CHAPTER 10 MOOD DISORDERS:
GENERAL CHARACTERISTICS OF MOOD DISORDERS:
mood disorders: involve disabling disturbances in emotion, from the sadness of depression to
the elation and irritability of mania.
DEPRESSION SIGNS AND SYMPTOMS:
depression: an emotional state marked by great sadness and feelings of worthlessness and
Depression in children often result ins in somatic complains. In older adults, depression is often
characterized by distractibility and complaints of memory loss.
Symptoms of depression exhibit some cross-cultural variation, probably resulting from
differences in cultural standards of acceptable behaviour.
Although it is commonly believed that people from non-western cultures emphasize somatic
symptoms of depression, while people from western cultures emphasize emotional symptoms,
studies suggest that people from various cultures tend to emphasize somatic symptoms rather
than the emotional symptoms.
psychologizers: people who emphasize the psychological aspects of depression.
Most depression, although recurrent, tends to dissipate with time. About one third of depressed
people suffer from chronic depression.
MANIA SIGNS AND SYMPTOMS:
Mania: an emotional state or mood of intense but unfounded elation accompanied by irritability
and impractical grandiose plans.
The person in the throes of a manic episode, which last from several days to several months, is
readily recognized by his loud and incessant stream of remarks, sometimes full of puns, jokes and
FORMAL DIAGNOSTIC LISTINGS OF MOOD DISORDERS:
Diagnosis of Depression:
The formal diagnosis of a major depressive disorder MDD) requires the presence of five of
the following symptoms for at least two weeks.
sad, depressed mood, most of the day, nearly every day
loss of interest and pleasure in usual activities
difficulties in sleeping (insomnia), or a desire to sleep a great deal of time
shift in activity level, becoming either lethargic (psychomotor retardation) or agitated
poor appetite and weight loss, or increased appetite and weight gain
loss of energy, great fatigue
negative self-concept, self-reproach and self-blame, feelings of worthlessness, and guilt
complaints of evidence of difficulty in concentrating such as slowed thinking and
recurrent thoughts of death or suicide
what is controversial s whether a patient with five symptoms and a two-week duration is
distinctly different from one who has only three symptoms for 10 days.
Even with fewer than five symptoms and duration of less than two weeks, co-twins were also
likely to be diagnosed with depression and patients were likely to have recurrences. Five symptoms increased weight, decreased weight, psychomotor retardation, indecisiveness
and suicidal thoughts were not independently associated with the diagnosis. These findings have
implications for the possible revision of the diagnosis criteria for MDD.
MDD is one of the most prevalent of the disorders. Lifetime prevalence rates range from 5.2% to
MDD is abut two times more common in women than in men. The gender difference does not
appear in preadolescent children, but it emerges at age 14 and seems to be maintained across the
Current and lifetime prevalence rates are higher among younger than older persons.
Participants with MDD who had certain coexisting personality disorders had a significantly longer
time to remission of symptoms than did MDD patients without any personality disorder.
kindling hypothesis: the notion that nce a depression has already been experiences, it takes
relatively less stress to induce a subsequent recurrence.
What is not clear is whether the apparent reduced role of life events stress in subsequent
depressions is because depression has become autonomous and no longer requires stress (the
autonomy hypothesis) or whether the person has become sensitized to stress (the sensitivity
hypothesis) and even small amounts of stress are sufficient to induce depression.
Diagnosis of Bipolar Disorder:
Bipolar I Disorder: involving episodes of mania or mixed episodes that include symptoms of
both mania and depression.
A formal diagnosis of a manic episode requires the presence of elevated or irritable mood plus
three additional symptoms.
Some clinicians do not regard euphoria as a core symptom of mania and report that irritable
mood and even depressive features are more common.
The following symptoms must be sufficiently severe to impair social and occupational
increase in activity level at work, socially or sexually
unusual talkativeness; rapid speech
flight of ideas or subjective impression that thoughts are racing
less than the usual amount of sleep needed
inflated self-esteem, belief that one has special talents, powers and abilities
distractibility, attention easily diverted
excessive involvement in pleasurable activities that are likely to have undesirable
consequences, such as reckless spending.
occurs less often than MDD, occurs equally often in men and women, like MDD, tends to recur
HETEROGENEITY WITHIN THE CATEGORIES:
Some bipolar patients experience the full range of symptoms f both mania and depression almost
everyday, termed a mixed episode. Other patients have symptoms of only mania or only
depression during a clinical episode.
Bipolar II disorder: patients have episodes of major depression accompanied by hypomania, a
change in behaviour and mood that is less extreme than full-blown mania.
Some depressed people may be diagnosed as having psychotic features if they are subject to a
delusions and hallucinations, a useful distinction among people with unipolar depression.
Depression with psychotic features is more severe than depression without delusions and
involves more social impairment and less time between episodes.
Some patients with depression may have melancholic features where people find no pleasure in
any activity and are unable to feel better.
Patients with melancholic features had more co-morbidity i.e. with anxiety, more frequent
episodes, and more impairment, suggesting it may be more severe type of depression.Both manic and depressive episodes may be characterized as having catatonic features, such as
motor immobility or excessive, purposeless activity. Both may also occur within four weeks
childbirth; in this case PTSD (Postpartum).
Both bipolar and unipolar disorders can be sub-diagnosed as seasonal if there is a regular
relationship between an episode and a particular time of the year.
The most prevalent explanation is that it is linked to a decrease in the number of daylight hours;
seasonal affective disorder (SAD).
A Study found that one in five people in an Inuit community were depressed.
Icelanders go without light for many months in the winter, yet as a group, they have surprisingly
low levels of SAD, 1.2%. Might have lower rate because they have adapted genetically to reduce
sunlight and are somehow protected against SAD.
CHRONIC MOOD DISORDERS:
Cyclothymic disorder: the person has frequent periods of depressed mood and hypomania,
which may be mixed with, may alternate with, or may be separated by periods of normal mood
lasting as long as two months.
during depression, they feel inadequate; during hypomania, their self-esteem is inflated. They
withdraw from people, then seek them out in an uninhibited fashion. They sleep too much and then
The person with dysthymic disorder is chronically depressed more than half the time for at
least two years.
insomnia or sleeping too much; feelings of inadequacy; ineffectiveness, and lack of energy;
pessimism; an inability to concentrate and to think clearly; and a desire to avoid the company of
others. Women are 2-3 times more likely than men.
Many people with it have episodes of major depression, as well, a condition known as doubl