Chpt 7 – Mood Disorders and
Suicide
I. Common feature: disturbance in mood
II. Mood
episodes
A. Major Depressive Episode
B. Manic Episode
C. Hypomanic Episode
III. Primary
mood disorders
A. Major Depression (unipolar
depression)
1. one or more major
depressive episodes (MDEs)
2. NO history of mania or hypomania EVER
B. Bipolar Disorder (manic depression)
1. one or more manic
(Bipolar I) or hypomanic (Bipolar II) episodes
2. may or may not also
have MDEs for Bipolar I
3. must have had at
least one MDE for Bipolar II
C. Subtypes (specifiers)
include:
1. seasonal type
(seasonal affective disorder)
2. postpartum onset
3. single episode vs recurrent
4. chronic
5. others based on
specific other symptoms
IV. Other
mood disorders
A. cyclothymia
B. dysthymia
C. uncomplicated
bereavement vs pathological grief
V. Etiology
A. Biological factors
1. Genetics:
MDD vs. Bipolar Disorder
2.
Neurochemical
a. roles of serotonin (esp for dep)
i. impact on other
neurotransmitters also
b. role of norepinephrine
(esp for bipolar)
c. role of dopamine (behavioral activation system
disturbance?)
d.
HPA axis overactivity? Impact of cortisol on hippocampus?
B. Psychoanalytic theories
1. Depression:
“Mourning and Melancholia” - fixation at oral stage combined with
loss/bereavement that becomes internalized (“anger turned inward”)
2. Mania:
Mania as a defense against depression
3. Thus, includes stressful event (loss) as
precipitating event
C. Cognitive and behavioral factors
1. Beck:
Negative triad à cognitive distortions
2. Learned helplessness
3. Reformulated helplessness
a. emphasis on attributional
style
4. Hopelessness theory
a. diatheses: attributional
style but others too (e.g. low self-esteem)
b. become an issue when contribute to
feeling hopeless
5. Lack of positive reinforcement
a. can include lack
of social support, below
6. Generally also include stressful events as
precipitants
D. Interpersonal and social factors
1. decreased social
support
2. decreased social
skills
3. interactional
nature of relationships
VI. Treatments
A. Biological
1. Electroconvulsive (shock) Therapy
2. Medication
a. tricyclics
b. MAOIs
c. SSRIs
d. Lithium
B. Evaluation of biological treatments
1. All found to be effective relative to placebo,
but…
2. Often don’t lead to remission, and don’t
relieve symptoms for many
3. May have unpleasant side effects (and severe SEs for kids/teens)
4. Lithium fairly dangerous, requires monitoring
3. See info below on meds vs
psychotherapy
C. Psychological treatments
1. Beck’s cognitive therapy
a. evaluating and
challenging thoughts
b. testing hypotheses
2. Behavioral Activation (Pleasant Activities
Scheduling)
a. increased
activities
b. decreased
avoidance of triggers for depression
c. importance of
exercise!
3. interpersonal
psychotherapy (IPT)
a. focus on one or
more of four interpersonal areas
b. identify issue,
work toward resolution (of dispute, skill deficit, etc)
4. For bipolar
disorder:
a. Psychoeducation
and more to increase compliance w/meds
b. Increasing awareness of incipient
manic episodes
c. Interpersonal and social rhythm therapy
c. Family-focused tx
5. Prevention programs, relapse prevention
(maintenance) programs
D. Evaluation of Psychological Treatments
1. IPT and CT
about equally effective with each other, and with IMI, and better than placebo
and other control tx (by
some measures, but not by others)
2. CT > meds
long-term
3. Combo tx (meds plus CBT) *may* be
superior
4. Psych tx for bipolar useful as adjunct
to meds
5.
Standalone psych tx
for bipolar shows initial promise
VII. Other
Issues in Mood Disorders
A. Noncompliance (esp for mania)
B. Age-related
differences in expression
C. Suicide
D. Gender differences
1. hormones?
2. impact of gender
roles
3. differential
societal advantages
4. differences in
coping styles