1. abnormal PSYCHOLOGY Fourth Canadian Edition Chapter 8 Mood Disorders Prepared by: Tracy Vaillancourt, Ph.D. Modified by: Réjeanne Dupuis, M.A.

2. Chapter Outline General Characteristics of Mood Disorders Psychological Theories of Mood Disorders Biological Theories of Mood Disorders Therapies of Mood Disorders Suicide

3. General Characteristics Involve disabling disturbances in emotion, from sadness of depression and elevation and irritability of mania Often associated with other psychological problems –Panic attacks –Substance abuse –Sexual dysfunction –Personality disorders

4. Depression: Signs and Symptoms Depression: An 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 Symptoms vary between cultures Most depressed individuals focus on somatic symptoms (~85%)

5. Mania: Signs and Symptoms Mania (NOT a diagnosis): An emotional state or mood of intense but unfounded elation accompanied by irritability, hyperactivity, talkativeness, flight of ideas, distractibility, and impractical, grandiose plans Noticed by others due to loud and incessant remarks, sometimes full of puns, jokes, rhyming, etc., difficult to interrupt, shifting from topic to topic, need for activity that can be annoying to others and with poor planning

6. 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

7. Depression (MDD) Lifetime prevalence rates in U.S.: from 5.2% to 17.1% –Similar ranges were found in a cross-cultural study –In Canada could vary from 20% to 50% –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 –Between 60% and 80% of university students with a diagnosable depression do not seek or receive treatment 2x more common in women than in men –Difference appears in adolescence and is maintained across the lifespan See Focus on Discovery 10.1

8. 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 + 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

9. Bipolar Disorder (cont.) Occurs less often than MDD Lifetime prevalence rate for BPI and BPII 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 –More than 50% have a recurrence w/in 12 months –More than 50% of cases have 4+ episodes

10. Mood Disorders in Canada Lifetime prevalence of MDD: 12.2% One-year prevalence of MDD: 4.5% In all age groups, more women than men hade MDD MDD almost doubles between adolescence and adulthood Almost 90% of those w/ MDD or BP mentioned that it interfered with their lives Almost 40% of youth (ages 15-24) met criteria for an anxiety disorder MDD and BP are more prevalent in Western provinces Risk factors associated w/ mood disorders: alcohol use and dependence, drug dependence

11. 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)

12. 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 Lifetime prevalence of 2.5% –Dysthymic disorder Lifetime prevalence of 2.5%; 2-3 times more frequent in women than in men –Double depression

13. 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 fixation in this stage

14. 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

15. 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

17. 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

18. 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

19. 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

20. 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

21. 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.

22. 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

23. Summary of Biological Theories

24. Beck’s Developmental Model of Depression

25. 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

26. Suicide Suicide was the 9 th leading cause of death in Canada in 2005 Suicide is the 2 nd cause of death (after accidents) in youth ages 15 to 24 (Statistics Canada, 2009) Females have higher rates of suicide attempts but lower rates of suicide as compared to males, a phenomenon called gender paradox (see Canetto, 2008)

27. 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

28. Suicide - Terminology 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

29. Suicide in Canada 13.4% Canadians over age 15 reported having seriously thought of suicide during their lifetime –Number of women who report suicidal thoughts decrease w/ age 3.1% of adults reported having attempted suicide in their lifetime –Twice as many women (4.2%) attempt suicide as men (2.0%) –Between ages 10 and 14, hospitalization among females is 5x as that of males In 2003, almost 4x as many males completed suicide as compared to females Overall mortality rates decreased from 1990 to 2003 Alcohol is strongly related to suicide

30. 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

31. 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

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

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