7/30/2019 mood dis
1/17
Chapter 9
MoodDisorders
7/30/2019 mood dis
2/17
Copyright 2007 by The McGraw-Hill Companies, Inc. All rights reserved.Chapter 9
Symptoms of Depression
Cognitive Poor concentration, indecisiveness,poor self-esteem, hopelessness, suicidal
thoughts, delusions
Physiological and
Behavioral
Sleep or appetite disturbances,
psychomotor problems, catatonia,
fatigue, loss of memory
Emotional
Sadness, depressed mood, anhedonia(loss of interest or pleasure in usual
activities), irritability
7/30/2019 mood dis
3/17
Copyright 2007 by The McGraw-Hill Companies, Inc. All rights reserved.Chapter 9
Major Depression Dysthymic Disorder
5 or more symptomsincluding sadness or
loss of interest or
pleasure
3 or more symptomsincluding depressed
mood
At least 2 weeks in
duration
At least 2 years in
duration
Numbero
f
symptom
s
Duration
Depression versus Dysthymia
7/30/2019 mood dis
4/17
Copyright 2007 by The McGraw-Hill Companies, Inc. All rights reserved.Chapter 9
Depression and Dysthymia
Dysthymia more chronic than depression (nevermore than 2 months without depressed mood).
When combined with major depression, may bereferred to as Double Depression.
High levels of comorbidity associated withdysthymia and depression.
7/30/2019 mood dis
5/17
Copyright 2007 by The McGraw-Hill Companies, Inc. All rights reserved.Chapter 9
Subtypes of Depression
Depression with Melancholic Features (loss of
pleasure, anorexia, guilt)
Depression with Psychotic Features (hallucinations,
delusions)Depression with Catatonic Features (lack of
movement or extreme agitation)
Depression withAtypical Features (positive
emotional experiencing)Depression with Postpartum Onset
Depression with Seasonal Patterns
7/30/2019 mood dis
6/17
Copyright 2007 by The McGraw-Hill Companies, Inc. All rights reserved.Chapter 9
Prevalence and Prognosis
Among adults, 15-to-24-year olds are most likely tohave had a major depressive episode in the pastmonth.
Depression is less common among children thanamong adults.
Depression may be most likely to leave psychologicaland social scars if it occurs initially during
childhood, rather than during adulthood.
7/30/2019 mood dis
7/17
Copyright 2007 by The McGraw-Hill Companies, Inc. All rights reserved.Chapter 9
Bipolar Disorder
Characterized by manic episodes. Elevated, expansive, or irritable mood Inflated self-esteem or grandiosity Decreased need for sleep More talkative than usual Flight of ideas Distractibility Increase in activity directed at achieving goals Excessive involvement in dangerous activities (risk taking)
Hypomania Less severe than mania Less interference with functioning
7/30/2019 mood dis
8/17
Copyright 2007 by The McGraw-Hill Companies, Inc. All rights reserved.Chapter 9
Bipolar Disorder
Bipolar I Disorder Mania
Likely (although not necessarily) will experience majordepression episodes (MDE)
May also experience periods of hypomania in betweenmanic episodes
Bipolar II Disorder
MDE necessary for diagnosis No manic episodes
Hypomanic episodes
7/30/2019 mood dis
9/17
Copyright 2007 by The McGraw-Hill Companies, Inc. All rights reserved.Chapter 9
Bipolar Disorder
CyclothymiaAlternates between episodes of hypomania and dysthymia
(or moderate depression).
Rapid cycling bipolar disorder 4 or more cycles of mania and depression within a year
Often given to individuals with borderline personalitydisorder INACCURATELY
7/30/2019 mood dis
10/17
Copyright 2007 by The McGraw-Hill Companies, Inc. All rights reserved.Chapter 9
Bipolar Disorder: Prevalence
Less common than unipolar depression
Approximately 1% lifetime prevalence
No gender differences Most likely to develop in late adolescence or
early adulthood
Can it be diagnosed in children?
7/30/2019 mood dis
11/17
Copyright 2007 by The McGraw-Hill Companies, Inc. All rights reserved.Chapter 9
Risk of Bipolar Disorder
0
10
20
30
40
50
60
70
MZ twins DZ twins Sibs, parents,
children
Biological
parents of BP
adoptees
Second-
degree
relatives
General
population
Percentwithbipolardisorder
7/30/2019 mood dis
12/17
Copyright 2007 by The McGraw-Hill Companies, Inc. All rights reserved.Chapter 9
Biological Theories
Genetics
Strong genetic component to bipolar disorder.
Concordance rate (probability both twins will develop a disorder)
is 60% among MZ twins. Neurotransmitter Dysregulation
Monoamine theory of depression and bipolar disorder:
Norepinephrine, Serotonin, and Dopamine (all found in limbic
system of the brainregulates sleep, appetite, and emotions) Type of imbalance determines the disorder (high sensitivity
mania, insensitivity depression)
May be state-dependent
7/30/2019 mood dis
13/17
Copyright 2007 by The McGraw-Hill Companies, Inc. All rights reserved.Chapter 9
Biological Theories
Brain structural abnormalitiesAmygdala enlargement
May bias people towards aversive or emotionally arousing
information, leading to rumination and increased contactwith negative environmental cues.
Neuroendocrine factors: Sensitivity and hyperactivity of the HPA axis
(hypothalamic pituitary adrenal axis) Inability to return to baseline
May inhibit monoamine receptors
7/30/2019 mood dis
14/17
Copyright 2007 by The McGraw-Hill Companies, Inc. All rights reserved.Chapter 9
Psychological Theories
Behavioral theories: Learned helplessness
Lewinsohn limited contact with positively reinforcingaspects of the environment
Cognitive theories: Causal attributions (reformulated learned helplessness
theory)
Internal vs. External Stable vs. Unstable
Global vs. Specific
Internal, stable, and global attributions worse
7/30/2019 mood dis
15/17
Copyright 2007 by The McGraw-Hill Companies, Inc. All rights reserved.Chapter 9
Psychological Theories
Ruminative Response Style Intense focus on internal experience to the exclusion of everything
else.
Focus occurs without any attempt to do anything to aversive internal
states.
Psychodynamic Theories Connected depression to the grief process
Individuals may be responding to real or imagined abandonment
and/or rejection Individuals at risk for depression are overly concerned with the
approval of others.
Introjected hostility
7/30/2019 mood dis
16/17
Copyright 2007 by The McGraw-Hill Companies, Inc. All rights reserved.Chapter 9
Treatment
Behavioral Behavioral scheduling
Behavioral activation
May take an interpersonal bentfocus on the patientsbehavior with others (including therapist)
Cognitive Focusing on restructuring maladaptive thoughts and rigid
attributions about the world and the self.
Eventually target depressive schemas and core beliefs(e.g., I am unlovable).
7/30/2019 mood dis
17/17
Copyright 2007 by The McGraw-Hill Companies, Inc. All rights reserved.Chapter 9
Relapse
Relapse common in depressionTeasdale, Segal, and Williams suggest that this is due to
fusion with thoughts We believe our thoughts.
Therefore, the presence of any depressive thought is animmediate sign that full-blown depression is not far away.
Treatment focused on increasing metacognitive
awareness awareness of thoughts as thoughts.
Top Related