Learning Unit 4: Mood
Disorders and Suicide
[CHAPTER 7]
PSPA3714
MOOD
DISORDERS Click icon to add picture
Mood disorders are those in which the
person experiences severe disturbances
in mood and emotion. They include
depressive disorders and bipolar and
related disorders. Depressive disorders
include major depressive disorder, which
is characterized by episodes of profound
sadness and loss of interest or pleasure in
usual activities and other associated
features, and persistent depressive
disorder, which marked by a chronic state
of sadness. Bipolar disorder is
characterized by mood states that
vacillate between sadness and euphoria;
a diagnosis of bipolar disorder requires
experiencing at least one manic episode,
which is defined as a period of extreme
euphoria, irritability, and increased
activity.
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TUTOR ACTIVITY: Case Study 1
Activity: Read through the following clinical case study and answer the questions that follow.
Ann is a 38-year-old female clerical worker. Most recently and for the first time in her life,
she has been troubled by crying spells at work, sometimes occurring so suddenly she
wouldn’t have enough time to run to the lady's room to hide her tears from others. She has
difficulty concentrating at work and feels a lack of enjoyment from work and activities she
used to enjoy. She harbours severe pessimistic and guilty feelings, which have been more
severe lately because she has been losing a lot of weight and has been neglectful in taking
care of herself. She sometimes feels that she deserves to be dead. She has been bothered
by sleeplessness for the past 6 months. She wakes up most days feeling worn out and just
“very down,” and remains tired throughout the day. During the interview, she cried
frequently and answered questions in a low monotone voice, staring downward continuously.
1. Name the principal DSM-5 diagnosis based on the information in the description of Ann.
2. Describe the DSM-5 diagnostic criteria of your diagnosis as listed in the DSM-5 manual.
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ANSWER:
1. Major Depressive Episode
2.
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TUTOR ACTIVITY: Case Study 2
Activity: Read through the following clinical case study and answer the questions that follow.
Jeanne is a 20-year-old student. For the past five days, she has gone without any sleep whatsoever and she has spent this
time in a heightened state of activity which she describes as “out of control.” For the most part, her behaviour is characterised
by strange and grandiose ideas. For example, she recently proclaimed to a group of friends that she did not menstruate
because she was “of a third sex, she is above the human sexes.” She explained further that she is a “superwoman” who can
avoid human sexuality and still give birth. That is, she is a woman who does not require sex to fulfil her place on earth.
Some of Jeanne’s bizarre thinking centres on the political, such as believing that she had somehow switched souls with the
senior senator from her state. She also developed six theories that would allow her to single-handedly save the world from
nuclear destruction. She went around, explaining these theories to friends and even to her professors on campus. She feels
that her recent experiences with switching souls with the senator would make her particularly well suited for a high position in
government perhaps even the presidency.
Jeanne often worries that she will forget some of her thoughts and has begun writing notes to herself everywhere, in her
notebooks, on her computer and even on the walls of her dormitory. Jeanne’s family and friends, who have always known her
to be extremely tidy and organised, have been shocked to find her room in total disarray with frantic and incoherent
messages written all over the walls. These messages reflect her disorganised, grandiose thinking about spiritual and sexual
themes.
Jeanne has experienced two previous episodes of wild and bizarre behaviour similar to what she is experiencing now, both
alternating with periods of intense depression. When she was depressed, she could not bring herself to attend class, she
suffered from insomnia, poor appetite and difficulty concentrating. At the lowest point of the depressive side of her disorder,
Jeanne contemplated suicide.
Collateral information indicates a family history of mood disorders – her grandfather and her aunt.
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1. Name the principal diagnosis based on the
information in the description of Jeanne.
2. Describe the DSM-5 diagnostic criteria of
your diagnosis as listed in the DSM-5 manual.
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ANSWER:
1. Bipolar I Disorder
2. A. Criteria have been met for at least one manic episode
(Criteria A-D under “Manic Episode”) [see DSM-5 Table 7.2
below].
B. The occurrence of the manic and major depressive
episode(s) is not better explained by schizoaffective
disorder, schizophrenia, schizophreniform disorder,
delusional disorder or other specified or unspecified
schizophrenia spectrum and other psychotic disorders.
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Activity:
Below is a pictorial representation of various course
configurations of non-bipolar depression. The horizontal axis
represents time and the vertical axis represents mood, with
the horizontal black line representing euthymic, or normal,
mood, and the magnitude of downward deflection (the blue
area) reflecting the severity of depressive symptoms.
Based on your knowledge of the different depressive
disorders and/or their course, identify the depressive disorder
or course for (a) to (f)
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ANSWER:
Panel (a) = non-chronic major depressive disorder (in this case, recurrent
[e.g., major depressive disorder, recurrent], as two depressive episodes
are depicted).
Panel (b) = persistent depressive disorder with pure dysthymic syndrome.
Panel (c) = double depression (major depressive episode occurring within
the course of dysthymia).
Panel (d) = chronic major depressive episode.
Panel (e) = major depressive episode in partial remission.
Panel (f) = recurrent major depression without full inter-episode recovery.
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DEPRESSIVE DISORDER
SPECIFIERS:
1. PSYCHOTIC FEATURES SPECIFIER
2. MELANCHOLIC SPECIFIER
3. CATATONOIC FEATURES SPECIFIER
4. ATYPICAL FEATURES SPECIFIER
5. SEASONAL PATTERN SPECIFIER
6. ANXIOUS DISTRESS SPECIFIER
7. MIXED FEATURES SPECIFIER
8. PERIPARTUM ONSET SPECIFIER
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TEST YOURSELF:
Maggie is a 27 year old waitress. For the past 2 years, she hasn’t felt
quite like herself. Most days, she feels down in the dumps. She finds
herself eating a bit more than she would like to, usually snacks in the
evening. Sometimes, she has trouble falling asleep at night and feels
tired the next day.
Persistent depressive disorder
Major Depressive disorder
Seasonal Pattern depression
Bipolar Disorder
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ANSWER: A
Chronic, low-level depressed mood for at least 2 years is
known as persistent depressive disorder
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TEST YOURSELF:
Bipolar 1 consists of
A) manic episodes with at least one episode of depression
B) depressive episodes with at least one episode of mania
C) equal episodes of mania and depression
D) normal behavior with one short episode of mania each
month
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ANSWER: A
manic episodes with at least one episode of depression
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THANK YOU!
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