Mood Disorders: Assessment and Treatment > Chapter 1 - What is a Mood Disorder?

Mood Disorders: Assessment and Treatment

Presented by
Lance J. Parks, LCSW

Approvals

This program is Approved by the the National Association of Social Workers (NASW) (Approval #886463870-6295) for 3 Clinical Social Work continuing education contact hours.
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This program is approved for 3 continuing education hours by:
The California Board of Behavioral Sciences # PCE 3457
The California Board of Registered Nursing # CEP 14462
The National Association of Social Workers (NASW) # 886463870
The Florida Board of Clinical Social Work, Marriage and Family Therapy and Mental Health Counseling #50-14000
Texas Board of Examiners of Marriage and Family Therapists # 628
Texas State Board of Examiners of Professional Counselors #1646
The Texas Board of Social Worker Examiners # 5547

Course Objectives


At the completion of this course, a social worker, nurse or family therapist shall be able to:

1. Differentiate between the various types of mood disorders coming from the branches of depression and bipolar disorders.
2. Identify and recognize the symptoms of various mood disorders.
3. Explain the value of getting treatment for mood disorders.
4. Indicate and use the common procedures for making a psychosocial assessment for mood disorders.
5. Explain the benefits and advantages of psychosocial treatments.
6. Use the recommended principles and guidelines for field professionals which help in reducing the stigmatization of individuals undergoing treatment.

Chapter I: What is a Mood Disorder?

This chapter clarifies some common misconceptions about mood disorders and examines the background for the history of the topic along with a discussion on the two distinguished types of mood disorders. Topics Covered

a. The simple definitions
b. A historical background to mood disorders
c. The branches of depression and bipolar disorders
d. The Causes

Mood Disorders

In common terms, a person’s mood is defined as the emotional state and the visible characteristics exhibited by a person in a particular mood (NCBI, 2006). In everyday language, the usage of terms like good or bad mood is an effective deblockedion of a person’s feelings and current state of mind (Feirman, 2005). It is likely that someone would say that “she is in a good mood” or that “she is in a bad mood,” and the people around that person would understand the emotional state of the speaker.

The clinical meaning of the term mood is not much different as per the definition given by Feirman (2005) which considers mood to be an observable state of a person. In medical terms, moods can be influenced by several different things and it is considered normal behavior to be in a good or bad mood.When the elevated or depressed moods interfere with everyday functioning and relationships, then he/she may be suffering from a mood disorder (NCBI, 2006).

A mood disorder can also be understood as a mental illness which causes the emotions of a person to be out of sync with the situation he/she is placed in. Mood disorders have two major branches which are commonly observed in clinics and social support situations. The first is depression, and the second is bipolar disorder. Both of these have several subtypes and associated qualifiers which help medical practitioners in understanding the exact nature of the ailment and to prescribe the proper treatment (Bland, 1997). As shown by history, a full understanding of these ailments came only after extensive trial and error.

The history of treatment for those suffering from a mental illness, or a mood disorder, is quite often a history of horror and misery (Leupo & Birge, 2001). It must be remembered that this judgment comes from the science which we have access to today.Historically, treatments were being conducted by the brightest and most scientific minds.The public accepted the conduct of the doctors as useful for the patients. One treatment which stands out is the use of the medical procedure called Leukotomy, which is popularly known as a “lobotomy.”

Demonic possession and witchcraft were often blamed for the symptoms of depression, bipolar disorder, schizophrenic disorders and several other mental problems which plagued individuals. As late as the eighteenth century, mental disorders were considered to be the result of unnatural acts performed with the help of the devil. The inquisition and other courts often burned mentally ill people at the stake so as to save their souls by killing their mortal bodies. Such treatment was considered merciful and was carried out throughout the western world.(Garcia, 1975).It was in 1938 that Egas Moniz, a Portuguese physician, developed the operation known as a Leukotomy to deal with mood disorders (Garcia, 1975).

This surgical procedure caused the nerves to the frontal lobes of the brain to be cut off. It met with resounding success since it often made aggressive mental patients extremely docile and helped calm several individuals who suffered from regular bouts of anxiety (Leupo & Birge, 2001). When this process was examined in light of modern discoveries, it was found that there could be no lasting benefits and the side effects were a destroyed mind and some patients left in a vegetative state. It is interesting to note that Egas Moniz was awarded the Nobel Prize in medicine for his discovery (The Nobel Foundation, 2005).

In the present day, the American Psychiatric Association publishes a Diagnostic and Statistical Manual of Mental Disorders (DSM, 2003) which recognizes four mood disorders listed as:

  • Major Depressive Disorder
  • Bipolar Disorder
  • Cyclothymic Disorder
  • Dysthymic Disorder


Cyclothymic and Dysthymic Disorders are more chronic types of disorders whose symptom are less acute that those of Bipolar or Major Depressive Disorders. (Schulberg & Burns, 1988).Because the symptoms are less acute it is sometimes difficult to determine whether a person is suffering from a cyclothymic or dysthymic disorder.Often, it requires a highly trained expert in the field of mood disorders to diagnose the exact type of disorder; therefore, differential diagnosis is usually based on whether a person has a Bipolar Disorder or Depressive Disorder (Angst & Cassano, 2005).

Depressive Disorders

Schulberg and Burns (1988) suggest that almost a third of all patients seeking primary case services are suffering from some sort of a depressive disorder, and many cases of these disorders go unreported within the general population. It is important to understand the effects and causes of the disorder along with the relevant symptoms that can be recognized. There is a common misconception that depression is a feeling of sadness for no apparent reason, and every person who might be feeling blue is said to be depressed (Foltz, 2006). This is not entirely true because clinical depression, is more complex than that.

Major Depression Disorder

Major Depression Disorder creates a highly intense state of sadness, combined with despair, that causes a disturbance in the social functioning of the individual. This illness affects the body and the mind, as well as the thought patterns of the individual, in very significant ways. It often changes a person’s self perception, as well as the perception of his/her situation, hopes, and dreams. The friends and family of the individual may think that he/she can pull him or herself out of the downward spiral if they tried (Ostman, 2004). This could be likened to the belief that a person with a broken bone can simply ignore the pain he/she is feeling and use the strength of will to get back to full strength.

This misconception comes from some basic misunderstandings about the causes of mental disorders and mental illnesses. Additionally, the media influences the public’s ideas about individuals who suffer from mood disorders or other mental illness (Harris, 2004). Without getting effective treatment, a person can continue to suffer the symptoms and effects of the disorder for an extended period of time. For example, Major Depression can last for years when it is not treated by medicine, psychotherapy or psychosocial therapy. It greatly reduces any chance a person has of enjoying life, or being able to contribute at work or in family life (Bland, 1997).

Like other physical ailments which have stages and recurrences, Major Depression is classified in technical terms.Tyrka et. al. (2006) provide the following levels of depression:

  • Mild
  • Moderate
  • Severe but without psychotic elements
  • Severe and with psychotic elements
  • In Partial Remission
  • In Full Remission
  • Unspecified

Dysthymia

In comparison to Major Depression Disorder, this ailment is less severe.Dysthymia does not cause the same level of mental and/or physical disability. A person suffering from Dysthymia can take part in day-to-day activities and even get some gratification out of those activities, but the feelings of sadness and a lack of self worth are persistent. A person with Dysthymia can also lapse into a full case of Major Depressive Disorder since the effects of Dysthymia are chronic and it is usually a long term condition which may require extensive therapy, as well as medication, in order to manage its symptoms (Bland, 1997).

Bipolar Disorders (BD)

Bipolar Disorder, also known as Manic-Depressive Disorder, used to be considered a subset of the Depressive Disorders group; however, the differentiation in treatments, symptoms and the subsets for Bipolar Disorder has changed the classification to an independent group of diagnoses. This disorder is typified by cycles of mood changes which range from severe cases of depression (depressive state) to an unreasonably elevated mood condition (manic state) (Angst & Cassano, 2005). In some individuals the mood changes occur quickly, and there may be multiple cycles per day. For others suffering from this disorder, moods may last for a period of weeks (Licinio, 2005).There may also be periods of normal mood in between the stages of mania and depression. Based on the nature of the changes of mood, the subtypes of Bipolar Disorder can be classified as Type I or Type II.

Type I Bipolar Disorder

A person with Type I experiences the state of mania at least once; however, the state of elation in mood, and the reversal of symptoms, are usually short lived and the emotional situation can quickly return to a depressive state. The effect of such a manic state can be quite devastating as the person may make irrational decisions concerning their personal life, financial situation, or their relationships without fully understanding the consequences (Sajatovic, 2002). They may also engage in reckless behavior, illicit drug use or go on a drinking/eating binge (McIntyre et. al., 2006). Additionally, the high may go to such an extreme level that a person suffering from Type I Bipolar Disorder may have to be confined in order to prevent harm to themselves or to others (Angst & Cassano, 2005).While coming down from the elevated mood there is a chance that the person could go into a further state of depression than before.

Type II Bipolar Disorder

With more than one or many changes of mood between manic states and depressive states, a person can be diagnosed as having Type II Bipolar Disorder.This type is different from Type I because the highs experienced are not at dangerously high levels. Even though there are shared symptoms of the high state with Type I, the person can still function without severe disturbance, and interact reasonably well socially (Angst & Cassano, 2005). For both Type I and Type II Bipolar Disorders, researchers have shown that there is a significant biological component and certain individuals could have a predisposition towards this disorder. As in the case of all other mental and mood disorders, the environmental factors play a large part in making the situation better or worse (Powell et. al., 2001).

The Causes

Depressive Disorder

Depression can strike anyone at any age and the causes of this disorder are many and complex. There have been moves to organize the causes according to the groups which are affected by it since women exhibit different causes for depression than men. Similarly, the elderly have different causes for depression as compared to children (AACAP, 2004). There is research which shows that there may be a connection between family history, a change in the brain structure/chemistry and depression (Powell et. al., 2001). Generally speaking, individuals with low self-esteem, a negative outlook on the world and life, along with strains of pessimism, are more prone to Depressive Disorders than others.

Physical changes in the body such as major operations, neurosurgery, emergence of cancer, Parkinson’s disease or changes in hormone levels may also contribute to a case of depression. These are particularly dangerous situations as patients need to have some strength and fortitude to defeat the disease, whereas a depressed patient may give up hope of recovery (Beers et. al., 1999). Environmental factors, such as going through a period of grief for the loss of a loved one, severe financial or situational difficulties, rapid stressful changes or even the move to a different location, can expose a latent Depressive Disorder. In addition, living through a natural disaster can bring out a case of Clinical Depression in some individuals (Silove et. al., 2006).

As mentioned, gender plays a role in depression.Men are only half as likely to experience (or report experiencing) depression as compared to women. The hormonal changes in a woman’s body throughout the periods of menstrual cycle alterations, pregnancy, postpartum, pre-menopause, menopause and even puberty can trigger depression for a woman. It is important to note that social stratification and setups place women at additional risks, since being a single parent or living with aging parents can contribute to depression. Postpartum Depression is a special case of depression which affects women alone because the major hormonal changes in the female body after delivery and the emotional responsibility of caring for her child can be quite traumatic (Bland, 1997).

While men are less likely to be affected by a case of Depressive Disorder, quite a large number of men do suffer from it, but are less likely than women to report a case of depression. This is reflected in that for every woman who commits suicide in America, there are four men who commit suicide. Additionally, older men are more likely to kill themselves as there is a greater chance of suicide amongst men after they are seventy years old. Clinically Depressed men are more likely to die of heart disease and use alcohol or other drugs as compared to the general population (NCBI, 2006).

A man may mask depression by working unusually long hours, which makes him a socially acceptable ‘workaholic’ instead of a socially reviled alcoholic. Moreover, a man may also present the symptoms of depression differently than a woman, making the diagnosis more difficult.Finally, due to the social taboos and misconceptions associated with being mentally ill or having a mood disorder, men are less likely to ask for assistance; often medical and social professionals need to recognize the symptoms of depression on their own (Bland, 1997).

Bipolar Disorder

The causes for Bipolar Disorder are difficult to pinpoint since there are both genetic elements as well as environmental factors which contribute to an onset of this disease. There is strong evidence to support the claim that Bipolar Disorder runs in a family, but the genes a person is born with do not present the whole picture (Donahue & Fristad, 2005). For example, a study on twins shows that, even though the genes of the twins are identical, they both may not develop Bipolar Disorder. However, the identical twin of an individual who has Bipolar Disorder is certainly at a greater risk to develop the disease (AACAP, 2004).

Of course, with this information in hand, scientists are quite interested in the genetic makeup of individuals with Bipolar Disorder and believe that as discoveries are made in the field of genetics, better tools and medicines will be created to handle this disease. Medical science has also shown that the brain images of individuals who have Bipolar Disorder are different from healthy samples (Tyrka al., 2006). A greater understanding of these differences will allow future medical professionals to better understand the disease and use effective therapies for curing the ailment.
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Question No.1. One of the simplest and most important questions you can ask a person while evaluating him/her for symptoms of depression is to ask:

a. Do you feel depressed?
b. Do you enjoy watching TV?
c. How often do you go for a walk or just do something for the sake of exercise?
d. How many times have you seen a psychiatrist or other physician in the past year?

Question No.2. In medical terms, a person’s mood is:

a. A state of feeling sad
b. A state of feeling happy
c. A disorder which needs to be corrected to the normal state
d. The emotional state and the associated visible characteristics

Question No.3. A depressed person is more likely to feel:

a. Sad due to the loss of a loved one
b. Intensely sad for the majority of the time
c. Happy due to the presence of caregivers
d. Intensely happy for the majority of the time
e. How many times have you seen a psychiatrist or other physician in the past year?

Question No.4.Which of the following can be a cause for Depressive Disorder:

a. Family History
b. Major surgical procedures
c. Hormonal and environmental changes
d. All of the above

Question No.5.Of the following, who is most likely to develop a Depressive Disorder:

a. An Adult woman
b. A teenage boy
c. An Adult man
d. A young girl

Question No.8. If a person has Bipolar Disorder, then the individual at the greatest risk of developing Bipolar Disorder from the patient’s social connections is:

a. The person’s primary care provider
b. The person’s significant other
c. Any of his/her cousins
d. An identical twin
 
Mood Disorders: Assessment and Treatment > Chapter 1 - What is a Mood Disorder?
Page Last Modified On: May 14, 2016, 04:23 PM