SLK 310 Chapter 7
Erin Polyblank
CHAPTER 7- MOOD DISORDERS AND
SUICIDE
Learning outcomes:
Identify basic biological, psychological and
Use scientific reasoning to
social components of behavioural
interpret behaviour:
explanations (e.g. inferences, observations,
operational definitions and interpretations)
Analyse the variability and continuity of behaviour
Describe key concepts, principles
and mental processes within and across animal
and overarching themes in
species
psychology:
Describe problems operationally to study them
Engage in innovative and
empirically
integrative thinking and problem
solving:
Recognise major historical events, theoretical
Develop a working knowledge of
perspectives and figures in psychology and their
the content domains of
link to trends in contemporary research
psychology:
Describe applications that employ Correctly identify antecedents and consequences
discipline-based problem solving: of behaviour and mental processes
Describe examples of relevant and practical
applications of psychological principles to
everyday life
UNDERSTANDING AND DEFINING MOOD DISORDERS
Mood: Enduring period of emotionality.
o Disorders that can be so incapacitating that violent suicide may seem by
far a better option than living.
Sometimes, mood disorders lead to tragic consequences.
o Often, they cause great suffering and distress and erode quality of life.
AN OVERVIEW OF DEPRESSION AND MANIA
Melancholia (literally black bile) has its origins in pre-Hippocratic times in
Ancient Greece.
1
,SLK 310 Chapter 7
Erin Polyblank
o It was believed that melancholy, or gloomy despair, was produced by
excessive black bile in the body, and that yellow bile resulted in mania.
o Mania was conceptualised as elation, increased energy and activity.
Jean-Pierre Falret introduced the term folie circulaire (circular madness) and
introduced the world to the current concept of bipolar mood disturbance, as
distinct from unipolar depression.
o Folie circulaire put an emphasis on the occurrence of periods of depression
and mania in patients afflicted by the condition.
Over the course of the twentieth century, manic-depressive illness came to
be understood as a recurrent, biphasic disturbance of affect or mood
characterised by distinct episodes of depression, mania or a mixture of the
two.
o Depression or mania can be expressed to varying degrees of intensity.
The term bipolar disorder is descriptive of the course of some mood disorders
but sheds little light on their emotional quality.
o Mood disorders: Group of disorders involving severe and enduring
disturbances in emotionality ranging from elation to severe depression.
The fundamental experiences of depression and mania contribute, either
singly or together, to all the mood disorders.
PATHOLOGCAL MOODS
The most commonly diagnosed major mood disturbance is called a major
depressive episode.
o Major Depressive episode: Morbid, or pathological expression of
depression, including depressed mood, anhedonia, feelings of guilt and
worthlessness, disturbances to sleep and appetite, poor concentration or
indecision, and thoughts around death and suicide, occurring most of the
day, most days of the week for at least two weeks.
Typically accompanied by a general loss of interest in things and an
inability to experience any pleasure from life, including interactions with
family or friends or accomplishments at work or at school.
Anhedonia: Inability to experience pleasure, associated with some
mood and schizophrenic disorders.
Evidence suggests that the most central indicators of a full major depressive
episode are the physical changes (sometimes called somatic or vegetative
2
, SLK 310 Chapter 7
Erin Polyblank
symptoms, along with the behavioural and emotional shutdown, as reflected
by low behavioural activation.
o People with depression show dysfunctional reward processing and
anhedonia (loss of energy and inability to engage in pleasurable activities
or have any 'fun').
Criteria for Major Depressive episode:
A) Five (or more) of the following symptoms have been present during the same two-week
period and represent a change from previous functioning; at least one of the symptoms
is either (1) depressed mood or (2) loss of interest or pleasure:
[Note: Do not include symptoms that are clearly due to a general medical
condition or mood-incongruent delusions or hallucinations.]
1. Depressed mood most of the day, nearly every day, as indicated by either subjective
report (e.g. feels sad or empty) or observation made by others (e.g. appears tearful).
[Note: In children and adolescents can be irritable mood.]
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the
day, nearly every day (as indicated by either subjective account or observation made
by others).
3. Significant weight loss when not dieting or weight gain (e.g. a change of more than
5% of body weight in a month or decrease or increase. in appetite nearly every day.
[Note: In children, consider failure to make expected weight gains.]
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day (observable by others, not
merely subjective feelings of restlessness or being slowed down).
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be
delusional) nearly every day (not merely self-reproach or guilt about being sick).
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either
by subjective account or as observed by others).
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation
without a specific plan, or a suicide attempt or a specific plan for committing suicide.
B) The symptoms cause clinically significant distress or impairment in social, occupational
or other important areas of functioning.
C) The symptoms are not due to the direct physiological effects of a substance (e.g. a drug
3
, SLK 310 Chapter 7
Erin Polyblank
of abuse or a medication) or a general medical condition (e.g. hypothyroidism).
The second fundamental state in mood disorders is mania.
o Mania: Period of abnormally excessive elation, euphoria, or irritability
associated with increased goal-directed activity, inflated self-esteem,
decreased need for sleep and rapid thinking and communication, often
accompanied by psychotic features lasting at least one week, unless
successfully treated.
Often times, this euphoria one feels during mania, gives way to irritability and
dysphoria, or a generally unpleasant, discontented feeling state.
o They also become hyperactive, require and wish for little sleep and may
develop grandiose plans, believing they can accomplish anything they
desire.
DSM-5 criteria for a manic episode require a duration of only one week, less if
the episode is severe enough to require hospitalisation.
o Manic Episode: Period of abnormally elevated or irritable mood that may
include inflated self-esteem, decreased need for sleep, pressured
speech/talk, flight of ideas, agitation or self-destructive behaviour, and
may be accompanied by psychotic symptoms.
o Irritability is often part of a manic episode.
o Paradoxically, being anxious or depressed is also commonly part of mania,
as described later - something that characterises mixed states.
o The duration of an untreated manic episode is typically three to four
months.
The occurrence of a single manic episode, conforming to the diagnostic
criteria, defines the presence of bipolar I disorder, irrespective of earlier
major depressive or hypomanic episodes.
o Bipolar I disorder: The occurrence of one manic or mixed manic episode,
often recurrent, or alternating with major depressive episodes.
DSM-5 also defines a hypomanic episode, a less severe version of a manic
episode that does not cause marked impairment in social or occupational
functioning and might last only 4 days rather than a week.
o A hypomanic episode is not in itself necessarily problematic, but its
presence does contribute to the definition of several mood disorders, for
instance bipolar Il and cyclothymic disorder.
4
Erin Polyblank
CHAPTER 7- MOOD DISORDERS AND
SUICIDE
Learning outcomes:
Identify basic biological, psychological and
Use scientific reasoning to
social components of behavioural
interpret behaviour:
explanations (e.g. inferences, observations,
operational definitions and interpretations)
Analyse the variability and continuity of behaviour
Describe key concepts, principles
and mental processes within and across animal
and overarching themes in
species
psychology:
Describe problems operationally to study them
Engage in innovative and
empirically
integrative thinking and problem
solving:
Recognise major historical events, theoretical
Develop a working knowledge of
perspectives and figures in psychology and their
the content domains of
link to trends in contemporary research
psychology:
Describe applications that employ Correctly identify antecedents and consequences
discipline-based problem solving: of behaviour and mental processes
Describe examples of relevant and practical
applications of psychological principles to
everyday life
UNDERSTANDING AND DEFINING MOOD DISORDERS
Mood: Enduring period of emotionality.
o Disorders that can be so incapacitating that violent suicide may seem by
far a better option than living.
Sometimes, mood disorders lead to tragic consequences.
o Often, they cause great suffering and distress and erode quality of life.
AN OVERVIEW OF DEPRESSION AND MANIA
Melancholia (literally black bile) has its origins in pre-Hippocratic times in
Ancient Greece.
1
,SLK 310 Chapter 7
Erin Polyblank
o It was believed that melancholy, or gloomy despair, was produced by
excessive black bile in the body, and that yellow bile resulted in mania.
o Mania was conceptualised as elation, increased energy and activity.
Jean-Pierre Falret introduced the term folie circulaire (circular madness) and
introduced the world to the current concept of bipolar mood disturbance, as
distinct from unipolar depression.
o Folie circulaire put an emphasis on the occurrence of periods of depression
and mania in patients afflicted by the condition.
Over the course of the twentieth century, manic-depressive illness came to
be understood as a recurrent, biphasic disturbance of affect or mood
characterised by distinct episodes of depression, mania or a mixture of the
two.
o Depression or mania can be expressed to varying degrees of intensity.
The term bipolar disorder is descriptive of the course of some mood disorders
but sheds little light on their emotional quality.
o Mood disorders: Group of disorders involving severe and enduring
disturbances in emotionality ranging from elation to severe depression.
The fundamental experiences of depression and mania contribute, either
singly or together, to all the mood disorders.
PATHOLOGCAL MOODS
The most commonly diagnosed major mood disturbance is called a major
depressive episode.
o Major Depressive episode: Morbid, or pathological expression of
depression, including depressed mood, anhedonia, feelings of guilt and
worthlessness, disturbances to sleep and appetite, poor concentration or
indecision, and thoughts around death and suicide, occurring most of the
day, most days of the week for at least two weeks.
Typically accompanied by a general loss of interest in things and an
inability to experience any pleasure from life, including interactions with
family or friends or accomplishments at work or at school.
Anhedonia: Inability to experience pleasure, associated with some
mood and schizophrenic disorders.
Evidence suggests that the most central indicators of a full major depressive
episode are the physical changes (sometimes called somatic or vegetative
2
, SLK 310 Chapter 7
Erin Polyblank
symptoms, along with the behavioural and emotional shutdown, as reflected
by low behavioural activation.
o People with depression show dysfunctional reward processing and
anhedonia (loss of energy and inability to engage in pleasurable activities
or have any 'fun').
Criteria for Major Depressive episode:
A) Five (or more) of the following symptoms have been present during the same two-week
period and represent a change from previous functioning; at least one of the symptoms
is either (1) depressed mood or (2) loss of interest or pleasure:
[Note: Do not include symptoms that are clearly due to a general medical
condition or mood-incongruent delusions or hallucinations.]
1. Depressed mood most of the day, nearly every day, as indicated by either subjective
report (e.g. feels sad or empty) or observation made by others (e.g. appears tearful).
[Note: In children and adolescents can be irritable mood.]
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the
day, nearly every day (as indicated by either subjective account or observation made
by others).
3. Significant weight loss when not dieting or weight gain (e.g. a change of more than
5% of body weight in a month or decrease or increase. in appetite nearly every day.
[Note: In children, consider failure to make expected weight gains.]
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day (observable by others, not
merely subjective feelings of restlessness or being slowed down).
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be
delusional) nearly every day (not merely self-reproach or guilt about being sick).
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either
by subjective account or as observed by others).
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation
without a specific plan, or a suicide attempt or a specific plan for committing suicide.
B) The symptoms cause clinically significant distress or impairment in social, occupational
or other important areas of functioning.
C) The symptoms are not due to the direct physiological effects of a substance (e.g. a drug
3
, SLK 310 Chapter 7
Erin Polyblank
of abuse or a medication) or a general medical condition (e.g. hypothyroidism).
The second fundamental state in mood disorders is mania.
o Mania: Period of abnormally excessive elation, euphoria, or irritability
associated with increased goal-directed activity, inflated self-esteem,
decreased need for sleep and rapid thinking and communication, often
accompanied by psychotic features lasting at least one week, unless
successfully treated.
Often times, this euphoria one feels during mania, gives way to irritability and
dysphoria, or a generally unpleasant, discontented feeling state.
o They also become hyperactive, require and wish for little sleep and may
develop grandiose plans, believing they can accomplish anything they
desire.
DSM-5 criteria for a manic episode require a duration of only one week, less if
the episode is severe enough to require hospitalisation.
o Manic Episode: Period of abnormally elevated or irritable mood that may
include inflated self-esteem, decreased need for sleep, pressured
speech/talk, flight of ideas, agitation or self-destructive behaviour, and
may be accompanied by psychotic symptoms.
o Irritability is often part of a manic episode.
o Paradoxically, being anxious or depressed is also commonly part of mania,
as described later - something that characterises mixed states.
o The duration of an untreated manic episode is typically three to four
months.
The occurrence of a single manic episode, conforming to the diagnostic
criteria, defines the presence of bipolar I disorder, irrespective of earlier
major depressive or hypomanic episodes.
o Bipolar I disorder: The occurrence of one manic or mixed manic episode,
often recurrent, or alternating with major depressive episodes.
DSM-5 also defines a hypomanic episode, a less severe version of a manic
episode that does not cause marked impairment in social or occupational
functioning and might last only 4 days rather than a week.
o A hypomanic episode is not in itself necessarily problematic, but its
presence does contribute to the definition of several mood disorders, for
instance bipolar Il and cyclothymic disorder.
4
