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Mood Disorders. Depressive Disorders Bipolar Disorders Suicide. Cato Grønnerød PSY2600. Defining Mood Disorders. Mood is different from ‘affect’ or ‘emotion’ Pervasive and sustained Depression is different from ‘sadness’ or ‘grief’

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mood disorders

Mood Disorders

Depressive Disorders

Bipolar Disorders

Suicide

Cato Grønnerød

PSY2600

defining mood disorders
Defining Mood Disorders
  • Mood is different from ‘affect’ or ‘emotion’
    • Pervasive and sustained
  • Depression is different from ‘sadness’ or ‘grief’
    • More serious cognitive, behavioural and somatic indicators
    • More severe and invariable in the face of objective events and situations
    • Longer duration
    • Often occurs without external trigger
defining mood disorders1
Defining Mood Disorders
  • Mania is different from ‘good mood’
    • Extremeness and insensitivity to external persons or situations
  • Defintions
    • Single episode versus stable/recurrent
    • Serious versus moderate
    • Unipolar versus bipolar
    • Unipolar: single or double
defining mood disorders2
Defining Mood Disorders
  • Major depressive disorder
    • Single episode
    • Recurrent
    • With melancholic features
    • With psychotic features
    • With postpartum onset
    • With seasonal pattern
  • Dysthymic disorder
depressive unipolar disorders
Depressive (Unipolar) Disorders
  • Currently the most prevalent psychological disorder
  • Children also suffer from depression
  • Women tend to be diagnosed with depression more often than men
  • No strong evidence of socio-economic differences without other risk factors
  • The similarities in people’s experiences outweigh the differences
major depressive disorder
Major Depressive Disorder
  • Emotional symptoms
    • Sadness, guilt, helplessness, hopelessness
    • Anxiety
  • Cognitive symptoms
    • Feeling of having failed, cause of own misery, pessimism about the future
  • Physiological symptoms
    • Loss of appetite, sleep disturbances, weight loss, somatic complaints
  • Motivational symptoms
    • Trouble doing daily routines, nothing seems worthwile, ambivalence
major depressive disorder1
Major Depressive Disorder
  • Person must not have experienced any episodes of mania
  • Must have experienced at least one major depressive episode.
  • Five or more symptoms out of 9 for at least 2 weeks
    • Change from normal functioning
    • Either depressed mood or decreased interest/pleasure
      • Must be one of the five symptoms
dysthymic disorder
Dysthymic Disorder
  • Chronic depression that becomes ‘personality like’
  • Similar symptoms to those for Major Depression
    • Must not have had a manic episode
    • Person is typically able to maintain normal functioning outwardly
  • Often goes undiagnosed
    • Symptoms are less severe and less changeable
    • People don’t report their difficulties
dysthymic disorder1
Dysthymic Disorder
  • Typically diagnosed when a person presents with other issues, including a Major Depressive Episode
  • Reasonably good responses to treatment
    • Indicate that it is a mood disorder and not a personality disorder
  • Long term negative impact on sense of self and life satisfaction
depressive disorders
Depressive Disorders
  • Depression can be difficult to recognise or diagnose
    • Cultural differences
    • Variety of presentation
    • Lack of self referral
      • Don’t feel depressed but behaviour suggests otherwise
    • Unwillingness to report symptoms
    • Requirement that there be a change from normal functioning
vulnerability to depression
Vulnerability to depression
  • Younger persons more at risk than older persons
  • Women more at risk than men
  • Ethnic differences
  • Life events
    • Prior depression
    • Bad childhood experiences
    • Stressful losses
course of depression
Course of depression
  • Depression usually dissipates in time
  • 75-90% recovery rate
  • Three courses after an episode
    • Recovery witout relapse
    • Recovery with recurrence
      • Greatest risk the first six months
    • Chronic depression (dysthymia)
biological causes
Biological Causes
  • Heritability: relatives have higher risk
  • Reduced amounts or poor circulation of norepinephrine and/or serotonin in the brain
  • Hormonal imbalance (e.g. low oestrogen/testosterone, long-term high exposure to cortisol)
  • Poor metabolic activity in certain areas of the brain (e.g. frontal lobes)
biological causes1
BiologicalCauses
  • Synaptic regulation
    • Discharge
    • Reception
    • Reuptake
    • Degration
biological causes2
Biological Causes
  • First hypothesis: Reduced avaiability of norepinephrine and dopamine
  • Serotonine levels were also reduced
  • Medication takes 2-3 weeks to have effect, yet serotonine levels change immediately
    • Downregulation
    • Kindling
  • Mononamine deficits only evident when the person is depressed
biological treatment medication
Biological Treatment: Medication
  • Tricyclic antidepressants
    • Block the reuptake of norepinephrine
    • Can have strong side effects and vulnerable to overdose
  • MAOIs (monoamine oxidase inhibitors)
    • Prevent the breakdown of norepinephrine
    • Dangerous side effects especially when combined with substances found in common foods and drinks
biological treatment medication1
Biological Treatment: Medication
  • SSRIs (selective serotonin reuptake inhibitors)
    • Blocks specifically the reuptake of serotonin
    • Currently the preferred drug group
    • Some evidence of danger emerging e.g. physical dependency
    • Links to suicide (e.g. Prozac and Paxil)
biological treatment
Biological Treatment
  • Electro Convulsive Therapy (ECT)
    • Bad reputation due to past overenthusiasm and poorly understood techniques
    • Still used in severe cases that do not respond to other treatments
      • Improved technology
      • More targeted and appropriate treatment
    • Still high relapse rates, due to treatment or disorder?
cognitive causes
Cognitive Causes
  • Explanatory Style (Martin Seligman)
    • Learned helplessness
      • People given inescapable events will become passive later on when they are given escapable events
    • Depressive patterns of negative thought
    • Internal causes for negative events, external for positive events
    • Causes are global and stable
cognitive causes1
Cognitive Causes
  • The Cognitive Triad (Aaron T. Beck)
    • Negative beliefs about 1) self, 2) world (experience) and 3) future
    • Arbitrary inference
      • Drawing conclusions when there is little support
    • Selective abstraction
      • Focusing on one insignificant detail while ignoring more important features
cognitive causes2
Cognitive Causes
  • The Cognitive Triad
    • Overgeneralization
      • Drawing global conclusions about worth, ability or performance on the basis of a single fact
    • Magnification or minimization
      • Small bad events are magnified and large good events are minimized
    • Personalization
      • Incorrectly taking responsibility for bad events
treatment of depression
Treatment of Depression
  • Cognitive Therapy
    • Helping the person first to become aware of and then counter their negative beliefs and expectations
    • Detecting and testing automatic thoughts
    • Usually paired with behavioural exercises
  • Interpersonal Therapy (IPT)
    • Psychodynamic therapy focused on present social and interpersonal relationships
    • Short-term (e.g. 10-12 sessions)
    • Helps person to examine the meaning of current interpersonal experiences
bipolar disorder
Bipolar Disorder
  • ‘Manic depression’
  • Less common than unipolar depression, but arguably greater impact, on others especially
  • Can resemble unipolar depression whilst in the depressed phase
    • But more severe, more rapidly severe, does not respond in the same way to anti-depressants
  • Presence of mania or manic episodes is the major distinguishing feature.
types and features of bipolar disorder
Types and Features of Bipolar Disorder
  • Mania
    • Characterised by euphoric or highly irritable mood; grandiose, rapid, irrational and even delusional thoughts and ideas; hyperactive, insistent and persistent behaviour; greatly reduced need for or desire for sleep
  • Cyclic pattern
    • A person’s cycle may stretch over many months or even years, or they may have a ‘rapid cycling’ pattern where swings between mania and depression occur more frequently e.g. every few weeks
types and features of bipolar disorder1
Types and Features of Bipolar Disorder
  • Bipolar I
    • At least one Manic Episode and one Major Depressive Episode
  • Bipolar II
    • At least one Hypomanic (less severe) Episode and one Major Depressive Episode
  • Cyclothymic
    • Repeated severe mood swings but not severe enough to be either Manic or Major Depressive Episodes
causes and treatment of bipolar disorder
Causes and Treatment of Bipolar Disorder
  • Genetic vulnerability – greater even than for unipolar depression
  • Dysfunction with self-correcting mechanisms in the brain that normally balance mood
  • Dysfunction with the inhibition-disinhibition system in the brain (protection vs. pleasure-seeking)
  • No adequate explanation for the co-occurrence of depression and mania
    • E.g. is one a defence against the presence of the other?
  • Treatment is largely drug-based
    • Lithium carbonate
    • Recently some anti-convulsants
seasonal affective disorder
Seasonal Affective Disorder
  • Depression that starts in October or November
  • Full remission by March or April
    • Sometimes toward mania
    • Remits shortly on travels southwards
  • Light therapy
    • Phosphor fluorescent lamps
suicide
Suicide
  • In the 45 years from 1950 to 1995, suicide rates increased 60% worldwide
    • Particular increases observed in the 15-34 age group
    • Among the top three causes of death for this age group
  • For every completed suicide there are 10-20 more attempted suicides
  • Suicide rates are particularly high among Eastern European countries according to 2003 data
  • Women attempt more suicides
    • Sleeping pills, wrist cutting
  • Men succeed more suicides
    • Weapons, jumping off buildings
suicidal risk factors
Suicidal Risk Factors
  • Demographic and sociocultural factors
    • Male, low SES, social isolation, atheism, unemployment
  • Psychopathological factors
    • Depression, bipolar disorder, schizophrenia
    • Impulsivity, substance abuse
    • Previous attempts
  • Biological and medical factors
    • Genetic predisposition
    • Neurochemical factors
    • Severe, painful and disabling physical illness
suicidal risk factors1
Suicidal Risk Factors
  • Life events
    • Separation/divorce or death of partner
    • Knowing other suicide attempts/victims
    • Physical and mental trauma, issues of sexual orientation
  • Environmental factors
    • Access to and availability of lethal means
    • Rural residence
    • Media portrayals of suicide
suicide prevention
Suicide Prevention
  • Apart from altruism, two main reasons for suicidal attempts
    • Surcease: to end suffering of self and others
    • Manipulation: to invoke responses from society or others
  • Prevention is difficult and inexact
  • Aftercare of suicide attempters is also important as is intervention for families and friends of victims
  • Risk assessment is crucial