BSCP 3-1D Date: March 13, 2010

Abnormal Pscyhology

MOOD DISORDERS

Leader: Cunamay, Christine Eve G.

0905-677-4837

Members:

Agapay, Michael E.

Bagay, Khristine B.

Evangelista, Cherrie

Laurina, Anna Ezra

Tabid, Nikko Lorenzo

 EPISODES

 MAJOR DEPRESSIVE EPISODE

A. Five or more of the following symptoms have been present during the same 2-
week period and represent a change from previous functioning; at least one of
the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

(1) depressed mood most of the day, nearly every day, as indicated by
either subjective report or observation made by others.

(2) markedly diminished interest or pleasure in all, or almost all, activities

most of the day, nearly every day

(3) significant weight loss when not dieting or weight gain, or a decrease
or increase in appetite nearly every day.

(4) insomnia or hypersomnia nearly every day.

` (5) psychomotor agitation or retardation nearly every day.

(6) fatigue or loss of energy nearly every day.

(7) feelings of worthlessness or excessive or inappropriate guilt nearly

every day.

(8) diminished ability to think or concentrate, or indecisiveness,, nearly

every day.

(9) recurrent thoughts of death, recurrent suicidal ideation without a

specific plan, or a suicide attempt or a specific plan for
committing suicide.

B. The symptoms do not meet criteria for a Mixed Episode.

C. The symptoms cause clinically significant distress or impairment in social,

occupational, or other important areas of functioning.

D. The symptoms are not due to the direct physiological effects of a substance or
a general medical condition.

E. The symptoms are not better acoounted for the Bereavement the symptoms
persist for longer than 2 months or are characterized by marked
functional impairment, morbid preoccupation with worthlessness, suicidal
ideation, psychotic symptoms, or psychomotor retardation.
 MANIC EPISODE

A. A distinct period of abnormally and persistently elevated, expansive, or

irritable mood, lasting at least 1 week.

B. During the period of mood disturbance, three (or more) of the following
symptoms have persisted and have been present to a significant degree:

(1) inflated self-esteem or grandiosity.

(2) decreased need for sleep.

(3) more talkative than usual or pressure to keep talking.

(4) flight of ideas or subjective experience that thoughts are racing.

(5) distractibility.

(6) increase in goal-directed activity or psychomotor agitation.

(7) excessive involvement in pleasurable activities that have a high

potential for painful consequences.

C. The symptoms do not meet criteria for a Mixed Episode.

D. The mood disturbances is sufficiently severe to cause marked impairment in

occupational functioning or in usual social activities or relationships
with others, or to necessitate hospitalization to prevent harm to self, or
others, or there are psychotic features.

E. The symptoms are not due to the direct physiological effects of a substance or a
general medication condition.

 MIXED EPISODE

A. The criteria are met both for a Manic Episode and a Major Depressive Episode
nearly every day during at least a 1-week period.

B. The mood disturbances is sufficiently severe to cause marked impairment in

occupational functioning or in usual social activities or relationships
with others, or to necessitate hospitalization to prevent harm to self or
others, or there are psychotic features.

C. The symptoms are not due to the direct physiological effects of a substance or
a general medical condition.
 HYPOMANIC EPISODE

A. A distinct period of persistently elevated, expansive, or irritable mood, lasting

throughout at least 4 days, that is clearly different from the usual
nondepressed mood.

B. During the period of mood disturbance, three (or more) of the following
symptoms have persisted and have been present to a significant degree:

(1) inflated self-esteem or grandiosity

(2) decreased need for sleep

(3) more talkative than usual or pressure to keep talking

(4) flight of ideas or subjective experience that thoughts are racing.

(5) distractibility

(6) increase in goal-directed activity or psychomotor agitation.

(7) excessive involvement in pleasurable activities that have a high

potential for painful consequences.

C. The episode is associated with an unequivocal change in functioning that is

uncharacteristic of the person when not symptomatic.

D. The disturbance in mood and the change in functioning are observable by

others.

E. The episode is not severe enough to cause marked impairment in social or

occupational functioning, or to necessitate hospitalization, and there are no psychotic
features.

F. The symptoms are not due to direct physiological effects of a substanceor a

general medical condition.
DEPRESSION

Depression takes over the whole person – emotions, bodily functions, behaviors
and thoughts.

Emotional Manifestations

 Sadness
 Depressed mood
 Anhedonia
 Irritability

Physiological Manifestations

 Sleep disturbances
 Appetite disturbances
 Psychomotor retardation to agitation
 Catatonia
 Fatigue and loss of energy

Cognitive Symptoms

 Poor concentration and attention

 Indecisiveness
 Sense of worthlessness and guilt
 Poor self-esteem
 Hopelessness
 Suicidal thoughts
 Delusions and hallucinations with depressing themes
 UNIPOLAR DEPRESSION

People experience only depression, no mania.

Two categories of unipolar depression

1. Major depression
2. Dysthymic disorder

MAJOR DEPRESSION

It is a serious illness that affects a person's family and personal relationships,

work or school life, sleeping and eating habits, and general health. Its impact on
functioning and well-being has been equated to that of chronic medical conditions such
as diabetes.

Is a mental disorder characterized by an all-encompassing low mood accompanied

by low self-esteem, and loss of interest or pleasure in normally enjoyable activities.

 Exhibits a very low mood

 Inability to experience pleasure in activities that were previously enjoyed
 Thoughts and feelings of worthlessness
 Inappropriate guilt or regret
 Helplessness
 Hopelessness
 Self-hatred

Diagnosis requires that a person experience either depressed mood or loss of

interest in usual activites plus at least four other symptoms of depression chronically for
at least two weeks. In addition, these symptoms have to be severe enough to interfere
with the person’s ability to function in everyday life.

Individuals with this disorder have more pain and physical illness and decreased
physical, social, and role functioning.

When severe, there are problems with:

 Suicidal risk
 Need for hospitalization
  Lack of insight/Treatment Refusal
 Cognitive Functioning
 Reality Testing
 Dysphoric Mood
 Physical Functioning
 Cluster A+C Personality Traits
 Employment-Economic Functioning
 Social functioning
 May have symptoms of psychosis

When moderate, there are problems with:

 Dysphoric mood
 Physical functioning
 Cluster A+B Personality Traits
 Social Functioning

Diagnostic Features

Characterized by one or more Major Depressive Episodes without a history of

Manic, Mixed, or Hypomanic Episodes. These Major Depressive Episodes are not due to
a medical condition, medication, abused substance, or Psychosis. If Manic, Mixed, or
Hypomanic Episodes develop, the diagnosis is changed to Bipolar Disorder.
Comorbidity
Alcoholism and illicit drug abuse dramatically worsen the course of this illness,
and are frequently associated with it. Dysthymic Disorder often precedes the onset of
this disorder for 10%-25% of individuals.
This disorder also increases risk of also having :
 Panic Disorder
 Obsessive-Compulsive Disorder
 Anorexia Nervosa
 Bulimia Nervosa
 Emotionally Unstable (Borderline) Personality Disorder.
 Cardiovascular disease (such as smoking and obesity)
 May suffer from lifetime Anxiety

 Anxiety symptoms can have a major impact on the course of a depressive illness,
with delayed recovery, increased risk of relapse, greater disability and increased suicide
attempts.
 The prevalence rates for this disorder appear to be unrelated to ethnicity,
education, income, or marital status. In childhood, boys and girls are equally affected.
However, in adolescence and adulthood, this disorder is twice as common in females as
in males.
 Stressors may play a more significant role in the precipitation of the episodes of
this diorder such as death of a loved one or a divorce.

DYSTHYMIC DISORDER

Greek word dysthymia means “bad state of mind” or “ill humor”. This is a type of
low-grade depression. As one of the two chief forms of clinical depression, it usually has
fewer or less serious symptoms than major depression but lasts longer.

People with dysthymia have a greater-than-average chance of developing major

depression. Fluctuating symptoms intensity can trigger a full blown episode of major
depression. This situation is sometimes called "double depression" because the intense
episode exists with the usual feelings of low mood.
As dysthymia is a chronic disorder, a person may often experience symptoms for many
years before it is diagnosed, if diagnosis occurs at all. As a result, they tend to believe
that depression is a part of his or her character. This, subsequently, may lead sufferers to
not even discuss their symptoms with doctors, family members or friends.
Dysthymia, like major depression, tends to run in families. It is two to three times more
common in women than in men. Some sufferers describe being under chronic stress.
When treating diagnosed individuals, it is often difficult to tell whether they are under
unusually high environmental stress or if the dysthymia causes them to be more
psychologically stressed in a standard environment.

Less severe than major depression, but is more chronic. To be diagnosed with this
disorder, a person must be experiencing depressed mood plus two other symptoms of
depression for at least two years.

To be diagnosed, an adult must experience 2 or more of the following symptoms

for at least 2 years. During these two years, the person must never have been without the
symptoms of depression for more than a two-month period.
  Feelings of hopelessness
 Insomnia or hypersomnia
 Poor concentration or difficulty making decisions
 Low energy or fatigue
 Low self-esteem
 Poor appetite or overeating.
 Irritability

When severe, there are problems with:

 Dysphoric mood
 Cluster A+C Personality Traits
 Social Functioning

When moderate, there are problems with:

 Dysphoric mood
 Cluster A+C Personality Traits

Diagnostic Features

Exclude Manic, Hypomanic or Mixed Episodes commonly associated

with bipolar disorder.

Comorbidity

 In adults, this disorder is associated with an increased risk of having Major

Depressive Disorder and Substance-Related Disorders.
 In children, this disorder is associated with an increased risk of having Attention-
Deficit/Hyperactivity Disorder
 Conduct Disorder
 Anxiety Disorders
 Learning Disorders
  Mental Retardation

BIPOLAR MOOD DISORDER

A person's normal moods are the body's reaction to outside or inside stimulation,
which allows a person to handle, cope, or otherwise experience healthy emotions.
Healthy responses to normal emotions are what allow us to socialize, retain community
responsibility, hold a job and otherwise deal with our daily functions.

How to understand mood disorder? It is one of several different conditions as

diagnosed where someone's moods are inconsistent with the appropriateness of their
circumstances or surroundings. The most common mood disorders are depression, in all
its forms, or bipolar mood disorder (simply: mood swings).

Bipolar mood disorder is the new name for what was called manic depressive
illness. The new name is used as it better describes the extreme mood swings - from
depression and sadness to elation and excitement - that people with this illness
experience.

Sometimes mood swings can last for a few minutes or hours, and can come and
go with no warning at all. Bipolar mood disorder is found to affect all types of sexes,
ethic, races, and social groups. It is thought that there might be a familial connection
between sufferers, but this has yet to be determined.

Most people start showing signs of bipolar disorder in their late teens (the average
age of onset is 21 years). These signs may be dismissed as "growing pains" or normal
teenage behavior. On occasion, some people have their first symptoms during childhood,
but the condition can often be misdiagnosed at this age and improperly labeled as a
behavioral problem. Bipolar disorder may not be properly diagnosed until the sufferer is
25-40 years old, at which time the pattern of symptoms may become clearer.

Because of the extreme and risky behavior that goes with bipolar disorder, it is
very important that the disorder be identified. With proper and early diagnosis, this
mental condition can be treated. Bipolar disorder is a long-term illness that will require
proper management for the duration of a person's life.

Bipolar Disorder Causes

The exact cause of bipolar disorder has not been discovered, but many experts
believe that multiple factors are involved which act together to cause the disease. Bipolar
disorder may result from a chemical imbalance within the brain. The brain's functions are
controlled by chemicals called neurotransmitters. An imbalance in the levels of one of
these neurotransmitters, such as norepinephrine, may cause bipolar disorder. When levels
of this chemical are too high, mania occurs. When levels of norepinephrine drop below
normal levels, a person may experience depression. Levels of other neurotransmitters,
such as serotonin and dopamine, are also believed to play a role.

There is a significant genetic component to bipolar disorder. If a family member

has bipolar disorder, other family members may be at risk. The identical twin of a person
with bipolar disorder is at the highest risk for developing the condition. However, stress
of some kind often is needed to trigger the onset of the disease. The disease does not
occur just because of one gene, and the cause of the disease is likely a combination of
multiple genetic and environmental factors.

Sometimes a period of emotional stress, drug use, an illness, or another event

seems to trigger the onset of the disease. Stresses can also trigger a manic or depressive
episode in people who are known to have the condition.

Not everyone with severe mood swings or a change in personality has bipolar
disorder. Mood swings can be caused by other medical conditions that need to be
diagnosed and treated properly. Medical diseases and medications that may have
symptoms similar to bipolar disorder include the following:

• Head trauma (blood clot or bleeding in the brain)

• Thyroid problem (both underactive and overactive)

• Systemic lupus erythematosus (a condition that may affect various body organs,
including the brain)

• Brain tumor

• Epilepsy (seizures)

• Neurosyphilis (a form of the sexually transmitted disease, syphilis, that has gone
to the brain because it went untreated too long)

• AIDS (acquired immunodeficiency syndrome, the ultimate result of infection with

the human immunodeficiency virus or HIV)

• Sodium imbalance (sodium, one of several elements found in body cells that is
necessary for their proper function)

• Diabetes mellitus (a disorder of, among other things, sugar processing in the
body)
 • Certain medications that decrease the amount of serotonin or norepinephrine, such
as some antihypertensive drugs and some preparations of steroids and birth
control pills

Bipolar Disorder Symptoms

Mania and depression are the opposing phases in bipolar disorder.

Mania: A person in the manic phase may feel indestructible, full of energy, and ready for
anything. Other times that person may be irritable and ready to argue with anyone who
tries to get in the way.

• Elevated mood - the person feels extremely high, happy and full of energy.
The experience is often described as feeling on top of the world and being
invincible.
• Increased energy and over - activity.
• Reduced need for sleep.
• Irritability - the person may get angry and irritable with people who
disagree or dismiss their sometimes unrealistic plans or ideas.
• Rapid thinking and speech - thoughts are more rapid than usual. This can
lead to the person speaking quickly and jumping from subject to subject.
• Lack of inhibitions - this can be the result of the person's reduced ability to
foresee the consequences of their actions. For example, spending large amounts of
money, buying items which are not really needed.
• Grandiose plans and beliefs - it is common for people experiencing mania
to believe they are unusually talented or gifted or are kings, film stars or prime
ministers, for example. It is common for religious beliefs to intensify or for
people with this illness to believe they are an important religious figure.
• Lack of insight - a person experiencing mania may understand that other
people see their ideas and actions as inappropriate, reckless or irrational.
However, they are unlikely to recognize the behavior as inappropriate in
themselves.

Depression: Many people with bipolar mood disorder experience depressive episodes.
This type of depression can be triggered by a stressful or unhappy event, but more
commonly occurs without obvious cause.

• Sadness and crying spells are common.

• People who are depressed may not care enough to wash or comb their hair,
change clothes, or even get out of bed in the morning.
• These people may sleep too much (hypersomnolence) or have difficulty getting to
sleep (insomnia).
 • Many of these people have no interest in food or have no appetite and lose weight.
However, some eat excessively.
• People with depression have trouble thinking; they may forget to do important
things such as paying bills because they feel so down.
• They withdraw from friends.
• Hobbies that used to bring pleasure suddenly hold no interest for people who are
depressed.
• Depression brings feelings of hopelessness, helplessness, pessimism, and
worthlessness.
• Some people may develop chronic pain or other bodily complaints that do not
actually have any physical cause.
• People who are depressed may not see a point in living anymore and may actually
think about ways to kill themselves.

Comorbidity of Bipolar Disorder and other psychiatric conditions and drug abuse

The most common mental disorders that co-occur with bipolar disorder are:

• Attention deficit/hyperactivity disorder (ADHD)

• Anorexia nervosa

• Drug abuse (cocaine, methamphetamine use)

• Bulimia nervosa

• Panic disorder

• Posttraumatic stress disorder

• Social phobia

• Schizoaffective disorder

• Schizophrenia

• Delusional disorder

The most common general medical comorbidities are migraine, thyroid illness,
obesity, type II diabetes, and cardiovascular disease.
 BIOLOGICAL THEORIES OF MOOD DISORDERS

BIOLOGICAL THEORIES OF MOOD DISORDERS

 focus on genetic abnormalities or dysfunctions in certain neurobiological
systems.

THE ROLE OF GENETICS

 family history and twin studies suggest that the mood disorders can be
transmitted genetically.

FAMILY HISTORY STUDIES

 family history studies of people with bipolar disorder find that their first
degree relatives (parents, children, and siblings) have rates of both bipolar
disorder and unipolar depression at least 2-3 times higher than the rates of
relatives of people without bipolar disorder. In other words, the risk is
higher for people with a bipolar relative but only a minority of them
develop the disorder.

 unipolar depression also runs in families. Family history studies find that
the first degree relatives of people with unipolar depression are 2-3 times
more likely also to have depression compared with the first degree
relatives of people without the disorder. The relatives of people with
depression do not tend to have any greater risk for bipolar disorder than do
the relatives of people with no mood disorder. This suggests that bipolar
disorder has a genetic basis different from that of unipolar depression.

TWIN STUDIES
 twin studies of bipolar disorder have shown that the probability that both
twins will develop the disorder, or its concordance rate, is about 60
percent among identical twins, compared with about 13 percent among
non indentical twins. This finding suggests that genetics plays a
substantial role in vulnerability to bipolar disorder.

SPECIFIC GENETIC ABNORMALITIES

 abnormalities on the serotonia transporter gene could lead to dysfunction
in the regulation of serotonin, which in turn could affect the stability of
individuals moods.

NEUROIMAGING STUDIES
  have shown abnormalities in the structure and functioning of the prefrontal
cortex, hippocampus, anterior cingulate cortex, and amygdala in people
with mood disorders.
 people with depression have chronic hyperactivity of the hypothalamic-
pituitary adreal (HPA) axis, which helps regulate the body’s response to
stress.
 abnormalities in the biological stress response my result from early
stressors in some people and contribute to depression.

PSYCHOLOGICAL THEORIES OF MOOD DISORDERS

The psychological theories of depression have focused on aspects of the

environment, of thinking, and of a person’s past.

I. BEHAVIORAL THEORIES

Depression often arises as a reaction to stressful negative events, such as the

breakup of a relationship, the death of a loved one, a job loss, or a serious medical illness.
Sixty-five percent of people with depression in one study reported a negative life event in
the six months prior to the onset of their depression. People with depression are more
likely than non-depressed people to have chronic life stressors, such as financial strain or
a bad marriage. People who suffer depression also tend to have a history of traumatic life
event, particularly events involving loss.

A. LEWINSOHN’S THEORY

Suggests that life stress leads to depression because it reduces the positive
reinforcers in a person’s life. The person begins to withdraw, which only results in a
further reduction in reinforcers, which leads to more withdrawal, and a self-perpetuating
chain is created.

B. LEARNED HELPLESSNESS THEORY

Another behavioral theory that suggests that the type of stressful event most likely
to lead to depression is uncontrollable negative events. Such events, especially if frequent
or chronic, can lead people to believe that they are helpless to control important outcomes
in their environment. In turn, this belief in helplessness leads people to lose their
motivation, to reduce actions that might control the environment, and to be unable to
learn how to control situations that are controllable.

II. COGNITIVE THEORIES

According to the cognitive theories of depression, these gloomy ways of thinking

are a cause of depression.
 A. Aaron Beck’s Theory

Aaron Beck argued that people with depression look at the world through a
negative cognitive triad: They have negative views of themselves, of the world, and of
the future. People with depression then commit many types of errors in thinking – such as
jumping to negative conclusions on the basis of little evidence, ignoring good events,
focusing only on negative events, and exaggerating negative events – that support their
negative cognitive triad.

B. REFORMULATED LEARNED HELPLESSNESS THEORY

Another influential cognitive theory of depression, the reformulated learned

helplessness theory, was proposed to explain how cognitive factors might influence
whether a person becomes helpless and depressed following a negative event. The theory
focuses on people’s causal attributions for events.

C. RUMINATIVE RESPONSE STYLES THEORY

Another cognitive theory, the ruminative response styles theory, focuses more on
the process of thinking, rather than the content of thinking, as a contributor to depression.
Some people, when sad and upset, focus intently on how they feel – their symptoms of
fatigue and poor concentration and their sadness and hopelessness – and can identify
many possible causes of these symptoms. They do not attempt to do anything about these
causes, however, and continue to engage in rumination about their depression.

III. PSYCHODYNAMIC THEORY

Depressed people are unconsciously punishing themselves because they feel

abandoned by another person but cannot punish that person; dependency and
perfectionism are risk factors for depression.

IV. INTERPERSONAL THEORIES

Like psychodynamic theories, interpersonal theories of depression are concerned

with people’s close relationships and their roles in their relationships. Disturbances in
these roles are thought to be the main source of depression. Depressed people have poor
relationships with others.
 MOOD DISORDERS
(SPECIFIERS)

If the full criteria are currently met for a Major Depressive Episode, the following
specifiers may be used to describe the current clinical status of the episode and to
describe features of the current episode:

Mild, Moderate, Severe Without Psychotic Features, Severe With Psychotic

Features

Chronic

Chronic Specifier for a Major Depressive Episode

This specifier indicates the chronic nature of a Major Depressive Episode (i.e., that full
criteria for a Major Depressive Episode have been continuously met for at least 2 years).

With Catatonic Features

The specifier With Catatonic Features is appropriate when the clinical picture is
characterized by marked psychomotor disturbance that may involve motoric immobility,
excessive motor activity, extreme negativism, mutism, peculiarities of voluntary
movement, echolalia, or echopraxia. Motoric immobility may be manifested by catalepsy
(waxy flexibility) or stupor. The excessive motor activity is apparently purposeless and is
not influenced by external stimuli.

With Melancholic Features

With Melancholic Features, is loss of interest or pleasure in all, or almost all, activities or
a lack of reactivity to usually pleasurable stimuli. The individual’s depressed mood does
not improve, even temporarily, when something good happens (Criterion A).

With Atypical Features

With Postpartum Onset

If the full criteria are not currently met for a Major Depressive Episode, the following
specifiers may be used to describe the current clinical status of the Major Depressive
Disorder and to describe features of the most recent episode:
In Partial Remission, In Full Remission

Chronic

With Catatonic Features

With Melancholic Features

With Atypical Features

With Postpartum Onset

The following specifiers may be used to indicate the pattern of the episodes and the
presence of interepisode symptoms for Major Depressive Disorder, Recurrent:

Longitudinal Course Specifiers (With and Without Full Interepisode Recovery)

With Seasonal Pattern

BSCP 3-1D Date: March 13, 2010
Abnormal Pscyhology

MOOD DISORDERS

Leader: Cunamay, Christine Eve G.

0905-677-4837

Members:

Agapay, Michael E.
Mood Disorders (Specifiers)

Bagay, Khristine B.
Bipolar Mood Disorder

Evangelista, Cherrie
Biological Theories of Depression

Laurina, Anna Ezra

Psychological Theories of Depression

Tabid, Nikko Lorenzo

Episodes