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Chapter 9

MoodDisorders

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Copyright 2007 by The McGraw-Hill Companies, Inc. All rights reserved.Chapter 9

Symptoms of Depression

Cognitive Poor concentration, indecisiveness,poor self-esteem, hopelessness, suicidal

thoughts, delusions

Physiological and

Behavioral

Sleep or appetite disturbances,

psychomotor problems, catatonia,

fatigue, loss of memory

Emotional

Sadness, depressed mood, anhedonia(loss of interest or pleasure in usual

activities), irritability

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Major Depression Dysthymic Disorder

5 or more symptomsincluding sadness or

loss of interest or

pleasure

3 or more symptomsincluding depressed

mood

At least 2 weeks in

duration

At least 2 years in

duration

Numbero

f

symptom

s

Duration

Depression versus Dysthymia

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Depression and Dysthymia

Dysthymia more chronic than depression (nevermore than 2 months without depressed mood).

When combined with major depression, may bereferred to as Double Depression.

High levels of comorbidity associated withdysthymia and depression.

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Subtypes of Depression

Depression with Melancholic Features (loss of

pleasure, anorexia, guilt)

Depression with Psychotic Features (hallucinations,

delusions)Depression with Catatonic Features (lack of

movement or extreme agitation)

Depression withAtypical Features (positive

emotional experiencing)Depression with Postpartum Onset

Depression with Seasonal Patterns

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Prevalence and Prognosis

Among adults, 15-to-24-year olds are most likely tohave had a major depressive episode in the pastmonth.

Depression is less common among children thanamong adults.

Depression may be most likely to leave psychologicaland social scars if it occurs initially during

childhood, rather than during adulthood.

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Bipolar Disorder

Characterized by manic episodes. Elevated, expansive, or irritable mood Inflated self-esteem or grandiosity Decreased need for sleep More talkative than usual Flight of ideas Distractibility Increase in activity directed at achieving goals Excessive involvement in dangerous activities (risk taking)

Hypomania Less severe than mania Less interference with functioning

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Bipolar Disorder

Bipolar I Disorder Mania

Likely (although not necessarily) will experience majordepression episodes (MDE)

May also experience periods of hypomania in betweenmanic episodes

Bipolar II Disorder

MDE necessary for diagnosis No manic episodes

Hypomanic episodes

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Bipolar Disorder

CyclothymiaAlternates between episodes of hypomania and dysthymia

(or moderate depression).

Rapid cycling bipolar disorder 4 or more cycles of mania and depression within a year

Often given to individuals with borderline personalitydisorder INACCURATELY

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Bipolar Disorder: Prevalence

Less common than unipolar depression

Approximately 1% lifetime prevalence

No gender differences Most likely to develop in late adolescence or

early adulthood

Can it be diagnosed in children?

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Risk of Bipolar Disorder

0

10

20

30

40

50

60

70

MZ twins DZ twins Sibs, parents,

children

Biological

parents of BP

adoptees

Second-

degree

relatives

General

population

Percentwithbipolardisorder

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Biological Theories

Genetics

Strong genetic component to bipolar disorder.

Concordance rate (probability both twins will develop a disorder)

is 60% among MZ twins. Neurotransmitter Dysregulation

Monoamine theory of depression and bipolar disorder:

Norepinephrine, Serotonin, and Dopamine (all found in limbic

system of the brainregulates sleep, appetite, and emotions) Type of imbalance determines the disorder (high sensitivity

mania, insensitivity depression)

May be state-dependent

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Biological Theories

Brain structural abnormalitiesAmygdala enlargement

May bias people towards aversive or emotionally arousing

information, leading to rumination and increased contactwith negative environmental cues.

Neuroendocrine factors: Sensitivity and hyperactivity of the HPA axis

(hypothalamic pituitary adrenal axis) Inability to return to baseline

May inhibit monoamine receptors

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Psychological Theories

Behavioral theories: Learned helplessness

Lewinsohn limited contact with positively reinforcingaspects of the environment

Cognitive theories: Causal attributions (reformulated learned helplessness

theory)

Internal vs. External Stable vs. Unstable

Global vs. Specific

Internal, stable, and global attributions worse

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Psychological Theories

Ruminative Response Style Intense focus on internal experience to the exclusion of everything

else.

Focus occurs without any attempt to do anything to aversive internal

states.

Psychodynamic Theories Connected depression to the grief process

Individuals may be responding to real or imagined abandonment

and/or rejection Individuals at risk for depression are overly concerned with the

approval of others.

Introjected hostility

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Treatment

Behavioral Behavioral scheduling

Behavioral activation

May take an interpersonal bentfocus on the patientsbehavior with others (including therapist)

Cognitive Focusing on restructuring maladaptive thoughts and rigid

attributions about the world and the self.

Eventually target depressive schemas and core beliefs(e.g., I am unlovable).

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Relapse

Relapse common in depressionTeasdale, Segal, and Williams suggest that this is due to

fusion with thoughts We believe our thoughts.

Therefore, the presence of any depressive thought is animmediate sign that full-blown depression is not far away.

Treatment focused on increasing metacognitive

awareness awareness of thoughts as thoughts.

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