Mood disorders Involve disabling disturbances in emotion DSM-IV recognises two broad types of mood disorders ; – Involve only depressive symptoms – Involve manic symptoms (bipolar disorders)
Mood disorder diagnoses Depressive Disorders Diagnostic CriteriaBipolar Disorders Diagnostic Criteria Major depressive disorder Sad mood or loss of pleasure for 2 weeks, along with at least 4 other symptoms Bipolar I disorder At least one lifetime manic or mixed episode Dysthymic disorder Mood is down and other symptoms are present at least 50% of the time for at least 2 years Bipolar II disorder At least one lifetime episode of hypomania and episodes of major depression Cyclothymic disorder Recurrent mood changes from high to low, without hypomanic or manic episodes for at least 2 years
Depressive disorders Profound sadness and/or inability to experience pleasure Physical symptoms – fatigue, low energy, physical aches and pains Exhaustion, lack of sleep, loss of appetite Psychomotor retardation or psychomotor agitation Social withdrawal
Major depressive disorder (MDD) Depressive symptoms present for at least 2 weeks Must include depressed mood (or loss of interest/pleasure) and at least 4 additional symptoms, changes in; sleep, appetite, attention, feelings of worthlessness, suicidal tendencies, psychomotor agitation or retardation Episodic disorder Tend to recur (average is 4)
Dysthymia Chronic depression More than half of the time for at least 2 years In addition – at least two other symptoms of depression. 16.4% population (USA) meet criteria for MDD, 2.5% meet criteria for dysthymia MDD is x2 common in women Both MDD and dysthymia comorbid; anxiety disorders, substance-related disorders, sexual dysfunctions, personality disorders.
Bipolar disorders DSM-IV-TR recognises 3 forms; Bipolar I disorder, Bipolar II disorder, cyclothymia Bipolar – people who experience mania tend to experience depression also Depression and mania = two opposite poles
Mania Intense elation or irritability accompanied by Flight of ideas Comes on suddenly over a day or two Mixed episodes
DSM-IV-TR Criteria for Manic and Hypomanic Episodes Distinctly elevated or irritable mood. At least 3 of the following (4 if mood irritable); Increase in goal-directed activity or physical restlessness Unusual talkativeness; rapid speech Flights of ideas or subjective impression that thoughts are racing Decreased need for sleep Inflated self esteem Distractibility Excessive involvement in pleasurable activities likely to have undesirable consequences Manic Episode:Hypomanic Episode; Symptoms last for 1 week or require hospitalization Symptoms cause significant distress or functional impairment Symptoms present for at least 4 days Functioning is different but not markedly impaired
Bipolar I disorder – A single episode of mania or a single mixed episode – Very rare, less than 1% population, high suicide rates, – One of the most severe mental illnesses Bipolar II disorder – Must have experienced at least one major depressive episode and one period of hypomania – 4% population, high suicide rates, Cyclothymia – Symptoms present for at least 2 years – Frequent but mild symptoms of depression alternating with mild symptoms of mania – 4% population
Anxiety disorders Anxiety = apprehension over a certain problem Fear = reaction to immediate danger Anxiety and fear = adaptive Anxiety disorders (high levels or frequent anxiety) – Phobias (specific and social) – Panic disorder – Generalised anxiety disorder (GAD) – Obsessive-compulsive disorder (OCD) – Posttraumatic stress disorder (PTSD)
Phobias Disruptive fear of a particular object or situation that is out of proportion to the danger posed Specific phobia = caused by presence of specific object or situation e.g. spiders, flying Social phobia = persistent, unrealistic fear of social situations
Panic disorder Frequent panic attacks which are unrelated to specific situations Worry about future panic attacks Panic attack = sudden attack of intense apprehension, terror and feelings of impending doom, laboured breathing, heart palpitations, nausea, chest pain, dizziness.
Generalised anxiety disorder Persistent worry – often about minor things Persistent worry – excessive, uncontrollable, long lasting Symptoms need to be present for at least 6 months
Obsessive-compulsive disorder (OCD) Characterised by persistent and uncontrollable thoughts or urges (obsessions) and the need to repeat certain acts over and over (compulsions) Obsessions intrusive and recurring thoughts, uncontrollable, usually appear irrational, interfere with normal activities Most frequent; contamination, sexual or aggressive impulses, body worries Compulsions Repetitive, clearly excessive behaviour, feels driven to perform in order to reduce the anxiety caused by obsessive thoughts Fears dire consequences if act is not performed Frequency with which such acts are performed can be staggering
Obsessive-compulsive disorder (OCD) Neurobiological Factors – Orbitofrontal cortex, caudate nucleus (part of the basal ganglia), anterior cingulate
Obsessive-compulsive disorder (OCD) Psychological Factors 1.Compulsions o Behavioural factors o Operantly conditioned responses o Cognitive factors o Lack of confidence in memory 2.Obsessions o Intrusive thoughts - normal o But, why are they persistent in OCD to cause distress o Thought suppression?
Posttraumatic Stress Disorder (PTSD) Childhood experiences of trauma, people with other anxiety or depressive disorders, high neuroticism, women High levels of brain activity in the amygdala Severity of the traumatic event is important
Posttraumatic Stress Disorder (PTSD) Neurobiological Factors – Patients with PTSD = smaller hippocampus volume – Hippocampus = emotional memories Psychological Factors – Coping More likely to develop PTSD if people cope with a trauma by trying not to think about it More likely to develop PTSD if individual experiencing dissociation at the time of trauma Dissociation and memory suppression help to maintain PTSD High levels of intelligence Strong social support
Summary Mood disorders – Depressive disorders – Manic disorders Types, characteristics, diagnosis Anxiety disorders – Phobias, panic disorder, GAD General characteristics – OCD and PTSD General characteristics Neurobiological and psychological factors
Revision Quiz – what’s the diagnosis? Case 1 – Jan, 42, business executive, offered exciting new job promotion in Florida, considering turning down the job after seeing a documentary entitled ‘Snakes in Florida’ Case 2 – Maureen, 30, accountant, over the past few years has become increasingly socially withdrawn, afraid to go to the supermarket in case she sees anyone she knows.