MOOD DISORDERS

AND SUICIDE
Prepared by: Donna P. Sombrea, MS, RPsy
 Mood disorders
• INVOLVE DISABLING disturbances in emotion—from the extreme
sadness and disengagement of depression to the extreme
elation and irritability of mania
Premenstrual
Dysphoric
Disorder
(PMDD)
Disruptive Mood
Dysregulation Disorder
 DEPRESSIVE DISORDER BIPOLAR DISORDER

A. Disruptive mood dysregulation A. Bipolar I disorder

disorder B. Bipolar II disorder,
B. Major depressive disorder C. Cyclothymic disorder,
C. Persistent depressive disorder
(dysthymia) D. Substance/Medication-Induced Bipolar
and Related Disorder
D. Premenstrual dysphoric disorder
E. Bipolar and Related Disorder-Due to
E. Substance/medication-induced Another Medical Condition
depressive disorder
F. Other Specified Bipolar and Related
F. Depressive disorder due to another
medical condition Disorder
G. Other specified depressive disorder G. Unspecified Bipolar and Related Disorder
H. Unspecified depressive disorder.
• CHELSEA, RAISED IN A STABLE AND LOVING FAMILY, was an A student and star athlete
throughout much of high school. However, in her senior year, she became
uncharacteristically irritable, frequently snapping at her parents and sister without
reason. She began to miss swimming practice and fell behind in her school
assignments. She seemed uninterested when friends contacted her. When her parents
tried to talk to her, she asked to be left alone and retreated to her bedroom. She spent
most of her weekends sleeping. As graduation approached, Chelsea became
increasingly withdrawn from family and friends. She felt guilty about how she was
treating everyone and finally agreed to see a therapist. During her first visit she told the
therapist, “I don’t know what’s wrong with me. Everything had seemed so right, and
now everything seems so wrong.”
CASE OF LENLEN
• Lenlen., a 38-year-old mother of four children, had been deeply depressed for about 2
months when she first went to see a psychologist. Three years earlier, she had returned
to work when health care bills made it hard for her family to get by on her husband’s
income as a high school teacher. About 7 months before her visit to the psychologist,
she was laid off from her job as an administrative assistant, which was a serious blow to
the family’s finances. She felt guilty about the loss of her job and became preoccupied
with signs of her overall incompetence. Each night, she struggled for more than an hour
to fall asleep, only to wake up frequently throughout the night. She had little appetite
and as a result had lost 10 pounds. She also had little energy for and no interest in
activities that she had enjoyed in the past. Household chores became impossible for
her to do, and her husband began to complain. Their marriage had already been
strained for 2 years, and her negativity and lack of energy contributed to further
arguments. Finally, realizing that Lenlen’s symptoms were serious, Mr. M. cajoled her
into making an appointment with a psychologist.
Jack has experienced recurrent episodes of major depressive
episodes. In the intervals between the episodes, he does not seem
to return to "normal." In fact, during those periods, he has been
diagnosed as suffering from persistent depressive disorder. Jack's
condition is referred to as _______________.

a) double depression
b) bipolar disorder
c) atypical depression
d) dysfunctional dysthymia
Jack has experienced recurrent episodes of major depressive
episodes. In the intervals between the episodes, he does not seem
to return to "normal." In fact, during those periods, he has been
diagnosed as suffering from persistent depressive disorder. Jack's
condition is referred to as _______________.

a) double depression
b) bipolar disorder
c) atypical depression
d) dysfunctional dysthymia
Morning light is thought to help with
seasonal affective disorder because it

a) produces phase advances of the melatonin rhythm.

b) reverses melatonin release.
c) increases the amount of melatonin released.
d) eliminates melatonin release.
Morning light is thought to help with
seasonal affective disorder because it

a) produces phase advances of the melatonin rhythm.

b) reverses melatonin release.
c) increases the amount of melatonin released.
d) eliminates melatonin release.
Depressive Disorders
Depressive Disorders
nonchronic major chronic major depressive
depressive disorder episode
(recurrent, as two
depressive episodes are
depicted).

persistent depressive major depressive episode

disorder with pure in partial remission
dysthymic
syndrome

double depression recurrent major depression

(major depressive without full interepisode
episode occurring recovery
within the course of
dysthymia)
 Additional Defining Criteria for
Depressive Disorders
• Symptom Specifiers • Atypical features
• Psychotic features • Oversleeping and overeating
• Hallucinations • Catatonic features
• Delusions • Catalepsy
• Anxious distress • Peripartum onset
• Comorbid disorders or anxiety symptoms • 13 -19% meet criteria for depression
• Mixed features • Seasonal pattern
• At least 3 symptoms of mania • Seasonal affective disorder (SAD)
• 2.7% of population
• Melancholic
• Melatonin Phototherapy
• Severe somatic symptoms • CBT
TREATMENT FOR DISORDERS
Biological Treatment
• Medication: Antidepressant medications
• Circadian-related Treatments
• Brain Stimulation Therapies

Psychological & Behavioral Treatments

• Behavioral Activation Therapy
• Interpersonal Psychotherapy
• Cognitive-Behavioral Therapy
• Mindfulness-Based Cognitive Therapy
 TREATMENT FOR DEPRESSION
Biological Treatment
• Medication: Antidepressant
medications
• Circadian-related Treatments
• Brain Stimulation Therapies
Psychological & Behavioral Treatments
• Behavioral Activation Therapy
• Interpersonal Psychotherapy
• Cognitive-Behavioral Therapy
• Mindfulness-Based Cognitive Therapy
Some treatments for
depression involve efforts to
reset the circadian clock.
• For example, a night of total
sleep deprivation followed by
a night of sleep recovery can
improve depressive
symptoms
Behavioral Activation Therapy
• Individuals with depression often lack the motivation to participate in social activities.
• It is based on principles of operant conditioning, focuses on helping those who are depressed to increase their
participation in enjoyable activities and social interactions. The goal is to have clients improve their mood by actively
engaging in life

Interpersonal Psychotherapy
• Depression may occur within an interpersonal context. Thus, this therapy focuses on relationship issues.
• Clients learn to evaluate their role in interpersonal conflict and make positive changes in their relationships.
• By improving communication, identifying role conflicts, and increasing social skills, clients develop more satisfying
relationships.

Cognitive-behavioral therapy
• CBT teach clients to identify negative, self-critical thoughts and the connection between negative thoughts and
negative feelings.
• They then learn to alter and replace inaccurate thoughts with realistic interpretations.

Mindfulness-based cognitive therapy (MBCT)

• To experience calm awareness of one’s present experience, thoughts, and feelings
• To promote an attitude of acceptance rather than judgment, evaluation, or rumination.
• It allows those affected by depression to disrupt the cycle of negative thinking by directing attention to the present
 CASE OF MOCHA NOSU
• Mrs. Nosu is a 48-year-old-married mother of two teenagers who works full-time as a store
manager. Over the past 2 months, she has developed symptoms of fatigue, irritability,
general aches and pains, loss of appetite, and reduced libido. Mrs. Nosu had been her
mother’s primary caregiver until 4 months ago when her mother lost her battle with
cancer. Her husband is supportive but feels overwhelmed by her depressive symptoms;
her children avoid her because of her temper and frequent outbursts of anger. In recent
months, Mrs. Nosu no longer attends church or participates in social events. She finally
agreed to see her doctor about her symptoms. Although her physical examination was
normal, she burst into tears midway through the examination and admitted that she feels
that life is hopeless (lie, 2012).
From Grief to Depression
• Depression frequently follows loss
• Integrated grief

• Pathological or impacted grief reaction

• Severity of symptoms
• Dysfunction
• Persistence of symptoms
 CASE OF JUNJUN
• Junjun, a 32-year-old insurance appraiser, had been married for 8 years. He and his wife and their
two children lived comfortably and happily in a middle-class neighborhood. He had not
experienced any clear symptoms until age 32. One morning, Junjun told his wife that he was
bursting with energy and ideas, that his job was unfulfilling, and that he was just wasting his talent.
That night he slept little, spending most of the time at his desk, writing furiously. The next morning
he left for work at the usual time but returned home at 11:00 am, his car overflowing with
aquariums and other equipment for tropical fish. He had quit his job, then withdrawn all the
money from the family’s savings account and spent it on tropical fish equipment. Junjun reported
that the previous night he had worked out a way to modify existing equipment so that the fish
“wont die anymore. We’ll be millionaires.” After unloading the paraphernalia, Junjun set off to
canvass the neighborhood for possible buys, going door-to-door and talking to anyone who
would listen.
Junjun reported that one in his family had been treated for bipolar disorder, but his mother
had gone through periods when she would stop sleeping and become extremely
adventurous. For the most part, the family had regarded these episodes as unproblematic,
but during one period she had set off across the country without the children and had
returned only after spending a major amount of money.

• The following bit of conversation indicates Junjun’s incorrigible optimism and

provocativeness:

• Therapist: Well, you seem pretty happy today.

• Junjun: Happy! Happy! You certainly are a master of understatement, you rogue! [Shouting,
literally jumping out of his seat.] Why, I’m ecstatic! I’m leaving for the West Coast today, on
my daughter’s bicycle. Only 3,100 miles. That’s nothing, you know. I could probably walk, but
I want to get there by next week. And along the way I plan to contact a lot of people about
investing in my fish equipment. I’ll get to know more people that way—you know, Doc,
“know” in the biblical sense. Oh, God, how good it feels.
CASE OF JUNJUN BIPOLAR
CASE
• It took ten years, a suicide attempt, an acute manic episode and a psychotic break for me
to finally get an accurate diagnosis _________. By that time, I was 29, and I had already
graduated law school, passed the bar, earned a Master’s in Public Health, published my first
book and won an award for it. . . .
• It took roughly a month for me to believe and acknowledge my diagnosis. The
antipsychotics worked remarkably fast, and soon, I was confronting the reality of my
hallucinations, delusions, and erratic and irrational behavior from the perspective of
someone who was neither acutely manic nor psychotic. I couldn’t very well deny the
diagnosis after looking back at the things I’d done while manic: disrobing in public, yelling
obscenities at an infant, trying to give away all my money and belongings— and that’s not
even the half of it . . .
• I’m now able to make a living as a full-time writer. . . . I’m not cured by any stretch. I struggle
with this illness every day. . . . living with bipolar disorder, writing and speaking about it, and
gaining strength from others who share in this fight, I’ve learned never to underestimate the
power of compassion, perseverance, resilience and faith. (Moezzi, 2014)
BIPOLAR I
CASE OF RODRIGO
• For many years, Rodrigo had no idea what was wrong. His depression began in his
midteens and sometimes lasted for months. In his twenties he began to have weeks
when everything seemed great. He felt energetic, clever, productive, creative, and
empowered. He saw himself as athletic, physically strong, and very sexy. He felt
unusually social, frequently texting or messaging friends or posting on social media. He
was not tired so he went out dancing and drinking, hooking up with women he met at
the local clubs. At work, he had ideas he enthusiastically shared, but became irritable
and impatient when co-workers asked questions or mentioned that his ideas seemed
unrealistic. These energized times would sometimes last for weeks. He might then
become “grouchy” and easily agitated, crashing into a dark world of depression. It
seemed like the depressions were getting longer, and it was getting harder to undo the
damage that occurred during his “good times.” After years of telling his family to “lay
off” and not to worry about him, he finally agreed that he needed to get some help.
CASE OF RODRIGO- BIPOLAR II
 Which of the following is NOT TRUE
about a hypomanic manic episode?
a) It is not necessarily problematic
b) It does contribute to the definition of several mood disorders.
c) It causes marked impairment in social or occupational functioning.
d) It need only last 4 days.
 Which of the following is NOT TRUE
about a hypomanic manic episode?
a) It is not necessarily problematic
b) It does contribute to the definition of several mood disorders.
c) It causes marked impairment in social or occupational functioning.
d) It need only last 4 days.
At various times, Cynthia, a 20-year-old college student, has been considered
by her family and/or friends to be moody, high-strung, explosive, or hyperactive.
She never fails to take care of her responsibilities, but the fact that she seems to
experience mood swings that are outside the norm has been noticed by those
around her. Knowing the criteria for mood disorders, you would diagnose
Cynthia with ___________.

a) major depressive disorder

b) panic disorder
c) persistent depressive disorder
d) cyclothymic disorder
At various times, Cynthia, a 20-year-old college student, has been considered
by her family and/or friends to be moody, high-strung, explosive, or hyperactive.
She never fails to take care of her responsibilities, but the fact that she seems to
experience mood swings that are outside the norm has been noticed by those
around her. Knowing the criteria for mood disorders, you would diagnose
Cynthia with ___________.

a) major depressive disorder

b) panic disorder
c) persistent depressive disorder
d) cyclothymic disorder
An Integrative Theory
 Biomedical Treatments
§ Mood-stabilizing medications such as lithium are
the foundation of treatment for bipolar disorder
§ Antidepressants are sometimes added to deal
with depressive symptoms.
TREATMENT § However, antidepressants are used cautiously
with bipolar disorder because of a significant
risk that they will produce or intensify
hypomanic/manic symptoms.
 Psychosocial Treatments
§ Interventions focused on regulating sleep patterns
§ Mindfulness therapies
§ Family-focused therapy, interpersonal therapy, and
TREATMENT cognitive-behavioral therapy
§ Educating families about bipolar disorder and
teaching communication and problem-solving
skills to all family members is effective in
reducing the risk of relapse and hospitalization
SUICIDE
 • Key Terms in the Study of
Suicidality
• Suicide ideation: thoughts of
killing oneself
• Suicide attempt: behavior
intended to kill oneself
• Suicide: death from deliberate
self-injury
• Non-suicidal self-injury:
behaviors intended to injure
Importance of assessment
oneself without intent to kill
Suicidal desire - Ideation oneself
Suicidal capability – Past
attempts
Suicidal intent - Plan
Risk Factors
Thank you
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