This document provides a comprehensive overview of mood disorders, focusing on their classification, diagnostic features, pathophysiology, causes, and medical management. It categorizes mood disorders as either bipolar or depressive and outlines specific disorders within these categories, detailing symptoms and treatment approaches, including occupational therapy interventions. Recent advancements in evidence-based group therapy and the impact of mindfulness on treatment outcomes are also highlighted.

1. MOOD DISORDERS
Done by
Grizelda Evangeline P
MOT (Paediatric)

2. SYNOPSIS
• Mood disorders
• Classification of mood disorders
• Diagnostic features of each mood disorders
• Pathophysiology and Psychopathology
• Causes
• Medical management
• Scales
• OT assessment
• Problems Identified
• OT approaches/FOR
• OT treatment and activities

3. MOOD DISORDER
Mood
A patient's mood is their underlying feelings, which are more consistent and sustained over
time.
Affect
A patient's affect is their immediate expression of emotion, which is more reactive and
shorter in duration than mood.
• According to DSM-5, Mood disorders are mental health conditions that can be categorized
as either bipolar or depressive.
• Mood disorders can cause intense and persistent changes in person’s mood, energy levels
and behaviour.
• Mood disorders are described by marked disruptions in emotions.

4. CLASSIFICATION OF MOOD DISORDERS
According to the Diagnostic and Statistical Manual of Mental disorders – 5th
edition DSM-5
Mood disorders are classified into two groups
1. Bipolar and related disorders
2. Depressive disorders

5. BIPOLAR AND RELATED DISORDERS
1. Bipolar I disorder
2. Bipolar II disorder
3. Cyclothymic disorder
4. substance/medication induced bipolar and related disorder
5. Bipolar and related disorder due to medical condition
6. Other specified Bipolar and related disorder.
7. Unspecified bipolar and related disorder

6. DEPRESSIVE DISORDERS
1. Disruptive mood dysregulation disorder
2. Major depressive disorder
3. Persistent depressive disorder – dysthymia
4. Premenstrual dysphoric disorder
5. Substance/medication induced depressive disorder
6. Depressive disorder due to other medical condition
7. Other specified depressive disorder
8. Unspecified depressive disorder

7. DIAGNOSTIC FEATURES OF EACH MOOD
DISORDERS
BIPOLAR DISORDER
• It is characterised by mood swings from profound depression to
extreme euphoria (mania), with interfering periods of normalcy.
• Delusions and hallucinations may or may not be present.

8. BIPOLAR TYPE I
Mania Episode
A Distinct period of abnormality and persistently elevated, expressive or
irritable mood.
Lasting for one week or more.
Inflated self esteem or grandiosity
Decreased need for sleep (3 hours of sleep)
More talkative and pressure to keep on talking
Flight of ideas
Distractibility (attention easily withdrawn to unimportant or irrelevant
external stimuli)
Psychomotor agitation (increase in goal directed activity)
Excessive involvement in pleasurable activities with painful
consequences (foolish business investments or sexual indiscretion)

9. Hypomania Episode
Milder degree of clinical symptoms of mania episodes.
Diagnostic features:
Same as mania episode but lasting at least 4 consecutive days.
The disturbance in mood and the change in functioning are observable
by others.
It is not severe enough to cause marked impairment in social or
occupational functioning.

10. Major Depressive Episode
Five or more of the following symptoms have been present during two
weeks or more.
Diagnostic features:
Depressed mood most of the day, nearly everyday.
Markedly diminished interest or pleasure in all or almost all
activities everyday.
Significant weight loss or weight gain
Insomnia or hypersomnia everyday
Psychomotor agitation or retardation nearly everyday
Fatigue or loss of energy nearly everyday
Feelings of worthlessness or excessive or inappropriate guilt.
Diminished ability to think or concentrate or indecisiveness nearly
everyday.
Recurrent thoughts of death, recurrent suicidal ideation

11. BIPOLAR TYPE II
• Criteria have been met for at least one hypomania episode and at least
one major depressive episode
• There has never been a mania episode
• The occurrence of the hypomania episode(s) and major depressive
episode(s) is not better explained by schizoaffective disorder,
schizophrenia, schizophreniform disorder, delusional disorder, or other
specified or unspecified schizophrenia spectrum and other psychotic
disorder.
• The symptoms of depression or the unpredictability caused by frequent
alternation between periods of depression and hypomania causes clinically
significant distress or impairment in social, occupational, or other
important areas of functioning.

12. CYCLOTHYMIA
For a diagnosis of cyclothymia, the Diagnostic and Statistical Manual of
Mental Disorders (DSM-5), published by the American Psychiatric
Association.
• many periods of elevated mood (hypomania symptoms) and periods of
depressive symptoms for at least two years (one year for children and
teenagers) — with these highs and lows occurring during at least half
that time.
• Periods of stable moods usually last less than two months.
• Your symptoms significantly affect you socially, at work, at school or in
other important areas.
• Your symptoms don't meet the criteria for bipolar disorder, major
depression or another mental disorder.
• Your symptoms aren't caused by substance use or a medical condition.

13. DEPRESSIVE DISORDERS
• Depression is an alteration in mood that is expressed by feelings of
sadness, despair and pessimism.
• There is a loss of interest in usual activities and somatic symptoms
may be evident.
• Changes in sleep and appetite pattern are evident.
Diagnostic features: same as mentioned before (major depressive
disorder)

14. DISRUPTIVE MOOD DYSREGULATION DISORDER
• Severe recurrent temper outbursts manifested verbally and or
behaviourally.
• The temper outbursts are inconsistent with developmental level
• The temper outbursts occur three or more times per week.
• The mood between temper outbursts is persistently irritable or angry
everyday.
• Present for 12 months or more.

15. DYSTHYMIA
• Dysthymia is also known persistent depressive disorder. It is a mental
disorder that causes a chronic low level depression that lasts for years.
• Dysthymia is similar to major depressive disorder but the symptoms are
less severe but last longer.

16. PREMENSTRUAL DYSPHORIC DISORDER
At least five symptoms must be present in the final week before the onset
of menses but starts to improve within few days after the onset of menses
Marked affective lability (mood swing)
Marked irritability or anger increased interpersonal conflict
Marked depressed mood, feelings of hopelessness or self
deprecating thoughts.
Marked anxiety, tension and or feelings of being keyed up or on
edge.
Diagnostic features same as depressive disorders

17. PATHOPHYSIOLOGY
Constant stress results from overactivation of the hypothalamic-
pituitary-adrenal (HPA) axis, which results in glucocorticoid cortisol
level increase.
Neuronal plasticity also plays a significant role in the pathophysiology
of mood disorder.
Patients with poor social support show signs of impaired neuronal
plasticity, predisposing them to mood disorders.
Mild to moderate impairment of neuronal plasticity causes depression,
while severe impairment results in mania.

18. PSYCHOPATHOLOGY
• Genetic factors
Bipolar Disorder is among the most heritable of disorders.
The risk of Bipolar Disorder among children of Bipolar Disorder parents
is four times greater than the risk among children of healthy parents.
• Neurotransmitters dysregualtion
Three neurotransmitters have received the most attention in studies of
mood disorders: norepinephrine, dopamine, and serotonin.
The original neurotransmitter models suggested depression was tied to
low levels of norepinephrine and dopamine, whereas mania was tied to
high levels of norepinephrine and dopamine.

19. CAUSES OF MOOD DISORDERS
• Life events:
Stressful life events, such as the death of a loved one, chronic stress, or traumatic events, can
increase the risk of developing a mood disorder.
• Genetics:
Mood disorders can run in families, and people with a strong family history are more likely to
develop them.
• Brain chemicals:
An imbalance of brain chemicals can contribute to mood disorders.
• Medications:
Some prescription drugs and street drugs can cause mood disorders.
• Withdrawal:
Withdrawing from benzodiazepines can cause depression, which usually improves after a few
months

20. MEDICAL MANAGEMENT
• Antidepressants – Amoxapine, Imipramine
• Lithium for mania
• Antipsychotics – Risperidone, Olanzapine, Haloperidol
• Mood stabilisers – Sodium valproate, carbamazepine,
Benzodiazepines
• ECT
• Psychosocial treatment

21. SCALES
Depression
• Hamilton Rating Scale for Depression (HAM-D)
• Montgomery-Asberg Depression Rating Scale (MADRS)
• Depression, Anxiety, stress scale
Mania
• Young Mania Rating Scale (YMRS)
• Manic State Rating Scale (MSRS)
• Bech-Rafaelsen Mania Rating Scale (MAS)
Mood disorder Questionnaire (MDQ)

22. OT ASSESSMENT
• Demographic data
• Medical history
• Personal history
• Educational history
• Premorbid personality
• General appearance
• Psychomotor activity
• Sensory perceptual evaluation
• Thought disorder
• Cognition evaluation
• Emotions
- Mood
- Affect
• Insight
• Interpersonal behaviour
• Intrapersonal behaviour
• Roles and routines
• ADL
• IADL

23. PROMBLEMS IDENTIFIED
• ADL are affected
- Self care
- Work
- Leisure
• Poor cognition
- Attention
- Concentration
- Problem solving
- Decision making
• Changes in Mood and affect
• Maladaptive behaviour
• Thought disorders – flight of
ideas, preoccupation, suicidal
thoughts
• Poor or absent of Insight
• Changes in sleep pattern
• Loss of appetite
• Poor interpersonal skills
• Poor intrapersonal skills

24. OT APPROACHES / FOR
• Psychoanalytical approach
• Cognitive behavioural FOR
• Behavioural FOR
• Acquisitional FOR

25. • Psychoanalytical approach
- Free flowing conversation
- Interpretation
• Cognitive behavioural approach
- Replacing depressive negative
cognition with new cognitive
and behavioural responses
- Self monitoring
- Cognitive restructuring
- Bibliotherapy
- Communication skills
• Behavioural FOR
- Modeling
- shaping
- Chaining
- Token economy system
- Fading
• Acquisitional FOR
- Activity based goals
- Natural progression
- Client awareness
- Imitation.

26. OT TREATMENT AND ACTIVITIES
• Psychoeducation
• Reality orientation therapy
• Social skills training
• Group therapy
• Guided imagery
• Stress management
• Assertiveness training
• Sleep hygiene techniques
• Relaxation techniques
• Projective techniques
• Family and marital therapy
• Sensory modulation techniques

27. • Psychoeducation
- Provide info and support to better
understand and cope with illness for patient
and caregiver
• Reality orientation therapy
- To help them maintain a sense of reality and
reduce disorientation and preoccupation
• Social skills training
- Motivation
- Demonstration
- Practice
- Feedback
• Sensory modulation techniques
- Calming sensory input
- Self regulation techniques
- Self soothing activities
• Relaxation techniques
- Deep breathing exercises
- Meditation
- Yoga
- Music and art therapy
• Sleep hygiene techniques
- Regular physical exercises
- Minimize daytime napping
- Sleep in a dark, quiet comfortable
environment.
- Avoid food intake one to two hours
before sleeping.
• Projective techniques
- Arts and crafts activities

28. RECENT ADVANCEMENTS
• Evidence based group therapy for mood disorders: Treatment for depression
and bipolar disorders. - 2024
- Cognitive behavioural group therapy and group cognitive therapy
- Group behavioural activation, group interpersonal therapy, group functional
remediation and group psychoeducation.
• Effectiveness and changes in brain function by an occupational therapy
program incorporating mindfulness in outpatients with anxiety and
depression – 2023
- Occupational therapy incorporating mindfulness (MOT) improves well being and
global function for those who struggles with social and occupational functioning.

29. REFERENCE
• A short textbook of psychiatry – Niraj Ahuja
• Mental health concepts and techniques – Mary Beth Early
• Diagnostic and statistical manual of mental disorders – fifth edition DSM
– 5th.

30. THANK YOU