Mood Disorders

Spectrum of Mood

1. depression - lowest mood

2. dysthymia

3. euthymia - neutral, positive mood

4. hypomania

5. mania - highest mood

Unipolar Disorders

mood that only goes in one direction (usually low mood)

1. Major Depressive Disorder (MDD)

2. Persistent Depressive Disorder (Dysthymia)

3. Premenstrual Dysphoric Disorder (PMDD

Bipolar Disorders

mood includes both direction (both hypomania/mania + depression)

1. Bipolar I Disorder (Manic Depression)

2. Bipolar II Disorder

3. Cyclothymic Disorder

Major Depressive Episode (how many symptoms + how long period)

At least 5 symptoms; present during the same 2-week period and represent change from previous functioning

at least one of the symptoms is

1. depressed mood

2. loss of interest or pleasure

anhedonia

lack of pleasure

(symptom of MDE)

psychomotor agitation

movement - fidgeting a lot

(symptom of MDE)

psychomotor retardation

profound slowing of speech, thought, movement

(symptom of MDE)

avolition

lack of drive

(symptom of MDE

Major Depressive Disorder (MDD)

• at least 1 major depressive episode

• no history of hypmania/manic episodes

Persistent Depressive Disorder (PDD)

A. Depressed mood for most of day; for at least 2 years (ADULTS); 1 year (ADOLESCNETS)

B. At least 2 symptoms

c. During 2 year period, individual has NEVER BEEN WITHOUT symptoms in Criteria A and B for more than 2 months at a time

D. never had a manic or hypomanic episode

Persistent Depressive Disorder symptoms

1. poor appetite or overeating

2. insomnia or hypersomnia

3. low energy or fatigue

4. low self-esteem

5. poor concentration; indecisiveness

6. feelings of hopelessness

Premenstrual Dysphoric Disorder (PMDD)

A. At least 5 symptoms present in the final week before onset of menses; start to improve within a few days after onset of menses

E. Criteria A should be confirmed by tracking system for 2 months into future

For PMDD, the symptoms must have occured for most menstrual cycles that occured in the _____ ____ (time)

past year

PMDD Symptoms 1

1.     Marked affective liability: big changes in mood – marked mood swings

2.     Marked irritability or anger or INC interpersonal conflicts

3.     Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts

4.     Marked anxiety, tension, and/or feelings of being keyed up or on edge

PMDD Symptoms 2

1.     Anhedonia: diminished interest in usual activities

2.     Poor concentration

3.     Low energy or fatigue fatigability

4.     Significant weight loss or gain; decrease in appetite

5.     Insomnia or hypersomnia

6.     Being overwhelmed or out of control

7.     Physical symptoms: breast tenderness or swelling, joint or muscle pain, sensation of “bloating”, weight gain

Manic Episode

A. Distinct period of elevated, expansive, or irritable mood; lasting at least 1 week

B. At least 3 symptoms

C. Marked impairment in social or occupational functioning, necessitate hospitalization, or psychotic features

How long must a manic episode last?

at least 1 week

Hypomanic Episode

A. Distinct period of elevated, exapansive, or irritable mood; increased energy lasting at least 4 consecutive days

B. At least 3 symptoms

C. unequivocal change in functioning that is not usual for the individual when nonsymptomatic

D. Disturbance in mood & change in functioning are observable by others

E. NOTTTTTT severe enough for marked imparirment, necessetating hospitalization, or psychotic features

7 Symptoms of Manic + Hypomanic Episodes

1.     Inflated self-esteem or grandiosity (thinking we’re special, chosen, superior)

2.     Decreased need for sleep (they haven’t slep in days but still feel energized)

3.     More talkative than usual or pressure to keep talking

4.     Flight of ideas or subjective experience that thoughts are racing

5.     Distractibility

6.     Increased goal-directed activity or psychomotor agitation

7.     Excessive involvement in risky activities that have a high potential or painful consequences

Bipolar I vs. Bipolar II

Bipolar I

• 1 manic episode

Bipolar II

• 1 hypomanic episode AND 1 major depressive disorder

Cyclothymic Disorder

A. For 2 years, person has hypomanic SYMPTOMS and depressive SYMPTOMS that do NOT meet criteria for hypomanic episode or depressive episode

B. During 2 years, hypomanic and depressive periods have been present for at least half the time and has NEVER BEEN WITHOUT symptoms for more than 2 months at a time

In Unipolar,

abnormal stress response

• HPA axis reactivity

• excess cortisol

what part of the brain shrinks in UNIPOLAR?

hippocampal shrinkage

In Unipolar,

neuroplasticity…?

LOW neuroplaticity + neurogenesis

In Unipolar,

describe the different neural response to emotional information

highetenend activity/response to negative stimuli; lower resposne to positive stimuli

In Unipolar,

neurotransmitters?

LOW serotonin, norepinephrine, dopamine

In Unipolar,

______ heritability; _____ genes

moderate heritability; many genes (one of them is S allele)

In Unipolar,

When does the genetic influence occur?

gentic influecnce occurs after puberty

In Unipolar,

Circadium Rhythm Disturbances

REM Sleep

1. shorter RED latency; ppl with depresstion enter REM sleep EARLIER in the night

2. REM is of LONGER duration

3. Shorter durations of Slow Wave Sleep (restorative) — explains why ppl w/ depression have fatigue and cogntitive issues

In Unipolar,

what do antidepressants do?

SUPRESS REM sleep

In Unipolar,

operant conditioning

inadequate or insufficient reinforcers

• because depression leads us to withdraw from activities we once enjoyed — we have losses of ppl and activities that used to reinforce us — no more reinforcers — losing opportunities for reinforcement

In Unipolar,

cognitive distortions

cogntive triad: thoughts about ourself, others (world), future

In Unipolar,

learned helplessness

belief we can’t control what’s happening to us

in Unipolar,

Attributional Style

internal/external, stable/unstable, global/specific

In Unipolar,

rumination & co-rumination

rumination: rehashing of past thoughts repeatedly, intensifying depression

co-rumination: with another person, keeping both of us stuck in depression

In Unipolar,

life events & social support

negative life events; lack of social support + resources

MDD’s 1st episode, 2nd episode and subsequent episodes

• 1st episode: brought by some sort of severe stressor

• 2nd episode: associated with a specific, identifiable event

• subsequent episodes: do NOT have identifiable stressors

How the West vs. East view Unipolar Depression

West: view depression as EMOTIONAL distress

East: view depression as PHYSICAL distress

In Bipolar,

CNS changes

CNS change: amygdala & reduced gray matter

In Bipolar,

imbalance between which two neurotransmitters?

imbalance btwn GABA and Glutamate levels

In Bipolar Disorders,

INC Glutamate —> ____ _____ —> ____

INC Glutamate —> INC excitation —> mania

In Bipolar,

INC neural sensitivity

1. at risk for manic episode after achievement

2. at risk for anger/irritability abt obstructions to a goal

In Bipolar,

______ heritability; ____ genetic predisposition

high heritability; complex genetic predisposition

In Bipolar,

Circadian Rhythm Abnormalities

GREATER RISK for manic/hypomanic episodes during time changes and timezone changes

During Manic Episode,

_____ (INC/DEC) amygdala activity; ____ (INC/DEC) prefrontal cortex PFC activity

INC amygdala activity; DEC prefrontal cortex (PFC) activity

this combo leads ot risk-taking behavior

In Manic Episode,

altered energy metabolism in which 2 structures of brian?

basal ganglia + frontal cortex

In Manic Episode,

INC glucose metabolism —> ____ (INC/DEC) energy —> ____(INC/DEC) sleep

INC glucose metabolism —> INC energy —> DEC sleep

In Manic Episode

neurotransmitters?

INC dopamine + Glutamate; DEC GABA

In Bipolar,

impulsivity due to

DEC/impaired executive functioning (PFC)

During Mania/Hypomania,

rumination

rumination contributes to lengthening the time a person spends in mania/hypomania

In Bipolar,

social rhythms

time we get out of bed, time we eat, time we talk to friends – are all out of wack (consequence of mania) + risk factors

in Bipolar,

what does CBT do to help social rhythms

CBT focuses on helping ppl get into a habit of more regular social rhythms

In Bipolar,

Gender Differences in Comorbidities

• Women;s: PTSD, ED (eating disorders)

• Men’s substance-use