MOOD Important Considerations in Distinguishing Clinical

DISORDERS Depressions from Normal Sadness

 Emotion – a state of arousal that is defined by subjective 1. The mood change is pervasive across situations and
states of feelings such as sadness, anger and disgust. persistent over time. The person’s mood does not
Emotions are often accompanied by physiological improve, even temporary, when he or she engages in
changes, such as changes in heart rate and respiration activities that are usually experienced as pleasant.
rate. 2. The mood change may occur in the absence of any
 Affect – the pattern of observable behaviors such as precipitating events, or it may be completely out of
facial expression that are associated with these proportion to the person’s circumstances.
subjective feelings. People also express affect through 3. The depressed mood is accompanied by impaired
pitch of their voices and with their hand and body ability to function in usual social and occupational
movements. roles. Even simple activities become overwhelmingly
 Mood – A pervasive and sustain emotional response that difficult.
in its extreme form, can color the person’s perception of 4. The change in mood is accompanied by a cluster of
the world (APA, 2000). additional signs and symptoms, including cognitive,
 Depression – can refer either to a mood or to a clinical somatic, and behavioral features.
syndrome, a combination of emotional cognitive and 5. The nature or quality of the mood change may be
behavioral symptoms. The feelings associated with a different from that associated with normal sadness. That
depressed mood often include disappointment and may feel “Strange,” like being and engulfed by a black
despair. People who are in a severely depressed mood cloud or sunk in dark hole.
describe the feeling as overwhelming, suffocating or
numbing. SYMPTOMS OF DEPRESSION
 Clinical depression – (in syndrome of depression) a Emotional  Depressed, or dysphoric (unpleasant),
mood.
depressed mood is accompanied by several or other
 Severity of a depressed mood can reach
symptoms, such as fatigue, loss of energy, difficulty in painful and overwhelming proportions.
sleeping, changes in appetite, changes in thinking and  May be irritable
overt behavior, cognitive symptoms such as extreme  Sometimes apprehensive, fearing that
guilt, feeling of worthlessness, concentration problems, matters will become worse than they
and thoughts of suicide. Behavioral symptoms may already are or that others will discovery
their inadequacy.
range from constant pacing and fidgeting to extreme
activity.
Cognitive  Thinking is slowed down, have trouble
 Mania – involves a disturbance in mood that is
concentrating, and easily distracted.
accompanied by additional symptoms.  Common preoccupations- guilt and
 Euphoria (elated mood) – the opposite emotional state worthlessness.
from a depressed mood. It is characterized by an  focus considerable attention on most
exaggerated felling of physical and emotional well-being negative features of themselves, their
(APA, 2000). Manic symptoms that frequently environments, and the future - a
combination known as the “depressive
accompany an elated mood include inflated self-esteem,
triad” (Beck,1967)
decreased need for sleep, distractibility, pressure to keep  Self-destructive ideas and impulses
talking and the subjective feeling of thoughts racing  Interest in suicide develops gradually
through the person’s head faster than they can be spoken. and may begin with the vague sense that
 Mood disorder – defined in terms of episodes discrete life is not worth living.
periods of time in which the person’s behavior is Somatic  fatigue, aches and pains
dominated by either a depressed or manic mood.  serious changes in appetite and sleep
Unfortunately, most people with the mood disorder patterns
 commonly lose their interest in
experience more than one episode. various types of activities that are
otherwise source of pleasure and
fulfilment.
Behavioral  Psychomotor Retardation 7. Feelings of worthlessness or excessive or inappropriate
guilt nearly every day (not merely self-reproach or guilt
about being sick).
SYMPTOMS OF MANIA 8. Diminished ability to think or concentrate, or
Emotional  Euphoria - periods in explicable and indecisiveness, nearly every day.
unbounded joy 9. Recurrent thoughts of death (not just fear of dying),
 as these feelings become more recurrent suicidal ideation without a specific plan, or a
intense and prolonged, they can suicide attempt or a specific plan for committing suicide.
become ruinous (out of control &
self-destructive)
 May be irritable. Their anger may  Dysthymia - differs from major depression in terms of
directed either at themselves or at both severity and duration. Dysthymia represent a
others; extremely argumentative and chronic mild depressive condition that has been present
abusive
for many years.
Cognitive  Thoughts are speeded up. Ideas flash
through their minds faster than they can -The person must over a period of at least a two years,
articulate their thoughts exhibit a depressed mood for most of the day on more
 Easily distracted days than not two or more of the following symptoms
 Grandiosity and inflated self-esteem must also be present:
Somatic  Drastic reduction in the need for sleep 1. Poor appetite or overeat
Behavioral  Gregarious and energetic 2. Insomnia or hypersomnia
 Flirtatious and provocative
3. Low energy or fatigue
4. Low self-esteem
UNIPOLAR DISORDER 5. Poor concentration or difficulty making decision
6. Feelings of hopelessness
The unipolar disorders include two specific types;
major depressive disorder and dysthymia. In order to meet  These symptoms must not be absent for more than two
the criteria for major depressive disorder, a person must months at a time during the two-year period. If, at any
experience at least one major depressive episode in the time during the initial two years the person met criteria
absence of any history of manic episodes. for a major depressive episode, the diagnosis would be
a major depression rather than dysthymia. As in the
Symptoms Listed in DSM-IV-TR for Major Depressive
case of major depressive disorder, the presence of a
Episode
Five more of the following symptoms have been present manic episode would rule out a diagnosis of
during the same two-week period and represent a change dysthymia.
from previous functioning; at least one of the symptoms is
either (1) depressed mood, or (2) loss of interest or BIPOLAR DISORDER
pleasure. Note: in children and adolescents, can be irritable
mood. A. Bipolar l Disorder - has experienced at least one manic
1. Depressed mood most of the day, nearly every day, as episode have episodes of major depression in addition to
indicated either by subjective report (for example, feel sad manic episodes.
or empty) or observation made by others (for example,
appears tearful). Symptoms Listed in DSM-IV-TR for Manic Episode
2. Markedly diminished interest or pleasure in all, or A. A distinct period of abnormally and persistently
almost all, activities most of the day, nearly every day. elevated, expansive of irritable mood, lasting at least
3. Significant weight loss when not dieting or weight gain one week (or any duration if hospitalization is
for example, a change of more than 5percent of body necessary).
weight in a month), or decrease or increase in appetite B. During the period of mood disturbance, three or
nearly every day. Note: in children, consider failure to more of the following symptoms have the persisted
make expected weight gains. (four if the mood is irritable) and have been present a
4. Insomnia or hypersomnia nearly every day. significant degree:
5. Psychomotor agitation or retardation nearly every day 1. Inflated self-esteem or grandiosity.
(observable by others). 2. Decreased need for sleep – for example, feels rested
6. Fatigue or loss energy nearly every day. after only three hours of sleep. 3.
More talkative than usual, or pressure to keep talking.
 4. Flight of ideas or subjective experience that play a central role in the onset and subsequent
thoughts are racing. 5. maintenance of depression after these thoughts
Distractibility- that is, attention too easily drawn to are activated by the experience of negative life
unimportant or irrelevant external stimuli. event.
6. Increase in goal-directed activity (either
socially, at work or school, or sexually) or
psychomotor agitation. Psychoanalytic:
7. Excessive involvement in pleasurable -Freud looked at the self-depreciation of
activities that have a high potential for people with depression and attributed that self-
painful consequences – for example, approach to anger turned inward related to either
The person engages in unrestrained buying a real or perceived loss. Feeling abandoned by
sprees, sexual indiscretion, or foolish
this loss, people became angry while both loving
business investments.
and hating the lost subject.
- Horney believed that children raised by
B. Bipolar ll Disorder – hypomania rejecting or unloving parents were prone to
experienced at least one major depressive episode, at least feelings of insecurity and loneliness making them
one hypomanic episode (episodes of increased energy that susceptible to depression and helplessness.
are not sufficiently severe to qualify as full-blown mania)
and no full-blown manic episodes. C. Biological Factors
 Genetics
The differences between manic and hypomanic The family and twin studies indicated the
episodes involve duration and severity. The symptoms genetic factors play an important role in the
need to be present for a minimum of only four days to development of mood disorders.
meet the threshold for a hypomanic episode (as oppose to  Structures of the Brain
one week for a manic episode). The mood change in a Areas of the brain affected by depression and the
hypomanic episode must be noticeable to others, but the symptoms that they mediate include the ff:
disturbance must not be severe enough to impair social or
 Hippocampus: Memory impairments, feelings of
occupational functioning or to require hospitalization. worthlessness and guilt.
 Amygdala: Anhedonia, anxiety, reduced
C. Cyclothymia – a chronic but less severe form of bipolar
motivation
disorder. It is, therefore, the bipolar equivalent of
dysthymia. In order to meet criteria for cyclothymia, the  Hypothalamus: Increased or decreased sleep and
person must experience several periods of time with appetite, decreased energy and libido
hypomanic symptoms and frequent periods of depression  Other limbic structures: Emotional alterations
(or loss of interest or pleasure) during a period of two
years. There must be no history of major depressive  Frontal Cortex: Depressed mood, problems
episodes and no clear evidence of a manic episode during concentrating.
the first two years of the disturbance.  Cerebellum: Psychomotor retardation/agitation

ETIOLOGY: DEPRESSION
 Neurotransmitter- It has been hypothesized that
A. Social Factors depressive illness may be related to a deficiency of
– Include primarily the influence of stressful life the neurotransmitter norepinephrine, serotonin and
events, especially severe losses that are dopamine at functionality important receptor sites in
associated with significant people or significant the brain.
roles.
B. Psychological Factors  D. Physiological Influences
 Cognitive Vulnerability Depressive symptoms that occur as consequence
– According to the cognitive perspective, of a non-mood disorder or as an adverse effect of
pervasive and persistent negative thoughts about certain medications are called a secondary
the self and pessimistic views of the environment depression. Secondary depression may be related to
 medication side effects, neurological disorders, TREATMENT
electrolyte or hormonal disturbances or
psychological conditions. Depression

ETIOLOGY: BIPOLAR DISORDER  Psychotherapies (Cognitive Therapy)

(with MANIA)  Psychopharmacology : Antidepressants
A. Psychoanalytic (SSRI, MAOI, TCA)
- Most psychoanalytic theories of mania view
manic episodes as a “defense” against underlying Bipolar Disorder
depression, with the id taking over the ego and acting
as an undisciplined, hedonistic being (child)  Psychopharmacology : Lithium Carbonate,
Anticonvulsants (Carbamazepine Tegretol or
B. Biological Factors valproic acid (Depakene)

 Genetics
- Research suggest bipolar disorder strongly
reflects an underlying genetic vulnerability.
Evidence from family, twin, and adoption studies
exist to support this observation.
 Brain structures
- Right sided lesions in the limbic system,
temporobasal areas, basal ganglla, and thalamus
have been shown to induce secondary mania.
Magnetic resonance imaging studies have revealed
enlarge the third ventricles and subcortical white
matter and periventricular hyperintensities in client
with bipolar disorders. (Dubovsky et al, 2003).
 Neurotransmitter
- Early studies have associated symptoms of
depression with a functional deficiency of
norepinephrine and dopamine and mania with a
functional excess of theses amines. The
neurotransmitter serotonin appears to remain low on
both states.