1. Depressive and Bipolar Disorders
Chapter 7
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2. DEPRESSIVE disorders
A disorder that involves periods of symptoms in which an individual experiences an unusually intense sad mood.
Dysphoria
The disorder’s essential element is an unusually elevated sad mood, known as dysphoria.
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3. Major Depressive Disorder
Acute, but time-limited, periods of depressive symptoms that are called major depressive episodes
Major depressive disorder: Individual experiences acute, but time-limited, episodes of depressive symptoms.
Major depressive episodes: Period in which the individual experiences intense psychological and physical symptoms related to a dysphoric mood.
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4. Table 7.1 - Criteria for a Major Depressive Episode
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5. Major Depressive Disorder
Two major categories of major depressive disorder:
Single episode
Recurrent
The lifetime prevalence of major depressive disorder in the United States is 16.6 percent of the adult population.
Each year, 6.7 percent of the adult population receives a diagnosis of major depressive disorder, with clinicians classifying 30.4 percent of these cases (2.0 percent of the adult population) as severe.
People receive a diagnosis of recurrent major depressive disorder if they have had two or more major depressive episodes with an interval of at least two consecutive months without meeting the criteria for a major depressive episode.
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6. Figure 7.1 - Prevalence of Major Depressive Disorder in the United States
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7. Persistent Depressive Disorder (Dysthymia)
A depressive disorder involving chronic depression of less intensity than major depressive disorder.
Symptoms present for at least 2 years.
The 12-month prevalence is 1.5 percent of the U.S. population,
Almost half of these (.8 percent of the adult population) classified as severe
People with dysthymic disorder have depressive symptoms:
Sleep and appetite disturbances, low energy or fatigue, low self-esteem, difficulty with concentration and decision-making, and feelings of hopelessness.
Dysphoria: The emotion of sadness.
The 12-month prevalence for dysthymic disorder is 1.5 percent of the U.S. population.
Approximately 2.5 percent of the adult population will develop this disorder in the course of their lives, with a peak in the 45- to 59-year-old age group (Kessler, Berglund, et al., 2005). The 12-month prevalence for dysthymic disorder is 1.5 percent of the U.S. population, with almost half of these (.8 percent of the adult population) classified as severe
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8. Disruptive Mood Dysregulation Disorder
A depressive disorder in children who exhibit chronic and severe irritability and have frequent temper outbursts.
Outbursts must be developmentally inappropriate and occur three or more times per week.
Between outbursts, children with this disorder are extremely irritable or angry.
Research suggests that they are at risk of developing depressive and/or anxiety disorders when they reach adulthood.
This diagnosis is used for children who exhibit chronic and severe irritability and have frequent temper outbursts that occur, on average, three or more times per week.
Follow-up data of children who show this extreme irritability and angry outbursts suggest that rather than developing bipolar disorder, they are at risk of developing depressive and/or anxiety disorders when they reach adulthood.
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9. Premenstrual Dysphoric Disorder (PMDD)
Women who experience depressed mood or changes in mood, irritability, dysphoria, and anxiety during the premenstrual phase that subside after the menstrual period begins for most of the cycles of the preceding year.
Changes in mood, irritability, dysphoria, and anxiety that occur during the premenstrual phase of the monthly menstrual cycle and subside after the menstrual period begins for most of the cycles of the preceding year
By making this disorder part of the standard psychiatric nomenclature, the DSM-5 authors believed that better diagnosis and treatment could result for women who truly experience a highly exaggerated mood
disturbance prior to their monthly menstrual cycle. Critics argue that the PMDD diagnosis pathologizes the normal monthly variations in mood that women may experience. However, the counterargument is that that the majority of women do not experience severe mood alterations on a monthly basis. By including PMDD as a diagnosis, women with these symptoms can receive treatment that might not otherwise be available to them.
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10. Disorders Involving Alterations in Mood
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11. Bipolar Disorder
Manic episodes and very disruptive experiences of heightened mood, possibly alternating with major depressive episodes
Bipolar disorder: Intense and very disruptive experience of a euphoric mood, which may also occur in alternation with major depressive episodes.
Euphoric mood: A feeling state that is more cheerful and elated than average, possibly even ecstatic.
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12. BIPOLAR DISORDER
Manic episode: A period of euphoric mood with symptoms involving:
Abnormally heightened levels of thinking, behavior, and emotionality
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13. Criteria for a Manic Episode
Inflated self-esteem or grandiosity
Decreased need for sleep
Pressure to keep talking
Flight of ideas
Distractibility
Increase in goal-directed activity
Excessive involvement in activities that have a high potential for painful consequences
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14. Bipolar Disorder Types
Bipolar I disorder - One or more manic episodes, and possibility of major depressive episodes
Bipolar II disorder - One or more major depressive episodes and at least one hypomanic episode
Hypomanic episode: A period of elated mood not as extreme as a manic episode.
Criteria for a hypomanic episode are similar to those of a manic episode, but involve a shorter duration (4 days instead of 1 week).
Mixed episode - Mixed depressive and manic episode.
Bipolar disorder has a lifetime prevalence rate of 3.9 percent in the U.S. population and a 12-month prevalence of 2.6 percent.
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15. criteria for a hypomanic episode
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16. Figure 7.2 - Range of Moods Present in People with Bipolar Disorder
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17. bipolar disorder, rapid cycling
Bipolar disorder with rapid cycling can be diagnosed if they have four or more episodes within the previous year that meet the criteria for manic, hypomanic, or major depressive disorder.
In some individuals, the cycling may occur within 1 week or even 1 day.
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18. Bipolar Disorder Factors that predict rapid cycling: Earlier onset
Higher depression scores
Higher mania scores
Lower global assessment of functioning
Hypothyroidism
Disturbances in sleep-wake cycles
Antidepressant medications
Rapid cycling form of bipolar disorder: Individuals with bipolar disorder who have four to eight mood episodes within the course of a year.
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19. Cyclothymic Disorder Not as intense as bipolar
Met the criteria for a hypomanic episode
Chronic condition
Lasts at least 2 years
Numerous periods of depressive symptoms
Never meet the criteria for a major depressive episode
Cyclothymic disorder: Symptoms that are more chronic and less severe than those of bipolar disorder.
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20. Theories and Treatment of Mood Disorders
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21. Biological Perspectives
First-degree relatives of those with major depression are two to four times the rates of nonrelatives
Twin studies
Altered serotonin functioning
Brain-derived neurotrophic factor (BDNF)
Heritability estimated at 60%
PCLO gene
Twin studies comparing identical or monozygotic (MZ) with fraternal or dizygotic (DZ) twins provide stronger evidence in favor of a genetic interpretation.
Altered serotonin functioning plays an important role in causing genetically predisposed individuals to develop major depressive disorders.
People with major depressive disorder involves brain-derived neurotrophic factor (BDNF), a protein involved in keeping neurons alive and able to adapt and change in response to experience.
PCLO gene seems to play a role in synaptic transmission.
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22. Biological Perspectives
Antidepressant medication
Treatment for bipolar disorder is lithium carbonate
Pharmacogenetics
Circadian rhythms
Light therapy
Antidepressant medication is the most common form of biologically based treatment for people with major depressive disorder.
SSRIs block the uptake of serotonin, enabling more availabilty of this neurotransmitter for action at the receptor sites.
Tricyclic antidepressants (TCAs) are effective in alleviating depression in people who have disturbed appetite and sleep.
MAOIs prolong the life of neurotransmitters, thus increasing neuronal flow.
Lithium is effective in treating acute mania symptoms and in preventing the recurrence of manic episodes.
Pharmacogenetics: Use of genetic testing to determine who will and will not improve with a particular medication.
Circadian rhythms are the daily variations that regulate biological patterns such as sleep-wake cycles.
Light therapy - Individual is seated in front of a bright light for a period of time, such as 30 minutes in the morning.
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23. Psychological Perspectives
Psychodynamic
Insecure attachment style
Defensive responses
Behavioral & cognitive
Behavioral activation
Role of dysfunctional thoughts as causes
Behavioral contracting combined with self-reinforcement
Pharmacological and psychological interventions
Psychoeducation
Psychodynamic
People with an insecure attachment style have a greater risk for developing a depressive disorder in adulthood.
Manic episodes are defensive responses through which individuals stave off feelings of inadequacy, loss, and helplessness.
Develop feelings of grandiosity and elation or become hyperenergetic as an unconscious defense against sinking into a state of gloom and despair.
Behavioral view: Depressed people withdraw from life because they no longer have incentives to be active.
Lack of positive reinforcement elicits the symptoms of low self-esteem, guilt, and pessimism.
Behavioral activation: Behavioral therapy for depression in which the clinician helps the client identify activities associated with positive mood.
Integrating behavioral with cognitive approaches that focus on the role of dysfunctional thoughts as causes, or at least contributors to mood disorders.
Clinicians believe that education is an essential component of therapy.
Clinicians are likely to incorporate psychological interventions designed to help clients develop better coping strategies in an effort to minimize the likelihood of relapse.
Psychoeducation is an especially important aspect of treating people with bipolar disorder.
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24. Cognitive Perspectives
Cognitive triad
A negative view of:
Self
World
Future
Cognitive triad: Negative view of self, world, and future that leads to a depressive schema.
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25. Examples of Cognitive Distortions
Overgeneralizing
Selective abstraction
Excessive responsibility
Assuming temporal causality
Making excessive self-references
Catastrophizing
Dichotomous thinking
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26. Psychological Perspectives
Interpersonal approaches
Assessing the magnitude and nature of the individual’s depression
Formulating a treatment plan
Implementation of treatment plan
Treatment
Interpersonal and social rhythm therapy
Interpersonal therapy (IPT): Treating people with major depressive disorder, based on the assumption that interpersonal stress induces an episode of depression in a person who is genetically vulnerable to this disorder.
Interpersonal therapy into three broad phases:
Involves assessing the magnitude and nature of the individual’s depression using quantitative assessment measures.
Therapist and the client collaborate in formulating a treatment plan that focuses on the primary problem.
Therapist then carries out the treatment plan, with the methods varying according to the precise nature of the client’s primary problem.
Interpersonal and social rhythm therapy proposes that relapses can result from the experience of stressful life events, disturbances in circadian rhythms.
Reduction of interpersonal stress in clients is important:
Stressful life events affect circadian rhythm because an individual feels a sense of heightened arousal of the autonomic nervous system.
Stressful and nonstressful life events cause changes in daily routines.
Major life stressors affect a person’s mood and lead to significant changes in social rhythms.
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27. Sociocultural Perspective
Individuals develop depressive disorders in response to stressful life circumstances
Exposure to an acute stress
Exposure to chronic strains
Behavioral-cognitive interplay: Lack of social skills leads to failed relationship, that leads to feelings of worthlessness, that leads to depression.
Stressful life circumstances:
Sexual victimization
Chronic stress such as poverty and single parenting
Episodic stress such as bereavement or job loss
Acute stress such as the death of a loved one or an automobile accident could precipitate a major depressive episode.
Chronic strains can interact with genetic predisposition and personality to lead to more persistent feelings of hopelessness.
Strong religious beliefs and spirituality lower an individual’s chances of developing depression.
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28. Suicide
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29. Suicide
Fatal self-inflicted destructive act with explicit or inferred intent to die
Suicidal behavior runs from a continuum of thinking about:
Ending one’s life
To developing a plan
To nonfatal suicidal behavior
To the actual ending of one’s life
The highest suicide rates by age are for people 45 to 54 years old.
Within the United States, white men are much more likely than are non-white men to commit suicide.
In one-third of countries, young adults are at highest risk of suicide.
Depression and alcohol-use disorders are a major risk factor for suicide with over 90 percent of suicides.
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30. Suicide Biopsychosocial perspective Sociocultural perspective
Biological theories
Psychological theories
Sociocultural perspective
Perspective of positive psychology
Biological theories emphasize the genetic and physiological contributions that contribute to the causes of mood disorders.
Psychological theories focus on distorted cognitive processes and extreme feelings of hopelessness that characterize suicide victims.
Sociocultural perspective suggests that there are contributions relating to an individual’s religious beliefs and values as well as to the degree to which the individual is exposed to life stresses.
Perspective of positive psychology provides a framework for understanding why individuals who are at high risk for the above reasons nevertheless do not commit suicide.
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31. Suicide Buffering hypothesis of suicidality
Resilience as separate dimension from risk
Risk and resilience as bipolar dimensions
Resilience as a psychological construct
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32. Suicide Factors that buffer suicide risk Ability to solve problems
High levels of self-esteem
Confidence in one’s problem-solving ability
General feelings of social support and support from family
Secure attachment
Suicide beliefs (not regarding suicide as a personal option)
Factors that comprise high resilience include the ability to make positive assessments of one’s life circumstances and to feel in control over these circumstances.
Low resilience occurs with high levels of perfectionism and hopelessness.
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33. Biopsychosocial Perspective
Disorders involve:
Disturbances in neurotransmitter functioning
Cognitive processes
Sociocultural factors
Development of evidence-based approaches allows individuals to:
Obtain treatment that regulates their moods and lead more fulfilling lives
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