Chapter 7 Mood Disorders Axis I Mood Disorders 1 Unipolar a Major Depression b Persistent Depression blown mania 0 6 Bipolar Bipolar I Manic episode lasting at least one week depressive episode Full Bipolar II Hypomanic episode lasting at least 4 days depressive episode Hypo mania or mini manic episode 0 4 Cyclothymia At least 2 years Numerous periods of hypomanic symptoms but NOT full hypomanic episodes Numerous periods of depressive symptoms but NOT full depressive episodes Bipolar I Vs Bipolar II Criteria Bipolar I Bipolar II Major Depressive Episodes Okay but not necessary Necessary Full Manic Episodes Hypomanic Episodes Necessary Okay but not necessary canNOT be present Necessary Manic episodes are more severe than hypomanic episodes Rates of Bipolar Disorder are equal in men and women Bipolar disorder can be treated effectively with medication Bipolar has a high genetic component Psychosocial theories for Bipolar Greater sensitivity to reward 2 a b c Stressful life events may be trigger for new episodes Changes in bodily rhythms or usual routines Biological Treatments for Bipolar Mood stabilizers Lithium Lithium decreases the function of some second mes sengers Lithium effects the neuroplasticity of the brain Anticonvulsants Atypical Antipsychotics Treated as chronic condition Patients remain on medication throughout life Psychological Treatments for Bipolar Interpersonal and Social Rhythm Therapy Combine interpersonal and behavioral techniques to help maintain routine Family Focused Therapy Focus on interpersonal stress in context of family Cognitive Behavioral Therapy Addresses problematic cognitions to reduce vulnerability to depression and mania The criteria for mood disorders require the presence or absence of Mood Episodes Major Depressive Episode Manic 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 De pressive Disorder Cognitive symptoms 1 2 3 Concentration problems Thoughts of death or suicide Thoughts of worthlessness Emotional symptoms must have at least one of these 1 2 Depressed mood Loss of interest or pleasure Biological symptoms 1 Increase or decrease in appetite weight 2 3 4 Sleep disturbances Psychomotor changes Loss of energy We 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 disorder No history of manic mixed or hypomanic episodes Persistent Depressive Less severe but more chronic Eyore Cognitive symptoms 1 2 Concentration problems Thoughts of worthlessness Emotional symptoms must have at least 2 of these for Dysthymia 1 2 Depressed mood Loss of interest or pleasure Biological symptoms 1 Increase or decrease in appetite weight 2 3 4 Sleep disturbances Psychomotor changes Loss of energy Major Depression Major spikes are NOT normal Hence major depression Double Depression Major Depression 16 lifetime prevalence 2x more common in women than men Rates are lowest in people over 60 bc Less willing to report symptoms Difficult to make diagnosis Depressed people don t live past 60 years Adaptive coping skills Higher rates in people 15 29 because Drastic change in hormones are believed to be a reason for depression Biological Theories of Depression 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 depression Gene by environment interaction s s double short alleles s l heterozygous allele l l preferred double long alleles Diathesis stress Epigenetics environment decides which genes are expressed Serotonin Norepinephrine are important in regulating our emotions mood 5 ht Serotonin Problems in production and regulation of serotonin norephinephrine depression Decreased synthesis Abnormalities in transport Increased degradation by synaptic enzymes Impaired release or reuptake Abnormalities with receptor Neuroendocrine factors Hypothalamic pituitary adrenal axis HPA Elevated levels of cortisol in depressed individuals Interacts with amygdala hippocampus cerebral cortex inhibits neurotransmitter receptors Amygdala Emotion fear danger Cortisol Stress hormone Psychological Theories of Depression Behavioral Theories Life stress reduces positive reinforcers individual withdraws Learned helplessness uncontrollable life stressors create a belief that individual has no control Cognitive Theories of Depression Negative Cognitive Triad Self World Future Depressed individuals exhibit errors in thinking which negatively affects mood Reformulated learned helplessness theory Causal attribution errors Believe causes of negative events are stable internal and global Thoughts emotions behaviors Example Jenny lost her job after 3 years Internal causal attribute It must have been my fault I didn t work hard enough on my assigned projects Stable causal attribute Global causal attribute I am not smart enough to do this kind of work and I never will be I am never going to be able to maintain a job Interpersonal Theories of Depression Rejection Sensitivity Easily perceive rejection from others Excessive reassurance seeking Constantly look for reassurance from others Biological Treatments for Depression MAOI Monoamine Oxidase Inhibitors Problems Fatal interactions with other meds Liver damage weight gain Fatal in overdose Tricyclic Antidepressants Problems Numerous side effects fatal in overdose SSRI Selective Serotonin Re uptake Inhibitors Most widely used medication Relief within a couple of weeks Less severe side effects better tolerated Not fatal in overdose SSNRI Selective Serotonin and Norepinephrine re uptake Inhibitors ECT electroconvulsive therapy Given to patients who DON T repond to medication 6 12 sessions Relieves depression in 50 60 but 85 relapse MEMORY LOSS VNS Vagus Nerve Stimulation 30 40 substantial relief 30 minimal relief rTMS Repetitive Transcranial Magnetic Stimulation Few side effects Patients remain awake unlike ECT All treatments increase neurotransmitters within the synapse Psychological Treatments for Depression Goals 1 2 Cognitive Change negative thinking Behavioral Increase positive reinforcers and decrease aversive experiences solve problems develop skills How Individual short term therapy sessions identifying
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