Download Chapter 14, Mood Disorders

Mood Disorders
Core Concept
• People with this diagnosis have an
abnormal mood characterized by:
Depression
Mania, or
Both symptoms in alternating fashion
• The abnormal mood may or may not
impair the person’s social or
occupational functioning.
Prevalence of Mood Disorders
Depression accounts for
more than 10 percent of all
disabilities in the US
Younger generations are
experiencing higher rates of
depression, and those who
become depressed are
doing so at an earlier age
Depression affects 13-14
million people each year
Prominent Feature
• The prominent feature of mood disorders is the
experience of …
• Emotional extremes
Types of Mood Disorders
Unipolar Mood Disorders
Major Depressive Disorder
Dysthymic Disorder
Bipolar Mood Disorders
Bipolar I Disorder
Bipolar II Disorder
Cyclothymic Disorder
Major Depressive Disorder
Symptoms of major depressive disorder include
feelings of sadness and emptiness, difficulties
getting out of bed, loss of appetite, excessive
feelings of guilt, difficulties concentrating, and
suicidal thoughts or plans.
Major depression is diagnosed when symptoms
are present for at least two weeks, have a
sudden onset and are significant enough to
impact daily functioning.
Dysthymia
Symptoms of dysthymia include feelings of
hopelessness; sleeping and eating too much or
too little; fatigue; poor concentration; and low
self-esteem.
These symptoms cause distress but are not as
severe as the symptoms of major depression.
Dysthymia is a long-term condition and is
diagnosed when these symptoms are present
nearly every day during a period of two years.
Bipolar I & Bipolar II
If you have only average
knowledge of bipolar
disorder, you may not know
that there are two major
forms of the illness - bipolar
I and bipolar II which are
separate diagnoses
Bipolar I & Bipolar II
The main difference between mania and
hypomania is a matter of severity.
In the hypomania of bipolar 2, a person has a sustained mood
that is elevated (heightened), expansive (grand, superior) or
irritable.
This mood has to be noticeably different from his
or her normal mood when not depressed.
In mania, that mood is extremely abnormal, and is also
combined with increased activity or energy that is also
abnormal.
Bipolar I
On the other hand, Hank's friend Robert, who
has manic episodes, is out-of-control
happy, even during serious events (he burst
out laughing disruptively during a funeral)
He ran around outside at midnight shouting
how much he loved all his neighbors (along
with other symptoms of mania). This is
abnormal behavior for anyone.
Bipolar II
For example, Hank, when he has hypomanic episodes, is
exceptionally cheerful, needs only three hours sleep
instead of his usual seven, spends more money than he
safely should and speaks far more rapidly than usual,
along with other symptoms of hypomania.
This behavior is noticeably different from his own stable
mood, yet there are cheerful people who need little sleep,
spend a lot and talk fast who don't have bipolar disorder,
so while it's abnormal for him, it's not outside the range
of possible behavior in general.
Mood Disorders: Additional Facts
and Statistics
• Lifetime Prevalence
• About 7.8% of United States population
• Sex Differences
• Females are twice as likely to have a mood
disorder compared to men
• The gender imbalance in depression
disappears after age 65
• Bipolar disorders are distributed equally
between males and females
Gender Differences
Women are two or three times more
vulnerable to depression than men
Sex hormones, stressful life events, childhood
adversity, etc.
May be more likely to seek treatment
May be more likely to be labeled as depressed
Children Statistics
Up to 2.5% of children in the
US suffer from depression
Up to 8.3% of adolescents
in the US suffer from
depression
Girls entering puberty are
twice as likely to experience
depression as boys
Mood Disorders
• Women tend to be
• In depression, the
twice as likely to get
greatest risk of
depression because
suicide occurs when
they are more likely
people begin to
to sense a lack of
rebound from their
personal control over
depression
their lives
Mood Disorders
• Severely depressed
individuals are
especially likely to
show reduced brain
activity in the left
frontal lobe
• In depression, the
greatest risk of
suicide occurs when
people begin to
rebound from their
depression
Mood Disorders
• Linkage Analysis • Linkage is the
serves as a way of
tendency for genes
gene-hunting and
and other genetic
genetic testing.
markers to be
inherited together
because of their
location near one
another on the
same chromosome.
Biological Factors: Genetics
There is a 1.5 to 3% greater chance for a
person to develop a depressive disorder
if a parent or sibling has it as well
50% of those with bipolar disorder have a
parent with history of clinical depression
25% of children of a parent who is bipolar
develop a depressive disorder
50-75% of children of two parents with bipolar
disorder develop a depressive disorder
Biological Factors: Twin
Studies
If one twin develops depression there is a
76% chance that the other twin will develop
a disorder as well
When raised apart the percentage is 67%
Because this number is not closer to 100%, there
is indication that other factors are also
responsible
Fraternal twins have a 19% chance of
developing a depressive disorder if the
other develops one
Twin Studies & Depression
• The greatest
incidence for major
depression are
between monozygotic
twins, where one twin
suffers from the
disorder
Types of Causes
Environmental Factors
Psychological Factors
Biological Factors
Environmental Factors:
Stress
Levels of stress may vary from person to person.
Depressive episodes can make a person more
vulnerable to further episodes, so small amounts
of stress can activate depression
“Learned Helplessness”- after experiencing chronic or
repeated stressful events, people can learn to feel
helpless
Environmental Factors:
Substance Abuse
Depression that is a result of drug abuse,
medication, or toxin exposure
Associated with use and withdrawal from: alcohol, amphetamine,
cocaine, hallucinogens, inhalants, opioids, phencyclidine, sedatives,
hypnotics and anxiolytics
Exposure or habitual use of chemicals can alter
brain structure and function resulting in depression
Environmental Factors:
Childhood Difficulties
Depression can develop in children who have
experienced a traumatic event including but not
limited to:
Death of family member or friend
Natural disaster
Divorce
Loss of parent’s job, home, etc...
Many of these children are emotionally damaged or
lack emotional development and often have
difficulties adjusting
Traumatic Event may affect the development of the
Limbic System
Continued…
The rate for depression occurring with medical
illness*:
Heart attack: 40-65%
Coronary artery disease (without heart attack): 18-20%
Parkinson's disease: 40%
Multiple sclerosis: 40%
Stroke: 10-27%
Cancer: 25%
Diabetes: 25%
*Reviewed by the doctors at The Cleveland Clinic Department of Psychiatry and Psychology.
Psychological Factors
Cognitive Vulnerability
People responding differently to the same
negative experience involving loss, failure and
disappointment
Biological Factors
Neurotransmitters and Neurons
The signal enters the neuron through the dendrite
and proceeds through the cell body to the axon
where it is switched from a electric signal to a
chemical one
Theses chemical signals are called
neurotransmitters
Upon release the transmitter is broken down by
monoamine oxidase (MAO) or its taken back in by the
neuron that released it, called “reuptake”
Biological Factors: Hormones
About one half of all depressed persons have a
high level of the hormone cortisol in their blood
A person with a depressive mood disorder may not
have their hypothalamus regulating the cortisol
production in the adrenal gland correctly
Normal cortisol levels peak at 8:00 a.m. and ebb
at 2:00 a.m. for non-depressed people, while a
person with depression may have the hormone
released at a constant level
How, Exactly, does Cortisol fit into
this Picture?
As we all know by now, cortisol levels are
elevated in response to stress, so any stressful
events encountered in the late afternoon to early
evening will hamper a person's ability to relax
and fall asleep that night.
If you'll recall, one of the many effects of cortisol is to increase a
person's level of alertness—which is exactly what you want to
avoid right before bedtime.
Social Cognitive Perspective
• Women are more
vulnerable to
depression than men
because they are
more likely to
• Sense a lack of
personal control
over their lives
Suicide
Suicide and SSRIs
There is evidence that the use of
antidepressants, especially SSRIs, can cause
an increase in suicidal thoughts, however it
does not show an increase in cases.
A severely depressed patient, or those with bipolar
syndrome in a “low” phase, usually only have the
energy to focus on their low.
As the medication begins to take affect they will have
an increase in energy and suicidal thoughts as they
transition from their “low” or depressed episode.
Withdrawls:
SNRIs
Stopping treatment with SNRIs, especially
when done suddenly, can cause
withdrawal-like symptoms:
nausea, vomiting, anxiety, diarrhea, agitation, confusion,
headaches, nightmares, coordination changes, or skintingling or shock-like sensations
Sometimes referred to as discontinuation syndrome
Suicide Risk Factors
22% of adolescents with completed suicides had
bipolar disorder
Family history of suicide
Substance abuse i.e. adolescent with impulse
control disorder, depression, suicidality,
substance use and access to a weapon is
potential for lethality