Chapter 10 Mood Disorders

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

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

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

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

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

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

Depressive Disorders Major Depression Clinical Description 2 Weeks or More

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

Depressive Disorders Dysthymia Clinical Description 2 Years or More

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

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

Depressive Disorders Double Depression Clinical Description Dysthymia Major Depression

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

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

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

Bipolar Disorders: Bipolar I Clinical Description Mania Major Depression

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

Bipolar Disorders: Bipolar II Clinical Description Hypomania Major Depression

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

Bipolar Disorders: Cyclothymia Clinical Description Hypomania Dysthmia

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

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

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

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

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

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

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

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

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

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

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

Helplessness Theories of Depression Ch 10.9

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

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

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

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

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

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

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

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

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

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

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)

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

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

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

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

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

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

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.