PS1000: Introduction to Abnormal PsychologyMood disorders and anxiety disorders

Dr Claire Gibsoncg95@le.ac.uk

School of Psychology, University of Leicester

OverviewMood disorders

– Depressive Disorders• Major Depressive Disorder• Dysthymic Disorder

– Bipolar disorders• Bipolar I disorder• Bipolar II disorder• Cyclothymic disorder

Anxiety disorders• Phobia• Panic disorder• Generalised anxiety disorder• Obsessive-Compulsive Disorder• Post-traumatic stress disorder

Mood disorders• Involve disabling disturbances in emotion• DSM-IV recognises two broad types of mood

disorders ;– Involve only depressive symptoms– Involve manic symptoms (bipolar disorders)

Mood disorder diagnosesDepressive Disorders

Diagnostic Criteria Bipolar Disorders

Diagnostic Criteria

Major depressive disorder

Sad mood or loss of pleasure for 2 weeks, along with at least 4 other symptoms

Bipolar I disorder

At least one lifetime manic or mixed episode

Dysthymic disorder

Mood is down and other symptoms are present at least 50% of the time for at least 2 years

Bipolar II disorder

At least one lifetime episode of hypomania and episodes of major depression

Cyclothymic disorder

Recurrent mood changes from high to low, without hypomanic or manic episodes for at least 2 years

Depressive disorders• Profound sadness and/or inability to experience

pleasure• Physical symptoms – fatigue, low energy, physical

aches and pains• Exhaustion, lack of sleep, loss of appetite• Psychomotor retardation or psychomotor agitation• Social withdrawal

Major depressive disorder (MDD)

• Depressive symptoms present for at least 2 weeks• Must include depressed mood (or loss of

interest/pleasure) and at least 4 additional symptoms, changes in;

sleep, appetite, attention, feelings of worthlessness, suicidal tendencies, psychomotor agitation or retardation

• Episodic disorder• Tend to recur (average is 4)

Dysthymia• Chronic depression• More than half of the time for at least 2 years• In addition – at least two other symptoms of depression.

• 16.4% population (USA) meet criteria for MDD, 2.5% meet criteria for dysthymia

• MDD is x2 common in women• Both MDD and dysthymia comorbid; anxiety disorders,

substance-related disorders, sexual dysfunctions, personality disorders.

Bipolar disorders

• DSM-IV-TR recognises 3 forms; Bipolar I disorder, Bipolar II disorder, cyclothymia

• Bipolar – people who experience mania tend to experience depression also

• Depression and mania = two opposite poles

Mania

• Intense elation or irritability accompanied by• Flight of ideas• Comes on suddenly over a day or two• Mixed episodes

DSM-IV-TR Criteria for Manic and Hypomanic Episodes

Distinctly elevated or irritable mood. At least 3 of the following (4 if mood irritable);

•Increase in goal-directed activity or physical restlessness•Unusual talkativeness; rapid speech•Flights of ideas or subjective impression that thoughts are racing•Decreased need for sleep•Inflated self esteem•Distractibility•Excessive involvement in pleasurable activities likely to have undesirable consequences

Manic Episode: Hypomanic Episode;

•Symptoms last for 1 week or require hospitalization•Symptoms cause significant distress or functional impairment

•Symptoms present for at least 4 days

•Functioning is different but not markedly impaired

• Bipolar I disorder– A single episode of mania or a single mixed episode– Very rare, less than 1% population, high suicide rates, – One of the most severe mental illnesses

• Bipolar II disorder– Must have experienced at least one major depressive episode and one

period of hypomania– 4% population, high suicide rates,

• Cyclothymia– Symptoms present for at least 2 years– Frequent but mild symptoms of depression alternating with mild

symptoms of mania– 4% population

Anxiety disorders

• Anxiety = apprehension over a certain problem• Fear = reaction to immediate danger• Anxiety and fear = adaptive• Anxiety disorders (high levels or frequent anxiety)– Phobias (specific and social)– Panic disorder– Generalised anxiety disorder (GAD)– Obsessive-compulsive disorder (OCD)– Posttraumatic stress disorder (PTSD)

Phobias

• Disruptive fear of a particular object or situation that is out of proportion to the danger posed

• Specific phobia = caused by presence of specific object or situation e.g. spiders, flying

• Social phobia = persistent, unrealistic fear of social situations

Panic disorder

• Frequent panic attacks which are unrelated to specific situations

• Worry about future panic attacks• Panic attack = sudden attack of intense

apprehension, terror and feelings of impending doom, laboured breathing, heart palpitations, nausea, chest pain, dizziness.

Generalised anxiety disorder

• Persistent worry – often about minor things• Persistent worry – excessive, uncontrollable, long

lasting• Symptoms need to be present for at least 6 months

Obsessive-compulsive disorder (OCD)

• Characterised by persistent and uncontrollable thoughts or urges (obsessions) and the need to repeat certain acts over and over (compulsions)

Obsessions• intrusive and recurring thoughts, uncontrollable, usually appear

irrational, interfere with normal activities• Most frequent; contamination, sexual or aggressive impulses, body

worries

Compulsions• Repetitive, clearly excessive behaviour, feels driven to perform in order

to reduce the anxiety caused by obsessive thoughts• Fears dire consequences if act is not performed• Frequency with which such acts are performed can be staggering

Obsessive-compulsive disorder (OCD)

Neurobiological Factors– Orbitofrontal cortex, caudate nucleus (part of the basal ganglia), anterior cingulate

Obsessive-compulsive disorder (OCD)

Psychological Factors1. Compulsions

o Behavioural factorso Operantly conditioned responses

o Cognitive factorso Lack of confidence in memory

2. Obsessionso Intrusive thoughts - normalo But, why are they persistent in OCD to cause distresso Thought suppression?

Posttraumatic Stress Disorder (PTSD)

• Childhood experiences of trauma, people with other anxiety or depressive disorders, high neuroticism, women

• High levels of brain activity in the amygdala• Severity of the traumatic event is important

Posttraumatic Stress Disorder (PTSD)• Neurobiological Factors

– Patients with PTSD = smaller hippocampus volume

– Hippocampus = emotional memories

• Psychological Factors– Coping

• More likely to develop PTSD if people cope with a trauma by trying not to think about it

• More likely to develop PTSD if individual experiencing dissociation at the time of trauma

• Dissociation and memory suppression help to maintain PTSD

• High levels of intelligence• Strong social support

Summary• Mood disorders– Depressive disorders– Manic disorders

• Types, characteristics, diagnosis

• Anxiety disorders– Phobias, panic disorder, GAD

• General characteristics

– OCD and PTSD • General characteristics• Neurobiological and psychological factors

Revision Quiz – what’s the diagnosis?

• Case 1– Jan, 42, business executive, offered exciting new job

promotion in Florida, considering turning down the job after seeing a documentary entitled ‘Snakes in Florida’

• Case 2– Maureen, 30, accountant, over the past few years

has become increasingly socially withdrawn, afraid to go to the supermarket in case she sees anyone she knows.