ch 7 mood disorders

mood

feelings state that color our psychological lives

mood disorders

people who experience disturbances in mood that are unusually severe or prolonged and impair their ability to function in normal responsibilities

depressive disorders

1. persistant depressive disorder (dysthmia)

2. premenstrual dysmorphic disorder (PMDD)

3. major depressive disorder (MDD)

bipolar disorders

1. bipolar disorder

2. clyclothymic disorder

mood thermometer

Major depressive disorder

based on the occurrence of atleast one major depressive episode in the absence of a history of mania or hypomania

• period of 2 weeks of symptoms

mania

state of unusual elation, energy, and activity

hypomania

a relatively mild state of mania

MDD DSM-5 criteria

5 or more of the following symptoms present for 2 1eeks and represent a change from previous functioning. atleast one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

• depressed mood most of the day, nearly every day, as indicated by either subjective report or observation made by others

• markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation)

• significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day

• insomnia or hypersomnia nearly every day

• psychomotor agitation or retardation nearly every day

• fatigue or loss of energy nearly every day

• feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day

• diminished ability to think or concentrate, or indecisiveness nearly every day

• recurrent thoughts of death , recurrent suicidal ideation without a specific plan, or a suicide attempt or specific committing suicide

- the symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

- the episode is not attribute to the physiological effects of a substance or to another medical condition

- the occurrence of the major depressive episode is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders

- there has never been a manic episode or a hypomanic episode

prevelance rates for MDD

• latinos, asian americans, non-hispanic black americans are less likely than non-hispanic white americans to receive treatment for depression

• MDD affects 20.6% of adults in their lifetime

• 1 in 10 adults experienced MDD in the past year

• women (26.1%) men (14.7%)

• estimated 330 million people in the world

risk factors of MDD

• age

• socioeconomic status

• marital status

• gender (women)

• history of child sexual abuse

• family history of MDD

seasonal affective disorder

seasonal changes might affect availability or use in brain of the mood regulating nuerotransmitter serotonin during winter months

SAD features

• affects 3-10% of population

• women twice as effected

• causes unknown—possibility that seasonal changes in light affect bodys underlying biological rhythms that regulate processes such as body temp and sleep wake cycles

SAD treatments

• phototherapy (artificial light)

• anti depressants

• cbt

postpartum depression

persistant and severe mood changes that occur after childbirth

• 10-15%

• depressed mood and crying spells, disturbed sleep, changes in appetite, low self esteem, difficulties maintaining concentration or attention, and difficulty bonding with the infant

• high rates in south african women and chinese women from hong kong

postpartum psychosis

new mother loses touch with reality and experiences symptoms such as

hallucinations, delusions, and irrational thinking

PPD treatment

• cbt

• interpersonal therapy

• antidepressants

Persistent depressive disorder

a chronic type of depressive disorder that lasts for atleast 2 yrs

• either chronic major depression or dysthymia (milder form)

• dysthymia 2.5% pop, derives from greek roots meaning bad spirit

• double depression- concurrent MDD and dysthymia

premenstural dysphoric disorder

more severe form of premenstrual syndrome where women experience a

range of significant psychological symptoms in the week before menstruation

premenstural DD symptoms

mood swings, sudden tearfulness or feelings of sadness, depressed mood or feelings of hopelessness, irritability or anger, feelings of anxiety, tension, being on edge, greater sensitivity to rejection negative thoughts about oneself

PMDD facts

• introduces as a diagnostic cat in DSm-5 intended to draw greater attention to the problem of mood swings and delivery services

• 1/5 women

bipolar disorder

psychological disorder characterized by mood swings between states of extreme elation and depression

• 2 types of bipolar disorder

bipolar 1 disorder

• atleast one full manic episode

• extreme mood swings between manic and major depressive episodes

• possible to not have a depressive episode, but is common

bipolar 2 disorder

• both hypomanic episodes and atleast one major depressive episode

• no full blown manic episode

Bipolar disorder prevelence

• 1%

• develops around age 20

• some not all bipolar 2 patients develop bipolar 1

• rapid cycling- a person experiences 2 or more full cycles of mania and depression within a yr without any intervening normal periods

• michaelangelo, vincent van gough all had

manic episode

• sudden elevation or expansion of mood

• unusually cheerful or euphoric

• extremely sociable → sometimes to point of becoming overly demanding and overbearing

• increased energy and activity

• poor judgement: argumentative, overly generous, etc

• rapid speech

• inflated ego and self esteem

• distractible

• lavish spending, reckless driving, sexual escapades

  severe cases: delusions, hallucinations

cyclothymic disorder

a mood disorder characterized by a chronic pattern of less severe mood swings than are found in bipolar disorder

• period of at least two years where person has numerous periods of hypomanic and depressive symptoms but not severe enough to meet the criteria for a hypomanic episode or major depression

stress and depression role in mood disorders

• stressful life events increase risk

  • loss of loved one, breakup, prolonged unemployment, serious physical illness, marital or relationship problems, separation or divorce, exposure to racism and discrimination, living in unsafe distressed neighborhoods

• early life experiences

  • lack of secure attachments to parents, parental divorce, physical abuse

• psychological factors as buffers against stress

  • strong marital relationship for example

psychodynamic theories on mood disorders (freud)

• depression represents anger directed inward rather than against significant others

• mourning is healthy process → pathological mourning does not, fosters lingering depression

• to preserve psychological connection to lost object, people introject a mental representation of the object → anger is turned inward, against the part of self that represents the inward representation of the lost person

freud and bipolar psychodynamic theories

• represents shifting dominance of individuals personality between ego and superego

• in depressive state, superego is dominant producing exaggerated notions of wrongdoing and flooding an individual with feelings of guilt and worthlessness

• ego rebounds and asserts supremacy, producing feelings of elation and self confidence that characterize the manic phase

stress focusing model (psychodynamic theories)

considers how people allocate their attentional processes after a loss such as the death of a loved one or personal failure or significant disappointment → depressed people have difficulty thinking about anything other than themselves and the loss they experienced

research evidence for psychodynamic theorists in mood disorders

• people become depressed when they cannot imbue their existence with meaning and make authentic choices that lead to self fulfillment

  • guilt may arises when people believe they have not lived up to their potential

• focus on loss of self esteem that can occur when people lose friends or family members or suffer occupational setbacks

• when role identities are lost, our sense of purpose and self worth can be shattered

learning theories of mood disorders

• learning theorists emphasize situational factors such as the loss of positive reinforcement

• lack of reinforcement for ones efforts can sap motivation and induce feelings of depression

• secondary source of reinforcement- people relieving depressed person from responsibilties

• changes in life circumstances may alter balance of effort and reinforcement

• physical activity can help depressionreinforcement.

interactional theory of mood disorders

• problems in interpersonal relationships may help explain lack of positive reinforcemnt

  • stressful living situation

• recipricol interaction - our behaviors influence how others respond to us, anger can lead to depression

• low social skills

cognitive theories of mood disorders

cognitive triad of depression

• negative beliefs about oneself

• negative beliefs about environment

• negative beleifs about future

• greater risk of becoming depressed

  beck views these concepts of the self and world as mental templates that are adopted in childhood and on the basis of early learning experiences

  • children may find nothing they do is good enough

• cognitive disortions, all or nothinng thinking, overgeneralization, mental filter, jumpting to conclusion, magnification and minimization, emotional reasoning, learned helplessness

cognitive specificity hypothesis

proposes that different disorders are characterized by different types of automatic thought

• certain types of negative thoughts are associated with depression while others to anxiety

humanisitc theories on mood disorders

humanistic theorists focus on the loss of self esteem that can occur when people lose firends, or family members or sufffer occupational setbacls

learning theories of mood disorders

learning therorists emphasize situational factors such as the loss of positive reinforcement

• peter lewisohn proposed that depression results from an inbalance between behavior and reinforcement

biological factors of mood disorders

• genetic factors

  • interactions of genetic and environmental factors in major depression and other mood disorders

  • runs in family

• biochemical factors and brain abnormalities

  • lack of serotonin or norpinephrine

  • unlikely the only cause

casual factors of mood disorders

• genetic factors

  • higher risk associated with higher paternal age (55)

  • family history

  • stressful life events may trigger episodes

• psychosocial

  • social support can enhance levels of functioning

  • helps speedy recovery form mood episodes and reduces likelihood of recurrent episodes

learned helplessness theory

proposes that people may become depressed because they learn to view themselves as helpless to change their lives for the better

(martin seligman)

• failing to learn to escape when escape is possible

• some forms of depression in humans might result from exposure to apparently uncontrollable situations → “why try?”

attributional style

• when bad things occur, we explain them in characteristic ways

• blaming ourselves, circumstances, typical events, isolated events, broader problems, evidence of precise and limited shortcomings

• internal factors: failures reflect personal inadequacies

• global factors: failures reflect sweeping flaws in personality

• stable factors: failures reflect fixed personality factors rather than unstable factors or beliefs that the factors leading to failures are unchangable

treatment of mood disorders

depressive disorders are typically treated with psychotherapy in the form of psychodynamic therapy, behavior or cognitive therapy, or with biomedical treatments such as antidepressants or electroconclusive therapy

psychodynamic treatments of mood disorder

• traditional psychoanalysis aims to help depressed people understand underlying ambivalent (conflicting) feelings toward important people (objects) in their lives whom they have lost or whose loss was threatened

• modern psychoanalysis focuses on unconscious conflicts but are more direct, relatively brief and focus on present as well as past conflicted relationships

interpersonal therapy (psychodynamic)

• brief therapy (no more than 9 to 12 months) that emphasizes the role of interpersonal issues in depression and help clients make healthy changes in their relationships

• similar to traditional psychodynamic approaches but focuses on clients current relationships rather than unconscious internal conflicts of childhood origin

behavior therapy (psychodynamic)

focus on helping depressed patients develop more effective social or interpersonal skills and increasing their participation in pleasurable or rewarding activities

• ____ activation encourages patients to increase their frequency of rewarding or enjoyable activities

• often used along with cognitive therapy (CBT)

CBT

• distorted thinking or cognitive distortions play a key role in the development of depression

• cognitive therapy is also brief 14 to 16 week

biomedical treatment antidepressants

tricyclics (TCAs)

• imipramine (Tofranil)

• antitriptyline (Elavil)

• desipramine (Norpramin)

• doxepin (Sinequan)

monoamine oxidase (MAO) inhibitors

selective serotonin-reuptake inhibitors (SSRIs)

• fluoxetine (Prozac)

• setraline (Zoloft)

serotonin-norepinephrine reuptake inhibitors (SNRIs)

• venlafaxine (effexor)

SSRIs are less toxic and have fewer cardiovascular side effects than tricyclics and MAO inhibitors

ketamine

• when used under medical supervision, has significant therapeutic benefits

• helps reduce suicidal ideation within hours

electroconclusive therapy

• shock therapy

• 6-12 treatments

• only used for people who dont respond to antidepressant meds

lithium and mood stabilizers

lithium helps reduce mania and stabilizes mood in bipolar patients → many patients either fail to respond to the drug or cannot tolerate it

other drugs

• carbamazepine (Tegretol)

• divalproex (Depakote)

• lamotrigine (Lamictal)

anticonvulsant drugs are especially help in cases in which bipolar patients have not esponded to lithium or cannot tolerate its side effects

diathesis stress model

suicide risk factors

• mood disorders

• schizophrenia

suicide in older adults

• highest among middle aged or older adults

• suffer from mourning, leading to isolation

gender and ethnic differences in suicide

• most common among white americans, american indians, and alaskan natives

• white americans are twice as likely to take their own lives as african amerians

• hopelessness and exposure to others who have attempted or committed may contribute to increased risk among AI/AN youth

• greater risk tend to be reared in communities that are laregely isolated from us society

• percieve themselves as having few opportunities to gain the skills necessary to join a workforce in a large society

suicide risks cont

• prior suicide attemps

• role of stress

• screen time - 50% of teens who spend 5 or more hours on device reported suicidal behavior

psychodynamic model on suicide

• suicide represents inward directed anger that turns murderous

• seek to vent their rage against internalized representation of the love object

emilie durkheim on suicide

• people who experienced anomie (who feel lost, without identity, rootless) are more likely to commit suicide

• higher levels of social support result in lower levels of suicidal thoughts

learning theorists on suicide

focus on lack of problem solving skills for handling significant life stress

social cognitive theory on suicide

• suggest suicide is motivated by personal experiences

• potential modeling effect of observing suicidal behaviors in others

• social contagion- spreading of suicide in a community

biological and casual factors of suicide

Biological factors

• genetic and neurotransmitter imbalances involving the mood regulating chemical serotonin

causal factors

• motivated by desire to escape from unbearable emotional pain

preventing suicide

behavioral clues

• suddenly sorting out affairs

• purchase gun

• suddenly feel at peace

• increased suicidal risk include substance abuse, financial problems, recent crisis, medical problems, relationship problem