6.mood_disorders2per

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Unformatted text preview: 10/20/10 An
Overview
of
Mood
Disorders
 •  Extremes
in
Normal
Mood




 – Nature
of
depression
 – Nature
of
mania
and
hypomania
 •  DSM‐IV
Depressive
Disorders
 – Major
depressive
disorder
 – Dysthymic
disorder
 – Double
depression
 1 10/20/10 An
Overview
of
Mood
Disorders
 •  DSM‐IV
Bipolar
Disorders
 – Bipolar
I
disorder
 – Bipolar
II
disorder
 – Cyclothymic
disorder
 Major
Depression:
An
Overview

 •  Major
Depressive
Episode
 –  Depressed
mood
 –  Anhedonia
 –  CogniAve
symptoms
 –  VegetaAve
symptoms
 •  Major
Depressive
Disorder
 –  Single
episode
 –  Recurrent
episodes
 2 10/20/10 Dysthymia:

An
Overview
 •  Overview
and
Defining
Features
 – Depressed
mood
for
at
least
2
years
 – Mild
 – Chronic
 •  Facts
and
StaAsAcs
 – Late
onset
–
early
20s
 – Early
onset
–
Before
age
21,
poorer
 prognosis
 Double
Depression:
Overview
 •  Overview
and
Defining
Features
 – Major
depressive
episodes
and
 dysthymic
disorder
 – Dysthymic
disorder
typically
first
 •  Facts
and
StaAsAcs
 – Severe
psychopathology
 – Poor
outcome
 – Most
difficult
to
treat
 3 10/20/10 
Bipolar
I
Disorder:
An
Overview
 •  Overview
and
Defining
Features
 – Full
manic
episodes
and
major
depression
 •  Facts
and
StaAsAcs
 – Average
age
on
onset
is
18
years
 – Chronic
 – Suicide
is
common
 Bipolar
II
Disorder:
An
Overview
 •  Overview
and
Defining
Features
 – Hypomanic
episodes
and
major
 depression
 •  Facts
and
StaAsAcs
 – Average
age
on
onset
is
22
years
 – Only
10
to
13%
of
cases
progress
to
 bipolar
I
 – Chronic
 4 10/20/10 Cyclothymic
Disorder
 •  Overview
and
Defining
Features
 – Milder
mania
and
depression

 – PaTern
must
last
for
at
least
2
years

 •  Facts
and
StaAsAcs
 – High
risk
for
developing
bipolar
I
or
II
 – Most
are
female
 – Average
age
on
onset
is
early
 adolescence
 The
Bipolar
Spectrum
 M m d D 5 10/20/10 Course
of
Mood
Disorders
 Major
Depression
Mnemonic
 •  •  •  •  •  •  •  •  •  SIGECAPS
 Sleep
 Interest
 Guilt
 Energy
 ConcentraAon
 AppeAte
 Psychomotor
 Suicide
 6 10/20/10 Mood
Disorders:

CharacterisAcs
 Mood Disorders: Subtypes Major Depressive Disorder Dysthymic Disorder With melancholic features With atypical features With psychotic features With catatonic features With postpartum features With seasonal onset (SAD) Bipolar Disorders Cyclothymic Disorder Depression Mania melancholic atypical psychotic catatonic postpartum seasonal onset 7 10/20/10 AddiAonal
Facts
and
StaAsAcs
 •  LifeAme
Prevalence
 – About
7.8%
of
US
populaAon
 •  Sex
Differences
 – MDD:

2:1
Women
to
Men
 – Bipolar
disorders:

1:1
 •  Most
Depressed
Persons
are
Anxious,
 Not
All
Anxious
Persons
are
Depressed
 GeneAc
Influences
 •  Strong
familial
inheritance
paTerns
for
both
 Major
Depression
and
Bipolar
 •  Serotonin
Transporter
gene
(5‐HTT)
is
ONE
 candidate
 •  Depression
in
MDD
and
Bipolar
have
same
 geneAcs
 •  Mania
has
a
separate
geneAc
influence
 8 10/20/10 GeneAc
Influences
 Neurobiological
Influences
 •  NeurotransmiHer
Systems
 – Serotonin
 – Permissive
hypothesis
 •  The
Endocrine
System
 – CorAsol
and
Dexamethasone
suppression
 test
(DST)
 •  Sleep
and
Circadian
Rhythms
 – Sleep
disturbance
=
hallmark
 9 10/20/10 Learned
Helplessness
 Barrier Shock Safe Shock Barrier Shock •  Animal
Research
(Seligman
&
Maier,
1967):
 –  Dogs
learn
to
avoid
shock
by
jumping
a
barrier.
 –  Dogs
who
previously
cannot
control
shock
do
not
 subsequently
learn
to
avoid
shock.
 –  Instead,
these
dogs
become
‘Helpless’
 Psychological
Dimensions
(Learned
 Helplessness)
 •  The
Learned
Helplessness
Theory
of
Depression
 –  Related
to
lack
of
perceived
control
over
life
events
 •  Depressive
AHribuAonal
Style
 –  Internal
aTribuAons
–
NegaAve
outcomes
are
one’s
 own
fault
 –  Stable
aTribuAons
–
Believing
future
negaAve
 outcomes
will
be
one’s
own
fault;
pessimism
 –  Global
aTribuAon
–
Believing
negaAve
events
will
 disrupt
many
life
acAviAes
 –  All
three
domains
contribute
to
a
sense
of
 hopelessness
 10 10/20/10 Beck’s
CogniAve
Triad
 I suck! The world sucks! We’ll always suck! Beck’s
CogniAve
Model
(1967)
 (Early) Experience Formation of Depressogenic Schemas Critical Incidents Schemas Activated Negative Automatic Thoughts (NATs) Symptoms Behavioural Cognitive Motivational Somatic Affective 11 10/20/10 Depressive
CogniAons
 Negative Cognitive Triad: (Pessimistic views of the self, the world & the future) Depressogenic (Negative) Schema: Triggered by negative life events. (e.g. “I must be the best at everything”) Cognitive Biases (Systematic Logical Errors): • Arbitrary Inference - The prof. Must think I’m stupid because I got a “D”. • Selective Abstraction - I did poorly because I’m stupid. • Overgeneralization - I got a “D” on the test. I’m going to flunk out of school. • Magnification & Minimization - That “A” was a fluke. • Personalization - The prof. Didn’t call on me; he must think I’m dumb. • Absolutistic Dichotomous Thinking - If I don’t get an “A” I’m a loser. • Should & Must Statements - I have to get the highest grade. Depression An
IntegraAve
Theory

 •  Shared
Biological
Vulnerability
 –  OveracAve
neurobiological
response
to
stress
 •  Exposure
to
Stress
 –  Stress
acAvates
hormones
that
affect
neurotransmiTer
 systems
 –  Stress
turns
on
certain
genes,
affects
circadian
 rhythms,
awakens
dormant
psychological
 vulnerabiliAes
(i.e.,
negaAve
thinking),

contributes
to
 sense
of
uncontrollability
(i.e.,
helplessness),
fosters
a
 sense
of
helplessness
and
hopelessness
 •  Social
and
Interpersonal
Support
are
Moderators
 12 10/20/10 Gene‐Environment
InteracAons
 •  Murphy
et
al.
(2001)
 –  Mice
with
altered
5‐HTT
suscepAble
to
stress
 •  Suomi
and
colleagues,
Bennet
et
al.
(2002)
 –  Macaques
with
5‐HTTs
gene
suscepAble
to
stress
 AND
show
lower
serotonin
levels
 •  Hariri
et
al.
(2002)
 –  Humans
with
5‐HTTs
show
INCREASED
amygdala
 acAvaAon
to
fearful
sAmuli
 •  Caspi
et
al.
(2003)
 Dr. Fred Rose 13 10/20/10 Treatment:
Tricyclic
MedicaAon
 •  Widely
Used
(e.g.,
Tofranil,
Elavil)
 •  Block
Reuptake
of
Norepinephrine
and
Other
 NeurotransmiHers
 •  Takes
2
to
8
Weeks
for
the
TherapeuAc
Effects
 to
be
Known
 •  NegaAve
Side
Effects
Are
Common
 •  May
be
Lethal
in
Excessive
Doses
 Monoamine
Oxidase
Inhibitors
(MAO‐ I)
 •  Blocks
Monoamine
Oxidase
 –  Monoamine
oxidase
(MAO)
is
an
enzyme
that
 breaks
down
serotonin/norepinephrine
 •  MAO
Inhibitors
Are
Slightly
More
EffecAve
 Than
Tricyclics
 •  Must
Avoid
Foods
Containing
Tyramine
(e.g.,
 beer,
red
wine,
cheese)
 14 10/20/10 SelecAve
Serotonin
Reuptake
 Inhibitors
(SSRI’s)
 •  Specifically
Block
Reuptake
of
Serotonin
 –  FluoxeAne
(Prozac)
is
the
most
popular
SSRI
 •  SSRIs
Pose
No
Unique
Risk
of
Suicide
or
Violence
 •  NegaAve
Side
Effects
Are
Common
but
Temporary
 –  Decreased
sexual
arousal/funcAoning
 –  “JiTeriness”
 –  Sleep
disturbance
 Treatment:

Lithium
 •  Lithium
Is
a
Common
Salt
 –  Primary
drug
of
choice
for
bipolar
disorders
 •  Side
Effects
May
Be
Severe
 –  Dosage
must
be
carefully
monitored
 •  Why
Lithium
Works
Remains
Unclear
 •  Common
AlternaAve:

Depakote
 15 10/20/10 Electroconvulsive
Therapy
(ECT)
 •  ECT
Is
EffecAve
for
Cases
of
Severe
Depression
 •  The
Nature
of
ECT

 –  Involves
applying
brief
electrical
current
to
the
brain
 –  Results
in
temporary
seizures

 –  Usually
6
to
10
outpaAent
treatments
are
required
 •  Side
Effects
Are
Few
and
Include
Short‐Term
Memory
 Loss
 •  Uncertain
Why
ECT
works
and
Relapse
Is
Common

 Psychosocial
Treatments
 •  CogniAve
Therapy
 –  Addresses
cogniAve
errors
in
thinking
 –  Also
includes
behavioral
components
 •  Interpersonal
Psychotherapy
 –  Focuses
on
problemaAc
interpersonal
 relaAonships

 •  Outcomes
with
Psychological
Treatments
Are
 Comparable
to
MedicaAons
 16 10/20/10 Data
from
Teasdale
2000
study
on
paAents
treated
 with
severe
depression
 Suicide
Facts
and
StaAsAcs
 •  Eighth
Leading
Cause
of
Death
in
the
United
States
 •  Overwhelmingly
a
White
and
NaAve
American
 Phenomenon
 •  Suicide
Rates
Are
Increasing,
ParAcularly
in
the
Young
 •  Gender
Differences
 –  Males
are
more
successful
at
comminng
suicide
than
 females
 –  Females
aTempt
suicide
more
ooen
than
males
 17 10/20/10 Method
of
Suicide
(1990)
 Female Male Suicide:

Risk
Factors
 Suicide
in
the
Family
Increases
Risk
 Low
Serotonin
Levels
Increase
Risk
 A
Psychological
Disorder
Increases
Risk
 Alcohol
Use
and
Abuse
 Past
Suicidal
Behavior
Increases
Subsequent
Risk
 Experience
of
a
Shameful/HumiliaAng
Stressor
 Increases
Risk
 •  Publicity
About
Suicide
and
Media
Coverage
Increase
 Risk
 •  •  •  •  •  •  18 10/20/10 Suicide:
What
to
Do
 •  Research
shows
that
threats
should
be
taken
 seriously
 •  Do
not
be
afraid
to
discuss
the
topic
 •  Get
assistance
‐
don’t
accept
responsibility
 •  Consider
hospitalizaAon
 Summary
of
Mood
Disorders
 •  All
Mood
Disorders
Share
 –  Gross
deviaAons
in
mood
 –  Common
biological
and
psychological
vulnerability
 •  Stress
and
Social
Support
Seem
CriAcal
in
Onset,
 Maintenance,
and
Treatment
 •  Suicide
Is
an
Increasing
Problem
Not
Unique
to
Mood
 Disorders
 •  MedicaAons
and
Psychotherapy
Produce
Comparable
 Results
 19 ...
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