Mood Disorders - Erika Manczak PDF

Preview

Summary

Erika Manczak...

Description

Overview of Mood Disorders ● Defining feature = extremes of emotion (affect) ● Other symptoms or co-occurring disorders ● Two key moods ○ Depression: feelings of extraordinary sadness and dejection ■ Unipolar: only depressive episodes ○ Mania: intense and unrealistic feelings of excitement and euphoria ■ Bipolar: manic and depressive episodes Major Depressive Disorder + Persistent Depressive Disorder History ● Depression is the leading cause of disability worldwide ● 300 million people are diagnosed with MDD - more than coronary disease, diabetes, arthritis, etc ● Annual cost of $500 billion worldwide ● 80% of people who develop MDD experience recurring episodes and other lifelong difficulties Major Depressive Disorder (“nearly every day”) ● A major depressive episode without having a manic, hypomanic, or mixed episodes ● Relapse and recurrence ● May include additional specifier symptoms ○ Anxious distress ○ Mixed features ○ Melancholic features (early morning awakening, depression worse in the morning, loss of appetite, excessive guilt, etc) ○ Atypical features (mood reactivity) ○ Mood congruent psychotic features (delusions or hallucinations ○ Mood incongruent psychotic features ○ Catatonia (range of psychomotor symptoms) ○ Peripartum onset ○ Seasonal pattern (at least two or more episodes in the past 2 years have occured at a specific time) ● DSM criteria (five or more during a 2-week period) ○ Depressed mood most of the day, nearly every day ○ Markedly diminished interest or pleasure in activities ○ Significant weight loss when not dieting, or decrease/increase in appetite ○ Insomnia or hypersomnia ○ Psychomotor agitation or retardation nearly every day ○ Fatigue or loss of energy ○ Feelings of worthlessness or excessive/inappropriate guilt ○ Diminished ability to think or concentrate ○ Recurrent thoughts of death MDD vs Normal Sadness ● Mood change is persistent and doesn’t improve with activities usually experienced as pleasant

● Occurs in the absence of precipitating events or out of proportion to circumstances ● Accompanied by impaired ability to function ● Accompanied by cognitive, somatic, and behavioral symptoms ● Nature or quality of the mood feels different MDD vs Bereavement ● Used to have “bereavement exclusion” in DSM ○ Needed to wait 2 months before diagnosing ● Opens door to more “false positives” ● Allows for possibility of more rapid treatment Prevalence ● Lifetime prevalence of MDD is nearly 17% ● 12 month prevalence rates are nearly 7% ● About twice as common in women than men, but school children boys are equally/more likely to be diagnosed Demographic Differences ● Native Americans have relatively high rates ● African Americans have relatively low rates ● U.S. rates of unipolar depression inversely related to socioeconomic status ● Top 5 countries are U.S., Ukraine, France, New Zealand, Netherlands ● Age of onset could begin at any time, incidence rises during adolescence Cross Cultural Differences ● Western: psychological symptoms ● Non Western: physical symptoms ● Rates of depression vary more than rates of bipolar disorder ● Lifetime prevalence of depression is 17-19% in U.S., but only 1.5% in Taiwan ● Reasons for different rates of depression are unclear Persistent Depressive Disorder (“more days than not”) ● Mild to moderate version of depression ● Persistently depressed mood most of the day for at least 2 years ● Intermittent normal moods occur briefly ● Lifetime prevalence of 2.5-6.0% ● Average duration is 4-5 years ● DSM criteria (two or more) ○ Poor appetite or overeating ○ Insomnia or hypersomnia ○ Low energy or fatigue ○ Low self esteem ○ Poor concentration or difficulty making decisions ○ Feelings of hopelessness ○ Individual has never been without symptoms for more than 2 months at a time Biological Causal Factors ● Genetic influences

○ Moderate heritability, serotonin transporter gene Disrupted neurotransmitter activity ○ Serotonin and dopamine ● Neuro-anatomical influences ○ Lower activity in left anterior and prefrontal cortex ● Hormone abnormalities ○ Cortisol, hypothyroidism ● Immune dysfunction ○ Increased levels of inflammatory cytokines ● Disrupted circadian rhythms ○ Sleep problems, season patterns ● Sex differences Psychological Causal Factors ● Stressful life events ○ Diathesis-stress ● Vulnerability factors ○ Neuroticism, early adversity, parental loss ●

Theories of MDD ● Freudian: anger turned inward ● Behaviorist: lack of positive reinforcers in environment ● Cognitive: negative beliefs about self, others, and future ○ Cognitive model of depression ● Learned helplessness ● Hopelessness theory ● Excessive rumination Interpersonal Factors ● Lack of social support or skills ● Hostility or rejection by others ● Marital dissatisfaction Depressive Realism ● Some work looking at cognitive biases has suggested that individuals with depression are more accurate in perceptions, in that they don’t show a positivity bias ● Meta analyses have not shown much evidence to strongly support this Treatments for MDD ● Cognitive behavioral therapy ● Interpersonal therapy ● Mindfulness-based approaches ● Psychotropic medications that target serotonin and dopamine systems ● Electroconvulsive therapy ● Ketamine ● Transcranial magnetic stimulation

Bipolar and Related Disorders ● Distinguished from unipolar disorders by presence of manic or hypomanic episodes ● Bipolar I: includes at least one manic or mixed episode ● Bipolar II: includes hypomanic episodes but not full blown manic Manic Episode ● A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 1 week and present most of the day every day ● Three or more symptoms (four if the mood is only irritable) ○ Inflated self esteem ○ Decreased need for sleep ○ More talkative than usual or pressure to keep talking ○ Flight of ideas or subjective experience that thoughts are racing ○ Distractibility ○ Increase in goal directed activity or psychomotor agitation ○ Excessive involvement in activities that have a high potential for painful consequences Bipolar I Disorder ● Criteria has been met for at least one manic episode ● Examples of behaviors during manic episodes: ○ Grandiose behaviors (contacting heads of universities/celebrities) ○ High risk sexual behaviors ○ Extreme work effort (painting 30 paintings, attempting to uncover theory of universe) ● Not simply a period of getting very excited or having more energy than usual Bipolar II Disorder ● A distinct period of abnormally elevated mood, lasting at least 4 consecutive days and present most of the day, nearly every day, along with at least one depressive episode ● Same 3 or more criteria as manic episode, but must only be hypomanic ● Episode is not severe enough to cause marked impairment in social or occupational functioning Bipolar I & II ● Occur equally in males and females ● Usually start in adolescence or young adulthood ● Average age of onset is 18 to 22 years ● About three times as many days are depressed as manic/hypomanic Cyclothymic Disorder ● Cyclical mood swings ● Less severe than those of bipolar disorder ● Symptoms present for at least 2 years ● Lacking severe symptoms and psychotic features of bipolar ● Depressive and manic episodes have been present for at least half the time of diagnosis

Biological Causal Factors in Bipolar Disorders ● Heredity ● Norepinephrine, serotonin, and dopamine ● Abnormalities in transportation of ions across neural membrane ● Shifting patterns of blood flow to prefrontal cortex ● Disturbances in biological rhythms Psychological Causal Factors in Bipolar Disorders ● Stressful life events ● Personality variables ● Low social support ● Pessimistic attributional style Treatments and Outcomes ● Pharmacotherapy ○ Lithium common mood stabilizer for bipolar ○ Antipsychotic drugs ● Alternative biological treatments ○ Electroconvulsive therapy ○ Transcranial magnetic stimulation ○ Deep brain stimulation ● Psychotherapy ○ Cognitive behavioral therapy ○ Behavioral activation treatment ○ Interpersonal therapy ○ Family and marital therapy Hurdles to Treatment ● Manic and hypomanic periods can be personally exhilarating ● Many people don’t show up until hospitalized ● Therapy often used to increase medication adherence Suicide ● Preferred language is “died by suicide” not “committed suicide” ● Risk significant factor in all types of depression ● Suicide is 15th leading cause of death in the world ○ More people die by suicide than by any other form of violence ● Non-Suicidal Self Injury: direct, deliberate destruction of body tissues in the absence of any intent to die Attempts and Deaths ● Attempts begin around age 12 and rises into mid 20’s ● Completed suicides peak in middle life (45-55) with slight decrease later ● Men experience sharp increase in age 75 ● Women are more likely to attempt suicide, but men are more likely to die

Associated Psychological Disorders ● Posttraumatic stress disorder ● Bipolar disorder ● Conduct disorder ● Intermittent explosive disorder ● Depression ○ Depression does not predict which people with suicidal thoughts act on them Psychological Factors ● Impulsivity ● Aggression ● Pessimism ● Family psychopathology or instability ● Hopelessness ● Negative affectivity Biological Factors ● Genetics ● Reduced serotonergic activity Sociocultural Factors ● Ethnicity ○ Whites have higher rates than African Americans ● Rates of suicide ○ Vary across cultures and religions Theoretical Models ● Diathesis stress model ● Joiner’s interpersonal-psychological model of suicide Suicide Prevention ● Antidepressant medication or lithium ● Benzodiazepines ● Cognitive-behavioral therapy Targeting High Risk Individuals ● Provide treatment aimed directly at decreasing suicidal thoughts and behaviors among those already experiencing these outcomes ● Use cognitive-behavioral therapy for suicide prevention for use with adolescents who have attempted suicide Suicide on College Campus ● Rates of suicide are higher on college campuses than surrounding areas ● DU: 7% of students seriously considered suicide in the past 12 months Risk Signs ● Talking about wanting to die ● Looking for a way to kill themselves ● Talking about feelings of hopelessness ● Talking about feeling trapped ● Talking about being a burden

● ● ● ● ● ●

Increasing the use of alcohol or drugs Acting anxious or agitated Sleeping too little or too much Withdrawing or isolating themselves Showing rage Extreme mood swings...