Chapter 7 Mood Disorders

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Chapter 7

Mood Disorders

Comer, Abnormal Psychology, 6e Chapter

81

Slides & Handouts by Karen Clay Rhines, Ph.D.

Seton Hall University

(edited by E. Schliecker, Ph.D. Gordon College, for

use in class)


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Mood Disorders

Two key emotions on a continuum:

Depression

Low, sad state in which life seems dark and

overwhelming

Mania State of breathless euphoria and frenzied energy

Comer, Abnormal Psychology, 6e

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Depression Mania


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Mood Disorders

Most mood disorders are

unipolar depression

Person has no history of mania

Mood returns to normal when depression lifts

When periods of depression alternate with periods of mania This pattern is called bipolar disorder

Unipolar mania, in which people suffer from mania only but thispattern is uncommon


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How Common Is Unipolar Depression?

About 7% of the U.S. population experiencessevere unipolar depression in any given year

As many as 5% experience mild depression

The prevalence is similar in Canada, England,France, and many other countries

Approximately 17% of all adults experience

unipolar depression at some time in their lives Rates have been steadily increasing since 1915


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How Common Is Unipolar Depression?

In almost all countries, women are twice as likely as

men to experience (or be diagnosed with) severe

unipolar depression

Lifetime prevalence: 26% of women vs. 12% of men

These rates hold true across socioeconomic classes

and ethnic groups

Approximately 50% recover within six weeks, some

without treatment

Most will experience another episode at some point


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What Are the Symptoms of Unipolar Depression? Five

main areas of functioning may be affected:

Emotional symptoms

Feeling miserable,empty, humiliated

Experiencing littlepleasure

Motivational symptoms

Lacking drive, initiative,spontaneity

Between 6% and 15% ofthose with severedepression commitsuicide

Behavioral symptoms

Less active, less

productive

Cognitive symptoms

Hold negative views of

themselves

Blame themselves for

unfortunate events

Pessimism

Physical symptoms

Headaches, dizzy spells,

general pain


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Diagnosing Unipolar Depression

Criteria 1: Major depressive episode

Marked by five or more symptoms lasting two or

more weeks

In extreme cases, symptoms are psychotic, including

Hallucinations

Delusions

Criteria 2: No history of mania


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Diagnosing Unipolar Depression

Two diagnoses to consider:

Major depressive disorder

Criteria 1 and 2 are met

Dysthymic disorder

Symptoms are mild but chronic

Depression is longer lasting but less disabling

Consistent symptoms for at least two years

When dysthymic disorder leads to major depressive

disorder, the sequence is called double depression Seasonal Affective Disorder:

Pineal gland & melatonin


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What Causes Unipolar Depression?

Stress may be a trigger for depression

Some clinicians distinguish reactive(exogenous) depression from endogenous

depression, which seems to be a response tointernal factors

The utility of this distinction is questionable and todaysclinicians usually concentrate on recognizing the

situational and the internal aspects of any given case


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The Biological View

Genetic factors

Family pedigree, twin, adoption, and molecular genestudies suggest that some people inherit a biologicalpredisposition

Researchers have found that as many as 20% of relatives of thosewith depression are themselves depressed, compared with fewerthan 10% of the general population

Twin studies demonstrate a strong genetic component:

Rates for identical (MZ) twins = 46%

Rates for fraternal (DZ) twins = 20% Adoption and molecular gene studies also have implicated a

genetic factor in cases of severe unipolar depression


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The Biological View

Biochemical factors

NTs: serotonin and norepinephrine

In the 1950s, medications for high blood pressure were found to causedepression

Some lowered serotonin, others lowered norepinephrine

This led to the discovery of effective antidepressant medicationswhich relieved depression by increasing either serotonin ornorepinephrine

Depression likely involves not just serotonin nor norepinephrine acomplex interaction is at work, and other NTs may be involved

Endocrine function abnormal levels of cortisol

abnormal melatonin secretion (or hypersensitivity)


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The Psychological Views

Three main models:

Psychodynamic model Little research, but some support

anger turned inward

Link between depression and grief (symbolic or actual loss)

Conflicted object relations

Behavioral model Modestly supported by research

As life changes, we experience a change (loss) of rewards

Social rewards are especially important

Cognitive model Has considerable research support

Negative thinking

Learned helplessness


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Psychodynamic view

Strengths:

Studies have offered general support for thepsychodynamic idea that depression may be triggeredby a major loss

Research supports the theory that early losses set thestage for later depression

Research also suggests that people whose childhood

needs were improperly met are more likely to becomedepressed after suffering a loss


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Psychodynamic view

Limitations:

Early losses dont inevitably lead to depression

May not be typicallyresponsible for development ofdepression

Many research findings are inconsistent

Theory is largely untestable because of its reliance on

unconscious processes


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Behavioral view

Strengths:

Researchers have compiled significant data to support

this theory Limitations:

Research has relied heavily on the self-reports ofdepressed subjects

Behavioral studies are largely correlational and do notestablish that decreases in rewards are the cause ofdepression


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Cognitive views Negative thinking (Beck)

1. Maladaptive attitudes

Beck suggests that upsetting situations later in life can triggerfurther rounds of negative thinking that had developed in

childhood2. The cognitive triad: negative interpretation of

(1) their experiences, (2) themselves, and (3) their futures innegative ways, leading to depression

3. Depressed people also make errors in their thinking, including:

Arbitrary inferences

Minimization of the positive and magnification of the negative4. Depressed people experience automatic thoughts

A steady train of unpleasant thoughts that suggest inadequacyand hopelessness


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Cognitive views

Strengths:

There is significant research support for Becks model:

High correlation between the level of depression and the

number of maladaptive attitudes Both the cognitive triad and errors in logic are seen in people

with depression

Automatic thinking has been linked to depression

Limitations:

Research fails to show that such cognitive patterns are the causeand core of unipolar depression


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Cognitive views

Learned helplessness

Theory asserts that people become depressed when

they think that: They no longer have control over the reinforcements in their

lives

They themselves are responsible for this helpless state

Theory is based on Seligmans work with laboratory

dogs


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Bipolar Disorders

People with a bipolar disorder experience

both the lows of depression and the highs of

mania

They describe their life as an emotional roller

coaster


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What Are the Symptoms of Mania?

Mania: dramatic and inappropriate rises in mood

1. Emotional symptoms

Active, powerful emotions in search of outlet

2. Motivational symptoms

Need for constant excitement, involvement, companionship3. Behavioral symptoms

Very active move quickly; talk loudly or rapidly

Key word: flamboyance!

4. Cognitive symptoms

Show poor judgment or planning Especially prone to poor (or no) planning

5. Physical symptoms

High energy level often in the presence of little or no rest


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Diagnosing Bipolar Disorders

Criteria 1: Manic episode

Three or more symptoms of mania lasting one

week or more

In extreme cases, symptoms are psychotic

Criteria 2: History of mania

If currently experiencing hypomania or depression


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DSM-IV-TR distinguishes between two kinds of

bipolar disorder:

Bipolar I disorder

Full manic and major depressive episodes

Most sufferers experience an alternation of episodes

Some experience mixed episodes

Bipolar II disorder

Hypomanic episodes and major depressive episodes

Rapid cycling: 4 or more episodes per year

Seasonal: moods vary with the seasons


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Individuals with bipolar disorder tend to experiencedepression more than mania over the years

In most cases, depressive episodes occur three times asoften as manic ones, and last longer

Between 1% and 2.6% of adults in the world sufferfrom a bipolar disorder at any given time

The disorders are equally common in women and men

Women may experience more depressive episodes and

fewer manic episodes than men

Rapid cycling is more common in women


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Cyclothymic Disorder

Mild symptoms for two or more years, interrupted by

periods of normal mood

Affects 0.4% of the population

May blossom into bipolar I or II disorder


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What Causes Bipolar Disorders?

biological research has produced some

promising clues

New insights have come from research into NT

activity, ion activity, brain structure, and genetic

factors


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Neurotransmitters

permissive theory about mood disorders:

Low serotonin may open the door to a mood disorder

and permit norepinephrine activity to define theparticular form the disorder will take:

Low serotonin + Low norepinephrine = Depression

Low serotonin + High norepinephrine = Mania


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Ion activity

Ions, which are needed to send incoming

messages to nerve endings, may be improperly

transported through the cells of individuals withbipolar disorder

This improper transport may cause neurons to fire

too easily (mania) or to resist firing (depression)

There is some research support for this theory


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Brain structure

Brain imaging and postmortem studies have

identified a number of abnormal brain structures

in people with bipolar disorder; in particular, thebasal ganglia and cerebellum among others

It is not clear what role such structural abnormalities

play


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Genetic factors Many experts believe that people inherit a biological predisposition to

develop bipolar disorders

Family pedigree studies support this theory; when one twin or sibling hasbipolar disorder, the likelihood for the other twin or sibling increases:

Identical (MZ) twins = 40% likelihood

Fraternal (DZ) twins and siblings = 5% to 10% likelihood

General population = 1% likelihood

Treatment Lithium (supports ion theory) or other mood

stabilizers combined with an anti-depressant


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Chapter 7 Mood Disorders

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