n Mood: … a temporary state of mind or feeling …

… a mix of feelings and emotions

Emotions -- Patterns of behavioral, hormonal, and autonomic responses
aimed at promoting survival. Emotions result from brain states that reflect
the dynamic integration of external cues, bodily signals, and cognitive
processes
- Emotions are universal (& innate)
- Emotions have a communicative function
- Expressions of emotions: face (& behavior)
… are there to help you
Emotions -- Patterns of behavioral, hormonal, and autonomic responses
aimed at promoting survival. Emotions result from brain states that reflect
the dynamic integration of external cues, bodily signals, and cognitive
processes
Creepy + interesting: OPTOGENETICA

Give sucrose … but …

Activate the kinine network
… are there help you; but not always
n Mood: … a temporary state of mind or feeling …

n Disorder: … an illness that disrupts normal functioning …

DSM 5 and ICD 10
Somatic symptom disorder

Addictions

Mood disorders

Schizophrenia

ADHD Anxiety
Autism
NULL / NONE

Unipolar depression
Depression: 5 (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 or 2.

1. Depressed mood most of the day, nearly every day. (Note: In children and adolescents, can be irritable mood.)

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/decrease or increase in appetite nearly every day. (Note: In
children, consider failure to make weight gain.)

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 (which may be delusional) nearly every day (not merely self-

reproach or guilt about being sick).

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.

• The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

• The episode is not attributable to a substance or to another medical condition.

Exclusion criteria:

(I) schizoaffective/psychotic comp., (II) [hypo] manic comp., (III) substance

/ medication induced (anti-conception and cholesterol lowering drugs)

Depression: 5 (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 or 2.

1. Depressed mood most of the day, nearly every day. (Note: In children and adolescents, can be irritable mood.)

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/decrease or increase in appetite nearly every day. (Note: In
children, consider failure to make weight gain.)

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 (which may be delusional) nearly every day (not merely self-

reproach or guilt about being sick).

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.

• The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

• The episode is not attributable to a substance or to another medical condition.

DSM-IV; death of a loved one + depressed mood ≠ depression

1 2 1 2
Depression: 5 (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 or 2.

1. Depressed mood most of the day, nearly every day. (Note: In children and adolescents, can be irritable mood.)

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/decrease or increase in appetite nearly every day. (Note: In
children, consider failure to make weight gain.)

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 (which may be delusional) nearly every day (not merely self-

reproach or guilt about being sick).

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.

• The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

• The episode is not attributable to a substance or to another medical condition.

Dynamic Systems Theory - Behavior is a complex dynamic system

Insomnia
Insomnia Concentration

Concentration

Weight
Weight
Dynamic Systems Theory - behavior is a complex dynamic system

Insomnia Concentration Guilt

Sadness Suicidality

Weight
Mental illness and COVID-19 Anxiety disorders N= 2354

Mood disorders N= 192599

course
Neurodev. disorders N= 1780

Psychotic spectrum N= 147306

SUD’s N= 11918

Mix category N= 161495

Mental illness and COVID-19 Anxiety disorders N= 441841

Mood disorders N = 25668806

related mortality
Neurodev. disorders N= 6994

Psychotic spectrum N= 702507

SUD’s N= 465731

Mix category N= 6558662

0.50 1.00 1.50 2.00 2.50 3.00

odds ratio
DISABILITY: THE GREAT DEPRESSION (Smith , Nature, 2014)

depression lung disease alcohol use disorder

neck/back pain iron deficiency diabetes

118 billion in the EU

Mania

Hypomania

NULL / NONE

Dysthymia

Unipolar depression
Mania: a “distinct period of abnormally and persistently elevated, expansive, or irritable mood.” The

episode must last at least a week. The mood must have at least three of the following symptoms:

1. high self-esteem

2. little need for sleep

3. increased rate of speech (talking fast)

4. flight of ideas

5. getting easily distracted

6. an increased interest in goals or activities

7. psychomotor agitation (pacing, hand wringing, etc.)

8. increased pursuit of activities with a high risk of danger

The population

1% bipolar disorder

16% depressed [lifetime]

(1-year = 7%)

(Kessler et al., JAMA Psychiatry, 2003)

Epidemiology; please be aware!

Symptoms Diagnoses
Mood varies; within and between individuals
Sow Ay – illustrator with secret identity
 EVENT

SYMPTOMS à

TIME à
CHRONIC ILLNESS???

SCARR??? KINDLING???
- Episode

- Remission / response
- Recovery

- Relapse

- Recurrence
Episode Having x symptoms for a certain period of time: symptomatic

(partial) Remission No longer (fully) symptomatic

Response Partial or full remission due to an intervention

Recovery Full remission, symptom free for a certain time (8 weeks)

Relapse An early return of symptoms following a positive response

Recurrence New episode, which can only occur during a recovery

RECOVERY (partial) Remission

av. episode duration: 6 months

SYMPTOMS à
Recovery (1 y; 25%)

TIME à

NEVER EVER AGAIN DEPRESSED (40%)

Relapse

SYMPTOMS à

Relapse (40-50%)

TIME à
Recurrence

SYMPTOMS à

Recurrence

TIME à
RESPONSE Response? on what?

SYMPTOMS à

TIME à
10 15 20 25 30 35 40 45 50 55 60 65 70 75 80

Age
Mood varies; within and between individuals
 3 1 4 0

vs vs vs … vs

1 3 0 4

mood varies within and between individuals

3 1 4 0

vs vs vs … vs

1 3 0 4
Unipolar depression: specifiers
Depression with anxious distress Depression with
Depression
mixed features Melancholic depression Atypical

depression Psychotic depression

Unipolar depression with psychotic features
Delusions of nihilism / mood congruent delusions

… I am such a weak person, I cannot even lift that cup …

… all the people in this world [or this room] hate me …

… I am absolutely nothing – in fact I do not even exist …

100% conviction that they are real (i.e., certainty) + no update in face of
logical and overwhelming evidence against (i.e., incorrigibility)
Unipolar depression: specifiers Otte et al. 2016, Nat Reviews Disease Primers

Depression with anxious distress Depression with

Depression
mixed features Melancholic depression Atypical

depression Psychotic depression Catatonic

depression Severity of the disorder Seasonal

affective disorder Female specific depression types

USEFUL: YOU KNOW SOMETHING
There is wind where the rose was;
Cold rain where sweet grass was;
…
Your ghost where your face was;
Sad winds where your voice was;
…
Tears, tears where my heart was;
Silence where hope was.

Walter de la Mare (1906)

Seasonal affective disorder
Seasonal affective disorder
 7%

2%

Yearly prevalence: 4%
Melatonine

1600 2000 2400 0400 0800 1200

Hours of the day
USEFUL: YOU KNOW SOMETHING
Mood varies; within and between individuals

MOOD CAN BE MODIFIED [and there is a lot to win]

 Stepped care:

Secondary specialist + Spec. diagnostics, ECT, … , EXP

Specialist / treatment Therapy (e.g., CT), antidepressants

Primary care interventions Psycho-education, … ST therapy, (?)

Recognition Detection ,…, diagnostics

Prevention and promotion … e.g., see next slide (fast track)

Depression
6-10 year 11-15 year 25 years

Suicidal ideation
Suicide attempts
Interpersonal, intrapersonal, and Hazardous drinking
academic skills Opioid use

Mini / light version of Cognitive Therapy (CT)

Mini / light version of Interpersonal Therapy (IPT)

 Stressful experiences in
development

“VULNERABILITY”
[latent dysfunctional schemas]

Activate these by e.g. stressful

events

Negative cognitive bias

Depression

Cognitive theory
Inter-Personal theory
Personal relationships are at the center of mental well-being
[interpersonal difficulties, losses, need for approval]
Topics: complicated bereavement, role transitions, role disputes,
inter-personal deficits
 Intervention Control

Any behaviour of despair

*
Suicidal ideation *
Suicidal behaviour / self-harm

Weekly hazardous drinking

*
Weekly opioid use *
5% 10% 15% 20% 25% 30% 35% 40%

Proportion exhibiting behaviour

INTERVENTION DEATHS OF DESPAIR

* Academic skills

*
* Intrapersonal skills

* Interpersonal skills
 PHARMACOLOGY

TCAs – MAOIs – SSRIs – SNRIs – NASSAs – ketamine

OVERALL: k = 65; d = -1.20
 FARMACOLOGIE

TCAs – MAOIs – SSRIs – SNRIs – NASSAs – ketamine

Ah … normalize serotonin/norepinephrine levels in the brain!

The main areas of research … show no support for the hypothesis that
depression is caused by lower serotonergic activity or concentrations.
Efficacy psycho-social interventions: refugees

Henkelmann, de Best, Deckers, Jensen, Shahab, Elzinga,& Molendik British Journal of Psychiatry 2020

Diagnosis (k = 23, N = 5,230)

Population (k = 12, N = 98,240) *** & **
War/conflict (k = 7, N = 1,018)

0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0
Prevalence rates and 95% confidence interval
Efficacy psycho-social interventions: refugees

Schafeld, Baart, Akçakaya, Schäfer, Rönnau, & Molendik In Preparation

Waitlist: k = 34; d = -0.30

Psycho-education: k = 17; d = -0.80

CBT: k = 28; d = -1.20

Interpersonal: k = 11; d = -1.00

Mood varies; within and between individuals

MOOD CAN BE MODIFIED [and there is a lot to win]