1. Chapter 10 Mood Disorders

2. Mood Disorders
Mood Disorders involve a disabling disturbance in emotion
Depression is an emotional state marked by
Sadness or loss of pleasure
Feelings of worthlessness and guilt
Withdrawal from others
Reduced sleep, appetite, sexual desire
Mania is an emotional state marked by
Intense elation
Hyperactivity, talkativeness, distractability
Ch 10.1

3. Diagnosis of Unipolar Depression
Unipolar depression diagnosis requires presence of 5 of the following:
Sad, depressed daily mood
Loss of interest in usual activities
Difficulties in sleeping
Poor appetite and weight loss
Loss of energy, great fatigue
Negative self-concept
Recurrent thoughts of suicide or death
Ch 10.2

4. Depression Issues Depression exists on a continuum
Major depression is quite common
Lifetime prevalence rates range from 5.2% to 17.1%
Women are twice as likely to develop depression as are men
Higher rates in young adults and among individuals in lower socioeconomic groups.
Depression prevalence varies across cultures
Prevalence of depression has been increasing over the last 50 years
Ch 10.3

5. Diagnosis of Bipolar Disorder
Bipolar disorder involves
Alternating episodes of mania and depression
Increase in activity level (work, social, sexual)
Unusual talkativeness, rapid speech
Reduced requirements for sleep
Inflated self-esteem
Distractability
Reckless spending
Ch 10.4

6. Chronic Mood Disorder
Chronic Mood Disorder refers to long-term changes in mood that are less severe than that of unipolar or bipolar depression
Cyclothymic disorder refers to frequent periods of depressed mood and hypomania
Dysthymic disorder involves chronic depression
-Recent studies suggest dysthymia may be more
debilitating over the long term than depression.
Ch 10.5

7. Depressive Disorders Major Depression Clinical Description
Extremely Depressed Mood
Lasting at Least 2 Weeks
Cognitive Symptoms
Anhedonia
Vegetative Symptoms
Single or Recurrent Episode
No Manic or Hypomanic Episodes

8. Depressive Disorders
Major Depression
Clinical Description
2 Weeks or More

9. Depressive Disorders Major Depression Facts and Statistics
Mean Age of Onset is 25 Years
Length of Episode Varies
Remission is Common
Risk of Suicide

10. Depressive Disorders
Dysthymia
Clinical Description
2 Years or More

11. Depressive Disorders Dysthymia Facts and Statistics
Mean Age of Onset Early 20s; Symptoms can persist unchanged over long periods (e.g., 20 years or more)
Onset Prior to Age 20
Greater Chronicity
Poor Prognosis
Stronger Family Link
Major Depressive Episodes are Common

12. Depressive Disorders Double Depression Clinical Description
Suffer From Both
Major Depression Episodes
Dysthymic Disorder
Dysthymic Usually Begins First
Associated With Severe Pathology
A Problematic Future Course

13. Depressive Disorders Double Depression Clinical Description Dysthymia
Major
Depression

14. Bipolar Disorders Major Features Experience Both
Manic Episodes
Major Depressive Episodes
Roller Coaster of Mood
What are Manic Episodes?

15. Bipolar Disorders Mania and Hypomania 1 Week 4 Days Elevated Mood
Grandiosity
4 Days
Increased Activity
Varied Impairment

16. Bipolar Disorders: Bipolar I Clinical Description
Major Depressive Episodes
Alternate With
Full Manic Episodes

17. Bipolar Disorders: Bipolar I Clinical Description Mania Major
Depression

18. Bipolar Disorders: Bipolar II Clinical Description
Major Depressive Episodes
Alternate With
Hypomanic Episodes
Only 10 to 13% of cases progress to full bipolar I disorder

19. Bipolar Disorders: Bipolar II Clinical Description Hypomania Major
Depression

20. Bipolar Disorders: Cyclothymia Clinical Description
Milder Depressive Episodes
Alternate With
Hypomanic Episodes
Average age of onset is about 12 or 14 years
Cyclothymia tends to be chronic and lifelong
Most are female
High risk for developing bipolar I or II disorder

21. Bipolar Disorders:
Cyclothymia
Clinical Description
Hypomania
Dysthmia

22. General Facts and Statistics
Bipolar
Disorders
General Facts and Statistics
Bipolar I
Onset Around 18 Years
Bipolar II
Onset Around 22 Years
16% Commit Suicide
Cyclothymia
Typically Chronic

23. Recent Episode and Pattern
Feature Specifiers
in Mood Disorders
Recent Episode and Pattern
Psychotic
Hallucinations and Delusions
Very Rare but Serious Condition
Poor Treatment Response

24. Recent Episode and Pattern
Feature Specifiers
in Mood Disorders
Recent Episode and Pattern
Postpartum
Major Depression and Mania
Four Weeks Following Birth
Mood Episodes of a Psychotic Nature
Relatively Rare

25. Specifiers Describing Course Course and Pattern Longitudinal Course
Rapid-Cycling
Seasonal Pattern
Bipolar and Recurrent Major Depression
Episodes During Certain Seasons

26. Mood Disorders: Facts and Prevalence Facts and Statistics
7.8% Lifetime Prevalence
Females > Males
Major Depression and Dysthymia
Females = Males
Bipolar Disorders
Similar in Children and Adults

27. Psychological Theories of Depression
Psychoanalytic theory views grief over object loss as the basis for depression
Cognitive views of depression include
Beck’s theory of depression: the way depressed people think is biased towards negative interpretations
Learned helplessness: depressed people are passive because they have been unable in the past to control traumatic events
Ch 10.6

28. Depression and Positive Emotion
Depressed individuals:
Display fewer positive expressions
Report experiencing less pleasant emotion in response to pleasant stimuli
Physiologically less responsive to positive, but not negative, stimuli

29. Mood Disorders: Psychological Causes Negative Cognitive Biases
Beck’s Cognitive Triad
Negative Schema About
Self,
World,
& Future

30. Cognitive Biases in Depression
Arbitrary influence refers to a conclusion drawn in the absence of sufficient evidence
Selective abstraction refers to a conclusion drawn on one of many elements in a situation
Overgeneralization refers to an overall sweeping conclusion drawn on a basis of a trivial event
Magnification of trivial events
Ch 10.7

31. Learned Helplessness
Learned helplessness view is that depression is a response to a history of failing to control traumatic life events
The Attribution-Learned helplessness view is that depressed people make global, stable and internal attributions
Hopelessness view is that depressed persons expect that desired outcomes will not occur, their actions will have no effect
Ch 10.8

32. Mood Disorders: Psychological Causes Stressful Life Events
Learned Helplessness
Attributional Style
Internal attributions – Negative outcomes are one’s own fault
Stable attributions – Believing future negative outcomes will be one’s fault
Global attribution – Believing negative events will disrupt many life activities
All three domains contribute to a sense of hopelessness

33. Helplessness Theories of Depression
Ch 10.9

34. Mood Disorders: Social & Cultural Dimensions
Marriage and Interpersonal Relationships
Marital dissatisfaction is strongly related to depression
This link is particularly strong in males
Gender Imbalances
Occur across all mood disorders, except bipolar disorders
Gender imbalance likely due to socialization (i.e., perceived uncontrollability and more rumination in women)
Social Support
Extent of social support is related to depression
Presence of social support delays onset of depression
High expressed emotion and/or family conflict predicts relapse
Substantial social support predicts recovery from depression but not from mania

35. Interpersonal Theory of Depression
Interpersonal relations are altered in depression
Depressed people have limited social support networks
Depressed people elicit rejection from others
Depressed people are low in social skills across a wide variety of situations
Depressed people seek reassurance from others, but this reassurance is temporary
Ch 10.10

36. Biological Theories of Mood Disorder
Genetic factors for bipolar disorder are supported by adoption, family and twin studies
The role of genetic factors in unipolar depression is not as strong as bipolar disorder
Neurochemistry studies link norepinephrine (NE) to mania/depression and serotonin (5-HT) to depression
Ch 10.11

37. Biological Dimensions
Mood Disorders:
Biological Causes
Biological Dimensions
Family Studies
Twin Studies
As Severity Increases, so Does the Genetic Connection
No Single Genetic Link

38. Mood Disorders: Biological Causes Sleep and Circadian Rhythms
Sleep Disturbances are Common
REM Sleep and Depression
Diminished Deep Sleep
Disruption of Circadian Rhythms

39. Neurochemistry of Mood Disorders
Tricyclic drugs and MAO inhibitors relieve depression and increase levels of NE and 5-HT by blockade of reuptake
Measurement of NE/5-HT metabolites in urine and blood does not assess brain activity
CSF levels of 5-HIAA (5-HT metabolite) are related to depression
Relief of depression takes 2 weeks or longer, but NE and 5-HT levels may have to previous state
Ch 10.13

40. Integrative Model of Mood Disorders
Shared Biological Vulnerability
Overactive neurobiological response to stress
Exposure to Stress
Activates hormones that affect neurotransmitter systems
Turns on certain genes
Affects circadian rhythms
Activates dormant psychological vulnerabilities (i.e., negative thinking)
Contributes to sense of uncontrollability
Fosters a sense of helplessness and hopelessness
Social and Interpersonal Relationships/Support are Moderators

41. Therapies for Mood Disorders
Psychoanalysis is not an effective treatment for depression
Beck’s cognitive-behavioral approach involves changing thought patterns and activity levels
Beck’s approach is an effective therapy for depression
Behavioral activation component may be crucial
Social skills training involves improving social interactions so as to lift depression
Ch 10.14

42. Psychological Treatment of Mood Disorders
Cognitive Therapy
Addresses cognitive errors in thinking
Also includes behavioral components (“activation”)
Behavioral Activation
Involves helping depressed persons make increased contact with reinforcing events
Interpersonal Psychotherapy
Focuses on problematic interpersonal relationships
Outcomes with Psychological Treatments Are Comparable to Medications

43. Biological Therapies for Mood Disorders
Electroconvulsive therapy (ECT) involves the induction of brain seizures by the application of electrical current to the skull
ECT is an effective therapy for severe depression, but its mechanism of action is unknown
Drug therapy involves ingestion of tricyclic drugs, MAO inhibitor drugs and selective serotonin reuptake inhibitor (SSRI) drugs, or mood stabilizers (e.g., Lithium, Tegretol, Depakote, Topamax) for bipolar disorder
Ch 10.15

44. Treatment of Mood Disorders: Lithium
Percentage of patients with bipolar disorder recovered after standard drug treatment or
drug treatment plus family therapy (Miklowitz et al., 2001; from Barlow/Durand, 3rd. Edition)

45. Psychological Treatment of Mood Disorders: Relapse Prevention
Data from Teasdale (2000) study on patients treated with severe depression (from Barlow/Durand, 3rd. Edition)

46. Suicide Suicide is the intentional ending of one’s own life
Suicide is often related to depression, to drug use and to borderline personality disorder
Suicide is the 9th leading cause of death in the US
There are gender differences in the methods of suicide (men choose guns, women choose drugs)
Ch 10.16

47. Deadlier Side of Mood Disorders: Suicide In the United States
300,000 Kill Themselves
9th Leading Cause of Death
Increasing in Adolescents & Elderly
Males > Females in Killing Themselves
Females > Males in Attempts

48. Ten Commonalities of Suicide
The common purpose of suicide is to seek a solution
The common goal of suicide is the cessation of consciousness
The common stimulus in suicide is intolerable psychological pain
The common stressor in suicide is frustrated psychological needs
The common emotion in suicide is hopelessness-helplessness
The common cognitive state in suicide is ambivalence
The common perceptual state in suicide is constriction
The common action in suicide is egression
The common interpersonal act in suicide is communication of intention
The common consistency in suicide is with lifelong coping patterns
Ch 10.17

49. Suicide Myths People who talk about suicide won’t do it
Suicide has no warning
Only people of a certain class commit suicide
All who commit suicide are depressed
Suicide is a lonely event
Suicidal people clearly want to die
Thinking about suicide is rare
Ch 10.18

50. The Nature of Suicide: Risk Factors
Suicide in the Family Increases Risk
Low Serotonin Levels Increase Risk
A Psychological Disorder Increases Risk
Alcohol Use and Abuse
Past Suicidal Behavior Increases Subsequent Risk
Experience of a Shameful/Humiliating Stressor Increases Risk
Hopelessness is a strong predictor of suicide (Beck et al.)
Publicity About Suicide and Media Coverage Increase Risk

51. Preventing Suicide Reduce the intense psychological pain and suffering
“Lift the blinders” (expand the constricted view by helping the person see other options other than the extremes of continued suffering or nothingness)
Encourage the person to pull back even a little from the self-destructive act.