Mood Disorders

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• Mood Disorders
• Descriptions of Diagnoses
• Unipolar Disorders
• Major Depression, Dysthymia
• Bipolar Disorders
• Bipolar I, Bipolar II, Cyclothymia
• Causal models explaining depression
• Treatments
• Suicide risks, prevention

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Mood Disorders

• A group of disorders in which mood is unusually
  high (mania) or low (depression)

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Two General Types of Mood Disorders

• Unipolar
• one polar mood
• depression
• Bipolar
• two polar moods
• fluctuating between periods of depression and
  mania

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Unipolar (Depressive) Disorder

• Major depressive disorder
• at least two weeks of depressed mood or loss of
  interest in everyday activities, plus additional
  symptoms
• Dysthymic disorder
• at least two years of depressed mood for more
  days than not, accompanied by signs of depression
  less severe than those of major depressive
  disorder

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Facts About Depressive Disorders

• Between 8 to 20 percent of population will
  experience a major depressive episode
• 100 million new cases each year
• Women more than twice as likely as men to be
  diagnosed
• Womens depressive episodes more severe, last
  longer, recur more frequently than mens episodes
• Native American, Southeast Asian cultures have
  higher rates

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Characteristics of a Major Depressive Episode

• Sleep disturbances Low self esteem
• Eating disturbances Helplessness
• Anhedonia Hopelessness
• Sad mood Guilt
• Various aches/pains Self-blame
• Loss of interest in sex Pessimism

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DSM-IV Criteria for Major Depressive Episode

• Five or more of following symptoms present during
  two-week period, representing change from
  previous functioning
• depressed mood most of day, most every day as
  indicated by self or others
• diminished interest or pleasure in most all
  activities of the day, most days
• significant weight loss when not dieting,
  decrease in appetite most days
• insomnia, hypersomnia every day

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• psychomotor agitation, retardation mostdays
• fatigue, loss of energy every day
• feelings of worthlessness, excessive guilt
• diminished ability to think, concentrate
• recurrent thoughts of death, suicidal
  ideation, suicide attempts
• At least one symptom is depressed mood or loss of
  interest or pleasure
• Symptoms cause distress or impairment in
  functioning are not the result of medical
  condition or substance abuse

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Major Depressive Disorder

• Presence of a single or multiple major depressive
  episodes
• Is not better accounted for by another disorder
• There has never been a manic episode

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Diagnostic Specifiers

• With catatonic features odd motor disturbance
• With psychotic features includes severe
  delusions
• Melancholic loss of interest in pleasurable
  activities
• Postpartum onset within four weeks of
  childbirth
• Seasonal mood disorder associated with a
  particular season (usually winter)

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Dysthymic Disorder

• Chronic, relatively mild, depressive disorder
• Lasts at least two years, but may last decades

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DSM-IV Criteria for Dysthymic Disorder

• Depressed mood most of day, for more days than
  not, for at least two years
• Presence of two or more of the following
• poor appetite, overeating
• insomnia, hypersomnia
• low energy, fatigue
• low self-esteem
• poor concentration, difficulty making
  decisions
• feelings of hopelessness
• Has not been without symptoms for more than two
  months during two-year period

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Bipolar Disorder

• Episodes of elevated mood (mania) alternating
  with periods of depression

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Bipolar Disorders

• Bipolar I disorder
• one or more manic or mixed episodes
• usually one or more major depressive episodes
• Bipolar II disorder
• recurrent major depressive episodes
• at least one hypomanic episode

• Cyclothymic disorder
• frequent mood swings
• hypomanic symptoms alternating with mild
  depression over a period of two years
• may be mixed with normal moods

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Facts About Bipolar Disorder

• One in 100 develop bipolar disorder
• Men and women equally likely to be diagnosed
• No marked ethnic differences
• Higher rather than lower socioeconomic groups
  diagnosed more often
• 15 percent diagnosed with depression go on to
  experience mania
• Signs usually appear in early adulthood
• Onset typically sudden

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Mania

• Period of elevated mood
• Feeling high or excited
• Grandiosity
• Irritability
• Belief of unusual abilities
• Flight of ideas
• Decreased need for sleep
• Heightened sex drive
• Rapid speech

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Hypomania

• Elated mood
• Little need for sleep
• Intense periods of activity

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Mixed Episode

• Display of manic symptoms while having a
  depressed mood

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DSM-IV Criteria for Manic Episode

• Distinct period of abnormally, persistently
  elevated, expansive, irritable mood, lasting at
  least one week
• During period, three or more symptoms persist
• inflated self-esteem, grandiosity
• decreased need for sleep
• more talkative than usual, perceived
  pressure to keep talking
• flight of ideas
• distractibility
• increase in goal-directed activity
  (socially,work, school, sexually)
• excessive involvement in pleasurable activities
  high potential for negative consequences

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DSM-IV Criteria for Manic Episode

• Severity of mood disturbance sufficient to cause
  impairment in functioning in usual activities,
  necessitate hospitalization, have psychotic
  features

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Causes of Mood Disorders

• Genetics
• Psychosocial factors

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Genetic Factors

• Looks for prevalence in immediate families
• Reviews twins, adoption studies
• Concordance rates for MDD
• Identical twins 79
• Fraternal twins 24
• Looks for genetic markers

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Possible Psychosocial Factors

• Psychoanalytic views
• Behavioral views
• Cognitive views
• Learned helplessness
• Interpersonal and social support

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Cognitive Views

• Cognitive Triad Negative views of self, world,
  future
• COMMON DYSFUNCTIONAL ATTITUDES
• Logical errors in thinking contributing to
  depression
• Arbitrary Inference drawing a conclusion in the
  absence of evidence to support it or when
  evidence is contrary
• Selective abstraction focusing on a detail taken
  out of context while ignoring other information

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Cognitive Views

• Overgeneralization drawing a general rule from
  one or more incidents and applying it to all
  situations
• Magnification/Minimization errors in evaluating
  the significance of an event magnify negative
  events, minimize positive ones
• Personalization relating external events to
  oneself even if they have nothing to do with you
• Absolutistic, dichotomous thinking 2 opposite
  categories

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Learned Helplessness

• Inescapable situations lead to lack of action
  once control is again possible
• Original research examined dogs in laboratory
  situation with electrified grid on floor of cage
  under inescapable and later escapable conditions

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Reformulated Theory of Learned Helplessness

• Attributions are explanations for why things
  happen
• Dimensions Global vs. Specific
• Internal vs. External
• Stable vs. Unstable
• Depressed persons tend to make internal, stable,
  global attributions for negative events
• Depressogenic Attributional Style

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Treatments of Mood Disorders

• Biological treatments
• drug treatment
• electroconvulsive therapy
• Psychological treatments
• psychoanalytic, interpersonal treatment
• cognitive-behavioral treatment

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Medication Treatments of Mood Disorders

• Have mechanisms of action by influencing
  neurotransmitter availability in the brain
• Bipolar Disorder Lithium carbonate
• - usually quite successful, but often patients
  stop using medications because they enjoy the
  manic phase

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Medication Treatments for Major Depressive
Disorders

• MAO Inhibitors
• - earliest form of treatment
• - serious side effects due to interaction
  with common foods
• - only used as last resort when other
  medications fail today

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Medication Treatments for Major Depressive
Disorders

• Tricyclic antidepressants
• - Examples Elavil, Tofrinil
• - Generally effective, but must build
• up a therapeutic level and
• typically take 2-4 weeks to see
• an effect on mood or behavior

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Medication Treatments for Major Depressive
Disorders

• Selective Serotonin Reuptake Inhibitors
• (known as SSRIs)
• - Example Prozac
• - Generally effective, but must build
• up a therapeutic level and
• typically take 2-4 weeks to see
• an effect on mood or behavior
• - Often preferred over Tricyclics because
• there are fewer side effects

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Electroconvulsive Therapy (ECT)

• Used as a treatment for severe depression (thats
  unresponsive to medication)
• Administered more humanely than in the past
  (muscle relaxant, anesthesia)
• Serious side effect includes memory loss

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Psychological Treatments

• Interpersonal treatment
• examine ways in which present social behavior
  prevents the person from forming satisfactory
  interpersonal relationships
• Cognitive-behavioral treatment
• identifies self-critical and negative thoughts
  and attempts to change them make behavioral
  changes
• Evidence suggests that combined psychological and
  medication interventions are usually most
  effective.

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Facts About Suicide

• 30,000 suicide deaths per year in U.S.
• Common among young people (under 25) and older
  people (over 60)
• Divorced, widowed, and single people have higher
  rates
• Sometimes linked to alcohol abuse

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Facts About Suicide

• Highest rates for Native Americans and whites
• At risk are college students, African American
  young males, homosexuals
• More men than women succeed at suicide
• men use more lethal means (firearms, hanging)
• women use less lethal means (pills, gas)

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Causes of Suicide

• Psychological disorders
• Alcohol abuse
• Sociocultural factors
• Psychological factors
• Genetics, physiology

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Prevention and Treatment of Suicide

• Crisis intervention
• Psychological interventions
• Primary and secondary prevention
• Reducing access to means
• Postvention

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Adjustment Disorder with Depressive Features

• Typical reaction to a stressful life circumstance
  if feelings dissipate within six months
• Called a transient reaction to a stressful
  circumstance