where a disturbance in the person's mood is hypothesized to be the main underlying feature.

1. Mood Disorders
M.S Sara Dawod

2. Introduction
• Mood disorders referred to it as affective
disorders and divided into two main categories:
depressive disorders and bipolar disorders.
• Depression could be the primary problem or
secondary to other problem.
• Depression affect F]M , Lower class.
• Mania: M=F
• Mania incidence increases with age and occur
more in high class, divorced persons, starts late
adolescence and early twenties.

3. Introduction
• Depression can occur at any age.
• Infant: withdrawal, non-responsive,
depression, vulnerability to physical illness or
failure to thrive when separated from the
mother.
• School aged: hyperactivity, social phobia,
excessive clinging to parents.
• Adolescents: poor academic achievement,
abuse substances, antisocial behaviors,
attempt suicide, running away.

4. Mood disorders
• Disorders that have a disturbance in mood:
• Major depressive episode.
• Manic episode.
• Mixed episode.
• Hypomanic episode.
• Major depressive disorder.
• Dysthymic disorder.
• Bipolar disorder.

5. Major depressive episode
• Five or more of the following symptoms have
been present during the same 2 weeks (persist
most of the day, nearly every day, for at least
two weeks), at least one of the symptoms
depressed mood and loss of interest or
pleasure.
1. Depressed most of the day (children and
adolescents: irritable).
2. Diminish interest or pleasure in all activities.
3. Weight loss or gain.

6. Major depressive episode
4. Insomnia or hypersomnia.
5. Psychomotor agitation.
6. fatigue.
7. Worthlessness or excessive guilt.
8. Inability to concentrate or think.
9. Recurrent thought of death or suicide.
10. Symptoms cause impairment in social,
occupational or other functions.

7. Manic episode
• Period of abnormally elevated mood lasting at
least one week.
• During the period of mood disturbances, 3 or
more of the following symptoms persist:
1. Inflated self esteem or grandiosity.
2. Decrease sleep.
3. Talkative than usual.
4. Flight of ideas.

8. Manic episode
5. distractibility.
6. Increase in goal directed activity.
7. Excessive involvement in pleasure activity that
have painful consequences.
• Note: the symptoms should be severe enough
to cause impairment in social or occupational
functions or to require hospitalization.

9. Mixed episode
• Period of time in which criteria are met for
manic episode and for major depressive
episode nearly every day for at least 1 week
which may cause impairment in occupation or
social activities, or relations or need
hospitalization to prevent harm.
• Common in males than females.
• Common in younger person than old over 60
years.

10. Mixed episode
• Differential diagnosis:
• Substance induced mood disorder.
• Mood disorder due to general medical
condition.
• Attention deficit/hyperactivity disorder (early
onset before 7 years, chronic rather than
episodic, lack of elevated mood).

11. Major depressive disorder
• Is characterized by one or more major depressive
episodes without history of manic, mixed, or
hypomanic episodes.
• Diagnostic criteria: for single episode: the presence
of single major depressive episode.
• For current: two or more episodes.
• It is not better accounted for by schizoaffective
disorders.
• There has been never a manic or hypomanic
episode.

12. Hypomania episode
• Period of persistently elevated or irritable mood lasting
throughout at least 4 days and 3 or more of the following
symptoms are present:
1. Grandiosity or inflated self-esteem.
2. Decrease need for sleep.
3. Talkative than usual.
4. Flight of ideas.
5. distractibility.
6. Increase in goal directed activity.
7. Excessive involvement in pleasure activity that have
painful consequences.
• Not sever enough to cause marked impairment in social or
occupational functioning or hospitalization.

13. Hypomania episode
• Sudden onset, and rapid escalation of
symptoms within one or two days.
• Differential diagnosis:
• Substance induced mood disorder.
• Mood disorder due to general medical
condition.
• Attention deficit/hyperactivity disorder (early
diagnosis before 7 years, absence of elevated
mood, chronic).

14. Dysthymic disorder
• Chronically depressed mood that occurs for most of the day
for at least 2 years and presence of two or more of the
following:
1. Poor appetite or overeating.
2. Insomnia or hypersomnia.
3. Fatigue, low self-esteem.
4. Poor concentrating.
5. Feeling of helplessness.
• These symptoms have been present at least for 2 months
during the 2 years period.
• Mood: in adult: sad or down.
• Children and adolescents: irritable and minimal duration 1
year.

15. Bipolar I disorder
• The occurrence of one or more of manic
episodes or mixed episodes.
• Onset: 20 years: M&F.

16. Bipolar II disorder
• Characterized by the occurrence of one or
more major depressive episodes and at least
one hypomania episodes.
• Common in females than men.

17. Differences between
unipolar and bipolar
• Unipolar : symptoms of major depression.
• Bipolar: bipolar I & II.

18. Etiology of mood disorders
• Neurobiological factors including:
• Genetics.
• Neurotransmitters: low level of norepinephrine,
serotonin and dopamine for depression and high
level of norepinephrine and dopamine for mania.
Resprime drugs(calm agitated schizophrenia)
decrease norepinephrine and serotonin.
• Neuroendocrine system: overactive hypothalamic
pituitary adrenal cortex which may lead to high level
of cortisol and causing depression. Dexamthasone
suppresses the release of cortisol and improve
depression. Hypothyroidism.

19. Etiology of mood disorders
• Interpersonal theory (social factors): stressful life
events, interpersonal problems, decrease social
support, feeling of rejection by others.
• Psychological factors: including:
• Psychoanalytic theory(freud): emphasize the
unconscious conflicts associated with grief and
loss.
• Freud hypothesized that the potential for
depression is created early in childhood during
oral stage. If the child's needs are insufficiently,
the person are become fixed at the oral stage and
become dependent on others for self-esteem.

20. Etiology of mood disorders
• After the loss of loved person, the mourner
identifies with the lost one (introject) to undo
the loss and unconsciously resent being
deserted and feel anger toward the loved one
for loss and feel guilt for real or imagined sin
against the lost person.
• In the mourning work, the mourner recall
memories of the lost one and separate himself
from the died person.

21. Etiology of mood disorders
• However, some may don’t loosen their
emotional bond with the died person and the
anger toward the lost one is directed inward,
developing ongoing self-blame and depression
(depression is anger turned against oneself).
• Little researches supported this theory.

22. Etiology of mood disorders
• For mania: manic episodes are viewed as
defense reaction against depression or due to
superego intolerable self criticism which is
replaced by euphoria or ego overwhelmed by
pleasure impulses such as sex or aggression.

23. Etiology of mood disorders
• Cognitive theory: negative thought and beliefs
are the major cause of depression.
• Becks theory: people develop depression
because their thinking is negative. Depression
is associated with negative triad: negative
views of self, world, and future.

24. Etiology of mood disorders
• In childhood people with depression acquired
negative schemata: tendency to view the
world negatively through stressful life events.
• This schema is activated whenever similar
situation occurs.

25. Etiology of mood disorders
• Cognitive error:
• Arbitrary inference: drawing a conclusion in the
absent of sufficient evidence (rain & party).
• Selective abstraction: drawing a conclusion by
focusing on one element only and ignoring
others (bad products and many workers).
• Overgeneralization: drawing a sweeping
conclusion on the basis of single event (one exam
result).

26. Etiology of mood disorders
• Magnification and minimization: gross error in
evaluating performance (car scratch or feel
worthless in spite of successful achievement).
• Some studies didn’t support this theory
especially the causal relation between
depression and negative thinking.

27. Psychological treatment of depression
• The therapist should confront the moral and
the political implication of his/her work
whether to help the client to alter his/her
situation life or to help her/him to adjust.
• Depression can be a healthy sign for a client
who is ready to make changes.

28. Psychological treatment of depression
• Interpersonal psychotherapy: it focus on
interpersonal problems and persons current
life and not the past problem in childhood. It
is short term (16 sessions).
• Focus: discussion of interpersonal problems,
exploration of negative feelings, improving
verbal and non-verbal communication,
problem solving.

29. Psychological treatment of depression
• Cognitive therapy: to alternate maladaptive
thought. The therapist helps the persons to
change their opinions about life and self and
monitor their negative thought. Also teach the
person to challenge negative beliefs.
• Behavioral techniques: do things such as get out
of bed, and the people are given an assignment.
This therapy is superior to drug therapy for
unipolar depression.

30. Psychological treatment of depression
• Social skills training.
• Psychoanalytic: help the patient to have
insight into repressed conflict and release of
inward hostility such as blame himself for the
death of person by confronting the facts that
he has this belief, recover memories from
stressful event and feeling of inadequacy (not
significant therapy).

31. Biological treatment for
mood disorders
• Somatic therapy: electroconvulsive therapy
(ECT) for severe depression: passing current
70-130 volts, giving the pt muscle relaxant and
anesthesia before performing it: risk short
term confusion and memory loss.

32. Medication
• Tricyclic and Monoamine oxidase inhibitors (e.g.
parnate) increase serotonin and norepinephrine.
• Tricyclic antidepressant: imipramine (Tofranil) and
amitriptyline (Elavil). It takes from 4-5 weeks to
work.
• Side effects: death, arrhythmia, orthostatic
hypertension, palpitation, tachycardia, sedation,
fatigue, low energy, ataxia, weight gain and
blurred vision.

33. Medication
• Selective serotonin reuptake inhibitor: (prozac
10-80 mg).
• Side effects: monitor hepatic and renal
function, DM, headache, weight loss, GI and
sleep disturbances.

34. Medication
• For mania: lithium carbonate (900-1800 mg):
it affect the renal (nephrotoxicity, heart and
thyroid-weakness, neurotoxicity, so ensure
adequate fluid intake, monitor ECG, hand
tremor, slurred speech, muscle weakness,
polyuria, TSH, blood account.
• Neuroleptic.