Mood DisordersEpisodes:Major Depressive Episode2 weeks with 5 symptomsHypomanic Episode4 days with 3 symptomsManic Episode1 week with 3 symptomsDiagnosesMajor Depressive DisorderBipolar Disorder (I and II)Dysthymic Disorder2 years, one year with fewer symptomsCyclothymic Disorder2 years with both hypomanic and non- Major Depressive Disorder symptoms (MDD)Major Depressive DisorderDepression is the “common cold” of psychological disorders.In a year, 5.8% of men and 9.5% of women report depression worldwideDepressed mood (anhedonia)Lack of appetite, motor action, sleep; fatigueDiminished ability to think/concentrateWorthlessness, guilt, suicidal ideationConsiderations with Younger FoldIrritability in childhoodSomatic Complaints (somatic=body)AdolescentsMood swingsHypersomnia (excessive sleepiness)Verbalization of hopelessness, guilt etc.Additional Thoughts on DepressionCo-morbidity is the ruleDepression usually brings friends like anxietyHigher rates of dx amongWomen (internalizing vs externalizing)Teens (up to 13% prevalence)Earlier onset= worse prognosisRecovers: 7-9 months (average), 8 weeks (median)Recurrence: 40% (3-5 years), 80% (5-7 years)The issue of symptom resolution over timeBipolar DisorderFormerly called manic-depressive disorder. An alternation between depression and mania signals bipolar disorder.Depressive Presentation:GloomyWithdrawnInability to make decisionsTiredSlowness of thoughtManic Presentation:Elation, EuphoriaIrritabilityDesire for action, pleasureLess sleep, more talkInflated self-esteemAffects men and women about equally1-2% both lifetime and current prevalenceMuch less well-understood than depressionInterventions should also be distinct from treatment for depressionSuicideThe most sever form of behavioral response to depressionEach year about 1 million people commit suicide worldwideSuicide stats considerRisk factorsRacial differencesGender differencesAge differencesTreatmentUnderstanding DepressionBiologyCognitive theoryBehavioral/Interpersonal linksStressful EventsBiological PerspectiveGenetic influences: Mood disorders run in the family.Depression rate is higher in identical twins (50%) than fraternal (20%)Heritability for depression is about 35% in some studiesCognitive TheoryNegative Autonomic thoughtsMaladaptive thinking:Self-blameSelective abstractionOverestimationCatastrophizingAttributional/Explanatory StyleStable, global, internalAptitude vs effortBehavioral/InterpersonalDepression is reinforced by:Social isolationLess social feedback/supportLow social problem-solving, emotion regulationFewer activitiesInterpersonal lossRole ChangesStressful life eventsDepression cycle1. Negative stressful events2. Pessimistic explanatory style3. Hopeless depressed stateThese impair the way the individual thinks and actsSocial Cognitive PerspectiveSuggests that depression arises partly from self-defeating beliefs and negative explanatory stylesSchizophrenia2 or more symptoms for at least 1 monthpositive symptoms (presence)delusionshallucinationsdisordered thoughts and speechderailed or incoherentNegative symptoms (absence)Flat or blunted affectPoverty of speechLack of motivationSigns must persist for 6 months with at least 1 month of active symptomsPositive symptoms respond much better to medicationSchizophrenia subtypesDisorganizedDisorganized speech/behaviorFlat/inappropriate affectCatatonicMotoric immobility, or purposeless and excessive movementMutism or motiveless resistance to all instructionsPeculiar movement (posturing, grimacing)Echolalia (imitation of speech) or echopraxia (movement)ParanoidPreoccupation with 1 or more delusions or auditory hallucinationsNo disorganized speech or behaviorResidualPersistence o negative symptomsUndifferentiatedDisorganized and delusional thinking“This morning when I was at Hillside [Hospital], I was making a movie. I was surrounded by movie stars … I’m Mary Poppins. Is this room painted blue to get me upset? My grandmother died four weeks after my eighteenth birthday.” – Sheehan, 1982This monologue illustrates fragmented, bizarre thinking with distorted beliefs called delusions (“I’m Mary Poppins”).Disturbed perceptionsA schizophrenic person may perceive things that are not there (hallucinations). Such hallucinations can be auditory, visual, somatosensory, olfactory, or gustatoryOnset Development of Psychotic DisordersPrevalence for schizophrenia is estimated at 1% of the general population.Lifetime prevalence of any psychotic disorder is estimated to be 3.5% of the population.Transition-age youth (particularly men) are at greatest risk for onset of psychosisThe Psychosis ProdromeInvestigating sub-psychotic positive symptoms OR genetic risk with recent functional declineExist prior to psychotic diagnosis (schizophrenia, schizoaffective disorder, mood disorder with psychosis)Pre-date conversion to psychosis by one year or lessMood Disorders-Episodes: oMajor Depressive Episode2 weeks with 5 symptomsoHypomanic Episode4 days with 3 symptomsoManic Episode1 week with 3 symptoms-DiagnosesoMajor Depressive DisorderoBipolar Disorder (I and II)oDysthymic Disorder2 years, one year with fewer symptomsoCyclothymic Disorder2 years with both hypomanic and non- Major DepressiveDisorder symptoms (MDD)Major Depressive Disorder-Depression is the “common cold” of psychological disorders.-In a year, 5.8% of men and 9.5% of women report depression worldwideoDepressed mood (anhedonia)oLack of appetite, motor action, sleep; fatigueoDiminished ability to think/concentrateoWorthlessness, guilt, suicidal ideationConsiderations with Younger Fold-Irritability in childhood-Somatic Complaints (somatic=body)-AdolescentsoMood swingsoHypersomnia (excessive sleepiness)-Verbalization of hopelessness, guilt etc.Additional Thoughts on Depression-Co-morbidity is the ruleoDepression usually brings friends like anxiety-Higher rates of dx amongoWomen (internalizing vs externalizing)oTeens (up to 13% prevalence)-Earlier onset= worse prognosis-Recovers: 7-9 months (average), 8 weeks (median)-Recurrence: 40% (3-5 years), 80% (5-7 years)-The issue of symptom resolution over timeBipolar Disorder-Formerly called manic-depressive disorder. An alternation between depression and mania signals bipolar disorder.oDepressive Presentation:GloomyWithdrawnInability to make decisionsTiredSlowness of thoughtoManic Presentation:Elation, EuphoriaIrritabilityDesire for