Mood Disorders

I. Introduction

Mood disorders can be traced to our earliest times (indeed, to the

Book of Genesis by some writers: Ostow, 1980) and across cultures (Al-

Issa, 1982; Carson, et al., 1988). Many famous people apparently

suffered from these disorders. Eg: Lincoln and Freud suffered from

depression. They are among the most prevalent of psychological

disorders (Reus, 1988).

The Mood Disorders are characterized by prolonged and persistent

positive and/or negative emotions, which are of such intensity that they

can color and interfere with all aspects of one's life. The key

ingredient here is mood. Although thoughts may also be disturbed,

thought disorder (ie: impairment of intellectual functioning - reflected

by incoherence, unconnected, chaotic thoughts, bizarre speech and the

like) is not a defining feature (Thought disorder is central to

Schizophrenia, which we will be discussing in later lectures).

The emotions experienced in these disorders are typically thought

to exist along a continuum with normal emotions (Beck, 1967; Reus,

1988). For example, we've all experienced sadness at some point in our

lives. But such experiences do not warrant a diagnosis. As we shall

see, clinical depression is very different from sadness.

The emotions (or moods) we will be focusing on are excessively

elevated moods and excessively depressed moods, or in other words, Mania

and Depression.

A. Manic States: elevated, expansive, grandiose, or irritable

mood.

A person in a manic state feels euphoric and high, eager to be

involved with others and with life in general. This expansive and

elevated mood may have an infectious quality for the uninvolved

observer, but for those who know the person well, the mood is

recognized as excessive.

Other characteristics:

inflated self-esteem

decreased need for sleep (eg: only 3 hours a night, or

stays awake for 3 or 4 days at a time)

talkative (eg: loud, difficult to interrupt, continuous

flow of speech)

racing ideas

easily distracted

nervous activity

high degree of risk taking (often dangerous)

One patient who went on to write a book about his experiences

(Custance, 1952), similarly describes mania:

intense sense of well-being

heightened sense of reality

release of inhibitions (sexual, moral)

delusions of grandeur and power

Others who have published personal accounts report similar

experiences when in a manic state (see Lerner, 1980).

Case Study:

When experiencing manic symptoms, a 38 year old woman,

periodically hospitalized because of her extreme moods, would

become "overactive and exuberant in spirits and visited her

friends, to whom she outlined her plans for reestablishing

different forms of lucrative business. She purchased many clothes,

bought furniture, pawned rings, and wrote checks without funds.

(She) played her radio until late in the night, smoked excessively,

took out insurance on a car that she had not yet bought. Contrary

to her usual habits, she swore frequently and loudly, (and) created

a disturbance in a club to which she did not belong. On the day

prior to her second admission to the hospital, she purchased 57

hats" (Kolk, 1973, pp376-377).

These states of mania occur as discreet episodes: a distinct

period of time during which the symptoms described above are

predominant. Episodes typically begin suddenly, initially with a

decreased need for sleep (Reus, 1988), and then escalate to last

for a few days, or months in some cases (APA, 1987). Initially,

the person's behavior may be quite creative and productive, and

other people may enthusiastically join in with him or her. Such

people can at first be quite engaging. But it soon becomes clear

that little caution or judgment is being exercised, and the

behavior deteriorates to socially inappropriate or self-destructive

activities (esp. substance abuse) (Reus, 1988). Hospitalization

often becomes necessary to prevent harm to self or others (APA,

1987).

In some cases, the person's