Mood Disorders

Mania

Bipolar Major Depression

Dysthymic Disorder

Moderate depression

that will go away

without therapy

Lasting from a couple

of weeks to months

Restlessness, inability to

concentrate, and

rapid speech

Swings of mania and

depression

Dysthemic disorder • The term dysthemic disorder comes from the Greek for “low

spirits.” •  In any given year, between 4 and 12 percent of the population

are affected by it. •  Thus, it is a fairly common problem.

• Of all the mental disorders in this chapter, dysthymic disorder is the most likely to clear up eventually without treatment. •  For both of these reasons, it is referred to as the common cold

of mental health.

Symptoms of Dysthymic Disorder

•  Typical symptoms of dysthymic disorder are: •  lack of energy, •  unhappiness, •  loss of interest in activities and people, •  loss of sense of humor, •  sadness, •  and rock-bottom feelings of self-worth.

•  The best way to know whether depression of this sort is normal is to see if it has served its “function” or instead remains and lingers on.

Major Depression •  Typical symptoms of severe depression, or major depression, are:

•  very slow speech, •  deep ongoing depression, •  disturbances in appetite and sleep patterns, •  lack of energy, •  a sense of hopelessness, •  extreme feelings of worthlessness, •  and frequent thoughts of death or suicide.

•  Most people with major depression have trouble carrying out simple daily tasks. •  Some may even lie motionless in a rolled-up fetal position for hours at a time.

•  Underneath it all, though, there is frequently a great deal of anger, sometimes directed at the self, sometimes broad and unfocused.

Mania • Some people go in the opposite direction from depression and

have extreme up moods. •  This behavior, called mania from the Greek for “mad

excitement,” involves: •  agitation, •  restlessness, •  inability to concentrate, •  and extremely rapid speech.

Manic Elements •  The speech problem is the most notable part of the behavior.

•  Thoughts are moving so quickly through the personʼ’s mind that they literally collide with one another into a mass of confused speech, making comprehension almost impossible. •  This problem is called a flight of ideas, meaning that thoughts

are flying in all directions. •  People with mania often get so excited that they begin to have

delusions that they have special powers or great influence. •  They make plans for controlling the world or some such project •  These are referred to as Delusions of Grandeur

Bipolar Disorder •  On occasion, people experience swings, between the ups of mania and

the downs of major depression. •  The official terms for this problem might confuse you at first, but it is

logical. •  First, remember that the word bi means “two.” •  Next, recall that the earth has two poles, north and south.

•  The word pole, in this sense, means “one of the two most extreme possibilities.”

•  One pole is at the top, the other at the bottom—they couldn’t get farther from one another.

•  So people who have these wild swings from up to down and back are categorized as having a bipolar disorder.

•  The patient, a 25-year-old woman, was admitted to the hospital for observation after the fire department was called by a neighbor who saw smoke. The patient was dresses in a grass skirt she had purchased in Hawaii during her honeymoon. She had built a “bonfire” in the middle of the living room floor and was dancing around the fire, leaping, jumping, and singing what seemed to be college football cheers.

•  At the hospital she was not only dancing, but trying to throw touchdown passes at the same time, mixing obscenities and quarterback play calls in a continuous outpouring. She seemed only partially aware of her surroundings.

A Case Study

•  The same patient was readmitted to the hospital 17 years later at the age of 42 with a diagnosis of bipolar disorder. Her husband brought her to the hospital because she had refused to eat for three days, slept only two or three hours a night, and spent long hours staring off into space. She would speak to others, but only after more or less continuous coaxing. In very slow, monotonous speech, she commented that she was talking to her dead sister who was wearing a white gown, but her face was eaten up by worms and part of her eye socket was missing. This hallucination was intermixed with a conversation with God, a combination of pleading with Him to do something about her sister and blaming him for her hospitalization.

•  In the years between her first hospitalization and her present admission, she had been treated on several occasions in the outpatient clinic for depressive episodes, but there had been one additional manic episode.

• Note that in the case mentioned, the person suffered from hallucinations.

• Whenever hallucinations are present, the patient is considered to be psychotic, or experiencing a Psychotic Break. • While most people with major depression are not

psychotic, such elements are sometimes present. •  A similar situation exists with bipolar disorders, but

psychotic elements are more frequent here.

4 Difficult to trace cause, as the problem can come and go without treatment.

4 Females are twice as likely to be moderately depressed and to suffer from dysthymic disorder as males; four times as likely to suffer from major depression. Males and females suffer from bipolar disorder at about the same rate, however.

4 Depression lies on a continuum from mild to severe; moderate depression can turn into major depression.

Causes of Mood Disorders

MILD MODERATE SEVERE

4 Learned helplessness is a factor associated with depression. In this situation, people believe they are unable to help themselves get better.

4 People with poor self-images are more prone to depression. 4 Levels of the chemical serotonin in the brain also play a role in

mania and depression. 4 Serotonin is the neurotransmitter associated with general

brain activity and with feeling pleasure and happiness

4 In many manics, the level of serotonin is very high. In depressives, the levels are very low.

Causes of Mood Disorders (continued)

What about Genetics? • There is often a family history of mood disorders,

especially bipolar disorder. •  In the case of manics then, genes may well play a

part.

• Depression cases more issues for researchers. • We know that depression is psychologically

“contagious,” so it may be that being around depressed family members is a much a cause as genetics.

Treatment • Several approaches can be taken to treat depression.

•  Various drugs are effective, particularly those that increase the amount of available serotonin

•  Psychotherapy can be highly effective

• There are drugs to treat mania as well, such as lithium, and they are usually quite effective.

Suicide •  Suicidal thoughts and behaviors occur with a much higher than average

frequency among people with mental disorders. •  The type of mental disorder most often associated with suicide is depression.

•  This is true not only for adults but for adolescents as well •  Compared with the general population, almost three times as man people with

mental disorders commit suicide. •  Approximately twice as many people try to commit suicide as succeed.

•  More males than females actually kill themselves, while females attempt it more often.

•  For adolescent girls, the ratio of attempts to completions is four to one. •  The major reason for these gender differences appears to be the method

chosen. •  Males most often use a gun; females often take a drug overdose.

Incidence of Suicide •  For the population as a whole, about 12 people per 100ʼ’000 kill

themselves every year. •  Among people aged 25 to 64 years, the rate is about 15 per

100ʼ’000; •  and for ages 65 to 74, about 18 per 100ʼ’000. •  For those 75 to 84, the figure jumps to 22 per 100ʼ’000 •  The suicide rate for teenagers between 15 and 19 years of age is

about 10 per 100ʼ’000, slightly below the overall national average. •  Although this rate is higher than it was decades ago, now it stays

roughly the same year after year. •  It is not the teenage but the elderly man who is at high risk of

killing himself.