Grief, LossCriteriaBipolar IBipolar IIFatal InjuryUnit 2: Chapters 7,14Chapter 7: Mood DisordersAxis I Mood Disorders1. Unipolar:a. Major Depressionb. Persistent Depression2. Bipolar:a. Bipolar Ib. Bipolar IIc. CyclothymiaThe criteria for mood disorders require the presence (or absence) of Mood Episodes:Major Depressive EpisodeManic Episode: One week or more of irritable mood.Hypomanic Episode: Four +Days of elevated or irritable mood Major Depressive Episode (5 or MORE symptoms needed to diagnose a Major Depressive Disorder):Cognitive symptoms:1. Concentration problems2. Thoughts of death or suicide3. Thoughts of worthlessnessEmotional symptoms (must have at least one of these):1. Depressed mood2. Loss of interest or pleasureBiological symptoms:1.Increase or decrease in appetite/weight2. Sleep disturbances3. Psychomotor changes4. Loss of energyWe all feel sad at times, therefore the duration of sadness is critical when diagnosing someone with MDD.Presence of a major depressive episode (2 weeks)Not better accounted for by another disorderNo history of manic, mixed or hypomanic episodesPersistent Depressive Disorder (Less severe, but more chronic [Eeyore])Cognitive symptoms:1. Concentration problems2. Thoughts of worthlessnessEmotional symptoms (must have at least 2 of these to be diagnosed PDD):1. Depressed mood2. Loss of interest or pleasureBiological symptoms:1.Increase or decrease in appetite/weight2. Sleep disturbances3. Psychomotor changes4. Loss of energyMajor Depression: Major spikes are NOT normal (Hence major depression)Double Depression= Major DepressionBasically long term persistent depression that dips deeper into major depressionDepression facts:16% lifetime prevalence2x more common in women than men.Leading cause in disease burden (productivity loss)Age differences:Rates are lowest in people over 60 bc:Less willing to report symptomsDifficult to make diagnosisDepressed people don’t live past 60 yearsAdaptive coping skillsHigher rates in people 15-29 because Drastic change in hormones, experimentation, transitions, stakesHigh rates in 85+ due to fear of death, boredom, abandonment, loss of loved ones, feeling of uselessness/hopelessness Biological Theories of Depression : Serotonin transporter gene- First degree relatives of people with unipolar depression are two to three times more likely to also have depression than are the first-degree relatives of people without the disorder, serotonin is one of the neurotransmitters implicated in depressiono Gene by environment interactiono S/S=double short alleleso S/L=heterozygous allele o L/L (preferred)=double long allelesDiathesis stress (no maltreatment, probable maltreatment, severe maltreatment)Epigenetics- environment decides which genes are expressedNeurotransmitters- Serotonin (5-ht)/ Norepinephrine are important in regulating our emotions (mood)- Dopamine: rewards system, pleasure, loss experience, disgustProblems in production and regulation of serotonin & norephinephrine depression- Decreased synthesis- Abnormalities in transport- Increased degradation by synaptic enzymes (enzymes eat neurotransmitter)- Impaired release or reuptake - Abnormalities with receptorBrain abnormalities -Prefrontal cortexo Problem solvingo Decision makingo Concentrationo Motivationso Coping mechanisms-Anterior cingulatedo Fight or flighto Overactive stress responseo Social interactions-Hippocampus o Memory – stronger memories of negative things stresso Criticism rumination-Amygdalao Emotions – fear/anger/dangero Identifies the emotional value of your environment – determines threato Overactive amygdala pay more attention to negative thingsNeuroendocrine factors- Hypothalamic-pituitary-adrenal axis (HPA)o Elevated levels of cortisol in depressed individualso Interacts with amygdala, hippocampus, & cerebral cortex inhibits neurotransmitter receptorsBiological Treatments for Depression:Drug treatments- MAOI (Monoamine Oxidase Inhibitors)o Prevents degredationo Problems: Fatal interactions with other meds Liver damage, weight gain Fatal in overdose- Tricyclic Antidepressants:o Increases seratonin and norepinephrineo Problems: Numerous side effects Fatal in overdose- SSRI(Selective Serotonin Re-uptake Inhibitors)o Increases the amount of serotonin in the synapseo Most widely used medication: Relief within a couple of weeks Less severe side effects (better tolerated) Not fatal in overdose Better for suicidal patients- SSNRI(Selective Serotonin and Norepinephrine re-uptake Inhibitorso Like SSRI but more stimulant too impulsive and pumped up- ECT(electroconvulsive therapy)o Only on the right side of the braino Given to patients who DON’T respond to medicationo 6-12 sessionso Relieves depression in 50-60%, but 85% relapseo MEMORY LOSS!- VNS(Vagus Nerve Stimulation:o More serotonin and norepinephrineo 30-40% substantial relief, 30% minimal relief- rTMS(Repetitive Transcranial Magnetic Stimulation):o re-polarize the neurons to increase serotonin and norepinephrine o Few side effectso Patients remain awake (unlike ECT)All treatments increase neurotransmitters within the synapsePsychological Theories of Depression:- Behavioral Theories:o Life stress reduces positive reinforcers, individual withdrawso Learned helplessness: uncontrollable life stressors create a belief that individual has no control- Cognitive Theories of Depression:o Negative Cognitive Triad: Negative thoughts about the Self, World, Future Depressed individuals exhibit errors in thinking, which negatively affects moodo Reformulated learned helplessness theory Causal attribution errors Believe causes of negative events are stable, internal, and global (things will never change, it’s my fault, I suck at everything) (-/+) Thoughts emotions behaviorso Example: Jenny lost her job after 3 years…. Internal causal attribute:– “It must have been my fault, I didn’t work hard enough on myassigned projects” Stable causal attribute:– “I am not smart enough to do this kind of work and I never will be” Global causal attribute:– “I am never going to be able to maintain a job”- Interpersonal Theories of Depressiono Rejection Sensitivity Easily perceive rejection from otherso Excessive reassurance seeking Constantly look for reassurance from others.Psychological Treatments for Depression:Goals:1. Cognitive – Change negative thinking2. Behavioral – Increase positive
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