1. DISORDERS OF MOOD CHAPTER 6

2. 2 DISORDERS OF MOOD 2 KEY EMOTIONS: DEPRESSION: LOW, SAD STATE IN WHICH LIFE SEEMS DARK; ITS CHALLENGES OVERWHELMING; NO HISTORY OF MANIA MANIA: STATE OF BREATHLESS EUPHORIA OR FRENZIED ENERGY DEPRESSIONN O R M A L M O O DMANIA

3. 3 UNIPOLAR DEPRESSION “DEPRESSION” OFTEN USED TO DESCRIBE GENERAL SADNESS OR UNHAPPINESS CLINICAL DEPRESSION CAN BRING SEVERE AND LONG-LASTING PSYCHOLOGICAL PAIN THAT MAY INTENSIFY AS TIME GOES BY

4. HOW COMMON IS UNIPOLAR DEPRESSION? AROUND 8% OF ADULTS IN ANY GIVEN YEAR AS MANY AS 5% SUFFER FROM MILD FORMS AROUND 19% OF ALL ADULTS AT SOME TIME IN THEIR LIVES HIGHER AMONG POOR ONSET: ANY AGE 4

5. HOW COMMON IS UNIPOLAR DEPRESSION? WOMEN ARE AT LEAST TWICE AS LIKELY AS MEN TO EXPERIENCE SEVERE UNIPOLAR DEPRESSION LIFETIME PREVALENCE: 26% OF WOMEN VS. 12% OF MEN AMONG CHILDREN, THE PREVALENCE IS SIMILAR AMONG BOYS AND GIRLS 5

6. CRITERIA FOR A MAJOR DEPRESSIVE EPISODE 6

7. DSM-5 LISTS SEVERAL TYPES OF DEPRESSIVE DISORDERS: MAJOR DEPRESSIVE DISORDER MAJOR DEPRESSIVE EPISODE WITH NO HISTORY OF MANIA PERSISTENT DEPRESSIVE DISORDER (DYSTHYMIC DISORDER) LONGER-LASTING (AT LEAST TWO YEARS) BUT LESS DISABLING PATTERN OF DEPRESSION 7

8. DSM-5 LISTS SEVERAL TYPES OF DEPRESSIVE DISORDERS: PREMENSTRUAL DYSPHORIC DISORDER REPEATEDLY EXPERIENCE CLINICALLY SIGNIFICANT DEPRESSIVE SYMPTOMS DURING THE WEEK BEFORE MENSTRUATION DISRUPTIVE MOOD REGULATION DISORDER (CHILDREN) CHARACTERIZED BY A COMBINATION OF PERSISTENT DEPRESSIVE SYMPTOMS AND RECURRENT OUTBURSTS OF SEVERE TEMPER 8

9. STRESS AND UNIPOLAR DEPRESSION STRESS: TRIGGER FOR DEPRESSION THOSE DIAGNOSED EXPERIENCE A GREATER NUMBER OF STRESSFUL LIFE EVENTS DURING THE MONTH JUST BEFORE THE ONSET OF SYMPTOMS LOSS OF A LOVED ONE, SERIOUS THREATS TO IMPORTANT RELATIONSHIPS OR ONE’S OCCUPATIONS, SEVERE ECONOMIC OR HEALTH PROBLEMS, EVENTS INVOLVING HUMILIATION. MINOR EVENTS MAY PLAY MORE OF A ROLE IN THE ONSET OF RECURRENT EPISODES THAN IN THE INITIAL EPISODE. 9

10. GENETIC FACTORS TWIN, ADOPTION, AND GENE STUDIES SUGGEST THAT SOME PEOPLE INHERIT A BIOLOGICAL PREDISPOSITION AS MANY AS 20% OF RELATIVES ARE DEPRESSED, COMPARED WITH FEWER THAN 10% OF THE GENERAL POPULATION CONCORDANCE RATES FOR IDENTICAL (MZ) TWINS = 46% CONCORDANCE RATES FOR FRATERNAL (DZ) TWINS = 20% MAY BE TIED TO SPECIFIC GENES (SEROTONIN-TRANSPORTER GENE) 10

11. BIOLOGICAL MODEL BIOCHEMICAL FACTORS SEROTONIN AND NOREPINEPHRINE DEPRESSION LIKELY INVOLVES NOT JUST SEROTONIN NOR NOREPINEPHRINE; A COMPLICATED INTERACTION IS AT WORK, AND OTHERS MAY BE INVOLVED 11

12. BIOLOGICAL MODEL ENDOCRINE SYSTEM / HORMONE RELEASE ABNORMAL LEVELS OF CORTISOL ABNORMAL MELATONIN SECRETION DEFICIENCIES OF IMPORTANT PROTEINS WITHIN NEURONS AS TIED TO DEPRESSION 12

13. BIOLOGICAL MODEL  ANATOMY  EMOTIONAL REACTIONS OF VARIOUS KINDS ARE TIED TO BRAIN CIRCUITS  LIKELY INCLUDE PREFRONTAL CORTEX, HIPPOCAMPUS, AMYGDALA 13

14. BIOLOGICAL MODEL IMMUNE SYSTEM WHEN STRESSED, THE IMMUNE SYSTEM MAY BECOME DYSREGULATED, WHICH SOME BELIEVE MAY HELP PRODUCE DEPRESSION 14

15. WHAT ARE THE BIOLOGICAL TREATMENTS FOR UNIPOLAR DEPRESSION? USUALLY BIOLOGICAL TREATMENT MEANS ANTIDEPRESSANT DRUGS: MONOAMINE OXIDASE INHIBITORS (MAO INHIBITORS) TRICYCLICS SECOND-GENERATION ANTIDEPRESSANTS SSRI’S- SELECTIVE SEROTONIN REUPTAKE INHIBITORS SSNRI’S - SELECTIVE SEROTONIN NOREPINEPHRINE REUPTAKE INHIBITORS 15

16. 16

17. WHAT ARE THE BIOLOGICAL TREATMENTS FOR UNIPOLAR DEPRESSION? ELECTROCONVULSIVE THERAPY (ECT) CONTROVERSIAL PROCEDURE CONSISTS OF TARGETED ELECTRICAL STIMULATION TO CAUSE A BRAIN SEIZURE ~ 6 TO 12 SESSIONS SPACED OVER 2 - 4 WEEKS 17

18. WHAT ARE THE BIOLOGICAL TREATMENTS FOR UNIPOLAR DEPRESSION? BRAIN STIMULATION VAGUS NERVE STIMULATION TRANSCRANIAL MAGNETIC STIMULATION DEEP BRAIN STIMULATION 18

19. PSYCHOLOGICAL MODELS THREE MAIN MODELS: PSYCHODYNAMIC MODEL NO STRONG RESEARCH SUPPORT BEHAVIORAL MODEL MODEST RESEARCH SUPPORT COGNITIVE VIEWS CONSIDERABLE RESEARCH SUPPORT 19

20. COGNITIVE MODEL LEARNED HELPLESSNESS – (SELIGMAN) ASSERTS PEOPLE BECOME DEPRESSED WHEN THEY THINK THAT: THEY NO LONGER HAVE CONTROL OVER THE REINFORCEMENTS (REWARDS AND PUNISHMENTS) IN THEIR LIVES THEY THEMSELVES ARE RESPONSIBLE FOR THIS HELPLESS STATE 20

21. COGNITIVE MODEL  LEARNED HELPLESSNESS ATTRIBUTIONS: INTERNAL/EXTERNAL, GLOBAL/SPECIFIC, STABLE/UNSTABLE. PESSIMISTIC ATTRIBUTIONAL STYLE ASSOCIATED WITH DEPRESSION. 21

22. COGNITIVE MODEL OTHERS SUGGEST ATTRIBUTIONS LEAD TO DEPRESSION WHEN THEY PRODUCE A SENSE OF HOPELESSNESS ONE HAS NO CONTROL OVER WHAT WILL HAPPEN AND SOMETHING BAD WILL HAPPEN. INTERNAL/EXTERNAL DIMENSION NOT IMPORTANT. LIKELY NEGATIVE CONSEQUENCES WILL OCCUR AND NEGATIVE INFERENCES ABOUT THE IMPLICATION OF THE EVENT FOR THE SELF-CONCEPT. 22

23. Beck: Negative thinking BECK THEORIZES FOUR INTERRELATED COGNITIVE COMPONENTS COMBINE TO PRODUCE UNIPOLAR DEPRESSION: 1. MALADAPTIVE ATTITUDES 2. COGNITIVE TRIAD 3. COGNITIVE DISTORTIONS 4. AUTOMATIC THOUGHTS 23

24. NEGATIVE COGNITIVE TRIAD 24

25. COGNITIVE DISTORTIONS 25

26. COGNITIVE MODEL BECK: NEGATIVE THINKING BECK’S COGNITIVE THERAPY–DESIGNED TO HELP CLIENTS RECOGNIZE AND CHANGE THEIR NEGATIVE COGNITIVE PROCESSES 1. INCREASING ACTIVITIES AND ELEVATING MOOD 2. CHALLENGING AUTOMATIC THOUGHTS 3. IDENTIFYING NEGATIVE THINKING AND BIASES 4. CHANGING PRIMARY ATTITUDES 26

27. SOCIOCULTURAL MODEL PROPOSE THAT DEPRESSION GREATLY INFLUENCED BY SOCIAL CONTEXT FAMILY-SOCIAL PERSPECTIVE MULTICULTURAL PERSPECTIVE 27

28. SOCIOCULTURAL MODEL GENDER AND DEPRESSION ARTIFACT THEORY HORMONE EXPLANATION LIFE STRESS THEORY BODY DISSATISFACTION EXPLANATION LACK-OF-CONTROL THEORY RUMINATION THEORY 28

29. BIPOLAR DISORDERS PEOPLE WITH A BIPOLAR DISORDER EXPERIENCE BOTH THE LOWS OF DEPRESSION AND THE HIGHS OF MANIA MANY DESCRIBE THEIR LIVES AS AN EMOTIONAL ROLLER COASTER 29

30. CRITERIA FOR MANIA 30

31. CRITERIA FOR HYPOMANIA 31

32. BIPOLAR DISORDERS I AND II Bipolar I disorder Includes at least one manic episode More severe More dangerous More impairments socially/occupationally Bipolar II disorder Includes hypomanic episodes & depression Less severe Can be MORE competent/social 32

33. DIAGNOSING BIPOLAR DISORDERS  ~1% AND 2.6% ADULTS  EQUALLY COMMON IN WOMEN AND MEN  ONSET USUALLY OCCURS BETWEEN 15 AND 44 (~22 YEARS) 33

34. CYCLOTHYMIC DISORDER Cyclical mood swings Less severe than those of bipolar disorder Symptoms present for at least 2 years Lacking severe symptoms and psychotic features of bipolar disorder 34

35. MANIC-DEPRESSIVE SPECTRUM.

36. WHAT CAUSES BIPOLAR DISORDERS? NEUROTRANSMITTERS OVERACTIVITY OF NOREPINEPHRINE 36

37. WHAT CAUSES BIPOLAR DISORDERS? SEROTONIN: “PERMISSIVE THEORY” MAY BE LINKED TO LOW SEROTONIN ACTIVITY: LOW SEROTONIN MAY “OPEN THE DOOR” TO A MOOD DISORDER AND PERMIT NOREPINEPHRINE ACTIVITY TO DEFINE THE PARTICULAR FORM THE DISORDER WILL TAKE: LOW SEROTONIN + LOW NOREPINEPHRINE = DEPRESSION LOW SEROTONIN + HIGH NOREPINEPHRINE = MANIA 37

38. WHAT CAUSES BIPOLAR DISORDERS? ION ACTIVITY SOME THEORISTS BELIEVE THAT IRREGULARITIES IN THE TRANSPORT OF THESE IONS MAY CAUSE NEURONS TO FIRE TOO EASILY (MANIA) OR TO STUBBORNLY RESIST FIRING (DEPRESSION) 38

39. WHAT CAUSES BIPOLAR DISORDERS? BRAIN STRUCTURE BASAL GANGLIA AND CEREBELLUM NOT CLEAR WHAT STRUCTURAL ABNORMALITIES PLAY 39

40. WHAT CAUSES BIPOLAR DISORDERS? GENETIC FACTORS IDENTICAL (MZ) TWINS = 40% LIKELIHOOD FRATERNAL (DZ) TWINS AND SIBLINGS = 5% TO 10% LIKELIHOOD GENERAL POPULATION = 1 TO 2.6% LIKELIHOOD 40

41. PHARMACOTHERAPY Lithium Anti seizure, antipsychotic drugs.

42. TREATMENTS FOR BIPOLAR DISORDER: DO NOT FULLY UNDERSTAND HOW MOOD STABILIZING DRUGS OPERATE  PSYCHOTHERAPY ALONE RARELY HELPFUL  MOOD STABILIZING DRUGS ALONE ARE NOT ALWAYS SUFFICIENT  30% OR MORE OF PATIENTS DON’T RESPOND, MAY NOT RECEIVE THE CORRECT DOSE, AND/OR MAY RELAPSE WHILE TAKING IT 42

43. RATES OF MOOD DISORDERS IN WRITERS AND ARTISTS HTTP://WWW2.SUNYSUFFOLK.EDU/HANAUEJ/ABNORMAL/WEB%20PAGES/MANIC-DEPRESSION%20AND%20CREATIVITY.PDF HTTP://WWW2.SUNYSUFFOLK.EDU/HANAUEJ/ABNORMAL/WEB%20PAGES/MANIC-DEPRESSION%20AND%20CREATIVITY.PDF.