Abnormal Psych F20 Mood Disorders Chapter 7

Mood Disorders
Learning Objectives
1.1 Explain how we define abnormality and classify mental
disorders.
1.2 Describe the advantages and disadvantages of
classification.
1.3 Explain how culture affects what is considered
abnormal and describe two different culture-specific
disorders.
Copyright © 2017, 2014, 2013 Pearson Education, Inc. All Rights Reserved.
Learning Objectives
7.5 Describe the causal factors influencing the

development and maintenance of bipolar disorders.
7.6 Explain how cultural factors can influence the
expression of mood disorders.
7.7 Describe and distinguish between different treatments
for mood disorders.
Learning Objectives
7.8 Describe the prevalence and clinical picture of suicidal

behaviors.
7.9 Explain the efforts currently used to prevent and treat
suicidal behaviors.
Mood Disorders: An Overview
Mood disorders
• Defining feature = extremes
of emotion (affect)
• Other symptoms or co-
occurring disorders
Mood Disorders: An Overview
Two key moods

• Depression
• feelings of extraordinary sadness
and dejection
• Mania
• intense and unrealistic feelings of
excitement and euphoria
Types of Mood Disorders
Unipolar
Bipolar depressive
depressive
disorders
disorders
• Only depressive • Manic and
episodes depressive
episodes
The Prevalence of Mood Disorders
Lifetime prevalence of major depressive disorder is nearly 17%
12-month prevalence rates are nearly 7%
About twice as common in women than men
Lifetime prevalence for bipolar disorder is near 1%
Unipolar Depressive Disorders
• A major depressive episode

without having manic, hypomanic,
Major or mixed episodes
Depressive • Relapse and recurrence
Disorder • May begin at any point in lifespan,
(MDD) incidence rises during adolescence
• May include additional symptoms
(specifiers)
Table 7.1 Specifiers of Major Depressive Episodes
Specifier Characteristic Symptoms

Three of the following: early morning awakening, depression worse in the morning, marked
With Melancholic Features psychomotor agitation or retardation, loss of appetite or weight, excessive guilt, qualitatively
different depressed mood
Delusions or hallucinations (usually mood congruent); feelings of guilt and worthlessness
With Psychotic Features
common
Mood reactivity—brightens to positive events; two of the four following symptoms: weight gain
With Atypical Features or increase in appetite, hypersomnia, leaden paralysis (arms and legs feel as heavy as lead),
being acutely sensitive to interpersonal rejection
A range of psychomotor symptoms from motoric immobility to extensive psychomotor activity,
With Catatonic Features
as well as mutism and rigidity
At least two or more episodes in past 2 years that have occurred at the same time (usually fall
With Seasonal Pattern or winter), and full remission at the same time (usually spring). No other nonseasonal
episodes in the same 2-year period
Persistent Depressive Disorder
Mild to moderate version of depression
• Persistently depressed mood most of

the day for at least 2 years
• Intermittent normal moods occur
briefly
• Lifetime prevalence of 2.5 to 6%
• Average duration is 4-5 years
Other Forms of Depression
Bereavement-
triggered depression
Postpartum
depression
Causal Factors in Unipolar
Mood Disorders
Causal
Factors
Biological Psychological
causal factors causal factors
Biological Causal Factors
Hormone &
Altered neuro-
Genetic immune system
transmitter
influences regulation
activity
abnormalities
Neuro-physical
Sleep and
& neuro-
biological Sex differences
anatomical
rhythms
influences
Psychological Causal Factors
Stressful Independent Vulnerability

vs. in response
life events dependent to stress
Risk-related Personality
Early
vulnerability and cognitive
adversity
factors diatheses
Freud
Theorists
Behaviorists
Cognitive model
Figure 7.4 Beck’s Cognitive Model of Depression
According to Beck’s cognitive model of depression, certain kinds of early experiences can lead to the
formation of dysfunctional assumptions that leave a person vulnerable to depression later in life if
certain critical incidents (stressors) activate those assumptions. Once activated, these dysfunctional
assumptions trigger automatic thoughts that in turn produce depressive symptoms, which further fuel
the depressive automatic thoughts.
(Adapted from Fennell, 1989.)
Figure 7.5 Negative Cognitive Triad
Beck’s cognitive model of depression describes a pattern of negative automatic thoughts. These
pessimistic predictions center on three themes: the self, the world, and the future.
Reformulated
helplessness theory
Theories
Hopelessness theory
Excessive rumination
Lack of social support or social skills

Interpersonal
effects
Hostility and rejection from others
Marital dissatisfaction
Bipolar and Related Disorders
Bipolar disorders
• Distinguished from unipolar

disorders by presence of
manic or hypomanic
episodes
Cyclothymic Disorder
Cyclical mood swings
• Less severe than those of bipolar

disorder
• Symptoms present for at least 2 years
• Lacking severe symptoms and
psychotic features of bipolar disorder
Bipolar Disorders (I and II)
Bipolar II
Bipolar I disorder
disorder
• Includes at • Includes
least one manic hypomanic
or mixed episodes but
episode not full-blown
manic or mixed
episodes
Bipolar Disorders (I and II)
Occur equally in males and females
Usually start in adolescence or young adulthood
Average age of onset is 18 to 22 years
About three times as many days are depressed as

manic/hypomanic
Figure 7.7 The Manic-Depressive Spectrum
There is a spectrum of bipolarity in moods. All of us have our ups and downs, which are indicated here
as normal mood variation. People with a cyclothymic personality have more marked and regular mood
swings, and people with cyclothymic disorder go through periods when they meet the criteria for
dysthymia (except for the 2-year duration) and other periods when they meet the criteria for hypomania.
People with bipolar II disorder have periods of major depression and periods of hypomania. Unipolar
mania is an extremely rare condition. Finally, people with bipolar I disorder have periods of major
depression and periods of mania.
(Adapted from Frederick K. Goodwin and Kay R. Jamison. (2009). Manic Depressive Illness. Copyright
© 1990. Oxford University Press, Inc.)
Causal Factors in Bipolar Disorders
Causal
factors
Biological Psychological
Abnormalities in
transportation of
Norepinephrine, ions across
serotonin, and neural
Heredity dopamine membrane
Disturbances
in biological
Shifting rhythms
patterns of
Cortisol blood flow to
levels prefrontal
cortex
Stressful life events

causal factors
Psychological
Personality variables
Low social support
Pessimistic
attributional style
Sociocultural Factors Affecting Unipolar
and Bipolar Disorders
Symptoms of Prevalence of
mood disorders mood disorders
• Can differ • Also differs
widely across across
cultures and cultures
demographic
groups
Cross-Cultural Differences
in Depressive Symptoms
• Western:
Form of psychological
depressio symptoms
n varies • Non-Western:
physical
across symptoms
cultures
Cross-Cultural Differences in
Prevalence
Rates of depression vary more than rates
of bipolar disorder
Lifetime prevalence of depression is 17-

19% in the U.S., but only 1.5% in Taiwan
Reasons for different rates of depression

are not yet clear
Treatments and Outcomes
Pharmacotherap
y
Alternative
biological
treatments
Psychotherapy
Pharmacotherapy
Antidepressants, mood-
stabilizing,
antipsychotic drugs
used to treat mood
disorders
Lithium common mood

stabilizer for bipolar
Alternative Biological Treatments
Electroconvulsive
therapy
Transcranial magnetic
stimulation
Deep brain stimulation
Bright light therapy
Psychotherapy
Forms of
effective
psychotherapy
• Cognitive-
behavioral therapy
• Behavioral
activation treatment
• Interpersonal
therapy
• Family and marital
therapy
Suicide: The Clinical Picture and the
Causal Pattern
Suicide risk Suicide is the

significant factor 15th leading
in all types of cause of death
depression in the world
Suicide: The Clinical Picture and the
Causal Pattern
Distinguis
h
between:
Suicidal
self-injury
Nonsuicidal
self-injury
(NSSI)
The Clinical Picture and
the Causal Pattern
Who Attempts and Dies by Suicide?
Psychological Disorders
Other Psychosocial Factors Associated with

Suicide
Theoretical Models of Suicidal Behavior
Who Attempts and
Dies by Suicide?
Suicide
attempts Gender
and age differences
Completed
suicides
and age
Psychological Disorders
• Posttraumatic stress
disorder
Increase • Bipolar disorder
risk of
• Conduct disorder
suicide
• Intermittent explosive
disorder
Other Psychosocial Factors Associated
with Suicide
Impulsivity
Aggression
Pessimism
Psychosocial
factors
Family psychopathology or instability
Hopelessness
Negative affectivity
Biological Factors
Reduced
serotonergic
Genetics activity
Sociocultural Factors
Rates of
Ethnicity
suicide
• Whites have • Vary across
higher rates cultures and
of suicide religions
than African
Americans
Theoretical Models of Suicidal
Behavior
Joiner’s
Diathesis–stress interpersonal-
models psychological
model of suicide
Figure 7.13 Joiner’s Interpersonal-Psychological Model of Suicide
Joiner proposes that people desire to die by suicide when they perceive that they are a burden to others
and experience a sense of thwarted belongingness. However, they cannot act on this suicidal desire
unless they also have acquired the capacity for suicide. When these three factors come together, Joiner
argues, a person is at high risk for suicide.
(Adapted from Joiner, 2005.)
Treatment of Mental Disorders
Antidepressant
medication or lithium
Prevention of
suicide can take
the form of
Benzodiazepines
treatment of the
underlying mental
disorder(s)
Cognitive-behavioral
therapy
Crisis Intervention
Help show
that distress
is impairing
judgment
Maintain Help show
supportive distress in
contact not endless
Cope with
immediate
crisis
Focus on High-Risk Groups
and Other Measures
Provide treatment aimed

Use cognitive-behavioral
directly at decreasing
therapy for suicide
suicidal thoughts and
prevention for use with
behaviors among those
adolescents who have
already experiencing these
attempted suicide
outcomes

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Mood Disorders

7.5 Describe the causal factors influencing the

7.8 Describe the prevalence and clinical picture of suicidal

Two key moods

Lifetime prevalence of major depressive disorder is nearly 17%

12-month prevalence rates are nearly 7%

About twice as common in women than men

Lifetime prevalence for bipolar disorder is near 1%

• A major depressive episode

Specifier Characteristic Symptoms

Mild to moderate version of depression

• Persistently depressed mood most of

Stressful Independent Vulnerability

Lack of social support or social skills

Hostility and rejection from others

• Distinguished from unipolar

Cyclical mood swings

• Less severe than those of bipolar

Occur equally in males and females

Usually start in adolescence or young adulthood

Average age of onset is 18 to 22 years

About three times as many days are depressed as

Stressful life events

Low social support

Lifetime prevalence of depression is 17-

Reasons for different rates of depression

Lithium common mood

Deep brain stimulation

Bright light therapy

Suicide risk Suicide is the

Other Psychosocial Factors Associated with

Biological Causal Factors

Theoretical Models of Suicidal Behavior

Provide treatment aimed

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