Mood Disorders. “Gross deviation in Mood” Major Depressive Episode Manic Episode/Hypo-manic...
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Transcript of Mood Disorders. “Gross deviation in Mood” Major Depressive Episode Manic Episode/Hypo-manic...
Mood Disorders
“Gross deviation in Mood”
• Major Depressive Episode
• Manic Episode/Hypo-manic Episode
• Mixed Episode
Major Depressive Episode
• Phenomenological– Affective: dysphoria, anhedonia,
irritability– Cognitive: worthlessness/guilt,
hopelessness, concentration, suicidal
• Behavioural – Changes in motor functioning
(agitated or retarded)
• Physiological– Changes in weight/appetite, sleep
disturbance, loss of energy
Manic Episode
• Phenomenological– Affective: elevated, expansive
mood (euphoria), irritability, inflated self-esteem
– Cognitive: flight of ideas, shifts of ideas, distractible
• Behavioural – Changes in motor functioning
(hyperactive, talkativeness, reckless behaviour)
• Physiological– Less sleep, increased energy
Types of Mood Disorders
• Unipolar Depression:– Major Depressive Disorder– Dysthymic Disorder
• Bipolar Disorder:– Bipolar I Disorder– Bipolar II Disorder– Cyclothymic Disorder
1) Major Depressive Disorder
• One or more Depressive Episode with no intervening periods of mania
• 17% Lifetime Prevalence
• Woman more effected than men
• 30% of undergrads are dysphoric and 10% are clinically depressed
Major Depressive Episode
• Onset age = ave. 27
• 90% spontaneous remission within 1 year
• Remission is often only partial
• 80% experience recurrences
2) Dysthymic Disorder
• Milder, but more chronic and persistent than MDD
• Median duration is 5 years
• Can have early or late onset– Before 21: poorer prognosis,
greater chronicity, greater likelihood of genetic involvement
Depression Symptom Modifiers
• Psychotic– Hallucinations & Delusions,
which can be mood congruent or incongruent
• Melancholic– Prominent somatic symptoms
• Atypical– Overeating, oversleeping, anxiety
• Catatonic– Limited movement
Types of Mood Disorders
• Unipolar Depression:– Major Depressive Disorder– Dysthymic Disorder
• Bipolar Disorder:– Bipolar I Disorder– Bipolar II Disorder– Cyclothymic Disorder
Bipolar Disorder
• Involves both manic and depressive phases
• Onset typically 18-22 years• Rapid cycling, poorer prognosis• 1% of general population, less
common than MDD• Almost always more than one Manic
Episode• Equal prevalence in males and
females• Briefer episodes
Bipolar I
• At least one manic (or mixed) episode and usually, but not necessarily, at least one major depressive episode as well
Bipolar II
• At least one major depressive episode and at least one hypomanic episode, but has never met criteria for a manic or mixed episode
Cyclothymia
• Chronic (at least 2 years), cycling between hypomania and depression without meeting criteria for a depressive episode
• Can become a way of life
• Equal prevalence among men and women
• 1/3-1/2 go on to develop Bipolar I or II
Qualities of Mood Disorders
• Psychotic vs. Neurotic
• Endogenous vs. Reactive
• Early vs. Late onset
Explaining Mood Disorders
• Psychodynamic Perspective
• Interpersonal Perspective
• Behavioural Perspective
• Cognitive Perspective
• Sociocultural Perspective
• Biological Perspective
Psychodynamic Perspective
• Freud/Abraham: Unconscious sorrow & rage in response to real or symbolic loss
• Neo-dynamic: Early loss or threatened loss of loved object (parent) – reactivated by current loss – recapitulating helplessness
• Fenichel: Compensation for low self-esteem – interpersonally functional (dependency)
• Affectionless control
Interpersonal Perspective
• Sullivan: Psychopathology is a relational phenomenon
• Recent models focus on current relationships
• Klerman: Grief, interpersonal disputes, role transitions, & lack of social skills – directly address these issues
Behavioural Perspective
• Lewinsohn: Extinction (behaviours no longer rewarded)
• Lack of positive reinforcement causes withdrawal and depression
• Amount of reinforcement depends on:– Number / range– Availability– Skills
Behavioural Perspective
• Negative interpersonal cycle: constantly seeking reassurance and obtaining ‘caring’ – others respond negatively.
Cognitive Perspective
• Seligman: Learned helplessness (expectation of lack of control)
• Recall attributions discussed earlier
• Beck: Negative self-schema
• Dependency vs. Self-criticism
Sociocultural Perspective
• Depression and suicide vary as a function of social factors
Biological Perspective
• Family studies suggest a genetic component (1st degree relatives 3X more likely for depression and 10X more likely for bipolar)
• Twin studies: – Bipolar, 72% vs. 14%
concordance – Unipolar. 40% vs. 11%
Biological Perspectives
• Adoption studies:– Bipolar, 31% prevalence in the
biological parents of the bipolar adoptees vs. 2% biological parents of non-bipolar adoptees
• Biological rhythms:– Sleep disturbance, hormone
differences, --”biological clock”– Change my disrupt biological
clock
Biological Perspectives
• Some evidence to suggest structural brain differences
• Hormone imbalance– Malfunction of the hypothalamus
• Neurotransmitter Imbalance– Catecholamine hypothesis