UNIT 5 MOOD DISORDERS AND SUICIDE
----------------------------------------------------------------------------------------------------------------
Explain the clinical descriptions, statistics, causes, risk factors and treatments of depressive
disorders, bipolar disorders and persistent mood disorders (C2)
----------------------------------------------------------------------------------------------------------------
Easy Way to Remember: “D-B-P”
• D – Depressive Disorders (Low mood, fatigue).
• B – Bipolar Disorders (Mood swings, mania).
• P – Persistent Mood Disorders (Chronic low mood).
----------------------------------------------------------------------------------------------------------------
Overview of Depressive Disorders, Bipolar Disorders, and Persistent Mood Disorders
Mood disorders are characterized by disturbances in emotion, affecting cognitive and
physical functioning. This section provides clinical descriptions, prevalence statistics,
causes, risk factors, and treatments for these disorders, along with ICD-11 and DSM-5
codes for reference.
1. Depressive Disorders (Major Depressive Disorder & Related Conditions)
ICD-11 Code: 6A70 (Single Depressive Episode), 6A71 (Recurrent Depressive Disorder)
DSM-5 Code: F32.0 - F32.9 (Single Episode), F33.0 - F33.9 (Recurrent Episodes)
Clinical Description
Major Depressive Disorder (MDD) is characterized by:
• Persistent low mood, loss of interest, and fatigue for at least two weeks.
• Other symptoms: Changes in appetite, sleep disturbances, difficulty concentrating, and
suicidal thoughts
Example: A person stops enjoying hobbies, sleeps excessively, and withdraws from
social life for weeks.
Prevalence Statistics
• Lifetime prevalence: 16-20% globally.
• Women are twice as likely as men to develop depression
Causes & Risk Factors
• Biological: Low serotonin and norepinephrine levels, hyperactivity of the HPA axis.
• Psychological: Negative thought patterns (Beck’s cognitive theory), learned helplessness.
• Environmental: Childhood trauma, chronic stress, lack of social support
Treatments
• Cognitive-Behavioral Therapy (CBT): Challenges negative thoughts.
• Medications: SSRIs (e.g., Fluoxetine), SNRIs, Tricyclic Antidepressants (TCAs).
• Electroconvulsive Therapy (ECT): Used for severe, treatment-resistant depression
2. Bipolar Disorders (Bipolar I, Bipolar II, and Cyclothymic Disorder)
ICD-11 Code: 6A60 (Bipolar Type I), 6A61 (Bipolar Type II), 6A63 (Cyclothymic Disorder)
DSM-5 Code: F31.0 - F31.9 (Bipolar I), F31.81 (Bipolar II), F34.0 (Cyclothymia)
Clinical Description
Bipolar disorders involve episodes of mania or hypomania alternating with depression:
• Bipolar I: At least one manic episode (extreme euphoria, impulsivity, hyperactivity).
• Bipolar II: Alternates between hypomanic and depressive episodes.
• Cyclothymic Disorder: Chronic mood fluctuations, lasting at least two years
Example: A person impulsively quits their job during a manic episode, only to
experience deep regret and depression weeks later.
Prevalence Statistics
• Bipolar I: 1% of the population.
• Bipolar II: 1.1% of the population.
• Equal prevalence in men and women
Causes & Risk Factors
• Biological: High dopamine and glutamate in mania, low serotonin in depression.
• Genetic: Strong hereditary component (first-degree relatives at 10x higher risk).
• Environmental: Stress, substance abuse, sleep disturbances
Treatments
• Mood Stabilizers: Lithium (most effective), Valproate, Carbamazepine.
• Atypical Antipsychotics: Used for manic episodes (e.g., Olanzapine).
• Psychotherapy: Interpersonal and Social Rhythm Therapy (IPSRT) stabilizes daily routines
3. Persistent Mood Disorders (Dysthymia / Persistent Depressive Disorder)
ICD-11 Code: 6A72
DSM-5 Code: F34.1
Clinical Description
• Chronic depressive symptoms for at least two years (one year in children).
• Less severe than MDD but longer lasting, often leading to double depression (persistent
depression + major depressive episodes)
Example: A person feels “down” most days for years, struggles with low energy and
motivation, but does not meet full criteria for MDD.
Prevalence Statistics
• 12-month prevalence: 0.5% (persistent depressive disorder), 1.5% (chronic MDD)
• More common in women.
Causes & Risk Factors
• Genetic: Heritability is 40%, with links to family history of depression.
• Neurobiological: Impaired function in prefrontal cortex, amygdala, hippocampus.
• Temperamental: Neuroticism (negative affectivity) increases risk
Treatments
• CBT and Interpersonal Therapy (IPT): Help restructure negative thinking patterns.
• Medications: SSRIs or TCAs for long-term treatment.
• Lifestyle Changes: Exercise, sleep regulation, stress management
Comparison of Mood Disorders
Disorder Key Feature Duration Prevalence Main Treatment
Persistent low mood, ≥2 16-20%
MDD SSRIs, CBT, ECT
loss of interest weeks lifetime
Mania + depressive Lithium,
Bipolar I Lifetime 1%
episodes Antipsychotics
Hypomania + Mood stabilizers,
Bipolar II Lifetime 1.1%
depression IPSRT
Disorder Key Feature Duration Prevalence Main Treatment
Chronic mood Therapy, Mood
Cyclothymia ≥2 years 0.4-1%
fluctuations stabilizers
Persistent Depressive
Chronic low mood ≥2 years 0.5-1.5% SSRIs, Therapy
Disorder (Dysthymia)
Conclusion
Mood disorders significantly affect daily functioning, requiring long-term treatment
strategies combining medication, psychotherapy, and lifestyle changes.
----------------------------------------------------------------------------------------------------------------
List and summarize the different subtypes of depression, bipolar and manic disorders (C2)
----------------------------------------------------------------------------------------------------------------
Mood disorders have varied subtypes that impact treatment and prognosis.
Easy Way to Remember: “S-R-P-M” for Depression, “B-C-M” for Bipolar
• S – Single Episode Depression
• R – Recurrent Depression
• P – Persistent Depressive Disorder (Dysthymia)
• M – Mixed Depression & Anxiety
• B – Bipolar I & II
• C – Cyclothymic Disorder
• M – Manic Disorders
----------------------------------------------------------------------------------------------------------------
Subtypes of Depression, Bipolar, and Manic Disorders
This section provides a structured summary of the subtypes of depressive, bipolar, and
manic disorders, based on ICD-11 and DSM-5 classifications.
1. Subtypes of Depressive Disorders
(A) Single Episode Depressive Disorder
• ICD-11 Code: 6A70
• DSM-5 Code: F32.0 - F32.9
• Characterized by one depressive episode lasting at least two weeks, with no prior
episodes.
Example: A person experiences intense sadness, fatigue, and loss of interest for three
weeks but recovers afterward
(B) Recurrent Depressive Disorder
• ICD-11 Code: 6A71
• DSM-5 Code: F33.0 - F33.9
• Involves multiple depressive episodes, separated by months without symptoms.
Example: A woman has three major depressive episodes in five years, each lasting over
a month
(C) Persistent Depressive Disorder (Dysthymia)
• ICD-11 Code: 6A72
• DSM-5 Code: F34.1
• Chronic low-grade depression lasting two years or more.
Example: A student has mild but persistent sadness for three years, affecting
motivation and relationships
(D) Mixed Depressive and Anxiety Disorder
• ICD-11 Code: 6A73
• Symptoms of both depression and anxiety, but not severe enough for a separate
diagnosis of each.
Example: A person frequently feels both sad and anxious, has trouble concentrating,
but symptoms do not meet criteria for MDD or GAD
(E) Depressive Disorder with Psychotic Symptoms
• ICD-11 Code: 6A71.4
• DSM-5 Code: F33.3
• Severe depressive episodes accompanied by delusions or hallucinations.
Example: A man with depression believes he is responsible for global catastrophes,
despite evidence to the contrary
2. Subtypes of Bipolar Disorders
(A) Bipolar Type I Disorder
• ICD-11 Code: 6A60
• DSM-5 Code: F31.0 - F31.9
• At least one manic episode, which may alternate with depressive episodes.
Example: A woman impulsively spends all her savings during a manic phase, then later
experiences severe depression
(B) Bipolar Type II Disorder
• ICD-11 Code: 6A61
• DSM-5 Code: F31.81
• Alternates between hypomanic and depressive episodes, without full mania.
Example: A man has high-energy, sleepless nights for days but does not experience full
mania
(C) Cyclothymic Disorder
• ICD-11 Code: 6A62
• DSM-5 Code: F34.0
• Chronic mood instability (hypomanic and depressive symptoms) lasting at least two
years.
Example: A teenager has frequent mood swings but never meets the full criteria for
manic or depressive episodes
(D) Bipolar Disorder with Mixed Features
• ICD-11 Code: 6A60.9
• DSM-5 Code: F31.6
• Episodes have both manic and depressive symptoms simultaneously.
Example: A person laughs excessively but also feels hopeless and suicidal
3. Subtypes of Manic Disorders
(A) Manic Episode without Psychotic Symptoms
• ICD-11 Code: 6A60.0
• DSM-5 Code: F30.1
• Elevated mood, increased energy, and impulsivity, but no delusions or hallucinations.
Example: A woman starts several business ventures in a week, believing she can do
anything
(B) Manic Episode with Psychotic Symptoms
• ICD-11 Code: 6A60.1
• DSM-5 Code: F30.2
• Delusions or hallucinations accompany mania.
Example: A man believes he is God and has supernatural powers
(C) Hypomanic Episode
• ICD-11 Code: 6A60.2
• DSM-5 Code: F30.0
• Mild manic symptoms lasting at least four days, without severe impairment.
Example: A student stays up for three nights feeling highly productive but can still
function normally
----------------------------------------------------------------------------------------------------------------
Enumerate and outline the different types of suicide and self-harm behaviors (C2)
----------------------------------------------------------------------------------------------------------------
Easy Way to Remember: “I-P-P-A-A-A-S” for Suicide, “N-S-E-T” for Self-Harm
• I – Impulsive Suicide
• P – Planned Suicide
• P – Suicide Pact
• A – Assisted Suicide
• A – Altruistic Suicide
• A – Anomic Suicide
• S – Suicidal Behavior Disorder
• N – Nonsuicidal Self-Injury
• S – Stereotypic Self-Injury
• E – Excoriation Disorder
• T – Trichotillomania
----------------------------------------------------------------------------------------------------------------
Types of Suicide and Self-Harm Behaviors
Suicidal behavior and self-harm are significant concerns in mental health. This section
provides a structured overview of the different types of suicide and self-harm behaviors,
including ICD-11 and DSM-5 classifications.
1. Types of Suicide
Suicide can be classified based on intent, method, and circumstances surrounding the act.
(A) Suicidal Behavior Disorder
• ICD-11 Code: 6B40.0
• DSM-5 Code: F42.2
• A person has attempted suicide at least once, with clear intent to die, and does not meet
the criteria for non-suicidal self-injury
Example: A person overdoses on medication intending to die but is found and rescued
in time.
(B) Impulsive Suicide
• Suicide is attempted without prior planning, often triggered by acute distress.
Example: A teenager jumps from a bridge after a sudden breakup.
(C) Planned or Premeditated Suicide
• The person plans the method and time in advance, often leaving a note.
Example: A man arranges his financial affairs and writes farewell letters before taking
his life.
(D) Suicide Pact
• Two or more people agree to die together, often due to shared distress.
Example: A couple facing extreme financial crisis decides to end their lives together.
(E) Assisted Suicide
• A person seeks help to end their life, often due to terminal illness.
Example: A patient with advanced cancer takes a doctor-prescribed lethal drug in a
country where assisted suicide is legal.
(F) Altruistic Suicide
• Suicide occurs due to a belief that it benefits others or society.
Example: A soldier sacrifices himself in a suicide mission to protect his comrades.
(G) Anomic Suicide (Based on Durkheim’s Classification)
• Results from sudden societal disruption, such as financial collapse.
Example: A businessman takes his life after losing everything in a stock market crash.
2. Types of Self-Harm Behaviors
Self-harm can be intentional but non-suicidal or indicate a risk of suicide.
(A) Nonsuicidal Self-Injury (NSSI)
• ICD-11 Code: 6B25.0
• DSM-5 Code: R45.88
• Repetitive self-harm without suicidal intent, often to relieve emotional distress
Example: A person cuts their arms to cope with feelings of numbness.
(B) Stereotypic Self-Injury
• Repetitive self-hitting, head-banging, or biting, often seen in neurodevelopmental
disorders.
Example: A child with autism repeatedly bangs their head against a wall when stressed
(C) Excoriation (Skin-Picking) Disorder
• ICD-11 Code: 6B25.1
• DSM-5 Code: F42.4
• Compulsive skin-picking, leading to wounds.
Example: A woman picks at her face daily, causing scars
(D) Trichotillomania (Hair-Pulling Disorder)
• ICD-11 Code: 6B25.0
• DSM-5 Code: F63.3
• Compulsive hair-pulling, leading to bald patches.
Example: A student pulls out hair during stressful exams
Conclusion
Understanding suicidal and self-harm behaviors helps in early intervention and prevention.
----------------------------------------------------------------------------------------------------------------
Discuss the various causes and risk factors for suicide (C2)
----------------------------------------------------------------------------------------------------------------
Easy Way to Remember: “B-P-E” for Causes, “D-P-S” for Risk Factors
• B – Biological Causes (Genetics, Brain Chemistry).
• P – Psychological Causes (Depression, Hopelessness).
• E – Environmental Causes (Abuse, Social Isolation).
• D – Demographic Risks (Age, Gender).
• P – Psychological Risks (Past Attempts, Impulsivity).
• S – Social Risks (Family Dysfunction, Access to Means).
----------------------------------------------------------------------------------------------------------------
Causes and Risk Factors for Suicide
Suicide is a complex phenomenon influenced by biological, psychological, and
environmental factors. This section explores the causes and risk factors, based on ICD-11
and DSM-5 classifications.
1. ICD-11 and DSM-5 Classification
Suicidal Behavior Disorder
• ICD-11 Code: 6B40.0
• DSM-5 Code: F42.2
• Defined as one or more suicide attempts, with clear intent to die, within the past 24
months
2. Causes of Suicide
(A) Biological Causes
• Neurotransmitter Imbalances:
• Low serotonin levels are linked to increased aggression and impulsivity
• Genetic Factors:
• Suicide risk is higher in families with a history of mood disorders.
• Brain Abnormalities:
• Dysfunction in the prefrontal cortex and limbic system, affecting emotional regulation
Example: A person with a family history of depression and suicide may be at higher risk
due to inherited biological vulnerabilities.
(B) Psychological Causes
• Mental Disorders:
• 90% of people who die by suicide have a mental illness, such as:
• Major Depressive Disorder (MDD)
• Bipolar Disorder
• Borderline Personality Disorder (BPD)
• Schizophrenia
• Cognitive Distortions:
• Feelings of hopelessness, worthlessness, and perceived burdensomeness.
• Impulsivity & Poor Problem-Solving Skills:
• Difficulty handling stress, leading to quick, unplanned suicide attempts.
Example: A teenager with BPD and impulsivity issues may attempt suicide after a
breakup.
(C) Environmental Causes
• Childhood Trauma and Abuse:
• Physical, emotional, or sexual abuse increases vulnerability
• Social Isolation:
• Lack of close relationships and poor social support contribute to suicidal thoughts.
• Financial or Academic Pressure:
• Unemployment, debt, or failing exams are strong predictors of suicide.
• Substance Abuse:
• Alcohol and drug dependence lower inhibition, making impulsive suicide more likely.
Example: A university student facing academic failure and loneliness may experience
suicidal ideation.
3. Risk Factors for Suicide
(A) Demographic Risk Factors
• Age:
• Suicide rates increase during adolescence and peak in middle-aged men
• Gender:
• Women attempt suicide more, but men complete it more due to lethal methods (e.g.,
firearms)
• Ethnicity & Geography:
• Higher rates in Western countries and among Indigenous populations
Example: A middle-aged, divorced man living alone is at high risk.
(B) Psychological Risk Factors
• Previous Suicide Attempts:
• A strong predictor of future suicide attempts.
• Hopelessness & Pessimism:
• Feeling that life will never improve.
• Exposure to Suicide (Suicide Contagion):
• Celebrity suicides or media influence increase risk, especially in adolescents
Example: After hearing about a celebrity’s suicide, some teenagers may engage in
copycat behavior.
(C) Social & Cultural Risk Factors
• Family Dysfunction & Abuse:
• Parental neglect, domestic violence, and childhood trauma increase risk.
• Religious & Cultural Beliefs:
• In some cultures, suicide is stigmatized (lower rates), while in others, it may be seen as an
escape from dishonor (higher rates).
• Easy Access to Means:
• Firearms, poisons, and high-rise buildings increase the likelihood of completed suicides.
Example: A person with chronic pain and access to strong medication is at higher risk
of overdose.
Conclusion
Suicide is a multifactorial issue that requires early intervention and support.
----------------------------------------------------------------------------------------------------------------
Summarize the various strategies for suicide prevention and intervention (C2)
----------------------------------------------------------------------------------------------------------------
Easy Way to Remember: “U-S-I-C-P” for Suicide Prevention & Intervention
• U – Universal Prevention (Awareness Campaigns, Gun Laws)
• S – Selective Prevention (Screening, Hotlines)
• I – Indicated Prevention (Hospitalization, Crisis Planning)
• C – Crisis Intervention (Emergency Counseling, Risk Assessment)
• P – Psychotherapy & Pharmacotherapy (CBT, Lithium)
----------------------------------------------------------------------------------------------------------------
Suicide Prevention and Intervention Strategies
Suicide prevention involves identifying risk factors, providing support, and implementing
interventions at various levels. This section outlines evidence-based prevention and
intervention strategies, incorporating ICD-11 and DSM-5 classifications.
1. ICD-11 and DSM-5 Classification
Suicidal Behavior Disorder
• ICD-11 Code: 6B40.0
• DSM-5 Code: F42.2
• Diagnosis requires one or more suicide attempts within the past 24 months, with clear
intent to die
2. Suicide Prevention Strategies
(A) Universal Prevention (For the General Population)
• Aimed at reducing suicide risk across society.
• Examples:
• Awareness Campaigns: Promotes mental health education.
• Restricting Access to Lethal Means: Gun control, safety barriers on bridges.
• School-Based Programs: Teaching coping skills to students
Example: Countries that enforce strict gun laws have lower suicide rates.
(B) Selective Prevention (For High-Risk Groups)
• Targets individuals with known risk factors (e.g., history of depression, trauma survivors).
• Examples:
• Suicide Hotlines: 24/7 support for individuals in crisis.
• Gatekeeper Training: Teaches teachers, police, and healthcare providers to recognize
suicide warning signs.
• Early Identification in Schools and Workplaces: Screening for suicidal thoughts in high-risk
populations
Example: A teacher trained in suicide prevention notices signs in a student and refers
them for counseling.
(C) Indicated Prevention (For Individuals at Immediate Risk)
• Focuses on people who have attempted suicide or show clear warning signs.
• Examples:
• Crisis Intervention: Emergency counseling and hospitalization for high-risk individuals.
• Follow-Up Care: Regular check-ins after a suicide attempt.
• Safety Planning: Helps patients develop a step-by-step crisis response plan
Example: A person discharged from the hospital after a suicide attempt receives
weekly therapy sessions to prevent relapse.
3. Suicide Intervention Strategies
Intervention is necessary when someone actively expresses suicidal intent or has made an
attempt.
(A) Crisis Intervention
• Immediate response to a person in suicidal distress.
• Steps:
1. Assess the Risk: Determine suicide intent and access to means.
2. Engage in Active Listening: Encourage open conversations.
3. Connect with Professional Help: Referral to therapy, hotline, or emergency services
Example: A friend calls a crisis helpline when a loved one expresses suicidal thoughts.
(B) Psychotherapy and Counseling
• Cognitive-Behavioral Therapy for Suicide Prevention (CBT-SP): Reduces suicidal thoughts
by addressing negative thinking.
• Dialectical Behavior Therapy (DBT): Teaches emotional regulation for individuals with
borderline personality disorder.
• Interpersonal Therapy (IPT): Helps resolve interpersonal conflicts contributing to suicidal
behavior
Example: A therapist helps a depressed patient identify triggers for suicidal thoughts
and develop healthier coping mechanisms.
(C) Pharmacological Treatment
• SSRIs (e.g., Fluoxetine): Treats depression but may increase suicide risk in adolescents.
• Lithium: Reduces suicide risk in bipolar disorder.
• Antipsychotics: Used when psychotic symptoms are present
Example: A bipolar patient on lithium experiences fewer suicidal thoughts.
4. Community and Social Support Strategies
(A) Family and Social Support
• Open communication within families reduces isolation.
• Family Therapy helps address interpersonal conflicts.
Example: A parent learns to support their child with depression through family
counseling.
(B) Online and Peer Support Groups
• Provides non-judgmental spaces for people to share experiences.
• Reduces social isolation among individuals struggling with mental health
Example: A teen joins an online support group for depression recovery.
Conclusion
Suicide prevention requires a combination of universal, selective, and indicated strategies
to be effective.
