WEEK 6

MOOD
DISORDER AND
SUICIDE (II)
DSM-5 Categorization
■ Depressive disorders
– Disruptive mood dysregulation disorder
– Major depressive disorder
– Persistent depressive disorder (dysthymia)
– Premenstrual dysphoric disorder
■ Bipolar and related disorders
– Bipolar I disorder
– Bipolar II disorder
– Cyclothymic disorder

PSY300 Abnormal Psychology by Dr Bobo Lau 2

Overview of depression and mania
■ Mood disorders = gross deviations in mood
■ Composed of different types of mood “episodes”
– Periods of depressed or elevated mood lasting days or weeks,
including:
■ Major depressive episodes
■ Manic episodes
■ Hypomanic episodes

PSY300 Abnormal Psychology by Dr Bobo Lau 3

 覺得自己無所不能 know everything, do everything ， superman ,superwoman

Manic episode 一種表現出過高水平的活動或精力、情緒或行為的情況。這種提升必須是

對你平時自我的改變，並且會被其他人注意到。症狀包括無敵的感覺、睡
眠不足、思緒紛亂、語速飛快以及有錯誤的信念或看法。

■ Elevated, expansive mood 膨脹 for at least 1 week

■ Finds extreme pleasure in every activity, persistently increased goal-directed
activity or energy; irritability shows up near the end of the episode
■ Examples of symptoms:
– Inflated self-esteem, decreased need for sleep, excessive talkativeness,
flight of ideas or sense that thoughts are racing, easy distractibility, increase
in goal-directed activity or psychomotor agitation, excessive involvement in
pleasurable but risky behaviors
■ Impairment in normal functioning
■ Hypomanic episode : shorter, less severe version, last at least 4 days, associated
with less impairment

PSY300 Abnormal Psychology by Dr Bobo Lau 4

 Vieta et al., 2019; Nature
Review Disease Primer
PSY300 Abnormal Psychology by Dr Bobo Lau 5
 Unipolar: depression does not cycle through other mental states, such as mania

Structure of mood disorders

■ Unipolar mood disorder: Only one extreme of mood is experienced
– E.g., only depression or only mania
– Depression alone is much more common than mania alone

■ Bipolar mood disorder: Both depressed and elevated moods are experienced
– Travel from one pole to the other and back again, E.g., some depressive
episodes and some manic or hypomanic episodes
– “Mixed features” = term for a mood episode with some elements reflecting the
opposite valence of mood
– E.g.,: Depressive episode with some manic features (e.g., distractibility, flight of
ideas, agitation)
Mixed
– E.g.,: Manic episode with some feature: 是指在躁狂、輕躁狂或抑鬱發作期間同時出現相
depressed/anxious features
反情緒極性的症狀。它的特點是精力充沛、失眠和思緒奔騰。
PSY300 Abnormal Psychology by Dr Bobo 同時，這個人可能會經歷絕望、絕望、易怒和自殺的感覺。 
Lau 6
 BIPOLAR
DISORDERS

PSY300 Abnormal Psychology by Dr Bobo Lau 7

 Bipolar disorders 描述了短暫的輕躁狂症狀與短暫的抑鬱症
狀交替出現，這些症狀不像完全輕躁狂發
作或完全抑鬱發作那樣廣泛或持久。

Bipolar I disorder Bipolar II disorder Cyclothymic disorder

循环情感性精神障碍

• Manic episodes • Major depressive • Mood instability with

有过至少一次躁
狂症发作，此发 episodes hypomanic and
作前后有轻度躁 • *Diagnosis of Bipolar I • Hypomanic episodes depressive symptoms
狂或重度抑郁症
requires only a history that do not meet the
状。某些情况下，
躁狂症可能会导 of mania. Major criteria for hypomanic
致患者脱离现实 depressive episode is or depressive episodes
（精神病）
not required, BUT 一種較溫和的情緒升高形式，包 • Chronic version (last
括較輕的輕躁狂發作，與嚴重抑
most patients 鬱期交替出現。
for 2 years+)
experience both types • Increased risk for
至少发生过一次严重抑郁症以
of mood disruptions bipolar I and II
從躁狂症到抑鬱症的嚴重情緒 及至少一次轻度躁狂发作，但
發作期 从没发生过躁狂症发作。
 For manic episode to be considered separate, there must be a symptom free period of at
least 2 months between episodes. Otherwise, one episode is seen as a continuation of the
last.

PSY300 Abnormal Psychology by Dr Bobo Lau 8

 Bipolar I

Bipolar II

Vieta et al., 2019; Nature

Review Disease Primer
PSY300 Abnormal Psychology by Dr Bobo Lau 9
https://www.hk01.com/%E8%AB%87%E6%83%85%E8%AA%AA%E6%80%A7/219304/%E6%87%B7%E5%BF%B5%E7%9B%A7%E5%87%B1%E5%BD%A4-%E8%BA%81%E9%AC
%B1%E7%97%87%E6%82%A3%E8%80%85%E7%97%9B%E8%8B%A6%E5%BE%98%E5%BE%8A%E6%96%BC%E9%AC%B1%E8%88%87%E8%BA%81%E5%85%A9%E6%A5%B5-
%E8%AB%8B%E5%88%A5%E5%B0%8D%E4%BB%96%E5%80%91%E8%AA%AA

PSY300 Abnormal Psychology by Dr Bobo Lau 10

Diagnostic specifiers for bipolar
disorders
Mood episode specifiers:
– With anxious distress
– With mixed features
– With psychotic features
■ Catatonic feature seldom apply to manic episode
■ Delusion of grandeur is common in manic episode
– With peripartum onset
– With melancholic features and with atypical features during depressive episodes (only)
Course specifiers:
- With seasonal pattern
- Manic episode is common during summer
- With rapid cycling

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 Diagnostic specifiers for bipolar
disorders
■ Rapid cycling specifier
– Moving quickly in and out of mania and depression
– Individual experiences at least four manic or depressive episodes within a year
– Occurs in between 20 to 50% of cases
– Severe case: increase in frequency and alternations without any break
– Associated with greater severity that does not respond well to standard treatment
– Ultra-rapid : cycle lengths only last for days to weeks
– Ultra-ultra-rapid : cycle lengths < 24 hours; switches into depression at night, and
into mania during daytime (related to circadian cycle?) Such as manic at morning, and depression at night
– 80% of rapid cycling individuals return to non-rapid-cycling subtype within 2 years
Easy to suicide, mood change like 過山車

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Onset of bipolar disorder
■ Average age of onset of bipolar I = 15-18; bipolar II = 19-22
■ More acute onset than depressive disorder
■ Relatively rare for people age 40+
■ Highly recurrent, chronic course
■ 67.5% of unipolar depression patient experience manic symptoms
=> What is the true distinction between unipolar depression and bipolar
depression? Mood disorder spectrum?
■ Suicides are very common, almost always occurring during depressive episodes
– 1/3 to ½ patients with bipolar disorders will attempt suicide at least once, and
15-20% of the attempts are lethal.

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Prevalence by age and sex
rarely
■ Generally speaking, the prevalence of bipolar disorders is >1% of the global
population.
■ Sex :
– Bipolar disorders approximately equally affect males and females
– Women more likely to experience rapid cycling and in depressive period
■ Age :
– Bipolar same in childhood, adolescence, and adults

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Difficulties in diagnosis

■ An average of 5-year delay to diagnosis from onset of symptoms

■ Time to diagnosis is even longer in patients with comorbidities and
depressive onset polarity.
自己 Detect 不到
■ Individuals are typically very conscious of their depressive symptoms,
but are not aware of their hypomanic or manic symptoms.
■ One question used to identify hypomanic / manic symptoms is to ask
patients “whether they have excessive energy or periods of extreme
irritability and high activity”

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The role of genes
■ Heritability is estimated to be up to 85%, one of the highest estimates for
psychiatric disorders.
■ Bipolar disorder confers increased risk of developing some mood disorder in
close relatives, but not necessarily bipolar disorder (Bipolar disorder is just a
more severe form of mood disorder?)
■ For identical twins, 80% concordance for polarity.
親戚如果 bipolar 的話，遺傳性較強，對比 depression

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Environmental and medical risk factors
■ Perinatal risk factors – Caesarean section delivery, maternal influenza
infection, material smoking during pregnancy, high paternal age
■ Life events – Childhood adverse events
■ Drug misuse – Consumption of cannabis
■ Use of antidepressants – which may induce hypomanic or manic episode
and “unmask” the underlying bipolar disorder
■ Change of season – From winter to spring, From summer to autumn,
increased light exposure

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 For your reference only
Vieta et al., 2019; Nature
Review Disease Primer

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Medical treatments - Lithium
■ Treatment of choice for bipolar disorder
■ Considered a mood stabilizer because it treats mania and relieve / prevent bipolar
depression
■ May lower thyroid and renal function (leads to low energy), toxic in large
amounts - Dose must be carefully monitored
■ Effective for 50% of patients: Those who don’t respond well to Lithium may take
other anti-manic drugs (e.g., antipsychotics, anticonvulsants (Valproate) and
calcium channel blockers)
■ Why lithium works is partially understood
■ Relapse is still common despite the use of Lithium
■ Patients may enjoy the manic episode and stop taking Lithium to return to the state

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Psychological treatments for bipolar
disorders
■ Medication (usually Lithium) is still first line of defence
■ Psychotherapy helpful in managing the problems (e.g., interpersonal,
occupational) that accompany bipolar disorder
■ Interpersonal and social rhythm therapy :
– Social rhythm therapy : regulate daily routines and emphasizes link
of circadian cycle to mood
– Interpersonal therapy : emphasizes link between mood to life events,
counter socially based stressors
– Education : habits and routines regarding medication

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