Chapter 6

Mood Disorders

Categories of Mood Disorders

Depressive disorders
:(

Bipolar disorders
:D :D :(

Five Mood Disorders:

Major Depressive Disorder Dysthymic Disorder/Dysthymia Bipolar I Disorder Bipolar II Disorder Cyclothymia/Cyclothymic Disorder

Major Depressive Episode

Five of the following symptoms for two weeks, with at least one of them being depressed mood or loss of interest or pleasure

Depressed mood most of the day, nearly every day

Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day Significant weight loss or weight gain/decrease or increase in appetite Insomnia (inability to sleep) or hypersomnia (sleeping too much) nearly every day Psychomotor agitation or retardation nearly every day (restlessness or sluggishness) Fatigue or loss of energy nearly every day Feelings of worthlessness or excessive or inappropriate guilt nearly every day Diminished ability to think or concentrate, or indecisiveness, nearly every day Recurrent thoughts of death (not just fear of dying); recurrent suicidal thoughts without a specific plan; a suicide attempt; or a specific plan for committing suicide

Depressive Disorders
Major Depressive Disorder: one or more major depressive episode (and no history of mania) Postpartum Onset Seasonal Pattern; Seasonal Affective Disorder Psychotic features

Depressive Disorders
Dysthymic Disorder: 1. At least two years of symptoms, including more days than not of depressed mood 2. While depressed, at least two of the following: A. Feelings of hopelessness. B. Impairment in cognitive functioning C. Loss of appetite or overeating D. Low levels of energy or fatigue E. Low self-esteem F. Problems with sleep

Manic Episode
A period of time in which elevated, expansive, or notably irritable mood is present, lasting for at least one week. There must be impairment in occupational, social, educational or other important functioning. Three or more of the following symptoms must be present: Inflated self-esteem or grandiosity Decreased need for sleep Excessive talking, pressured speech Flight of ideas, racing thoughts Extreme distractibility Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

Hypomanic Episode
A period of time in which elevated, expansive, or notably irritable mood is present, lasting for at least four days At least three of the symptoms of mania listed in the criteria for Manic Episode

Bipolar Disorders
Bipolar I: The occurrence of one or more manic episode or mixed episode Bipolar II: The occurrence of at least one hypomanic episode and at least one major depressive episode Cyclothymia: At least two years of alternating between periods of hypomania and dysthymic mood

Suicide
There is a greatly increased risk with all mood disorders. The most increased risk is with Major Depressive Disorder. Women are almost twice as likely to attempt suicide. Men are four to five times more likely to complete suicide. Highest rate of suicide is among elderly white males

Mood Disorder Demographics

Age Depression often manifests differently in children and elderly. Unipolar depression: typically in 20s or 30 Bipolar: typically earlier onset Gender Bipolar: approximately equal Depression: Women>Men Genetic/Biological Social/Environmental

Biological Components
Genetic predisposition
Heritability rates Bipolar has very high heritability (85%); 70% concordance rate for MZ twins

Neurotransmitters
Monoamine hypothesis
Too little of neurotransmitter? Postsynaptic receptor sensitivity?

Biological (continued)
Structural Findings
Increased activation in amygdala Decreased volume of prefrontal cortext Decreased volume of hippocampus

Neuroendocrine System
HPA Axis (Hypothalamus, Pituitary, Adrenal)
High blood levels of cortisol in depressed patients Inducing depression-like symptoms in animals using cortisol

Biological Interventions: Depression

Pharmacological (Drugs) For Depression: Tricyclics Monoamine Oxidase Inhibitors (MAOIs) SSRIs For Bipolar: lithium dangers anticonvulsants antipsychotics Electroconvulsive Therapy (ECT) Differences between original and modern methods

Psychological Factors: Cognitive Theories of Depression

Seligman Learned Helplessness Explanatory Style Chicken or Egg? Longitudinal study Becks Cognitive Theory Negative Cognitive Triad The self, world, future Cognitive Distortions

Cognitive Intervention
Becks Cognitive Therapy Challenge and substitute negative automatic thoughts Behavioral activation

Psychological Factors: Behavioral Theories of Depression

Interruption of reinforcement from environment
Poor social skills Environment Diminished capacity to enjoy reinforcement/heightened sensitivity to negative events

Behavioral Intervention:
Behavioral Activation Therapy

Social Components
Contributors:
Lack of social support High Expressed Emotion in family

Intervention:
Interpersonal Psychotherapy (IPT)
Incorporates aspects of multiple perspectives Structured, goal-oriented, relatively short