Unit 7: Mood Disorders and Suicide

Discuss biological and psychosocial causal factors in unipolar mood disorders.

Biological Causal Factors: Genetic Influences. Mood disorders is approximately two to three times higher among blood relatives of persons with clinically diagnosed unipolar depression. results of studies suggested that about 31 to 42% of the variance in liability two major depression is due to genetic influences. Sullivan and colleagues review concluded that even more variance in the liability to most forms of major depression is due to non-shared environmental influences (i.e. experiences that family members do not share) then to genetic factors. It seems very probable that there is a genetic contribution to dysthymia because of its strong linked to elevated levels of the personality trait neuroticism, which is moderately heritable. One a very promising candidate for a specific Gene that might be implicated is the serotonin transporter gene—the gene involved in the transmission and reuptake of serotonin. Their results were very striking: individuals who possessed the genotype with the SS (short/short) alleles were twice as likely to develop a major depressive episode following four or more stressful life events in the past five years as those who possess the genotype with the ll (long/long) alleles and had experienced four or more stressful events (those with sl (short/long) alleles were intermediate). This observation led to the once influential monoamine theory of depression (including norepinephrine and serotonin)—that depression was at least sometimes due to an absolute or relative depletion of one or both of these neurotransmitters that important receptor sites in the brain. This depletion could come about through impaired synthesis of these neurotransmitters in the presynaptic neuron, through increased degradation of the neurotransmitters once they were released into the synapse, or through altered functioning of postsynaptic receptors. Other more recent research also suggests that dopamine dysfunction (especially reduced its dopaminergic activity) plays a significant role in at least some forms of depression, including depression with atypical features and bipolar depression. Because the neurotransmitter dopamine is so prominently involved in the experience of pleasure and reward, such findings are in keeping with the prominence of anhedonia, the inability to experience pleasure, which is such an important symptom of depression. Abnormalities of Hormonal Regulatory and Immune Systems. Blood plasma levels of cortisol are known to be elevated in some 20 to 40% about patients with depression and in about 60 to 80% of hospitalized patients with severe depression. Sustained elevations in cortisol— a "Hallmark of mammillion stress responses"—can result from increased corticotropin-releasing hormone (CRH) activation (for example, during sustained stress or threat), increased secretion of adrenocorticotropic hormone (ACTH), for the failure of feedback mechanisms. One line of evidence that implicates the failure of feedback mechanisms in some patients with depression comes from robust findings that in about 45% of patients with serious depression, a potent suppressor of plasma cortisol in normal individuals, dexamethasone, either fails entirely to suppress cortisol or fails to sustain its suppression. The other endocrine access that has relevance to depression is the hypothalamic-pituitary-thyroid axis because disturbances to this axis are also linked to mood disorders. For example, people with low thyroid levels (hypothyroidism) often become depressed. In addition, about 20 to 30% of patients with depression who have normal thyroid levels nevertheless show dysregulation of this access. moreover, preliminary findings suggest that some patients who have not responded to traditional antidepressant. treatments may show Improvement when administered thyrotropin releasing hormone, which leads to increased thyroid hormone levels. Neurophysiological and Neuroanatomical Influences. Earlier neurological findings show that damage (for example, from a stroke) to the left, but not the right, anterior prefrontal cortex often leads to depression. When one measures the electroencephalographic (EEG) activity of both cerebral hemispheres and people who are depressed, one finds an asymmetry or imbalance in the EEG activity of the two sides of the prefrontal regions of the brain. In particular, people with depression show relatively low activity in the left hemisphere in these regions and relatively high activity in the right hemisphere. The relatively lower activity on the left side of the prefrontal cortex in depression is thought to be related to symptoms of reduced positive affect and approach behaviorist rewarding stimuli, an increase right side activity is thought to underlie increased anxiety symptoms and increased negative effect associated with increased vigilance for threatening information. The orbital prefrontal cortex, which is involved in responsibility to reward, shows decrease volume. lower levels of activity in the dorsolateral prefrontal cortex, which are associated with decreased cognitive control. the hippocampus, which is critical to learning and memory and regulation of adrenocorticotropic hormone, is led to decreased hippocampal volume and this reduction in volume May precede the onset of depression. The anterior cingulate cortex, which both shows decrease volume and abnormally low levels of activation in patients with depression. The amygdala, which is involved in the perception of threat and then directing attention, tends to show increased activation with depression. Sleep And Other Biological Rhythms. - Sleep: Moreover, research using EEG recordings has found that many patients with depression and to the first. of REM sleep after only 60 minutes or less of sleep (i.e. 15 to 20 minutes sooner than patients who are not depressed do) and also show greater amounts of REM sleep during the early cycles then are seen in persons without depression. The intensity and frequency of their rapid eye movements are also greater than in patients who are not depressed. Because this is the period of the night when most deep sleep (stages 3 and 4) usually occurs, the person with depression also gets a lower than normal amount of deep sleep. both see reduce latency to enter REM sleep and the decrease amount of deep sleep often precede the onset of depression and persist following recovery, which suggests that they may be vulnerability markers for certain forms of major depression. - Circadian Rhythms: Two current theories are (1) that the size or magnitude of the circadian rhythms is blunted, and (2) that the various circadian rhythms that are normally well synchronized with each other become desynchronized or uncoupled. - Sunlight and Seasons: Patients with depression who fit the seasonal pattern usually show increased appetite and hypersomnia rather than decrease appetite and insomnia. They also have clear disturbances and their circadian cycles, showing weaker 24-hour patterns than individuals were not depressed. Biological Explanations For Sex Differences. For the majority of women, hormonal changes occurring at various points do not play a significant role in causing depression. For women who are already at high risk, hormonal fluctuations May trigger depressive episodes, possibly by causing changes in the normal processes that regulate neurotransmitter systems. Psychological Cause Factors: Stressful Life Events As Causal Factors. Most of the episodic stressful life events involved in precipitating depression involve loss of a loved one, serious threats to important close relationships or to one's occupation, or severe economic or serious health problems. An important distinction that has been made between stressful life events that are independent of the person's behavior and personality (independent life events, such as losing a job because one's company is shutting down or having one's house hit by hurricane) and events that may have been at least partly generated by the depressed person's Behavior or personality (dependent life events). Evidence to date suggests that dependent life events play an even stronger role in the onset of major depression then do independent life events. Severely stressful episodic life event play a causal role (most often within a month or so after the event) in about 20 to 50% of cases. - Mildly Stressful Events and Chronic Stress: It has been demonstrated that chronic stress is associated with increased risk for the onset, maintenance, and recurrence of major depression. Different Types Of Vulnerabilities For Unipolar Depression. - Personality and Cognitive Diathesis: Neuroticism is the primary personality variable that serves as a vulnerability factor for depression. People who have high levels of this trait are prone to experiencing a broad range of negative moods, including not only sadness but also anxiety, guilt, and hostility. There is limited evidence that high levels of introversion (or low positive affectivity) may also serve as vulnerability factors for depression, either alone or when combined with neuroticism. The cognitive diatheses that have been studied for depression generally focus on particular negative patterns of thinking that make people who are prone to Depression more likely to become depressed when faced with one or more stressful life events. - Early Adversity As A Diathesis: A range of adversities in the early environment (such as family turmoil, parental psychopathology, physical or sexual abuse, and other forms of intrusive, harsh, and coercive parenting) can create both a short-term and a long-term vulnerability to depression. If the exposure to early adversity is moderate rather than severe a form of stress inoculation may occur that makes the individual less susceptible to the effects of later stress. The stress inoculation effect seem to be mediated by strengthening socio-emotional and neuroendocrine resistance to subsequent stressors. Psychodynamic Theories. Freud and a colleague, Karl Abraham, both hypothesized that when a loved one dies the mourner regresses to the oral stage of development (when the infant cannot distinguish self from others) and interjects or incorporates the Lost person, feeling all the same feelings toward the self as toward the last person. These feelings were thought to include anger and hostility because Freud believed that we unconsciously hold negative feelings toward those we love, in part because of their power over us. This is what led to the psychodynamic idea that depression is anger turned inward. Freud hypothesized that depression could also occur in response to imagined or symbolic losses. Behavioral Theories. Behavioral theories of depression, proposing that people become depressed either when their response is no longer produce positive reinforcement or when their rate of negative reinforcements increases. They do not show that depression is caused by these factors. instead, it may be that some of the primary symptoms of depression cause the person with depression to experience these lower rates of reinforcement, which in turn may help maintain the depression. Beck's Cognitive Theory. Beck hypothesized that the cognitive symptoms of depression often precede and cause the affective or mood symptoms rather than vice versa. first, there are the underlying dysfunctional beliefs, known as depressogenic schemas, which are rigid, extreme, and counterproductive. Note that back did not mean tame that simply having these dysfunctional beliefs is sufficient to make someone depressed; instead, he maintained that these dysfunctional beliefs need to be activated by the occurrence of some form of stress. When does functional beliefs are activated by current stressors or depressed mood, they tend to feel the current thinking pattern, creating a pattern of negative automatic thoughts—thoughts that often occur just below the surface of awareness and involve unpleasant, pessimistic predictions. These pessimistic predictions tend to center on three themes of what back calls the negative cognitive triad: (1) negative thoughts about the self (I'm ugly; I'm worthless; I'm a failure); (2) negative thoughts about one's experiences and the surrounding world (no one loves me; people treat me badly); and (3) negative thoughts about one's future (it's hopeless because things will always be this way). The negative cognitive triad tends to be maintained by a variety of negative cognitive biases or errors. (a) dichtomous or all are non reasoning, which involves a tendency to think in extremes; (b) selective abstraction, which involves a tendency to focus on one- detail of a situation while ignoring other elements of the situation; (c) arbitrary inference, which involves jumping to a conclusion based on minimal or no evidence. The House And Hopelessness Theories Of Depression. It states that when animals or humans find that they have no control over aversive events (such as shock), they may learn that they are helpless, which makes them unmotivated to try to respond in the future. - The Reformulated Helplessness Theory: Abramson and colleagues proposed that when people (probably unlike animals) are exposed to uncontrollable negative events, they ask themselves why, and the kinds of attributions that people make are, in turn, Central to whether they become depressed. These investigators proposed three critical dimensions on which attributions are made: (1) internal / external, (2) global / specific, and (3) stable / unstable. They proposed that a depressogenic or pessimistic attribution for a negative event is an internal, stable, and global one. Abramson and colleagues proposed that people who have a relatively stable and consistent pessimistic attributional style have a vulnerability or diathesis for depression when faced with uncontrollable negative life events. This kind of cognitive style seems to develop, at least in part, through social learning. The helplessness theory has been used to explain sex differences in depression. This theory proposes that by virtue of their roles in society, women are more prone to experiencing a sense of lack of control over negative life events. These feelings of helplessness might stem from poverty, discrimination in the workplace leading to unemployment or underemployment, the relative in balance of power in many heterosexual relationships, high rates of sexual and physical abuse against women (either currently or in childhood), role overload (e.g. being a working wife and mother), and less perceived control over traits that men value when choosing a long-term mate. Interpersonal Effects Of Mood Disorders. - Lack Of Social Support And Social Skills Deficits: Many more Studies have since supported the idea that people who are lonely, socially isolated, or lacking social support are more vulnerable to becoming depressed and that individuals with depression have smaller and less supportive social networks, which tends to precede the onset of depression.

Discuss biological and psychosocial causal factors in bipolar mood disorders.

Biological Causal Factors: Genetic Influences. There is a greater genetic contribution to bipolar 1 disorder then to unipolar disorder. This and other studies suggest that genes account for about 80 to 90% of the variance in the liability to develop bipolar 1 disorder, which is higher than unipolar disorder or any of the other major adults psychiatric disorders, including schizophrenia. Neurochemical Factors. The early monoamine hypothesis for unipolar disorder was extended to bipolar disorder, the hypothesis being that if depression is caused by deficiencies of norepinephrine or serotonin, then perhaps mania is caused by excessive of these neurotransmitters. There is good evidence for increased norepinephrine activity during manic episodes and less consistent evidence for lowered norepinephrine activity during depressive episodes. However, serotonin activity appears to be low in both depressive and manic phases. Abnormalities of Hormonal Regulatory Systems. Some neurohormonal research on bipolar disorder has focused on the HPA axis. Cortisol levels are elevated in bipolar depression (as they are in unipolar depression), but they're usually not elevated during manic episodes. During a manic episode, their rate of dexamethasone suppression test (DST) abnormalities has generally, but not always, been found to be much lower. Many bipolar patients have subtle but significant abnormalities in the functioning of the axis. Neurophysiological and Neuroanatomical Influences. Several summaries of the evidence from studies using pet and other neuroimaging techniques show that, whereas blood flow to the left prefrontal cortex is reduced during depression, during mania it is increase in certain other parts of the prefrontal cortex. Thus they're shifting patterns of brain activity during mania enduring depressed in normal moods. evidence that there are deficits in activity in the prefrontal cortex and bipolar disorder, which seem related to neurophysiological deficits that people with bipolar disorder have in problem solving, planning, working memory, shifting of attentional sets, and sustained attention on cognitive tasks. This is similar to what is seen in unipolar depression, as are deficits in the anterior cingulate cortex. However, structural imaging studies suggest that certain subcortical structures, including the basal ganglia and the amygdala, are enlarged and bipolar disorder that reduced in size and unipolar depression. The decreases in hippocampal volume that are often observed in unipolar depression are generally not found in bipolar depression. Sleep and Other Biological Rhythms. During manic episodes, patients with bipolar disorder tend to sleep very little (seemingly by choice, not because of insomnia), and this is the most common symptom to occur prior to the onset of a manic episode. During depressive episodes, they tend toward hypersomnia (too much sleep). Even between episodes people with bipolar disorder show substantial sleep difficulties, including high rates of insomnia. Psychological Causal Factors: Stressful Life Events. Stressful life events appear to be as important in precipitating bipolar depressive episode as unipolar depressive episodes, and there is some evidence that stressful life events or sometimes involved in precipitating manic episodes as well. Other Psychological Factors in Bipolar Disorder. There is also some evidence that personality and cognitive variables May interact with stressful life events in determining the likelihood of relapse. For example, the personality variable neuroticism has been associated with symptoms of depression and mania, and two studies even found that neuroticism predict increases in depressive symptoms in people with bipolar disorder just as in uniform or disorder. Moreover, personality variables and cognitive styles that are related to goals driving, drive, and incentive motivation have been associated with bipolar disorder. For example, teo personality variables associated with high levels of achievement striving and increased sensitivity to rewards in the environment predicted increases in manic symptoms—especially during periods of active goal striving of goal attainment (such a studying for an important exam and then doing very well on it). Another study found that students with a pessimistic attributional style who also had negative life events showed an increase in depressive symptoms whether they had bipolar or unipolar disorder. interesting lie, however, the bipolar students who had a pessimistic attributional style and experience negative life events also showed increases in manic symptoms are at a point in time.

Explain the sociocultural and biological variables that affect suicide.

Biological Causal Factors: The concordance rate for suicide in identical twins is about 3 times higher than that in fraternal twins. Neurochemical correlates of suicide victims often have alterations in serotonin functioning, with reduced serotonergic activity being associated with increased suicide risk. Socio-cultural Causal Factors: Whites have significantly higher rates of suicide than African American and young native American men show suicide rate similar to that of white males. countries with low rates, or less than 9 per 100,000, including Greece, Italy, Spain, and the United kingdom. In contrast, Hungary, with an annual incidence of more than 40 per 100,000, has the world's highest rate (almost four times that of the United States). Japan is one of the few societies in which suicide has been socially approved under certain circumstances—such as conditions that bring disgrace to an individual or group. During world War II, many Japanese villagers and Japanese military personnel were reported to have committed mass suicide when faced with defeat and imminent capture by allied forces.

Describe various types of bipolar disorders.

Bipolar disorders are distinguished from unipolar disorders by the presence of manic or hypomanic episodes, which are nearly always preceded or followed by periods of depression. Cyclothymic Disorder: Because individuals with cyclothymia are at greatly increased risk of later developing full-blown bipolar 1 or 2 disorder, dsm-iv-tr recommends that they be treated. Criteria: a) for at least two years, the presence of numerous periods with hypomanic symptoms and numerous periods with depressive symptoms that do not meet criteria for a major depressive episode. Note, in Children and adolescents, the duration must be at least one year. b) during the above 2 year period (one year in Children and adolescents), the person has not been without the symptoms in criterion A for more than two months at a time. c) no major depressive episode, manic episode, or mixed episode has been present during the first two years of the disturbance. note, after the initial two years of cyclothymic Disorder, there may be superimposed manic or mixed episodes (in which case both bipolar 1 disorder and cyclothymic disorder may be diagnosed) or major depressive episodes (in which case both bipolar 2 disorder and cyclothymic disorder may be diagnosed). d) the symptoms in criterion A are not better accounted for by schizoaffective disorder and are not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or psychotic disorder not otherwise specified. e) the symptoms are not due to the direct physiological effects of a substance (e.g. a drug of abuse, a medication) or a general medical condition like hyper thyroidism. f) the symptoms cause clinically significant distress or impairment in Social, occupational, or other important areas of functioning. Bipolar Disorders (I and II): Today dsm-iv-tr calls this illness bipolar disorder, although the term manic depressive illness is still commonly used as well. bipolar 1 disorder is distinguished from major depressive disorder by at least one manic episode or mixed episode. A mixed episode is characterized by symptoms of both full-blown manic and major depressive episodes for at least one week, whether the symptoms are intermixed or alternate rapidly every few days. Criteria: Bipolar 1: (a) there are six separate criteria sets for bipolar 1 disorder; single manic episode, most recent episode hypomanic, most recent episode manic, most recent episode mixed, most recent episode depressed, and most recent episode unspecified. (b) bipolar 1 disorder, single manic episode, is used to describe individuals who are having a first episode of mania. the remaining criteria sets are used to specify the nature of the current or most recent episode in individuals who have had recurrent mood episodes. Bipolar II Disorder (Recurrent Major Depressive Episodes with Hypomanic Episodes): (a) presents or history of one or more major depressive episodes; (b) presents or history of at least one hypomanic episode. (c) there has never been a manic episode or a mixed episode. (d) the mood symptoms in criteria A and B are not better accounted for by schizoaffective disorder and are not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or psychotic disorder not otherwise specified. (e) the symptoms cause clinically significant distress or impairment in Social, occupational, or other important areas of functioning. As with unipolar major depression, leave recurrences can be seasonal in nature, in which case bipolar disorder with the seasonal pattern is diagnosed. Features of Bipolar Disorder: Although there is a high degree of overlap in symptoms, the most widely replicated differences are that, relative to people with a unipolar depressive episode, people with a bipolar depressive episode tend, on average, to show more mood liability, more psychotic features, more psychomotor retardation, and more substance abuse. By contrast, individuals with unipolar depression, on average, show more anxiety, agitation, insomnia, physical complaints, and weight loss. In spite of the high degree of similarity and symptoms, research clearly indicates that major depressive episodes in people with bipolar disorder are, on average, more severe than those seen in unipolar disorder, and, not surprisingly, they also cause more role impairment.

Explain how various sociocultural factors affect unipolar and bipolar disorders.

Cross Cultural Differences in Depressive Symptoms. In some non-western cultures such as China and Japan where rates depression are relatively low, many of the psychological symptoms of depression are often not present. Instead people tend to exhibit so-called somatic and vegetative manifestations such as sleep disturbance, loss of appetite, weight loss, and loss of sexual interest. The psychological components of depression that often seem to be missing (from me Western standpoint) are the feelings of guilt, suicidal ideation, worthlessness, and self-recrimination, which are so commonly seen in the developed countries. Several possible reasons for these symptom differences stem from Asian beliefs in the unity of the Mind and body, a lack of expressiveness about emotions more generally, and the stigma attached to mental illness in these cultures. Cross Cultural Differences in Prevalence. There is some similarity in the lifetime prevalence rates for bipolar spectrum disorders across many different countries ranging from India and Japan to the United States, Lebanon, and New Zealand (0.1 to 4.4%). Furthermore, there is remarkable similarity in the patterns of comorbidity across countries, with anxiety disorders being the most common conditions that are comorbid with bipolar disorder. Prevalence rates for depression in Taiwan the lifetime prevalence has been estimated at 1.5%, whereas in the United States and Lebanon it has been estimated at 17 to 19%. Recurrent suicide attempts are also higher in Western cultures than in eastern cultures. Demographic Differences in the United States. The lifetime prevalence of major depression was hiring European white Americans than an African Americans. Native Americans, by contrast, have significantly elevated rates compared to white Americans. There are no significant differences among such groups for bipolar disorder. Another group that has elevated rates of mood disorders consist of individuals who have high levels of compliments in the arts. indeed, a good deal of evidence has shown that both unipolar and bipolar disorder, but especially bipolar disorder, occur with alarming frequency and poets, writers, composers, and artists.

Identify the mild to moderate depressive disorders.

Dysthymic disorder is generally considered to be of mild to moderate intensity, but its primary homework is its chronicity. To qualify for a diagnosis of dysthymic disorder (or dysthymia), a person must have a persistently depressed mood most of the day, for more days than not, for at least 2 years (one year for children and adolescents). In addition, individuals with they dysthymic disorder must have at least two of six additional symptoms when depressed. Periods of normal mood may occur briefly, but they usually last for only a few days to a few weeks (and for a maximum of two months). These intermittently normal moods are one of the most important characteristics distinguishing dysthymic disorder from major depressive disorder, which typically occurs in more discrete major depressive episodes. nevertheless, in spite of the intermittently normal moods, because of its current course people with dysthymia show poor outcomes and as much impairment as those with major depression.

Explain prevalence rates of suicide among people with mood disorders.

Estimates are that about 50 to 90% of those who complete the ACT do so during a depressive episode or in the recovery phase. estimates are that approximately 90% of people who either attempted or successfully committed suicide had some psychiatric disorder at the time, although only about half of those had been diagnosed prior to the suicide. In the United States, it is the 10th or 11th leading cause of death, with current estimates of about 35,000 suicides each year.

Describe who is likely to attempt suicide and who is likely to complete suicide.

For suicide attempt, it is people between 18 and 24 years old who have the highest rates, women are about three times as likely to attempt suicide as men, and suicide rates are three to four times higher in people who are separated or divorced than in those with any other marital status. For completed suicides, which are far less frequent than suicide attempts, it is the 7th leading cause of death for men, 15th leading cause for death for women, and in people who have bipolar disorder, among whom as many, or even more, women as men actually complete suicide. The highest rate of completed suicides in the elderly aged 65 and over. For women, the method most commonly used as drug ingestion; men tend to use methods more likely to be lethal, particularly gunshot, which may be a good part of the reason why completed suicides are higher among men. Major Depression was found to be the strongest risk factor for suicide ideation but not for suicide plans or individuals with ideation. In contrast, anxiety, impulse control, and substance use disorders are the strongest predictors of suicide plans and attempts. Suicide in Children: children are most at risk if they've lost a parent or have been abused. forms of psychopathology, depression, antisocial behavior, and tie impulsivity, are risk factors. Suicide in Adolescents and Young Adults: those most at risk are 15 to 19 years old, which account for approximately 11% of total deaths in this age range. surveys found that about 10% of college students had seriously contemplated suicide in the past year and that most of these temperatures had had some sort of plan. Known risk factors for adolescent suicide include depression, anxiety, alcohol and drug use, and conduct disorder problems, and including availability of firearms. Warning signs for student suicide. For most suicidal students, both male and female, the major precipitating stressor appears to be either the failure to establish, or the loss of, a close interpersonal relationship. Often the breakup of the romance is the key precipitating factor. It has also been noted that significantly more suicide attempts and suicides are made by students from families that have experienced separation, divorce, or the death of a parent.

Define the characteristics of mood disorders.

Mood disorders involve much more severe alterations in mood for much longer periods of time. In such cases the disturbances of mood are intense and persistent enough to be clearly maladaptive and often lead to serious problems in relationships and work performance. Depression ranked among the top 5 health conditions in terms of years lost to disability in all parts of the world except Africa, and it was the number one such health condition in the United States. All mood disorders (formerly called affective disorders), extremes of emotion or affect—soaring elation or deep depression—dominate the clinical picture. Other symptoms are also present, but the abnormal mood is the defining feature. The two key moods involved in mood disorders are mania, often characterized by intense and unrealistic feelings of excitement and euphoria, and depression, which usually involves feelings of extraordinary sadness and dejection. Unipolar depressive disorders arwen the person experiences only depressive episodes. Bipolar disorders are when the person experiences both manic and depressive episodes. To differentiate among the mood disorders in terms of (1) severity—the number of dysfunctions experience and the relative degree of impairment evidenced in those areas; and (2) duration—whether the disorder is acute, chronic, or intermittent (with periods of relatively normal functioning between the episodes of disorder). The most common form of mood episode that people present with is a major depressive episode. The other primary kind of mood episode is a manic episode. Criteria for Major Depressive Episode: 1) major depressive disorder, single episode: (a) presence of a single major depressive episode. (b) the major depressive episode is not better accounted for by schizoaffective disorder and is not super imposed on schizophrenia, schizophreniform disorder, delusional disorder, or psychotic disorder not otherwise specified. (c) there has never been a manic episode, a mixed episode, or a hypomanic episode. 2) major depressive disorder, recurrent: (a) presence of two or more major depressive episodes. Note: to be considered separate episodes, there must be an interval of at least two consecutive months in which criteria are not met for a major depressive episode. (b) the major depressive episodes are not better accounted for by schizoaffective disorder and are not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or psychotic disorder not otherwise specified. (c) there has never been a manic episode, a mixed episode, or a hypomanic episode. Criteria for Manic Episode: A) a distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary). B) during the period of mood disturbance, three or more of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree: (1) inflated self-esteem or grandiosity. (2) decreased need for sleep (e.g. feels rested after only 3 hours of sleep). (3) more talkative than usual or pressure to keep talking. (4) flight of ideas or subjective experience that thoughts are racing. (5) distractibility (i.e. I need attention too easily drawn to unimportant or irrelevant external stimuli). (6) increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation. (7) excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g. a drug of abuse, a medication, or other treatments) or a general medical condition (e.g. hyperthyroidism).

Differentiate depressions that are not mood disorders from those that are.

Normal depressions are nearly always the result of recent stress. Loss and the Grieving Process: Bowlby's four phases of normal response to the loss of a spouse or close family member: (1) numbing and disbelief, (2) yearning and searching for the dead person, (3) disorganization and despair that sets in when the person accepts the loss as permanent, and (4) some reorganization as the person gradually begins to rebuild his or her life. The dsm-iv-tr suggests that major depressive disorder is not to be diagnosed for the first two months following the loss, even if all the symptom criteria are met. Bereaved individuals following the loss of a spouse, life partner, or parent have found that about 50% exhibit genuine resilience in the face of loss, with minimal, very short-lived symptoms of depression or bereavement. Resilient individuals are not emotionally maladjusted or unattached to their spouses. Postpartum "Blues": Even though the birth of a child would usually seem to be a happy event, postpartum depression sometimes occurs in new mothers and occasionally father's following the birth of a child, and is known to have adverse effects on child outcomes. Recent evidence suggests that only postpartum blues are very common and occur in as many as 50 to 70% of women within 10 days of the birth of their child and usually subside on their own. Women are especially at high risk for developing major depression after the postpartum blues— especially if they are severe.

Explain the prevalence of mood disorders.

Of the two types of serious mood disorders, unipolar major depressive disorder (MDD) is the most common. Lifetime prevalence rates of unipolar major depressive are nearly 17%. Rates for unipolar depression are always much higher for women than for men (usually about 2:1) The other type of major depressive disorder, bipolar disorder (in which both manic and depressive episodes occur), is much less common. The NCS-R estimated that the lifetime risk of developing the classic form of this disorder is about 1%, and there is no discernible difference in the prevalence rates between the sexes.

Assess treatments and outcomes of mood disorders.

Pharmacotherapy: Antidepressant, mood stabilizing, and antipsychotic drugs are all used in the treatment of unipolar and bipolar disorders. antidepressant medications known as monoamine oxidase inhibitors (MAOIs) because they inhibit the action of monoamine oxidase—the enzyme responsible for the breakdown of norepinephrine and serotonin once released. The MAOIs can be as effective in treating depression as other categories of medications, but they can have potentially dangerous, even sometimes feel, side effects. Depression with atypical features is the one subtype of depression that seems to respond preferentially to the MAOIs. Moderately to seriously depressed patients, including those with dysthymia, are treated with tricyclics antidepressants because of their chemical structure, such as imipramine, which are known to increase neurotransmission of the monoamines. Only about 50% show what is considered clinically significant Improvement, and many of these patients still have significant residual depressive systems. Tricyclics have unpleasant side effects. Because these drugs are highly toxic when taken in large doses, there's some risk in prescribing them for suicidal patients, who might use them for an overdose. Antidepressants from The selective serotonin reuptake inhibitor (SSRI) category. These SSRI medications are generally no more effective than the tricyclics; indeed some findings suggest that the tricyclics are more effective than SSRIs for severe depression. However, the SSRIs tend to have many fewer side effect and are better tolerated by patients, as well as being less toxic in large doses. - Lithium and Other Mood-stabilizing Drugs. Lithium therapy has now become widely used as a mood stabilizer in the treatment of both depressive and manic episodes of bipolar disorder. The term mood stabilizer is often used to describe lithium and related drugs because they have both antimanic and antidepressant effects—that is, they exert mood-stabilizing effects in either direction. Lithium has been more widely studied as a treatment of manic episodes than of depressive episodes, and estimates are that about three-quarters of manic patients show at least partial Improvement. Lithium is also often effective in preventing cycling between manic and depressive episodes (although not necessarily for patients with rapid cycling), and bipolar patients are frequently maintained on lithium therapy over long time periods, even when not manic or depressed, simply to prevent new episodes. lithium therapy can have some unpleasant side effects such as lethargy, cognitive slowing, weight gain, decreased motor current ordination, and gastrointestinal difficulties. Long term use of lithium is occasionally associated with kidney malfunction and sometimes permanent kidney damage, although end of stage renal disease seems to be a very rare consequence of long-term lithium treatment. Alternative Biological Treatments: - Electroconvulsive Therapy. Because antidepressants often take 3 to 4 weeks to produce significant improvements, electroconvulsive therapy (ECT) is often used with severely depressed patients (especially among the elderly)who made present an immediate and serious suicidal risk, including those with psychotic or melancholic features. It is also used in patients who cannot take antidepressant medications or who are otherwise resistant to medications. remission of symptoms occurs for many patients after 6 to 12 treatments. The most common immediate side effect is confusion, although there is some evidence for lasting adverse effects on cognition, such as amnesia and slowed response time. - Transcranial Magnetic Stimulation (TMS). TMS is a non-invasive technique allowing focal stimulation of the brain in patients who are awake. brief but intense pulsating magnetic fields that induce electrical activity in certain parts of the cortex are delivered. The procedure is painless, and thousands of simulations are delivered in each treatment session. It is a promising approach for the treatment of unipolar depression. moreover, TMS has advantages over ECT in that cognitive performance and memory are not affected adversely and sometimes even improve, as opposed to BCT, where memory recall deficits are common. - Deep Brain Stimulation. Deep brain stimulation involves implanting an electrode in the brain and then stimulating that area with electric current. although more research on deep brain stimulation is needed, initial results suggest that it may have potential for treatment of unrelenting depression. - Bright Light Therapy. This was originally used in the treatment of seasonal affective disorder, but it has now been shown to be affected in non-seasonal depressions as well. Psychotherapy: - Cognitive-Behavioral Therapy. One of the two best-known psychotherapies for unipolar depression with documented effectiveness is cognitive behavioral therapy, also known as cognitive therapy. Cognitive therapy consists of highly structured, systematic attempt to teach people with unipolar depression to evaluate systematically their dysfunctional beliefs and negative automatic thoughts. They are also taught to identify and correct their biases or distortions in information processing and to uncover and challenge their underlying depressogenic assumptions and beliefs. When compared with pharmacotherapy, it is at least as effective when delivered by well-trained cognitive therapists. It also seems to have a special advantage in preventing relapse, similar to that obtained by staying on medication. Moreover, evidence is beginning to accumulate that it can prevent recurrence several years following the episode when the treatment occurred. One possibility is that medications May Target the limbic system where is cognitive therapy may have greater effect on cortical functions. Although the vast majority of research on CBT has focused on unipolar depression, recently there have been indications that a modified form of CBT may be quite useful, in combination with medication, in the treatment of bipolar disorder as well. There is also a preliminary evidence that mindfulness-based cognitive therapy may be useful in treating bipolar patients between episodes. - Behavioral Activation Treatment. A relatively new and promising treatment for unipolar depression is called behavioral activation treatment. This treatment approach focuses intensively on getting patients to become more active and engaged with their environment and with their interpersonal relationships. These techniques include scheduling daily activities and reading pleasure and mastery while engaging in them, exploring alternative behaviors to reach goals, and role-playing to address specific deficits. traditional cognitive therapy attends to these same issues but to a lesser extent. Behavioral activation treatment, by contrast, does not focus on implementing cognitive changes directly but rather on changing Behavior. The goals are to increase levels of positive reinforcement and to reduce avoidance and withdrawal. - Interpersonal Therapy. Interpersonal therapy seems to be about as effective as medications or cognitive behavioral treatment for unipolar depression. This interpersonal therapy approach focuses on current relationship issues, trying to help the person understand and change maladaptive interaction patterns. Interpersonal therapy can also be useful in long-term follow-up for individuals with severe recurrent unipolar depression. - Family and Marital Therapy. For married people who have unipolar depression and marital discord, marital therapy (focusing on the marital discord rather than on the depressed spouse alone) is as effective as cognitive therapy in reducing unipolar depression in the depressed spouse. Marital therapy has the further advantage of producing greater increases in marital satisfaction than cognitive therapy.

Describe criteria for diagnosing major depressive disorder and the subtypes.

The diagnostic criteria for major depressive disorder, also known as major depression, require that the person exhibit more symptoms than a required for dysthymia and that the symptoms be more persistent (not intervene with periods of normal mood). To receive a diagnosis of major depressive disorder, a person must be in a major depressive episode (single if initial, or recurrent) and never have had a manic, hypomanic, or mixed episode. An affected person must experience either markedly depressed moods or marked loss of interest in pleasurable activities most of every day, nearly every day, for at least two consecutive weeks. In addition 2 showing one or both of these symptoms, the person must experience at least three or four additional symptoms during the same period (for a total of at least five symptoms). In addition to the obvious emotional symptoms, these symptoms also include cognitive symptoms (such as feelings of worthlessness or guilt, and thoughts of suicide), behavioral symptoms (such as fatigue or physical agitation), and physical symptoms (such as changes in appetite and sleep patterns). Depression As A Recurrent Disorder: When a diagnosis of major depressive disorder is made, it is usually also specified whether this is a first, and therefore single or initial, episode or a recurrent episode (preceded by one or more previous episodes). This reflects the fact that depressive episodes are usually time-limited; the average duration of an untreated episode is about six to nine months. Although most depressive episodes remit (which is not said to occur until symptoms have largely been gone for at least two months), depressive episodes often recur at some Future point. In recent years, recurrence has been distinguished from relapse, where the ladder term refers to the return of symptoms within a fairly short. of time, a situation that probably reflects the fact that underlying episode of depression has not yet run its course. For example, relapse May commonly occur when pharmacotherapy is terminated prematurely—after symptoms have remitted but before the underlying episode is really over. Depression Throughout The Life Cycle: About one to 3% of school-aged children meet the criteria for some form of unipolar depressive disorder, with a smaller percentage exhibiting dysthymic disorder then major depression disorder. Even infants may experience a form of depression, formerly known as anaclitic depression or despair, if they are separated for a prolonged. from their attachment figure. The occurrence of major depression continues into later life. Although the one-year prevalence of major depression is significantly lower and people over age 65 than in younger adults, major depression and dysthymia in older adults are still considered a major public health problem today. Specifiers for Major Depressive Episodes: Some individuals who meet the basic criteria for diagnosis of a major depressive episode also have additional patterns of symptoms or features that are important to note when making a diagnosis because these patterns have implications for understanding more about the course of the disorder and its most effective treatment. - major depressive episode with melancholic features: This severe subtype of depression is more heritable than most other forms of depression and is more often associated with the history of childhood trauma. Characteristic symptoms: three of the following: early morning Awakening, depression worse in the morning, marked psychomotor agitation or retardation, loss of appetite or weight, excessive guilt, qualitatively different depressed mood. - severe major depressive episode with psychotic features: Individuals who are psychotically depressed are likely to have longer episodes, more cognitive impairment, and a poor long-term prognosis than those suffering from depression without psychotic features. Characteristic symptoms: delusions or hallucinations, usually mood congruent; feelings of guilt and worthlessness are common. - major depressive episode with atypical features: A disproportionate number of individuals who have atypical features are females. Atypical depression is linked to a mild form of bipolar disorder that is associated with hypomanic rather than manic episodes. Responds to a different class of antidepressants, the monoamine oxidase inhibitors. Characteristic symptoms: Mood reactivity—brightens to positive events; two of the four following symptoms: weight gain or increase in appetite, hypersomnia, leaden paralysis, being acutely sensitive to interpersonal rejection. - major depressive episode with catatonic features: Characteristic symptoms: A range of psychomotor symptoms from motoric immobility to extensive psychomotor activity, as well as mutism and rigidity. - recurrent major depressive episode with a seasonal pattern or seasonal affective disorder: Characteristic symptoms: At least two or more episodes in past two years that have occurred at the same time (usually fall or winter), and full remission at the same time (usually spring). No other non-seasonal episodes in same two year period. Major depression can coexist with dysthymia. Known as double depression, it is moderately depressed on a chronic basis (meeting symptom criteria for dysthymia) but undergo increase problems from time to time, during which they also meet criteria for major depressive episode.