Mood Disorders

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  1. Four Components of Major Depressive Disorder
    • 1.Cognitive: Ruminating thoughts of
    • worthlessness/hopelessness/guilt

    • 2. Behaviour: Psycho-motor agitation/retardation/ eating
    • fluctuations/sleep disturbance/ suicidal gestures

    • 3. Physiology/sensations: sad expression/
    • irritability/somatic complaints

    • 4. Affect: feeling sad/lack of pleasure distinctively
    • different than pre depression
  2. Subtypes of Depression
    1. Major Depressive Disorder (MDD)

    2. Dysthymia (DD)

    3. Episodic vs. Chronic Specifiers
  3. Aetiology MDD: Diathesis Stress Model Perspective
    • 1. Interaction of stressful life events & predisposition
    • (stressful event may be positive)

    2. Interpersonal loss/feelings of humiliation & defeat

    3. Women's response style = ruminations vs distraction (more male)
  4. Aetiology MDD: Reinforcement Perspective (Lewinsohn)
    1. Less contingent reinforcement - Leads to -Less activity

    (low rate of bhv causes all other symptoms of dep)

    2. Depressed behaviour can be reinforced
  5. Aetiology MDD: Biological Perspective
    1. Genetic contribution: MDD=50%/ DD= 10%.

    • 2. Short Allele of 5HTT: (serotonin) + stress above
    • individual threshold triggers gene.

    3. Neuroendocrine: stress response system dysfunction +hormone change

    • 4. Neurological: structural/circuitry
    • dysfunction/ neurotransmitter deregulation in
    • -Serotonin/dopamine/norepinephrine/neuropeptides
  6. Aetiology MDD: Cognitive Perspective
    (Becks ABC model)
    • -Cognitive Biases, distortions & errors:
    • (ie filtering/ overgeneralising/ perceived failure etc)

    -Schemas/belief systems: Process information and form view based on prior experiences/schema is re-activated by similar experiences

    -Schemas determine how they will cope with future problems
  7. Aetiology MDD: Learned Helplessness Perspective (Seligman)
    • - (Pervasive) Hopelessness; negative expectations of future
    • events & belief of no control over negative events.

    -Attribution styles- explain neg events as internal, stable & global (depressogenic attributional style) often results in perceived failure.

    -Memory Bias- only remember bad events/catastrophizing
  8. Aetiology MDD: Interpersonal Perspective (Weissmand & Makowitz 1994)
    1. Disturbance in formation/maintenance/ or renewal of bonds historically & currently

    2. Loss of relationship in preceding 6 mths

    3. Association with global deficits in social functioning
  9. Aetiology MDD: Integrative systems (barlow & Durand 2002)
    1.Bio vulnerability/ Psych vulnerability/ Stressful life events

    2. Maintenance of depression via

    (a) Activation of stress hormones/change in neurotransmitters

    (b) Activation of neg attributions

    • (c)leads to problems in interpersonal relationships and lack
    • of social support.
  10. Prevalence of MDD
    MDD- Lifetime Prevalence =16%/

    Dysthymia - Lifetime Prevalence = 3%

    • -Leading cause of diability worldwide (10% of all
    • disabilities).
  11. Onset of MDD
    • 1. Early 30's
    • 2. 5% increase in younger ages 18-29yrs
  12. Course/ Duration of MDD
    Duration varies

    • -Most have at least 2 episodes (Mean 5-6 episodes in
    • lifetime).

    -Most recover from episode <6 months

    *Dysthymia at least 2 years.
  13. Gender Difference in MDD
    More women than men across cultures

    • *Women's response style: more ruminations compared to men who use distraction methods more.
    • *Gender roles: women learned helplessness/victim
  14. DSM Diagnosis/ Criteria for MDD
    Depressed mood and/or loss of pleasure (anhedonia) in all/most activities for at least 2 weeks + 4 symptoms (below)

    1.Sleep Disturbance

    2.Appetite disturbance (5% change in weight in 1mth)


    4.Impaired thinking/difficulty concentrating

    5.Feelings of worthlessness

    6.Suicidal ideation/attempts
  15. DSM Diagnosis/ Criteria for Dysthymia
    1.Depressed mood for most of the day, more days than not, for 2 years + 4 symptoms for MDD.

    2.No break in depressed mood of more than 2 months.

    3.Less severe but more chronic symptoms of MDD.
  16. Melancholia
    Severe form of MDD

    Requires biological treatment (Med+ECT)

    • Psychotic features/ Postpartum onset
    • (within 4 wks. of birth).
  17. Vulnerability Factors for Depression
    1.Previous history of depression

    2.Sensitivity to adverse events


    4.Low self-esteem

    5.20-40yrs old

    6.Low coping skills

    7.Low SES

    8.Low threshold of evocation of self-schemata

    9.Children under 7yrs
  18. Protective Factors in Depression
    1.Learned resourcefulness

    2.High frequency of pleasant events

    3.Self-perceived social competence

    • 4.High level of social support ( *clinical sig. to relapse
    • prevention*)

    Emotional Resilience
  19. Suicidal ideation & NSSI
    -Symptoms of dep usually present

    -10:1 ratio for attempts to completion rates

    (F=15-19yrs more attempts/ males higher completion rates with age)

    -NSSI: Common to Borderline/Substance abuse/ ED/ MDD/DD

    • *Biggest predictor of Completed suicide*
    • Desire to end one's life combined with ability to enact lethal self-injury.
  20. Prevalence of Suicide
    3rd Leading Cause of death in 15-24yr olds

    15-19yrs -19% males/15.9% females

    20-24 yrs -24.2% males/17.2% females.
  21. Biological Treatment for MDD & DD
    • Medication:
    • Target levels of neurotransmitters (serotonin & norepinephrine)

    • -Antidepressants:
    • SSRI's /NSRI's/Tricyclics/MAOI's/St John's Wart
    • -2-4wks min before improvement/1-2 mths to reach optimal dose/ if dep resistant at optimal dose or melancholic episode may need ECT.

    • ECT
    • -Course= 3 per week for 2-7 weeks
    • -Side effects severe but transient (memory loss)
  22. Psychotherapy Treatment of MDD & DD

    2.Interpersonal Therapy

    3.Psychodynamic (not evidence based)

    4.Behavioural Activation & Exercise

    5.Light Therapy (for Seasonal Affective Disorder)

    • 6.Interpersonal & Social Rhythm Therapy (Focus on
    • interactions b/w symptoms & social interactions)
  23. CBT: Treatment of MDD & DD
    • Psycho-education - explain role of dep, symptoms &
    • responses/ ABC model- role of belief systems & schemas/ Homework & compliance.

    • -Cognitions -identitfy helpful vs unhelpful cogs
    • -Antecedence,belief's & consequences
    • -Challenge unhelpful /underlying thoughts/ acceptance /alternative thoughts & responses.

    -Emotions- Tolerance/acceptance of unpleasant emotions

    • -Behaviours -Increase activity/schedule pleasant
    • events/ self-reinforcement
  24. Interpersonal Therapy:Treatment of MDD & DD
    • -Focus on identification & amelioration of patient's
    • interpersonal difficulties contributing to current depression.

    • -Typical problem areas; unresolved grief, interpersonal
    • disputes, role of transitions, interpersonal deficits.

    • -Importance for relapse prevention/ good evidence for
    • efficacy.
  25. Behavioural Activation & Exercise (Lewinsohn): Treatment of MDD & DD
    -Encouraging patient to perform behaviors that will improve the patient’s mood and achieve the patient’s goals/ discourage behaviour that interferes with achieving goals.

    -Focuses on the consequences of behavior:

    Evidence based efficacy = to CBT & meds
  26. Treatment Comparisons in MDD & Dysthymia
    • CBT, IPT and Tricyclic meds equally effective in approx 50-70% of cases.
    • (more than placebo or brief Psychodynamic)

    • -Long term efficacy better for CBT
    • *30% well for CBT
    • *26% well for IPT
    • *19% well for Tricyclics
    • *20% well in placebo
  27. Relapse predictors for MDD and Dysthymia
    -Chronicity or no. of episodes

    -High levels of emotional expressiveness

    -Post-treatment severity & Cognitive style

    -Dissatisfaction with major life areas

    -Coexisting medical Problem *significantly higher risk
  28. Relapse Prevention for MDD and Dysthymia
    -50% relapse rate if cease medication (Stay on meds to 6-12mths once better).

    • -CBT has 20% lower relapse rate after 12 wks
    • treatment.

    -Adaptive coping strategies & plan in place

    -Booster sessions

    -Pleasant activity schedule
Card Set
Mood Disorders
Abnormal psychology Mood Disorders
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