Chapter 9

Mood Disorders

Symptoms of Depression

Cognitive

Poor concentration, indecisiveness, poor self-esteem, hopelessness, suicidal thoughts, delusions

Physiological and Behavioral Emotional

Sleep or appetite disturbances, psychomotor problems, catatonia, fatigue, loss of memory Sadness, depressed mood, anhedonia (loss of interest or pleasure in usual activities), irritability

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Depression versus Dysthymia

Major Depression
Number of symptoms

Dysthymic Disorder 3 or more symptoms including depressed mood

5 or more symptoms including sadness or loss of interest or pleasure At least 2 weeks in duration

Duration

At least 2 years in duration

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Chapter 9

Depression and Dysthymia

Dysthymia more chronic than depression (never more than 2 months without depressed mood). When combined with major depression, may be referred to as Double Depression. High levels of comorbidity associated with dysthymia and depression.

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Subtypes of Depression
Depression with Melancholic Features (loss of pleasure, anorexia, guilt) Depression with Psychotic Features (hallucinations, delusions) Depression with Catatonic Features (lack of movement or extreme agitation) Depression with Atypical Features (positive emotional experiencing) Depression with Postpartum Onset Depression with Seasonal Patterns
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Prevalence and Prognosis

Among adults, 15-to-24-year olds are most likely to have had a major depressive episode in the past month. Depression is less common among children than among adults. Depression may be most likely to leave psychological and social scars if it occurs initially during childhood, rather than during adulthood.

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Bipolar Disorder

Characterized by manic episodes.

Elevated, expansive, or irritable mood Inflated self-esteem or grandiosity Decreased need for sleep More talkative than usual Flight of ideas Distractibility Increase in activity directed at achieving goals Excessive involvement in dangerous activities (risk taking)
Less severe than mania Less interference with functioning

Hypomania

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Bipolar Disorder

Bipolar I Disorder
Mania Likely (although not necessarily) will experience major depression episodes (MDE) May also experience periods of hypomania in between manic episodes

Bipolar II Disorder
MDE necessary for diagnosis No manic episodes Hypomanic episodes

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Bipolar Disorder

Cyclothymia

Alternates between episodes of hypomania and dysthymia (or moderate depression).

Rapid cycling bipolar disorder

4 or more cycles of mania and depression within a year Often given to individuals with borderline personality disorder INACCURATELY

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Bipolar Disorder: Prevalence

Less common than unipolar depression Approximately 1% lifetime prevalence No gender differences Most likely to develop in late adolescence or early adulthood

Can it be diagnosed in children?

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Chapter 9

Risk of Bipolar Disorder

70 60
Percent with bipolar disorder

50 40 30 20 10 0
MZ twins DZ twins Sibs, parents, Biological children parents of BP adoptees Seconddegree relatives General population

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Biological Theories

Genetics
Strong genetic component to bipolar disorder. Concordance rate (probability both twins will develop a disorder) is 60% among MZ twins.

Neurotransmitter Dysregulation

Monoamine theory of depression and bipolar disorder:

Norepinephrine, Serotonin, and Dopamine (all found in limbic system of the brain regulates sleep, appetite, and emotions) Type of imbalance determines the disorder (high sensitivity mania, insensitivity depression) May be state-dependent
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Biological Theories

Brain structural abnormalities

Amygdala enlargement

May bias people towards aversive or emotionally arousing information, leading to rumination and increased contact with negative environmental cues.

Neuroendocrine factors:
Sensitivity and hyperactivity of the HPA axis (hypothalamic pituitary adrenal axis) Inability to return to baseline May inhibit monoamine receptors

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Psychological Theories

Behavioral theories:
Learned helplessness Lewinsohn limited contact with positively reinforcing aspects of the environment

Cognitive theories:

Causal attributions (reformulated learned helplessness theory)

Internal vs. External Stable vs. Unstable Global vs. Specific

Internal, stable, and global attributions worse

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Chapter 9

Psychological Theories

Ruminative Response Style

Intense focus on internal experience to the exclusion of everything else. Focus occurs without any attempt to do anything to aversive internal states.
Connected depression to the grief process Individuals may be responding to real or imagined abandonment and/or rejection Individuals at risk for depression are overly concerned with the approval of others. Introjected hostility
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Psychodynamic Theories

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Treatment

Behavioral
Behavioral scheduling Behavioral activation May take an interpersonal bent focus on the patients behavior with others (including therapist)

Cognitive
Focusing on restructuring maladaptive thoughts and rigid attributions about the world and the self. Eventually target depressive schemas and core beliefs (e.g., I am unlovable).

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Relapse

Relapse common in depression

Teasdale, Segal, and Williams suggest that this is due to fusion with thoughts We believe our thoughts. Therefore, the presence of any depressive thought is an immediate sign that full-blown depression is not far away. Treatment focused on increasing metacognitive awareness awareness of thoughts as thoughts.

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