ABNORMAL PSYCHOLOGY
FOURTEENTH EDITION
ANN M. KRING & SHERI L. JOHNSON
CHAPTER 5
MOOD DISORDERS
CHAPTER OUTLINE
• CLINICAL DESCRIPTIONS AND EPIDEMIOLOGY OF
DEPRESSIVE DISORDERS
• CLINICAL DESCRIPTIONS AND EPIDEMIOLOGY OF
BIPOLAR DISORDERS
• ETIOLOGY OF MOOD DISORDERS
• TREATMENT OF MOOD DISORDERS
• SUICIDE
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TABLE 5.1 OVERVIEW OF THE MAJOR DSM-5
MOOD DISORDERS
Unipolar Depressive Disorders
DSM-5 Diagnoses
Major Features
Major depressive disorder
Five or more depressive symptoms, including sad mood or loss of
pleasure, for 2 weeks
Persistent depressive disorder
Low mood and at least two other symptoms of depression at least half
of the time for 2 years
Premenstrual dysphoric disorder
Mood symptoms in the week before menses
Disruptive mood dysregulation disorder
Severe recurrent temper outbursts and persistent negative mood for at
least 1 year beginning before age 10
Bipolar Disorders
DSM-5 Diagnoses
Major Features
Bipolar I disorder
At least one lifetime manic episode
Bipolar II disorder
At least one lifetime hypomanic episode and one major depressive
episode
Cyclothymia
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Recurrent mood changes from high to low for at least 2 years, without
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hypomanic or depressive episodes
MAJOR DEPRESSIVE DISORDER (MDD)
• EPISODIC
• RECURRENT
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EPIDEMIOLOGY AND CONSEQUENCES
OF DEPRESSION
•
•
•
•
•
DEPRESSION IS COMMON
PREVALENCE VARIES ACROSS CULTURES
SYMPTOMS VARY ACROSS CULTURES
AGE OF ONSET
CO-MORBIDITY
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FIGURE 5.1: WITH EACH GENERATION, THE
MEDIAN AGE OF ONSET FOR MDD GETS YOUNGER
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BIPOLAR DISORDERS
• SEVERITY AND DURATION OF MANIA DEFINING
FEATURE OF EACH: BIPOLAR I, BIPOLAR II,
CYCLOTHYMIA
• MANIA
• MOST PEOPLE WILL ALSO EXPERIENCE AN EPISODE OF
DEPRESSION
• DEPRESSIVE EPISODE REQUIRED FOR BIPOLAR II, BUT
NOT BIPOLAR I
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DSM-5 CRITERIA FOR MANIC AND HYPOMANIC
EPISODES
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•
•
•
DISTINCTLY ELEVATED OR IRRITABLE MOOD
ABNORMALLY INCREASED ACTIVITY AND ENERGY
PLUS 3 OTHER SYMPTOMS (FOUR IF MOOD IS IRRITABLE)
SYMPTOMS ARE PRESENT MOST OF THE DAY, NEARLY EVERY
DAY
• FOR A MANIC EPISODE
• FOR A HYPOMANIC EPISODE
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DSM-5 CRITERIA FOR BIPOLAR DISORDERS
• BIPOLAR I
• BIPOLAR II
• CYCLOTHYMIC DISORDER (CYCLOTHYMIA)
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EPIDEMIOLOGY AND CONSEQUENCES OF BIPOLAR
DISORDER
•
•
•
•
PREVALENCE RATES LOWER THAN MDD
AVERAGE AGE OF ONSET IN 20S
NO GENDER DIFFERENCES IN RATES OF BIPOLAR DISORDERS
SEVERE MENTAL ILLNESS
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ETIOLOGY OF MOOD DISORDERS: GENETIC
FACTORS
• HERITABILITY ESTIMATES
• UNLIKELY ONE GENE EXPLAINS THESE ILLNESSES
• SEROTONIN TRANSPORTER GENE (5-HTT)
POLYMORPHISM
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FIGURE 5.2 STRESSFUL LIFE EVENTS INTERACT WITH
SEROTONIN TRANSPORTER GENE TO PREDICT
DEPRESSION
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ETIOLOGY OF MOOD DISORDERS:
NEUROTRANSMITTERS (NTS)
• NOREPINEPHRINE, DOPAMINE, AND SEROTONIN 37%
MDD
• ORIGINAL MODELS FOCUSED ON ABSOLUTE LEVELS OF
NTS
• NEW MODELS FOCUS ON SENSITIVITY OF
POSTSYNAPTIC RECEPTORS
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FIGURE 5.3: SEROTONIN AND DOPAMINE
PATHWAYS
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FIGURE 5.4: DRUG ACTION ON SYNAPTIC ACTIVITY
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ETIOLOGY OF MOOD DISORDERS: BRAIN
FUNCTION
• OVERSENSITIVITY TO EMOTIONAL STIMULI (ELEVATED
AMYGDALA)
• INTERFERENCE WITH EMOTION REGULATION
(ELEVATED ANTERIOR CINGULATE, DIMINISHED
PREFRONTAL CORTEX AND HIPPOCAMPUS)
• MOTIVATION TO PURSUE REWARDS (STRIATUM)
• DISRUPTIONS IN THE CONNECTIVITY OF THESE
REGIONS
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TABLE 5.2 SUMMARY OF NEUROBIOLOGICAL
HYPOTHESES ABOUT MAJOR DEPRESSION AND
BIPOLAR DISORDER
Neurological Hypothesis
Major Depression
Bipolar Disorder
Genetic Contribution
Moderate
High
Neurotransmitter (serotonin,
dopamine) dysfunction
Mixed evidence
Mixed evidence
Changes in activation of
regions in the brain in
response to emotion stimuli
Present
Present
Activation of regions in the
brain in response to emotion
stimuli
Diminished
Elevated
Cortisol awakening Response
Elevated
Elevated among those with
depression
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FIGURE 5.5: KEY BRAIN REGIONS INVOLVED IN
MOOD DISORDERS
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ETIOLOGY OF MOOD DISORDERS:
NEUROENDOCRINE SYSTEM
• OVERACTIVITY OF HPA AXIS
o
AMYGDALA ACTIVATES HPA AXIS, WHICH RELEASES
CORTISOL
o
CORTISOL, STRESS HORMONE, INCREASES ACTIVITY
OF IMMUNE SYSTEM TO PREPARE FOR THREAT
o
PROLONGED HIGH CORTISOL LEVELS CAN CAUSE
HARM TO BODY SYSTEMS
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ETIOLOGY OF MOOD DISORDERS: SOCIAL
FACTORS IN DEPRESSION
• LIFE EVENTS
• INTERPERSONAL DIFFICULTIES
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ETIOLOGY OF MOOD DISORDERS: PSYCHOLOGICAL
FACTORS IN DEPRESSION
•
•
•
•
•
NEUROTICISM
COGNITIVE THEORIES
BECK’S THEORY
HOPELESSNESS THEORY
RUMINATION THEORY
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SOCIAL AND PSYCHOLOGICAL FACTORS IN
BIPOLAR DISORDER
• TRIGGERS OF DEPRESSIVE EPISODES IN BD APPEAR
SIMILAR TO TRIGGERS IN MDD
• PREDICTORS OF MANIA
o REWARD SENSITIVITY
o SLEEP DISRUPTION
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PSYCHOLOGICAL TREATMENT OF DEPRESSION
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•
•
•
•
INTERPERSONAL PSYCHOTHERAPY (IPT)
COGNITIVE THERAPY (CT)
MINDFULNESS-BASED COGNITIVE THERAPY (MBCT)
BEHAVIORAL ACTIVATION (BA) THERAPY
BEHAVIORAL COUPLES THERAPY
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PSYCHOLOGICAL TREATMENT OF BIPOLAR
DISORDER
• PSYCHOEDUCATIONAL APPROACHES
• COGNITIVE THERAPY (CT)
• FAMILY-FOCUSED TREATMENT (FFT)
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BIOLOGICAL TREATMENT OF MOOD DISORDERS
• ELECTROCONVULSIVE THERAPY (ECT)
• TRANSCRANIAL MAGNETIC STIMULATION FOR
DEPRESSION (RTMS)
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TABLE 5.6 MEDICATIONS FOR TREATING MOOD
DISORDERS
Antidepressants
Category
Generic Name
Trade Name
MAO inhibitors
tranylcypromine
Parnate
Tricyclic antidepressants
Imipramine, amitriptyline
Tofranil, Elavil
Selective serotonin reuptake inhibitor
(SSRI)
fluoxetine, sertraline
Prozac, Zoloft
Serotonin norepinephrine reuptake
inhibitor (SNRI)
venlafaxine, duloxetine
Effexor,
Cymbalta
Generic Name
Trade Name
lithium
Lithium
divalproex sodium
Depakote
olanzapine
Zyprexa
Mood Stabilizers
Category
Anticonvulsants
Antipsychotics
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MEDICATIONS FOR DEPRESSIVE DISORDERS
• MOST COMMONLY USED AND BEST-RESEARCHED TREATMENTS
o 75% PPL RECEIVING TXT PRESCRIBED ANTIDEPRESSANTS
• VERY EFFECTIVE AT TREATING SEVERE, PERSISTENT DEPRESSION
o MIGHT NOT BE HELPFUL FOR MILD-MODERATE SX
• STAR-D (RUSH ET AL., 2006)
o SEQUENCED TXT ALTERNATIVE TO RELIEVE DEPRESSION
• STUDY CONDUCTED USING SATELLITE PROGRAM TO ATTEMPT
TO EVALUATE EFFECTIVENESS OF ANTIDEPRESSANTS
• SOME PPL CO-MORBID W. OTHER PD
• 33% ACHIEVED FULL SX RELIEF
• ~30% NRACHIEVED REMISSION W/ DIFF. ATD
• REMISSION RATES LOW & RELAPSE RATES HIGH
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RESEARCH COMPARING TREATMENTS
FOR MAJOR DEPRESSIVE DISORDER
• COMBINING PSYCHOTHERAPY AND
ANTIDEPRESSANT MEDICATIONS INCREASES
ODDS OF RECOVERY OVER EITHER ALONE BY 1020%
• LATER STUDIES (HOLLON & DERUBEIS, 2003)
o
CT EFFECTIVE AS MEDS FOR SEVERE DEPRESSION
• CT>MEDS IN EFFECT @ PREVENT RELAPSE
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MEDICATIONS FOR BIPOLAR DISORDER
• LITHIUM
• OTHER MOOD STABILIZERS
o ANTICONVULSANTS
o ANTIPSYCHOTICS (OFFER IMMEDIATE CALMING EFFECT)
o RECOMMENDED IF PEOPLE ARE UNABLE TO TOLERATE
LITHIUM SIDE EFFECTS
o CAN BE COMBINED WITH LITHIUM
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KEY TERMS IN THE STUDY OF SUICIDALITY
• SUICIDE IDEATION: THOUGHTS OF KILLING
ONESELF
• SUICIDE ATTEMPT: BEHAVIOR INTENDED TO
KILL ONESELF
• SUICIDE: DEATH FROM DELIBERATE SELF-INJURY
• NON-SUICIDAL SELF-INJURY: BEHAVIORS
INTENDED TO INJURE ONESELF WITHOUT
INTENT TO CAUSE DEATH
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EPIDEMIOLOGY OF SUICIDE AND SUICIDE
ATTEMPTS (1 OF 2)
• 10TH LEADING CAUSE OF DEATH IN US
• WORLDWIDE: 9% REPORT SUICIDAL IDEATION AT LEAST
ONCE IN THEIR LIVES AND 2.5% HAVE MADE AT LEAST
ONE SUICIDE ATTEMPT
• GUNS ARE THE MOST COMMON MEANS OF SUICIDE IN
THE US (50%)
• MEN ARE MORE LIKELY THAN WOMEN TO KILL
THEMSELVES
• WOMEN ARE MORE LIKELY THAN MEN ARE TO MAKE
SUICIDE ATTEMPTS THAT DO NOT RESULT IN DEATH
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EPIDEMIOLOGY OF SUICIDE AND SUICIDE
ATTEMPTS (2 OF 2)
• MEN USUALLY SHOOT OR HANG THEMSELVES
• WOMEN MORE LIKELY TO USE LESS LETHAL MEANS
• THE HIGHEST RATES OF SUICIDE IN THE UNITED STATES
ARE FOR WHITE MALES OVER AGE 50
• THE RATES OF SUICIDE FOR ADOLESCENTS AND
CHILDREN IN THE UNITED STATES ARE INCREASING
DRAMATICALLY
• BEING DIVORCED OR WIDOWED ELEVATES SUICIDE RISK
FOUR- OR FIVEFOLD
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FIGURE 5.8: ANNUAL DEATHS IN THE US
DUE TO SUICIDES
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RISK FACTORS FOR SUICIDE
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PSYCHOLOGICAL DISORDERS
NEUROBIOLOGICAL MODELS
SOCIAL FACTORS
PSYCHOLOGICAL MODELS
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PREVENTING SUICIDE
• TALK ABOUT SUICIDE OPENLY AND MATTER-OFFACTLY
• MOST PEOPLE ARE AMBIVALENT ABOUT THEIR
SUICIDAL INTENTIONS
• TALKING ABOUT SUICIDE CAN HELP THE PERSON
IDENTIFY OTHER WAYS TO RELIEVE THE PAIN
• TREAT THE ASSOCIATED MENTAL HEALTH DISORDER
• TREAT SUICIDALITY DIRECTLY
• HOSPITALIZATION FOR SAFETY
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BROADER APPROACHES TO SUICIDE PREVENTION
• STUDYING SUICIDE PREVENTION WITHIN THE MILITARY
• MEANS RESTRICTION
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