PYSC 407 1st Edition Lecture 12 Outline of Last Lecture I. What is mood?II. What are mood disorders?III. Types of DSM-IV-TR mood disorders (unipolar)a. Major depressive disorder (MOST SERVERE)b. 2. Dysthymic disorder(LESS SERVERE)c. 3. Double depressionIV. Types of DSM-IV-TR mood disorders (bipolar)a. Bipolar I disorderb. Bipolar II disorderc. Cyclothymic disorderV. What is Severity?VI. Introduction to DysthymiaVII. Introduction to Double DepressionVIII. What is Bereavement?IX. Therapeutic Approach to GrievingX. The Bipolar Disordersa. Maniab. Bipolar 1 Disorder Outline of Current Lecture II. The Bipolar DisorderIII. What is Bipolar II?IV. What is Cyclothmia?V. What are Mood Disorders?VI. What is An Integrative Theory?Current LectureThe Bipolar DisorderBipolar I: major depressive episodes alternations between full manic episodes and depressive episodesBiopolar II: Major depressive episodes and hypomanic. Less intenseThese notes represent a detailed interpretation of the professor’s lecture. GradeBuddy is best used as a supplement to your own notes, not as a substitute.Cyclothymia: alternating depressed moods and Bipolar II Disorder• Overview and defining features– Alternations between major depressive and hypomanic episodes• Facts and statistics– Average age of onset is 22 years– Can begin in childhood– 10% to 13% of cases progress to full bipolar I disorder– Tends to be chronicCyclothymic Disorder• Overview and defining features– Chronic version of bipolar disorder– Manic and major depressive episodes are less severe– Manic or depressive mood states persist for long periods with relatively few periods of normal mood– Must last for at least 2 years (1 year for children and adolescents)– People are considered moody, but moods interfere w/functioningCyclothymic Disorder: An Overview (continued)• Facts and statistics– Average age of onset is 12 to 14 years– Most are female– Cyclothymia tends to be chronic and lifelong– High risk for developing bipolar I or II disorderDifferences in the Course of Mood Disorders• Course specifiers– Longitudinal course• Past history of mood disturbance• History of recovery from depression and/or mania– Rapid cycling pattern• Applies to bipolar I and II disorder only– (at least 4 manic or depressive episodes a year)– (20-40% experience this)– May have mixed episode - manic but depressed about the uncontrollability of the maniaMood Disorders: Additional Facts and Statistics• Worldwide lifetime prevalence– 16% for major depression• Sex differences– Females are twice as likely to have major depression (not bipolar)– Gender imbalance disappears after age 65– Bipolar disorders equally affect males and females• Fundamentally similar in children and adults• Prevalence of depression seems to be similar across subcultures• Relation between anxiety and depression – negative affect– Most depressed persons are anxious– Not all anxious persons are depressedMood Disorders: Familial and Genetic Influences• Family studies – Rate is high in relatives of probands– Relatives of bipolar probands tend to have unipolar depression– Adoption studies – data are mixed • Twin studies– Concordance rates are high in identical twins– Severe mood disorders have a strong genetic contribution– Heritability rates are higher for females compared to males– Vulnerability for unipolar or bipolar disorder• Appears to be inherited separatelyMood Disorders: Neurobiological Influences• Interact in complex ways with each other• Low levels serotonin implicated in mood disorders (serotonin regulates emotional reactions)• When serotonin low, other NTs (dopamine and Nor-E) ‘permitted’ to be dysregulated and contribute to mood imbalanceTHE PERMISSIVE HYPOTHESISSleep• Sleep disturbance– Hallmark of most mood disorders– Relation between depression and sleep-• Shorter period in depressed before REM begins• We achieve the most rest in these pre-REM stages • Have more intense REM• Have less slow-wave sleep, the deepest sleep• Depriving pts. of sleep in second half of night tends to improve condition temporarily. (Giedke & Schwarzler, 2002)Circadian RhythmsRelationship between sleep disturbances and biological rhythmsJet lag, night shiftOther Biology• Cortisol- Higher levels of plasma cortisol (a stress hormone) in depressed individuals.• HPA Hypothalamic-pituitary-adrenocortical pathway doesn’t shut down after a stressor. • Stress hormones decrease ability to keep neurons healthy and growingChanging the stress-response• Cognitive processes can change sympatho-adrenal response.• PERCEPTION of stress can elicit correlates of fear and anxietyMood Disorders: Psychological Dimensions (Stress)• Stressful life events– Stress is strongly related to mood disorders• Poorer response to treatment• Longer time before remission– The relation between context of life events and moodWhat’s good for you may not be good for othersMust ask about meaning– Reciprocal-gene environment modelMood Disorders: Psychological Dimensions (Learned Helplessness)• The learned helplessness theory of depression– Lack of perceived control over life events– Stressful event produces anxiety which produces attempts to cope. If you can’t cope or perceive you can’t cope you have learned helplessness– Learned helplessness and a depressive attributional style – Internal attributions– Negative outcomes are one’s own fault– Stable attributions– Believing future negative outcomes will be one’s fault– Global attribution– Believing negative events will disrupt many life activities – All three domains contribute to a sense of hopelessnessMood Disorders: Psychological Dimensions (Cognitive Theory)• Negative coping styles– Depressed persons engage in cognitive errors– Tendency to interpret life events negatively• Types of cognitive errors– Arbitrary inference – overemphasize the negative (I think I’m a bad teacher because two of you fall asleep)– Overgeneralization – negatives apply to all situations (one “C”means you fail the course)– Beck: Cognitive errors and the depressive cognitive triad• Neg events in childhood produce neg schema an enduring belief system’ becomes automatic– Think negatively about oneself– Think negatively about the world– Think negatively about the futureMood Disorders: Social and Cultural Dimensions•