chapter 6 - mood disorders

7/31/2019 Chapter 6 - Mood Disorders

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Chapter 6

Mood Disorders


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Categories of Mood Disorders

Depressive disorders

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Bipolar disorders

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:D :(


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Five Mood Disorders:

Major Depressive Disorder

Dysthymic Disorder/Dysthymia

Bipolar I Disorder Bipolar II Disorder

Cyclothymia/Cyclothymic Disorder


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Major Depressive Episode

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 (restlessnessor sluggishness)

Fatigue or loss of energy nearly every day

Feelings of worthlessness or excessive or inappropriate guilt nearlyevery day

Diminished ability to think or concentrate, or indecisiveness, nearlyevery day

Recurrent thoughts of death (not just fear of dying); recurrent suicidalthoughts without a specific plan; a suicide attempt; or a specific plan

for committing suicide

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


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Depressive Disorders

Major Depressive Disorder: one or more majordepressive episode (and no history of mania)

Postpartum Onset

Seasonal Pattern; Seasonal AffectiveDisorder

Psychotic features


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Depressive Disorders

Dysthymic Disorder:

1. At least two years of symptoms, including moredays 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


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Manic Episode

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 workor school, or sexually) or psychomotor agitation Excessive involvement in pleasurable activities that have

a high potential for painful consequences (e.g., engagingin unrestrained buying sprees, sexual indiscretions, or

foolish business investments)

A period of time in which elevated, expansive, or notably

irritable mood is present, lasting for at least one week. Theremust be impairment in occupational, social, educational orother important functioning. Three or more of the followingsymptoms must be present:


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Hypomanic Episode

A period of time in which elevated,expansive, or notably irritable mood ispresent, lasting for at least four days

At least three of the symptoms of manialisted in the criteria for Manic Episode


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Bipolar Disorders

Bipolar I: The occurrence of one or moremanic episode or mixed episode

Bipolar II: The occurrence of at least onehypomanic episode and at least one majordepressive episode

Cyclothymia: At least two years ofalternating between periods of hypomaniaand dysthymic mood


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Suicide

There is a greatly increased risk with allmood disorders.

The most increased risk is with Major

Depressive Disorder. Women are almost twice as likely toattemptsuicide.

Men are four to five times more likely tocomplete suicide.

Highest rate of suicide is among elderlywhite males


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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


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Biological Components

Genetic predisposition Heritability rates

Bipolar has veryhigh heritability (85%); 70%

concordance rate for MZ twins Neurotransmitters

Monoamine hypothesis

Too little of neurotransmitter?

Postsynaptic receptor sensitivity?


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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 ofcortisolin depressed patients

Inducing depression-like symptoms in animals usingcortisol


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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


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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


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Cognitive Intervention

Becks Cognitive Therapy Challenge and substitute negative

automatic thoughts

Behavioral activation


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Psychological Factors:Behavioral Theories of Depression

Interruption of reinforcement fromenvironment Poor social skills

Environment

Diminished capacity to enjoyreinforcement/heightened sensitivity to

negative events Behavioral Intervention:

Behavioral Activation Therapy


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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

chapter 6 - mood disorders

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