Mood Disorders: Unipolar Disorders

• Mood disorders are characterized by a disturbance in mood that is intense, persistent, and maladaptive.
• The two main types of mood states are depression and mania.
• Mood states typically exist on a continuum, with depression and mania at opposite ends and normal mood in the middle.

Unipolar Disorders

• Major depressive disorder (MDD) and persistent depressive disorder are types of unipolar disorders.

Major Depressive Disorder (MDD)

• Diagnostic criteria include meeting the criteria for a major depressive episode.
• The episode cannot be better explained by other conditions.
• There should be no history of manic or hypomanic episodes.
• MDD can be diagnosed as single episode or recurrent.
• Recurrence is not the same as a relapse.

Hypomanic Episode

• Symptoms are the same as in a manic episode but must occur for at least 4 days.
• Functioning is less impaired compared to mania, so hospitalization is typically not needed.
• Others notice the mood change in individuals experiencing a hypomanic episode.
• An individual also meets criteria for a major depressive episode.

Bipolar I Disorder

• Characterized by alternating episodes of depression and mania.
• In two-thirds of cases, manic episodes occur immediately before or after a depressive episode.
• In one-third of cases, periods of normal functioning separate manic and depressive episodes.
• Even if a person only exhibits manic symptoms initially, a depressive episode is assumed to occur eventually.
• Depression might be the first presentation but the diagnosis becomes Bipolar I once mania occurs.
• Comorbidity is common with substance use disorder, anxiety disorders, and ADHD, which complicates treatment.

Bipolar II Disorder

• Involves alternating episodes of depression and hypomania.
• There is a risk of progressing to Bipolar I disorder; 10-25% of people with Bipolar II will develop Bipolar I.
• Comorbidity includes substance use, anxiety disorders, and binge eating disorder.

Additional Info About Bipolar Disorders

• Rapid cycling involves experiencing four or more episodes (manic or depressive) in a year.
• Standard treatment is not as effective for rapid cycling.

Cyclothymic Disorder

• Individuals experience depressive symptoms but do not meet the full criteria for a major depressive episode.
• Individuals also experience hypomanic symptoms but do not meet the criteria for a hypomanic episode.
• Individuals have never met the criteria for bipolar disorder or MDD.
• Depression is not as severe as in major depression.
• Symptoms must be present for a minimum of 2 years.
• A diagnosis of cyclothymia should not be given if a person is symptom-free for two months or more over the two years.
• Symptoms cannot be better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, or delusional disorder.

Age of Onset and Prevalence in Bipolar Disorders

• Bipolar I disorder has a mean age of onset of 22 years (21.5 for women, 23 for men).
• The 12-month prevalence of Bipolar I is 1.5%.
• Bipolar II disorder has a mean age of onset in the mid-20s.
• The 12-month prevalence of Bipolar II not specified.
• Cyclothymic disorder typically begins in early adolescence or early adulthood.
• The lifetime prevalence of cyclothymic disorder is 0.4-2.5%.

Barabra's Symptoms (Persistent Depressive Disorder)

• Consistently feels down for about 5 months without a specific reason.
• Experienced anger toward her children, spending days in bed, and suicidal thoughts.
• Feels physically lethargic, with heavy arms, and finds simple tasks like watching TV difficult.
• Feels poorly about herself, experiences suicidal ideations, and fears she wouldn't die.
• Has frequent, uncontrollable crying spells, increased eating, and insomnia.
• Started to isolate from friends and family, avoiding answering the phone or door.
• Assumes everyone feels suicidal, not knowing what normal feels like.

Mary's Symptoms (Bipolar 1)

• Mary talks slower and seemed more aware about her depressive states compared to Barabra's.
• Her statements were more unrealistic; she talked about voices, the devil, and feeling judged, and she gets sidetracked.
• She discussed past traumas, believes she is possessed, and talks about medication effects.
• She experiences suicidal ideations and substance use.
• Manic: Describes feeling on top of the world and is aggressive towards her husband.
• States she is a spy for the lord, believes she can control the weather, and has hysterical laughter.
• She describes getting drunk on water, coffee, and Kool-Aid, and experiences insomnia.
• Still describes hearing voices.

Causes of Unipolar Disorders

• Causes will be posted on Moodle

Causes of Bipolar Disorders

• Diathesis-stress model is relevant.
• Genetic factors are involved.
• Multiple genes are likely responsible.
• Can be seen in multiple family members.
• Stressful events often trigger early mania and depressive episodes.
• Possessing a diathesis increases the risk of developing the disorder but a stressor is needed.

Biological Treatment for Unipolar Disorders

• Medications are effective for 60-70% of people who complete medication treatment.
• Stopping medication may cause the disorder to return.
• Monoamine oxidase inhibitors (MAOIs) such as Nardil and Marplan prevent the breakdown of serotonin, norepinephrine, and dopamine.
• Tricyclics such as Elavil, Anafranil, and Tofranil block the reuptake (reabsorption) of serotonin and norepinephrine.

Selective Serotonin Reuptake Inhibitors (SSRIs)

• SSRIs like Paxil, Prozac, and Zoloft block the reuptake (reabsorption) of serotonin.
• Conditions treated include GAD, OCD, social phobia, panic disorder, BDD, and PTSD.
• SSRIs have fewer side effects than tricyclics and can be used more long-term.

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

• SNRIs such as Effexor and Cymbalta block the reuptake (reabsorption) of serotonin and norepinephrine.
• Conditions treated include panic disorder and GAD.
• Common side effects include dry mouth, nausea, dizziness, and excessive swallowing.
• Other side effects include urination difficulties, constipation, insomnia, sexual difficulties, loss of appetite, and headache.
• If going off these medications, it is important to do so carefully with supervision.

Psychological Treatment of Unipolar Disorders

• About 50-70% of patients benefit from psychological treatment.

Cognitive Therapy (CT)

• Cognitive restructuring is an important component.
• It involves identification of automatic negative thoughts.
• Challenging automatic negative thoughts, including behavioral experiments.
• Tackling intermediate and core beliefs.
• Starting with immediate beliefs.
• The goal is to find things that do not support their core belief.
• Role-playing is a very important part of cognitive therapy.

Behavioral Activation (BA)

• Derived from cognitive therapy.
• It involves sitting with the client, finding old activities, and adding new things.
• The client is encouraged to engage in enjoyable, reinforcing activities.
• Activities have to be feasible and enjoyable.

Interpersonal Psychotherapy (IPT)

• Assumes that symptoms and problems occur within the context of interpersonal relationships.
• The four main themes worked on are:
• Role disputes
• Adjusting to the loss of a relationship
• Identifying and correcting social skill deficits
• Acquiring new relationships

Treatment Resistant Depression

• Typically, someone who is resistant to medications.
• Electroconvulsive therapy (ECT) is effective for treatment-resistant depression.
• It involves administering a current of 70-130 volts of electricity.
• Unilateral ECT involves administering the current to the nondominant side.
• The patient has a seizure and is unconscious for a short period.
• 6-12 sessions are given.
• Memory loss is a side effect.
• Transcranial magnetic stimulation (TMS) provides a less invasive way of altering electrical activity in the brain.
• It involves placing a magnetic coil over the head and providing an electromagnetic pulse.
• Pulses stimulate neurons.
• Headaches can be a side effect of TMS.

Treatment of Bipolar Disorders

• Biological treatment involves Lithium, a mood stabilizer.
• It is a naturally occurring chemical element.
• Effective in preventing manic episodes.
• Lithium toxicity can occur if not carefully monitored.
• Recommended for long-term use.
• Other mood-stabilizing medications include Depakote (anticonvulsant) and Zyprexa (antipsychotic).

Psychological Treatment of Bipolar Disorders

• Used to supplement medication.
• Psychoeducational: -The client is taught about the disorder. -Symptoms, Expected time course of symptoms, Triggers for symptoms -Helps with adherence to medication
• Cognitive Therapy (CT) helps relieve symptoms of depression more than mania.
• Family-focused treatment involves supplementing medication treatment.
• Educating the family about the illness (knowledge)
• Developing problem-solving skills for the client and family
• Enhancing communication between client and family It is associated with lower rates of relapse compared to medication and crisis management, reducing the likelihood of cycling.
• Interpersonal and social rhythm therapy (IPSRT) is used for non-rapid cycling.
• Patients are taught how to regulate sleep cycles and daily schedules (helps with circadian rhythm).
• They learn skills to help with interpersonal relationships. Clients receiving IPRST went longer without developing mania or depression as compared to clinical management.
• Dialectical Behavior Therapy (DBT) is a multi-component treatment (for borderline personality disorder).
• Individual psychotherapy and group-based skills training.
• Distress tolerance, emotion regulation, mindfulness, and interpersonal effectiveness.

Suicide Theory

• Distal factors: genes, temperament, mental disorders.
• Percival burdensomeness ("my death will be worth more than my life to others").
• Thwarted Belongingness.
• Person feels alienated and lonely.
• Acquired capability/capable of suicide.
• Past suicidal behavior.
• Repeated injuries such as childhood abuse.
• Repeated witnessing of pain, violence, or injury.
• The key aspect is being capable of suicide.