MOOD

DISORDERS
Rona Manjares
Bernard Paderes
Kem Sumatra
Presentation
Outline
I. Classification and Assessment
II. Theoretical Perspectives
III. Signs and Symptoms
IV. Risks and Prevalence
V. Case Presentation
VI. Recent Researches
VII. Differential Diagnosis
VIII. Impact and Effect
IX. Treatment and Prevention
I. Classification and Assessment
of Mood Disorders

A. Clarification of Terms
B. Types of Mood Disorders
C. Assessment Tools
It refers to the state of
arousal that is defined by Emotion, Affect, and Mood
subjective states of feeling,
such as anger, sadness, and
disgust. It is accompanied
by physiological changes,
such as changes in heart
rate and respiration rate.

A. Affect
B. Emotion
C. Mood
It refers to the state of
arousal that is defined by Emotion, Affect, and Mood
subjective states of feeling,
such as anger, sadness, and
disgust. It is accompanied
by physiological changes,
such as changes in heart
rate and respiration rate.

A. Affect
B. Emotion
C. Mood
It refers to the pattern of Emotion, Affect, and Mood
observable behaviors (e.g.,
facial expressions, hand
gestures, voice pitch, etc.)
that are associated with
these subjective feelings.

A. Affect
B. Emotion
C. Mood
It refers to the pattern of Emotion, Affect, and Mood
observable behaviors (e.g.,
facial expressions, hand
gestures, voice pitch, etc.)
that are associated with
these subjective feelings.

A. Affect
B. Emotion
C. Mood
This refers to a pervasive Emotion, Affect, and Mood
and sustained emotional
response that, in its
extreme form, can color
the person’s perception of
the world (APA, 2000).

A. Affect
B. Emotion
C. Mood
This refers to a pervasive Emotion, Affect, and Mood
and sustained emotional
response that, in its
extreme form, can color
the person’s perception of
the world (APA, 2000).

A. Affect
B. Emotion
C. Mood
 Mood Disorders

These are defined in terms of

episodes⎻discrete period of time
in which the person’s behavior
is dominated by either a
depressed or manic mood.
Types of Mood Disorders
 Depressive Disorders
Also known as unipolar mood
disorders, these are characterized
by episodes of depression.
- Disruptive mood dysregulation disorder
- Major depressive disorder
- Persistent depressive disorder
- Premenstrual dysphoric disorder
 Bipolar Disorders

Formerly known as manic-

depressive disorder, these
are characterized by episodes
of both mania and depression.
- Bipolar disorder I
- Bipolar disorder II
- Cyclothymic disorder
 Assessment
Important Considerations in Distinguishing Clinical
Depression from Normal Sadness

1. The mood change is pervasive across situations

and persistent over time.
2. The mood change may occur in the absence of any
precipitating events.
3. The depressed mood is accompanied by impaired
ability to function in usual and occupational roles.
4. The change in mood is accompanied by additional
signs and symptoms, including cognitive, somatic,
and behavioral features.
5. The nature or quality of mood change may be
different from that of normal sadness.
Assessment Tools
1. Center for Epidemiological Studies – Depression
(Radloff, 1977)
This is a 20-item instrument answerable by a
four-point Likert scale.

Sample items:
I felt people are unfriendly.
I felt everything I did was an effort.
My appetite was poor.
 Assessment Tools
2. University Students Depression Inventory (Khawaja & Kelly,
2008)
This instrument measures the academic motivational
aspect of depressive using three sub-scales, namely: lethargy,
cognitive-emotional, and academic motivation.

Sample items:
I am more tired than I used to be. (Lethargy)
I wonder whether life is worth living. (Cognitive-emotional)
Going to university is pointless. (Academic motivation)
II. Theoretical Perspectives

A. Biological View
B. Cognitive View
C. Psychodynamic View
Biological
Perspectives
• Genetics
• Brain Features
• Neurochemical and
Hormones
• Sleep Deficiencies
• Stressful Life Events
 Genetics

• Major depressive disorder

occurs more commonly
within families, and its
prevalence may be 3 times
higher among first-degree
relatives of people with the
condition.
• Twin and family studies
show a moderate degree of
genetic influence, with
heritability of 42% for
females and 29% for males.
 Brain Features
• People with mood disorders often
display reduced activity and size
changes in prefrontal and other
cortical areas of the brain. This is
related to the decreased serotonin
levels.
• Other brain areas implicated in mood
disorders include amygdala,
hippocampus, caudate nucleus, and
anterior cingulate cortex (these areas
are involved in goal-directed behavior,
inhibition of negative moods and
troublesome thoughts) which may be
smaller or damaged.
Neurochemical and Hormonal Features
• People with depression have
lower levels of serotonin,
norepinephrine, and
dopamine. These
neurotransmitters are closely
link to the limbic and other
key brain systems the
influence motivation level and
emotional state.
• People with depression have
increased cortisol levels,
especially after experiencing a
stressor.
 Sleep Deficiencies
• People with depressive and
bipolar disorders often have
disruptions in their normal
sleep-wake-cycle. They
enter rapid eye movement
too quickly and display less
slow-wave, or deep sleep.
 Stressful Life Events
• Stressful life events such as
exit events (e.g., death,
divorce, and separation)
• Certain predispositions and
vulnerability
Cognitive Theories of Depression

• The cognitive triad of negative

automatic thinking (Beck, 1976)
• Learned Helplessness (Seligman,
1998)
• Attribution Model of Depression
(Abramson, Seligman, & Teasdale,
1998)
 Learned
Helplessness

Seligman (1975) proposed

a cognitive-behavioral
theory of depression that
centers on the person’s
belief the he or she has
little control over the
important events in life.
Attribution Model
of Depression
Abramson, Seligman, and Teasdale
(1998) proposed that attributions about
the causes of events are made across
three dimensions:
a. internal-external,
b. stable-unstable
c. global-specific.
Psychodynamic
View

• Disturbances in the
infant-mother
relationship during the
oral phase
• Real or imagined object
loss
IV. Signs and Symptoms

V. Risks and Prevalence

Depressive
Disorders
Disruptive Mood
Dysregulated
Disorder
Signs and Symptoms
• Severe recurrent temper outbursts manifested
verbally which are inconsistent with
developmental level.
• The mood between temper outbursts is persistently
irritable or angry most of the day, nearly every
day, and is observable by others.
Prevalence
• Common among children presenting to pediatric
mental health clinics.
• The overall 6-month to 1-year period-prevalence of
DMDD among children and adolescents probably
falls in the 2%-5% range.
• Rates are expected to be higher in males and
school-age children.
Disruptive Mood
Dysregulated
Disorder

Risk and Prognostic Factors

Ø Between 0.8 and 3.3 percent of children

between the ages of 2 and 17 fit the
criteria for DMDD
Ø DMDD may be more common in
youngsters than in teenagers.
Ø Children with DMDD may
have temperamental vulnerabilities, and
at a young age may have been more prone
to difficult behavior, moodiness,
irritability, anxiousness
 Major Depressive Disorder
Signs and Symptoms

• Depressed mood most of the day

• Markedly diminished interest or pleasure in all
• Significant weight loss when not dieting
• Insomnia or hypersomnia nearly every day
• Psychomotor agitation or retardation nearly every day.
• Fatigue or loss of energy nearly every day.
• Feelings of worthlessness or excessive or inappropriate guilt nearly
every day.
• Diminished ability to think or concentrate, or indecisiveness, nearly
every day.
• Recurrent thoughts of death, recurrent suicidal ideation without a
specific plan, or a suicide attempt or a specific plan for committing
suicide.

Prevalence
• Overall prevalence of depression in the Philippines is 3.3 percent (World
Health Organization, 2017), implying that over 3.3 million Filipinos are
suffering from depressed symptoms (Philippine Statistics Authority,
2016)
 Major Depressive Disorder
Risk and Prognostic Factors

Temperamental.
- Neuroticism (negative affectivity)
- High levels appear to render individuals more likely to develop
depressive episodes in response to stressful life events.

Environmental
- Adverse childhood experiences
- Stressful life events

Genetic and physiological

- First-degree family members of individuals with major depressive
disorder
- Relative risks appear to be higher for early-onset and recurrent forms
- Heritability is approximately 40%,
Persistent Depressive Disorder
Signs and Symptoms
• Poor appetite or overeating.
• Insomnia or hypersomnia.
• Low energy or fatigue.
• Low self-esteem.
• Poor concentration or difficulty making decisions.
• Feelings of hopelessness.

Prevalence
• The 12-month prevalence in the United States is
approximately 0.5% for persistent depressive
disorder and 1.5% for chronic major depressive
disorder.
Risk and Prognostic Factors

Temperamental
• Factors predictive of poorer long-term outcome include
higher levels of neuroticism

• greater symptom severity

• poorer global functioning
• presence of anxiety disorders or conduct disorder.
Environmental
- Childhood risk factors include parental loss or separation
Genetic and Physiological
• Higher proportion of first-degree relatives with PDD than
do individuals with MDD.
• A number of brain regions have been implicated in
persistent depressive disorder
• Possible polysomno- graphic abnormalities exist as well
Premenstrual
Dysphoric Disorder
Signs and Symptoms
• Affective lability
• Irritability, anger, increased interpersonal conflicts
• Depressed mood, feelings of hopelessness, or self-
depreciating thoughts
• Anxiety, tension, and/or feelings of being keyed up or
on edge
• Decreased interest in usual activities
• Subjective difficulty in concentration
• Lethargy, easy fatigability, or marked lack of energy
Prevalence

• Twelve-month prevalence of premenstrual dysphoric

disorder is between 1.8% and 5.8% of menstruating women.
• The most rigorous estimate of premenstrual dysphoric
disorder is 1.8% for women whose symptoms meet the full
criteria without functional impairment
• 1.3% for women whose symptoms meet the current criteria
with functional impairment and without co-occurring
symptoms from another mental disorder.

Risk and Prognostic Factors

Environmental.

• stress, history of interpersonal trauma, seasonal changes,

and sociocultural aspects of female sexual behavior in
general, and female gender role in particular.

Genetic and physiological.

• Premenstrual symptoms, estimates for heritability range
between 30% and 80%,
• With the most stable component of premenstrual symptoms
estimated to be about 50% heritable.
 Bipolar
Disorders
Bipolar I Disorder
Manic Episode
§ Inflated self-esteem or grandiosity.
§ Decreased need for sleep.
§ More talkative than usual or pressure to keep talking.
§ Flight of ideas or subjective experience that thoughts are racing.
§ Distractibility as reported or observed.
§ Increase in goal-directed activity or psychomotor agitation.
§ Excessive involvement in activities that have a high potential for
painful consequences.
Hypomanic Episode
§ Inflated self-esteem or grandiosity.
§ Decreased need for sleep.
§ More talkative than usual or pressure to keep talking.
§ Flight of ideas or subjective experience that thoughts are racing.
§ Distractibility as reported or observed.
§ Increase in goal-directed activity or psychomotor agitation.
§ Excessive involvement in activities that have a high potential for
painful consequences.
Major Depressive Episode
§ Depressed mood most of the day
§ Markedly diminished interest or pleasure in all
§ Significant weight loss when not dieting or weight gain
§ Insomnia or hypersomnia nearly every day.
§ Psychomotor agitation or retardation nearly every day.
§ Fatigue or loss of energy nearly every day.
§ Feelings of worthlessness or excessive or inappropriate guilt.
§ Diminished ability to think or concentrate, or indecisiveness.
§ Recurrent thoughts of death, recurrent suicidal ideation without a
specific plan, or a suicide attempt or a specific plan for committing
suicide.
Prevalence
§ Twelve-month prevalence of bipolar I disorder across 11 countries ranged
from 0.0% to 0.6%.
§ The lifetime male-to-female prevalence ratio is approximately 1.1:1.

Risk and Prognostic Factors

Environmental.
§ more common in high-income than in low-income countries (1.4 vs. 0.7%).
§ Separated, divorced, or widowed individuals have higher rates of bipolar I
disorder
Genetic and physiological
§ A family history
§ There is an average 10-fold increased risk among adult relatives of
individuals with bipolar I and bipolar II disorders.
Bipolar II Disorder
Hypomanic Episode
§ Inflated self-esteem or grandiosity.
§ Decreased need for sleep.
§ More talkative than usual or pressure to keep talking.
§ Flight of ideas or subjective experience that thoughts are racing.
§ Distractibility
§ Increase in goal-directed activity or psychomotor agitation.
§ Excessive involvement in activities that have a high potential for painful
consequences.
Major Depressive Episode
§ Depressed mood most of the day
§ Markedly diminished interest or pleasure in all
§ Significant weight loss when not dieting or weight gain
§ Insomnia or hypersomnia nearly every day.
§ Psychomotor agitation or retardation nearly every day.
§ Fatigue or loss of energy nearly every day.
§ Feelings of worthlessness or excessive or inappropriate guilt.
§ Diminished ability to think or concentrate, or indecisiveness.
§ Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or
a suicide attempt or a specific plan for committing suicide.
Prevalence
§ The 12-month prevalence of bipolar II disorder,
internationally, is 0.3%.

Bipolar disorder in the Philippines

§ 0.2% 520,614 0.2% females | 0.5% males 5.0%

Risk and Prognostic Factors

Genetic and physiological.

§ Be highest among relatives of individuals with
bipolar II disorder

Course modifiers
§ More likely for individuals of younger age and with
less severe depression
 Cyclothymic Disorder
Signs and Symptoms
§ For at least 2 years there have been numerous periods with
hypomanic symptoms that do not meet criteria for a hypomanic
episode and numerous periods with depressive symptoms that do
not meet criteria for a major depressive episode.
§ During the above 2-year period, the hypomanic and depressive
periods have been present for at least half the time and the individual
has not been without the symptoms for more than 2 months at a time.
§ Criteria for a major depressive, manic, or hypomanic episode have
never been met.
Prevalence
§ The lifetime prevalence is approximately 0.4%-l%.
§ Prevalence in mood disorders clinics may range from 3% to 5%.
§ equally common in males and females
Risk and Prognostic Factors
Genetic and physiological.
§ More common in the first-degree biological relatives of individuals with
bipolar I disorder
§ Major depressive disorder, bipolar I disorder, and bipolar II disorder
are more common among first-degree biological relatives of individuals
with cyclothymic disorder than in the general population.
VI. Case Analysis
 Case Study

“Anne” was initially seen at age 6 years, 10 months for irritability,

oppositional behavior and tantrums lasting hours on end. Her parents reported
trying almost every approach recommended by her pediatrician and what they
read in books and online, with no improvement. The meltdowns occurred
almost daily at home, but in school, with friends and in public, Anne held it
together. Triggers included, but were not limited to, tactile sensitivity (clothing,
touch, getting hair and nails cut); minor frustrations; redirection and attempts
to calm or distract her; most any transition or changes in routine; and any
perceived criticism. She was an active girl and a thrill seeker who was
preoccupied with spinning and somersaults, and became overly excited during
and after movement activity. Mood would rapidly change from expansive to
rage and tearfulness. At times she shared feelings of self-loathing and guilt, but
for the most part she blamed others or circumstances for setting her off.
A. Bipolar Disorder I C. Disruptive Mood Dysregulated Disorder
B. Cyclothymic Disorder D. Major Depressive Disorder
 Case Study

“Anne” was initially seen at age 6 years, 10 months for irritability,

oppositional behavior and tantrums lasting hours on end. Her parents reported
trying almost every approach recommended by her pediatrician and what they
read in books and online, with no improvement. The meltdowns occurred
almost daily at home, but in school, with friends and in public, Anne held it
together. Triggers included, but were not limited to, tactile sensitivity (clothing,
touch, getting hair and nails cut); minor frustrations; redirection and attempts
to calm or distract her; most any transition or changes in routine; and any
perceived criticism. She was an active girl and a thrill seeker who was
preoccupied with spinning and somersaults, and became overly excited during
and after movement activity. Mood would rapidly change from expansive to
rage and tearfulness. At times she shared feelings of self-loathing and guilt, but
for the most part she blamed others or circumstances for setting her off.
A. Bipolar Disorder I C. Disruptive Mood Dysregulated Disorder
B. Cyclothymic Disorder D. Major Depressive Disorder
 Case Study

Gary is a 19-year-old who withdrew from college after experiencing a manic episode during
which he was brought to the attention of the Campus Police (“I took the responsibility to pull multiple
fire alarms in my dorm to ensure that they worked, given the life or death nature of fires”). He had
changed his major from engineering to philosophy and increasingly had reduced his sleep, spending
long hours engaging his friends in conversations about the nature of reality. He had been convinced
about the importance of his ideas, stating frequently that he was more learned and advanced than all
his professors. He told others that he was on the verge of revolutionizing his new field, and he grew
increasingly irritable and intolerant of any who disagreed with him. He also increased a number of
high-risk behaviors – drinking and engaging in sexual relations in a way that was unlike his previous
history. At the present time, he has returned home and his been placed on a mood stabilizer (after a
period of time on an antipsychotic), and his psychiatrist is requesting adjunctive psychotherapy for his
bipolar disorder. The patient’s parents are somewhat shocked by the diagnosis, but they acknowledge
that Gary had early problems with anxiety during pre-adolescence, followed by some periods of
withdrawal and depression during his adolescence. His parents are eager to be involved in treatment,
if appropriate.

A. Bipolar I Disorder C. Disruptive Mood Dysregulated Disorder

B. Cyclothymic Disorder D. Persistent Depressive Disorder

 Case Study

Gary is a 19-year-old who withdrew from college after experiencing a manic episode during
which he was brought to the attention of the Campus Police (“I took the responsibility to pull multiple
fire alarms in my dorm to ensure that they worked, given the life or death nature of fires”). He had
changed his major from engineering to philosophy and increasingly had reduced his sleep, spending
long hours engaging his friends in conversations about the nature of reality. He had been convinced
about the importance of his ideas, stating frequently that he was more learned and advanced than all
his professors. He told others that he was on the verge of revolutionizing his new field, and he grew
increasingly irritable and intolerant of any who disagreed with him. He also increased a number of
high-risk behaviors – drinking and engaging in sexual relations in a way that was unlike his previous
history. At the present time, he has returned home and his been placed on a mood stabilizer (after a
period of time on an antipsychotic), and his psychiatrist is requesting adjunctive psychotherapy for his
bipolar disorder. The patient’s parents are somewhat shocked by the diagnosis, but they acknowledge
that Gary had early problems with anxiety during pre-adolescence, followed by some periods of
withdrawal and depression during his adolescence. His parents are eager to be involved in treatment,
if appropriate.

A. Bipolar I Disorder C. Disruptive Mood Dysregulated Disorder

B. Cyclothymic Disorder D. Persistent Depressive Disorder

Current Researches on Mood Disorders in the Philippines

• Factors associated with

depressive symptoms
among Filipino
university students
• Facebook usage and
depressive levels
Factors Associated with Depressive Symptoms
among Filipino University Students

Romeo B. Lee, Madelene Sta. Maria,

Susana Estanislao, and Cristina Rodriguez
 Context of the Study

This study was conducted as part of the researchers’

community engagement activities to help the prevention of mental
disorders and subsequently of suicide among Filipinos. Prevention of
depression, particularly in developing countries, is urgent. Students
with this kind of mental disorder are not only suffering in silence but
are also placing their academic and future life goals in peril.
 Methodology

• Descriptive-quantitative research
• A total of 2,436 Filipino university students (15% of the total
undergraduate population) of a large private university participated
in the study.
• The study utilized the University Students Depression inventory
(Khawaja & Kelly, 2008) . It has three subscales, namely: lethargy,
cognitive-emotional, and academic motivation.
• Socio-demographic characteristics (i.e. sex, age category, course
category, year level, religion, frequency of smoking, frequency of
drinking, living/not living with parents, and level of closeness with
peers.
 Findings and Recommendations

• Among the 11 factors, 6 of them were associated with

depressive symptoms: frequency of smoking, frequency
of drinking, not living with biological parents,
dissatisfaction with one’s financial condition, level of
closeness with parents, and level of closeness with peers
were found to statistically associated with more intense
levels of depressive symptoms.

• There is a need to carry out more surveys to develop the

pool of local knowledge on student depression.
Facebook Usage and Depression Levels
of Selected Filipino College Students
G.P.A. Magalong and M.F.R. Dy
 The study aimed to
increase the consciousness
regarding the relationship of
Rationale of Facebook usage and
the Study depression and the need to
educate young social media
users on its possible mental
health outcomes.
 Participants: A total of 347
respondents were purposively
Research selected for the study.

Methodology Instrument: The Center for

Epidemiological Studies –
Depression was administered.
 § Sex has a weak positive association
with depression.

§ Age did not vary much across

depression level.

§ There is a moderate positive

association between minutes spend on
Findings Facebook and depression.

and § There is a weak positive association

frequency of Facebook visits and
Recommendations depression level.

§ Facebook activities are positively

correlated to depression.

§ Young social media users are

encouraged to use it moderately to
avoid mental health outcomes.
Differential Diagnosis
(Depressive Disorders)

• Adjustment disorder with depressed mood. A

major depressive episode that occurs in response
to a psychological stressor is distinguished from
adjustment disorders with depressed mood by the
fact the the full criteria for a major depressive
episode are not met in adjustment disorder.
• Psychotic disorders. Depressive symptoms are
commonly associated feature of chronic psychotic
disorders (e.g., schizophrenia, delusional disorder,
etc.). A separate diagnosis of persistent depressive
disorder is not made if the symptoms occur only
during the course of the psychotic disorder.
Differential Diagnosis
(Bipolar Disorders)
• Anxiety disorders. Anxious ruminations may be
mistaken for racing thoughts, and efforts to
minimize anxious feelings may be taken as
impulsive behavior.
• Attention-deficit/hyperactivity disorder. This
disorder may be misdiagnosed as bipolar disorder,
especially in adolescents and children. Many
symptoms overlap with manic symptoms.
• Personality disorder. Personality disorders such
as borderline personality disorder may have
substantial symptomatic overlap with bipolar
disorders, since mood lability and impulsivity are
both common in both conditions.
 VIII. Functional Consequences
• Individuals with bipolar disorders may return to
fully functional level between episodes but 30%
show severe impairment in work role function.
Also, 15% continue to have inter-episode
dysfunction. Moreover, they also perform poorly
on cognitive tests.
• Children with disruptive mood dysregulation
disorder disrupt their family and peer
relationships, as well as their school
performance.
• Individuals with major depressive disorder may
have impairments that range from very mild to
incomplete incapacity such as those who are
unable to attend basic self-care needs or is mute
or catatonic.
Treatments
for Mood
Disorders
Biological
Treatments

1. Medications

2. Electroconvulsive Therapy

3. Transcranial Magnetic Stimulation

Psychological
Treatments
1. Interpersonal Therapy
2. Cognitive Therapy
3. Behavioral Therapy
Movies about Mood Disorders
References
Lyons, C.A. & Martin, B. (2019). Abnormal Psychology: Clinical
and Scientific Perspectives. CA: BVT Publishing, LLC.

Maglunog, G.P.A. & Dy, M.F.R. (2019). Facebook usage and

depression levels of selected Filipino college students.
International Journal of Psychology and Educational Studies,
6(2), 35-50.

Oltmanns, T.F. & Emery, R.E. (2019). Abnormal Psychology (9th

ed.). Pearson Education, Inc.
References:

Kearney, C.A. & Trull, T.J. (2018). Abnormal Psychology and Life (3rd ed.).
MA: Cengage Learning.

Lee, R.B., Sta. Maria, M., Estanislao, S., & Rodriguez, C. (2013). Factors
associated with depressive symptoms among Filipino university students.
PLoS One, 8(11).

Lyons, C.A. & Martin, B. (2019). Abnormal Psychology: Clinical and Scientific
Perspectives. CA: BVT Publishing, LLC.

Magulog, G.P.A. & Dy, M.F.R. (2019). Facebook usage and depression levels of
selected Filipino college students. International Journal of Psychology and
Educational Studies, 6(2), 35-50.

Oltmanns, T.F. & Emery, R.E. (2012). Abnormal Psychology (9th ed.). Pearson
Education, Inc.
THANK YOU.