Mood Instability Flashcards
Define mood instability
Rapid oscillations of intense affect, with a difficulty in regulating these oscillations or their behavioural consequences
Mood instability with other disorders evidence?
- Transdiagnosit phenomenon: part of diagnostic symptoms with many other disorders, so itself cannot be used to diagnose
- 40-60% of depression & anxiety disorders (Marwaha et al 2013)
- mental disorder pts have higher affective lability and lower affect control (no difference in intensity) - (Marwaha et al 2018)
Mood instability in the general population evidence?
Developmental specificity?
- UK adult survey UK: peak aged 16-24 w/ decline over time (Marwaha et al, 2013)
- Adolescents have more variability and extremes w/ mood (this reduces in young adults), (Larson and co. 2002)
- Part of prodomal symptoms of depr and bipolar in young ppl (Howes et al, 2013)
Clinical relevance of mood instability?
- wide range of mental dysorders associated w/ poorer clinical outcomes (w/ suicidal thoughts and HCservice use)- (Patel et al 2015)
- assoc w/ self harm and addiction (Marwaha et al, 2014)
- assoc w/ trauma and BPD, BP (Marhawa et al 2016)
- worse functional outcomes in BD (Strejlievich et al, 2015)
- predictor of outcome for psych interventions in BD (depressive instabl assoc w/ lower likelihood and longer recover (Stange, 2016)
[studying dimensional phenomena slide]
[studying dimensional phenomena slide]
How mood instability can be measured?
Traditionally
- self-report scales of trait constructs]- affective lability scale, affective intensity measure, affective control scale
- weekly restrospective symptom ratings (but memory bias)
- mean, maximum, SD
STEP-BD
clinician-rated assessmentts
Root mean square successive difference (rMSSD)- reflects size and temporal order of mood changes
True Colours
engages pt
sends weekly text/email to self report AND sends reminds for non-responders
shows pts/carers graphs of their mood
New digital tools
weekly monitoring via text/email
daily mood monitoring
using more sophisticated mathematical models- time series analysis
e.g. MoodZoom, an app allowing daily ratings]- this can differentiate between BP/BPD/HC
Evaluate the use of digital measurement for mood instability?
Ecological momentary assessment (EMA): repeated sampling of behaviour in real time minimises recall bias and maxes ecological validity (Shiffman, 2008)
BD group w/ high symptom variability found MoodZoom (twice daily monitoring) more convenient and user friendly than questionnaires (Shwarz and colleagues, 2016)
Mobile phone mood ratings correlated w/ clinician rated depressive symptom severity vs paper and pencil ratings (Depp and co., 2012)
For mania: Electronic self monitoring of mood in depression appears to be valid measure of mood compared to self-monitoring (Faurholt-Jepsen et al, 2016)
BD: increased trend to using digital tracking (mood BUT ALSO other stuff like sleep, screentime etc), positive xp and self reflection but apps can have poor usability or be hard to interpret (Murnane et al, 2016)
Neurocognitive models for mood instability evidence?
Emotional processing biases?
BD: -ve memory biases give greater instability in depressive & manic symptoms (Bilderbeck et al, 2014)
Attention dysfunction
Abnormal attention network test for ADHD and BPD (Lundervold et al, 2011)
Neurocog. pathology for mood instability evidence?
- increased connectivity between amyg and PFC and reduced connectivity between amyg and ACC (Broome et al, 2015)
- ACC increased activity during emotional processing tasks w/ reduced IFC in emotional regulation (Broome et al, 2015)
- worsening affective lability (scale) = increased amygdala and ventrolateral PFC activity over time (Bertocci et al, 2017)
What is mental imagery?
Occurs when perceptual information accessed from memory (mind’s eye)
[by contrast, perception is when information is directly from senses]
NB: doesn’t have to come from events, can be created from combined perceptual info in novel ways
Mental imagery in depression?
- negative intrusive images of past events (Holmes and co, 2016)
- flash-fwd images assoc w/ suicide or its aftermath (Di Simplico et al, 2016)
[imagery in mania and anxiety]
[imagery in mania and anxiety]
Mental imagery in BD?
- higher livels of intrusive prospective imagery and more vivid imag of future -ve events (Bonsall and co. 2012)
The affect of imagery on mood instability (experimental evidence)?
Higher mood instability assoc w/ greater disposition for intrusive imagery after traumatic movie (O’Donnel et al, 2018)
Positive imagery generation task
greater mixed affect after +ve imagery generation
greater +ve affect moderated by imagery vividness (O’Donnel et al, 2018)
BD, MDD, HC had stronger subjective imagery characteristics (esp future imagery) (Di Simplico et al, 2017)
Manipulating imagery (done daily and symptom measured too)]- appears to be a valid concept-> manipulating imagery can reduce instability as less factors need to be measured as a result (Holmes et al, 2016)
