mooddisordersb

• Bipolar Disorder:
– Bipolar I Disorder – Bipolar II Disorder – Cyclothymic Disorder
Bipolar Disorder
• Involves both manic and depressive phases • Onset typically 18-22 years • Rapid cycling, poorer prognosis • 1% of general population, less common than MDD • Almost always more than one Manic Episode • Equal prevalence in males and females • Briefer episodes
Cyclothymia
• Chronic (at least 2 years), cycling between hypomania and depression without meeting criteria for a depressive episode • Can become a way of life • Equal prevalence among men and women • 1/3-1/2 go on to develop Bipolar I or II
• Unipolar Depression:
– Major Depressive Disorder – Dysthymic Disorder
• Bipolar Disorder:
– Bipolar I Disorder – Bipolar II Disorder – Cyclothymic Disorder
Sociocultural Perspective
• Depression and suicide vary as a function of social factors
Biological Perspective
• Family studies suggest a genetic component (1st degree relatives 3X more likely for depression and 10X more likely for bipolar) • Twin studies:
Depression Symptom Modifiers
• Psychotic
– Hallucinations & Delusions, which can be mood congruent or incongruent
• Melancholic
– Prominent somatic symptoms
• Biological rhythms:
– Sleep disturbance, hormone differences, --”biological clock” – Change my disrupt biological clock
Biological Perspectives
• Some evidence to suggest structural brain differences • Hormone imbalance
• Atypical
– Overeating, oversleeping, anxiety
• Catatonic
– Limited movement
Types of Mood Disorders
• Unipolar Depression:
– Major Depressive Disorder – Dysthymic Disorder
• Behavioural
– Changes in motor functioning (hyperactive, talkativeness, reckless behaviour)
• Physiological
– Less sleep, increased energy
Types of Mood Disorders
– Affective: dysphoria, anhedonia, irritability – Cognitive: worthlessness/guilt, hopelessness, concentration, suicidal
• Behavioural
– Changes in motor functioning (agitated or retarded)
Mood Disorders
“Gross deviation in Mood”
• Major Depressive Episode • Manic Episode/Hypo-manic Episode • Mixed Episode
Major Depressive Episode
• Phenomenological
Cognitive Perspective
• Seligman: Learned helplessness (expectation of lack of control) • Recall attributions discussed earlier • Beck: Negative self-schema • Dependency vs. Self-criticism
1) Major Depressive Disorder
• One or more Depressive Episode with no intervening periods of mania • 17% Lifetime Prevalence • Woman more effected than men • 30% of undergrads are dysphoric and 10% are clinically depressed
– Number / range – Availability – Skills
Behavioural Perspective
• Negative interpersonal cycle: constantly seeking reassurance and obtaining „caring‟ – others respond negatively.
Psychodynamic Perspective
• Freud/Abraham: Unconscious sorrow & rage in response to real or symbolic loss • Neo-dynamic: Early loss or threatened loss of loved object (parent) – reactivated by current loss – recapitulating helplessness • Fenichel: Compensation for low self-esteem – interpersonally functional (dependency) • Affectionless control
Qualities of Mood Disorders
• Psychotic vs. Neurotic • Endogenous vs. Reactive • Early vs. Late onset
Explaining Mood Disorders
• • • • • • Psychodynamic Perspective Interpersonal Perspective Behavioural Perspective Cognitive Perspective Sociocultural Perspective Biological Perspective
Interpersonal Perspective
• Sullivan: Psychopathology is a relational phenomenon • Recent models focus on current relationships • Klerman: Grief, interpersonal disputes, role transitions, & lack of social skills – directly address these issues
– Bipolar, 72% vs. 14% concordance – Unipolar. 40% vs. 11%
Biological Perspectives
• Adoption studies:
– Bipolar, 31% prevalence in the biological parents of the bipolar adoptees vs. 2% biological parents of non-bipolar adoptees
– Malfunction of the hypothalamus
holamine hypothesis
Bipolar I
• At least one manic (or mixed) episode and usually, but not necessarily, at least one major depressive episode as well
Bipolar II
• At least one major depressive episode and at least one hypomanic episode, but has never met criteria for a manic or mixed episode
Behavioural Perspective
• Lewinsohn: Extinction (behaviours no longer rewarded) • Lack of positive reinforcement causes withdrawal and depression • Amount of reinforcement depends on: