1. MOOD DISORDERS: Basic Concepts
SOSC. 103
Fall 2011

2. Emotional extremes of mood disorders come in two principal forms.
Major depressive disorder
Bipolar disorder
Preview Question 6: What are mood disorders, and what forms do they take?

3. Mood disorders
Disturbances in emotion that cause discomfort or hinder functioning
Rank among the top 10 causes of worldwide disability
a leading cause of absenteeism and diminished productivity in workplace
prevalence for all mood disorders is 15 percent for males, 24 percent for females

4. Mood disorders: General Stats
Likelihood of recurrence is
50 percent after one episode
70 percent after two
90 percent after three
Women twice as likely as men to become depressed except for Bipolar 1

5. Major Depressive Disorder
Depression is the “common cold” of psychological disorders. It is the leading cause of disability worldwide affecting 5.8% of men and 9.5% of women report depression in a given year (WHO, 2002).
To feel bad as a reaction to sad events is a normal response. But prolonged, this can become maladaptive.

6. Major Depressive Disorder
Major depressive disorder occurs when at least five signs of depression (including lethargy, feelings of worthlessness, or loss of interest in family or friends) last two weeks or more and are not caused by drugs or medical conditions.

7. Major Depressive Episode
A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. Note:  Do note include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations. (1) depressed mood most of the day. Note: In children and adolescents, can be irritable mood. (2) markedly diminished interest or pleasure in all, or almost all, activities (3) significant weight loss when not dieting or weight gain, decrease or increase in appetite nearly every day. (4) insomnia or hypersomnia nearly every day (5) psychomotor agitation or retardation nearly every day (6) fatigue or loss of energy nearly every day (7) feelings of worthlessness or excessive or inappropriate guilt (8) diminished ability to think or concentrate, or indecisiveness (9) recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
B. The symptoms do not meet criteria for a Mixed Episode. C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism). E. The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

8. Major Depressive Episode cont’d
B. The symptoms do not meet criteria for a Mixed Episode. C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism). E. The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

10. Bipolar Disorder
Formerly called manic-depressive disorder, bipolar disorder is an alternation between the lows of depression and the euphoric, hyperactive state of mania.
Though it is less common than major depressive disorder, it is often more dysfunctional.

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

12. Manic Episode: For a week, or less of manic symptoms (less only if symptoms are severe manic symptoms enough for hospitalization)
Affective symptoms: ELEVATED OR IRRITABLE MOOD (expansive mood, boundless energy, and enthusiasm)
Cognitive symptoms: Speech, attention, judgment
Behavioral symptoms:
Mania: more disruptive grandiosity, incoherent speech; hallucinations and delusions possible
Physiological symptoms: High arousal and decreased need for sleep, weight loss
Elevated mood,
Expansiveness,
Irritability,
Hyperactivity

13. Manic Episode
NOTE: The person may become involved in more activities than usual – starting new projects etc also shopping sprees, money on luxury items, reckless sexual behavior or driving etc….

14. Hypomanic Episodes – a minimum duration of four days
Less severe mania that does not cause impairment in social or occupational functioning
Overactive in behavior but no delusions like mania

15. Explaining Mood Disorders
Since depression is so prevalent worldwide, investigators want to develop a theory of depression that will suggest ways to treat it.
Lewinsohn et al., (1985, 1998) note that a theory of depression should explain the following:
Preview Question 7: What causes mood disorders, and what might explain the Western world’s rising incidence of depression among young people?
Behavioral and cognitive changes
Common causes of depression

16. Theory of Depression
Women and more than twice as vulnerable as men to major depression.

17. Theory of Depression Most depressive episodes self-terminate.
Stressful events often precede depression.
Depression is increasingly striking earlier in life and affecting more people.

18. Suicide
The most severe form of behavioral response to depression is suicide. Each year some 1 million people commit suicide worldwide.
National differences
Racial differences
Gender differences
Age differences
Other differences
Suicide Statistics
Fig 32.4

19. Biological Perspective
Genetic Influences: Mood disorders run in families. The rate of depression is higher in identical (50%) than fraternal twins (20%).
Linkage analysis link possible genes and dispositions for depression.

20. 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

21. The Depressed Brain
At least two neurotransmitter systems play a role in depression. Norepinephrine, which boosts mood and increases arousal and serotonin. Both are scare during depression.

22. Social-Cognitive Perspective
The social-cognitive perspective suggests that depression arises partly from self-defeating beliefs and negative explanatory styles.

23. Negative Thoughts and Moods
Explanatory style plays a major role in becoming depressed.

24. Depression Cycle Negative stressful events.
Pessimistic explanatory style.
Hopeless depressed state.
These hamper the way the individual thinks and acts, fueling personal rejection.