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CHAPTER FIVE

CHAPTER FIVE. Mood Disorders. Mood Disorders. Basic definitions Unipolar mood disorders Special topic: Depression & interpersonal relationships Bipolar mood disorders Subtypes Epidemiology Etiology Treatment. Types of Mood Disorders. Episodic vs. Continuous.

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CHAPTER FIVE

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  1. CHAPTER FIVE Mood Disorders

  2. Mood Disorders Basic definitions Unipolar mood disorders Special topic: Depression & interpersonal relationships Bipolar mood disorders Subtypes Epidemiology Etiology Treatment

  3. Types of Mood Disorders

  4. Episodic vs. Continuous Mood disorders should be thought of as episodic

  5. Chart: MDD & Bipolar Disorder

  6. Types of Mood Disorders

  7. Mood Disorders • Basic definitions • Unipolar mood disorders • Special topic: Depression & interpersonal relationships • Bipolar mood disorders • Subtypes • Epidemiology • Etiology • Treatment

  8. Major Depressive Disorder is more than just feeling depressed Sadness alone is insufficient and unnecessary for a diagnosis Severity, intensity, duration and impairment Depressed Mood vs. Major Depressive Disorder (MDD)

  9. Depressed/dysphoric mood Anhedonia– loss of interest or pleasure Weight loss/gain or appetite increase/decrease Insomnia or hypersomnia Psychomotor agitation or retardation Fatigue or loss of energy Feelings of worthlessness or inappropriate guilt Diminished ability to concentrate or make decisions Suicidal ideation, plan or attempt Symptoms ofMajor Depressive Episode

  10. Criteria for Unipolar Mood Disorder

  11. Symptoms of Dysthymia Depressed mood for most of the day on more days than not Poor appetite or overeating Insomnia or hypersomnia Low energy or fatigue Low self-esteem Poor concentration or difficulty making decisions Feelings of hopelessness

  12. Chart: Dysthymia

  13. Criteria for Unipolar Mood Disorder

  14. Occupational / Academic Social Other important domains of life Clinical Impairment in MDD and Dysthymia

  15. Not due to a general medical condition (e.g., thyroid condition) Not due to substance use (e.g., alcohol) Not bereavement – “normal” grief Exclusion Criteria

  16. Depression & Interpersonal Relationships Special Topic

  17. Interpersonal Relationships & DepressionCoyne, 1976 Questions Do people respond differently to depressed patients? Do depressed people induce depression and hostility in others? Are they rejected socially? Method Students spoke on the phone with either a depressed outpatient, non-depressed outpatient, or non-psychiatric control Completed questionnaires on mood, perceptions, and willingness to interact

  18. Results Participants were more… depressed, anxious & hostile after interacting with depressed patients than with any other group. rejecting of the depressed patients than they were of any other group. likely to reject opportunities for future interaction if their own mood was depressed following the conversation. Interpersonal Relationships & DepressionCoyne, 1976

  19. People who are separated or divorced are the most likely to be depressed. Depression is also higher in those who are never-married than those who are married which may suggest the importance of social support. But, if you are in an unhappy marriage that may cause depression. Depression can also lead to marital problems NOTE: potentially vicious feedback cycle Interpersonal Relationships & Depression[Marriage & Depression]

  20. Mood Disorders • Basic definitions • Unipolar mood disorders • Special topic: Depression & interpersonal relationships • Bipolar mood disorders • Subtypes • Epidemiology • Etiology • Treatment

  21. Elevated mood Irritable/angry mood Inflated self-esteem or grandiosity Decreased need for sleep More talkative than usual or pressure to keep talking Flight of ideas or racing thoughts Distractibility Increase in goal-directed activity or psychomotor agitation Excessive involvement in pleasurable activities that have a high potential for painful consequences Symptoms of Manic & Hypomanic Episodes

  22. Manic vs. Hypomanic Episode

  23. Criteria for Bipolar Mood Disorder

  24. Charts: Bipolar I Disorder

  25. Charts:Bipolar II Disorder & Cyclothymia

  26. Chart: Bipolar I Disorder As is the case with unipolar mood disorders, there must be clinical impairment or distress The symptoms cannot be: Due to a medical condition Due to substance use

  27. Mood Disorders • Basic definitions • Unipolar mood disorders • Special topic: Depression & interpersonal relationships • Bipolar mood disorders • Subtypes • Epidemiology • Etiology • Treatment

  28. Mood Disorders with Psychotic Features

  29. Mood Disorders with Postpartum Onset Denotes a major depressive or manic episode beginning within 4 weeks after childbirth The available evidence suggests that it is not caused primarily, if at all, by hormones Most women do not get this out of the blue; most of them have had prior depressive episodes.

  30. Mood Disorders • Basic definitions • Unipolar mood disorders • Special topic: Depression & interpersonal relationships • Bipolar mood disorders • Subtypes • Epidemiology • Etiology • Treatment

  31. Epidemiology: Culture Cross-cultural differences Vocabulary and social differences make this difficult to investigate. Symptoms are interpreted differently and emotions have different expressions. Most studies indicate, however, that clinical depression is a universal phenomenon (although symptoms may vary considerably from culture to culture).

  32. Lifetime Prevalence of Major Depressive & Manic Episodes by Race

  33. Epidemiology of Mood Disorders by Gender: Lifetime Prevalence

  34. Prevalence of MDD: Employment & Income

  35. Prevalence of MDD by Age

  36. Researchers previously thought that depression occurred more frequently in the elderly. Mood disorders are lesscommon among elderly people than they are among younger adults. Certain subgroups of the elderly population, however, may have high incidence of mood disorders (e.g., those about to enter residential care). Birthcohorttrend: Those born after WWII are more likely to develop mood disorders and have an earlier age of onset than people from previous generations. Epidemiology: Age

  37. Chart: What is Cohort Effect?

  38. Chart: What is Cohort Effect?

  39. Comorbidity the manifestation of more than one disorder simultaneously Of those with mental disorders, 25% have two or more disorders. Comorbidity: Definition

  40. Comorbidity: Major Depressive Disorder

  41. Average age of onset is 23 for males and 25 for females. Minimum duration of at least 2 weeks. Most people who have major depression will have at least 2 depressive episodes. MDD is frequently a chronic and recurrent condition. Half recover from their episode of major depression within 6 months; 40% of people who recover relapse within a year. Course & Outcome: Major Depressive Disorder

  42. Onset is usually between ages 18-20. Average duration of manic episode is 2-3 months; bipolar II patients tend to have shorter and less severe episodes. Long-term course Most will have more than one episode Length of intervals between episodes varies and is difficult to predict 40-50% of patients are able to achieve a sustained recovery; rapid cycling patients have a worse prognosis Course & Outcome: Bipolar Disorders

  43. Mood Disorders • Basic definitions • Unipolar mood disorders • Special topic: Depression & interpersonal relationships • Bipolar mood disorders • Subtypes • Epidemiology • Etiology • Treatment

  44. Loss and depression significant others social role self-esteem Relationships and depression Social support (or lack of) and depression Etiology: Social Factors & Depression

  45. Stressful life events and mood disorders: causality can go both ways… Severely stressful life often precede the development of mood disorders and relapse Stressful life events may be generated by those with mood disorders Etiology: Mood Disorders & Life Events

  46. Learned Helplessness passive behavior in the face of negative situations Uncontrollable negative events  learned helplessness Learned helplessness  depression But model does not explain why some become depressed and others do not! Etiology: Learned Helplessness TheorySeligman (1965)

  47. Uncontrollable event Belief that what happens is uncontrollable Depressogenic Attributional Style Attribute negative event to stable, global, and internal factors Expectation of future uncontrollable events Symptoms of helplessness and depression Reformulated Learned Helplessness Theory(Abramson, Seligman, & Teasdale, 1978)

  48. These biases act as a lens through which people view and interpret the world A schema is an expectation for how things work in the world A depressive schema is a risk factor to depression in the face of “failure” events Beck’s Cognitive Triad: Negative thoughts about the self, the world, and the future Why is this important?

  49. Genetics Family studies and twin studies suggest a mild genetic influence for unipolar depression and a stronger one for bipolar disorder Unipolar depression concordance rates: MZ = .54, DZ = .24 Bipolar disorder concordance rates: MZ = .43, DZ = .06 No strong evidence of a single gene responsible for mood disorders. Etiology: Biological Factors

  50. We know that stress leads to depression in some people, but not others. Why? Could genes have something to do with it? Behavioral genetics suggest that they do, but we would like to be able to support this with actual genes! Etiology: Stress-Gene Interactions

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