Download PS1000: Introduction to Abnormal Psychology Mood disorders and

PS1000: Introduction to Abnormal Psychology
Mood disorders and anxiety disorders
Dr Claire Gibson
[email protected]
School of Psychology, University of Leicester
Overview
Mood disorders
– Depressive Disorders
• Major Depressive Disorder
• Dysthymic Disorder
– Bipolar disorders
• Bipolar I disorder
• Bipolar II disorder
• Cyclothymic disorder
Anxiety disorders
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Phobia
Panic disorder
Generalised anxiety disorder
Obsessive-Compulsive Disorder
Post-traumatic stress disorder
Mood disorders
• Involve disabling disturbances in emotion
• DSM-IV recognises two broad types of mood
disorders ;
– Involve only depressive symptoms
– Involve manic symptoms (bipolar disorders)
Mood disorder diagnoses
Depressive
Disorders
Diagnostic Criteria
Bipolar
Disorders
Diagnostic Criteria
Major
depressive
disorder
Sad mood or loss of pleasure
for 2 weeks, along with at
least 4 other symptoms
Bipolar I
disorder
At least one lifetime manic or
mixed episode
Dysthymic
disorder
Mood is down and other
symptoms are present at
least 50% of the time for at
least 2 years
Bipolar II
disorder
At least one lifetime episode of
hypomania and episodes of
major depression
Cyclothymic
disorder
Recurrent mood changes from
high to low, without
hypomanic or manic episodes
for at least 2 years
Depressive disorders
• Profound sadness and/or inability to experience
pleasure
• Physical symptoms – fatigue, low energy, physical
aches and pains
• Exhaustion, lack of sleep, loss of appetite
• Psychomotor retardation or psychomotor agitation
• Social withdrawal
Major depressive disorder (MDD)
• Depressive symptoms present for at least 2 weeks
• Must include depressed mood (or loss of
interest/pleasure) and at least 4 additional symptoms,
changes in;
sleep, appetite, attention, feelings of
worthlessness, suicidal tendencies, psychomotor
agitation or retardation
• Episodic disorder
• Tend to recur (average is 4)
Dysthymia
• Chronic depression
• More than half of the time for at least 2 years
• In addition – at least two other symptoms of depression.
• 16.4% population (USA) meet criteria for MDD, 2.5%
meet criteria for dysthymia
• MDD is x2 common in women
• Both MDD and dysthymia comorbid; anxiety disorders,
substance-related disorders, sexual dysfunctions,
personality disorders.
Bipolar disorders
• DSM-IV-TR recognises 3 forms; Bipolar I
disorder, Bipolar II disorder, cyclothymia
• Bipolar – people who experience mania tend
to experience depression also
• Depression and mania = two opposite poles
Mania
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Intense elation or irritability accompanied by
Flight of ideas
Comes on suddenly over a day or two
Mixed episodes
DSM-IV-TR Criteria for Manic and Hypomanic Episodes
Distinctly elevated or irritable mood. At least 3 of the following (4 if mood irritable);
•Increase in goal-directed activity or physical restlessness
•Unusual talkativeness; rapid speech
•Flights of ideas or subjective impression that thoughts are racing
•Decreased need for sleep
•Inflated self esteem
•Distractibility
•Excessive involvement in pleasurable activities likely to have undesirable
consequences
Manic Episode:
Hypomanic Episode;
•Symptoms last for 1 week or require
hospitalization
•Symptoms cause significant distress or
functional impairment
•Symptoms present for at least 4 days
•Functioning is different but not markedly
impaired
• Bipolar I disorder
– A single episode of mania or a single mixed episode
– Very rare, less than 1% population, high suicide rates,
– One of the most severe mental illnesses
• Bipolar II disorder
– Must have experienced at least one major depressive episode and one
period of hypomania
– 4% population, high suicide rates,
• Cyclothymia
– Symptoms present for at least 2 years
– Frequent but mild symptoms of depression alternating with mild
symptoms of mania
– 4% population
Anxiety disorders
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•
•
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Anxiety = apprehension over a certain problem
Fear = reaction to immediate danger
Anxiety and fear = adaptive
Anxiety disorders (high levels or frequent anxiety)
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Phobias (specific and social)
Panic disorder
Generalised anxiety disorder (GAD)
Obsessive-compulsive disorder (OCD)
Posttraumatic stress disorder (PTSD)
Phobias
• Disruptive fear of a particular object or situation that
is out of proportion to the danger posed
• Specific phobia = caused by presence of specific
object or situation e.g. spiders, flying
• Social phobia = persistent, unrealistic fear of social
situations
Panic disorder
• Frequent panic attacks which are unrelated to
specific situations
• Worry about future panic attacks
• Panic attack = sudden attack of intense
apprehension, terror and feelings of impending
doom, laboured breathing, heart palpitations,
nausea, chest pain, dizziness.
Generalised anxiety disorder
• Persistent worry – often about minor things
• Persistent worry – excessive, uncontrollable, long
lasting
• Symptoms need to be present for at least 6 months
Obsessive-compulsive disorder (OCD)
• Characterised by persistent and uncontrollable thoughts
or urges (obsessions) and the need to repeat certain acts
over and over (compulsions)
Obsessions
• intrusive and recurring thoughts, uncontrollable, usually appear
irrational, interfere with normal activities
• Most frequent; contamination, sexual or aggressive impulses, body
worries
Compulsions
• Repetitive, clearly excessive behaviour, feels driven to perform in
order to reduce the anxiety caused by obsessive thoughts
• Fears dire consequences if act is not performed
• Frequency with which such acts are performed can be staggering
Obsessive-compulsive disorder (OCD)
Neurobiological Factors
– Orbitofrontal cortex, caudate nucleus (part of the basal ganglia), anterior cingulate
Obsessive-compulsive disorder (OCD)
Psychological Factors
1. Compulsions
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Behavioural factors
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Operantly conditioned responses
Cognitive factors
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Lack of confidence in memory
2. Obsessions
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Intrusive thoughts - normal
But, why are they persistent in OCD to cause distress
Thought suppression?
Posttraumatic Stress Disorder (PTSD)
• Childhood experiences of trauma, people with
other anxiety or depressive disorders, high
neuroticism, women
• High levels of brain activity in the amygdala
• Severity of the traumatic event is important
Posttraumatic Stress Disorder (PTSD)
• Neurobiological Factors
– Patients with PTSD = smaller hippocampus
volume
– Hippocampus = emotional memories
• Psychological Factors
– Coping
• More likely to develop PTSD if people cope with a
trauma by trying not to think about it
• More likely to develop PTSD if individual
experiencing dissociation at the time of trauma
• Dissociation and memory suppression help to
maintain PTSD
• High levels of intelligence
• Strong social support
Summary
• Mood disorders
– Depressive disorders
– Manic disorders
• Types, characteristics, diagnosis
• Anxiety disorders
– Phobias, panic disorder, GAD
• General characteristics
– OCD and PTSD
• General characteristics
• Neurobiological and psychological factors
Revision Quiz – what’s the diagnosis?
• Case 1
– Jan, 42, business executive, offered exciting new
job promotion in Florida, considering turning down
the job after seeing a documentary entitled ‘Snakes
in Florida’
• Case 2
– Maureen, 30, accountant, over the past few years
has become increasingly socially withdrawn, afraid
to go to the supermarket in case she sees anyone
she knows.