1. PowerPoint® Presentation by Jim Foley
Psychological Disorders
PowerPoint® Presentation
by Jim Foley
© 2013 Worth Publishers

2. Module 49: Mood Disorders

3. Mood Disorders: Not just feeling “down;” not just sad about something
Major Depressive Disorder: Stuck in dark withdrawal
Bipolar Disorder: sometimes fleeing depression into mania
Prevalence and Course of depression: Common, but for many it goes away
Genetic Influences on Depression
Suicide and Self-Injury
Negative Moods and Negative thoughts: Explanatory style
The vicious cycle: Interaction of bad experiences  depressive thoughts  mood changes  behavior changes  more sad days
No animation.

4. Mood Disorders Major depressive disorder [MDD] is:
more than just feeling “down.”
more than just feeling sad about something.
Click to reveal text.
Bipolar disorder is:
more than “mood swings.”
depression plus the problematic overly “up” mood called “mania.”

5. Criteria of Major Depressive Disorders
Major depressive disorder is not just one of these symptoms.
It is one or both of the first two, PLUS three or more of the rest.
Depressed mood most of the day, and/or
Markedly diminished interest or pleasure in activities
Significant increase or decrease in appetite or weight
Insomnia, sleeping too much, or disrupted sleep
Lethargy, or physical agitation
Fatigue or loss of energy nearly every day
Worthlessness, or excessive/inappropriate guilt
Daily problems in thinking, concentrating, and/or making decisions
Recurring thoughts of death and suicide
Click to reveal bullets.
Diagnosing major depressive disorder, as with making other diagnoses, requires seeing the whole pattern rather than just one or two symptoms. Depression crosses the line into a disorder when it impairs daily functioning and/or causes significant distress.
With this list, the pattern is one or both of the first two symptoms and three to four of the rest of the symptoms, lasting more than two weeks.
The criteria related to weight loss does not include weight loss caused by deliberate dieting.

6. Major Depression: Not Just a Depressive Reaction
Some people make an unfair criticism of themselves or others with major depression: “There is nothing to be depressed about.”
If someone with asthma has an attack, do we say, “what do you have to be gasping about?”
It is bad enough to have MDD that persists even under “good” circumstances. Don’t add criticism by implying the depression is an exaggerated response.
Click to reveal bullets. The two related images appear with the middle bullet point.
Answer to the question on the slide: the depression is the illness and it doesn’t need further justification. It is not a problem of being depressed “about” something. The question is harmful because it brings about shame, and in depression, the question is most likely to be asked of oneself, “why am I depressed when other people have much worse problems?” This question misses the fact that depression IS the problem.
(Powerpoint clip art).

7. Depression is Everywhere
Depression shows up in people seeking treatment:
Phobias are the most common (frequently experienced) disorder, but depression is the #1 reason people seek mental health services.
Depression appears worldwide:
Per year, depressive episodes happen to about 6 percent of men and about 9 percent of women.
Over the course of a lifetime, 12 percent of Canadians and 17 percent of Americans experience depression.
Depression: The “Common Cold” of Disorders?
Although both are “common” (occurring frequently and pervasively), comparing depression to a cold doesn’t work.
Depression:
is more dangerous because of suicide risk.
has fewer observable symptoms.
is more lasting than a cold, and is less likely to go away just with time.
is much less contagious.
And…depressive pain is beyond sniffles.
Click to reveal bullets and sidebar.
Instructor: the information in the sidebar is included for your optional use. Although it is a minor issue in the text, this analogy was a major complaint for a few of my students each semester. They reacted to the connotation of the word “common” as “no big deal,” and did not notice Myers’ sympathetic disclaimer that comparing depression to the common cold “effectively describes its pervasiveness but not its seriousness.” If you do some form of pre-class feedback, hopefully you’ll know in advance if you need this slide.
This analogy will come up again soon when discussing schizophrenia, so we may as well clarify it now.

8. Seasonal Affective Disorder [SAD]
Seasonal affective disorder is more than simply disliking winter.
Seasonal affective disorder involves a recurring seasonal pattern of depression, usually during winter’s short, dark, cold days.
Survey: “Have you cried today”? Result: More people answer “yes” in winter.
Percentage who cried
Men
Women
August 4 7
December 8 21
Click to reveal bullets.

9. Bipolar Disorder
Bipolar disorder was once called “manic-depressive disorder.”
Bipolar disorder’s two polar opposite moods are depression and mania.
Mania refers to a period of hyper-elevated mood that is euphoric, giddy, easily irritated, hyperactive, impulsive, overly optimistic, and even grandiose.
Contrasting Symptoms
Depressed mood: stuck feeling “down,” with:
Mania: euphoric, giddy, easily irritated, with:
exaggerated pessimism
social withdrawal
lack of felt pleasure
inactivity and no initiative
difficulty focusing
fatigue and excessive desire to sleep
exaggerated optimism
hypersociality and sexuality
delight in everything
impulsivity and overactivity
racing thoughts; the mind won’t settle down
little desire for sleep
Click to reveal bullets and table of contrasting symptoms.
A typical pattern is three to seven weeks of depression, followed by three to seven DAYS of mania. People enjoying their mania often forget or deny that the manic phase leads back into depression.
Like depression, this euphoria is self-sustaining; in mania, it’s not that you’re happy about something.

10. Bipolar Disorder and Creative Success
Many famous and successful people have lived with the ups and downs of bipolar disorder. Some speculate that the depressive periods gave them ideas, and the manic episodes gave them creative energy. Any evidence of mood swings here?
Animation: after a click from the instructor, the pictures will move up and down at different rates to simulate up and down swings of mood.

11. Bipolar Disorder in Children and Adolescents
Does bipolar disorder show up before adulthood, and even before puberty?
Many young people have cycles from depression to extended rage rather than mania.
The DSM-V may have a new diagnosis for these kids: disruptive mood dysregulation disorder.
Click to reveal bullets.
Many have questioned whether children and adolescents who have swings in mood have bipolar disorder or something else. The 2013 edition of the diagnostic manual, the DSM-V, may have a new diagnosis which is designed to describe many of these kids: “Disruptive mood dysregulation disorder.” This awkward diagnoses has gone through a few name changes between 2010 and 2012, and in earlier versions including the inclusion of the word “dysphoric” (depressed mood) and “temper” (as in, temper tantrum).

12. Understanding Mood Disorders
Why are mood disorders so pervasive, and more common among the young, and especially among women?
No animation.
You might remind students that the evolutionary perspective has difficulty with mood disorders; it is unlikely that they helped our ancestors survive in any way.
Instructor: warn students that we may not answer this question in this section.

13. Why Does Depression Have so Many Symptoms?
No animation.

14. Understanding Mood Disorders Can we explain…
why does depression often go away on its own?
the course/development of reactive depression?
Often, time heals a mood disorder, especially when the mood issue is in reaction to a stressful event. However, a significant proportion of people with major depressive disorder do not automatically or easily get better with time.
Click to reveal bullets.
Depression in reaction to life events often results in a temporary period of withdrawal, worrying, and feeling down.

15. Suicide and Self-Injury
Every year, 1 million people commit suicide, giving up on the process of trying to cope and improve their emotional well-being.
This can happen when people feel frustrated, trapped, isolated, ineffective, and see no end to these feelings.
Non-suicidal self-injury has other functions such as sending a message, or self-punishment.
Click to reveal bullets.
Beyond the 1 million who succeed, many more attempt suicide or make suicidal gestures, acts that look like suicide attempts, without clear intent to succeed. The numbers get much larger if we consider those who have had thoughts about suicide or wanting to be dead.
Other purposes of NSSI besides the ones above mentioned in the text: distracting from emotional pain, giving themselves an excuse to cry when emotional pain doesn’t feel justified, or eventually to get the endorphin response which can come especially with repeated self-cutting. I mention these because students might speak up to comment that the reasons given in the text are inadequate.

16. Understanding Mood Disorders
Biological aspects and explanations
Evolutionary
Genetic
Brain /Body
Social-cognitive aspects and explanations
Negative thoughts and negative mood
Explanatory style
The vicious cycle
Click to reveal text boxes and examples.

17. An Evolutionary Perspective on the Biology of Depression
Depression, in its milder, non-disordered form, may have had survival value.
Under stress, depression is social-emotional hibernation. It allows humans to:
conserve energy.
avoid conflicts and other risks.
let go of unattainable goals.
take time to contemplate.
Click to reveal bullets.
This information is presented in the book earlier in the chapter, but it also fits here.
However, students might consider that from an evolutionary perspective, it seems just as likely that depression serves no survival purpose, as evidenced by suicide, and is in the process of being eliminated by natural selection.

18. Biology of Depression: Genetics
Evidence of genetic influence on depression:
DNA linkage analysis reveals depressed gene regions
twin/adoption heritability studies
No animation.
DNA linkage analysis shows that regions of chromosomes are similar across generations of people in depressed families Another genetic factor to mention here, though it doesn’t come up in the text until the discussion of neurotransmitters (p. 629): people with depression had a variation of a serotonin-controlling gene, although the text notes that this result may not be reliable.
Regarding the chart, see if students can recall the definition of heritability from the chapter on intelligence. Remind them that 80 percent heritability does NOT mean that genes are 80 percent of the cause of schizophrenia, as we shall soon see; it means that 80 percent of the variation among people is caused by genes.

19. Biology of Depression: The Brain
Brain activity is diminished in depression and increased in mania.
Brain structure: smaller frontal lobes in depression and fewer axons in bipolar disorder
Brain cell communication (neurotransmitters):
more norepinephrine (arousing) in mania, less in depression
reduced serotonin in depression
Click to reveal bullets.
Fewer axons, less white matter, and larger ventricles (fluid filled areas in the center of the brain) point to a problem in having different parts of the brain work together smoothly.

20. Preventing or Reducing Depression: Using Knowledge of the Biology of Depression
Adjust neurotransmitters with medication.
Increase serotonin levels with exercise.
Reduce brain inflammation with a healthy diet (especially olive and fish oils).
Prevent excessive alcohol use .
Click to reveal bullets.
Some medications, such as Wellbutrin try to reduce depression by increasing norepinephrine; other medications, such as Prozac, Zoloft, and Celexa increase the availability of serotonin.
Exercise has other benefits related to depression.
This is the “Mediterranean” diet, although some people try to get the benefits of this diet by taking Omega 3 supplements.
Alcohol abuse its related not only to biological changes but also to problems in behavior and coping skills.

21. Understanding Mood Disorders: The Social-Cognitive Perspective
Discounting positive information and assuming the worst about self, situation, and the future
Low Self-Esteem
Self-defeating beliefs such as assuming that one (self) is unable to cope, improve, achieve, or be happy
Learned Helplessness
Depression is associated with:
Click to reveal bubbles.
Discounting the positive: “You’re only spending time with me because you feel sorry for me.”
Depression is also associated with cognitive errors, such as assuming one can know the future or the thoughts of others.
Depressive Explanatory Style
Rumination
Stuck focusing on what’s bad

22. Depressive Explanatory Style
How we analyze bad news predicts mood.
Problematic event:
Assumptions about the problem
The problem is:
The problem is:
Click through to animate the chart.
This chart implies that the negative explanatory style leads to depression. However, as the next chart will show, depression makes it more likely to make cognitive problems such as this negative attributional style.
As Martin Seligman has suggested (quote in the text), depression can be caused by “preexisting pessimism encountering failure.”
The problem is:
Mood/result that goes along with these views:

23. Depression’s Vicious Cycle
A depressed mood may develop when a person with a negative outlook experiences repeated stress.
The depressed mood changes a person’s style of thinking and interacting in a way that makes stressful experience more likely.
Click to reveal second text box and chart.