Download Anxiety Disorders

Mood Disorders
“Gross deviation in
Mood”
• Major Depressive Episode
• Manic Episode/Hypo-manic
Episode
• Mixed Episode
Major Depressive
Episode
• Phenomenological
– Affective: dysphoria, anhedonia,
irritability
– Cognitive: worthlessness/guilt,
hopelessness, concentration,
suicidal
• Behavioural
– Changes in motor functioning
(agitated or retarded)
• Physiological
– Changes in weight/appetite, sleep
disturbance, loss of energy
Manic Episode
• Phenomenological
– Affective: elevated, expansive
mood (euphoria), irritability,
inflated self-esteem
– Cognitive: flight of ideas, shifts of
ideas, distractible
• Behavioural
– Changes in motor functioning
(hyperactive, talkativeness,
reckless behaviour)
• Physiological
– Less sleep, increased energy
Types of Mood
Disorders
• Unipolar Depression:
– Major Depressive Disorder
– Dysthymic Disorder
• Bipolar Disorder:
– Bipolar I Disorder
– Bipolar II Disorder
– Cyclothymic Disorder
1) Major Depressive
Disorder
• One or more Depressive
Episode with no intervening
periods of mania
• 17% Lifetime Prevalence
• Woman more effected than men
• 30% of undergrads are
dysphoric and 10% are
clinically depressed
Major Depressive
Episode
• Onset age = ave. 27
• 90% spontaneous remission
within 1 year
• Remission is often only partial
• 80% experience recurrences
2) Dysthymic Disorder
• Milder, but more chronic and
persistent than MDD
• Median duration is 5 years
• Can have early or late onset
– Before 21: poorer prognosis,
greater chronicity, greater
likelihood of genetic involvement
Depression Symptom
Modifiers
• Psychotic
– Hallucinations & Delusions,
which can be mood congruent or
incongruent
• Melancholic
– Prominent somatic symptoms
• Atypical
– Overeating, oversleeping, anxiety
• Catatonic
– Limited movement
Types of Mood
Disorders
• Unipolar Depression:
– Major Depressive Disorder
– Dysthymic Disorder
• Bipolar Disorder:
– Bipolar I Disorder
– Bipolar II Disorder
– Cyclothymic Disorder
Bipolar Disorder
• Involves both manic and depressive
phases
• Onset typically 18-22 years
• Rapid cycling, poorer prognosis
• 1% of general population, less
common than MDD
• Almost always more than one Manic
Episode
• Equal prevalence in males and
females
• Briefer episodes
Bipolar I
• At least one manic (or mixed)
episode and usually, but not
necessarily, at least one major
depressive episode as well
Bipolar II
• At least one major depressive
episode and at least one
hypomanic episode, but has
never met criteria for a manic or
mixed episode
Cyclothymia
• Chronic (at least 2 years),
cycling between hypomania and
depression without meeting
criteria for a depressive episode
• Can become a way of life
• Equal prevalence among men
and women
• 1/3-1/2 go on to develop
Bipolar I or II
Qualities of Mood
Disorders
• Psychotic vs. Neurotic
• Endogenous vs. Reactive
• Early vs. Late onset
Explaining Mood
Disorders
•
•
•
•
•
•
Psychodynamic Perspective
Interpersonal Perspective
Behavioural Perspective
Cognitive Perspective
Sociocultural Perspective
Biological Perspective
Psychodynamic
Perspective
• Freud/Abraham: Unconscious
sorrow & rage in response to real or
symbolic loss
• Neo-dynamic: Early loss or
threatened loss of loved object
(parent) – reactivated by current loss
– recapitulating helplessness
• Fenichel: Compensation for low
self-esteem – interpersonally
functional (dependency)
• Affectionless control
Interpersonal
Perspective
• Sullivan: Psychopathology is a
relational phenomenon
• Recent models focus on current
relationships
• Klerman: Grief, interpersonal
disputes, role transitions, & lack
of social skills – directly
address these issues
Behavioural Perspective
• Lewinsohn: Extinction
(behaviours no longer
rewarded)
• Lack of positive reinforcement
causes withdrawal and
depression
• Amount of reinforcement
depends on:
– Number / range
– Availability
– Skills
Behavioural Perspective
• Negative interpersonal cycle:
constantly seeking reassurance
and obtaining ‘caring’ – others
respond negatively.
Cognitive Perspective
• Seligman: Learned helplessness
(expectation of lack of control)
• Recall attributions discussed
earlier
• Beck: Negative self-schema
• Dependency vs. Self-criticism
Sociocultural
Perspective
• Depression and suicide vary as
a function of social factors
Biological Perspective
• Family studies suggest a genetic
component (1st degree relatives
3X more likely for depression
and 10X more likely for
bipolar)
• Twin studies:
– Bipolar, 72% vs. 14%
concordance
– Unipolar. 40% vs. 11%
Biological Perspectives
• Adoption studies:
– Bipolar, 31% prevalence in the
biological parents of the bipolar
adoptees vs. 2% biological
parents of non-bipolar adoptees
• Biological rhythms:
– Sleep disturbance, hormone
differences, --”biological clock”
– Change my disrupt biological
clock
Biological Perspectives
• Some evidence to suggest
structural brain differences
• Hormone imbalance
– Malfunction of the hypothalamus
• Neurotransmitter Imbalance
– Catecholamine hypothesis