Ch7 Psyc 451 Student

Mood Disorders–Chapter 7 Barlow and Durand

Mood Disorders

Major Depressive Episode An extremely depressed mood state that lasts at least 2 weeks and includes  Cognitive Symptoms – 

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Physical Symptoms –

Major Depressive Episode Every action requires an overwhelming effort  Loss of Interest  No pleasure in life (anhedonia)  Average untreated duration is 9 months 

Manic Episode 

Mania –

Find extreme pleasure in every activity  Extraordinarily active  Require very little sleep  Grandiose plans 

Manic Episode Believe they can accomplish anything  Rapid Speech  Flight of ideas  Criteria – 

Irritability near end of episode  Duration untreated – 

Hypomanic Episode 

Less severe than manic episode

Unipolar Disorders 

A person experiences either depression or mania

Bipolar Disorders 

A person experiences BOTH deviations of depression and mania

Major Depressive Disorder – Single Episode 

The occurrence of just 1 episode in a lifetime is rare

Major Depressive Disorder Recurrent 2 or more major depressive episodes occur and are separated by at least 2 months of no depression  Otherwise symptoms are same for both Major Depressive Disorder – Single Episode and Major Depressive Disorder - Recurrent 

Stats on Depressive Disorders 

Major Depressive Disorder – Recurrent usually has a family history unlike those with single episodes

Stats on Depressive Disorders Median number of Major Depressive Episodes in a lifetime is 4  Median Duration is  Mean age of onset is 

Stats on Depressive Disorders Born before 1905 only 1% have a depressive episode by age 75  Born since 1955 6% have a depressive episode by age 24 

Dysthymic Disorder Many of the same Sx of Major Depressive Disorder, but milder  Course of disorder lasts for long periods of time unchanged – 

Dysthymic Disorder Persistently depressed mood that continues for at least 2 years and patient has not been symptom free for more than 2 months at a time  Many with dysthymia will eventually develop major depressive disorder 

Dysthymic Disorder 53% recover at some point but 45% of those will relapse  Dysthymia more likely to attempt suicide than Major Depressive Disorder 

Dysthymic Disorder If onset is before age 21 it is associated with  Greater Chronicity  Poor Treatment Prognosis 

Double Depression Dysthymia and Major Depressive Disorder co-occurring  79% of those with dysthymia also had major depressive disorder at some point 

Bipolar Disorders 

Mania Alternates with Depression

Cyclothymic Disorder Milder version of Bipolar Disorder, but symptoms last much longer  More chronic  Much like dysthymia is to major depression  Not severe enough to reach criteria for full mania or major depressive episodes 

Cyclothymic Disorder 

Criteria –

Bipolar II Disorder Major Depressive Episodes alternate with Hypomanic Episodes rather than full Manic Episodes  Average age of onset is  10-13% will 

Bipolar I Disorder Criteria is the same as for Bipolar II Disorder  However, individual experiences FULL manic episodes  There must be 2 month periods of no symptoms between cycling of the episodes (otherwise episodes are seen as continuations of the last) 

Statistics on Bipolar Disorders 

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These individuals often will not admit they have a problem (especially in the manic state) When they get into a manic stage the high is so wonderful they often stop taking their meds 1/3 of cases begin in adolescence Rare to develop after age 40 Chronic

Statistics on Bipolar Disorders

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Usually can be managed with meds Suicide is very common (almost always occurs in a Depressive Episode) 17% attempt suicide –

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24% attempt suicide –

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12% attempt suicide –

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Defining Criteria of Mood Disorders 

There is a great diversity within mood disorders so we use specifiers

6 Specifiers of Most Recent Episode 

Atypical features – individuals consistently oversleep and overeat during episodes of major depressive disorder or dysthymia and gain weight.

6 Specifiers of Most Recent Episode  Melancholic

Features – Full criteria of Major Depressive Episode must be met – includes also some of the more severe somatic Sx (early morning awakenings, weight loss, loss libido, excessive and inappropriate guilt, anhedonia)

6 Specifiers of Most Recent Episode 

Chronic Features – Must have met criteria for Major Depressive Episodes for past 2 years continuously.

6 Specifiers of Most Recent Episode 

Catatonic Features – Applies to Major Depressive Episodes and Manic Episodes. They are very rare. A total absence of movement or catalepsy –

6 Specifiers of Most Recent Episode 

Psychotic Features – Hallucinations and Delusions. Can apply to Major Depressive Episodes or Manic Episodes. Delusions can be mood congruent, incongruent, or of grandeur

6 Specifiers of Most Recent Episode 

Postpartum Onset – Applies to Major Depressive Episodes and Manic Episodes. Severe manic episodes or major depressive episodes of a psychotic nature that occur during postpartum period (4 weeks following childbirth)

3 Specifiers for Course of Mood Disorders 

Applies to recurrent episodes only

3 Specifiers for Course of Mood Disorders 

Longitudinal –

3 Specifiers for Course of Mood Disorders 

Rapid Cycling –

3 Specifiers for Course of Mood Disorders 

Seasonal Pattern –

Seasonal Affective Disorder (SAD) Mood co-occurs with seasons  Usually depression in the winter and mania in the summer  5% of North Americans  Research has shown the differences in prevalence based on the differences in sunlight (2% in Florida vs. 10% in New Hampshire) 

Treatment for Seasonal Affective Disorder 

Phototherapy – light exposure tends to be helpful in many cases.

Prevalence of Mood Disorders 

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Woman are twice as likely to develop Major Depression and Dysthymia Bipolar Disorders tend to occur evenly across gender Major Depressive Disorder and Dysthymia are much more common among whites and Hispanics than blacks

Mood Disorders and Children and Adolescence  

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Can occur Fundamentally similar in adults and children Vulnerable to low Depressive Disorders are less frequent in children than adults, but more frequent in adolescence than in adults

Mood Disorders and Children and Adolescence In young children dysthymia is more common than major depression, but major depression is more common in adolescence than dysthymia  Children under 9 present with irritability and emotional swings rather than classic manic states and are often mistaken as hyperactive 

Mood Disorders and Children and Adolescence Mood Disorders tend to be more chronic in children whereas they are more episodic in adults  Boys tend to become aggressive and destructive during periods of depression and often get misdiagnosed with conduct disorders or ADHD 

Mood Disorders and the Elderly      

18-20% develop major depression Associated with marked sleep difficulties, hypochondriasis, agitation Looks like physical illness or dementia The Prevalence of mood disorders is less in elderly than in the general population Depression in the elderly is comorbid often with anxiety disorders Here the sex ratio for depression becomes balanced again

Mood Disorders Across Cultures Varies in somatic complaints from culture to culture  Expression and subjective feelings are often shown in different ways 

Anxiety and Depression

Causes of Mood Disorders?

Causes of Mood Disorders?

Causes of Mood Disorders?      

Sleep and Circadian Rhythms Decreased slow wave sleep (deepest sleep) Enter REM sleep too quickly and is overly intense Depriving patients of sleep during the 2nd half of the night improves their condition temporarily Increased sensitivity to light (Greater suppression of melatonin) Insomnia can trigger mania

Causes of Mood Disorders? Psychological Causes  Stressfull life events tend to precipitate the first of recurrent episodes 

Psychological Causes of Mood Disorders Learned Helplessness – Martin Seligman  If rats can control shocks they’re fine, if they can not they get the animal equivalent of depression 

More Learned Helplessness

Psychological Causes of Mood Disorders Negative Cognitive Styles  Making the worst of everything  Set-backs are catastrophes  Aaron Beck 

Negative Cognitive Styles Cont. Arbitrary Inference – Depressed individuals emphasize the negative rather than the positive in all situations  Overgeneralizations – 

Negative Cognitive Styles Cont. 

Cognitive Triad

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Negative Schema – look at everything negatively

Social and Cultural Causes   

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Marital Relations In marital relations it is much more likely for men to develop mood disorders Women – women appear to be more susceptible to developing all mood disorders except Bipolar Disorders This is consistent across the world Lack of social support facilitates depression

Best Approach to Determining Causes 

INTEGRATE ALL THEORIES!!!

Treatments for Mood Disorders 

Meds –

For Depressive Disorders  Tricyclic Antidepressants – (Tofranil, Elavil) – Relieves 65-70% - but are lethal if taken in large doses so clinicians must be very careful with suicidal patients 

Antidepressants Cont. 

Monoamine Oxidase Inhibitors (MAOIs) –

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Serotenergic Reuptake Inhibitors (SSRIs) – (Fluoxetine, Prozac) –

Meds for Bipolar Disorders Lithium  Mood Stabilizer  Treats Bipolar Disorders  Dosages must be exact and very careful or can be lethal  Weight Gain  66% helped 34% relapse  Depakote is most recent form 

ECT – Electroconvulsive Therapy Shock Therapy  When someone does not respond to meds  Patients are anesthetized  Given muscle relaxing drugs  Shock directly through the brain for less than 1 second in duration 

ECT – Electroconvulsive Therapy     

Produces a seizure and several minutes of convulsions Once every other day for 6-10 treatments Few Side Effects Short term memory loss and confusion which subsides in a week or two Relapse rate is 60%

Psychosocial Treatments for Mood Disorders (Depressive) Cognitive Therapy  15-20 sessions once per week  Highly structured  Automatic Thoughts  Correct Cognitive Errors  Substitute less depressive and more realistic thoughts 

Psychosocial Treatments for Mood Disorders (Depressive) 

Interpersonal Psychotherapy (IPT)

Preventing Relapse Cognitive therapy has a 50% less relapse rate than drugs alone  Integrate techniques – situation specific 

Psychosocial Treatment for Bipolar Disorder Lithium is preferred  Family therapy has been used 

Suicide Statistics 30,000 people per year in the US alone  8th leading cause of death in the US  Actual number is 2-3 times higher  Adolescent rates are rising  3rd leading cause of death for teens  Females attempt 3 times more than males 

Suicide Statistics Males are 4-5 times more likely to “commit” than females – types of attempts are more fatal  Males tend to use guns/hang  Females tend to overdose or cut wrists 

Suicide Terms 

Suicide attempt –

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Suicidal Ideation –

Suicide Risk Factors

Suicide Risk Factors Has the person created a plan?  Are they giving away possessions?  Have they taken precautions against being discovered? 

MHP Suicide Plan of Action 

If a MHP can not get a person to sign a “no suicide” contract or they have doubts about the sincerity at the time of signing and the risk is high then hospitalization is required even against the will of the patient