Mood Disorders I (Chapter 7) March 7, 2014 PSYC 2340: Abnormal Psychology Brett Deacon, Ph.D.

Announcements Exams will be returned on Monday This unit: Mood disorders (4 classes) Spring break (3/17 – 3/21) Eating disorders (2-3 classes) Substance use disorders (4-5 classes) Exam #3 on 4/11

Mood Disorders Disorders/problems covered in this section Major Depression Bipolar Disorder Suicide

Mood Disorders Specific attention to: DSM-IV diagnostic system Causes (biological, psychological, social), including those from scientific studies and promoted in the media Treatment (biological, psychological)

Special Topics Special topics of interest in the mood disorders section: Causes of depression: myths vs. reality Effects of different causal explanations on depressed individuals Mental health screenings Why have rates of disabling depression skyrockted in the US in recent decades? Antidepressants: myths vs. reality FDA approval process Effectiveness vs. placebo Suicide risk Adverse effects Long-term effects

Mood Disorders Organization of the DSM-IV mood disorders section 1. Types of mood “episodes” – building blocks for defining mood disorders Major depressive episode Manic episode

Mood Disorders 2. Diagnostic criteria for specific mood disorders Depressive disorders – major depressive disorder, dysthymic disorder Bipolar disorder – bipolar disorder I, bipolar disorder II, cyclothymic disorder Mood disorders defined by etiology – due to medical condition or effects of a substance

Major Depressive Episode 5 or more symptoms must be met during a 2-week period Person must have at least 1 of these symptoms: (1) depressed mood most of the day, nearly every day, and (2) diminished interest or pleasure in all or almost all activities most of the day, nearly every day Other symptoms include: Significant weight loss/gain or change in appetite Insomnia or hypersomnia Psychomotor agitation or retardation Fatigue or loss of energy Feelings of worthlessness or inappropriate guilt Difficulty thinking or concentrating Recurrent thoughts of death or suicidal ideation

Major Depressive Episode Cardinal features Persistent sadness Anhedonia (loss of interest/pleasure) “Vegetative” symptoms (changes in sleep, appetite, psychomotor activity) Cognitive symptoms Psychotic features – 5%-20% of cases Hallucinations Delusions

Major Depressive Episode What does a Major Depressive Episode look like? Video clips of Barbara

Major Depressive Disorder DSM-IV diagnostic criteria: Presence of major depressive episode Episode not part of a psychotic disorder No history of manic episodes

Major Depressive Disorder Single episode vs. recurrent depression 85% have recurrent episodes Typical # episodes = 4 Typical episode duration = 4-5 months Treatment implications?

Major Depressive Disorder Lifetime prevalence = 16.1% Twice as common in women Gender differences disappear by age 65 Few differences across subcultures Mean age of onset = 25

Most Common Disorders in the National Comorbidity Survey Replication Study Kessler et al. (2005) % With Disorder

Manic Episode One-week period of elevated, expansive, or irritable mood During period, 3 or more of these symptoms: Inflated self-esteem or grandiosity Decreased need for sleep More talkative than usual or pressured speech Flight of ideas/racing thoughts Distractibility Increase in goal-directed behavior or psychomotor agitation Excessive involvement in pleasurable activities with potentially negative consequences

Mood Episodes For both major depressive and manic episodes: Symptoms cause significant distress or impairment Symptoms are not substance-induced or due to medical condition

Manic Episode What does a Manic Episode look like? Video clips of Mary

Bipolar Disorder DSM-IV diagnostic criteria: Presence of manic episode Person may or may not have a history of major depressive episodes Episode not part of a psychotic disorder

Bipolar Disorder Lifetime prevalence = 1.3% No gender differences Age of onset – Tends to be chronic

Causes of Mood Disorders Psychological influences Stressful life events – context and meanings Death of loved one Breakup of relationship More negative life events = greater risk of depression

Causes of Mood Disorders Marriage and interpersonal relationships Marital dissatisfaction strongly related to depression - particularly in men Gender imbalance Found in depression but not bipolar disorder Likely due to socialization Social support

Causes of Mood Disorders What is the typical behavior pattern for depressed people? How might this maintain or even worsen depression?

Causes of Mood Disorders Learned helplessness Lack of perceived control over life stress Some stressors are simply not controllable Poverty Family

Depressive Attributional Style Event: significant other breaks up with you. Internal vs. external attribution It’s my fault vs. we weren’t a good match Stable vs. situational attribution I’ll screw up all future relationships vs. I’ll find the right person someday Global vs. specific attribution I’ll fail at all that I do in life vs. this unfortunate circumstance doesn’t mean I be successful in other areas of my life

Causes of Mood Disorders Depressed persons engage in cognitive errors - tendency to interpret life events negatively Examples: Overgeneralization All-or-nothing thinking Cognitive triad: erroneous thinking about… Oneself Immediate world Future