MOOD DISORDERS:

 

Diagnostic Criteria for Major Depression & subtypes—see handout.

 

Dysthymia:

Depressed mood more days than not for at least 2 years, no remission for more than 2 months, plus 2 two other symptoms.

Relapse typical w/in 2 years (even w/recovery w/in 5)

 

Double depression (not a specific disorder):

Dysthymia with major depressive episodes.

 

 

Prevalence

16% lifetime prev

Young adults have higher rates

Women 2x as likely to have mild and severe depr.

 

Less common in kids vs adults

2.5% of kids, 8.3 of adolesc.

1.7% and 8% for dysthymia

 

Adolescents more likely to be just under the bar

Girls’ rates escalate during puberty

 

Bipolar disorder-

Mania alternating with depression

 

Symptoms:

Elevated, expansive or irritable mood for at least one week plus at least 3 of these:

• Inflated self esteem or grandiosity
• Decreased need for sleep
• More talkative than usual, a pressure to keep talking
• Flight of ideas or sense of thoughts racing
• Distractibility
• Increase in activity directed at achieving goals
• Excessive involvement in potentially dangerous activities

 

Bipolar I—Mania, but depression not necessary…most will have depressive episodes.

 

Bipolar II—depressive episodes necessary for diagnosis, episodes of hypomania but not full blown manic episodes.

 

Cyclothymia—hypomania and moderate, but disruptive depression

 

4 or more cycles of mania and depression in a year=rapid cycling.

 

Lifetime course—

cycles become more frequent & closer together. 

Separated by periods of relatively normal functioning.  Typically manic right before or right after a depressive episode

 

Prevalence—

Bipolar I --1% lifetime prevalence

Bipolar II--.5% lifetime prevalence

 

Mood disorders

Etiological theories:

 

Biological

Genes—

Bipolar disorder 60% concordance in MZ twins, 13% in DZ

 

Neurotransmitters—problems correlated but not necessarily the cause of mood disorders.

 

Abnormalities in number and sensitivity of receptors for monamine neurotransmitters

 

Probably part of a complex interaction w/other chemical systems.

 

Neurophysiological abnormalities—

Neuroendocrine abnormalities—

 

Sleep—

more early REM, not enough deep sleep

 

Circadian rhythms

Sunlight & seasons

 

Psychosocial

Depression “often” (20-50%) follows from severely stressful events interacting with personal problem solving patterns.

 

Behavioral—

Reduction in positive reinforcers

Learned helplessness

 

Cognitive

Beck—negative cognitive triad of rigid, extreme, counterproductive dysfunctional beliefs

• I’m bad~the world is bad~the future is bad

 

Attribution style—pessimistic, stable global internal

 

Ruminative responses—process of thinking, noting feelings, figuring out possible causes but not doing anything about the causes…continue to ruminate

 

Psychodynamic—

Early loss

 

Interpersonal—

Attachment theory

 

Disturbances in close relationships—stemming from attachment issues

 

Decline in social support

 

Social

 

Cohort effect—different generations show different rates of depression

 

Social status—

 

Culture—

 

Mood Disorders

Treatments

 

Biological—

• SSRIs—

• Tricyclics—

• Atypical agents—

• MAOIs—

• ECT—

• rTMS—

• Vagus Nerve Stimulation—

• Light therapy for SAD

 

• Lithium for Bipolar Disorder

Also for bipolar disorder:

Anticonvulsants, Antipsychotics, Calcium channel blockers

 

Psychological Treatments

 

Behavior therapies

Behavior analysis—

Cognitive behavior therapy—blending the cognitive with behavior change

 

Interpersonal therapy—

 

Psychodynamic therapy—