PAN AFRICAN CHRISTIAN UNIVERSITY B.

A COUNSELLINNG

ABNORMAL PSYCHOLOGY

PRESENTATION

GROUP WORK MOOD DISORDERS

LECTURER

LYDIA GITAU

PRESENTERS ARE

NELIUS MBURU MCP21097 CATHERINE W. KAMAU MCP21147 DAVID KUNGU MCP21170 DAMARIS W. KAMAU MCP21162 MICHAEL

SUBMITTED DATE

OCTOBER 10TH 2011

TABLE OF CONTENTS Introduction...1 Normal Depression3 Grief and the Grieving process..4 Other normal mood variations...5 Causes of mood disorders..6 General social cultural factors7 Treatment and Outcomes7 Mild to Moderate Mood Disorder8 Cyclothymia.8 Dysthymia9 Adjustment Disorder with Depressed Mood..10 Treatment...10 Severe Depression..11 Causes of severe depression...13 Treatment & Intervention..14 Summary....15

MOOD DISORDERS INTRODUCTION Mood disorders are mental disorders characterized by intense and prolonged shifts in mood. A person with a mood disorder might feel very happy or very sad for long periods of time and for no apparent reason. Because of this, their moods affect the way they perceive everything in their daily lives, making it very difficult to function well. According to Coleman C.(1988) mood disorders are not new in the history of humankind. Descriptions of such disorders are found among the early writings of the Egyptians, Greeks, Hebrews and Chinese. Mood disorders are usually classified into is unipolar or bipolar. When only one extreme in mood (the depressed state) is experienced, this condition is called unipolar. Major depression refers to a single severe period of depression, marked by negative or hopeless thoughts and physical symptoms like fatigue. In major depressive disorder, some patients have isolated episodes of depression. In between these episodes, the patient does not feel depressed nor have other symptoms associated with depression. Other patients have more frequent episodes. Bipolar depression or bipolar disorder (sometimes called manic depression) refers to a condition in which people experience two extremes in mood. According to Mondimore F (2006).Bipolar disorder causes radical emotional changes and mood swings, from manic, restless highs to depressive, listless lows. Most bipolar individuals experience alternating episodes of mania and depression.

In all mood disorders extremes of emotion soaring elation or deep depression dominate the clinical picture. By contrast, the schizophrenic and paranoid disorders are predominantly

disturbances of thought, although often they have some distortion of affect too. In severe cases of any these types of disorder, disturbances of thought and affect may involve a loss of contact with reality to the extent that delusional beliefs are harbored or bizarre perceptions are reported. When disorder reaches these proportions, the traditional terms psychosis or psychotic are applied as additional descriptors. Most, but not all, instances of mood disorder fall short of this level of disorganization. Disordered thought processes are not typical in mood disorders, except where the disorder reaches extreme intensity; even here, though the disturbed thinking is often restricted and seems in some sense appropriate to the extremes of the emotion that the person is experiencing. When a mood change, because of its extent brings about behavior that seriously endangers the welfare of the person undergoing it, psychologists and other mental health professionals conclude that the person is disordered. Such mood disorders are considered heterogeneous. When a mood change, because of its extent, brings about behavior that seriously endangers the welfare of the person under going it, psychologists and other mental health professionals conclude that the person is disordered. Moderate to severe moods the disorders seem to array themselves along broken continuum (a group pf disorders which are almost the same, but the last one is very different from the first) meaning it is heard to tell which type of disorder. Mood disorders differ as we have seen we have mild moderate and severe. It is not also early to differentiate the severity type and the duration f disorder. The pattern of symptoms (e.g., sleep disturbance psychomotor retandation/agitation) may vary greatly from individual to individual and may exist partially independently of severity.

It is not easy to differentiate instances of either mania or depressive symptoms. Because both talk of strong desires of doing things (extremes) this is because the symptoms can occur at varying levels of intensity. NORMAL DEPRESSION Normal depression also called reactive depression or an adjustment disorder with depressed mood. This type of depression is something almost everyone will have to deal with at some point in life triggered by an event or circumstance in which you react too emotionally, such as the death of a loved one, the loss of a job, or the breakup of a relationship. According to Olson B. (2006), he says that This type of depression is psychological because you are emotionally reacting to something that has happened. Hence, the term Reactive depression. For

example, a person will grieve the death of the loved one or the loss of the relationship, or he will likely find another job and move on. There will be emotions to deal with and adjustments to make, but the person is generally not debilitated by the event, at least not for very long. At most, he may require some talk therapy.

While the distinction between normal and abnormal is unclear, any reasonable estimate would suggest that normal depressions far surpass abnormal ones in terms of the numbers of persons affected at a given time. Most people suffering from normal depression will not need the specialized services of a mental health professional although, in doubtful cases, it is certainly better to err on the conservative side and seek such assistance.

Normal depressions are as a result of more or less obvious recent stress. Some depressions are considered adjustment disorders (in response to stressors) rather than mood disorders. Many major depressions for instance are clearly related to the occurrence of obvious stressors. Some forms of normal depression are: (i) Grief and the Grieving Process: According to stroebe & Stroebe (1983), We usually think of grief as the psychological process one goes through following the death of a loved one. This is a process

incidentally that appears to be more damaging for men than women. While this may be the common and intense form of grieving, many other types of loss will give rise to a similar state in the affected person. Loss of a favoured status or position, separation or divorce, financial loss, retirement etc may all give rise to the symptoms of acute grief. Whatever the source, the condition has certain characteristic qualities beyond the virtually omnipresent weeping spells. The grieving person will normally turn off in response to events that would normally provoke a strong response; figuratively, he or she seems to roll up in a ball, fending off any and all possibilities of additional involvement and hurt by the simple expedient of losing interest in nearly all external happenings. At the same time, the griever often becomes very actively involved in fantasies that poignantly depict the now unavailable former situation of satisfaction and gratification. Initially very painful, these fantasies, if only by sheer repetition, gradually lose their capacity to evoke pain a process of response extinction.

(ii)

Other Normal Mood Variations: Many situations in life other than obvious loss can provoke depressive feelings, and some people seem especially prone to develop depressive responses. It is a commonplace observation, for instance, that some doctoral candidates in various fields, including those in clinical psychology, undergo pronounced depressive reactions soon after completion of their final oral exams. A seemingly similar phenomenon is called post-partum depressive reaction of some new mothers on the birth of a child. A large number of college students experience greater or shorter period of depression during their college years of supposed freedom and personal growth. Depression is similar for males and females, and it involves three main psychological variables i.e. dependency, the sense that one is in the need of help and support from others; self criticism: the tendency to exaggerate ones faults and to engage in self-devaluation and inefficacy, the sense that events in the world are independent of not contingent upon ones own actions or efforts. Since dependency and self-criticism are commonplace among the more severely depressed, it lends support to the notion of a continuous severity dimension.

Causes of mood disorders. In considering the development of major mood disorders we need to examine the possible roles of biological, psychological and socio-cultural factors.

Biological factors - This is a basic of major disorders. These disorders run the familiar gamut from genetic mostly related to disturbances of the normal cycles of brain activity during sleep or by seasonal variations in ambient light/darkness. Hereditary predisposition Mood disorders are considered to be higher among the blood relatives Slater (1944) found that approximately 15 percent of the brothers and sisters, parents and children develop some disorder Manic-depressive (bipolar) Kallmann (1958) found the concordance rate for these disorders to be higher for identical than for fraternal twins. (Perris 1979 Mendlewics 1985) supported the same. Psychological factors These disorders occur when there is interaction between two people (Complex interaction). Stress as a precipitating factor psychological stressors lead to altered bodily functioning. Stressors may also affect biochemical balances and other conditions in the brain. Barchas and his colleagues (1978) suggest that psychosocial stressors. May cause long-term changes in which the brain functions and that there changes may play a role in the development of mood disorders Akisbal (1979) and Kupfer (Thase etal.1985) suggested the same. (Dunner & Hall, 1980) summarizes the stressors that hard most often preceded severe depression. The following are some of the stressful events sexual identity threat, changes in marital relationships, changes in work, to face denied reality, physical illness, failure in job performance, failure of children to meet parents goal, increased responsibility, damage to social status death of important person. Beck (1967) argues that psychosocial stressors provoke severe depressive reactions only in persons who already have a negative cognitive set. Bibring (1953), a psychoanalyst, held that the basic mechanism of awareness of its helplessness in regard to its aspirations such that the depressed person has lost his incentives and gives up. Interpersonal effects of mood disorders. The manic individual apparently feels that wishing to rely on others or to be taken care of is threatening and unacceptable. Coyne (1976) has suggested that the presence or absence of support may depend on whether the depressed individual is skillful enough to circumvent and turn to advantage the negative effect he/she tends to create in other people.

General social cultural factors. In some countries particularly China rates of depression are low but appear to be manifested as somatic symptoms (Kleinman 1986) Carothens (1947, 1951, 1959) in early studies found manic disorders to be fairly common among the East Africans. In our own society the role of social cultural factors in mood disorders is gradually becoming classified. It would appear that conditions that increase life stress such as being a home maker mother being with young children at home lead to a higher incidence of there as well as other disorders. Treatment and Outcomes. For most severely depressed patients the drug treatment of choice will be one of the standard antide presents such as imipramine, or increasingly, second generations antidepressant chosen from a growing list of such products. This drug is often effective in prevention as well as treatment for patients subject to recurrent episodes.

(Hollon & Beck, 1978; Mindham, 1982; NollDavis, & Deleon Jones, 1985) Consequently psychodynamic treatment for depression will include an exploration of past events to discover unresolved painful experiences and the resultant anger that appears to be related to depressive symptoms. Also by discovering the challenges of faulty thinking or distortions any where they are found. The treatment of depression is not confined to drugs or drugs plus electroconvulsive therapy but usually is combined with individual or group psychotherapy directed at helping the patient develop a more stable long-range adjustment. Combination of drugs/psychotherapy is most encouraged for treating depression and mood disorders. Klerman and Schecter (1982) Beckham and Leber (1985) and conte et al. (1986) They have said that the two types of treatment make a complementary contribution. Cognitive Behavioral therapy have proved to be very effective in treating depression and mood disorders. This is because of the applied techniques in the treatment. This includes

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training in progressive goal attainment, decision making, and self reinforcement. Social skills and relaxation. (Reynolds & Coats 1986).

MILD TO MODERATE MOOD DISORDER The point on the severity continuum at which mood disturbance becomes mood disorder is, in the final analysis, a matter of clinical judgment. Unfortunately, while criteria exist for judgment, they are not precise enough to grantee consensus among Christians. Perhaps more important it is decidedly unclear that any such sharp demarcation would meet the requirement of validity. That is, that it would actually provide a meaningful measure of depression. Although the more severe forms of mood disorder are obviously abnormal to even the casual observer, there a gray area where distinction between normal and abnormal is difficult to establish. There are three main DMS-III-R categories for mood disorders for mild to moderate severity: a) Cyclothymia b) Dysthymia c) Adjustment disorder with depression mood CYCLOTHYMIA It has long been recognized that certain persons are subjected to cyclical mood alterations with relative excess of elation called hypo mania, and depression, while substantial, are not disability. These in essence, are the symptoms of cyclothymia. The DSM-III-R definitions of cyclothymia make it sound like a junior-grade version of major bipolar disorder minus certain essential symptoms and psychotic features such as dimensions. In the depressed phase of cyclothymia, the person's mood is dejected and there is a loss of interest

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or pleasure in usual activities and pastimes. In addition the individual may exhibit sleep irregularity(too much or too little); low energy level; feelings of inadequacy, decreased efficiency; proclamation, talkativeness; and cognitive sharpness; social withdrawal; restriction of pleasurable activities, including a relative disinterest in sex a pessimistic and brooding attitude; and fearfulness. The counterpart hypo manic (mania of mild degree) phase consists essentially of the opposites of these characteristics, except that the sleep disturbance is invariably one of an apparent decrease need for sleep. In short, cyclothymia consists of mood swings that at, either extreme, are clearly maladaptive but of insufficient intensity to merit the major disorder designation. DYSTHYMIA The symptoms of dysthymia are essentially identical to these indicated for the depressed phase of cyclothymia. The main difference is that dysthymia disorder persons evidence no tendency toward hypomanic episodes in their life histories. Rather they exhibit moderate, non-psychotic level of depression over a chronic period, that is at least two years of more or less uninterrupted duration. Normal moods may briefly intercede, but they last at most from a few days to a few weeks. As in the case of cyclothymia, no identifiable precipitating circumstances need necessarily be present, though each circumstance are frequently observed for depressions of this type. Indeed the depressed person tends to call forth reactions from the social environment that will bring about bad feelingson a continuous basis (Strack & Coyne, 1983)

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ADJUSTMENT DISORDER WITH DEPRESSED MOOD This is basically behaviorally indistinguishable phase of dysthymia or the depressed phase of cyclothymia. It differs from the after two conditions in that it does not exceed six moths in duration, and it requires the existence of an identifiable psychosocial stressful the cents life within three months prior to the onset of depression. The justification for rendering a clinical diagnosis is that the client is experiencing impaired social or occupational functioning, or that the observed stressor would not normally be considered severe enough to account for the client's reaction. There is a difficulty here, of course, since assessing stressor severity is highly subjective matter. It should be noted that a few, if any, depressions including milder ones occur in the absence of significant anxiety at clinical levels that little rigorous empirical support (Dabson, 1958). In any event the depressed person will normally also be notably fearful and anxious. Perhaps the person becomes frightened as a consequence of observing the physically paralyzing effects of his or her developing depression. TREATMENT Anti-depressions, antipsychotic, and anti-anxiety drugs are all used with the more severe disturbed manic and and depressive patients. The role of medication in the mild and moderate forms of depression is minimal and such patients are likely to benefit from appropriate forms of therapy (Beckham &Leber,1985a;Klerman,1982). Two of the best known of the depression psychotherapies are:

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I. The cognitive-behavioral approach of Beck and colleague (Beck et at al 1979). II. The interpersonal therapy (IPT) by Kleman and Weissman and associates (Klerman et al, 1948). III. Behavioral Therapy.(T. Carson & Adams, 1982;Hoberman & lewinson,1985) SEVERE DEPRESSION Definition: This is a mood disorder marked by depression so intense and prolonged that the person may be unable to function properly. It lasts for at least 2 weeks. Symptoms of severe depression Depressed mood most of the day. Irritable mood in children and adolescents. Marked diminished interest or pleasure in most daily activities. Significant weight loss when not dieting or weight gain, significant decrease or increase in appetite. Insomnia or hypersomnia. Agitated or slowed down behaviours. Fatigue or loss of energy. Feelings of worthlessness or excessive guilt. Diminished ability to think or concentrated. Recurrent thoughts of death, suicide, ideation or suicide attempt. Clinically significant distress or impairment. Total emersion in misery. Not associated with bereavement. Persistence for longer than 2 months (based on DSM-IV TR.APA 2000). Depression in children and adolescents. Infants of depressed mothers display marked depressive behavoiur that is, sad faced, slow movement, lack of responsiveners. (field, et, all, 1998). This behavouir is not proven whether it

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is associated with genetic / heredity from the mother or the result of early childhood interaction patterns with a depressed mother or a combination of both. Children under 3 years of age might manifest depression by their facial expressions as well as by their eating, sleeping and play behaviuor, quite different from children 9-12 years according to Carlos and Kashani (1998). Major depressive disorders are more frequent in girls than boys. It is often difficult to diagnose depression in the elderly because its symptoms are similar to those of medical ailments or dementia. Subtypes of severe depressions i) With melancholic features: Inability to experience pleasure, distinct depressed mood. Depression regularly worse in the morning. Early morning awakening. Significant anorexia or weight loss. Excessive guilt. ii) With psychotic features Presence of depressing delusious or hallucination.

iii) Catatonic features iv) Catatonic behaviuors. Excessive motor activity Severe disturbances in speech. With psychotic features Positive mood reaction to some events. Significant weight gain or increase in appetite.

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v)

Hypersommia. Heavy or laden feelings in arms or legs. Long standing patterns of sensitivity to interpersonal rejection.

With postpartum Onset. Onset of major depressive episode within 4 weeks of delivery of a baby.

vi) With seasonal pattern (SAD) Seasonal Affective Disorder. History of at east 2 years in which major depressive episodes occur during one season of the year (winter or cold seasons). Depression occurs when daylight is short and recover when day hours are longer. CAUSES OF SEVERE DEPRESSION.
1. Genetic factors: tend to run in families (not fully proven). 2. Neuro transmitter theories.

Imbalances in levels of norepinephrine or serotonin and their receptor contribute to depression. Simply hormonal imbalances.
3. Chronic hyperactivity: of the hypothalamus, pituitary and adrenal axis which

regulate the bodys response to stress. 4. Psychological theories.

i)

Behavioural theories of depression view stress as a trigger to depression by reducing the number of reinforces available to people. Stress can be physical, social, economic, psychology. Learned helplessness theory of depression argue that uncontrollable events can lead people to believe that important outcomes are outside their control and thus can lead them to develop depression. Cognitive theories of depression argues that depressed people think in distorted and negative ways. They concentrate on negative events and depressive symptoms.

ii)

iii)

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Psychodynamic theory views depressed people as overly dependent on external locus of evaluation on their self-esteem as a result of poor nurturing by their parents. The interpersonal theories of depression suggest that poor attachment relationships in early life can lead children to win the approval to develop expectations that they be or do certain things in order win the approval of others, which put them at risk of depression

v)

5). Social theories attribute depression to the effects of low social status. 6). Brain damage due to accidents or physical illness also can cause depression. TREATMENT & INTERVENTION. 1. Drug therapies / antidepressants. 2. Electroconvulsive therapy.
3. Behavoiur therapy concentrate on positive reinforcement and decrease negative events

by building social skills and teach clients to engage in pleasant activities. Cognitive behaviuor therapies focus on helping depressed people to develop more adaptive ways of thinking. Interpersonal therapy helps depressed people to change their patterns in relationships. Psychodynamic therapies help depressed people uncover unconscious hostility and fear of abandonment.
4. Combination of drug therapy and psychotherapy is more effective for people with

chronic depression.
5. Effective prevention has been designed to reduce the risk of onset of major depression

in high-risk groups.

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SUMMARY Mood formerly affective disorders are those in which extreme variations in mood either low or high are the predominant feature. We all experience such variations at mild to moderate levels in the natural course of life. In some instances, however the extremity of the persons mood in either direction in casually related to behaviors direction is casually related to behavior that most would consider maladaptive. The disorders associated with these maladaptive mood variations involve some types of mental depression in which the in individual experiences, depression in which the individual experiences at the experiences, at the mildest levels, self depreciation, excessive dependency , and a sense that outcomes are independent of ones copying with efforts.

As these problems deepen into disorder, all of these characteristics are intensified, and the person may become preoccupied with feelings of guilt and worthlessness. Often in such cases, basis, and worthlessness. Often in such cases, basic and biological functioning to such cases, basic biological functioning seems to be altered or the person may become in food or eating. In hypomanic or manic variation (i.e.in cyclothymia or biporal disorders in which the current episode is one of being excessively light essentially the opposite patterns obtain. However, depressive syndromes are much more common than manic ones, they appear to be much more heterogeneous in nature that those in which manic or hyper manic appears in persons in history,

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the person is considered to have a bipolar predisposition to react in both depression and manic ways.

Except for certain syndromes that seems secondary to organic brain impairment, the mood disorders are divided in major and non major categories. The major mode disorders are those of major depression and biporal disorders. For more common are variety of depression, or less often hypomanic condition that are typically less severe in intensity including dysthymia, cydothymia and adjustment disorder with depressed mood.

In general the efficient of biologically-based treatment such as drugs is limited to more severe or major disorder. In the milder forms of mood disorder, physically treatment are in an increasing variety, seem equally or more effective. Combination treatment approaches are showing great promise and may become treatment of choice.

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BIBLIOGRAPHY
1. Beck, AT (1967): Depression, causes and treatment. Philadelphia University of

Pennsylvania Press.

2. Butcher C. (1998). Abnormal Psychology and Modern Life (8th Ed.) Harper Collins

Publishers.

3. Carson, Robert C, (1988) Abnormal Psychology and Modern Life

4. Carson, Robert C, Abnormal Psychology and modern life, 1988 David G.Mayers, Psychology, 2nd Ed.1989

5. David G. Mayers (1989) Psychology (2nd Ed)

6. Ellis, A. (1962). Reason and Emotions in Psychology. New York; Lyle Stuart Lester M. Sdorow, wim, C.Brown communications (1995) Psychology (3rd Ed)

7. Mondimore M. (2006) Bipolar Disorder: A Guide for Patient and families (2nd Ed)

Baltimore: John Hopkins University Press References

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8. V.Mark Durand H.Barlow Thomson learning Wadsworth. (2003) Essential of Abnormal Psychology (3rd Ed)