
 Behavioral therapy  Stage of dispute mic
treatment
 Increased positive Negotiation stage
events
Impasse stage.
 Exercise
Resolution stage
Suicide
Terms

 Suicidal ideation - thinking seriously about suicide

 Suicidal plans - the formulation of a specific method
for killing oneself
 Suicidal attempts - the person survives
 Attempters - self-injurers with the intent to die
 Gesturers - self-injurers who intend not to die but to
influence or manipulate somebody or communicate a
cry for help.
 Statistics in Suicide
 Caucasians
 High incidence
 Rapid increase among
teenagers
 16 – 30% of suidical ideation
results to attempts
 3rd leading cause of death
 2nd leading cause of death
among college students
 Gender
 Men are 4 times likely to
commit suicide in all ages
(except in China)
 Men uses violent methods
 Women are 3 times more
likely to attempt
Types of suicide (Durkheim,
a sociologist)
 Altruistic - an individual who brought
dishonor to himself ought to commit
suicide; individual’s death is
perceived as a means of helping
others
 Egoistic – loss of social support
 Anomic – loss of social prestige such
a job
 Fatalistic – loss of control over one’s
destiny
Risk Factors
 Family history – incidence of suicide in the family
 Neurobiology – low levels of serotonin
 Preexisting disorder - More than 80% of people who kill
themselves suffer from a psychological disorder, usually
mood, substance use, or impulse control disorders
 Alcohol and drug use and abuse - 25% to 50% of suicides
and are particularly evident in suicide among college
students
 Stressful life event
 Shameful/humiliating stressor
 Suicide publicity and media coverage
References:
 Barlow D., & Durand V.M. (2013). Abnormal Psychology: An integrative Approach, Seventh
Edition. pp.213-264
 Fekadu N, Shibeshi W, Engidawork E (2017) Major Depressive Disorder: Pathophysiology and
Clinical Management. J Depress Anxiety 6: 255. doi:10.4172/2167-1044.1000255
 Lee, R., Sta. Maria, M., Estanislao, S., & Rodriguez, C. (2013). Factors Associated with
depressive Symptoms among Filipino University Students. Plos ONE 8(11):e79825.
doi:10.1371/journal.pone.0079825
 Morin, A. (2018) Depression Statistic Everyone Should know. Article published online:
https//www.verywellmind.com
 Reyes, K. (2018). On mental health and depression in the Philippines. Published article from
Manila Bulletin, 13 Feb 2018 issue, retrieved from PressReader.com,
https//www.pressreader.com
 Streltzer, J. (2017). Culture and Psychopathology: A guide to Clinical Assessment, Second
Edition, pp.21-30