MOOD DISORDERS

1

• MOOD DISORDERS
• Historical perspective
• Galen bodily fluids and temperament
• black bile and melancholia
• Endogenous vs. reactive depression
• Neurotic vs. psychotic depression

2

• MOOD DISORDERS
• Diagnostic issues
• DSM-IV lists 10 mood disorders
• Major depressive disorder
• Dysthymic disorder
• Bipolar I
• Bipolar II
• Cyclothymic disorder
• Rapid cycling depression/mania
• Seasonal affective disorder
• Mood disorder with postpartum onset
• Mood disorder due to general medical condition
• Substance-induced mood disorder

3

• MOOD DISORDERS
• Diagnostic issues
• a number of specifiers (e.g., severity,
  chronicity) are used in diagnosis
• Two broad categories unipolar and bipolar
• Two important criteria in diagnosis duration
  and severity

4

• MOOD DISORDERS
• Diagnostic issues Types of symptoms
• mood and emotion
• cognitions
• behavior and motivation
• physical
• the experience of depression

5

• MOOD DISORDERS
• Unipolar disorders Major depression
• symptoms include feelings of sadness, loss of
  interest or inability to experience pleasure,
  unexplained weight loss, difficulty sleeping,
  fatigue, difficulty concentrating, feelings of
  worthlessness or guilt, suicidal thoughts,
  agitation or slowing down
• typically lasts 6-9 months

6

• MOOD DISORDERS
• Unipolar disorders Major depression
• estimates suggest about 5 of Americans suffer
  from depression (1-year prevalence rate) 22
  lifetime prevalence for major depression
• twice as common in women biological
  differences, expression of symptoms, social
  acceptability, role strain and stress
• estimates are that half of people who recover
  from major depression will experience another
  episode those with 2 or more episodes have
  70-80 chance of having another episode

7

• MOOD DISORDERS
• Unipolar disorders Major depression
• Problem of underdiagnosis
• no obvious marker for depression
• many symptoms do not obviously point to
  depression
• stigma associated with diagnosis of depression

8

• MOOD DISORDERS
• Unipolar disorders Dysthymia
• many of the same symptoms as major depressive
  disorder, but less severe
• dysthymia persists for at least 2 years with
  only brief times mood returns to normal chronic
  sadness

9

• MOOD DISORDERS
• Bipolar disorders Mania
• flamboyance and expansiveness
• extreme or prolonged mania presumed to be
  psychotic state
• less severe episodes are called hypomanic
• some people experience mania as a high
• there can be unipolar mania

10

• MOOD DISORDERS
• Bipolar disorders Bipolar I and II
• Bipolar I one or more manic episodes and one
  or more depressive episodes
• Bipolar II at least one hypomanic episode and
  one or more episodes of major depression
• Bipolar disorders less prevalent than unipolar,
  .8-1.6 of population
• age of onset in 20s
• Rapid cycling depression/mania 4 or more
  episodes per year

11

• MOOD DISORDERS
• Bipolar disorders Cyclothymia
• long-standing pattern of alternating mood
  episodes that do not meet criteria for major
  depression or mania
• criteria include duration of at least 2 years
  with recurrent periods of mild depression
  alternating with hypomania

12

• MOOD DISORDERS
• Bipolar disorders Seasonal Affective Disorder
  (SAD)
• vulnerable to changes in sunlight, especially
  fall and spring
• prevalence rates of 4-6, found more often in
  northern latitudes
• many SAD symptoms opposite of those found in
  major depression increase in appetite, weight
  gain, more sleep

13

• MOOD DISORDERS
• Bipolar disorders Seasonal Affective Disorder
  (SAD)
• hormone melatonin
• photoherapy

14

• MOOD DISORDERS
• Etiology Psychological models
• Psychodynamic fixation at oral stage
• mourning and melancholia introjection of lost
  loved one, anger turned inwards
• Depressive personality
• Attachment Bowlby, anaclitic depression,
  introjective depression

15

• MOOD DISORDERS
• Etiology Psychological models
• Cognitive Beck negative cognitive triad
• negative schemata
• cognitive distortions selective abstraction,
  arbitrary inference, overgeneralization,
  magnification and minimization

16

• MOOD DISORDERS
• Etiology Psychological models
• Learned helplessness and causal attributions
  Seligman
• Life stress especially loss experiences
• Interpersonal effects marital violence,
  expressed emotion (EE)
• 3 components of EE criticism, hostility,
  overinvolvement

17

• MOOD DISORDERS
• Etiology Biological models
• Genetics first degree relatives of people with
  unipolar disorder have 30-35 prevalence rate for
  depression second degree relatives, 12-15
  prevalence rate
• Twin study (McGuffin et al., 1991) Concordance
  rates of 53 for MZ twins, 28 for DZ for
  unipolar disorder

18

• MOOD DISORDERS
• Etiology Biological models
• Twin study (Bertelsen et al., 1977)
  Concordance rates of 67 for MZ twins, 20 for DZ
  for bipolar disorder
• Neurotransmitter deficiencies catecholamines
  (NE and serotonin)
• Monoamine hypothesis shortage of NE, dopamine,
  and serotonin

19

• MOOD DISORDERS
• Etiology Biological models
• EEG findings higher alpha readings in left
  front region
• Sleep disturbances decrease in slow wave sleep
  and earlier onset of REM
• MRI and PET studies show increased ventricle
  size and decreased activity in left lateral
  prefrontal cortex

20

• MOOD DISORDERS
• Treatment Psychological models
• Depression often improves without treatment
• Cognitive therapy
• Behavioral strategies
• Interpersonal therapy

21

• MOOD DISORDERS
• Treatment Biological models
• Antidepressant therapy MAOs, tricyclics,
  selective serotonin reuptake inhibitors (SSRIs)
• Mood stabilizers lithium carbonate for bipolar
• Combining pharmacotherapy and psychological
  therapy
• ECT a controversial treatment

22

• MOOD DISORDERS
• SUMMARY
• Mood disorders are very common mental disorders,
  yet they often go undetected and untreated
• There are gender differences in rates of
  diagnosed depression

23

• MOOD DISORDERS
• SUMMARY
• The 2 main types of mood disorder are unipolar
  and bipolar
• Within these 2 categories there are wide
  differences in severity and duration of symptoms
• Biopsychosocial model appears to give the best
  account of mood disorders

24

• MOOD DISORDERS
• SUMMARY
• but, not much on the social origins of
  depression
• Bipolar appears to have a stronger biological
  component than unipolar disorders
• There are effective psychological and biological
  treatments for the different mood disorders