Studied by 13 people
mood disorders
characterized by gross deviations in mood
general characteristics of mood disorders
much more serious than typical emotional states that everyone feels
involves significant disturbances in emotion; extreme sadness (depression) or elation/irritability (mania)
are disabling
associated with other serious psychological problems (panic attacks, substance abuse, sexual dysfunction, personality disorders, anxiety)
depression (mood disturbances)
an emotional state marked by great sadness
feelings of worthlessness and guilt
depression (cognitive disturbance)
self-criticism, self blame
indecisiveness, slowed thinking, thoughts of death or suicide
depression (physiological (somatic) and behavioural disturbances)
loss or excess of sleep, appetite
loss of interest and pleasure in usual activities (anhedonia)
anhedonia
inability to experience pleasure
mania
a period of abnormal elevated or irritable mood lasting for at least one week or requires hospitalization
extreme pleasure in every activity
diagnostic criteria for manic episodes
individual must possess three or more of the following
inflated self esteem
decrease need for sleep
talkativeness
flight of ideas
increased goal-directed activity
hypomanic episode
not as severe as a manic episode
no marked impairment in social or occupational functioning
hypo = below
depressive mood disorders
mood remains at one pole of depression-mania continuum
bipolar mood disorders
mood travels between depression-elation poles
mixed featuresa
mix of symptoms
depressive disorders
marked by low mood only
major depressive disorder (formerly unipolar disorder)
persistent depressive disorder (dysthymia)
premenstrual mood dysregulation disorder
bipolar and related disorders
characterized by both high and lows in moods
bipolar disorder
bipolar 1
bipolar 2
cyclothymic disorders
major depressive disorder
presence of severe depression, absence of mania; severe enough to impair a persons interest in or ability to engage in normally enjoyable activities
diagnosis of major depressive disorder
presence of 5 of the following symptoms for at least 2 weeks: *note depressed mood or loss of interest and pleasure must be 1 of the 5
sad, depressed mood, most of the day, nearly every day
loss of interest and pleasure in usual activities
difficulties sleeping -shift in activity level
changes in appetite and weight
loss of energy, fatigue
negative cognitive appraisal (feeling worthless)
difficulty concentrating
recurrent thoughts of death or suicide
persistent depressive disorder (dysthymia)
depression relatively unchanged over long periods
a chronic state of depression; the symptoms are the same as those of major depression, but they are less severe
lasting 2 or more years (at least one in children and teens) and never without symptoms for more than 2 months
double depression
people with persistent depressive disorder may also experience episodes of major depressive disorder
clinicians use 8 specifiers
with psychotic features (mood-congruent or mood incongruent) hallucinations, delusions
with anxious distress (restlessness, concentration, issues due to worry, fear or losing control)
with mixed features
with melancholic features
with atypical features
with catatonic features (e.g., motoric immobility) or excessive movement, mutism, posturing, compulsive repetition of someone else's movements or words
with peripartum onset (post partum depression)
with seasonal pattern (seasonal affective disorder SAD) accompanies episodes during certain seasons (winter depression); depressive episode: begins in late fall; ends start of spring; bipolar: depression- winter, mania-summer
integrated grief
the finality of death and its consequences are acknowledged and the individual adjusts to the loss
complicated grief
grief characterized by debilitating feelings of loss and emotions so painful that a person has trouble resuming a normal life; designated for further study as a disorder by DSM-5
premenstrual dysphoric disorder (PMDD)
physical symptoms, severe mood swings, and anxiety
decreased interest in usual activities; difficulty in concentration; lack of energy; hypersomnia or insomnia
changes in appetite
interference with work, relationships incapacitation during most menstrual cycles, starting in the final week before the onset of menses
disruptive mood dysregulation disorder
condition in which a child has chronic negative moods such as anger and irritability without any accompanying mania
different from ADHD
supporters: too many children diagnosed with bipolar, needs this diagnostic criteria
critics: don't think temper tantrums should be considered mental illness, labeling
bipolar 1 disorder
major depressive episodes alternate with full manic episodes
involves episodes of mania or mixed episodes that include symptoms of both mania and depression
rapid cycling specifier
moving quickly in and out of depressive and manic episodes (does not seem to be permanent)
at least 4 manic or depressive episodes within a year
rapid switching/rapid mood switching
ultra rapid cycle
ultra-ultra rapid cycle
rapid switching or rapid mood switching
the direct transition from one mood state to another (no euthymic mood period in between)
ultra rapid cycle
cycle length that only lasts for days to weeks
ultra ultra rapid cycle
cycle lengths are less than 24 hours
bipolar 2 disorder
a pattern if major depressive episodes and hypomanic episodes, but the episodes are less severe than the manic episodes in bipolar 1 disorder
onset and duration of bipolar disorders
bipolar 1: 18 years
bipolar 2: 22 years
rare to develop bipolar disorder after the age of 40
develop more suddenly as compared to depressive disorders
high risk of suicide
cyclothymic disorder
a chronic condition ( at least two years) characterized by fluctuations that alternate between hypomania and depressions
episodes not as severe as with mania or major depression
age of onset: 12 to 14
episodes not intense enough or do not last long enough to qualify as hypomanic or depressive episodes
comorbidity and bipolar disorder
physical disorders (thyroid disorder, migraine headaches, heart disease, diabetes, obesity)
metal disorders (anxiety disorders, eating disorders, ADHD, substance use)
objectification theory
tendency to be viewed as an object, appraised by others -> negative influence on self esteem
estrogen and progesterone (mixed support)
mood disorders across cultures
more in individualistic cultures
mood disorders among the creative
creativity associated with manic episodes
many poets and writers bipolar and suicidal
joint heritability of anxiety and depression
close relationship among depression, anxiety, and panic
same genetic factors contribute to both anxiety and depression
biological vulnerability
neurotransmitter systems in mood disorders
low levels of norepinephrine and dopamine lead to depression
high levels lead to mania
low levels of serotonin
chronic stress reduces dopamine levels
MAO-A levels in brain are elevated during untreated depression
MOA-A
an enzyme that metabolizes monoamines such as serotonin, norepinephrine, and dopamine
the endocrine system
diseases (e.g., hypothyroidism) leading to excessive secretion of cortisol leads to depression
elevated levels of cortisol in people with depression (stressful events)
the dexamethasone suppression test - a biological test for depression
neurotransmitter activity in hypothalamus regulates HPA axis
sleep and circadian rhythms
REM starts sooner after falling sleep in depressed people
people with depression experience more intense REM activity
slow wave (deep) sleep occurs later
bidirectional relationship between sleep and mood
depressed individuals show:
greater right-sided anterior activation of brain and less left-sided activation
psychological factors of mood disorders
stressful life events: interpretation of stressful events
psychoanalytic theory of depression: fixation during oral stage -> dependency to maintain self esteem; depression is seen to be like a mourner who over-identifies with (introjects) the loss if a loved one
freud-analysis of bereavement
learned helplessness theory of depression
seligman: people become depressed when they feel they have no control over life's stresses
some studies with humans: helpessness inductions -> subsequent improvement of performance
depressive paradox: if people see themselves as helpless, how can they blame themselves?
learned helplessness theory
depressive attribution style is:
internal: the individual attributes negative events to personal failings/external
stable: even after a particular negative event passes, the attribution that "additional bad things will always be my fault" remains/unstable
global: the attributions extend across a wide variety of issues/specific
hopelessness theory
hopelessness: an expectation that desirable outcomes will not occur or that undesirable ones will occur and the person has no responses available to change the situation
2 more diathesis (in addition to negative attribution style): low self esteem, a tendency to infer that negative life events will have severe negative consequences
anxiety and depression: helplessness; believe they lack control
depression: hopelessness about ever regaining control
Beck's cognitive theory/negative cognitive styles
depression arises from interpreting everyday events negatively
negative life events -> development of negative schema in childhood and adolescence- a tendency to see the world negatively
thinking is biased towards negative interpretations
automatic, not necessarily conscious
self blame schema, self evaluation schema
negative schema + cognitive biases -> negative cognitive triad-thinking negatively about the self, immediate world, and future
arbitrary inferences
a conclusion drawn in the absence of sufficient evidence or of any evidence at all
e.g., a man concluded he is worthless because it's raining the day he is hosting an outdoor party
overgeneralization
an overall sweeping conclusion drawn on the basis of a single perhaps, trial, event
e.g., i got a C on a psychology test. i will never be a psychologist
dichotomous or "all or nothing" thinking
thinking in all or nothing terms
e.g., if i can't do something perfectly i may as well quit
selective thinking
concentrating on your weaknesses and forgetting your strengths
e.g., it does not matter that i am a good singer. i cannot dance or act
catastrophizing
only paying attention to the dark side of things, or overestimating the chances of disaster
e.g., i didn't get into the best university. i will never have a decent career
personalizing
taking things personally that have little or nothing to do with you
e.g., jenny is so quiet. she must be really angry with me
cognitive vulnerability for depression: an integration
depression always associated with: pessimistic/depressive explanatory style and negative cognitions
cognitive vulnerabilities predispose some people to view events in a very negative way; puts them at risk for depression
interpersonal theory of depression
sparse social networks that provide little support
decrease an individuals ability to handle negative life events
increase vulnerability to depression
seek reassurance of others; validation
marital relations
marital dissatisfaction: disruptions lead to depression
high conflict, low support: deterioration in marital relationships
bipolar individuals less likely to marry, more likely to divorce if they marry
mood disorders in women
70% with major depressive and persistent depressive disorders are women
perceptions of uncontrollability
societal roles assigned to women, poverty, childbirth, menopause, single mothers, abuse histories
treatments for mood disorder
first generation antidepressants: tricyclics (imipramine, amitriptyline), MAOIs (tranylcypromine)
second generation antidepressants: SSRIs (fluoxetine-prozac)
third generation antidepressants: SNRIs (venlafaxine-effexor)
what do tricyclics (imipramine, amitriptyline) do and what are the side effects
targets NE but other neurotransmitters SE, DA are also effected
side effects: blurred vision, dry mouth, constipation, difficulty urinating, drowsiness, weight gain, cardiac side effects, sexual dysfunction (in some)
lethal if taken in excessive doses
what are MAOIs (tranylcypromine)and what are the two serious issues with their use?
as effective as tricyclics with fewer side effects
used less often
2 serious issues: consuming food containing tryptamine (cheese, red wine) -> severe hypertension -> death; interaction with common medications such as cold medications
SSRIs (fuoxetine-Proazac) reports, findings and side effects
initial reports of relationship with suicide preoccupations, paranoid reactions, occasionally violence
recent findings: risk of suicide with fluoxetine are no greater than any other antidepressants
major side effects: physical agitation, sexual dysfunction (50-70% of cases)
SNRIs (venlafaxine)
selective norepinephrine reuptake inhibitor-reboxetine-edronax
natural herb - st John's Wort (hypericum)
response to antidepressant medications
better in people with good social support
worse in people with co-occuring anxiety disorders
lithium for bipolar
effective in preventing and treating manic episodes for 50% of patients
mood stabilizing drug
careful dosage to prevent toxicity
people who do not respond to lithium may be prescribed:
drugs with anti-manic properties such as antipsychotics and anticonvulsants (carbamazepine; valproate)
valproate is less effective in preventing suicide
electroconvulsive therapy (ECT)
Cerletti & Binni
biological treatment for severe, , chronic depression involving the application of electrical impulses through the brain to produce seizures. unknown reason for effectiveness
unilateral/unilateral (non-dominant, typically right cerebral hemisphere)
transcranial magnetic stimulation (TMS)
effective in treating depression
magnetic coil over head -> localized electromagnetic pulse
less effective than ECT in severe cases
deep brain stimulation
light therapy/phototherapy
SAD- winter depression, exposure to bright white light
within first hour of waking up in the morning
20-30 minutes
more effective if combined with CBT
CBT may be more effective in severe cases
cognitive therapy
correcting cognitive errors in deep-seated negative thinking
between sessions-realistic thinking encouraged by monitoring and logging thought processes
homework-other activities to decrease depression encouraged (behavioural experiment)
psychodynamic therapies
depression-insight into the repressed conflict and outward release of anger
research on the effectiveness-sparse; mixed results
interpersonal psychotherapy (IPT)
Weissman & Klerman
focuses on resolving problems in existing relationships
highly structured; 15-20 sessions
identify and define an interpersonal issue; bring the dispute to a resolution
stage of the dispute: negotiation stage, impasse stage, resolution stage
negotiation stage of dispute
both partners are aware of dispute
impasse stage of dispute
low-level resentment-no attempts to resolve it
resolution stage of dispute
take action: divorce or separation
behavioural activation
focuses on increased contact with positive reinforcement for healthy behaviours which results in positive mood
combined treatment
generally just as effective as separate drug or psychosocial therapies in treatment of depression
in severe depression, combination of drug and psychosocial treatments effective
preventing relapse
maintenance treatment; CBT
mindfulness-based cognitive therapy (MBCT-Vindel Segal); group therapy teaches recovered depressed patients to disengage from negative thinking; mindfulness meditation; viewing thoughts as mental events rather than accurate reflections of reality; therapy
psychosocial treatments for bipolar disorder
treatment compliance-psychoeducation: reduction in mood swings; stability
interpersonal and social rhythm therapy (IPSRT): regulates circadian rhythms by helping patients regulate their eating and sleep cycles and other daily schedules and cope more effectively with stressful life events, particularly interpersonal issues
family-focused treatment combined with meditation: new coping and communication skills
CBT with rapid cycling patients
suicide gestures/parasuicides
self injury in which there is no intent to die
risk factors for suicide
depression
personality disorders
drug abuse (alcohol or cannabis)
childhood abuse
family history of depression and suicide
suicide ideation increase in indigenous peoples living off reserve
psychological autopsy
post-mortem psychological profile of a suicide victim constructed from interviews with people who knew the person before death
neurobiology risk factor for suicide
low levels of serotonin
vulnerability to act impulsively
overreacting to situations
stressful life events risk factor for suciide
severe experiences:
shame, humiliation, unexpected arrest, rejection, physical or sexual abuse, natural disasters
preexisting vulnerabilities, lack of social support
Durkheim's sociological theory
Emile Durkheim
suicide types based on social or cultural conditions: altruistic (formalized suicides), egoistic, anomic, and fatalistic
altruistic (formalized suicide)
sacrificing one's life to benefit others-to preserve tradition or honour of the family-as in ancient Japanese custom Hara-Kiri
egoistic suicide
the loss of social supports as an important provocation for suicide
anomic suicide
the result of marked disruptions, such as the sudden loss of a high-prestige job
fatalistic suicide
result from a loss of control over our own destiny
Baumeister's escape theory
painfully aware of personal shortcomings-> emotional suffering, depression:
become suicidal to escape aversive self-awareness
unrealistically high expectation-failing to meet these expectations
Joiner's interpersonal theory of suicide
the tendency to commit suicide is a product of two interpersonal constructs:
need to belong
perceived burdensomeness
people at risk when they feel excluded and they are also at risk when they regard themselves a burden and that other people would be better off without them
Shneidman's approach
conscious effort to stop unbearable pain
suicidal individuals are experiencing psychache which is intense anguish
sufferer-suicide ends consciousness and unendurable pain
is suicide contagious? treatment
positive relationship between suicidal behaviour and exposure to media coverage
clusters of suicides
teenagers
romanticizing suicide in media
clinical and ethical issues in dealing with suicide
therapists' responsibilities
physician-assisted suicide
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