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Mood
Disorders

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 Table of Content
• What is a Mood Disorder?
• Causes
• Symptoms of common mood disorders?
• Mood Disorders Types
– Unipolar
– Bipolar
• Diagnosis
• Etiology
• Treatment
• Conclusion
 What is a Mood Disorder?
• A mood disorder is a mental health problem that
primarily affects a person’s emotional state. It is a
disorder in which a person experiences long periods
of extreme happiness, extreme sadness, or both.
• It is normal for someone’s mood to change,
depending on the situation.
 Causes of mood disorders?
There may be several underlying factors,
depending on the type of the disorder. Various
genetic, biological, environmental, and other
factors have been associated with mood
disorders.
Risk factors include:
• Family history
• Previous diagnosis of a mood disorder
• Trauma, stress or major life changes in the
case of depression
• Physical illness or use of certain medications.
• Brain structure and function in the case of
bipolar disorder
 Symptoms of common mood
disorders?
Symptoms depend on the type of mood disorder that is present.
Symptoms of major depression may include:
• Feeling sad most of the time or nearly every day
• Lack of energy or feeling sluggish
• Feeling worthless or hopeless
• Loss of appetite or overeating
• Gaining weight or losing weight
• Loss of interest in activities that formerly brought enjoyment
• Sleeping too much or not enough
• Frequent thoughts about death or suicide
• Difficulty concentrating or focusing
 Symptoms of common mood
disorders?
Symptoms of bipolar disorder may include both depression and
mania. Symptoms of hypomanic or manic episodes include:
• Feeling extremely energized or elated
• Rapid speech or movement
• Agitation, restlessness, or irritability
• Risk-taking behavior, such as spending too much money or
driving recklessly
• Unusual increase in activity or trying to do too many things at
once
• Racing thoughts
• Insomnia or trouble sleeping
• Feeling jumpy or on edge for no apparent reason
 Mood Disorders Types
• Unipolar • Bipolar
– Major Depression – Cyclothymia
– Dysthymia – Bipolar I
– Depressive Disorder NOS – Bipolar II

• Substance induced mood disorder

• Mood disorder due to a medical condition
• Mood Disorder NOS
 Major Depression
• Must have
– 1) Depressed Mood -dysphoria
Or
– 2) Loss of Interest or Pleasure in almost all activities-anhedonia

• Other symptoms (3-4)

• Biological/Vegetative-Appetite, sleep, psychomotor,
fatigue, libido
• Psychological-concentration, neg thought, decision
making, guilt, low self esteem, hopeless, SI
Nearly every day for 2 weeks
Marked impairment in Functioning
 Major Depression
• Diagnosis is not made if:
– Symptoms meet criteria for Mixed episode
(symptoms of mania and major depression
occurring nearly every day for at least a week)
– No functional impairment exists
– Symptoms are direct physiological effects of a
medical condition or substance induced
– Symptoms are better accounted for by
Bereavement
 Major Depression Presentation
• Tearful, flat affect • Relational difficulties
• Irritability • Poor/increased appetite
• Ruminations • Sleep problems
• Psychomotor changes • Impaired ability to think,
• Fatigue concentrate, make decisions,
• Sense of worthlessness/guilt recall
• • Reduced libido and sexual
Worry over physical health
• functioning
Complaints of pain
• Substance abuse
• Suicidal Ideations
• Increased use of medical
• Psychotic Features services
 Cultural Presentations
• May present more somatically
• Latino/Mediterranean: Nerves, headaches
• Chinese/Asian: weakness, tired, imbalance
• Middle Eastern: Problems of the “heart”
• Hopi: Heart Broken
• Nigeria and Ghana: “worms crawling all over the
head”
• Amish, Kenya and Rwanda-virtually unheard of
 Age Related Presentations
• Children: somatic, irritability, social
withdrawal
• Not common in children: psychomotor
retardation, hypersomnia and delusions
• Adolescents: Irritability, behavioral problems
• Elderly: disorientation, memory loss,
distractibility
 Major Depression
• Twice as frequent in women than men
• Occurs over the life span
• Genetic links important to assess
 Dysthymia
• Does not meet criteria for Major Depression
• At least 2 years with no normal mood longer than 2
months
• No Manic, Mixed, Hypomanic, Cyclothymic episode
ever experienced
• No psychotic symptoms
• Does not meet Major Depression Criteria during the
first two years
• Not due to medical or substance
 Dysthymia
• Chronically depressed mood for 2 yrs, more
days than not
• An additional two symptoms: appetite, sleep
disturbance, fatigue, low self-esteem, poor
concentration or hopelessness
• Some clinically significant distress or
impairment in functioning
 Specifies
• Early onset: Before 21 (More likely to develop
Major Depressive Disorder)
• Late Onset: Onset 21 yrs or later
• With Atypical Features: Reactive mood plus 2
(increased appetite, hypersomnia, arms/legs
feel heavy, rejection sensitivity even when not
depressed)
 Dysthymic Presentation
• Feelings of inadequacy
• General loss of interest or pleasure
• Social withdrawal
• Feelings of guilt of brooding over the past
• Irritability/anger
• Decreased activity
• Vegetative symptoms are less common
 Dysthymia
• Women 2-3 times more likely than men
• Equally in male and female children
• Early onset and chronic course
• Genetically linked to Major depression and
Dysthymia
 Cyclothymia
• Hypomania and Dysphoria
• At least 2 years
• No normal mood for over 2 months at a time
• Does not meet criteria for Major Depressive Disorder
• No Mania, Mixed or Major Depression during the first 2 years
• Not due to psychosis
• Not due to substance or medical
• Clinically significant distress or impairment of functioning
 Cyclothymia
• Chronic, fluctuating mood
• Symptoms do not have to meet criteria for
hypomania or dysthymia, but must
demonstrate symptoms similar to both
disorders
 Cyclothymia
• Onset: adolescents and early adulthood
• Equally common in men and women
• Chronic course
• Genetic link to other mood disorders
(especially Bipolar I)
 Bipolar I
• One or more Manic episode or mixed episode
• Often they have Major Depression Episodes as
well
• Specifiers are the same as for Bipolar II and
will be covered in the next section
 Criteria needed for Manic Disorder
• Distinct period (at least one week) of elevated,
expansive or irritable mood
• Three or more: grandiosity, sleep (3 hrs), pressured
speech, thoughts racing, distractibility, increased goal
directed activity (planning and participating in several
activities) or psychomotor agitation, excessive
involvement in high risk pleasurable activities
• Symptoms do not meet criteria for Mixed disorder
• Not medical/substance induced
• Marked impairment in functioning
 Manic Presentation
• Do not recognize they are ill and resist treatment
• Poor judgment and impulsivity combined with
accelerated activity are likely to lead to behaviors that
will have neg. consequences
• After the episode there is usually regret for behaviors
• Mood is fun, irritable, angry, even depressed at times.
If the depression meets criteria for major depression
and occurs every day with mania-then a mixed
episode is diagnosed
 Adolescents and Mania
• Adolescents with mania are likely to have
psychotic features, school truancy and failure,
antisocial behaviors, and substance abuse.
They may have long standing behavioral
problems before their first manic episode
 Course of Mania
• Onset: early 20’s is average, but may begin at
other times
• Usually last a few weeks to several months
and begin and end abruptly
 Mixed episode
• At least one week in which criteria for Mania and
Major Depression are both met
• Presentation includes rapid altering of sadness,
irritability, and euphoria. Individuals are often
agitated, insomnic, have appetite changes, psychotic
features (disorganized thinking and behavior) and
suicidal ideations
• Must cause marked impairment in functioning, have
psychotic features, or require hospitalization
• Not due to substances, Medical, of medicines
 Bipolar II
• Hypomania and Major Depression
• No history of mania or mixed episodes
• Not caused by substance or medical
• Impairment in functioning
Hypomanic Episode Criteria needed
for Bipolar II
• Elevated, expansive, or irritable mood lasting 4 days
• Three or more: grandiosity, sleep (3 hrs), pressured
speech, thoughts racing, distractibility, increased goal
directed activity (planning and participating in several
activities) or psychomotor agitation, excessive
involvement in high risk pleasurable activities
• Mood and change noticeable by others
• No severe functioning difficulties
• No medical/substance cause
 Specifiers for Bipolar I and II
• Hypomanic (current or most recent episode)
• Depressed (current or most recent episode)
– Current major depressive episode
• Mild, moderate or severe without psychotic features or
with psychotic features
• Chronic
• With catatonic features
• With melancholic features
• With atypical features
• With postpartum onset
 Specifiers for Bipolar I and II
• If criteria for Major Depressive Disorder or
Hypomanic Disorder are not met
– In partial remission, In full remission
– Chronic
– With Catatonic features
– With Melancholic features
– With Atypical features
– With postpartum onset
 Specifiers to indicate pattern or
frequency of episodes of Bipolar I
and II
• Longitudinal Course Specifiers (with or
without interepisode recovery)
• With Seasonal Pattern
• With Rapid Cycling
 Additional Considerations
• If hypomanic episode occurs after age 40,
strongly explore medical possibilities
• Women with Bipolar II are more likely to have
postpartum symptoms
• Genetic transmission
 Mood Disorder due to a General
Medical Condition
• Mood is the direct physiological effect of a medical condition
• Subtype
– With depressive features
– With major depressive-like episode
– With manic Features
– With mixed features
Impairment in functioning

Note the type of medical condition on Axis I (due to …) and on Axis III
ICD-9-CM code

GIVE HANDOUT
 Substance Induced Mood Disorder
• Direct physiological effect of a substance
• Only made when symptoms exceed those expected
from intoxication or withdrawal from the substance
(otherwise dx substance intoxication or substance
withdrawal)
• Subtypes: w/ depressed features, w/ manic features,
w/ mixed features
• With onset during intoxication, with onset during
withdrawal
• GIVE HANDOUT
 Differential Diagnosis
• Uncomplicated Bereavement
• Acting out in adolescents: reduce acting out
(defense), depression may show itself
• Schizophrenia and schizodisorders: Mood
disorders can have psychotic symptoms
• Adjustment disorders with depressed mood
 Etiology
• Family hx and genetics: depression, alcoholism,
antisocialism, suicide attempts
• Neurological: serotonin, norepinephrine, dopamine
• Psychosocial: loss of parent in 1st 5 years or father
from 10-14, low social support, abuse hx,
predisposition & stress, personality factors
• Neuroendocrine: hormonal, adrenal (cortisol), thyroid
• Sleep Problems
 Medical Treatments
• ECT
• TCA’s
• SSRIs
• SNRIs and other atypical drugs
• MAOIs
• Antipsychotics
• Lithium
• anticonvulsants
 Conclusion
• Everyone feels down or euphoric from time to
time. For some people, these feelings can last
for long periods of time and can also co-occur
with other symptoms that, in combination,
interfere with their everyday lives.
• When people experience an MD or a manic
episode, they see the world differently.
 References
– Google.com
– Wikipedia.org
– Studymafia.org
– Slidespanda.com
 Thanks
To
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