CHAPTER 5 - MOOD DISORDERS

mood disturbances

signfiicant disturbances in emotion

what two types of mood disturbances are there?

unipolar depressive disorders: only depressive symptoms
bipolar disorder: also manic symptoms

what are the four unipolar depressive disorders

1) major depressive disorder (MDD)
2) persistent depressive disorder (PDD)
3) premenstrual dysphoric disorder
4) disruptive mood dysregulation disorder

major depressive disorder

5 or more depressive symptoms, including sad mood or anhedonia, of 2 weeks

persistent depressive disorder

low mood and at least two other symptoms of depression at least half of the time for 2 years

premenstrual dysphoric disorder

mood symptoms in the week before menses

disruptive mood dysregulation disorder

severe recurrent temper outbursts and persistent negative mood for at least 1 year beginning before age 10

name the three bipolar disorders

bipolar 1 disorder, bipolar 2 disorder, cyclothymia

bipolar 1 disorder

at least one lifetime manic episodeb

bipolar 2 disorder

at least one lifetime hypomanic episode and one major depressie episode

cyclothymia

recurrent mood changes from high to low for at least 2 years wihtout hypomanic or depressive episodes

depression
- symptoms

profound sadness and or. anhedonia - inability to expereince pleasure
- symptoms: negative self-focus, social withdrawal, loss of initiative, physical fatigue, sleep disturbances, appetite changes, sexual disinterest, and psychomotor changes.

when is MDD diagnosed - DSM-5 criteria

individual expereinces sad mood or anhedonia + 4 of the following for 2 weeks:
- sleeping too much or too little
- psychomotor retardation or agitation
- weight loss or change in appetite
- loss of energy
- feelings of worthlessness or excessive guilt
- difficulty concentrating or making decisions
- recurrent thoguths of death or suicide

what are recurrence rates of MDD, and in how many years

40-50% experiences an episode within 10 years

when is PDD diagnosed - DSM-5 criteria

chronic depressed mood for most of the day on more than half of the days for at least 2 years, with at least 2 of the following:
- sleeping too much or too little
- poor appetite or overeating
- low energy
- poor self-esteem
- trouble concentrating or making decisions
- feelings of hopelessness

prevalence rate MDD and PDD
men or women?
SES
age of onset of MDD

prevalence MDD is 16.2% and prevalence PDD is 5%
both are twice as common in women than men
both are more common among those wiht lower SES
the age of onset of MDD has been decreasing a lot to adolescents and college students

what is depression linked to as consequences?

impacts on functioing, increasing disability, impairing worka nd parenting, heightened suicide risk, cardiovascular disease and other health problem

why are women twice as likely to experince depressive disorder (name 3 things)

1) biological; hormonal fluctuations around puberty, menstruation, postpartum and menopause may increase stress reactivity
2) social; highger rates of childhood sexual abuse, chronic stressors and more exposure to others’ stress
3) stress reactivity: women’s social roles may intensify responses to social stressors, while men more often respond to financial and occupational stress

bipolar 1 disorder DSM-5 criteria

at least one manic episode, regardless of whether the indiviudal is experiencing mania.
Symtpoms of manic episode:
- elevated or irritable mood with increasing actiivty or energy
- noticeable changes in at least three or four areas:
→ icnreased goal-directed behaviour or psychomotor agitation
→ rapid or excessive speech
→ flight of ideas or racing thoughts
→ reduced need for sleep
→ inflated self-esteem or grandiosity
→ distractibility
→ risk-taking behaviour

bipolar 2 disorder

at least one hypomanic episode and one depressive episode

hypomania

milder form of mania, in which noticeable changes in behavhiour or mood occur, but doesn’t cause significant impairment or psychosis

what do symptoms of hypomania result in?

increased sociability, productivity, or energy without the severe consequences seen in full manic episodes

cyclothymic disorder
- do symptoms meet criteria for full manic or depressive episodes?

chronic mood disorder featuring frequent but mild fluctuations between hypomanic and depressive symptoms
- symptoms don’t meet crtieria for full manic or deprssive episodes but persist for at least 2 years

symptoms of cyclothymic disorder

1) numerous periods of hypomanic and depressive symptoms that fall short of formal episode criteria
2) symptoms occur at least half the time and don’t resolve for more than 2 months at a time
3) major depressive, manic or hypomanic episodes are absent

prevalences of all three bipolar disorders

bipolar 1: 0.6% globally, but 1% in the US
bipolar 2: 0.4 to 2%
cyclothymic: 4%

age of onset? men or women? in bipolar disorders

age of onset is often before age 25.
bipolar disorders are equally common in men and women though women experience more depressive episodes.

why is bipolar 1 disorder one of the most severe psychiatric conditions

high rates of unemployment, functional impairment and suicide.
elevated mortality rates due to suicide and physical conditions (twice as high)

what influences the mood disorders?

genetic influences
neural regions invoolved in emotion and rewards processing
psychological influences
cognitive theories

what disruptions are common in depression and bipolar disorder

circadian rhythms and sleep patterns
- insomnia and irregular sleep patterns predict depression severity and relapse
- sleep deprvivation can trigger manic episodes in bipolar disorder
- genetic polymorphism linked to sleep issues overlap with those for mood disorders

when are circadian and sleep disturbances problematic

in adoelscents, contributing to rising rates of depression

what triggers depressive episodes, and what is the percentage of those with depression reporting this trigger

stressful life events in 42-67%

explain the cogntive theories in mood disorders
- 3 theories

They emphasize the role of negative thoughts and beleifs in driving depression
1) Beck's theory: depression is associated with a negative triad of views about the self, the world and the future. Negative schemas formed are activated by stress and perpetuate depressive thoguths through biases in attention, memory and interpretation
2) hopelessness theory: depression is triggered by a sense of hopelessness, involving beleifs that desireable outcomes are unattainable and unchangeable
3) Rumination theory: Repetitive dwelling on sad expereinces increases depression risk. Ruminaition predicts depressive episodes and is more common in women.

Reward sensitivity
- what is it
- what lowers it, and what predicts it
- what predicts heightened reward sensitivity
- what can trigger mania
- who are responsive to rewards, and what predicts that

People with MDD display reduced neural and behavioural responses to rewards, even after recovery.
- Stress lowers rewards senitivity and predicts depressive symptoms.
- Heightened rewards sensitivity predicts increases in manic symptoms
→ dopamine-enhancing drugs can trigger mania
→ people with bipolar disorder are highly responsive to rewards, which rpedicts the onset and severity of manic episodes

what are the treatments of mood disorders

psychological treatment, IPT, CT, MBCT, BA therapy,

what does the psychological treatment target

MDD, but are also beneficial for chronic depressive symptoms

Interpersonal therapy

addresses depression linked to interpersonal problems by examining and resolving issues like role transitions and grief. The therapists guide patients in identifying emotions, decision-making, and adopting better communication and problem-solving skills

cogntive therapy

aims to modify negative thought patterns contributing to depression. The client learns to connect thoguths with moods and are guided to challenge and replace overly negative beliefs.

MBCT
- example

helps individuals recognize and distance themselves from depressive thoughts by adopting a decentered perspective.
- mediation enables individuals to view thgouths as transient events rather than factual representation

BA therapy

focuses on the idea that risk factors for depression reduce positive reinforcement. The withdrawal and inactivity further decrease reinforcement create a cycle of depression. BA wants to break this cycle by increasing participation in rewarding activities

Psychological treatment of bipolar disorder

Psychoeducation improves medication adherence and reducing relapse
CT manages early signs of mania
Family-focused therapy enhances communication and problem-solving skills

IPT emphasizes social stability

biological treatment of mood disorders

medications ofr depressive disorders
1) antidpressants
2) Gepirone and dextromethorphen-bubropion
→ 60% of users experience symtpom relief
→ at least 6 months, lowers recurrence risks
-→ only 43% recover fully

biological approaches for treatment-resistant depression

add-on medications: esketamine provides rapid symtpom relief as an add-on for resistant depression
TMS: magnetic pulses to activate specific brain areas
ECT: highly effective for severe depression
→ cogntive side effects are common, but usually resolves quickly

medications for bipolar disorder

1) mood-stabilising medications
→ lithium benefits up to 80% of individuals with bipolar 1, but requires monitoring due to potential toxicity
→ anticonvulsants and antipsychotics
2) antidepressants: risk triggering mania without mood stabilizer
3) atypical antipsychotics

who does suicide affect

the survivors
- children under 18 who lose a parent to suicide have a three times higher risk

what four types of suicidal things are there?

suicidal ideaition, suicide attempts, completed suicide, and non-suicidal self-harm

give the numbers of suicide
- how many die anually
- % of those who report suicidal thooughts, % that have attempted, suicide accounts for …. deaths worldwide
- men or women and how much
- decline or rise
- age in time that has highest rates

• 700000

• 9% has suicidal thoughts, 2.5% have attempted, accounts for 1 in 100 deaths worldwide

• men are 2.3 times more likely to commit worldwide, and 4 times more likely in the US

• declined globally, but has risen in US (36%) and Eastern Mediterrean

  • increasing among adolescents and children, but remain lower than adults rates

risk factors of suicide

psychological disorders, neurobiological factors, social influences, psychological influences

how can we try and prevent suicide

treating the associated psychological disorder
treating suicidality directly
national hotlines, like means restriction

explain what treating the associated psychological disorder means in suicide prevention

it means:
giving lithium for bipolar disorder
giving antidepressants and ECT for depressive disorder
giving antiwpsychotics for schizophrenia
giving ketamine for rapid reduction of suicidal ideation

explain what treating suicidality directly means in suicide prevention

CBT; safety planning, understanding triggers, challenging negative thoughts, improving distress tolerance, and enhancing problem solving and social support

DBT; integrates mindfulness and acceptance with CBT strategies for emotion regulation

CAMS; focuses on understanding the patient’s perspective and targeting drivers of suicidality

explain what the national hotlines do for suicide prevention and also explain means restriction

provide accessible, anonymous support and address a high volume on contacts
means restriction; limits access to lethal methods since many suicide attempts occur impulsivity
→ phasing out coal gas ovens - 1/3 reduction
→ installing barriers on bridges to prevent jumping
→ restricting soldiers access to firearms off-base in israel - 40%
→ reducing availability and lethality of drugs and poison