Mood disorders pt 2 (MOST IMPORTANT)

Manic episode DSM criteria

• Elevated, expansive or irritable mood and increased goal-directed activity or energy

• three or more of the following

  • Grandiosity

  • Decreased need for sleep

  • More talkative

  • Racing thoughts/ideas

  • distractibility

  • Increase in goal directed activity or psychomotor agiation

  • High involvement in high risk activities

Bipolar disorder 1

• Usually major depressive episodes and always full manic episodes

• Previously known as manic depression

Bipolar disorder 2

• Usually major depressive episodes

• Hypomanic episodes

  • Min 4 days

  • Less severe mania

• There has never been a manic episode

• More seasonal variation

Cyclothymic disorder

• Chronic alteration of mood elevation and depression that does not meet severity of manic or major depressive episodes

• At least 2 years

Rapid cycling disorder

• Specifier of bipolar 1 and 2

• At least 4 depressive/manic episodes in a year (any mix but can’t be one type)

Bipolar disorders: onset and duration

• Bipolar 1: 18

• Bipolar 2: 22

  • Both can begin in childhood

• Very rare to develop after 40

• Chronic and suicide is a common consequence of these disorders

Developmental influences of depressive and bipolar disorders

The elderly:

• Symptoms of depression are skyrocketing in older people → caused by lack of integration into communities and lower birth rates (which means older people don’t get as much care)

Across cultures

• Higher rates of depression in individualistic cultures

Among the creative

• Bipolar disorders are more prevalent among creative people

Causes of mood disorders: bio

• There is joint heritability of anxiety and depression (why they are quite comorbid)

• Neurotransmitter systems

  • Cortisol, neurohormones

• Sleep and circadian rythms

  • More intense REM sleep, reduction of deep sleep

Proband

the first individual identified in a study or family who has the condition being investigated. They are essentially the starting point for examining patterns of a disorder among groups/families.

Causes of mood disorders: Psychological dimensions

• Stressful life events

• learned helplessness

  • Lack of perceived control of their life

  • Depressive attributional style: internal, stable, and global

• Negative cognitive styles

  • Negative cognitions about the Depressive cognitive triad: selves, immediate world, future

    • “I am worthless”, “the world is cruel”, “Things will never get better”

Causes of mood disorders: social and cultural dimensions

• Marital dysfunction

• Women have more disorders because:

  • Feelings of loss of control

  • Value of social relationships are higher (so if they go poorly they will be affected more)

  • Rumination

  • Poverty and abuse

• Lack of social support

Causes of mood disorders: Integrative theory

Treatment for mood disorders pt 1

Medications:

• Tricyclics, MAOI’s, SSRI’s (antidepressants)

• Lithium - mood stabilizer

Electroconvulsive therapy

Transcranial magnetic stimulation:

• Localized electromagnetic pulse

Treatment for mood disorder pt 2

Psychosocial treatments:

• Cognitive therapy

• Interpersonal therapy - combined treatments

  • Psychosocial + medication

• Preventing relapse - mindfulness-based cognitive therapy

Suicide components

• Suicidal ideation

• Suicidal attempts

  • Parasuicides/None suicidal self injury

• Suicide completion

• Psychological autopsy

  • investigation into a deceased person’s mental state, behavioral patterns, and life stressors

Suicide risk factors

family history

• Strong predictor

Neurobiology

• Low serotonin

Psychological disorders

• Estimated 90% of completed suicides; mood disorders, alcohol use disorder; borderline PD

Stressful life events

Suicide treatment

• Problem-solving CB interventions

• Coping-based interventions

• Stress reduction techniques