2. MOOD DISORDERS Madiha Anas Institute of Psychology Beaconhouse National University

3. Introducing Mood Mood and Affect  often used interchangeably  but increasingly the word mood is preferred. In mental disorders, mood may be abnormal:  It may fluctuate more or less than usual  It may be inconsistent with the patient’s thoughts, actions or with current events.

4. Mood Disorders Depressive Disorders -Major Depression -Dysthymic Disorder Bipolar Disorders -Bipolar I Disorder -Bipolar II Disorder -Cyclothymic Disorder

5. Depression an emotional state marked by  great sadness  feelings of worthlessness  guilt  withdrawal from others etc.

6. Features in Major Depression Psychotic Depression LLoss of contact with reality WWith delusions (false beliefs) WWith hallucinations (false sensory perceptions) Melancholic UUnaffected by pleasurable events DDominated by motor, sleep and appetite disturbances Seasonal Affective FFluctuate with seasonal changes

7. “SIG E CAPS” Major Depression- Symptoms “SIG E CAPS” Sleep (insomnia or hypersomnia) Interest (diminished) Guilt (feelings of worthlessness) Energy (loss of or fatigue) Concentration (diminished ability to think) Appetite (decreased or increased; unintentional weight loss) Psychomotor agitation or retardation Suicidal ideation

8. DSM IV-TR Criteria for Major Depression Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning;  depressed mood most of the day, nearly every day.  markedly diminished interest or pleasure in all, or almost all, activities most of the day  significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month)  insomnia or hypersomnia nearly every day  psychomotor agitation or retardation nearly every day  fatigue or loss of energy nearly every day  feelings of worthlessness or inappropriate guilt  diminished ability to think or concentrate, or indecisiveness, nearly every day  recurrent thoughts of death (not just fear of dying)

9. DSM IV-TR Criteria for Major Depression (cont). The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism). The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one

10. PREVALENCE Estimates of the prevalence of depression range from 12 percent to 17 percent, thus indicating that depression is a problem that afflicts a substantial proportion of the population (Kessler et al., 1994, as cited in Holmes, 1997).

11. DYSTHYMIC DISORDER  Have symptoms of major depression, but not as deeply or as intensely.  Chronic: Have symptoms for at least 2 years, during which they are symptom- free for no more than 2 months.

12. Major DepressionDysthymic Disorder 5 or more symptoms including sadness or loss of interest or pleasure. 3 or more symptoms including depressed mood. At least 2 weeks in duration. At least 2 years in duration. Have symptoms everyday. Don’t necessarily have symptoms everyday.

13. Bipolar Disorder Bipolar Disorder Type I Bipolar Disorder Type II Cyclothymic Disorder

14. Bipolar Disorder also known as manic depression a person’s mood can alternate between the "poles“  mania (highs) and depression (lows). This change in mood or "mood swing" can last for hours, days, weeks or months. episode Every time you experience symptoms at one pole for at least 1 week, it is called an episode.

15. BIPOLAR DISORDER  Bipolar I disorder: One or more manic episodes, and maybe depressive episodes.  Bipolar II disorder: One or more major depressive episodes and at least one hypomanic (mildly manic) episode. TYPES

16. CYCLOTHYMIC DISORDER Dramatic and recurrent mood shifts. Not as intense as bipolar. Chronic condition:  Lasts at least 2 years. May feel productive and creative but others regard them as moody, irritable.

17. Bipolar Disorder - “DIGFAST” 1. Distractibility 2. Impulsivity 3. Grandiosity - inflated self-esteem; may be delusional 4. Flight of Ideas- racing thoughts 5. Activities - increase in goal-directed activities 6. Sleep - decreased need for 7. Talkativeness - tend to be more talkative

18. Bipolar Type I Cyclothymic Disorder Manic episodes and possibly depressive episodes. Hypomania with major depressive episodes. Duration varies. At least 2 years in duration. Bipolar Type II Hypomania with mild depressive episodes. Duration varies.

19. Etiology of Mood Disorders

20. BIOLOGICAL THEORY OF MOOD DISORDERS Monoamine Hypothesis  depression is due to depletion of norepinephrine and/or serotonin

21. PSYCHOLOGICAL PERSPECTIVES PSYCHODYNAMIC  Rejection or loss of parental love  Defense mechanisms BEHAVIORAL  Lack of positive reinforcement  Stressful life events  Learned helplessness

22. COGNITIVE PERSPECTIVES A negative view of 1.the self 2.the world, and 3.the future. A negative view of 1.the self 2.the world, and 3.the future.

23. Overgeneralizing Catastrophic thinking Cognitive Distortions Drawing erroneous or negative conclusions from experience.

24. Mood Disorder: Precursor of Suicide?

25. Suicide Edwin Shneidman  suicide is an intentioned death – a self-inflicted death in which one makes an intentional, direct and conscious effort to end one’s life.

26. Shneidman has distinguished four kinds of people who intentionally end their lives :  Death seekers have a clear intention of ending their lives at the time they attempt suicide.  Death initiators also clearly intend to end their lives, they act on a conviction that the process of death is already under way and that they are simply hastening the process.  Death ignorers they believe that they are trading their present life for a better or happier existence  Death darers are ambivalent in their attempt, and they show this ambivalence in the act itself.