Mood Disorders

Dr. U. Gauthamadas
Professor & Head
Department of Psychiatry
Mood Disorders
Psychological Disorders
characterized by
emotional extremes.
Major Depressive
Disorder
Bipolar Disorder
Seasonal Affective
Disorder
Dysthymic Disorder
Depression
The common cold of psychological
disorders.
It is like a warning that
something is wrong.
Depression
Depression
Major Depressive Disorder
A person, for no
apparent reason,
experiences two or
more weeks of
depressive moods.
Includes feelings of
worthlessness and diminished
interest or pleasure in most
activities.
Major depressive episode
1. Depressed mood
Sad, empty, weepy; irritable, angry
2. Loss of interest or pleasure in previously
enjoyable activities
3. Change in weight or appetite
4. Sleep changes
More depressive symptoms
5. Noticeable change in movement
6. Fatigue
7. Feelings of worthlessness or guilt
8. Impaired cognition or volition
9. Repeated thoughts of death or suicide, or
planned or attempted suicide
The five symptoms must occur in the same
two weeks
Dysthymic Disorder
Suffering from
mild depression
every day for at
least two years.
Seasonal Affective Disorder
Bipolar Disorder
Person alternates between the
hopelessness and lethargy of depression
and the overexcited state of mania.
Manic episode
One week of persistently high, expansive, or
irritable mood, and 3 of:
Grandiose self-esteem
Lower sleep need
Overly talkative
Racing thoughts
Easily distracted
Increased activity or agitation
High risk activities
Mixed episode
One week of both manic and major depressive
symptoms with rapidly alternating moods
Common symptoms:
Agitation
Insomnia
Irregular appetite (binge-fast)
Delusions
Thoughts of suicide
Hypomanic episode
Four days of manic episode symptoms
Mood disturbance does not critically impair
ability to work or maintain social
responsibilities
Response pattern is uncharacteristic
Not euthymia
Bipolar Brain
Etiology of mood disorders
Psychoanalytic theory: Evaluation of
experiences
Cognitive theories: Thought patterns
Interpersonal theory: Rejection
Biological theories: Genes and NTs
Existential theory: Loss of meaning
Psychoanalytic theory
Oral fixation: Depends on others for self-esteem
Bereavement, introjection, and mourning work
Symbolic loss
But dream themes of depressed patients are of loss
and failure, not anger and hostility (Beck and Ward,
1961)
Depressed people do express anger
Cognitive theories
Becks theory:
Character of pessimism (NegativeTriad)
Habits of negativity (Negative schemas)
Erroneous thinking (Characteristic biases)
DEPRESSION
Characteristic biases
Arbitrary inference
Selective abstraction
Overgeneralization
Magnification and minimization
Assessment of Becks theory
Depressed people do show cognitive biases in
their thinking
Their apparent pessimism, however, is
accurate
The theory is correlational, not causal
The model is multidimensional
Treatment based on the theory is helpful
Helplessness/hopelessness theories
Learned helplessness (Seligman & Maier, 1967)
Attributional reformulation (Abramson, Seligman &
Teasdale, 1978)
Personal/Environmental (a.k.a. Internal/External)
Stable/Unstable
Global/Specific
Hopelessness: Add diatheses of low self-esteem and
hopelessness
Interpersonal theory
Reduced interpersonal support
Experiences of rejection
Due to social structure
Inadequate social networks
Others may dislike them
Elicited by patient
Consequences of behavioral choices
Critical comments by spouse
Poor social skills and seeking reassurance
Behavioral theories
Learned helplessness/hopelessness is a
behavioral theory with a cognitive twist.
Reduction in reinforcement leads to a
reduction in activity.
Depressive behaviors are reinforced.
Depressed people have taken part in fewer
pleasant events.
Availability of reinforcers
The amount of reinforcement available is a
function of
Personal characteristics
Environment or milieu
Repertoire of reinforcement-producing behaviors.
Biological theories
Genetics:
Bipolar MZ concordance = 43% to 72%
Bipolar DZ concordance = 6% to 25%
Unipolar MZ concordance = 46%
Unipolar DZ concordance = 20%
Linkage analysis: Mixed results
Multiple genes?
Chromosomes 13 and 22
Brain chemistry theories
Serotonin and norepinephrine
Drug treatments: Tricyclics, MAOIs, and SSRIs
But the time course doesnt match
Current hypothesis: Antidepressant drugs
change the density or sensitivity of
postsynaptic serotonin receptors
Brain structure theories
For Major Depressive Disorder only
Subgenual Cingulate Region (Mayberg,
2005):Deep brain stimulation
Ventral Anterior Capsule, white matter
connecting prefrontal cortex to thalamus, has
been blocked in treatment for OCD, with the
observation that it affected mood as well.
Neuroendocrine theory
Hypothalamus-pituitary-adrenocortical axis
High levels of cortisol correlate with
depression
Dexamethasone Suppression Test identifies
major depressive episodes