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Mood disorders
  • Affect = mood
  • Continuum from depression to mania
  • Unipolar vs. Bipolar (one or both extremes)
  • Biological vs. Situational depressions
  • Cyclical/Episodic
  • "Common Cold"
Depressive Episode Criteria
MUST HAVE 5 of 9

Either...


  • depressed mood  OR

  • diminished interest in activities


Somatic symptoms:

  • Weight and appetite

  • Sleep problems

  • Psychomotor agitation or retardation

  • Fatigue


Cognitive symptoms:

  • Worthlessness or guilt

  • Concentration

  • Thoughts of death

Manic Episode Criteria
A - Distinct period of abnormally elevated mood for at least 1 week
B - must have 3 of 7:
  • Inflated self-esteem or grandiosity
  • Decreased need for sleep
  • More talkative
  • Ideas racing
  • Highly distractible
  • Increase in goal-directed activities
  • Excessive involvement in pleasurable activities wiith potential for painful consequences
C - Causes impairment in lives (arrest, hospitalization)
Hypomanic Episode Criteria
Identical to manic with one exception -

NO IMPAIRMENT

included because 90% go on to have manic episodes
Major Depressive Disorder (MDD)
Unipolar Depression
  • Must have at least 1 major depressive episode
  • Must never had manic or hypo
  • Cyclical, will have ups & downs
  • 85% have more episodes
MDD/Unipolar
prevalence
onset
20% women, 10% men
mid-20s
MDD/Unipolar

Risk Factors
  • Female
  • Genetic predisposition
  • NOT in elderly
  • NOT related to income
  • NOT related to race
Bipolar Disorders

Prevalencce
Onset
Risk Factors
1% equally men&women
around age 18
very heavily GENETIC!
Bipolar I Criteria
  • must have had a manic episode
  • may have had a depressive or hypomanic episode
90% of those with mania will have depressive as well

having manic at any point in life = BP-I
Bipolar II Criteria
  • Must have had both depressive and hypomanic episode
  • Must NEVER had manic episode
If patient changes to manic, they become BP-I
Dysthymia
depressed mood for most of the day for at least 2 years but sx don't meet depressive episode criteria
Cyclothymia
For at least 2 years, numerous periods of hypo and depressive sx that do not meet criteria for episodes
Biological Causes of Mood Disorders

Genetics
  • Family: person 2-3 times more likely than the avg. person if first-degree relative has MDD.
  • Adoption: few but linked to genetics
  • Twin: Genetic contribution very high for bipolar disorder. MZ twins 67% DZ twins 19%
Biological Causes of Mood Disorders

Joint Heritability
anxiety and depression may share the same underlying genetic factors

may inherit a predisposition to develop anxiety, depression or both - determined by social and psychological factors
Biological Causes of Mood Disorders

Neurotransmitters
  • Low serotonin related to depression but cannot prove causation.
  • Serotonin regulates emotional reactions and other NT levels.
  • High dopamine related to mania
Biological Causes of Mood Disorders

Endocrine system
Hypothyroidism - underactive thyroid - appear depressed, tired, gain weight, etc.
Biological Causes of Mood Disorders

Sleep and Circadian Rhythm
sleep disturbances accompany depression
Biological Causes of Mood Disorders

Brian Wave Activity
new area of research
depressed people have different brain waves that may occur before the depression
Psychological Causes of Mood Disorders

Stressful life events
20-50% people who experience stressful life event with develop depression

Diathesis-stress model: inherited disposition in combination with stress leads to depression

First depressive episode usually triggered by a life event.
Psychological Causes of Mood Disorders

Cognitive/Psych Vulnerabilities
Predisposed to see the world and events in a negative way

Result of childhood adversity
Psychological Causes of Mood Disorders

Seligman's Learned Helplessness theory
1975 - shocked dogs learned there was no escape and learned helplessness
Psychological Causes of Mood Disorders

Seligman's Attribution theory
depressed people make 3 kinds of attributions:
  • Internal - blame themselves
  • Stable - consistent cause of events
  • Global - applied to wide variety of circumstances
Psychological Causes of Mood Disorders

Seligman's Hoplessness model
helplessness = control issues, anxiety

hopelessness = giving up, depression
Social and Cultural Factors of Mood Disorders

Marital relationships
dissatisfaction and depression linked

causation flows both ways
Social and Cultural Factors of Mood Disorders

Being WOMEN
depression 2x as likely due to hormones and
discrimination and poverty
victimization
perceptions of uncontrollability


Social and Cultural Factors of Mood Disorders

Social support
more social support = better treatment and remission
Personality
stable, characteristic ways a person feels, behaves, thinks in a wide variety of situations

Both biological and environmental.
Personality Disorders
Enduring behavior which:
1.  is inflexible, rigid, extreme
2.  can lead to significant stress/impairment
3.   is stable and of long duration
4.   can be traced back to at least adolescence

Continuum from gullible to paranoid, low self-esteem to grandiose, passive to agressive.

Axis I Disorders
  • Symptom disorders (one part of you)
  • Episodic/Cyclical
  • Ego-dystonic (not how you perceive yourself)
  • Develops later in life
  • May vary across time and situations 
Axis II Disorders
  • Overall personality
  • Never transient
  • Always present
  • Ego-syntonic (consistent with view of youself)
  • Develops early, by adolscence or adulthood
  • Inflexible - does not change across time or situations
Personality Disorders

Cluster A
  • odd and eccentric
  • social isolation
  • positive or negative psychotic-like symptoms
  • Paranoid PD
  • Schizoid PD
  • Schizotypal PD
Personality Disorders - Cluster A

Paranoid PD
  • pervasive, unjustified distrust and suspiciousness of others
  • others' motives interpreted as malevolent
  • intepret normal statements and actions as personal attacks
Personality Disorders - Cluster A

Schizoid PD
  • detachment from social relationships
  • restricted range of emotions
  • show many negative sx of schizophrenia
Personality Disorders - Cluster A

Schizotypal PD
  • somewhere in between schizophrenic and borderline
  • not at all genetic so not schizo.
  • pattern of social  & interpersonal deficits with cognitive and perceptual distrortions or eccentricities
  • suspicious, paranoid perceptions
  • fringe sx - belief in martians, telepathy
Personality Disorders -

Cluster B
dramatic, emotional, erratic
Personality Disorders - Cluster B

Antisocial PD Intro.
DSM criticized for over-emphasizing the obervable, criminla behaviors and underemphasizing personality traits/psycho. factors which may not be observable or illegal.
Personality Disorders  -

ASPD
Criminal Behavior
observable, illegal, with some evidence

Personality Disorders -

ASPD
Psychopathy
Hare & Cleckley Criteria
  • focus on personality traits, not criminal behaviors
  • superficial charm
  • manipulative and conning
  • lack of remorse or empathy
  • grandiose
  • prone to boredom, so thrill-seeking
  • pathological lying
Personality Disorders -

ASPD Criteria in DSM
pattern of disregard for & violation of the basic rights of others since at least age 15
Personality Disorders -

ASPD risk factors

  • lower SES

  • location in urban/cities

  • males (3% vs females 1%)

  • chronic

Personality Disorders -

ASPD Genetic Influences

  • clearly runs in families

  • adoption studies show strong genetics but also environ.

  • MZ twins 55% DZ twins 13%

Personality Disorders -

ASPD Neurobiological Influences
  • general brain damage - NOT the cause
  • Underarousal hypothesis: low levels of cortical arousalso they seek stimulation via risks
  • Fearlessness hypothesis: higher threshold for fear so commit more crimes
Personality Disorders -

ASPD PscyhoSocial Influences

  • Different response to reward & punishment

  • Coercive Family Processes: ineffective parental discipline and noncompliant child - push to get their way

  • Stress and trauma may cause some to act in violent, illegal ways

Personality Disorders - Cluster B

Histrionic PD

  • excessive emotionality and attention-seeking

  • drama queens

  • very exaggerative, overreactive, vain, theatrical

  • Ultimately interferes with daily life

Personality Disorders - Cluster B

Narcissistic PD
  • Grandiosity - think highly of themselves
  • Excessive need for admiration
  • Lack empathy
  • Continuum from low self-esteem to narcissism
Personality Disoders - Cluster B

Borderline PD description
  • Between neurotic &psychotic
  • Very distressed, mood swings, splitting (all or nothing), manipulative, fear of being alone, take up most of doctors' time
Personality Disorders - Cluster B

Borderline PD Prevalence, Onset, Course
  • 2% of population
  • 75% of those being women
  • Occurs globally
  • Tends to be lifelong
  • 6% of patients commit suicide
Personality Disorders - Cluster B

Borderline PD Biological factors
  • 5x greater risk in 1st degree relatives
  • Adoption and twin show some genetic component
  • Too little serotonin
  • Inherited traits like impulsivity
  • Neurological impairments: exposure to drugs/alcohol in utero
Personality Disorders - Cluster B

Borderline PD Cognitive vulnerability
memory bias to remember the bad things; this creates distorted perceptions of life events
Personality Disorders - Cluster B

Borderline PD Environmental factors
MOST RELEVANT CAUSE
75-90% of patients experienced severe trauma and stress like sexual victimization

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