MOOD DISORDERS

Involve disabling disturbances in emotion-from the extreme sadness and disengagement of

depression to the extreme elation and irritability of mania.
 Two broad types:
I. Involves only depressive symptoms
II. Involves manic symptoms (Bipolar Disorder)
 Depression characterized by:
I. Sadness
II. Feelings of worthlessness and guilt
III. Withdrawal from others
IV. Changes in sleep and appetite
 Mania characterized by:
I. Intense elation or irritability
II. Hyperactivity, talkativeness, distractibility
Major Depressive Disorder
Involves a clinically significant change in functioning involving a range of depressive symptoms,
including depressed mood (feeling sad, hopeless, or "down in the dumps") and/or loss of interest
or pleasure in all or virtually all activities for a period of at least two weeks. Average number of
episodes is 4 (Judd, 1997)
 Episodic
 Symptoms tend to dissipate over time
 Subclinical depression
 Sadness plus 3 other symptoms for 10 days
 Significant impairments in functioning even though full diagnostic criteria are not met
Specifiers of Major Depressive Disorder
Psychotic features - individuals in the midst of a major depressive (or manic) episode may
experience psychotic symptoms, specifically hallucinations (seeing or hearing things that aren't
there) and delusions
 Mood incongruent- do not seem consistent with the depressed mood.
 Mood Congruent - consistent with the depressed mood
Anxious distress specifier - The presence and severity of accompanying anxiety
Mixed features specifier. Predominantly depressive episodes that have several (at least three)
symptoms of mania
Melancholic features specifier. This specifier applies only if the full criteria for a major
depressive episode have been met, whether in the context of a persistent depressive disorder or
not.
Catatonic Features Specifiers - This serious condition involves an absence of movement (a
Stuporous state) or catalepsy in which the muscles are waxy and semirigid, so a patient's arms
or legs remain in any position in which they are placed.
Atypical Features Specifier - individuals with this specifier consistently oversleep and overeat
during their depression and therefore gain weight
Peripartum onset specifier. Peri means "surrounding", in this case the period of time just
before and just after the birth. This specifier can apply to both major depressive and manic
episodes.
Seasonal pattern specifier. It accompanies episodes that occur during certain seasons (for
example, winter depression).

Grief
 Grief is characterized by a number of depressive symptoms as well as anxiety, emotional
numbness, and denial due to death of a loved one.
 Can be considered normal as an initial reaction to the loss of loved one.

Premenstrual Dysphoric Disorder

 Intended to apply to women who experience a range of significant psychological
symptoms in the week before menses (and improvement beginning within a few days
following the onset of menses
 A range of symptoms need to be present to diagnose PMDD, including symptoms such as
mood swings, sudden tearfulness or feelings of sadness, depressed mood or feelings of
hopelessness, irritability or anger, feelings of anxiety, tension, being on edge, greater
sensitivity to cues of rejection, and negative thoughts about oneself.
Disruptive Mood Dysregulation Disorder
 Severe recurrent temper outbursts and persistent negative mood for at least 1 year
beginning before age 10
Chronic Depressive Disorder (Dysthymia)
 Characterized by either chronic major depressive disorder or a chronic but milder form of
depression
 Typically begins in childhood or adolescence and tends to follow a chronic course through
adulthood
 Depressed mood for most of the day more than half of a time for 2 years (or 1 year for
children and adolescents)
 Double depression applies to those who have a major depressive episode superimposed
on a longer-standing dysthymia.
o have more severe depressive episodes than do people with major depression alone

Gender Differences in Depression

 MDD twice as common in women than men
 Similar discrepancy occurs in many countries
 Differences emerge in adolescence
 Some biological and psychological factors may factors:
 Hormones
 Girls twice as likely to experience sexual abuse
 Women more likely to experience chronic stressors
 Girls and women more likely to worry about body image
 Women may react more intensely to interpersonal loss
  Women spend more time ruminating; men tend to distract.
o Ruminating may intensity and prolong sad moods (Nolen-Hoeksema, et al., 1993)

Bipolar Disorders
 The proposed DSM-5 recognizes three forms of bipolar disorders: bipolar I disorder, bipolar
l disorder, and cyclothymic disorder.
 Manic symptoms are the defining feature of each of these disorders.
 Differentiated by how severe and long-lasting the manic symptoms are.
 These disorders are labeled "bipolar" because most people who experience mania will also
experience depression during their lifetime.
 An episode of depression is not required for a diagnosis of bipolar I, but it is required for a
diagnosis of bipolar Il disorder.
Bipolar Disorders: Three Forms
1. Bipolar I - At least one episode or mania or mixed episode
2. Bipolar Il - At least one major depressive episode with at least one episode of hypomania
3. Cyclothymic disorder (Cyclothymia)
o Milder, chronic form of bipolar disorder
o Lasts at least 2 years. Numerous periods with hypomanic and depressive symptoms

Manic and Hypomanic Episodes

The distinction is based on whether the person has ever experienced a full-blown manic episode
Mania
 Typically begins abruptly
 The hallmark feature of a manic episode is increased activity or energy
 During a manic episode, the person experiences a sudden elevation or expansion of mood
and feels unusually cheerful, euphoric, or optimistic
 Symptoms last for 1 week or require hospitalization
 Symptoms cause significant distress or functional impairment
Hypomania
 Characterized by less severe symptoms of mania
 Symptoms last at least 4 days
 Clear changes in functioning that are observable to others, but impairment is not marked
 No psychotic symptoms are present
Cyclothymic Disorder
 Usually begins in late adolescence or early adultho0d and persists for years
 During a period of at least two years, the adult with cyclothymia has numerous periods of
hypomanic symptoms that are not severe enough to meet the criteria for a hypomanic
episode and numerous periods of mild depressive symptoms that do not measure up to a
major depressive episode
 Rapid-Cycling Specifier - presence of at least four manic or depressive episodes within a
year
o When this direct transition from one mood state to another happens, it is referred to as
rapid switching or rapid mood switching
Epidemiology and Consequences
 Prevalence rates lower than MDD
 1% for Bipolar I (Weissman et al., 1996)
 The average age of onset for bipolar I disorder is from 15 to 18 and for bipolar II disorder
from 19 and 22, although cases of both can begin in childhood No gender differences
 Tends to be recurrent
 Severe mental illness
 A third unemployed a year after hospitalization (Harrow et al., 1990)
 Suicide rates high (Angst et al., 2002)

Etiology of Mood Disorders

Neurobiological Factors
Summary of Neurobiological Hypotheses about Major Depression and Bipolar Disorder
Neurobiological Hypothesis Major Depression Bipolar
Disorder
Genetic contribution Moderate High
Serotonin and dopamine receptor dysfunction Present Present
Cortisol dysregulation Present Present
Changes in activation of emotion-relevant regions Present Present
in the brain

Increased activity of the striatum Not Present Present during

mania
Changes in cell membranes and receptors Not Present

Neurotransmitters
 MDD
 Low levels of norepinephrine, dopamine, and serotonin
 Mania
 High levels of norepinephrine and dopamine, low levels of serotonin
 However, medication alters levels immediately, yet relief takes 2-3 weeks
 New models focus on sensitivity of postsynaptic receptors
 Depleting tryptophan, a precursor of serotonin, causes depressive symptoms in
individuals with personal or family history of depression
 Individuals who are vulnerable to depression may have less sensitive serotonin
receptors (Sobczak et al., 2002)
Neurobiological Factors (Depression)
 Brain Imaging
 Structural studies
 o Focus on number of or connections among cells
 Functional activation studies
o Focus on activity levels

Brain Structures Involved in Major Depression

Brain Structure Functional Activation Studies
Prefrontal cortex (dorsolateral portion) Diminished
Anterior cingulate (dorsal portion) Diminished
Hippocampus Amygdala Diminished Elevated

Key Brain Structures Involved in MDD

 Feeling of disappointment in depression has been linked to the hyperactivity in lateral
habenula (Malinow, 2014)
 People who'd experienced depression had hyper-connectivity in areas of the brain which
have been associated with rumination. (Jacobs et. al., 2014)

Neurobiological Factors (Mania)

 Overactivity of the neurotransmitter norepinephrine could be related to mania
 Research has found that mania like depression may be linked to low serotonin activity
Neuroendocrine System
 Overactivity of HPA axis
o Triggers release of cortisol (Stress hormone)
 Findings that link depression to high cortisol levels
o Cushing's syndrome
 Causes over secretion of cortisol
 Symptoms include those of depression
 Injecting cortisol in animals produce depressive symptoms
Social Factors
 Life events
o Prospective research
 42-67% report a stressful life event in year prior to depression onset e.g.,
romantic breakup, loss of job, death of loved one
 Replicated in 12 studies across 6 countries (Brown & Harris, 1989b)
o Lack of social support may be one reason a stressor triggers depression.
 Interpersonal Difficulties
o High levels of expressed emotion by family member predicts relapse
o Marital conflict also predicts depression
 Behavior of depressed people often leads to rejection by others
o Excessive reassurance seeking
o Few positive facial expressions
o Negative self-disclosures
o Slow speech and long silences
Psychodynamics
Depression
 Loss of loved person (object) perceived as rejection/self-hatred
 Rigid superego serves to punished oneself
 Caused by anger converted into self-hatred
Mania
 Viewed as defense against underlying depression
 Feelings of worthlessness are converted by means of denial, reaction formation and
projection to grandiose delusions
Emotional Factors
Affect
 High negative affect
 Low positive affect
In response to positive stimuli, depressed individuals experience:
 Fewer positive facial expressions
 Report less pleasant emotion
 Show less motivation
 Demonstrate less psychophysiological activity
Personality Factors
 Neuroticism
 Tendency to react with higher levels of negative affect
 Predicts onset of depression (Jorm et al., 2000)
 Extraversion
 Associated with high levels of positive affect
 Low extraversion does not always precede depression
 Inadequacy
 If the child has overbearing, critical and authoritarian parents, it is likely that whatever
the child will never be enough to please the parent
 Anger
 Those who suppressed their anger has a greater tendency for depression
 Dependency on others
 Low self-esteem
Cognitive View
 Depression
 Beck's theory
 Negative triad
o Negative view of: Self World Future
 Negative schemata
o Underlying tendency to see the world negatively
 Negative schemata cause cognitive biases
o Tendency to process information in negative ways
 Mania
  individual denies certain aspects of reality in order to promote or preserve an
unrealistic set of self-perceptions
 A superficial one that serves to cover up underlying depressed thinking
Psychological Treatment of Mood Disorders
 Interpersonal Psychotherapy (IPT)
o Short term psychodynamic therapy
o Focus on current relationships
 Cognitive therapy
o Monitor and identify automatic thoughts
 Replace negative thoughts with more neutral or positive thoughts
 Behavioral activation
o increase participation in positively reinforcing activities
o Mindfulness based cognitive therapy (MBCT)
 Strategies, including meditation, to prevent relapse
Treatment for Bipolar Disorders
 Psychoeducational approaches typically help people learn about the symptoms of the
disorder, the expected time course of symptoms, the biological and psychological triggers
for symptoms, and treatment strategies.
Suicide
• Key Terms in the Study of Suicidality
o Suicide ideation: thoughts of killing oneself
o Suicide attempt: behavior intended to kill oneself
o Suicide: death from deliberate self-injury
o Non-suicidal self-injury: behaviors intended to injure oneself without intent to kill oneself

Epidemiology of Suicide and Suicide Attempts

 Worldwide, about 9 percent of people report suicidal ideation at least once in their lives,
and 2.5 percent have made at least one suicide attempt
 Men are four times more likely than women to kill themselves
 Women are more likely than men are to make suicide attempts that do not result in death
Etiology of Suicide
Psychodynamic model
 Views depression as the turning inward of anger against the internal representation of a
lost love object. Suicide then represents inward-directed anger that turns murderous.
 May be motivated by the "death instinct"
Existential and Humanistic Theory
 Relate suicide to the perception that life has become meaningless, empty, and essentially
hopeless.
Socio-cultural Theory
 People who experienced anomie-who feel lost, without identity, rootless–are more likely to
commit suicide. alienation may play a role in suicide
Learning Theory
  Lack of problem-solving skills for handling significant life stress
Social-Cognitive Theory
 May be motivated by personal expectancies, such as beliefs that one will be missed by
others or that survivors will feel guilty for having mistreated the person, or that suicide will
solve one's own problems or even other people's problems
 potential modeling effects of observing suicidal behavior in others
Biological Factors
Genetic factors
 Genes that affect the regulation of serotonin in the brain are also implicated in suicide
Neurotransmitter imbalances
 Lowered serotonin activity leads to disinhibition, or release, of impulsive behavior that
takes the form of a suicidal act in vulnerable individuals.