NOVEMBER 2019
#1
MOOD DISORDERS SPCC Psychology Enthusiasts' Circle
DISUPTIVE MOOD
WHAT ARE MOOD DISORDERS? Mood disorders are characterized
DYSREGULATION
2
DISORDER
MANIC DEPRESSIVE DISORDER
4
by a serious change in mood that cause disruption to life
PERSISTENT
activities. Though many
DEPRESSIVE DISORDER
7
different sub-types are recognized, three major subtypes of mood disorders exist: depressive disorders, substanceinduced disorders, and bipolar disorders.
CYCLOTHYMIC DISORDER
9
SEASONAL DEPRESSION
11
TRAUMA-INDUCED DEPRESSION
13
INTRODUCTION BY RACHEL LEE
Mood is defined as a feeling or a person’s specific state of mind at any particular time. When we were younger, we were all taught to control our emotion. But to be honest, we cannot control the existence of certain emotions. When we are “controlling emotions”, we are just controlling whether they are seen or not. We are just hiding them. Or ignoring them. Telling ourselves “I shouldn’t be feeling like this”, this thought is terribly wrong. There is no right or wrong for the existence of emotions. Emotions are never to be judged.
People refuse to accept their own emotions in order to fit in with the socalled “high EQ” category or also known "normal". And hence, lead to the rationalization of mood disorders.
Mood disorders doesn't mean that you don’t have the ability to control whether emotions are shown by your words or actions. It is the cause of the existence of emotions (which is usually the cause of specific feelings) that differs you from healthy people. In some cases, people with mood disorder do not really have a cause considered rational for anger or depression etc. As I have mentioned, it is not that they have wrong emotions, but just that their emotions are stronger. Imagine if people with mood disorders take up 99.999% of the population and you are the only healthy person. Then you will probably be considered mad. Mood disorders lead to disruption of daily activities. That is because “daily activities” are for “healthy people”. If people with mood disorders came from another planet, on that planet they would be absolutely fine! Hence, I hope that this newsletter can not only inform you about some commonly seen mood disorders, but also to raise your awareness towards the victims of them, and hopefully when you see one, you can lend him or her a helping hand.
PAGE 1
Disruptive Mood Dysregulation Disorder BY JADE DUONG Have you watched one of Pixar’s most iconic movies of all times, Inside Out? If you happen to do so, you should be able to recognize most of the characters in this film, such as the one on the right. For those who are unfortunately clueless, this charming fellow above is nicknamed Anger. What does this have to do with Disruptive Mood Dysregulation Disorder (DMDD), you ask? Well, I guarantee that everyone must have experienced irritation or anger, perhaps towards a certain someone or an object; imagine that fury inside of you asbubbling if you are stirring a boiling and filled with rage and cauldron annoyance. Then, pour out all of the pot’s content and release this inner wrath of yours! After this outburst, do it at least 3 more times per week! And---------congratulations, you have this mood disorder! To clarify, no mood disorders should be taken lightly or as a joke, I am simply trying to catch your attention to read this, so that my time and effort will not go down the drain. And now, of course, it’s time for us to become intellectuals.
Are there any signs? What even is this disorder? Disruptive Mood Dysregulation Disorder (DMDD) is a mental disorder that affects children and adolescents, the most identifiable symptom of this disorder is a persistence of irritability, anger and frequent mood bursts that are considerably more severe and recurrent than the typical reaction of their peer group. Other symptoms include relentlessly screaming, crying, shouting, throwing of objects, resorting to physical violence (hitting, slapping, biting) and destruction of toys and furniture; it was also discovered that such affected children would start showing these signs during the preschool years.There are diagnostic criteria which illustrate the setting, duration and onset of DMDD: the outbursts must be consistent for at least 12 months, and the mood bursts must be extreme in at least one of the two settings (home and school). The diagnosis must also happen between the ages of 6 to 18 years old.
PAGE 2
Why does this happen to certain individuals? To the present day, the causes of DMDD are poorly understood, one might even dare say that the idea of DMDD and the reasons for this disorder are abstract. Both biological and environmental causes are to be considered and well-analyzed too. While there are few biologically accurate and scientifically-proven factors, the mechanisms of the human brain and genetics do play a role. Some children and adolescents may suffer from neurological disability, frequent migraines for example; reports have shown that these children will often develop chronic irritability and aggressive behaviour that will eventually develop into DMDD. Studies have also shown that DMDD children have enhanced activation in areas of the brain (frontal gyrus and anterior contex) in which control belligerence and inhibition; it is also notable to mention that children of substance-abusive parents are more subjected to this mental disorder. For environmental aspects, trauma in early childhood enables the triggering of DMDD, and even worsen the mental illness. Recent family death, divorce, recolation, lack of adequate nutrition or vitamin deficiency contributes to the development of symptoms of DMDD.
How can this disorder be treated? Good news! DMDD can be treated DMDD can be treated. Dialectical behaviour therapy for children (DBT-C) helps children learn how to regulate their emotions and avoid extreme or prolonged outbursts. Instead of dismissing their emotions as insignificant, the therapists validate these feelings and guide affected children on how to cope when their emotions are getting out of hand. Mindfulness, distress-tolerance, emotional regulation and interpersonal effectiveness skills are achieved throughout this program. Parents can also take up the offer to be trained professional and hence learn these skills to stabilize their children and manage their own natural responses towards their offsprings’ mood bursts. Medicine acts as a last resort when therapy and parental guidance are not available, or not effective alone. Stimulant medication, which helps kids rein in impulses, and an antidepressant with mild side effects, like SSRIs, are usually a first step when medication seems necessary. If that combination doesn’t work, or if there’s an urgency to the situation, a low dose of an atypical antipsychotic such as Risperdal can also be prescribed.
Woops...... I do hope that I did not go overboard with these information about DMDD! However, before you start diagnosing other people yourself, please understand that despite reading this, it doesn’t give you the ability to accurately know what’s going on as this mental disorder can be easily confused with Attention Deficit Hyperactivity Disorder (ADHD), Childhood Bipolar Disorder, Oppositional Defiant Disorder (ODD) and so much more. Please leave this for professionals to do instead.
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MANIC DEPRESSIVE DISORDER By Cheryl Yung
Why is she so moody today? Oh my gosh, he’s crazy, yelling in the streets like that. Everyone has those, she needs to stop acting like she’s “special”. These may be voices you’ve heard or thoughts you’ve had when you see people acting differently in public. However, things may not be as simple as you think. All of the above are common misconceptions about bipolar disorder, previously known as manic depressive disorder. It is a mental disorder that causes periods of depression and abnormally elevated moods. When triggered, people with manic depressive disorder may feel unusually energetic, happy or irritated, causing them to make irrational decisions. In 2007, studies report that as many as 180,000 Hong Kong citizens may be suffering
from
manic
depressive
Hong Kong people that may be suffering from manic depressive disorder without realizing 2.5%
2.5%
disorder without realizing, as most of them have been misdiagnosed with major depressive disorder. Globally, 46 million people are suffering from this disorder,
making
population,
with
up
0.6%
New
of
the
Zealand,
Australia, Brazil, Finland and Sweden ranking as the first few countries.
97.5%
Note: The graph is drawn by estimation
PAGE 4
Nowadays, the causes of manic depressive disorder still remain unclear. Psychologists have split the reasons into three factors, namely the genetic, environmental and neurological factors. In terms of genetics, the risk of manic depressive disorder is ten times higher if the immediate family also suffers from it. In terms of the environment, negative real life events and interpersonal relationships may trigger the disorder. Traumatic and abusive memories may also contribute to the onset or recurrence of the disorder. In terms of neurology, the disorder may be related to a neurological condition or injury, such as stroke or traumatic brain injury. People suffering from manic depressive disorder experience extreme mood fluctuation. They may be over-energetic, confident and talkative sometimes, while feeling lethargic and lack the motivation to meet other people or go outdoors in other periods. There are three stages that a patient can go through: manic episodes, hypomanic episodes and depressive episodes. During manic episodes, patients may speak rapidly, have a decreased need for sleep and a shorter attention span. They may be easily agitated and carry out impulsive actions. Individuals usually have a history of substance abuse and may experience psychosis. Some warnings of manic episodes are sleep disturbances, mood or appetite changes. During hypomanic episodes, patients experience a milder version of manic episodes and they rarely progress to a full-blown manic episode. These episodes vary according to patients as some find it to be a good experience while others do not enjoy it. During depressive
PAGE 5
episodes, patients may experience constant feelings of sadness, loss of interest in previously enjoyed activities, hopelessness, and other symptoms that are shared with patients with major depressive disorder.
While manic depressive disorder is not untreatable, it will require massive support from family, friends and external substances. One of the more common treatments are prescribed drugs such as mood stabilizers, antidepressants and anti-mania drugs. Patients can also seek professional psychological treatment such as psychotherapy. In order to support them, we should learn to be understanding and patient, ultimately accepting both their and your limits. While we as supporters cannot prevent manic episodes from occurring, we can help them by setting up daily routines that includes meal and bedtimes or communicating openly so as to reduce stress.
So, the next time you see someone on the street during a manic episode, please reconsider your words and thoughts. They may be strangers to you, but every single ounce of support and kindness they receive may encourage and motivate them. The situation in Hong Kong may be just the tip of the iceberg, and there are certainly more individuals silently suffering around the globe. It will require a lot of effort and time to reduce the stigma surrounding mood disorders and advocate mental health to the general public, so let us all learn more about this field of psychology and work hand in hand to raise awareness for mental wellness.
PAGE 6
Persistent Depressive Disorder By Tiffany Mao
Chances are, you probably don’t know or haven’t even heard of dysthymia, in other words, Persistent Depressive Disorder (PDD). You might be thinking, are the symptoms of this mood disorder just being sad? Well yes, but not really. I’m here to help you along your journey on recognizing Persistent Depressive Disorder :) First, let’s start off with some basic
Percentage of the world's population affected by PDD 1.3%
facts. PDD affects approximately 1.3%
1.3%
of the world’s population, and it is more commonly diagnosed in women than men. Most people are often in contact
with
PDD
starting
in
childhood or during the teenage years, but only become aware of it after they grow up. Firstly, what exactly is PDD?.
98.7%
PAGE 7
I’m sure we all have heard of another mood disorder: depression. At some point in our lives, we’ve all definitely thrown the word ‘depressed’ around knowing that we aren’t actually depressed. PDD is basically a less severe form of depression but with longer-lasting symptoms. PDD symptoms usually come and go over a period of years, and their intensity can change over time. These symptoms include a loss of interest in daily activities, avoidance of social activities, irritability, excessive anger, hopelessness and so on. If these thoughts and feelings happen continuously for over 2 months at a time, then you might be diagnosed with PDD. PDD often lasts for years, and PDD may significantly interfere with your daily life. If you’re just feeling unhappy over a test that you failed, or a competition you didn’t win, don’t worry, everyone has experienced the feeling of sadness, but it doesn’t necessarily mean that we are depressed. We should all agree on the fact that it’s totally normal for us as human beings to have emotions, but long periods of sadness and devastation might result in Persistent Depressive Disorder. No one knows the exact cause of PDD. As all of this happens inside our brain, inside our body, it’s often very difficult for scientists to determine the exact cause and know exactly what’s happening in our complex brain. After reading these facts, it all may seem a little scary to you. Although there's no sure way to prevent persistent depressive disorder, but there are a few steps we can take to lower the risk of you and I being diagnosed with PDD. We should try to find ways to cope with stress, and lead a healthy, happy life. You should also consult a doctor if you have any signs of PDD to help prevent symptoms from worsening. That’s all? Yes. That’s all scientists have managed to discover in the field of psychology until now. I hope all of you can take notice of the people around you which may be victims of Persistent Depressive Disorder. Take everything they say seriously, and try your best to help them. No one wants to go through a phase of darkness in their life, so I urge you to lend a helping hand to those in need. A simple hug can go a long way. With your help, we can all move forward together. Further reading on Persistent Depressive Disorder: https://www.everydayhealth.com/depression/understanding/what-is-dysthymia.aspx https://www.mayoclinic.org/diseases-conditions/persistent-depressivedisorder/symptoms-causes/syc-20350929
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Cyclothymic Disorder
Cyclothymic disorder, commonly referred to as cyclothymia because people get to mention less syllables, is a mood disorder with symptoms that are relatively moderate compared to the other
By Matthew Kwok
disorders
you
will/have
already
read
about.
Cyclothymia, to put it simply, causes people to have mood swings. Different ends of the mood swing spectrum include mild depression and moderate mania episodes. Keen - eyed readers will no doubt have recognized the similarities between cyclothymia and bipolar disorder, which is a lot more well - known and recognized
by
most
enthusiasts
may
also
people.
Psychology
acknowledge
that
cyclothymia is in fact a form of bipolar disorder. So what are the differences between cyclothymia and bipolar disorder? The general term “bipolar disorder” actually refers to four major forms of bipolar disorder. These are bipolar I disorder, bipolar II disorder, cyclothymic disorder, and “mixed features”, which is a coined term
for
previous
experiencing three
major
symptoms forms.
from
Most
the
people
associate bipolar I disorder (bipolar one) with the term “bipolar disorder”, which is excusable, since bipolar one is the prominent form in general society. Cyclothymia is often recognized through its milder intensity in mood fluctuations and longer lasting depressive-manic cycles, as opposed to bipolar disorder. For clinical psychologists to diagnose a person with cyclothymia, symptoms must be present for at least two years, as opposed to bipolar one, which requires one year.
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Cyclothymic Disorder
Symptoms of cyclothymia more or less coincide with the symptoms of depression and mania, since cyclothymia is technically a hybrid of the two. For the readers that are not familiar with mania, you may have heard students teasing others for being hyperactive and reasonably associated this as a symptom of mania, this is not the case. Mild mania includes feeling overly euphoric, increased energy levels and being highly irritable. Severe mania may even cause delusions and leave people in a delirious state, although cyclothymia does not include severe manic states. Cyclothymia is a chronic condition, which means that it is near impossible to get rid of, so treatment will be needed throughout a person’s entire life. Skipping medication may very well cause symptoms to worsen and develop into bipolar one, which gives another level of meaning to self discipline. Common treatment for cyclothymia, as you guessed it, also coincides with the treatment for mild depression and mania. Mood stabilizers and antidepressants are commonly used in combating manic episodes and depressive states. Psychotherapy is also integral in the treatment for cyclothymia. Split into cognitive behavior therapy and well-being therapy, psychotherapy aims to improve
one’s
psychological
mindset
and
replace
unhealthy behavior with positive ones. Joker would do well with some psychotherapy, all he has are negative thoughts anyways. Although cyclothymia is not as severe a mental disorder as bipolar I disorder, it’s no joke. If cyclothymia is left untreated for an extended period of time, prolonged neglect
to
depressive
and
manic
symptoms
can
increase your risk of developing bipolar one, which will increase the intensity of
your symptoms, so don’t
dismiss all warnings your body is giving you as signs of stress. Stay vigilant towards not only your mental health, but also your friends and family, and don’t forget to give them the support they need to help build up a healthy mental profile.
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Seasonal Affective Disorder ~The story of an SAD patient By Laraine Kwok Have you ever heard of Seasonal affective disorder, SAD? If you have, what pops into your mind may be those suffering in those freezing winter days, feeling gloomy and hopeless. But for me, I was diagnosed with SAD, summer depression, a few years ago. This might sound a bit weird, but summer blues are real. But there’s nothing worth pitying, at least I’ll get to enjoy the beauty of winter.. The specific reason for SAD remains unknown, but some say is because the change in season will disrupt the balance of the body's level of melatonin, which plays a role in sleep patterns and mood. Some also say that it is because where I live is near the equator, with high temperatures and uncomfortable humidity. Some other factors may include family history, gender (where women are more common to diagnose with SAD. I am quite unfortunate to discover this disease late in my life. In the first year, I experienced a loss of appetite and insomnia, which led to severe weight loss. I wanted to cry every day, and I lost my interest in things I used to enjoy. When the situation got severe, I tried suicide. I just couldn’t find the meaning of living, then why not just extricate from this torture? Once, I even tried to stand on the rooftop of my building, swinging my legs from the perch on the railing, precariously balanced 40 stories above the ground. As I looked at the view, I asked myself, can I end this horrible war in this beautiful city and become a free star in the universe? I wouldn’t regret anything. But would I? Turned out, I couldn’t give up my life. A security guard patrolling the building and saw me, yelling at me to come down. I was exhausted. I didn’t protest. When I reached home, my elder sister found me in my room. It was the first time I saw her shell-shocked expression, the first time she actually asked about me, the first time I went to see the doctor. He gave me a body check, a blood test, asked me loads of questions about my symptoms, thoughts and behaviours… To be honest, I was terrified at that time since I didn’t know what kind of disease dominated my mind. After I was diagnosed with SAD, I didn’t know how to feel. I blamed myself, for not realising the seriousness of my disease. At the same time, I was grateful for therapy and mental support from my family. PAGE 11
In order to prevent other cases like mine happening to unaware kids, I’ll share three therapies I had over the years which I found really useful. Firstly, I took darkroom therapy. Instead of light therapy, patients with summer seasonal affective disorder should spend more time in dark rooms as it is believed that summer depression is connected to sunlight, indicating that the patients should spend more time in a dark environment to make alleviate the disease. Timing of light exposure during the day is important for successful treatment, so I decided to go to the cinema for at least one day per week. At first, I was terrified by the mere notion of staying in a dark place but, luckily, my sister accompanied me for the whole movie and I kind of enjoyed the cinema after a few months. My SAD also got better then. Secondly, I chose the medical treatment, an extended-release version of the antidepressant bupropion which will help prevent depressive episodes in people with a history of SAD. My doctor recommended me to start treatment with an antidepressant before my symptoms typically begin each year. I had to try loads of different medicines at first and, trust me, they weren’t delicious at all. It took me several weeks to notice full benefits from an antidepressant, and I had a super hard time sticking to the disgusting medicine. However, I found the best medicine for me which has the least side effects on me, and I’m taking regular doses of it now. It helped my SAD a lot and I regained my positive attitude towards life, got more sleep and increased my appetite. Thirdly, is the psychotherapy, also called talk therapy. It helps you identify and change negative thoughts and behaviours that may be making you feel worse. If you feel insecure or scared talking to a random stranger about your deepest fears, don’t be. I also felt that way at first and my mom had to literally drag me to the psychotherapy centre. But the psychotherapist helped me a lot on the road towards recovery. Individually, I tried on some mind-body techniques to try to help cope with SAD, for example, yoga, meditation and music therapy. I also had to practice stress management as unmanaged stress can lead to depression, unhealthy thoughts or behaviours. Although it is hard for me to social, I will also participate in different programs in winter, which will help me expand my social circle. This will benefit when I’m feeling down so that they can offer support, which is really helpful. Before my symptoms are getting worse, my doctor will also suggest me to take a trip to cooler locations to make me feel better. With these treatments, I’m starting to feel better and better, no matter on how to handle my situations or manage my behaviours. When days past, I started to feel grateful: at least I’m just suffering from SEASONAL affective disorder, not long-term depression. And from now on, whenever I’m suffering from this huge burden, I’ll just tell myself: This season too shall past!
PAGE 12
“ I F
YOU
WANT
HAP P Y,
T O
B E
B E . "
TRAUMA-INDUCED DEPRESSION By Charmaine Wong Leo Tolstoy, a great Russian writer once said, “If you want to be happy, be." Have you ever heard people saying something similar to you? Or you said this to others with good intentions? But does it help people who are in a depression? Is it that simple to be happy? You may agree that everyday life is a roller coaster of emotions. You may feel super high when you get a good grade from your tests, but the next minute you could be down because of a little argument with your best friend. These are just normal emotions. But if someone is encountering a serious change in mood that disrupts life activities, it may be a symptom of mood disorder. Depression is one kind of mood disorder. Depression is a very complicated disease. No one knows the exact causes of depression. But usually, it can be triggered by several reasons, according to a study. Some people experience depression during a serious medical illness. Others have a family history of depression. Those who do may experience depression and feel overwhelmed with sadness and loneliness for no known reason. I would like to talk about those who experience depression after trauma. This kind of depression is called trauma-induced depression. PAGE 13
Trauma-induced depression can be caused by both one-off and ongoing events. A one-off event could be an accident, natural disaster, or an attack. On-going trauma can result from relentless stressful events such as childhood sexual, emotional or physical abuse. Responses can include feeling numb, changing emotions such as shock, denial, guilt or self-blame, increased use of alcohol or drugs and repeating memories or bad dreams about the trauma etc. People with trauma-induced depression may be constantly watchful or jumpy. Their sleep is often disturbed, and they may feel irritable and angry with themselves and others. Memory, concentration and decision-making are often affected.
It’s a pity to see people suffer from such depression. They could be very capable people in society, well educated, with good social status. They could be able to earn a high income and make a great contribution to society. Their lives turned upside down after certain tragedies, for example, losing their beloved family members, being kidnapped and tortured etc. Just because of the trauma, the victims would become severely depressed. Many people would feel sympathetic to them and would love to offer their helping hands. But what can we do? One of the ways is to learn Psychology and become a psychotherapist in the future to help these people directly. To bring them back to their normal life, to help them get out of the trap caused by trauma, and to resume their activities as before. Unfortunately, no one is immune to trauma or depression. If a loved one has gone through a traumatic experience and/or is experiencing depression, it’s important to act in a proactive, compassionate way. So how can we deal with depression? There are some general cures to trauma-induced depression. There are a lot of options, such as medication, talking therapies and counselling etc. PAGE 14
Here are some other things to help others cope. We can listen to our loved ones patiently and try to help. When someone expresses their feelings to you, we should truly listen to what they’re saying. If they mention suicide at all, we shall always take it seriously. We should guide them to seek professional help immediately. Secondly, showing our support to them is important. We should try our best to be understanding, compassionate and encouraging. We can invite them to do some meaningful events to distract them. We should always put ourselves into their shoes and give as kindhearted feedback as possible. With your passion, let’s go hand in hand with those victims who are in depression and particularly those in trauma-induced depression to leave the darkness of life behind! References 1. https://www.webmd.com/depression/guide/causes-depression#1 2. https://depression.org.nz/the-causes/trauma/ 3. https://www.mentalhealth.org.nz/get-help/a-z/resource/45/post-traumatic-stress-disorder 4. https://genesight.com/trauma-induced-depression-3-ways-to-cope/
Thanks for reading this to the end (if you actually did read it) and go spend your day productively, children.
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