Top Banner
Mood Disorders
25

Mood Disorders. “Gross deviation in Mood” Major Depressive Episode Manic Episode/Hypo-manic Episode Mixed Episode.

Dec 26, 2015

Download

Documents

Coleen Goodman
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Page 1: Mood Disorders. “Gross deviation in Mood” Major Depressive Episode Manic Episode/Hypo-manic Episode Mixed Episode.

Mood Disorders

Page 2: Mood Disorders. “Gross deviation in Mood” Major Depressive Episode Manic Episode/Hypo-manic Episode Mixed Episode.

“Gross deviation in Mood”

• Major Depressive Episode

• Manic Episode/Hypo-manic Episode

• Mixed Episode

Page 3: Mood Disorders. “Gross deviation in Mood” Major Depressive Episode Manic Episode/Hypo-manic Episode Mixed Episode.

Major Depressive Episode

• Phenomenological– Affective: dysphoria, anhedonia,

irritability– Cognitive: worthlessness/guilt,

hopelessness, concentration, suicidal

• Behavioural – Changes in motor functioning

(agitated or retarded)

• Physiological– Changes in weight/appetite, sleep

disturbance, loss of energy

Page 4: Mood Disorders. “Gross deviation in Mood” Major Depressive Episode Manic Episode/Hypo-manic Episode Mixed Episode.

Manic Episode

• Phenomenological– Affective: elevated, expansive

mood (euphoria), irritability, inflated self-esteem

– Cognitive: flight of ideas, shifts of ideas, distractible

• Behavioural – Changes in motor functioning

(hyperactive, talkativeness, reckless behaviour)

• Physiological– Less sleep, increased energy

Page 5: Mood Disorders. “Gross deviation in Mood” Major Depressive Episode Manic Episode/Hypo-manic Episode Mixed Episode.

Types of Mood Disorders

• Unipolar Depression:– Major Depressive Disorder– Dysthymic Disorder

• Bipolar Disorder:– Bipolar I Disorder– Bipolar II Disorder– Cyclothymic Disorder

Page 6: Mood Disorders. “Gross deviation in Mood” Major Depressive Episode Manic Episode/Hypo-manic Episode Mixed Episode.

1) Major Depressive Disorder

• One or more Depressive Episode with no intervening periods of mania

• 17% Lifetime Prevalence

• Woman more effected than men

• 30% of undergrads are dysphoric and 10% are clinically depressed

Page 7: Mood Disorders. “Gross deviation in Mood” Major Depressive Episode Manic Episode/Hypo-manic Episode Mixed Episode.

Major Depressive Episode

• Onset age = ave. 27

• 90% spontaneous remission within 1 year

• Remission is often only partial

• 80% experience recurrences

Page 8: Mood Disorders. “Gross deviation in Mood” Major Depressive Episode Manic Episode/Hypo-manic Episode Mixed Episode.

2) Dysthymic Disorder

• Milder, but more chronic and persistent than MDD

• Median duration is 5 years

• Can have early or late onset– Before 21: poorer prognosis,

greater chronicity, greater likelihood of genetic involvement

Page 9: Mood Disorders. “Gross deviation in Mood” Major Depressive Episode Manic Episode/Hypo-manic Episode Mixed Episode.

Depression Symptom Modifiers

• Psychotic– Hallucinations & Delusions,

which can be mood congruent or incongruent

• Melancholic– Prominent somatic symptoms

• Atypical– Overeating, oversleeping, anxiety

• Catatonic– Limited movement

Page 10: Mood Disorders. “Gross deviation in Mood” Major Depressive Episode Manic Episode/Hypo-manic Episode Mixed Episode.

Types of Mood Disorders

• Unipolar Depression:– Major Depressive Disorder– Dysthymic Disorder

• Bipolar Disorder:– Bipolar I Disorder– Bipolar II Disorder– Cyclothymic Disorder

Page 11: Mood Disorders. “Gross deviation in Mood” Major Depressive Episode Manic Episode/Hypo-manic Episode Mixed Episode.

Bipolar Disorder

• Involves both manic and depressive phases

• Onset typically 18-22 years• Rapid cycling, poorer prognosis• 1% of general population, less

common than MDD• Almost always more than one Manic

Episode• Equal prevalence in males and

females• Briefer episodes

Page 12: Mood Disorders. “Gross deviation in Mood” Major Depressive Episode Manic Episode/Hypo-manic Episode Mixed Episode.

Bipolar I

• At least one manic (or mixed) episode and usually, but not necessarily, at least one major depressive episode as well

Page 13: Mood Disorders. “Gross deviation in Mood” Major Depressive Episode Manic Episode/Hypo-manic Episode Mixed Episode.

Bipolar II

• At least one major depressive episode and at least one hypomanic episode, but has never met criteria for a manic or mixed episode

Page 14: Mood Disorders. “Gross deviation in Mood” Major Depressive Episode Manic Episode/Hypo-manic Episode Mixed Episode.

Cyclothymia

• Chronic (at least 2 years), cycling between hypomania and depression without meeting criteria for a depressive episode

• Can become a way of life

• Equal prevalence among men and women

• 1/3-1/2 go on to develop Bipolar I or II

Page 15: Mood Disorders. “Gross deviation in Mood” Major Depressive Episode Manic Episode/Hypo-manic Episode Mixed Episode.

Qualities of Mood Disorders

• Psychotic vs. Neurotic

• Endogenous vs. Reactive

• Early vs. Late onset

Page 16: Mood Disorders. “Gross deviation in Mood” Major Depressive Episode Manic Episode/Hypo-manic Episode Mixed Episode.

Explaining Mood Disorders

• Psychodynamic Perspective

• Interpersonal Perspective

• Behavioural Perspective

• Cognitive Perspective

• Sociocultural Perspective

• Biological Perspective

Page 17: Mood Disorders. “Gross deviation in Mood” Major Depressive Episode Manic Episode/Hypo-manic Episode Mixed Episode.

Psychodynamic Perspective

• Freud/Abraham: Unconscious sorrow & rage in response to real or symbolic loss

• Neo-dynamic: Early loss or threatened loss of loved object (parent) – reactivated by current loss – recapitulating helplessness

• Fenichel: Compensation for low self-esteem – interpersonally functional (dependency)

• Affectionless control

Page 18: Mood Disorders. “Gross deviation in Mood” Major Depressive Episode Manic Episode/Hypo-manic Episode Mixed Episode.

Interpersonal Perspective

• Sullivan: Psychopathology is a relational phenomenon

• Recent models focus on current relationships

• Klerman: Grief, interpersonal disputes, role transitions, & lack of social skills – directly address these issues

Page 19: Mood Disorders. “Gross deviation in Mood” Major Depressive Episode Manic Episode/Hypo-manic Episode Mixed Episode.

Behavioural Perspective

• Lewinsohn: Extinction (behaviours no longer rewarded)

• Lack of positive reinforcement causes withdrawal and depression

• Amount of reinforcement depends on:– Number / range– Availability– Skills

Page 20: Mood Disorders. “Gross deviation in Mood” Major Depressive Episode Manic Episode/Hypo-manic Episode Mixed Episode.

Behavioural Perspective

• Negative interpersonal cycle: constantly seeking reassurance and obtaining ‘caring’ – others respond negatively.

Page 21: Mood Disorders. “Gross deviation in Mood” Major Depressive Episode Manic Episode/Hypo-manic Episode Mixed Episode.

Cognitive Perspective

• Seligman: Learned helplessness (expectation of lack of control)

• Recall attributions discussed earlier

• Beck: Negative self-schema

• Dependency vs. Self-criticism

Page 22: Mood Disorders. “Gross deviation in Mood” Major Depressive Episode Manic Episode/Hypo-manic Episode Mixed Episode.

Sociocultural Perspective

• Depression and suicide vary as a function of social factors

Page 23: Mood Disorders. “Gross deviation in Mood” Major Depressive Episode Manic Episode/Hypo-manic Episode Mixed Episode.

Biological Perspective

• Family studies suggest a genetic component (1st degree relatives 3X more likely for depression and 10X more likely for bipolar)

• Twin studies: – Bipolar, 72% vs. 14%

concordance – Unipolar. 40% vs. 11%

Page 24: Mood Disorders. “Gross deviation in Mood” Major Depressive Episode Manic Episode/Hypo-manic Episode Mixed Episode.

Biological Perspectives

• Adoption studies:– Bipolar, 31% prevalence in the

biological parents of the bipolar adoptees vs. 2% biological parents of non-bipolar adoptees

• Biological rhythms:– Sleep disturbance, hormone

differences, --”biological clock”– Change my disrupt biological

clock

Page 25: Mood Disorders. “Gross deviation in Mood” Major Depressive Episode Manic Episode/Hypo-manic Episode Mixed Episode.

Biological Perspectives

• Some evidence to suggest structural brain differences

• Hormone imbalance– Malfunction of the hypothalamus

• Neurotransmitter Imbalance– Catecholamine hypothesis