Chapter 7 Flashcards
The two key moods involved in mood disorders are:
depression, mania
– Depression:
involves feelings of extraordinary sadness and
dejection
– Mania:
often characterized by intense and unrealistic feelings of excitement and euphoria
Unipolar depressive disorder:
a person experiences
only depressive episodes
• Bipolar disorder:
a person experiences both depressive
and manic episodes
– Depressive episode:
when a person is markedly depressed or
loses interest in formerly pleasurable activities for at least 2 weeks
– Manic episode:
markedly elevated, expansive, or irritable mood
for at least 4 days
▪ Hypomanic episode:
abnormally elevated, expansive, or irritable
mood for at least 4 days; the person must also have at least 3 other symptoms similar to those involved in mania
Major Depressive Disorder
• Diagnostic criteria for MDD require that a person must
be in a major depressive episode and never had a
manic, hypomanic, or mixed episode
Unipolar Depressive Disorder
recurrent disorder
Onset of unipolar depressive disorders most often
occurs during late adolescence up to middle adulthood Incidence of depression rises sharply during adolescence
Recurrence:
the onset of a new episode of depression
– Occurs in about 40-50 percent of people who experience a depressive episode
Relapse:
the return of symptoms within a fairly short
period of time
Specifiers:
different patterns of symptoms or features
• Major depressive episode with melancholic features:
includes loss of interest, not reacting to usually pleasurable stimuli or desired events
• Severe major depressive episode with psychotic features:
depression is accompanied by psychotic symptoms
• Major depressive episode with catatonic features
includes a range of psychomotor symptoms
• Criteria for recurrent major depressive episode with a
seasonal pattern
(seasonal affective disorder) include at
least 2 episodes of depression in the past 2 years at the same time of year
POSTPARTUM “BLUES”
• Symptoms include changeable mood, crying easily,
sadness, and irritability, often intermixed with happy
feelings
• Symptoms occur in up to 50-70 percent of women within 10 days of giving birth
• Postpartum Depression (different)
unipolar mood disorders GENETIC INFLUENCES
• Family studies have shown that the prevalence of mood
disorders is about 2-3 times higher among blood
relatives of persons with clinically diagnosed unipolar
depression
• One candidate for a specific gene that might be
implicated is the serotonin-transporter gene
– Involved in the transmission and reuptake of serotonin
– One of the key transmitters involved in depression
causal factors unipolar mood disorders ABNORMALITIES OF HORMONAL REGULATORY AND
IMMUNE SYSTEM
• Majority of attention has been focused on the hypothalamic-
pituitary-adrenal (HPA) axis
– Recent evidence suggests that dexamethasone nonsuppression may
be a general indicator of mental stress rather than specific to depression
• The other endocrine axis relevant to depression is the
hypothalamic-pituitary-thyroid axis
– Drugs used to increase thyroid hormone and lower depression in people who show dysregulation of this axis
BIOLOGICAL EXPLANATIONS FOR SEX DIFFERENCES
• hormonal factors such as normal fluctuations in ovarian
hormones for sex differences in depression
– inconsistent results
• women have a greater genetic vulnerability?
– Inconsistent results
BEHAVIORAL THEORIES depression
• Depression occurs when an individual’s response no
longer produce positive reinforcement or when the rate
of negative reinforcement increases
BECK’S COGNITIVE THEORY
• Beck hypothesized that the cognitive symptoms of depression often precede and cause the affective or mood symptoms, rather than vice versa
• Underlying dysfunctional beliefs, known as depressogenic schemas, are rigid, extreme, and counterproductive
• The negative cognitive triad includes negative thoughts
about the self, the world, and the future
• Research conducted to test Beck’s theory has generated a very effective form of treatment for depression known as cognitive therapy
INTERPERSONAL EFFECTS OF MOOD DISORDERS
• Lack of Social Support and Social-Skills Deficits
– Many studies support that people who are lonely, isolated, or lacking
support are more vulnerable to becoming depressed
• The Effects of Depression on Others
– Depressive behaviour can elicit negative feelings and rejection in other
people, including strangers, roommates, and spouses
• Marriage and Family Life
– High correlation between marital dissatisfaction and depression for
both women and men
– Marital distress increases relapse for depression
– Parental depression puts children at high risk for depression
Bipolar disorders are distinguished from unipolar
disorders by
the presence of manic or hypomanic
episodes
Cyclothymic disorder:
the repeated experience of
hypomanic symptoms for a period of at least 2 years
• Less serious version of bipolar disorder—lacks the
extreme mood and behaviour changes
Bipolar I
Person has full-blown mania.
• Person experiences episodes of mania and periods of depression. Even if the
periods of depression do not reach the threshold for a major depressive
episode, the diagnosis of bipolar I disorder is still given.
Bipolar II:
• Person experiences periods of hypomania, but his or her symptoms are below
the threshold for full-blown mania.
• Person experiences periods of depressed mood that meet the criteria for major
depression.
Biological Causal Factors bipolar disorder
genetic influences
• Genes account for about 80-90 percent of the variance
in the liability to develop bipolar I disorder
• Efforts to locate the chromosomal site(s) of the
implicated genes suggest that it is polygenic
NEUROCHEMICAL FACTORS
Biological Causal Factors bipolar disorder
• Increased levels of dopamine may be related to manic
symptoms
• Serotonin activity appears to be low in both depressive
and manic phases
hormonal FACTORS
Biological Causal Factors bipolar disorder
ABNORMALITIES OF HORMONAL REGULATORY
SYSTEMS
• Cortisol levels are elevated in bipolar depression, but not
usually during manic episodes
• Many bipolar patients have abnormalities in the
functioning of the hypothalamic-pituitary-thyroid axis
• Thyroid hormone can precipitate manic episodes in
patients with bipolar disorder
bipolar: SLEEP AND OTHER BIOLOGICAL RHYTHMS
• Patients with bipolar disorder tend to sleep very little during
manic episodes
• In depressed states, patients tend toward hypersomnia (too
much sleep)
Psychological Causal Factors
bipolar
STRESSFUL LIFE EVENTS
• May influence the onset of episodes by activating underlying
vulnerability
OTHER PSYCHOLOGICAL FACTORS IN BIPOLAR
DEPRESSION
• People with low social support show more depressive
recurrences
• Neuroticism has been associated with symptoms of
depression and mania
Pharmacotherapy start
• 1950s: first category of antidepressants is the
monoamine oxidase inhibitors (MAOIs)
• Drug treatment of choice from the 1960s-early 90s was
tricyclic antidepressants (TCAs)
• The side effects of TCAs have led to the prescribing of
selective serotonin re-uptake inhibitors (SSRIs)
today treating mood disorders drugs
THE COURSE OF TREATMENT WITH
ANTIDEPRESSANT DRUGS
• Drugs usually require 3-5 weeks to take effect
• About 50 percent of patients don’t respond to the first drug prescribed
• Discontinuing a drug when symptoms have remitted may
result in relapse
LITHIUM AND OTHER MOOD-STABILIZING DRUGS
• Lithium has been widely studied to treat manic episodes
• Anticonvulsants are often effective in those who do not respond well to lithium
Alternative Biological Treatments
ELECTROCONVULSIVE THERAPY
BRIGHT LIGHT THERAPY
TRANSCRANIAL MAGNETIC STIMULATION
DEEP BRAIN STIMULATION
ECT
• Electroconvulsive therapy (ECT) is often used in patients
who are severely depressed and may be at an immediate
suicidal risk
• Most common side effects are confusion, amnesia, and
slowed response time
DEEP BRAIN STIMULATION
• Explored as a treatment approach for individuals with
refractory depression who have not responded to other
treatments
• Involves implanting an electrode in the brain and then
stimulating that area with an electrical current
BRIGHT LIGHT THERAPY
• Originally used in the treatment of seasonal affective
disorder
• Now been shown to be effective in nonseasonal
depressions
TRANSCRANIAL MAGNETIC STIMULATION
• Noninvasive technique allowing focal stimulation of the brain in
patients who are awake
• Many studies have shown that TMS is more effective than antidepressants, and without the side effects of ECT
Psychotherapy for mood disorders
CBT, BEHAVIORAL ACTIVATION TREATMENT, INTERPERSONAL THERAPY
BEHAVIORAL ACTIVATION TREATMENT
• Behavioral activation treatment is a relatively new and
promising treatment for unipolar depression
• Goals are to increase levels of positive reinforcement and to
reduce avoidance and withdrawal
COGNITIVE-BEHAVIORAL THERAPY
• Cognitive-behavioral therapy (cognitive therapy) focuses
on here-and-now-problems
• Teaches people to systematically evaluate their dysfunctional
beliefs and negative automatic thoughts
INTERPERSONAL THERAPY
• Interpersonal therapy (IPT) has not yet been as extensively
studied or used as CBT, or as widely available
– Focuses on current relationship issues, trying to help the person
understand and change maladaptive interaction patterns
FAMILY AND MARITAL THERAPY
• Marital therapy is as effective as cognitive therapy in reducing unipolar depression in a depressed spouse
suicide
Depression is the disorder most commonly linked with
suicidal behavior
Important to distinguish suicidal behaviors from
nonsuicidal self-injury (NSSI)
NSSI
nonsuicidal self-injury. Refers to direct, deliberate destruction of body tissue in the
absence of any intent to die
suicide stats
Women are significantly more likely than men to think
about suicide and to make nonlethal suicide attempts
– Men are four times more likely to die by suicide than women
• Suicidal thoughts and behaviors increase in prevalence
starting around age 12 and continue to increase into the
early to mid 20s
• The suicide rate for white men in the U.S. shows a
dramatic increase at age 75
Crisis Intervention
• Primary objective of crisis intervention is to help a person
cope with an immediate problem as quickly as possible
Suicide Prevention and Intervention
Focus on High-Risk Groups and Other Measures
• A recent study found that cognitive therapy is quite
beneficial for reducing the risk of suicide attempts in
adults who had already made at least one prior attempt
• Cognitive-behavioral therapy for suicide prevention is
also feasible for use with adolescents who have
attempted suicide
