Mood disorder(abpsych)


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Mood disorder(abpsych)

  1. 1. Mood Disorders Disturbances in emotions that cause subjective discomfort, hinders a person’s ability to function, or both. (Depression and mania are central to these disorders.) Depression: Emotional state characterized by intense sadness, feelings of futility and worthlessness, and withdrawal from others. Mania: Emotional state characterized by elevated mood, expansiveness, or irritability, often resulting in hyperactivity. Depression occurs ten times as frequently as mania. Depression is the most common complaint of individuals seeking mental health care. Lifetime prevalence: o Severe depression: 5-12% of males and 10-25% of females o Mood disorder: 15% of males and 24% of females
  2. 2. Risk of another episode increases with each episode o 50% after one episode, 70% after second, 90% after third The Symptoms of Depression  Affective: Depressed mood, dejection, excessive and prolonged mourning, worthlessness, lack of joy.  Cognitive: Pessimism, decreased energy, disinterest, loss of motivation, self-accusations of being incompetent  Cognitive Triad: Negative views of self, outside world, and the future.  Behavioral: Uninhibited, impulsive sexual activity, abusive discourse  Hypomania: “High” mood and overactive behavior; poor judgment, delusions (rare), start many projects but complete few, dominate conversations, often grandiose.  Mania: Pronounced overactivity, grandiosity, irritability; incoherent speech, no tolerance for criticism or restraint  Physiological: Decreased need for sleep, plus high levels of arousal. Classification of Mood Disorders  Depressive Disorders (also called unipolar disorders because no mania is exhibited):  Major depressive disorders  Dysthymic disorder  Depressive disorders not otherwise specified  Bipolar Disorders: Characterized by one or more manic or hypomanic episodes and usually by one or more depressive episodes.  Bipolar disorder I  Bipolar disorder II  Cyclothymic disorder
  3. 3. Depressive Disorders  Major Depression: A disorder in which a group of symptoms, such as depressed mood, loss of interest, sleep disturbances, feelings of worthlessness, and inability to concentrate, are present for at least two weeks.  Dysthymic Disorder: Characterized by chronic and relatively continual depressed mood that does not meet the criteria for major depression.  Pessimism, guilt, loss of interest, poor appetite or overeating, low self-esteem, chronic fatigue, social withdrawal, concentration difficulties. Bipolar Disorders  Bipolar I Disorders: Single manic episodes, most recent episode hypomanic, most recent episode manic, most recent episode mixed, most recent episode depressed, and most recent episode unspecified.  Bipolar II Disorders: Recurrent major depressive episodes with hypomanic episode.  Manic episodes without depressive episodes are extremely rare.  Cyclothymic Disorder: Chronic and relatively continual mood disorder with hypomanic episodes and depressed moods that do not meet criteria for major depressive episode.  Symptoms present for more than 2 years, never symptom free for more than 2 months Other Mood Disorders  Mood Disorder Due to General Medical Condition: Characterized by depressed mood and/or elevated or irritable mood as a direct result of a general medical condition.  Substance-Induced Mood Disorder: Prominent and persistent disturbance of mood attributable to use of a substance or cessation of substance use.
  4. 4. Symptom Features and Specifiers  Specifiers: Describe major depressive episodes in terms of severity, presence or absence of psychotic symptoms, and remission status.  Useful for prognosis  May include information such as: ○ Melancholia: Loss of pleasure, lack of reactivity to pleasurable stimuli, depression that is worse in the morning, early morning awakening, excessive guilt, weight loss. ○ Catatonia: Motoric immobility, extreme agitation, negativism, or mutism.  Course specifiers:  Rapid Cycling: Episodes occurred 4 or more times during the previous 12 months.  Seasonal Pattern: Moods are accentuated during certain times. ○  Seasonal Affective Disorder (SAD): Serious depression fluctuates according to the season. Postpartum Onset: Occurs within 4 weeks of childbirth. Comparison of Depressive and Bipolar Disorders  Genetic studies:  Increased incidence of manic disturbances for blood relatives of bipolar patients.  More evidence of genetic/ psychophysiological influences for bipolar than unipolar disorders.  Relatives of unipolar patients have a greater probability of having unipolar disorders, but relatives of bipolar patients have a greater probability of having bipolar AND unipolar disorders.  Age of onset is earlier for bipolar (early 20s) than unipolar (late 20s).  Psychomotor retardation and risk of suicide greater for bipolar than unipolar.  Unipolars are more likely to exhibit anxiety.
  5. 5.  Bipolar patients respond to lithium.  Prevalence differences:  1-2% of adult population has experienced bipolar disorder.  8-19% of adult population has experienced major depressive disorder.  No gender differences in bipolar I disorder.  Women are more likely than men to experience major depression and bipolar II disorder. The Etiology of Mood Disorders Psychological or Sociocultural Approaches to Depression  Psychodynamic: Focus on separation and anger (“symbolic loss”)  Cognitive: Low self-esteem, stable and enduring cognitive styles:  Negative thoughts and errors in thinking  Beck: Depression is a disturbance in thinking, not mood.  Schemas set people up for depression. The Etiology of Mood Disorders Psychological or Sociocultural Approaches to Depression  Cognitive:  Depressed people operate from a primary triad of negative self-views, present experiences, and future expectations. ○ Four errors in logic typify this negative schema:  Arbitrary inference  Selected abstraction  Overgeneralization  Magnification/ minimization
  6. 6.  Behavioral: Separation or loss, but reduced reinforcement is the cause and leads to less activity; secondary gain from reinforcement of inactivity.  Lewinsohn suggests 3 sets of variable that help or hinder access to positive reinforcement ○ Number of potentially reinforcing events/activities ○ Availability of reinforcements ○ Individual’s instrumental behavior  Cognitive-learning approaches:  Learned Helplessness: The belief that one is helpless and unable to affect outcomes in one’s life. ○  Seligman: Belief in one’s own helplessness Attributional Style: People who feel helpless make speculations (causal attributions) about why they are helpless. ○ Internal/external, stable/unstable, global/specific  Cognitive-learning approaches:  Response Styles: People have consistent styles of responding to depressed moods that affect the course of depression. ○ Ruminative Responses: Dwelling on why one feels bad, considering possible consequences of symptoms, and expressing how badly one feels.  Cognitive-learning:  Diathesis-Stress: Vulnerability (negative cognitions or pessimistic attributional styles) in the presence of stress (negative life events) results in depression.
  7. 7.  Sociocultural: Culture, social experiences, and psychosocial stressors (including stress and gender)  Social support: Acts as a buffer against depression  Stress and depression: ○ Diathesis: Individual genetic, constitutional, or social conditions may produce vulnerability to developing depression. ○ Chronic stress more strongly related to depression than acute stress  Gender and depression:  Universally, women are twice as likely as men to develop major depression. ○ Women are more likely to seek treatment or report their depression to others. ○ Possible diagnostic bias ○ Depression may take other forms in men. ○ Possible biological factors ○ Traditional gender roles ○ Response styles (women ruminate) The Etiology of Mood Disorders Biological Perspectives on Mood Disorders  Role of heredity:  Adoption studies: Incidence of mood disorders is higher among biological families than among adoptive families.  Twin studies: Concordance rates are higher for monozygotic twins than for dizygotic twins (especially for bipolar disorders), although non-genetic factors also have an influence.  Polygenetic interactions Etiology of Mood Disorders Neurotransmitters and Mood Disorders  Neurotransmitters: Chemical substances that are released by axons of sending neurons and that are involved in the transmission of neural impulses to the dendrites of receiving neurons.
  8. 8.  Catecholamine Hypothesis: Depression results from a deficit of specific neurotransmitters, mania is caused by too much.  Neurotransmitters are broken down or chemically depleted by MAOs.  Neurotransmitters are reabsorbed by the releasing neuron in the reuptake process.  Dysregulation of Serotonin (5HT) and Norepinephrine (NE) in the brain are strongly associated with depression.  Dysregulation of 5HT and NE in the spinal cord may explain an increased pain perception among depressed patients.  Imbalances of 5HT and NE may explain the presence of both emotional and physical symptoms of depression.  Low norepinephrine levels related to inaction.  Other possible neurotransmission issues:  Blunted receptor response  Dysregulation in neurotransmission  Neuroendocrine abnormalities:  Depression is linked with high levels of cortisol (hormone secreted by adrenal cortex).  Dexamethasone suppression test (DST) measures cortisol levels.  REM sleep disturbances:  Depression is linked to relatively rapid onset of and increase in REM sleep.  May be connected to severe life stress Etiology of Mood Disorders Evaluating Causation Theories  Longitudinal/prospective studies allow more insight into links between life experiences and depression.  Technological advances in identifying biological markers and processes in mood disorders.  Increased attention to viewing depression as a heterogeneous collection of disorders.
  9. 9.  Many theories are too simplistic or too complex, hard to test empirically, don’t account for relevant variables, or are too limited.  Range of mood stages result from interaction between environmental and biological factors. The Treatment of Mood Disorders  Biomedical treatments:  Medications heighten level of a target neurotransmitter at the neuronal synapse:  Boost neurotransmitter’s synthesis  Block its degradation  Prevent its reuptake from synapse  Mimick its binding to postsynaptic receptors  Electroconvulsive therapy (ECT): For severe depression  Only used after drug treatments have not worked.  Virginia Teen Charged With Raping, Killing Sister, Beating Toddler Niece With Sledgehammer  MARY SMITH SAID SHE DOES NOT BELIEVE WALTER SMITH KILLED HIS SISTER.  "HE DON'T REMEMBER NOTHING HE DID," SHE SAID. "HE WAS OUT OF IT OR SOMETHING LIKE THAT. IT WAS AN ACCIDENT. HE DON'T REMEMBER THAT STUFF."  MARY SMITH SAID HER SON HAD NO HISTORY OF VIOLENCE, BUT SAID HE WAS ON MEDICATION FOR DEPRESSION.  From FoxNews 9-5-07  Psychotherapy and behavioral treatments for depressive disorders:  Psychoanalysis: Gain insight into unconscious and unresolved feelings of separation or anger.  Behavior therapy: Increase exposure to pleasurable events and to improve social skills.
  10. 10.  Psychotherapy and behavioral treatments:  Interpersonal: Short-term, psychodynamic-eclectic; targets interpersonal relationships.  Cognitive-behavioral: Teaches patient to identify negative, self-critical thoughts, to see their connection with depression, to examine distorted thoughts and to replace them with realistic interpretations.  Interpersonal psychotherapy and cognitive-behavioral therapy are both effective for treating depression.  Combination of psychotherapy and medication (imipramine) may be best.  Effects of treatment diminish over time, although cognitive therapy has better long-term outcomes. Treatment for Bipolar Disorders  Same forms of psychotherapy and behavior therapy used for unipolar disorder are used for bipolar disorder (particularly family therapy).  Typical treatment for bipolar patient involves lithium carbonate, which is 60-80% effective.  Negative physical side effects; also, lack of compliance or self-regulation of dosage.  Anticonvulsant drugs are also being used.