Mood Instability

Question 1

Define mood instability

Answer 1

Rapid oscillations of intense affect, with difficulty in regulating these oscillations or their behavioural consequences

Question 2

Name at least 3 disorders which feature mood instability

Answer 2

Bipolar disorder, borderline personality disorder, ADHD, PTSD

Question 3

What percentage of patients with depression or anxiety disorders have mood instability? (Marwaha et al, 2013)

Answer 3

40-60%

Question 4

When does the incidence of mood instability peak? (Marwaha et al, 2013)

Answer 4

16-24

Question 5

State some consequences of mood instability

Answer 5

Poor clinical outcomes, suicidal thoughts, increased use of healthcare services, self-harm, addiction

Question 6

State the 2 traditional ways of measuring mood instability

Answer 6

Self-report scales of trait constructs and clinician-rated assessments

Question 7

Give a disadvantage of self-report scales for mood instability

Answer 7

They are retrospective, and hence can be affected by memory biases

Question 8

Describe the True Colours system for rating mood instability

Answer 8

Patients are sent a weekly email or text-reminder to self-report their symptoms using mood rating scales. Patients are then sent mood graphs so that they can understand fluctuations in their mood, and how those correlate with other symptoms (e.g. lack of sleep)

Question 9

Describe how the MoodZoom app could differentiate between borderline personality disorder and bipolar disorder (Tsanas et al, 2016)

Answer 9

Borderline personality disorder caused greater overall variability and more irritability than bipolar disorder

Question 10

Give 2 advantages of app-based mood monitoring (Scwartz et al, 2016)

Answer 10

Collects more data so more sophisticated mathematical models can be applied, more convenient and user-friendly than conventional questionnaires

Question 11

Give a disadvantage of app-based mood monitoring (Faurholt-Jepsen et al, 2016)

Answer 11

While it seems to be valid in depression, it may not be in mania

Question 12

Describe the emotional processing biases in bipolar disorder

Answer 12

Patients have negative memory biases, and prospectively perceive greater instability in their depressive and manic symptoms

Question 13

Describe the neural correlate of emotional processing biases in bipolar disorder

Answer 13

Patients have abnormalities in reciprocal connectivity between the amygdala and other areas of the brain - increased connectivity between the ventromedial prefrontal cortex and amygdala, but decreased connectivity between the anterior cingulate cortex and amygdala

Question 14

Describe the difference in brain activity between bipolar disorder patients and healthy controls during emotion processing

Answer 14

Inferior frontal cortex activity is less in bipolar disorder patients than healthy controls, but anterior cingulate cortex activity increases

Question 15

Name 2 brain networks which are dysfunctional in bipolar disorder

Answer 15

Central executive network (involved in functional control) and salience network (involved in emotion regulation)

Question 16

Describe the relationship between affective lability and brain activity in those at-risk of developing bipolar disorder (Bertocci et al, 2017)

Answer 16

Worsening affective lability is associated with increased amygdala and ventrolateral prefrontal cortex activity

Question 17

Define mental imagery

Answer 17

Perceptual information accessed from memory, allowing ‘seeing with the mind’s eye’ or ‘hearing with the mind’s ear’ etc.

Question 18

Describe the relationship between mental imagery and depression

Answer 18

Depression is associated with negative intrusive images of past events and a lack of positive mental imagery

Question 19

Describe the relationship between suicide and mental imagery

Answer 19

Suicide can be associated with flash-forward images of the act of suicide or the aftermath (e.g. seeing others at one’s funeral)

Question 20

Describe the relationship between social anxiety and mental imagery

Answer 20

It features embarrassing mental images, such as seeing oneself from the outside bright red and sweaty

Question 21

Describe the relationship between bipolar disorder and mental imagery (Bonsall et al, 2012)

Answer 21

Bipolar disorder is associated with higher levels of intrusive negative prospective imagery, and higher levels of intrusive future imagery correlating with higher levels of anxiety and depression in unstable bipolar disorder