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Mood Disorders. Bipolar Disorders Depressive Disorders. Episodes and Patterns. Major depressive episode Manic episode Mixed episode Hypomanic episode Cycling patterns. Major depressive episode.

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mood disorders

Mood Disorders

Bipolar Disorders

Depressive Disorders

episodes and patterns
Episodes and Patterns
  • Major depressive episode
  • Manic episode
  • Mixed episode
  • Hypomanic episode
  • Cycling patterns
major depressive episode
Major depressive episode
  • Five or more of the following, most of the day and/or nearly every day, including at least symptom 1 or 2:
  • 1. Depressed mood
    • Sad, empty, weepy; irritable, angry
  • 2. Loss of interest or pleasure in previously enjoyable activities
  • 3. Change in weight or appetite
  • 4. Sleep changes
more depressive symptoms
More depressive symptoms
  • 5. Noticeable change in movement
  • 6. Fatigue
  • 7. Feelings of worthlessness or guilt
  • 8. Impaired cognition or volition
  • 9. Repeated thoughts of death or suicide, or planned or attempted suicide
  • The five symptoms must occur in the same two weeks
manic episode
Manic episode
  • One week of persistently high, expansive, or irritable mood, and 3 of:
  • Grandiose self-esteem
  • Lower sleep need
  • Overly talkative
  • Racing thoughts
  • Easily distracted
  • Increased activity or agitation
  • High risk activities
mixed episode
Mixed episode
  • One week of both manic and major depressive symptoms with rapidly alternating moods
  • Common symptoms:
    • Agitation
    • Insomnia
    • Irregular appetite (binge-fast)
    • Delusions
    • Thoughts of suicide
hypomanic episode
Hypomanic episode
  • Four days of manic episode symptoms
  • Mood disturbance does not critically impair ability to work or maintain social responsibilities
  • Response pattern is uncharacteristic
  • Not euthymia
bipolar disorders
Bipolar disorders
  • Bipolar I Disorder
    • One or more manic or mixed episodes
    • Usually one or more major depressive episodes
    • Subcategorized based on the character of the most recent episode
      • Most recent episode depressed
      • Most recent episode manic
      • Most recent episode mixed
bipolar disorders9
Bipolar disorders…
  • Bipolar II Disorder
    • One or more major depressive episodes
    • One or more hypomanic episodes
    • NO manic or mixed episode
  • Cyclothymic Disorder
    • Two years of alternating hypomanic and depressive symptoms
    • No remission of more than two months
    • NO major depressive, manic, or mixed episodes
depressive disorders
Depressive disorders
  • No history of manic, hypomanic, or mixed episodes
  • Major Depressive Disorder
    • Current major depressive episode
  • Dysthymic Disorder
    • Two years of chronically depressed mood
    • Two additional depression symptoms (appetite, sleep, energy, concentration, low self-esteem, hopeless feelings)
patterns of mood disorders
Patterns of mood disorders

Manic

Hypo-

manic

De-

pressed

Identify episodes:

Manic

Mixed

Weeks

Hypomanic

Major Depressive

more patterns
More patterns...

Manic

Hypo-

manic

De-

pressed

depressive disorders nos
Depressive Disorders NOS
  • Premenstrual dysphoric disorder
  • Minor depressive disorder
    • Fewer than five symptoms
  • Recurrent brief depressive disorder
    • Monthly episodes lasting <2 weeks
  • Postpsychotic depressive disorder of Schizophrenia
    • Residual phase phenomenon
mood disorder specifiers
Mood Disorder Specifiers
  • These specifiers may be applied to mood disorder diagnoses, where appropriate:
    • Mild/moderate/severe w/o psychotic features
    • With:psychotic/ catatonic/ melancholic/ atypical features (m-older, a-younger)
    • In remission/chronic/seasonal pattern
    • With postpartum onset
    • Rapid cycling for Bipolar I or II Disorder
etiology of mood disorders
Etiology of mood disorders
  • Psychoanalytic theory: Evaluation of experiences
  • Cognitive theories: Thought patterns
  • Interpersonal theory: Rejection
  • Biological theories: Genes and NTs
  • Existential theory: Loss of meaning
psychoanalytic theory
Psychoanalytic theory
  • Oral fixation: Depends on others for self-esteem
  • Bereavement, introjection, and mourning work
  • Symbolic loss
  • But dream themes of depressed patients are of loss and failure, not anger and hostility (Beck and Ward, 1961)
  • Depressed people do express anger
cognitive theories
Cognitive theories
  • Beck’s theory:

Character of pessimism (NegativeTriad)

Habits of negativity (Negative schemas)

Erroneous thinking (Characteristic biases)

DEPRESSION

characteristic biases
Characteristic biases
  • Arbitrary inference
  • Selective abstraction
  • Overgeneralization
  • Magnification and minimization
assessment of beck s theory
Assessment of Beck’s theory
  • Depressed people do show cognitive biases in their thinking
  • Their apparent pessimism, however, is accurate
  • The theory is correlational, not causal
  • The model is multidimensional
  • Treatment based on the theory is helpful
helplessness hopelessness theories
Helplessness/hopelessness theories
  • Learned helplessness (Seligman & Maier, 1967)
  • Attributional reformulation (Abramson, Seligman & Teasdale, 1978)
    • Personal/Environmental (a.k.a. Internal/External)
    • Stable/Unstable
    • Global/Specific
  • Hopelessness: Add diatheses of low self-esteem and hopelessness
interpersonal theory
Interpersonal theory
  • Reduced interpersonal support
  • Experiences of rejection
    • Due to social structure
      • Inadequate social networks
      • Others may dislike them
    • Elicited by patient
      • Consequences of behavioral choices
      • Critical comments by spouse
    • Poor social skills and seeking reassurance
behavioral theories
Behavioral theories
  • Learned helplessness/hopelessness is a behavioral theory with a cognitive twist.
  • Reduction in reinforcement leads to a reduction in activity.
  • Depressive behaviors are reinforced.
  • Depressed people have taken part in fewer pleasant events.
availability of reinforcers
Availability of reinforcers
  • The amount of reinforcement available is a function of
    • Personal characteristics
    • Environment or milieu
    • Repertoire of reinforcement-producing behaviors.
biological theories
Biological theories
  • Genetics:
    • Bipolar MZ concordance = 43% to 72%
    • Bipolar DZ concordance = 6% to 25%
    • Unipolar MZ concordance = 46%
    • Unipolar DZ concordance = 20%
  • Linkage analysis: Mixed results
    • Multiple genes?
    • Chromosomes 13 and 22
brain chemistry theories
Brain chemistry theories
  • Serotonin and norepinephrine
  • Drug treatments: Tricyclics, MAOIs, and SSRIs
  • But the time course doesn’t match
  • Current hypothesis: Antidepressant drugs change the density or sensitivity of postsynaptic serotonin receptors
brain structure theories
Brain structure theories
  • For Major Depressive Disorder only
  • Subgenual Cingulate Region (Mayberg, 2005):Deep brain stimulation
  • Ventral Anterior Capsule, white matter connecting prefrontal cortex to thalamus, has been blocked in treatment for OCD, with the observation that it affected mood as well.
neuroendocrine theory
Neuroendocrine theory
  • Hypothalamus-pituitary-adrenocortical axis
  • High levels of cortisol correlate with depression
  • Dexamethasone Suppression Test identifies major depressive episodes
existential theory
Existential theory
  • Frankl and the search for meaning
  • A spiritual approach: Logotherapy
  • Suffering has meaning: What is it?
  • Reversing helplessness?