Psychopathology

Chapter 5: Mood Disorders

Mood Disorders
o Primary disturbance in mood
Too down = depression
Too up = mania
Too labile
Labile: constant erratic changes in mood
Types of Mood Disorders
o Unipolar:
Major Depressive Disorder
Persistent Depressive Disorder
Premenstrual Dysphoric Disorder
Disruptive Mood Dysregulation Disorder
o Bipolar:
Bipolar I Disorder
Bipolar II Disorder
Cyclothymic Disorder
Diagnosis of mood disorder depends on experience of one or
more mood episodes

Major Depressive Disorder

Distinct period of low mood, which represents a change from
previous functioning or mood, and which lasts at least 2
weeks
MUST have either:
o Depressed mood
o Diminished interest or pleasure (anhedonia)
Plus 4 other symptoms:
o Weight loss/gain (appetite change)
o Insomnia/hypersomnia
o Psychomotor agitation/retardation
o Fatigue/loss of energy
o Feelings of worthlessness or excessive guilt
o Diminished ability to concentrate/indecisiveness
o Recurrent thoughts of death or suicide
Persistent Depressive Disorder (formerly Dysthymia)
Depressed mood more often than not for at least 2 years (1 year
for children/adolescents)
o Must have at least 2 other symptoms:
o Poor appetite/overeating
o Insomnia/hypersomnia

o Low energy or fatigue

o Low self-esteem
o Poor concentration or difficulty making decisions
o Feelings of hopelessness
Symptoms do not clear for more than 2 months at a time

Premenstrual Dysphoric Disorder

Depressive symptoms (at least 5) associated with significant
distress/ impairment during the week before menses
Primary symptoms (at least 1):
Affective lability
Irritability
Depressed mood, hopelessness, self-deprecating thoughts
Anxiety
At least 1 other symptom:
Diminished interest in usual activities
Difficulty concentrating
Lack of energy
Changes in appetite
Sleeping disturbance
Feeling overwhelmed/out of control
Physical symptoms
Disruptive Mood Dysregulation Disorder
Intended to be diagnosed in children (onset prior to age 10, after
age 6)
Characterized by severe recurrent temper outbursts that are out
of proportion to the situation
Persistent negative mood for at least one year
Present in at least two settings
Epidemiology of Depressive Disorders
About 16% of the US population meet criteria for MDD at
some point (Kessler et al., 2005)
10-25% of women; 5-12% of men
2:1 women to men
Prevalence for Dysthymia is 2.5-3% (Kessler et al., 2005)
Mean age of onset is mid-20s (and decreasing) (Kessler et al.,
2005; Kessler et al., 2003)
Cross-cultural variability in prevalence how to interpret?
MDD: developmental considerations
Less frequent during childhood equal rates among boys and
girls

Sharp increase during early-mid adolescence by age 15,

twice as many girls as boys
Geriatric population 20% of elderly nursing home patients
experience a major depressive episode

Manic Episode
Distinct period of abnormally and persistently elevated or
irritable mood lasting at least 1 week
Abnormally increased activity or energy
3 symptoms required:
Inflated self-esteem or grandiosity
Decreased need for sleep
Excessive talkativeness/pressured speech
Flight of ideas or racing thoughts
Distractibility
Increase in goal-directed activity or psychomotor agitation
Excessive involvement in pleasurable but high-risk
activities (e.g., buying sprees, sexual indiscretions, foolish
investments)
Hypomanic Episode
Distinct period of abnormally and persistently elevated or
irritable mood lasting at least 4 days
Abnormally increased energy and activity
3 or more manic symptoms
NOT severe enough to warrant hospitalization or cause
marked impairment in functioning
Bipolar Disorders
Presence of both manic and depressive episodes
Bipolar I = alternation of full manic episodes and depressive
episodes
Prevalence: .4% to 1.6%
Bipolar II = Hypomanic episodes alternating with depressive
episodes
Prevalence: .5%
10-13% of Bipolar II cases progress to full Bipolar I

Cyclothymic Disorder
Chronically fluctuating mood for at least 2 years
Separate periods of hypomanic sx and depressive sx
(neither severe enough to meet criteria for full blown
episodes)
Few periods of neutral mood

 Prevalence: less than 1%

Avg age of onset = 12-14 yrs
Mostly female
Etiology
Biological Models of Depression
Genetic contributions
Family Studies rate of mood disorders is 2-3x higher
among relatives of a person diagnosed with a mood
disorder than among relatives of non-diagnosed people
Twin Studies concordance rates are much higher for
identical twins
Neurotransmitter deficiences
Serotonin, norepinephrine, dopamine (BP)
Functional changes in brain systems involved in emotion
regulation (e.g., amygdala)
Overactive HPA axis (elevated cortisol)
Etiology Psychological Models of Mood Disorders
Stressful life event may trigger depression in people with an
inherited vulnerability (aka, Diathesis-Stress Model)
Stressors can be precipitating events (e.g., breakup with
boyfriend; loss of job) or predisposing factors (e.g.,
prolonged financial strain; history of abuse)
Etiology Psychological Models of Mood Disorders
Cognitive Model (Beck) depression is due to a disturbance of
core attitudes and beliefs
Negative Triad: negative cognitions/thoughts about the
self, world & the future
People with depression make cognitive errors and set up
cognitive schema that automatically and unconsciously
filters impressions of life
Learned Helplessness Model of Depression (Seligman)
Depression is due to perceived lack of control over life events
Develop an attributional bias: interpret negative events to be
global, internal, and stable
Hopelessness expectation that negative things will happen
and that there is nothing you can do to change the outcome
Behavioral Model of Depression
Depression is seen as being due to lack of reinforcement for
positive or pleasant behaviors
Behavioral interventions are often helpful activity scheduling
with reinforcement for accomplishing tasks
Bio-Psychological Models of Bipolar Disorders
Reward sensitivity

Sleep disruption
Treatment for Mood Disorders
Medications
Antidepressants (SSRIs, Tricyclics, MAOIs)
Mood Stablizers
Electroconvulsive Therapy (ECT)
Psychotherapy
Cognitive Behavioral Therapy
Interpersonal Psychotherapy
Psychopharmacological Treatment (cont)
SSRI Selective Serotonin Reuptake Inhibitors:
Block specific reuptake receptors for serotonin which
increases level of serotonin available in synapse
Fewer side effects and less toxicity than other meds
Side Effects: physical agitation, sexual dysfunction,
insomnia, and GI upset
Psychopharmacological Treatment
Tricyclic Antidepressants
Work by blocking reuptake of certain NTs (most notably NE)
Unpleasant side effects (e.g., dry mouth, constipation,
weight gain, drowsiness)
Takes 2-8 wks to become effective
Psychopharmacological Treatment (cont)
MAOI - Monamine Oxidase Inhibitors:
Block the enzyme responsible for the breakdown of NE
End result is greater NE in synapse, with similar effects as
tricyclics
MAOIs tend to be more effective for the atypical
depressions
Slightly more effective than tricyclics and have fewer side
effects but potential for dangerous interactions with certain
foods and many OTC meds
Psychopharmacological Treatment of Bipolar Disorders
Lithium:
Mood stabilizer that works to control manic sx
Appears to reduce DA and NE, and has effects on the
neuroendocrine system
Can be very toxic, which increases threat of overdose
Significant side effects including excessive weight gain and
lowered thyroid functioning
Issues with compliance
30-60% of people with bipolar d/o respond well to Lithium
tx
Non-pharmacological Treatment of Mood Disorders

Electroconvulsive Therapy (ECT):

Induces seizures and convulsions by administering electric
shock directly to the brain
Appears to temporarily alleviate severe depression that
has not responded to other therapies
Few side effects short term memory loss
Invasive requires sedation and hospitalization
Also shows promise in some forms of schizophrenia
Psychological Treatments for Depression
Treatment strategy varies with theoretical orientation (e.g.,
humanistic vs. cognitive-behavioral vs. psychoanalytic)
Only 2 psychotherapeutic approaches have demonstrated
clinical efficacy
Cognitive Behavioral Therapy (CBT)
Interpersonal Psychotherapy (IPT)
Cognitive-Behavioral Treatment
Goal is to identify and change depressive thought processes
Use behavioral strategies to build in pleasureable activities
try to elicit social reinforcement and instill hope
CBT can be relatively brief 10-20 sessions with booster
sessions to maintain progress
Interpersonal therapy for mood disorders
Problems in interpersonal relationships are viewed as
precipitating factors in depression
Therapy focuses on resolving problems in existing
relationships and/or building skills to develop new
relationships
Look at role disputes, adjustment to a loss, acquiring new
relationships, identifying and correcting deficits in social skills
Highly structured type of therapy typically 15-20 sessions
Treatment effectiveness
Meds typically work more quickly than therapy however,
over 50% of patients will relapse after taken off of meds
without psychological therapy
When used alone, psychological therapies and antidepressant
meds have similar effectiveness rates