2. Mood disorder
Mood disorder is a mental health
problem that primarily affects the
person’s mental state.
It is also defined as any of the
several psychological disorders
characterized by abnormalities of
emotional state -from Merriam
Webster
It is also called as affective
disorder
3. Types of mood disorder
Unipolar depressive disorder –
person experience only depressive episodes.
Bipolar and related disorder –
Person experiences both maniac and depressive
episodes.
Manic episode –
Person shows markedly elevated, euphoric or
expansive mood.
Hypomanic episodes –
Person experiences abnormally elevated,
expansive or irritable mood for at least 4 days
4. Unipolar mood disorder
It involves several depressive symptoms
(extremely low mood)
It shows persistent or pervasive
depression that doesn’t involve maniac,
episode, hyper maniac episode, or a mixed
episode
5. Criteria for major depressive disorder
Depressed mood most of the day, nearly everyday indicated by
depression, sad, empathy, hopelessness.
Markedly diminished interest or pleasure ,almost in all activities
Significant weight loss.
Insomnia or hypersomnia nearly everyday
Fatigue or loss of energy
Feelings of worthlessness or excessive or inappropriate guilt
Diminished ability to think or concentrate
Recurrent thoughts of death.
6. Criteria for maniac episode
Distinct period of abnormally and
persistently elevated, expansive, or
irritable mood lasting at least one week.
Inflated self esteem or grandiosity.
Decreased need for sleep.
More talkative than usual or pressure
to keep talking.
7. Flight of ideas.
Distractibility
Increase in goal directed activity or
psychomotor agitation
Excessive involvement in activities that
have a high potential for painful
consequences.
Cause impairment in social or occupational
functioning or to necessitate hospitalization
to prevent harm to self or others
8. Unipolar depressive disorder
Sadness, discouragement, pessimism and hopelessness about, matters
improving are familiar feeling to most people.
Other forms of depression
Loss and the grieving process – 1) numbing and disbelief 2) yearning
and searching for the dead person 3) disorganization and despair 4)
some reorganization as the person gradually begins to rebuild his or her
life. – 4 phases for the normal response for the loved ones (Bowlby -
1980)
Postpartum “blues” – occurs in new mothers or fathers and it is known
to have adverse effect on child outcomes
The symptoms of postpartum blues includes changeable mood,
crying easily, sadness and irritability, often liberally intermixed with
happy feelings.
It occurs in 50 to 70% of women within 10 days of the birth of their
child.
Hormonal readjustment and alteration in serotonergic and
noradrenergic functioning may plays a role in postpartum blues and
depression, although the evidence on this is mixed.
9. Dysthymic disorder
(persistent depressive disorder)
Depressive mood for most of the days
Poor appetite or overeating
Insomnia and hypersomnia
Low energy or fatigue
Low self esteem
Poor concentration or difficulty making decisions
Feelings of hopelessness
Criteria may occurs for more than 2 years
There has never been a manic episode or
hypomanic episode and criteria
have never been met for cyclothymic disorder.
10.
11. Major depressive disorder
Accompanied by,
Low self esteem
Loss of interest in normally enjoyable activities
Low energy
Pain without clear cause
They never had have an mixed episode, maniac, hypomanic
Depression as a recurrent disorder
Approximately 10 to 20 % of people with major depression,
symptoms do not remit over 2 years
Recurrence has been different from relapse,
relapse refers to return of symptoms within short period of
time
12. Specifiers of major depressive episodes
With melancholic features -
early morning awakening,
depression worse in the morning ,
psychomotor agitation or retardation
loss of appetite or weight
excessive guilt
qualitatively different depressive mood
13. with psychotic features
delusions or hallucinations
feelings of guilt
with Atypical feature
mood reactivity –brightens to positive
events;
weight gain or increase in appetite
hypersomnia
leaden paralysis
actually sensitive to interpersonal rejection
14. with catatonic features
Mutism and rigidity
Immobility to extreme
psychomotor activity
with seasonal pattern
At least two or more episode in
past 2 years that have occurred at
the same time.
16. Biological causal factors
Genetic influences
Family studies shows that 2 to 3 times higher among blood relatives of
person with clinically diagnosed unipolar depression.
Twin studies it provides more conclusive evidence of genetic influence on a
disorder (monozygotic twin)
Role of neurotransmitters
The view of depression may arise due to disruption in delicate balance of
neurotransmitter substance that regulate and mediate the activity of brain
nerve cells – receives the great deal of attention
Early attention mainly focused on two primary neurotransmitters
Norepinephrine
Serotonin
Neurotransmitters are known be involved in behavioral activity, stress,
emotional activity and vegetative function
Recent researches shows that dopamine dysfunction plays a major role in
depression
17. Abnormalities of hormonal regulatory and immune system – process of
secretion of cortisol
Hypothalamic-pituitary adrenal axis and in the particular on the hormone
cortisol – which is excreted by outermost portion of adrenal glands and is
regulated through complex feedback loop
Hpa – partly controlled by norepinephrine and serotonin
The perception of threat or stress can leads to norepinephrine activity in
the hypothalamus causing the release of corticotrophin releasing hormone
CRH from the hypothalamus.
This turns adrenocorticotrophic hormone ACTH from the pituitary
Then ACTH travels through the blood to the adrenal cortex of adrenal
gland where cortisol is released
Elevated cortisol activity is highly adaptive in short term because it
promotes survival in response to life threatening or overwhelming life
circumstances.
Research also revealed that patient having high depression with elevated
cortisol also tend to show memory impairments problem with abstract
thinking and complex problem solving
18. Sleep and other biological rhythms
Patient with depression shows one or more
variety of sleep problems such as early morning
awakening, periodic awakening during night and
difficulty in falling asleep
EEG – recordings shows patient with
depression enters Ist period of REM sleep after
only 60 minutes or less of sleep and also shows
greater amount of REM .
19. Circardian rhythm
Abnormalities in circardian rhythm occurs in patient with
depression
Environmental causes
Sunlight and seasons
People with seasonal affective disorder, in which most of
them affected seems to be responsive to the total quantity of
available light in environment
Majority may depressed in winter and fall ,
normalize in summer and spring
20. Biological explanation for sex
difference
Hormonal factors such as normal fluctuation
in ovarian hormones account for sex difference
in depression
In majority of women hormonal changes are
occurring at various points such as onset of
puberty, before menstruation, postpartum
period, menopause etc
Some researches has shows that women have
greater genetic vulnerability than men.
21. PSYCHOLOGICAL CAUSAL FACTOR
1. Stressful life events
•Mildly stressful events and chronic stress
•Vulnerability and response to stressor
2. Major depressive disorder
Prolonged persistent period of extreme sadness
3. Bipolar disorder
Seasonal affective disorder – SAD
A form of depression most often associated with fewer hours of daylight in
far northern and southern latitude from late fall to early spring
4. Cyclothymic disorder
The disorder that causes ups and downs that are less extreme than bipolar
disorder
5. Premenstrual dysphoric disorder
Mood disorder and irritability that occur during premenstrual phase of
women cycle and go away with the onset of menses.
22. 6. Persistent depressive disorder
A long term chronic form of depression
7. Disruptive mood dys-regulation disorder
Disorder of chronic, severe and persistent irritability in
children that often includes frequently temper outburst
that are inconsistent with child’s developmental age.
8. Depression related to medical illness
A persistent depressed mood and significant loss of
pressure in most or all activities that are directly related to
the physical effects of another medical condition
9. Depression includes substance use or medication
Depression symptoms that develops or soon after
substance use or withdrawal or after exposure to
medication
23.
24. DEFINITION
Bipolar disorder is also known as maniac
depression, is a mental illness that brings severe
high and low moods and changes in sleep, energy,
thinking and behavior.
•People with bipolar disorder can have periods in
which they feel overly happy and energized and
other period of feelings very sad, hopeless or
slugglish.
25. Different Types of Bipolar Disorder
1.Bipolar I disorder
•This type of bipolar disorder is diagnosed when manic
episodes last at least seven days and are accompanied by
psychotic features, or the manic symptoms are severe
enough to require immediate hospitalization to prevent
harm to oneself or others.
•Depressive episodes, typically lasting at least two weeks,
also often occur.
• A person may have manic episodes with some
depressive features or depressive episodes with some
manic features.
26. 2. Bipolar II disorder
•Mania is not involved in bipolar II disorder. Instead, the illness
involves recurring episodes of major depression and
hypomania, a milder form of mania.
•In order to be diagnosed with bipolar II disorder, you must
have experienced at least one hypomanic episode and one major
depressive episode in your lifetime.
•Common symptoms that occur in a major depressive episode
include:
•Insomnia or hypersomnia
•Unexplained or uncontrollable crying
•Severe fatigue
•Loss of interest in things the person typically enjoys
•Recurring thoughts of death or suicide
27. 3. Cyclothymic disorder
•Cyclothymia is a milder form of bipolar disorder. Like
bipolar disorder, cyclothymia consists of cyclical mood
swings. However, the highs and lows are not severe
enough to qualify as either mania or major depression.
•The condition usually develops in adolescence.
•People with the disease often appear to function
normally, although they may seem “moody” or
“difficult” to others.
•People will often not seek treatment because the mood
swings do not seem severe. If left untreated,
cyclothymia can increase your risk of developing
bipolar disorder.
28. 4. Bipolar disorder due to another medical or
substance abuse disorder
•Some bipolar disorders don’t have a specific pattern.
They also don’t match the other three disorders. Yet, they
still have to meet the criteria for abnormal mood changes.
•For example, a person may experience mild depressive
or hypomanic symptoms that last less than the two years
specified for cyclothymia.
•Another example is if a person has depressive episodes,
but their symptoms of mood elevation are too mild or
brief to be diagnosed as mania or hypomania.
29. 1. Biological causal factors
It includes
•Genetic influences
•Neurochemical factors
•Abnormalities of hormonal
regularities
•Neurophysiological and
neuroanatomical influences
•Sleep and other biological rhythms
30. 2. Psychological factor
•Stressful life events
•And it also includes other psychological factors
such as personality variables – neuroticism has been
associated with the symptoms of maniac and
depression
3. Socio cultural factors for unipolar and
bipolardisorders
•Cross cultural differences in depressive
symptoms
•Cross cultural differences in prevalence
31.
32. Treatments and outcomes
1. Pharmacotheraphy
Antidepressant , mood stabilizing and antipsychotic drugs are used
in the unipolar and bipolar disorders
• MAOIs – monoamine oxidaze inhibitors (1950) , an enzyme which
is responsible for the breakdown of norephenephrine and serotonin
are released
Advantages
About 50% showed response to the initial trial of medication
Disadvantages
Unpleasant side effects such as (dry mouth, constipation, sexual
dysfunction, weight gain etc)
These drugs are considered to be toxic when is taken in an extreme
quantity
33. Selective serotonin reuptake inhibitor
(SSRI)
Treat people with mild depressive disorder
Lithium and other mood stabilizing drugs
Lithium has been more wildly studied as a
treatment for maniac episodes than of depressive
episode , and are estimated that about three-
quarters of maniac patients shows atleast partial
improvement
34. 2. Alternative biological treatment
I. Electro convulusive therapy – is often used with
severe depressive patients who may present an
immediate and serious suicidal risk, including those
with psychotic and melancholic features.
II. Deep brain stimulation – it involves implanting an
electrode in the brain and then stimulating that area
with electric current
III. Bright light therapy – it was originally used in the
treatment of seasonal affective disorder , but it is
now effective in non seasonal depression as well
36. Psychotherapy
1. Cognitive behavioral therapy
•It was originally developed by Beck and
colleagues
•It consist of structural and systematic attempts
to each people with unipolar disorder
•To evaluate systematically to their dysfunctional
belief
•They are also taught to correct their biases and
distortions in information processing and to
uncover and challenge their underlying
depressogenic assumptions and belief.
37. 3. Family and marital therapy
•It gives further advances in providing greater
increases in marital satisfaction than cognitive therapy
2. Behavioral activation treatment
•This approach focus intensively on getting patient to
become more active and engaged with their
interpersonal relationships
•This techniques includes scheduling daily activities
and rating pleasure and mastery while engaging in
them, exploring alternative behaviors to reach goals,
and role playing to address specific deficits
•The goal is to increase the positive reinforcement and
to reduce the avoidance or withdrawal
38. Interpersonal therapy
•It provides its strong efforts to effectiveness for
treating unipolar depression
•It focuses on current relationship issues
•It focuses on stabilizing daily social rhythms, in which
patients are taught to recognize the effect of
interpersonal events
•And their social and circardian rhythms and to
regularize the rhythms
39. Conclusions
• Even without formal therapy , the greater majority
patients with mania and depression recover from the
given episodes in less than one year.
• Although relapses and recurrences often occur , they
can now often be prevented or atleast reduced in
frequency by maintenance therapy like continuation of
medication and suggested therapies.
