Mood Disorders

Outline:
● Introduction
● DSM V and ICD 10 Criteria
● Phenomenologies
● Neurobiological model
● Evidence-based therapies
● Case Studies

History:
● Hippocrates: 400 BCE, termed mania and melancholia for psychological disturbance
● Celsus, 30AD, melancholia (black bile)
● Robert Burton, 1621, Anatomy of Melancholy.
● Jules Falret, 1854, folie circulaire - Experience of alternative modes such as Mania and
depression
● Karl Kahlbaum, German, 1882, coined the term cyclothymia coming under the same illness.
● Emil Kraepelin in 1899 observed the absence of deteriorating course in reference to dementia
praecox

Introduction:

● Mood can be defined as a pervasive and sustained emotion or feeling tone that influences a
person’s behavior and colors his or her perception of being in the world.
● Also called affective disorders
● It consists of
○ Bipolar disorders
○ Manic Episodes
○ Major Depression (unipolar Depression)
○ Cythothymia
○ Dysthymia

1. Depression: In the absence of mania, mixed, or a hypomanic episode, with a period of

experiencing the symptoms for at least two weeks.
2. Elevated mood:
a. Mania: A persistent period of 1 week experiencing elevated, expansive ( unrestrained
expression of emotion), and irritable mood.
b. Hypomania: would last for at least 4 days but it is not sufficiently severe to impair social
and occupational functioning, with an absence of psychotic features.
- Both Mania and Hypomania have features of inflated self-esteem, decrease in the need for sleep,
distractibility, excessive physical and mental activity, and an over-involvement in pleasurable
activities.
3. Major Depression: Major Depressive Episode.

4. Bipolar 2 Disorder: Major depressive episode and hypomanic episode

5. Dysthymia and Cyclothymia: both are less severe in intensity than a Major depressive episode
and a Manic episode
a. Dysthymia: 2 years of depressed mood but not severe enough to warrant major
depressive disorder
b. Double Depression:

c. Cyclothymic disorder: 2 years of frequently occurring or intermittent hypomanic

Symptoms not sufficient enough to warrant Mania or major depression
 Etiology

A. Biological Factors:

● Dysfunction as neurotransmitter level: i.e dysregulation in serotonin, dopamine, epinephrine and

norepinephrine, and histamine
● The shift has been observed from understanding a unitary behavior of a neural circuit or
neurotransmitter towards understanding an ecological system of different mechanisms, giving
due consideration to epiphenomenal effects.
a. Biogenic Amines:
i. Norepinephrine
ii. Serotonin:
iii. Dopamine:
b. Hormonal Imbalance:
i. HPA axis
ii. Thyroid axis activity
iii. Growth Hormone

B. Genetic Factors: 10 to 15 percent risk if the parents have mood disorders, if both parents are having
mood disorders the risk would increase twofold

C. Psychosocial Factors:
● Stressful life events may precede the onset of the disorder, leading to a change in interneuronal
functioning and various neurotransmitters
E.g. grief, unemployment, and SES
● Personality Factors: Traits of OCD, Histrionic and Borderline personality
 Diagnostic Criteria:

Depression:

ICD 10: F32 Depressive Episode

Core Features:
- Depressed mood
- Loss of interest and enjoyment
- Reduced energy leading to increased fatigability and diminished activity

Other common symptoms

1. Reduction in concentration and attention
2. Reduced self-esteem and self-confidence
3. Ideas of guilt and unworthiness
4. Bleak and Pessimistic view of the future
5. ideas or acts of self-harm or suicide
6. Disturbed sleep
7. Diminished appetite

Note: The F32 category should be used only for the first occurrence of depression the later occurrences
should be classified under recurrent depressive disorder (F33)

Exclude:
- Mental retardation
- Dementia
- Other medical conditions

F32.0: Mild Depressive Episode (2 of the core symptoms and 2 other common symptoms, duration 2
weeks)

- Depressed mood
- Loss of interest and enjoyment
- Increase fatiguability

F32.1: Moderate depressive episode (3 of the most typical symptoms and at least 3 other common
symptoms, duration: 2 weeks)
F32.2 Severe depressive episode without psychotic symptoms (3 of the most typical symptoms and at
least 4 other common symptoms, duration: 2 weeks
- considerable distress and agitation
- marked retardation may be present
- suicide may be a distinct danger
- somatic syndrome will almost always be present

The client may have difficulty describing their symptoms in detail.

F32.3: Severe depressive episode with psychotic symptoms

- Features that may be present are delusions, hallucinations, or depressive stupor.
- Delusions may involve ideas of sin, poverty, or imminent disasters and the responsibility may be
assumed by the patient/client
- Auditory or olfactory hallucinations may be present in terms of accusatory voices or rotting filth
or decomposing flesh

F32.8: Other depressive episodes

F33: Recurrent depressive episode

- repeated episodes of depression in the absence of elevated mood and over activities that may full fill the
criteria for Mania.