Mood Disorders I (Chapter 7) March 7, 2014 PSYC 2340: Abnormal Psychology Brett Deacon, Ph.D.

1. Mood Disorders I(Chapter 7)March 7, 2014PSYC 2340: Abnormal PsychologyBrett Deacon, Ph.D.

2. Announcements • Exams will be returned on Monday • This unit: • Mood disorders (4 classes) • Spring break (3/17 – 3/21) • Eating disorders (2-3 classes) • Substance use disorders (4-5 classes) • Exam #3 on 4/11

3. Mood Disorders • Disorders/problems covered in this section • Major Depression • Bipolar Disorder • Suicide

4. Mood Disorders • Specific attention to: • DSM-IV diagnostic system • Causes (biological, psychological, social), including those from scientific studies and promoted in the media • Treatment (biological, psychological)

5. Special Topics • Special topics of interest in the mood disorders section: • Causes of depression: myths vs. reality • Effects of different causal explanations on depressed individuals • Mental health screenings • Why have rates of disabling depression skyrockted in the US in recent decades? • Antidepressants: myths vs. reality • FDA approval process • Effectiveness vs. placebo • Suicide risk • Adverse effects • Long-term effects

6. Mood Disorders • Organization of the DSM-IV mood disorders section • 1. Types of mood “episodes” – building blocks for defining mood disorders • Major depressive episode • Manic episode

7. Mood Disorders • 2. Diagnostic criteria for specific mood disorders • Depressive disorders – major depressive disorder, dysthymic disorder • Bipolar disorder – bipolar disorder I, bipolar disorder II, cyclothymic disorder • Mood disorders defined by etiology – due to medical condition or effects of a substance

8. Major Depressive Episode • 5 or more symptoms must be met during a 2-week period • Person must have at least 1 of these symptoms: (1) depressed mood most of the day, nearly every day, and (2) diminished interest or pleasure in all or almost all activities most of the day, nearly every day • Other symptoms include: • Significant weight loss/gain or change in appetite • Insomnia or hypersomnia • Psychomotor agitation or retardation • Fatigue or loss of energy • Feelings of worthlessness or inappropriate guilt • Difficulty thinking or concentrating • Recurrent thoughts of death or suicidal ideation

9. Major Depressive Episode • Cardinal features • Persistent sadness • Anhedonia (loss of interest/pleasure) • “Vegetative” symptoms (changes in sleep, appetite, psychomotor activity) • Cognitive symptoms • Psychotic features – 5%-20% of cases • Hallucinations • Delusions

10. Major Depressive Episode • What does a Major Depressive Episode look like? • Video clips of Barbara

11. Major Depressive Disorder • DSM-IV diagnostic criteria: • Presence of major depressive episode • Episode not part of a psychotic disorder • No history of manic episodes

12. Major Depressive Disorder • Single episode vs. recurrent depression • 85% have recurrent episodes • Typical # episodes = 4 • Typical episode duration = 4-5 months • Treatment implications?

13. Major Depressive Disorder • Lifetime prevalence = 16.1% • Twice as common in women • Gender differences disappear by age 65 • Few differences across subcultures • Mean age of onset = 25

14. Most Common Disorders in the National Comorbidity Survey Replication Study % With Disorder Kessler et al. (2005)

15. Manic Episode • One-week period of elevated, expansive, or irritable mood • During period, 3 or more of these symptoms: • Inflated self-esteem or grandiosity • Decreased need for sleep • More talkative than usual or pressured speech • Flight of ideas/racing thoughts • Distractibility • Increase in goal-directed behavior or psychomotor agitation • Excessive involvement in pleasurable activities with potentially negative consequences

16. Mood Episodes • For both major depressive and manic episodes: • Symptoms cause significant distress or impairment • Symptoms are not substance-induced or due to medical condition

17. Manic Episode • What does a Manic Episode look like? • Video clips of Mary

18. Bipolar Disorder • DSM-IV diagnostic criteria: • Presence of manic episode • Person may or may not have a history of major depressive episodes • Episode not part of a psychotic disorder

19. Bipolar Disorder • Lifetime prevalence = 1.3% • No gender differences • Age of onset – 18-22 • Tends to be chronic

20. Causes of Mood Disorders • Psychological influences • Stressful life events – context and meanings • Death of loved one • Breakup of relationship • More negative life events = greater risk of depression

21. Causes of Mood Disorders • Marriage and interpersonal relationships • Marital dissatisfaction strongly related to depression - particularly in men • Gender imbalance • Found in depression but not bipolar disorder • Likely due to socialization • Social support

22. Causes of Mood Disorders • What is the typical behavior pattern for depressed people? • How might this maintain or even worsen depression?

23. Causes of Mood Disorders • Learned helplessness • Lack of perceived control over life stress • Some stressors are simply not controllable • Poverty • Family

24. Depressive Attributional Style • Event: significant other breaks up with you. • Internal vs. external attribution • It’s my fault vs. we weren’t a good match • Stable vs. situational attribution • I’ll screw up all future relationships vs. I’ll find the right person someday • Global vs. specific attribution • I’ll fail at all that I do in life vs. this unfortunate circumstance doesn’t mean I be successful in other areas of my life

25. Causes of Mood Disorders • Depressed persons engage in cognitive errors - tendency to interpret life events negatively • Examples: • Overgeneralization • All-or-nothing thinking • Cognitive triad: erroneous thinking about… • Oneself • Immediate world • Future