Mood disorders

1. MOOD SWING AND SUICIDE
Submitted by
Optional : English
Candidate names : Athulya
Ayesha
Bhagyalekshmy
Darsana
Preethy
Riny
Rincy
Sona
Sulthana

2. OVERVIEW
SEVERAL TERMS TO DESCRIBE
PROBLEMS ASSOCIATED WITH
EMOTIONAL RESPONSE SYSTEMS
• EMOTION
• AFFECT
• MOOD
• CLINICAL SYNDROME

3. Emotion - Refers to a state of arousal
that is defined by subjective states of
feelings, such as sadness, anger, and
happiness.
Affect - Refers to pattern of observable
behaviors associated with emotions
(e.g. facial expression, voice pitch).
Mood - Refers to a pervasive and
sustained emotional response that can
influence a person’s perception of the
world (e.g. depressed mood).
Clinical syndrome - is a combination of
emotional, cognitive, and behavioral
symptoms associated with a depressed
mood (e.g. clinical depression).

4.  The mood change is pervasive across situations and
persistent over time.
 The mood change may occur in the absence of any
precipitating events.
 The depressed mood impairs social and occupational
functioning.
 The change in mood is accompanied symptoms that
include cognitive, somatic, and behavioral features.
 The nature of the mood change is different than normal
sadness.
How can we differentiate between normal sadness &
clinical depression?

5. Mood disorders - are
defined in terms of
episodes
• Discreet periods of time in
which the person’s behavior
dominated by depressed or
manic mood or both.

6. Symptoms & Features
• Emotional symptoms
• Cognitive symptoms
• Somatic symptoms
• Behavioral symptoms

7. Emotional symptoms
• Brief negative emotions serve a
useful communicating function
• Prolonged, intense emotions
become problematic to our daily
functioning
• Dysphoric mood (e.g. feeling
gloomy), anxiety
• In mania there is euphoria, elation,
as well as irritability

8. Cognitive symptoms
• Changes in the way people think
• Unrealistic expectations
• Preoccupations and cognitive distortions
• Thinking slowed down or sped up
• Memory difficulties
• Self-blame
• Suicidal ideation

9. Somatic symptoms
Clinically significant changes in:
• fatigue
• aches & pains
• sleep patterns
• appetite
• hygiene
• sexual drive

10. Behavioral symptoms
• Apparent lack of caring for
others
• Changes in the things people
do and how they do them
• Psychomotor retardation in
depressed individuals
• Sped up, impulsive behavior in
mania

11. Contemporary perspective
Unipolar disorders
• dysthymia
• major depressive disorder
Bipolar disorders
• bipolar i
• bipolar ii
• cyclothymic disorder
• mixed episode

12. Dysthymia
Represents a chronic mild depressive condition that
has been present for many years (i.e., at least 2)
- depressed mood most of the day on more days than not,
plus 2 or more of the following:
• poor appetite or overeating
• insomnia or hypersomnia
• low energy
• low self-esteem
• poor concentration or difficulty making decisions
• feelings of hopelessness

13. Bipolar ii
A person who has experienced at least one major depressive
episode, at least one hypomanic episode, and no full blown
manic episodes.
Hypomania - episodes of increased energy that is not as
severe as full blown mania.
Cyclothymia - numerous hypomanic episodes and numerous
periods of depression during a 2 year period.
Mixed episode – the criteria is met for a manic and major
depressive episode for 1 week period.

14. Subtypes and Descriptors
• Episode specifiers
• early vs. late onset
• psychotic
• post-partum onset
• melancholia
 severe form of depression
 possible different etiology
 biological treatments successful
• Course specifiers
• seasonal affective disorder
• rapid cycling
 denotes poor prognosis for bipolar disorder

15. Course and Outcome
Unipolar disorders
• onset generally in middle age, average age is mid 40s
• 10% have depression for 2 years
• 50% will recover within 6 months
• of those, 50% will relapse in 3 years
Bipolar disorders
• onset typically between 28-33 yrs - 1% of population
• could start as manic or depressive
• average duration of an episode: 2-3 months
• onset is gradual - 5 - 15% will be rapid cyclers

16. Comorbidity
• 40% of alcohol dependent
people are alcohol dependent
• anxiety disorder and
depression is closely linked
• psychotic features

17. Epidemiology
• Incidence/prevalence
• difficult to measure as many people do not seek
treatment
• approximately 30% seek treatment
• Gender
• women are far more vulnerable to depression
• 12% women and 7% males
• Culture
• depression is a universal phenomena
• higher in some cultures (e.g., aboriginal canadians)

18. Epidemiology
• Lifespan risk
• most frequent among young and middle-aged adults
• elderly is hard to diagnose
• Cross-generational comparisons
• people born after world war ii more likely to develop a mood disorder then
previous generations

19. Etiological considerations
• Social factors
• depression: stressful life events
• bipolar: goal-attainment events
• Psychological factors
• cognitive vulnerability

20. Etiological considerations:
cognitive theory
• Beck’s theories:
• distortions leading to and sustaining depression
• depressive triad (demeaning sense of self, world, others)
• negative schema formation
• abcd model
• Hopelessness
• refers to the person’s negative expectations about future events
and the associated belief that these events cannot be controlled
• depressogenic attributional style

21. Etiological considerations: interpersonal
factors
• Certain people create
difficult circumstances that
increase stress
• Self-critical people elicit
criticism and rejection
from others
• Person’s own behaviour
causes negative life events

22. Specific interpersonal factors
A) social relationships
• Negative effects on others’
moods
• Negative interactions
• Smaller social networks
B) response styles & gender
• Ruminative vs. Distracting style

23. Biological factors: genetics
 Family studies
 Twin studies
– Heritability of depression: 52%
– 80% for bipolar disorder
 Genetic risk/sensitivity to stress
– Predisposition to coping ability
 Mode of transmission & linkage studies
– Single-gene vs. Polygenic
– Chromosome 18: bipolar

24. Treatment: unipolar disorders
• Cognitive therapy
• Alter maladaptive schemas
• Interpersonal therapy
• Focus on relationships
• Antidepressant medications
• Ssris
• Tcas (dopamine,
norepinepherine)
• Maois

25. Depression medications
• 40-50% improve
• 20-30 improve partially
• 20-25 do not respond at all

26. Treatment: bipolar disorders
• Lithium – is one of the most widely used and studied medication for
treating bipolar disorders. It helps reduce the severity and frequency
of mania. It may also prevent or relieve bipolar depression. – 75%
success rate
• Anticonvulsant medications – at first this method is prescribed only
for people who did not respond to lithium. Today this is prescribed
along with lithium to control mania – 60% success rate
• Psychotherapy – a general term for treating mental health problem
by talking with psychiatrist, psychologists or other mental health
provider

27. Electroconvulsive therapy (ECT)
• Severe cases/last resort
• Unilateral vs. Bilateral
• 2-3 sessions per week, 6-8 session overall
• Reason for effectiveness not understood
• Ethics of ECT controversial
• Pervasive and persistant
• Memory losss

28. Suicide
• 15-20% of mood disordered patients commit suicide
• 50% of completed suicides occur as a result of a mood disorder
• Suicide rates among canadian adolescents have doubled over the past
30 years
• Ratio of attempted suicides to completed suicides are 10:1
• More women than men attempt suicide, however, men are 4x more
likely to kill themselves

29. Suicide: Durkheim’s classification
• Egoistic
• Sense of meaninglessness
• Altruistic
• Sacrifice self for the group
• Anomic
• Social crisis
• Fatalistic
• Traumatic conditions

30. Treatment of suicidal individuals
• Crisis centres /hot lines
• Medication
• Involuntary hospitalization
• Psychotherapy
• Reduce lethality
• Negotiate agreements
• Offer support
• Expand perspective

31. Thank you