Training Program

In
Clinical Psychology
 Day 8
Psychopathology 5
 Mood Disorders
Children and adults with mood disorders suffer
from extreme, persistent, or poorly regulated
emotional states—for example, excessive
unhappiness, irritability, or swings in mood from
deep sadness to high elation.

Mood disorders are common and are among the

most persistent and disabling illnesses in young
and adults.

There are two major types of mood disorders:

depressive disorders and bipolar disorders.
● Depression in children and adults involve numerous and persistent symptoms, including impairments in
mood, behavior, attitudes, thinking, and physical functioning.
● For a long time it was mistakenly believed that depression did not exist in children in a form comparable to
depression in adults. It is now known that depression in young people is prevalent, disabling, and often
under-referred.
● The way in which children express and experience depression changes with age and it can persist till
adulthood. It is important to distinguish between depression as a symptom, a syndrome, and a disorder. Three
types of
● DSM-5 depressive disorders are major depressive disorder (MDD), persistent depressive disorder
[P-DD], or dysthymia, and disruptive mood dysregulation disorder (DMDD) [only in children,
adolescents and young adults]
Major Depressive Disorder (MDD)
The key features of MDD are sadness, loss of interest or pleasure in nearly all activities, and irritability, plus many
specific symptoms that are present for at least 2 weeks.

Diagnostic criteria:

(1) depressed mood or (2) loss of interest or pleasure. Almost all young people recover from their initial
depressive episode, but about 70% have another episode within 5 years and many develop bipolar disorder.

For adults, prevalence is 17% of the total population. With proper medication & psychotherapy one can come out of
depression.
Persistent Depressive Disorder [P-DD] (Dysthymia)
Children with PDD display a depressive or irritable mood for most of the day, on most days for at least 1 year
and 2 years for adults. While depressed, they also experience a number of somatic and cognitive symptoms. The
most common age at onset for P-DD is between 11 and 12 years, with an average episode length of between 2 and 5
years. Almost all young people eventually recover from their P-DD, but many will develop MDD. P-DD is a revised
category in DSM-5 that combines the previous DSM-IV categories of Dysthymic Disorder and MDD—Chronic.
This was done because of the lack of differences between youths with a dysthymic disorder and those with a chronic
type of major depression.
 Bipolar Disorder
Bipolar disorder is distinguished
from major depressive disorder by
the presence of mania.

A mixed episode is characterized by

symptoms of both full-blown
manic/hypomanic and major
depressive episodes for at least 1
week, whether the symptoms are
intermixed or alternate rapidly every
few days. Such cases were once
thought to be relatively rare but have
increasingly been recognized as
relatively common nowadays.
Bipolar I & II:
Bipolar I:

● The most important aspect of bipolar I disorder is the presence of mania.

● People with bipolar I disorder experience episodes of mania and periods of depression. Even if the periods of
depression do not reach the threshold for a major depressive episode, the diagnosis of bipolar I disorder is still given.

Bipolar II:

● People with bipolar II disorder experience periods of hypomania but their symptoms are below the threshold for
full-blown mania.

● The person diagnosed with bipolar II disorder also experiences periods of depressed mood that meet the criteria for
major depression.
Causes of Mood Disorders:
1. Genetic and Family Risk

2. Neurobiological Influences-low
serotonin level

3. Family Influences

4. Stressful Life Events-acts as

triggers

5. Emotion Regulation
Treatment of Mood Disorders
1. Cognitive–behavioral therapy and interpersonal psychotherapy have had the most success in
treating depression.

2. SSRIs have been recommended as the first line of drug treatment for depression, but concerns have
been raised about their use.

3. A high priority needs to be given to programs aimed at preventing depression in young people.
POSTPARTUM DEPRESSION
Postpartum “Blues” Even though the birth of a child
would usually seem to be a happy event, postpartum
depression sometimes occurs in new mothers (and
occasionally fathers) and it is known to have adverse
effects on child outcomes. In the past it was believed
that postpartum major depression in mothers was
relatively common, but more recent evidence suggests
that only “postpartum blues” are very common. The
symptoms of postpartum blues typically include
changeable mood, crying easily, sadness, and
irritability, often liberally intermixed with happy
feelings.

Such symptoms occur in as many as 50 to 70 percent

of women within 10 days of the birth of their child
and usually subside on their own. New findings show
that hypomanic symptoms are also frequently
observed, intermixed with the more depression-like
symptoms. Let's watch a video
Premenstrual Dysphoric Disorder
After years of study, surrounded by some
controversy, a new disorder called
Premenstrual Dysphoric Disorder, has been
added to the Depressive Disorders category in
DSM-5. This disorder is diagnosed if a woman
has had a certain set of symptoms in the
majority of her menstrual cycles for the past
year. In particular she must have at least one of
the following four symptoms in the final week
before the onset of menses; these symptoms
must start to improve within a few days after
the onset of menses, and become minimal or
absent in the week post-menses.
The four symptoms of which one must occur include
(1) marked affective lability such as mood swings, (2) marked irritability or anger or increased interpersonal
conflicts, (3) marked depressed mood, or feelings of hopelessness or self deprecating thoughts, or (4) marked
anxiety, tension or feelings of being “keyed up” or “on edge.”

There are seven other symptoms that are listed and a total of five symptoms must be experienced. These
other symptoms include
(1) decrease interest in usual activities, (2) subjective sense of difficulties in concentration; (3) lethargy, easily
fatigued, or lack of energy, (4) marked changes in appetite or overeating, (5) hypersomnia or insomnia, (6) a
sense of being overwhelmed or out of control, and (7) physical symptoms such as breast tenderness or
swelling, a sense of bloating, weight gain, etc. This is one form of depression where hormones clearly play an
important role.
Case Discussion
Paxton is a 19-year-old who withdrew from college after experiencing an episode. He had changed his major from engineering to
philosophy and increasingly had reduced his sleep, spending long hours engaging his friends in conversations about the nature of
reality. He had been convinced about the importance of his ideas, stating frequently that he was more learned and advanced than all
his professors. He told others that he was on the verge of revolutionizing his new field, and he grew increasingly irritable and
intolerant of any who disagreed with him.

He also increased a number of high-risk behaviors – drinking and engaging in sexual relations in a way that was unlike his previous
history. At the present time, he has returned home and his been placed on a mood stabilizer (after a period of time on an
antipsychotic), and his psychiatrist is requesting therapy for his issues. The patient’s parents are somewhat shocked by the
diagnosis, but they acknowledge that Paxton had early problems with anxiety during pre-adolescence, followed by some periods of
withdrawal and depression during his adolescence.

His Symptoms are- Alcohol Use, Depression, Elevated Mood, Impulsivity, Irritability, Rapid Mood Cycles & Risky Behaviors.
Any Questions ???