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Disorders of Mood. Chapter 6. 2 key emotions: Depression: Low, sad state in which life seems dark; its challenges overwhelming; no history of mania Mania: State of breathless euphoria or frenzied energy Depression Mania. Disorders of Mood . - PowerPoint PPT Presentation
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DISORDERS OF MOODCHAPTER 6
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DISORDERS OF MOOD • 2 KEY EMOTIONS:•DEPRESSION: LOW, SAD STATE IN WHICH LIFE SEEMS DARK; ITS
CHALLENGES OVERWHELMING; NO HISTORY OF MANIA•MANIA: STATE OF BREATHLESS EUPHORIA OR FRENZIED ENERGY
DEPRESSION N O R M A L M O O D MANIA
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UNIPOLAR DEPRESSION•“DEPRESSION” OFTEN USED TO DESCRIBE GENERAL
SADNESS OR UNHAPPINESS•CLINICAL DEPRESSION CAN BRING SEVERE AND LONG-
LASTING PSYCHOLOGICAL PAIN THAT MAY INTENSIFY AS TIME GOES BY
HOW COMMON IS UNIPOLAR DEPRESSION?
•AROUND 8% OF ADULTS IN ANY GIVEN YEAR •AS MANY AS 5% SUFFER FROM MILD FORMS
•AROUND 19% OF ALL ADULTS AT SOME TIME IN THEIR LIVES•HIGHER AMONG POOR•ONSET: ANY AGE
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HOW COMMON IS UNIPOLAR DEPRESSION?•WOMEN ARE AT LEAST TWICE AS LIKELY AS MEN TO
EXPERIENCE SEVERE UNIPOLAR DEPRESSION•LIFETIME PREVALENCE: 26% OF WOMEN VS. 12% OF
MEN•AMONG CHILDREN, THE PREVALENCE IS SIMILAR
AMONG BOYS AND GIRLS
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CRITERIA FOR A MAJOR DEPRESSIVE EPISODE
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DSM-5 LISTS SEVERAL TYPES OF DEPRESSIVE DISORDERS:•MAJOR DEPRESSIVE DISORDER•MAJOR DEPRESSIVE EPISODE WITH NO HISTORY OF MANIA
•PERSISTENT DEPRESSIVE DISORDER (DYSTHYMIC DISORDER)• LONGER-LASTING (AT LEAST TWO YEARS) BUT LESS
DISABLING PATTERN OF DEPRESSION
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DSM-5 LISTS SEVERAL TYPES OF DEPRESSIVE DISORDERS:
• PREMENSTRUAL DYSPHORIC DISORDER•REPEATEDLY EXPERIENCE CLINICALLY SIGNIFICANT
DEPRESSIVE SYMPTOMS DURING THE WEEK BEFORE MENSTRUATION
•DISRUPTIVE MOOD REGULATION DISORDER (CHILDREN)•CHARACTERIZED BY A COMBINATION OF PERSISTENT
DEPRESSIVE SYMPTOMS AND RECURRENT OUTBURSTS OF SEVERE TEMPER
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STRESS AND UNIPOLAR DEPRESSION
•STRESS: TRIGGER FOR DEPRESSION• THOSE DIAGNOSED EXPERIENCE A GREATER NUMBER OF
STRESSFUL LIFE EVENTS DURING THE MONTH JUST BEFORE THE ONSET OF SYMPTOMS• LOSS OF A LOVED ONE, SERIOUS THREATS TO
IMPORTANT RELATIONSHIPS OR ONE’S OCCUPATIONS, SEVERE ECONOMIC OR HEALTH PROBLEMS, EVENTS INVOLVING HUMILIATION.
• MINOR EVENTS MAY PLAY MORE OF A ROLE IN THE ONSET OF RECURRENT EPISODES THAN IN THE INITIAL EPISODE.
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GENETIC FACTORS• TWIN, ADOPTION, AND GENE STUDIES SUGGEST THAT SOME
PEOPLE INHERIT A BIOLOGICAL PREDISPOSITION•AS MANY AS 20% OF RELATIVES ARE DEPRESSED, COMPARED
WITH FEWER THAN 10% OF THE GENERAL POPULATION•CONCORDANCE RATES FOR IDENTICAL (MZ) TWINS = 46%•CONCORDANCE RATES FOR FRATERNAL (DZ) TWINS = 20% •MAY BE TIED TO SPECIFIC GENES (SEROTONIN-TRANSPORTER
GENE)
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BIOLOGICAL MODEL•BIOCHEMICAL FACTORS•SEROTONIN AND NOREPINEPHRINE•DEPRESSION LIKELY INVOLVES NOT JUST
SEROTONIN NOR NOREPINEPHRINE; A COMPLICATED INTERACTION IS AT WORK, AND OTHERS MAY BE INVOLVED
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BIOLOGICAL MODEL• ENDOCRINE SYSTEM / HORMONE RELEASE•ABNORMAL LEVELS OF CORTISOL•ABNORMAL MELATONIN SECRETION•DEFICIENCIES OF IMPORTANT PROTEINS WITHIN
NEURONS AS TIED TO DEPRESSION
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BIOLOGICAL MODEL·ANATOMY
·EMOTIONAL REACTIONS OF VARIOUS KINDS ARE TIED TO BRAIN CIRCUITS·LIKELY INCLUDE PREFRONTAL CORTEX, HIPPOCAMPUS,
AMYGDALA
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BIOLOGICAL MODEL•IMMUNE SYSTEM•WHEN STRESSED, THE IMMUNE SYSTEM
MAY BECOME DYSREGULATED, WHICH SOME BELIEVE MAY HELP PRODUCE DEPRESSION
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WHAT ARE THE BIOLOGICAL TREATMENTS FOR UNIPOLAR DEPRESSION?
• USUALLY BIOLOGICAL TREATMENT MEANS ANTIDEPRESSANT DRUGS:•MONOAMINE OXIDASE INHIBITORS (MAO INHIBITORS)• TRICYCLICS• SECOND-GENERATION ANTIDEPRESSANTS• SSRI’S- SELECTIVE SEROTONIN REUPTAKE INHIBITORS• SSNRI’S - SELECTIVE SEROTONIN NOREPINEPHRINE REUPTAKE INHIBITORS
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WHAT ARE THE BIOLOGICAL TREATMENTS FOR UNIPOLAR DEPRESSION?• ELECTROCONVULSIVE THERAPY (ECT)•CONTROVERSIAL • PROCEDURE CONSISTS OF TARGETED ELECTRICAL
STIMULATION TO CAUSE A BRAIN SEIZURE•~ 6 TO 12 SESSIONS SPACED OVER 2 - 4 WEEKS
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WHAT ARE THE BIOLOGICAL TREATMENTS FOR UNIPOLAR DEPRESSION?
•BRAIN STIMULATION•VAGUS NERVE STIMULATION•TRANSCRANIAL MAGNETIC STIMULATION•DEEP BRAIN STIMULATION
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PSYCHOLOGICAL MODELS
• THREE MAIN MODELS:•PSYCHODYNAMIC MODEL•NO STRONG RESEARCH SUPPORT
•BEHAVIORAL MODEL•MODEST RESEARCH SUPPORT
•COGNITIVE VIEWS•CONSIDERABLE RESEARCH SUPPORT
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COGNITIVE MODEL•LEARNED HELPLESSNESS – (SELIGMAN) ASSERTS
PEOPLE BECOME DEPRESSED WHEN THEY THINK THAT:•THEY NO LONGER HAVE CONTROL OVER THE
REINFORCEMENTS (REWARDS AND PUNISHMENTS) IN THEIR LIVES•THEY THEMSELVES ARE RESPONSIBLE FOR THIS
HELPLESS STATE
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COGNITIVE MODEL· LEARNED HELPLESSNESS
•ATTRIBUTIONS: INTERNAL/EXTERNAL, GLOBAL/SPECIFIC, STABLE/UNSTABLE.•PESSIMISTIC ATTRIBUTIONAL STYLE ASSOCIATED
WITH DEPRESSION.
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COGNITIVE MODELOTHERS SUGGEST ATTRIBUTIONS LEAD TO DEPRESSION WHEN THEY PRODUCE A SENSE OF HOPELESSNESS
•ONE HAS NO CONTROL OVER WHAT WILL HAPPEN AND SOMETHING BAD WILL HAPPEN.• INTERNAL/EXTERNAL DIMENSION NOT IMPORTANT.• LIKELY NEGATIVE CONSEQUENCES WILL OCCUR AND
NEGATIVE INFERENCES ABOUT THE IMPLICATION OF THE EVENT FOR THE SELF-CONCEPT.
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Beck: Negative thinkingBECK THEORIZES FOUR INTERRELATED COGNITIVE COMPONENTS COMBINE TO PRODUCE UNIPOLAR DEPRESSION:
1. MALADAPTIVE ATTITUDES
2. COGNITIVE TRIAD
3.COGNITIVE DISTORTIONS
4.AUTOMATIC THOUGHTS 23
NEGATIVE COGNITIVE TRIAD
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COGNITIVE DISTORTIONS
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COGNITIVE MODELBECK: NEGATIVE THINKING
BECK’S COGNITIVE THERAPY–DESIGNED TO HELP CLIENTS RECOGNIZE AND CHANGE THEIR NEGATIVE COGNITIVE PROCESSES
1.INCREASING ACTIVITIES AND ELEVATING MOOD2.CHALLENGING AUTOMATIC THOUGHTS3.IDENTIFYING NEGATIVE THINKING AND BIASES4.CHANGING PRIMARY ATTITUDES
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SOCIOCULTURAL MODELPROPOSE THAT DEPRESSION GREATLY INFLUENCED BY SOCIAL CONTEXT
• FAMILY-SOCIAL PERSPECTIVE•MULTICULTURAL PERSPECTIVE
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SOCIOCULTURAL MODELGENDER AND DEPRESSION•ARTIFACT THEORY •HORMONE EXPLANATION •LIFE STRESS THEORY•BODY DISSATISFACTION EXPLANATION•LACK-OF-CONTROL THEORY•RUMINATION THEORY
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BIPOLAR DISORDERS•PEOPLE WITH A BIPOLAR DISORDER EXPERIENCE BOTH
THE LOWS OF DEPRESSION AND THE HIGHS OF MANIA•MANY DESCRIBE THEIR LIVES AS AN EMOTIONAL
ROLLER COASTER
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CRITERIA FOR MANIA
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CRITERIA FOR HYPOMANIA
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BIPOLAR DISORDERS I AND IIBipolar I disorder
• Includes at least one manic episode
• More severe• More dangerous• More impairments
socially/occupationally
Bipolar II disorder• Includes hypomanic
episodes & depression
• Less severe• Can be MORE
competent/social
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DIAGNOSING BIPOLAR DISORDERS·~1% AND 2.6% ADULTS ·EQUALLY COMMON IN WOMEN AND MEN·ONSET USUALLY OCCURS BETWEEN 15
AND 44 (~22 YEARS)
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CYCLOTHYMIC DISORDERCyclical mood swings
• Less severe than those of bipolar disorder
• Symptoms present for at least 2 years
• Lacking severe symptoms and psychotic features of bipolar disorder
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MANIC-DEPRESSIVE SPECTRUM
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WHAT CAUSES BIPOLAR DISORDERS?•NEUROTRANSMITTERS•OVERACTIVITY OF NOREPINEPHRINE
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WHAT CAUSES BIPOLAR DISORDERS?•SEROTONIN: “PERMISSIVE THEORY” •MAY BE LINKED TO LOW SEROTONIN ACTIVITY:
•LOW SEROTONIN MAY “OPEN THE DOOR” TO A MOOD DISORDER AND PERMIT NOREPINEPHRINE ACTIVITY TO DEFINE THE PARTICULAR FORM THE DISORDER WILL TAKE:•LOW SEROTONIN + LOW NOREPINEPHRINE = DEPRESSION•LOW SEROTONIN + HIGH NOREPINEPHRINE = MANIA
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WHAT CAUSES BIPOLAR DISORDERS?• ION ACTIVITY•SOME THEORISTS BELIEVE THAT IRREGULARITIES IN THE
TRANSPORT OF THESE IONS MAY CAUSE NEURONS TO FIRE TOO EASILY (MANIA) OR TO STUBBORNLY RESIST FIRING (DEPRESSION)
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WHAT CAUSES BIPOLAR DISORDERS?•BRAIN STRUCTURE•BASAL GANGLIA AND CEREBELLUM •NOT CLEAR WHAT STRUCTURAL
ABNORMALITIES PLAY
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WHAT CAUSES BIPOLAR DISORDERS?•GENETIC FACTORS
•IDENTICAL (MZ) TWINS = 40% LIKELIHOOD•FRATERNAL (DZ) TWINS AND
SIBLINGS = 5% TO 10% LIKELIHOOD•GENERAL POPULATION = 1 TO
2.6% LIKELIHOOD 40
PHARMACOTHERAPYLithium
Anti seizure, antipsychotic
drugs
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TREATMENTS FOR BIPOLAR DISORDER:•DO NOT FULLY UNDERSTAND HOW MOOD
STABILIZING DRUGS OPERATE·PSYCHOTHERAPY ALONE RARELY HELPFUL ·MOOD STABILIZING DRUGS ALONE ARE NOT
ALWAYS SUFFICIENT·30% OR MORE OF PATIENTS DON’T RESPOND,
MAY NOT RECEIVE THE CORRECT DOSE, AND/OR MAY RELAPSE WHILE TAKING IT 42
RATES OF MOOD DISORDERS IN WRITERS AND ARTISTS
HTTP://WWW2.SUNYSUFFOLK.EDU/HANAUEJ/ABNORMAL/WEB%20PAGES/MANIC-DEPRESSION%20AND%20CREATIVITY.PDF
.