Types of mood disorders

• What is bipolar - unipolar?

  Rosenthal and Klerman (1967) divided unipolar depression into three groups: ​1. The unitary - depressive episodes, marked by a common set of characteristics, a common aetiological pattern, should respond to a particular treatment programme 2. The dualistic - endogenous-reactive;​psychotic-neurotic;primary-secondary​- where on these scales would depend on treatment etc – reminds us diagnoses are different across people 3. The Pluralistic - depressive episodes are multifaceted with a variety of variables, that require a variety of treatment​
• Bipolar affective disorder


  Depression with at least one episode of mania
• Manic episode

  • Elevated mood
  • Flight of ideas
  • Psychomotor overactivity
• Cycling

  Alternating between depression and mania
• Bipolar affective disorder is often misdiagnosed as unipolar depression until mania presents
• Differences in depression to unipolar

  • Minimal anger
  • Few somatic complaints
  • More hypersomnia
  • More psychomotor retardation
• Hypomania

  Less than mania
• Mania development

  1. Preceded by a period of hypomanic signs and symptoms

  2. Gradually increases in severity
• Mania

  • Extremely active
  • Lots of energy
  • Unusually socially active
  • Pressure of speech
  • Flight of ideas
  • Inflated self esteem
• Genetic and biochemical factors

  The predominant theory for the cause of bipolar affective disorder, although no specific CNS structure or biochemical abnormality has been discovered
• Monozygotic bipolar twins had a concordance rate of approximately 70 per cent, while the concordance rate for unipolar illness was 40 per cent
• Dizygotic bipolar twins had a concordance rate of approximately 15 per cent versus 10 per cent for unipolar twins, indicating an element of environmental factors
• No research supports an X-linked mode of transmission for bipolar illness in spite of the disproportionate number of ill females among affectively ill relatives
• Treatment for bipolar depression

  Lithium carbonate
• Postpartum depression

  Depressed mood or decreased interest in pleasurable activities as well as disturbances in sleep, appetite and cognition for more than two weeks after the birth of a child
• Postpartum depression

  • Excessively emotionally labile, i.e. cry more easily than usual or are more irritable than usual
• 15 per cent of women experience postpartum depression after delivery
• Women who have had postpartum depression with the birth of their first child

  Have a 25 per cent greater risk of a recurrence with subsequent births
• Major hypotheses concerning postpartum depression

  • Mood changes occur as a result abrupt hormonal withdrawal
  • Activation of a biological system underlying mammalian mother-infant attachment behaviour regulated primarily by the hormone oxytocin
• Postpartum depression causes difficulty in infant bonding and care giving
• What is cyclothymic disorder?

  Chronic but a milder form of bipolar mood disorder. ​​

  Often the hypomania is described as euphoria and/or excitement – hard to distinguish from good mood​​

  Separated by short periods of normal mood ​

  Causes = similar to bipolar ​

  Genetic factors appear to be causative in cyclothymia as in biopolar disorders - often occurs in families​

  Treatment is similar to bipolar and includes medication and psychotherapy. Medication response not as strong​
• What is dysthamia?

  Chronic depressed mood most of the time for at least two years. ​​

  Dysthymia is diagnosed if the individual does not meet all the qualifications for a major depressive disorder and no evidence of hypomanic, manic, mixed episodes or psychotic disorder. ​​

  Different for children ​

  Treatment consists of medication and therapy with studies reporting good efficacy for antidepressant medication (Kevkovitz, Tedeschini & Papakostas, 2011)​]
• Season affective disorder

  Winter depression with remission in the spring and summer
• Symptoms of season affective disorder

  • Depression
  • Anxiety
  • Fatigue
  • Lowered motivation
  • Hypersomnia
  • Increased appetite and weight
  • Irritability
  • Increased sleep duration
  • Appetite changes
  • Craving for foods high in carbohydrates
  • Difficulty concentrating
  • Reduced sociability
• Season affective disorder is more common in geographical areas far from the Equator
• Cause of season affective disorder

  Situational and genetic - family history of seasonal affective disorder which indicates the possibility of having inherited specific gene combinations that place individuals at higher risk
• The exact mechanism of SAD is unknown and likely multi-factorial, substantial data suggests a dysfunction in normal circadian rhythms
• Treatment for season affective disorder

  Light therapy effective