Ch 6 - Mood Disorders Note-taking Outline & Study Guide (1) EMIL KRAEPLIN 3 CATEGORIEZ FOR EXAM

I. MOOD DISORDERS: AN OVERVIEW

Key Moods

The two primary moods in mood disorders are depression and mania, each representing extreme points on a spectrum of affective experience.

A. Types of Mood Disorders

• Unipolar Depressive Disorders: Characterized by experiencing depression without mania, this type includes conditions such as Major Depressive Disorder (MDD) and Persistent Depressive Disorder (Dysthymia). Symptoms can manifest in various ways affecting daily functioning and quality of life.

• Bipolar Disorder: Involves the experience of both depression and mania. This disorder is nuanced and further divides into Bipolar I and Bipolar II disorders, each defined by the severity and type of mood episodes.

  • Depressive Episodes: Defined by persistent low mood lasting for at least two weeks, typically accompanied by other symptoms such as fatigue, feelings of worthlessness, and suicidal ideation.

  • Manic Episodes: Elevated mood, increased activity, and decreased need for sleep lasting for at least a week, often leading to significant impairment in social and occupational functioning.

  • Hypomanic Episodes: Similar to manic episodes but less severe and shorter (lasting at least four days), with less disruption to daily functioning.

B. Prevalence of Mood Disorders

• Major mood disorders are significantly more frequent than schizophrenia and show comparable rates to anxiety disorders.

• Lifetime Prevalence: Nearly 20% for unipolar major depression, highlighting the widespread nature of this mood disorder; the 12-Month Prevalence is approximately 7%.

• Gender Disparities: Women are diagnosed with mood disorders at significantly higher rates than men, with a common ratio of approximately 2:1.

• Bipolar Disorder: Occurs less commonly, with a lifetime risk estimated at less than 1% of the population.

• Variability Across Ethnic Groups: There are lower rates of mood disorders reported among African Americans compared to European Americans and Hispanic Americans, suggesting potential cultural, social, and economic influences.

• Relationship to Socioeconomic Status (SES): There is an inverse relationship with SES; individuals from lower socioeconomic backgrounds report higher rates of depression.

• Higher Rates in Arts: Studies indicate that individuals with substantial accomplishments in the arts show elevated rates of mood disorders, potentially due to the emotional and psychological demands of creative expression.

II. UNIPOLAR DEPRESSIVE DISORDERS

A. Major Depressive Disorder (MDD)

• Diagnosis involves meeting specific criteria, including depressed mood, sleep disturbances, changes in appetite, and difficulties concentrating; assessments often utilize standardized diagnostic manuals.

• Recurrent Disorder: Often involves specifications regarding whether it's the first episode or a recurrent episode.

• Relapse and Recurrence: Understanding these terms is critical; relapse refers to the return of symptoms after recovery, while recurrence is identified as a new episode following a period of recovery.

• Age of Onset: MDD commonly begins in late adolescence to middle adulthood with sharp increases during adolescence, indicating a critical developmental period.

• Specifiers for MDD: Distinct patterns of symptoms are identified, with melancholic features such as anhedonia and psychomotor impairment, and atypical features like increased sleep and appetite.

B. Persistent Depressive Disorder (Dysthymia)

• Characterized by chronic low mood lasting for at least two years, often leading to significant life disruptions.

• Double Depression: Occurs when individuals experience persistent depressive disorder coupled with major depressive episodes, further complicating treatment and management.

• Prevalence: Common with prevalence estimates between 3-6%, emphasizing the need for awareness and understanding of this condition.

• Average Duration: Typically lasts 4-5 years; however, some cases can exceed 20 years, indicating the potential for chronic suffering.

• Common Onset: Most individuals exhibit common onset during adolescence, with over 50% experiencing symptoms before the age of 21.

III. PSYCHOLOGICAL CAUSAL FACTORS

A. Stressful Life Events

• Life events such as loss, serious threats, and severe health or economic crises can precipitate episodes of depression.

• A critical distinction is made between independent life events and those that arise from personal behavior, shedding light on the complexity of causation.

• Impact of Stress: Research suggests that around 20-50% of cases of depression link directly to significant stressful life events, highlighting the importance of situational context.

• Hypothesis: Minor stressors may trigger recurrent episodes more frequently than the initial episodes of depression.

B. Vulnerabilities for Unipolar Depression

• Personality & Cognitive Factors: Traits such as neuroticism and negative affectivity are recognized as vulnerabilities.

• Negative Attribution Styles: An individual's thinking style, particularly those characterized as internal, stable, and global, increases the risk for depression.

• Early Adversities: Early environmental adversities can create both short- and long-term vulnerabilities, leading to an increased incidence of mood disorders later in life.

  • Moderate adversities may confer a certain level of resilience to later stress.

• Behavioral Theories: Depressive symptoms have been shown to correlate with a lack of positive reinforcement and increased feelings of negative reinforcement within their environment.

• Cognitive Theories (Beck's Theory):

  • Dysfunctional Beliefs: These beliefs underlie negative thoughts about oneself, the world, and future, forming the negative cognitive triad that is pivotal in understanding depression.

  • Maintaining Factors: Various cognitive biases serve to perpetuate negative views, contributing to the chronic nature of mood disorders.

IV. BIPOLAR AND RELATED DISORDERS

• Differentiation from unipolar disorders is established by the presence (or absence) of manic or hypomanic episodes, essential for diagnosis.

A. Cyclothymic Disorder

• Characterized by chronic mood swings that do not reach full depressive or manic episodes. Symptoms must persist for at least two years to warrant a diagnosis.

B. Bipolar Disorders (I and II)

• Tendency for recurrent cycles of mania and melancholy; previously termed manic-depressive insanity, indicating the serious nature of the condition.

• Bipolar I Disorder: Defined by the presence of at least one manic episode, often leading to significant impairment.

• Bipolar II Disorder: Characterized by at least one hypomanic episode without the occurrence of full-blown manic episodes; recent prevalence estimates suggest 2-3% in the U.S.

• Comparison of Symptoms and Severity: Episodes of depression in bipolar disorder are often more severe than those seen in unipolar depression; pronounced role impairments are frequently observed.

V. CAUSAL FACTORS IN BIPOLAR DISORDERS

A. Biological Factors

• Genetic Influences: Studies show higher rates of bipolar disorder in first-degree relatives, with heritability estimates approaching 80-90%, emphasizing the genetic component of this mood disorder.

B. Psychological Factors

• Stressful Life Events: Following genetic predispositions, stressful life events can be significant triggers for manic or depressive episodes, particularly in susceptible individuals.

C. Sociocultural Factors

• Global differences in the forms and prevalence of depression and bipolar disorders exist, reflecting the influence of cultural context.

• The impact of Western cultural values on reported depressive symptoms has been noted in non-Western cultures, indicating a potential bias in mental health diagnoses.

• The efficacy of lithium and other mood stabilizers is well-documented, though side effects such as weight gain and long-term health risks must be considered in treatment plans.

VI. SUICIDE: CLINICAL PICTURE

A. Suicide Overview

• Defined as intentional self-harm resulting in death, highlighting the severity of these outcomes.

• There is a strong association with psychological disorders, particularly depression, underscoring the need for early intervention.

• Important to distinguish suicide from non-suicidal self-injury (NSSI), which does not necessarily involve an intent to die.

B. Who Attempts and Dies by Suicide?

• Gender disparities and age patterns in suicidal behavior are notable; men have higher completion rates, while women are more likely to attempt suicide.

• The rising prevalence of suicide among adolescents correlates with various social factors, including increased mental health pressures and diminished coping strategies.

C. Psychological Disorders and Suicide

• The presence of any psychological disorder significantly raises the risk for suicidal behavior, making comprehensive treatment essential.

D. Biological Factors

• Genetic concordance rates have been observed in suicide attempts within families, suggesting a heritable aspect to suicidal behavior.

E. Theoretical Models

• Diathesis-stress models illustrate the intricate interactions of vulnerability factors and stressful life events, offering valuable insights into the pathways leading to suicide.

VII. SUICIDE PREVENTION AND INTERVENTION

A. Crisis Intervention

• This crucial approach focuses on providing immediate support and effective coping strategies for individuals in crisis.

• Establishment of suicide hotlines and resources for immediate assistance is vital in reducing suicide rates and providing care.

Overall, mood disorders present a complex and multifaceted challenge requiring extensive understanding and targeted intervention.