1. abnormal PSYCHOLOGY Third Canadian Edition Prepared by: Tracy Vaillancourt, Ph.D. Chapter 10 Mood Disorders

2. Involve disabling disturbances in emotion Often associated with other psychological problems –panic attacks –substance abuse –sexual dysfunction –personality disorders

3. Depression: Signs and Symptoms Depression— emotional state marked by great sadness and feelings of worthlessness and guilt. Additional symptoms include: –withdrawal from others –loss of sleep, appetite, and sexual desire –loss of interest and pleasure in usual activities

4. Mania: Signs and Symptoms Mania— emotional state or mood of intense but unfounded elation accompanied by irritability, hyperactivity, talkativeness, flight of ideas, distractibility, and impractical, grandiose plans.

5. Diagnosis of Depression Presence of 5 of the following symptoms for at least 2 weeks. –Note. Depressed mood or loss of interest and pleasure must be 1 of the 5 symptoms Symptoms –sad, depressed mood, most of the day, nearly every day –loss of interest and pleasure in usual activities –difficulties in sleeping –shift in activity level –changes in appetite and weight –loss of energy, great fatigue –negative appraisal (feeling worthless) –difficulty in concentrating –recurrent thoughts of death or suicide

6. Depression (MDD) Lifetime prevalence rates range from 5.2% to 17.1% –About 80% of those with MDD experience another episode –Average # of episodes is 4 and lasts for 3 to 5 months –12% of MDD cases lasts more than 2 years May be explained by kindling hypothesis— once a depression has already been experienced, it takes less stress to induce a subsequent recurrence 2 X more common in women than in men –difference does not appear in preadolescent children –emerges consistently by mid-adolescence and is maintained across the lifespan See Focus on Discovery 10.1

7. Diagnosis of Bipolar Disorder Bipolar I disorder– involves episodes of mania or mixed episodes that include symptoms of both mania and depression. –Diagnosis of a manic episode requires the presence of elevated or irritable mood plus 3 additional symptoms  in activity level at work, socially, or sexually unusual talkativeness; rapid speech flight of ideas or subjective impression that thoughts are racing less than the usual amount of sleep needed inflated self-esteem distractibility excessive involvement in pleasurable activities that are likely to have undesirable consequences

8. Bipolar Disorder cont. Occurs <often than MDD Lifetime prevalence rate of 4.4% of the population Average age of onset is in the 20s Occurs equally often in men and women –In women, episodes of depression are more common and episodes of mania less common than among men Tends to recur –> than 50% of cases have 4+ episodes

9. Heterogeneity Examples Bipolar I Disorder with mixed episodes Bipolar II Disorder –episodes of major depression accompanied by hypomania MDD with psychotic features Bipolar and unipolar disorders can be sub- diagnosed as seasonal –Seasonal affective disorder (SAD)

10. Chronic Mood Disorders Symptoms of disorders must have been evident for at least 2 years and are not severe enough to warrant a diagnosis of MDD or manic episode. –Cyclothymic disorder –Dysthymic disorder –Double depression

11. Psychological Theories Psychoanalytic Theory of Depression –According to Freud depression is created early in childhood. During the oral period, child’s needs are insufficiently or over- sufficiently gratified, causing fixated in this stage

12. Psychological Theories cont. Beck’s Theory of Depression –thinking is biased toward negative interpretations Negative triad –Negative views of the self, the world, and the future Principle Cognitive Biases –Arbitrary inference –Selective abstraction –Overgeneralization –Magnification and minimization

13. Helplessness/Hopelessness Theories Learned Helplessness –individual’s passivity and sense of being unable to act and control own life is acquired through unpleasant experiences and traumas that were unsuccessfully controlled. Attribution and Learned Helplessness –Revised theory is the concept of attribution – Global attributions – Attributions to stable factors – Attributions to internal characteristics Hopelessness Theory –advantage of theory is that it can deal the comorbidity of depression and anxiety disorders

15. Issues with Theories 1.Which type of depression is being modeled? 2.Are the findings specific to depression? 3.Are attributions relevant? 4.Key assumption is that depressive attributional style is a trait –But research shows that depressive attributional style disappears following depressive episode

16. Other Theories of Depression Interpersonal Theory of Depression –sparse social networks that provide little support  an individual’s ability to handle negative life events  vulnerability to depression –depressed people also elicit negative reactions from others and are low in social skills –they also constantly seek the reassurance of others Psychological Theories of Bipolar Disorder –largely neglected by scholars and clinicians

17. Biological Theories Genetic Data Bipolar –concordance rate is as high as 85% –adoption studies provide support for a strong heritable component –may be linked to a dominant gene on the 11th chromosome –brain-derived neurotrophic factor (BDNF) gene also implicated MDD –heritability estimate= 35% –Relatives of unipolar probands are at  risk for unipolar depression –serotonin transporter gene-linked promoter region (5-HTTLPR) is being considered

18. Biological Theories cont. Postulated that  levels of norepinephrine and dopamine lead to depression and  levels to mania. Serotonin theory –Serotonin produces depression and mania Clues for drugs –Tricyclic drugs prevent some of the reuptake of norepinephrine, serotonin, and/or dopamine by the presynaptic neuron after it has fired, –Monoamine oxidase (MAO) inhibitors keep the enzyme monoamine oxidase from deactivating neurotransmitters therefore  the levels of serotonin, norepinephrine, and/or dopamine in the synapse. –Selective serotonin reuptake inhibitors inhibit the reuptake of serotonin Drug actions suggest that depression and mania are related to serotonin, norepinephrine, and dopamine. –BUT mechanism not straightforward

19. Biological Theories cont. Neuroimaging studies –  hippocampal volume and neurocognitive impairment Cingulated area 25 –induction of dysphoria in healthy people  glucose metabolism in cingulated area 25 –treatment with paroxetine showed a  reduction of hypermetabolism in cingulated area 25 MAO-A levels in the brain are elevated during untreated depression.

20. Biological Theories cont. Neuroendocrine System HPA axis may play a role in depression –  levels of cortisol in depressed patients Disorders of thyroid function are often seen in bipolar patients –thyroid hormones can induce mania Right hemisphere dysfunction

21. Summary of Biological Theories

22. Therapies for Mood Disorders Psychological Therapies –Psychodynamic Therapies –Cognitive and Behaviour Therapies –Mindfulness-Based Cognitive Therapy –Social Skills Training Biological Therapies –Electroconvulsive therapy (ECT) –Drug therapy

23. Suicide Suicidal ideation –thoughts and intentions of killing oneself. Suicide attempts –self-injury behaviours intended to cause death but that do not lead to death Suicide gestures –self-injury in which there is no intent to die Suicide –behaviours intended to cause death and death occurs

24. Suicide cont. 12-month prevalence estimates of suicide ideation, plans, and attempts –2.6, 0.7, and 0.4%, respectively. Ideators with a plan are more likely to make an attempt (31.9%) than those without a plan (9.6%) –But 43% of attempts were unplanned History of prior attempts the strongest correlate of 12-month attempts

25. Psychological Theories of Suicide A Risk Factor Model –4 categories of relevant factors: Predisposing factors Precipitating factors Contributing factors Protective factors Baumeister’s Escape Theory and Perfectionism Shneidman’s Approach Perfection and Moderator Hypotheses Additional Psychological Factors

26. Neurobiology and Suicide MZ twins have a much  concordance for suicidality than DZ twins  levels of 5-HIAA Postmortem studies of brains have revealed  binding by serotonin receptors

27. Preventing Suicide Treating the underlying mental disorder Treating Suicidality Directly Suicide Prevention Centres Government Suicide Prevention Programs in Canada

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