CHAPTER 8

DISORDERS OF MOOD

DANNY EURESTI

FRANCISCO HERNANDEZ

HAVANNAH CASCOS

TWO GROUPS:

Mania• Euphoria, Energetic, Exaggerated Beliefs

Depression• Low, Sad, Dark, Overwhelming Challenges

Depressive Disorder• Unipolar depression

Bipolar Disorders

- Unipolar Mania (uncommon)

TWO KEY EMOTIONS:

UNIPOLAR DEPRESSION:

Loose use of the term “Depression”

• Normal periods melancholy

• Can be beneficial

Actual Clinical Syndrome

• Severe

• No redeeming characteristics

HOW COMMON IS UNIPOLAR DEPRESSION? In the United States

• 8% Severe

• 5% Mild

• 19% of all Adults

• Higher among poor people

Age

• 40’s more likely than any other age group

• Median age 26 (in United States)

Women vs Men

• Women are at least twice as likely to experience an episode

• 26% Women

• 12% Men

After Treatment

• 85% recover

• 40% will experience at least one more episode

SYMPTOMS – 5 MAIN AREAS

Varies among people

• Severe– sobbing, indecisive, despair, anger, worthlessness

• Mild – able to function, ineffective, no pleasure

Emotional

Motivational

Behavioral

Cognitive

Physical

EMOTIONAL SYMPTOMS

Feeling sad and dejected

Miserableness, Humiliation, and Emptiness

Anhedonia

Experiencing anger, anxiety, and agitation

MOTIVATIONAL SYMPTOMS

Loss of desire to perform activities

Lack drive, initiative, and spontaneity

“Paralysis of Will”

• Must force themselves to partake in activities

Suicide

• 6% - 15% commit suicide

BEHAVIORAL SYMPTOMS

Less active and productive

Slower speech and movements

COGNITIVE SYMPTOMS

Negative views of themselves

• Inadequacy, undesirableness, and inferiority

Pessimism

• Helplessness, hopelessness, procrastination

Complain about intellectual ability

• Confusion, distraction, forgetful

PHYSICAL SYMPTOMS

Physical Ailments

• Headaches, indigestion, constipation, dizziness, pain

Misdiagnoses

• Caused by the physical ailments

Eating and Sleeping

• Most: eat less and sleep less

• Some: excessively eat and sleep

DIAGNOSING UNIPOLAR DEPRESSION

Major depressive episode

• 2 or more weeks

• At least 5 symptoms of depression

Extreme Cases

• Hallucinations

• Delusion

DIAGNOSING UNIPOLAR DEPRESSION CONT’D

Major depressive disorder

• Seasonal, recurrent, catatonic, postpartum, or melancholic

Dysthymic disorder

• Similar to MDD but less severe and more persistent

Premenstrual dysphoric

• Depressive or related symptoms one week before menstruation

Disruptive mood regulation disorder

• Persistent depressive symptoms

• Recurrent temper outbursts

CELEBRITIES AND MOOD DISORDERS

Gwyneth Paltrow

• Postpartum depression after birth of second child

Abraham Lincoln

• “I am now the most miserable man living”

Tiki barber

• Depression after retiring from NFL. “I would literally... sit on the couch and do nothing for 10 hours.”

Carrie Fisher

• Diagnosed with by polar disorder

Others• Moses, Nebuchadnezzar, Saul, Queen Victoria, Ernest Hemingway, Sylvia Plath,

Jim Carrey, Rodney Dangerfield, Eminem, and Beyoncé Knowles

WHAT CAUSES UNIPOLAR DEPRESSION ?

Stress

• Key trigger of depression

• Experience and report more stressful events

Reactive (exogenous) depression

Endogenous depression

THE BIOLOGICAL VIEW

Diseases and drugs have been know to cause mood changes

Evidence from genetic, biochemical, anatomical, and immune studies

BIOLOGICAL VIEW CONT’D

Genetic Factors

• Twin, Adoption, and Family pedigree studies

Biochemical Factors

• Norepinephrine, Serotonin, Cortisol, Melatonin (Dracula Hormone)

Brain Anatomy and Circuits

• Prefrontal cortex, hippocampus, amygdala, and Brodmann Area 25

Immune System

• Decrease in white blood cells, increase in C-reactive protein, and higher incidence of illness

PSYCHOLOGICAL VIEWS

Psychodynamic

• not strongly supported by research

Behavioral

• modest support

Cognitive

• Considerable research, support, and following

PSYCHODYNAMIC VIEW

Freud and Abraham

Connection to loss

• Regression to oral stage

• Introjection

Symbolic Loss (Imagined loss)

Support

• Anaclitic depression

Limitations

• Parenting only sometimes relates to depression

• Inconsistent findings

• Certain features are impossible to test

BEHAVIORAL VIEW

Change number of rewards and punishments

Support from research

• Lewinsohn

• Social rewards

Limitations

• Relies on self-reports

• Do not establish decreases in rewards as cause

COGNITIVE VIEWS

Negative Thinking

• Cognitive Triad – experiences, themselves, futures

• Automatic thoughts

Learned helplessness (Seligman)

• No control over reinforcements

• They themselves are responsible for their helpless state

• Internal attributions that are global and stable

Limitations

• Does not show cognitive patterns cause unipolar depression

• Laboratory helplessness does not parallel depression in every way

• Relies heavily on animals

SOCIOCULTURAL VIEWS

Influenced by social context that surrounds people

Supported by findings that show depression is triggeresd by outside stressors

2 kinds of sociocultural views

• The family-social perspective

• The multicultural perspective

THE FAMILY-SOCIAL PERSPECTIVE

Individual with depression display social deficits

• Other people –avoid the individual

• Further deterioration of social skills

Depression tied to unavailability of support such found in a happy marriage

• Divorced people show 3 times the depression of those married or widowed

• Double the rate of those never married

• Correlation between marital conflict and sadness: .37 for men and .42 for women

• Those isolated without intimacy become depressed in times of stress

MULTICULTURAL PERSPECTIVE

Gender and Depression

• Artifact Theory – equally prone but clinicians fail to detect depression in men

• Hormone Explanation – changes in hormones trigger depression for women

• Life Stress Theory – women experience more stress than men

• Body Dissatisfaction Explanation – women are taught to seek low weight and slender bodies

• Lack of Control Theory – women feel less in control of their lives than men do

• Rumination theory – rumination makes people become depressed and stay depressed longer

MULTICULTURAL PERSPECTIVE CONT’D

Cultural Background and Depression

• Constant symptoms of depression across all countries

• Depression in Non-Western countries –more physical

• Depression in Western countries – more cognitive

Ethnic groups

• Symptoms and overall rates are similar

• Chronicity – Hispanic and African Americans are 50 percent more likely to have recurrent episode of depression

• Specific population high rates of depression – For Native Americans: 37% of women, 19% of men, and 28% overall

• Depression is unevenly distributed within minority groups due to varied backgrounds and cultural values

BIPOLAR DISORDERS

Lows of depression and highs of mania

“Emotional rollercoaster”

Suicidal

Impacts friends and family

WHAT ARE THE SYMPTOMS OF MANIA?

Inappropriate rises in mood

5 main areas – emotional, motivational, behavioral, cognitive, and physical

• Emotional - active powerful emotions

• Motivational- urge for excitement, involvement, and companionship

• Behavior – talk loud and fast, move quickly, flamboyance

• Cognitive – poor judgment

• Physical – very energetic

DIAGNOSING BIPOLAR DISORDERSManic episode – one week, high/irritable mood, increased activity or energy, at 3 other

symptoms

Hypomanic episode – less severe, causing little impairment

Bipolar I Disorder – alternating between manic and major depressive episodes

Bipolar II Disorders – alternating between hypomanic and major depressive episodes

• Rapid Cycling – four or more episodes in one-year period

• Seasonal – episodes vary with the seasons

• Experience depression more than mania

• 1% - 2.6% at any given time; 4% over a lifetime

• Equally common in women and men

• Occurs between 15 and 44 years of age

Cyclothymic disorder

WHAT CAUSES BIPOLAR DISORDERS?

Research for a cause has made little progress

Biological research has brought more promising findings

• Neurotransmitter activity

• Ion activity

• Brain Structure

• Genetic Factors

NEUROTRANSMITTER

Overactivity of norepinephrine could lead to mania

• Supported by research studies

High serotonin expected to be related to mania

• Contradictory- results show that bipolar disorder may be linked to low serotonin

ION ACTIVITY

Role of ions – relay messages within a neuron

Theorists suggest irregularities in transport of ions may cause…

• Neurons to fire too easily – leading to mania

• Resist firing – leading to depression

Invesitgative findings of those dealing with bipolar disorder

• Abnormalities in funtioning of the proteins that transport ions

BRAIN STRUCTURE

Brain imaging and postmortem studies found abnormal brain structures

• Smaller ganglia and cerebellum

• Lower volume of gray matter in the brain

• Structural abnormalities in dorsal raphe nucleus, striatum, amygdala, hippocampus and prefrontal cortex

Unclear what role these abnormalities play in bipolar disorder

GENETIC FACTORS

Belief that people inherit a biological predisposition to develop bipolar disorder

• Family pedigree studies support this idea

• Identical twins - 40% likelihood

• Fraternal, siblings, and other close relatives – 5 -10% likelihood

Genetic linkage studies

Molecular biology

• Bipolar disorders linked to X chromosome

Wide range of findings

• Genetic abnormalities may combine to help bring about bipolar disorders