Mood Disorders

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Mood Disorders

• Emotion-based disturbance strong enough to
  intrude on everyday life
• Symptoms may include
• Cognitive, behavioral, or physical symptoms
• Interpersonal difficulties
• Types
• Major depressive disorder, dysthymic disorder,
  cyclothymia
• Bipolar disorder

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Major Depressive Disorder (MDD)

• Extreme Sadness, Despair, With No Obvious Cause
• Characterized by
• Episodes of deep unhappiness
• Loss of interest in life
• Secondary symptoms include
• Elevated or decreased changes in sleep and
  appetite
• Loss of interest in sex
• Loss of overall energy
• Difficulties concentrating and making decisions

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Major Depressive Disorder

• 5 of 9 symptoms must be met over a 2 week period
• Depressed mood most of the day
• Reduced interest or pleasure in all or most
  activities
• Significant weight loss or gain, or significant
  decrease or interest in appetite
• Trouble sleeping or sleeping too much
• Psychomotor agitation or retardation
• Fatigue or loss of energy
• Feeling worthless or guilty in an excessive or
  inappropriate manner
• Problems in thinking, concentrating, making
  decisions
• Recurrent thoughts of death and suicide

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Prevalence Rates

• 16.2 percent of adults will suffer from
  depression at least once during their lifespan
• 6.2 in the past year

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Dysthymic Disorder

• Dysthymic Disorder
• Chronic depression
• Unbroken depressed mood lasting most of 2 years
  (adult) or 1 year (child)
• Fewer Symptoms than MDD
• Defined by presence of 2 out of 6 symptoms
• Poor appetite or overeating
• Insomnia or hypersomnia
• Low energy or fatigue
• Low self-esteem
• Poor concentration, difficulty making decisions
• Feelings of hopelessness

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Dysthymic Disorder
Dysthymic disorder lies between a blue mood and
major depressive disorder. It is a disorder
characterized by daily depression lasting two
years or more.
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Major Depression vs. Dysthymia
Recurrent Major Depressive Episodes
Dysthymia
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Etiology

• Biological Perspective
• Low levels of Serotonin
• Leads to low levels of norepinephrine
• Chemical imbalance
• What made us first hypothesize this?
• Drugs used to treat depression increase levels of
  serotonin
• Genetic link
• Runs in families
• Twin studies supports a genetic link

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Etiology

• Biological Perspective
• Why more women? - Estrogen fluctuations
• Post-partum depression, depression that follows
  pregnancy
• Depression rates raise after puberty
• More women than men are affected

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Etiology

• Psychological Perspectives
• Psychodynamic
• Unconscious conflict due to
• childhood experiences
• Behavioral
• Stress reduces positive reinforcers
• Learned helplessness
• Cognitive
• Maladaptive thought patterns, negative thinking
• Which came first? The negative thoughts or the
  depression?

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Seasonal Affective Disorder (SAD)

• Diagnoses
• Same as for depression, but must occur at the
  same time of year each year (typically winter
  time)
• Prevalence
• Most common in areas close to the arctic circle
• 10 of Alaskan population
• 20 of Irish population
• Etiology
• Unknown thought to be related to sunlight
• in some way
• Treatment
• Most common treatment is light therapy
• Also treated with anti-depressants

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Bipolar Disorder

• Diagnosis and Symptoms
• Characterized by extreme mood swings
• Depression and manic episodes
• Please note, this is not simply being moody
• Frequency and separation of episodes
• Manic episodes must last 1 week
• Average about 8 to 16 weeks
• Episodes usually separated by 6 months

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At least 3 criterion

• inflated self-esteem or grandiosity
• decreased need for sleep (e.g., feels rested
  after only 3 hours of sleep)
• more talkative than usual or pressure to keep
  talking
• flight of ideas or subjective experience that
  thoughts are racing
• distractibility (i.e., attention too easily drawn
  to unimportant or irrelevant external stimuli)
• increase in goal-directed activity (either
  socially, at work or school, or sexually) or
  psychomotor agitation
• excessive involvement in pleasurable activities
  that have a high potential for painful
  consequences (e.g., engaging in unrestrained
  buying sprees, sexual indiscretions, or foolish
  business investments)

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Bipolar Disorder
Many great writers, poets, and composers suffered
from bipolar disorder. During their manic phase
creativity surged, but not during their depressed
phase.
Earl Theissen/ Hulton Getty Pictures Library
George C. Beresford/ Hulton Getty Pictures Library
The Granger Collection
Bettmann/ Corbis
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Cyclothymic Disorder

• Cyclothymic Disorder
• Moderate Mood Swings
• A mild form of depression that may include
  long-term bouts of irritability.
• Likened to a milder form of Bipolar disorder.
• hypomania

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Prevalence

• Small percentage of the population, 1 3
• Men and Women are affected EQUALLY
• Cyclothymia may lead to bipolar disorder later in
  life

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Etiology

• Biological
• Neurotransmitters
• Serotonin
• Dopamine
• Norepinephrine
• Drugs that alleviate mania decrease
  norepinephrine
• Hormones
• Hyperactivity of cortisol
• Estrogen
• Structural Abnormalities
• Low activity in frontal lobe, prefrontal cortex
• Neuron death
• High activity in amygdala

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Etiology GENETICS
Bipolar Disorder
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The Depressed Brain

• PET scans show that brain energy consumption
  rises and falls with manic and depressive
  episodes.

Courtesy of Lewis Baxter an Michael E. Phelps,
UCLA School of Medicine
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Etiology

• Psychological Approaches Similar to depression
• Sociocultural
• Interpersonal relationships
• Social support
• Age
• 20s for women
• 40s for men
• Stress

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Biopsychosocial Model Explanation of Mood
Disorders
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Treatments for Mood Disorders Early techniques
include

• Electroconvulsive Therapy (ECT) (also called
  shock therapy)
• http//www.youtube.com/watch?vDCUmINGae44
• ECT is used for severely depressed patients who
  do not respond to drugs. (uncommon now)
• The patient is anesthetized and given a muscle
  relaxant. Patients usually get a 100 volt shock
  that relieves them of depression.

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Treatments Early techniques include

• Psychosurgical techniques
• http//www.youtube.com/watch?v_0aNILW6ILk
• Dr. Freeman (Frontal lobotomies)
• My Lobotomy A Memoir
• Howard Dully
• Prefrontal lobotomy The frontal lobes of the
  brain are severed from the deeper centers of the
  brain.
• Psychosurgery is used as a last resort in
  alleviating psychological disturbances.
  Psychosurgery is irreversible. Removal of brain
  tissue changes the mind.

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Treatments

• Early Medications Included
• MAOIs (Monoamine oxidase inhibitor) (Parnate,
  Nardil)
• Side effects include Toxicity, food and medicine
  interactions
• Tricyclic (Adapin, Sinequan)
• Side effects include Cardiac problems,
  mania,confusion, memory loss, fatigue
• MAOIs and Tricyclics are still prescribed if
  other, newer treatments do not work

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Treatments

• Medication
• SSRIs (Zoloft, Paxil, Prozac)
• Selective Serotonin Reuptake Inhibitor
• SNRIs (Effexor, Cymbalta)
• Serotonin Norephinephrine reuptake inhibitor
• Side effects of medications
• Nausea, nervousness, insomnia, loss of sexual
  interest, suicidal thoughts
• Can be dangerous if prescribed as the only
  medication to a person with Bipolar disorder

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Treatments

• Medication
• Mood stabilizers (lithium, Depakote)
• Bipolar disorder ONLY!
• Side effects Toxicity, cardiac problems
• Non-compliance
• Supplements
• Omega fatty acids
• St. Johns Wort
• Medically dangerous

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• Cognitive therapy is focused on teaching adaptive
  change in thinking, and thus behavior
• Emphasis of this Approach
• Thoughts are the primary source of abnormal
  behavior and psychological problems
• Focus on overt problems
• Structured and analytical approach
• Goals of Therapy
• Cognitive Restructuring learn how to identify
  disordered thinking (Cognitions) and change them

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• Elliss Rational-Emotive Behavior Therapy
• Irrational and self-defeating beliefs are harmful
• Eliminate beliefs through rational examination
• Directive, persuasive, confrontational

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Cognitive Therapies

• Becks Cognitive Therapy
• Illogical thoughts ? psychological problems
• Challenge accuracy of automatic thoughts
• Im so fat, Im going to fail this test
• Less directive has a reflective, open-ended
  dialogue

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Cognitive Behavioral Therapy

• Pushes for self-efficacy
• Confronts the illogical/irrational thoughts and
  changes them and the behaviors associated with it
• Most effective therapy type
• Combined with medication often
• Thoughts arent the whole picture

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Comparison

• Elliss ABCD (RET)

• Becks Cognitive Therapy

• Anxiety Disorders
• Therapist is a teacher not a friend
• Directive - confrontational

• Depression
• Quality therapeutic relationship
• Self-directed, client needs to discovers errors
  themselves