3.1: Mood Disorders

Question 1

Types of Mood Disorders:

Answer 1

• Depression [Depressive episode, Depressive disorder- single or recurrent, Dysthymic disorder, double depression]
• Bipolar Disorder
• Suicide

Question 2

Depression:

Answer 2

: a mood disorder involving emotional, motivational, behavioural, physical, and cognitive symptoms.
The DSM-5 revised the categorisation and diagnosis of major depressive disorder.
It specifies criteria for a major depressive episode (not a codable disorder), and then defines two main types of depressive disorder.
- major depressive disorder (single episode)
- major depressive disorder (recurrent)

Question 3

Depressive episode

Answer 3

episode of major depression, not a codable condition but forms the basis of major depression.
Depressive episode is characterised by the presence of five or more depressive symptoms during the same 2-week period, as stated by the DSM-5.

Need at least one of:
- Depressed mood
- Apathy/loss of interest
Need four or more of:
- Weight/ appetite changes
- Sleep disturbance
- Psychomotor agitation
- Fatigue
- Worthlessness
- Executive dysfunction
- Suicidal ideation

Need at least = 1+4 or 2+3

Additional Criteria (DSM-5)
B. the symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C. the episode is not attributable to the direct physiological effects of a substance or to anther medical conditions.

Question 4

Depresive Disorder (DSM-5)

Answer 4

• presence of a single major depressive episode (not attributable to normal and expected reactions to behaverment) without previous manic or hypomanic episodes
• symptoms not better attributed by other disorder
• ## symtoms cause singnificant distress and impared daily functioning

Question 5

other depressive disorder:

Dysthymic disorder

Answer 5

form of depression in which sufferer has experiences at least 2 years of depressed mood for more days than not

Question 6

Premenstrual dysphoric disorder (PMDD)

Answer 6

condition in which some women experience severe derpession symptoms between 5-11 days prior to the menstrual cycle. symptoms improve significantly a few days after the onset of menses.

Question 7

seasonal affective disorder (SAD)

Answer 7

condition of regularyl occuring depression in winter with a remission the following spring or summer

Question 8

chronic fatigue symptoms (CSF)

Answer 8

disorder characterised by depression and mood fluctuations together with physical symptoms such as extreme fatgue, muslce pain

Question 9

Biological Theories of Depression

Genetic Factors

Answer 9

• Family Studies:
  o First-degree relatives of depressed individuals are 2-3 times more likely to develop depression.
• Heritability:
  o Meta-analyses estimate heritability at 30-40%.
  o Twin studies show equal contributions of genetic and environmental factors.
• Specific Genes:
  o Serotonin Transporter Gene (SLC6A4):
   Regulates serotonin activity.
   May influence depression by enhancing or terminating serotonin action.
   Gene-environment interaction: Childhood maltreatment or stress interacts with this gene to increase depression risk.
• Diathesis-Stress Model:
  o Interaction of high-risk genes and stressful life events contributes to severe depression.

Question 10

Biological Theories of Depression

Neurochemical Factors

Answer 10

• Depression is linked to low levels of monoamines:
  o Serotonin: Reduced receptor binding in the amygdala and frontal, temporal, and limbic regions.
  o Norepinephrine: Low activity contributes to depressive symptoms.
  o Dopamine: Depletion impairs the brain’s reward system, reducing motivation and pleasure.
  Complex Neurotransmitter Interactions:
• Depression may result from an imbalance between neurotransmitters rather than deficits in one specific neurotransmitter (Rampello et al., 2000).
• Interaction between serotonin and norepinephrine:
  o Low serotonin + low norepinephrine = depression.
  o Low serotonin + high norepinephrine = mania (Mandell & Knapp, 1979).
  Monoaminergic Pathway Dysfunction: Impaired activity alone is insufficient to cause depression; it may require additional factors like genetic predisposition or a history of depressive episodes.
• Antidepressant Mechanisms: block the reuptake of neurotransmitters at the presynaptic neuron, increasing the level of serotonin in the synapse.
  o Tricyclic Antidepressants (TCA): Block reuptake of serotonin and norepinephrine.
  o Selective Serotonin Reuptake Inhibitors (SSRIs): Block serotonin reuptake.
  o Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): Target serotonin and norepinephrine.
  o Complex Interactions: Imbalance between neurotransmitters, not individual deficits, drives depression

Question 11

Brain Regions and Roles in Depression:

Answer 11

Prefrontal Cortex:
- Associated with goal representation and means to achieve goals.
- Depression involves lower activation in this area leads to failure to anticipating incentives.
Anterior Cingulate Cortex (ACC)
* Important for emotional regulation and adapting behaviour when outcomes are undesired.
* Depression involves decreased activation
* Deficits may reflect a lack of the “will-to-change” in depressed individual’s
Hippocampus:
* Key in hormone regulation (adrenocorticotropic hormone secretion) and learning context of emotional reactions.
* Dysfunction may result in dissociating affective responses from context (Mervaala et al., 2000).
o E.g., sadness occurs inappropriately across contexts, not tied to specific events like bereavement.
Amygdala:
* Directs attention to emotionally salient stimuli and prioritises processing of such information.
* Depression involves increased activation, leading to:
o Prioritisation of threatening information.
o Negative interpretation of such stimuli (Abercrombie et al., 1998).

Structural Abnormalities
* Decreased Grey Matter:
o Found in:
 Prefrontal cortex
 Orbitofrontal cortex
 ACC
 Basal ganglia (Kaltenboeck & Harmer, 2018).
* White Matter Lesions:
o Common in late-life depression.
o May disrupt limbic projections to the prefrontal cortex, impairing mood regulation.

Question 12

Psychodynamic theories depression

Answer 12

Freud’s Symbolic Loss:
* Depression stems from unresolved childhood loss or poor parenting (e.g., affectionless control).
Unconscious Regression:
* Loss triggers regression to the oral stage of development.
* Empirical limitations: Difficult to test concepts like “symbolic loss” or “unconscious processes.”

Question 13

Cognitive Theories depression

Answer 13

• Beck’s Cognitive Model:
• Idea: depressed individuals engage frequently in negative thinking and experience negative intrusive thoughts.
• Depression influenced by negative schemas.
   Negative Schema: Stable patterns of negative beliefs about self, world, and future.
   Cognitive Triad:
  1. Negative views of the self.
  2. Negative views of the world.
  3. Negative views of the future.

self fulfilling profecy
attentional bias
memory bias
learned helplessness
attributional bias
rumanation theory

Question 14

Bipolar Disorder

Answer 14

mood disorder characterised by altering periods of depression and mania.

Question 15

Manic Episode DSM-5

Answer 15

usual and continual elevated, unreserved, or irritable mood and unusual adn contunual increase in energy levels lasting at least a week:

presence of at least 3 of the following:
- inflated self-esteem or gradiosity
- less need for sleep
- increased talkativeness
- racing thoughts
- easily distractible
- increase in goal-directed activity or unintentional and purposeless motion
- unnecessary participation in activities with a high potential for painful consequences

Question 16

Types of Bipolar Disorder (DSM-5)

Answer 16

• Bipolar I Disorder:
  o Definition: Alternating episodes of full mania and major depression.
  o Prevalence: Most common of the two types.
• Bipolar II Disorder:
  o Definition: Alternating episodes of major depression and hypomania (mild mania).

o Key Features:
 Symptoms must cause distress or impairment.
 Individuals may remain relatively productive during hypomanic episodes (Jamison, 1995).

Question 17

Hypomania, DSM-5

Answer 17

• Definition: Mild episodes of mania, less severe than full manic episodes.
• unusual continual elevated, unreserved, or irritable mood and unusual and continual increase in energy levels lasting at least a week
• presence of at least three of the following
• inflated self-esteem or grandiosity
• less need for sleep
• increased talkativeness
• racing thoughts
• easily distractable
• increase in goal-directed activity or unintentional and purposeless motions
• unnecessary participation in activities with a high potnetial for painful consequence

Question 18

Bipolar disorder I and II DSM-5

Answer 18

Bipolar disorder I: has to have at least one manic episode, sometimes they also have depressive episodes (-/+)

• presence of at least one manic episode
• the manic episode may have been preceded by and may be followed by hypomanic or major depressive episodes
• symptoms are not better accounted for by schizoaddective disorder or other disorders

Bipolar disorder II: always have depressive episodes.

• presence or history of at least one major depressive episode
• presence or history of at least one hypomanic episode
• no history of manic episodes
• symptoms are not better accounted for by shizoaffective disorder or other dusorders

Question 19

biological theories of bipolar

genetic factors

Answer 19

• Bipolar disorder has a strong genetic component:
  o Family Studies:
   10–25% of first-degree relatives report mood disorder symptoms.
   7% of first-degree relatives develop bipolar disorder compared to a 0.4–1.6% general population prevalence.
  o Twin Studies:
   Monozygotic twins: 69% concordance rate.
   Dizygotic twins: 29% concordance rate.
   Heritability: Up to 93% for Bipolar I disorder (Kieseppä et al., 2014).

Question 20

biological theory bipolar

neurochemical factors

Answer 20

• Dopamine Dysregulation:
  o Mania is associated with overactive dopamine receptors and hyperactive reward networks.
• Norepinephrine:
  o Elevated norepinephrine levels correlate with manic symptoms (Altshuller et al., 1995).
• Serotonin:
  o Plays a lesser role in bipolar disorder compared to unipolar depression.
  o Antidepressant efficacy is often insufficient in bipolar patients.
• Complex Pathophysiology:
  o Bipolar disorder involves imbalances across neurotransmitter systems, contributing to alternating mania and depression.

Question 21

biological theories bipolar

Brain Structure and Function

Answer 21

• Prefrontal Cortex:
  o Reduced activation impairs goal-directed behaviours during depressive episodes.
• Emotion Regulation Deficits:
  o Impaired executive functioning (working memory, attention) limits emotional control.
• Sleep and Circadian Rhythm Dysregulation:
  o Disrupted sleep patterns trigger hypomanic or manic episodes:
   E.g., sleep deprivation and circadian rhythm disturbances lead to mania, particularly in women.

Question 22

psychological theories of bipolar

Cognitive Deficits.

Answer 22

• Bipolar disorder involves:
  o Poor executive functioning (e.g., difficulty inhibiting negative thoughts).
  o Maladaptive emotion regulation strategies:
   Increased rumination and reduced cognitive reappraisal.
  Key cognitive deficits include:
  o Verbal and nonverbal memory.
  o Attention.
• Working memory

Question 23

psychological theories

Behavioural Activation System (BAS) Dysregulation- model for mania

Answer 23

• BAS Theory (Depue & Iacono, 1989):
  o Mania arises from heightened sensitivity to rewards and goals.
  o Dysregulated BAS activity leads to:
   Manic Behaviours: Elevated arousal, incentive-driven actions, sociability.

Question 24

psychological theory bipolar

Triggers for Episodes

Answer 24

• Depressive Episodes:
  o Losses, failures, and chronic stress.
• Manic Episodes:
  o Reward sensitivity (e.g., positive events like passing an exam).
  o Circadian rhythm disruption (e.g., shift work, sleep deprivation).
  o Antidepressant medications

Question 25

social theories bipolar

Social stressor

Answer 25

• Stressful life events (e.g., loss, family conflicts) trigger both manic and depressive episodes.
• High Emotional Expression (family criticism or over-involvement):
  o Predicts relapse and episode severity in bipolar patients (Proudfoot et al., 2011).

Question 26

social theory bipolar

sleep and rhythms

Answer 26

• Social and work-related demands disrupt sleep and circadian rhythms, exacerbating bipolar symptoms.
  Sleep and Circadian Rhythm Disruption:
  o Sleep duration predicts hypomanic symptoms the following morning (Leibenluft et al., 1996).
  o Circadian disruptions (e.g., night shifts, long flights) trigger hypomania within 24 hours.
  o Sleep deprivation:
   Found to trigger mania, especially in females and individuals with bipolar I disorder.
   Does not significantly influence depressive episodes (Lewis et al., 2017).
• Sleep Deprivation as a Final Pathway
• Sleep deprivation may be the final common pathway through which various factors (e.g., stress, circadian disruption) trigger manic episodes

Question 27

biological Interventions bipolar

pharmacological treatment

Answer 27

1. Mood Stabilisers:
   o Lithium:
    First-line treatment for bipolar disorder.
    Reduces manic symptoms and suicide risk.
   o Valproate and Carbamazepine:
    Effective for rapid-cycling bipolar disorder and mixed states.
2. Antipsychotics:
   o Atypical Antipsychotics (e.g., olanzapine, quetiapine):
    Used for acute mania and maintenance therapy.
3. Antidepressants:
   o Used cautiously due to the risk of triggering mania.
   o Combined with mood stabilisers to manage bipolar depression.
4. Sleep Stabilisation:
   o Medications like benzodiazepines aid in managing insomnia and circadian disturbances.

Question 28

psychological interventions bipolar

Psychoeducation

Answer 28

• Educates patients and families about bipolar disorder.
• Enhances treatment adherence and reduces relapse rates.

Question 29

psychological interventions bipolar

CBT

Answer 29

• CBT for Bipolar Disorder:
  o Identifies triggers for mood episodes.
  o Helps patients challenge cognitive distortions (e.g., unrealistic thoughts during mania).

Question 30

psychological interventions bipolar

Interpersonal and Social Rhythm Therapy (IPSRT)

Answer 30

• Focuses on stabilising sleep patterns and daily routines.
• Reduces circadian rhythm disruptions to prevent manic or depressive episodes.

Question 31

psychological interventions bipolar

Family-Focused Therapy (FFT)

Answer 31

• Involves families in treatment:
  o Reduces high emotional expression (e.g., criticism).
  o Improves communication and support.

Question 32

social interventions bipolar

Answer 32

A. Social Support and Group Therapy
* Support Groups:
o Provide validation, shared experiences, and coping strategies.
* Community Programs:
o Address isolation, improve social functioning, and reduce stressors.
B. Vocational Rehabilitation
* Assists individuals with bipolar disorder in maintaining employment and managing workplace challenges.
C. Addressing Social Stressors
* Interventions to reduce family stress, improve financial stability, and manage lifestyle factors.