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Mood Disorders

Mood Disorders. “Gross deviation in Mood”. Major Depressive Episode Manic Episode/Hypo-manic Episode Mixed Episode. Major Depressive Episode. Phenomenological Affective: dysphoria, anhedonia, irritability Cognitive: worthlessness/guilt, hopelessness, concentration, suicidal Behavioural

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Mood Disorders

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  1. Mood Disorders

  2. “Gross deviation in Mood” • Major Depressive Episode • Manic Episode/Hypo-manic Episode • Mixed Episode

  3. Major Depressive Episode • Phenomenological • Affective: dysphoria, anhedonia, irritability • Cognitive: worthlessness/guilt, hopelessness, concentration, suicidal • Behavioural • Changes in motor functioning (agitated or retarded) • Physiological • Changes in weight/appetite, sleep disturbance, loss of energy

  4. Manic Episode • Phenomenological • Affective: elevated, expansive mood (euphoria), irritability, inflated self-esteem • Cognitive: flight of ideas, shifts of ideas, distractible • Behavioural • Changes in motor functioning (hyperactive, talkativeness, reckless behaviour) • Physiological • Less sleep, increased energy

  5. Types of Mood Disorders • Unipolar Depression: • Major Depressive Disorder • Dysthymic Disorder • Bipolar Disorder: • Bipolar I Disorder • Bipolar II Disorder • Cyclothymic Disorder

  6. 1) Major Depressive Disorder • One or more Depressive Episode with no intervening periods of mania • 17% Lifetime Prevalence • Woman more effected than men • 30% of undergrads are dysphoric and 10% are clinically depressed

  7. Major Depressive Episode • Onset age = ave. 27 • 90% spontaneous remission within 1 year • Remission is often only partial • 80% experience recurrences

  8. 2) Dysthymic Disorder • Milder, but more chronic and persistent than MDD • Median duration is 5 years • Can have early or late onset • Before 21: poorer prognosis, greater chronicity, greater likelihood of genetic involvement

  9. Depression Symptom Modifiers • Psychotic • Hallucinations & Delusions, which can be mood congruent or incongruent • Melancholic • Prominent somatic symptoms • Atypical • Overeating, oversleeping, anxiety • Catatonic • Limited movement

  10. Types of Mood Disorders • Unipolar Depression: • Major Depressive Disorder • Dysthymic Disorder • Bipolar Disorder: • Bipolar I Disorder • Bipolar II Disorder • Cyclothymic Disorder

  11. Bipolar Disorder • Involves both manic and depressive phases • Onset typically 18-22 years • Rapid cycling, poorer prognosis • 1% of general population, less common than MDD • Almost always more than one Manic Episode • Equal prevalence in males and females • Briefer episodes

  12. Bipolar I • At least one manic (or mixed) episode and usually, but not necessarily, at least one major depressive episode as well

  13. Bipolar II • At least one major depressive episode and at least one hypomanic episode, but has never met criteria for a manic or mixed episode

  14. Cyclothymia • Chronic (at least 2 years), cycling between hypomania and depression without meeting criteria for a depressive episode • Can become a way of life • Equal prevalence among men and women • 1/3-1/2 go on to develop Bipolar I or II

  15. Qualities of Mood Disorders • Psychotic vs. Neurotic • Endogenous vs. Reactive • Early vs. Late onset

  16. Explaining Mood Disorders • Psychodynamic Perspective • Interpersonal Perspective • Behavioural Perspective • Cognitive Perspective • Sociocultural Perspective • Biological Perspective

  17. Psychodynamic Perspective • Freud/Abraham: Unconscious sorrow & rage in response to real or symbolic loss • Neo-dynamic: Early loss or threatened loss of loved object (parent) – reactivated by current loss – recapitulating helplessness • Fenichel: Compensation for low self-esteem – interpersonally functional (dependency) • Affectionless control

  18. Interpersonal Perspective • Sullivan: Psychopathology is a relational phenomenon • Recent models focus on current relationships • Klerman: Grief, interpersonal disputes, role transitions, & lack of social skills – directly address these issues

  19. Behavioural Perspective • Lewinsohn: Extinction (behaviours no longer rewarded) • Lack of positive reinforcement causes withdrawal and depression • Amount of reinforcement depends on: • Number / range • Availability • Skills

  20. Behavioural Perspective • Negative interpersonal cycle: constantly seeking reassurance and obtaining ‘caring’ – others respond negatively.

  21. Cognitive Perspective • Seligman: Learned helplessness (expectation of lack of control) • Recall attributions discussed earlier • Beck: Negative self-schema • Dependency vs. Self-criticism

  22. Sociocultural Perspective • Depression and suicide vary as a function of social factors

  23. Biological Perspective • Family studies suggest a genetic component (1st degree relatives 3X more likely for depression and 10X more likely for bipolar) • Twin studies: • Bipolar, 72% vs. 14% concordance • Unipolar. 40% vs. 11%

  24. Biological Perspectives • Adoption studies: • Bipolar, 31% prevalence in the biological parents of the bipolar adoptees vs. 2% biological parents of non-bipolar adoptees • Biological rhythms: • Sleep disturbance, hormone differences, --”biological clock” • Change my disrupt biological clock

  25. Biological Perspectives • Some evidence to suggest structural brain differences • Hormone imbalance • Malfunction of the hypothalamus • Neurotransmitter Imbalance • Catecholamine hypothesis

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