MODULE 3

Mood Disorders

About 85 percent of all psychoses are classified as schizophrenia. The psychoses discussed in this module make up the major portion of the remaining 15 percent. They are:

We will discuss these psychoses, treating them as if they were distinct from schizophrenia and from each other. In actual fact, however, a diagnosis is often extremely difficult to make. The symptoms of one disorder may appear in a patient whose general picture indicates another type of psychosis, or symptoms may appear and disappear from time to time. Clinical psychologists and psychiatrists who treat psychotics have become very cautious about labeling or making a firm diagnosis of a disorder.

The mood of a bipolar mood disorder may swing from high elation to deep depression

Bipolar mood disorder reactions are disorders of an emotional nature. Normal people have swings in mood from elation to depression. In between these swings are periods of relative calm. Figure 1 is a graphic representation of the emotional changes in normal people.

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The bipolar mood disorder also shows variations in mood, but the swings are much more extreme. When a person with this disorder is elated he is very elated; when depressed he is very depressed. There is a rapid shift from a calm state to an active state. Figure 2 illustrates the mood swings of three types of bipolar mood disorders.

Figure 2. Emotional changes of three mood disorder types

Moods shifts from calm to extremely depressed are depressive disorders. A rarer form of manic- depressive is a type in which the individual alternates between the extremes of elation and the extremes of depression.

The manic individual is continually engaged in a great number of unrelated activities with no real purpose. Very often the manic patient is certain that he alone is responsible for the safety of the entire world. He is generally an extrovert, appearing outwardly gay and happy, perhaps in order to rid himself of the great responsibility he feels. The state of extreme elation is called "mania." A case history is given below.

Eddie was admitted to the hospital and diagnosed as a bipolar mood disorder, manic type. He was taken into custody at the airport where he was trying to enlist the aid of travelers in his crusade against a world tragedy. He was observed as being quite active while keeping up a constant stream of chatter about his future plans. This was the second time Eddie had gone through this behavior.

Depressive type manic-depression involves mood shifts between calmness and the extremes of depression.

Mary had often had depressed feelings. On her first meeting with a doctor she sat for an hour slumped over in the chair with a bewildered expression on her face. When asked what was troubling her, she mumbled that she was not sure. After this one session with the therapist Mary did not return. Three weeks later she committed suicide.

The depressive state described above is brought about by feelings of deep gloom and of utter worthlessness. When, as in Mary's case, the condition is extreme, the patient cannot even report these feelings. At this point in the disorder there is evidence of mental and motor retardation, perplexity, and stupor. In extreme cases, suicide may be attempted.

There is a web site devoted to the subject of depression. The site is maintained by the staff of a health agency that publishes a yellow pages book by the McGraw HIll publishing Company, a reputable book publisher. Educational funding for the site comes from the Brystol-Myers Squibb Company, a maker of drugs; so the information provided may be subject to some vested interests. Click on the link below.
Depression web site

An interesting study was just recently reported in Science magazine (August 20, 1999) about the relationship between depression and a physical characteristic found in some men. It appears to be ". . .the first physiological marker for depression in men: ring fingers that are longer than index fingers" (p. 1205). Apparently the same genes control the development of fingers as control the gonads. And long fingers appear to be related to a high level of fetal testosterone (which also appear related to left-handedness, higher fertility rates, and musical ability). In any event, John Manning at the University of Liverpool in England, found the correlation between the long ring fingers and a tendency toward depression. A famous painting by John Singer Sargent occurs in the article -- showing Robert Louis Stevenson, who was said to be moody, and the unusually long ring finger. Remember, though, these are correlation studies. While they may predict better than chance, they do not necessarily explain why.

The bipolar mood disorder alternates between moods of extreme elation and extreme depression showing all of the symptoms of both the manic and the depressive types. A patient may be elated, gay and hyperactive for a period and then shift rapidly to extreme depression with feelings of guilt and sadness. Mental impairment and motor retardation, along with the other observable symptoms of depressive disorders, will be seen at this point. After weeks or months of depression, a rapid shift toward elation occurs once again.


MODULE 3
PROGRESS CHECK 1

Now test yourself without looking back.

1. The major symptoms displayed by manic patients are:

a. motor activity that is inefficient.
b. ideas of improving the world.
c. ideas of reference.
d. gloom and foreboding.
e. random and unrelated behavior.
f. secretive and introverted affect.

2. Match.

1 ) Manic type _

2) Depressive disorder_

3) Bipolar disorder_

a. An emotional condition of dejection, gloomy thoughts, sadness, feelings of sworth- lessness and guilt, with some apprehension
b. Excessive, inefficient expenditure of energy in motor activity with a great deal of random, unrelated behavior
c. Mood swings back and forth between depression and elation

3. Because the depressive tends to feel very guilty, worthless, and miserable, he may attempt to________________________________________

4. The cyclic type of bipolar mood disorder psychosis is a:

a. common form of the disease.
b. rare form of the disease.

ANSWER KEY PAGE 49

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4 OR MORE CORRECT PAGE 27
FEWER THAN 4 CORRECT PAGE 23

MODULE 3
EXERCISES

The predominant symptoms of bipolar mood disorder psychosis involve mood swings of elation, depression, or both. In this way, manic depressive psychosis is primarily a disorder of:
a. affect.
b. intellect.

______________________________________ 2

In the manic type of mood disorder psychosis, mood swings from a relatively calm state to__________________________________.

Patients who are periodically depressed and then return to calmness may be mood disorder of the ________________________________ type.

A less common form of bipolar mood disorder psychosis produces alternation between the extremes of elation and depression. Because it tends to repeat a pattern over and over again, this form of illness was named_______________________________________4

Individuals suffering from the manic type of bipolar mood disorder psychosis all have one outstanding behavior in common. They tend to expend excessive amounts of energy by running around with strange notions about the importance of what they are doing. In addition, behavior of the manic patient is characterized by extroversion. He tends to be gay and happy. He often has the idea that he is going to help or improve the world.

Which of the following best defines the major symptoms of mania?

a. Engaging in meaningful pursuits or projects that are meticulously planned

b. Excessive, inefficient energy expenditure in motor activity, heightened by random, unrelated behavior
____________________________________________ 5

The essential feature of the depressive personality is extreme guilt. Which of the following would you expect to find in depressed persons without knowing anything other than the fact that they have guilty feelings?

a. Sadness
b. Joy
c. Gloomy thoughts
d. Happy thoughts
e. Feelings of worthlessness
f. Feelings of self-worth or importance

_____________________________________________!

An emotional condition of dejection, gloomy thoughts, sadness, feelings of worthlessness and guilt, with some apprehension, are symptoms of__________________________________

Excessive, inefficient expenditure of energy in motor activity with a great deal of random, unrelated behavior is a symptom of___________________________________________3

ANSWERS

1 a, c, e
2 a
3 depressive disorder
4 elation, mania depressed cyclic
5 b


A less common form of bipolar mood disorder psychosis exhibits both extremes of mood. Because it cycles again and again through the same mood swings, it is called the cyclic type. Match the following.

1) Manic type _____

2) Depressed type _____

3) Bipolar type________

a. Mr. A was hospitalized because of a suicide attempt. He recovered, and several years later shot himself in the head. During the years between his hospital stay and his death, he seemed normal.

b. Mr. B began to be so extremely active on his construction job that his boss reported him. He often walked across high girders shouting and laughing. His wife reported that he had been calm most of the time until this hyperactivity started.

c. Mr. C runs around a public park, shouting at people to unionize. He was gloomy two months ago.

_______________________________ 1

ANSWERS

1
1) b
2) a
3) c

NOW TAKE PROGRESS CHECK 2

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MODULE 3
PROGRESS CHECK 2

1. Which of the following are the major symptoms displayed by manic patients?

a. Well-coordinated motor activity
b. Extroversion and elation
c. Random and unrelated activity
d. Secretive and introverted affect
e. Motor activity that is inefficient

2. The depressive may attempt to end his life because_____________________________________

3. What is the least common form of mood disorder psychosis?___________________________________

4. Match. 1 ) Depressive type____________

2) Manic type____________

3) Bipolar type______________

a. Symptoms swing back and forth between those of the manic type and the depressive type

b. An emotional state of dejection, gloom, sadness, feelings of worthlessness, and feelings of guilt and some apprehension

c.Excessive, inefficient expenditure of energy in motor activity with a great deal of random, unrelated behavior; elation and extroversion

ANSWER KEY PAGE 49

4 OR MORE CORRECT PAGE 27-
FEWER THAN 4 CORRECT INSTRUCTOR CONFERENCE

Unit 11 Table of Contents

Psych 200 Home Page

November 3, 2000