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 % 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 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 (1 st 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