15.7-15.9

• Mood disorders


  Severe disturbances in mood and emotions - most often depression, but also mania and elation
• Categories of mood disorders

  • Depressive disorders
  • Bipolar and related disorders
• Depression


  An intense and persistent sadness
• Mania


  A state of extreme elation and agitation
• Major depressive disorder


  Defined by depressed mood most of the day, nearly every day and loss of interest and pleasure in usual activities
• Major depressive disorder


  • Episodic - symptoms present at full magnitude for a period of time then gradually abate
  • Around 50-60% of people who experience an episode will have a second episode
  • Around 70% recover within a year
  • Around 12% show serious signs of impairment after 5 years
  • Many who recover still show minor symptoms that fluctuate in severity
• Subtypes of depression


  • Seasonal pattern (winter blues)
  • Peripartum onset (postpartum depression)
  • Persistent depressive disorder (dysthymia)
• Peripartum-onset depression


  Depression experienced during pregnancy or 4 weeks after childbirth, often with anxiety, panic, guilt, agitation, and difficulty caring for the newborn
• Around 14% of women screen positive for peripartum-onset depression, and nearly 20% report thoughts of harming themselves
• Persistent depressive disorder


  Chronically depressed mood most of the day nearly every day for at least 2 years, plus at least 2 other symptoms of major depressive disorder
• Schizophrenia


  A psychological disorder characterized by major disturbances in thought, perception, emotion, and behavior
• Bipolar disorder (commonly known as manic depression)


  A person experiences mood states that vacillate between depression and mania
• To be diagnosed with bipolar disorder, a person must have experienced a manic episode at least once in their life; although major depressive episodes are common in bipolar disorder, they are not required for a diagnosis (APA, 2013)
• Manic episode


  A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy lasting at least one week, that lasts most of the time each day (APA, 2013, p. 124)
• Dissociative disorders


  Characterized by an individual becoming split off, or dissociated, from their core sense of self. Memory and identity become disturbed; these disturbances have a psychological rather than physical cause.
• Dissociative disorders listed in the DSM-5

  • Dissociative amnesia
  • Depersonalization/derealization disorder
  • Dissociative identity disorder
• Symptoms of manic episode

  • Mood that is almost euphoric
  • Excessively talkative
  • Spontaneously starting conversations with strangers
  • Excessively irritable and complaining or making hostile comments
  • Talking loudly and rapidly, exhibiting flight of ideas
  • Easily distracted
  • Grandiosity, with inflated but unjustified self-esteem and self-confidence
  • Taking on several tasks at the same time and showing little need for sleep
  • Recklessly engaging in pleasurable activities that could have harmful consequences
• Dissociative amnesia


  An individual is unable to recall important personal information, usually following an extremely stressful or traumatic experience
• Dissociative fugue


  Whereby an individual suddenly wanders away from their home, experience confusion about their identity, and sometimes even adopt a new identity
• About 1.8% of residents in communities in upstate New York experienced dissociative amnesia in the previous year
• Rapid-cycling subtype of bipolar disorder


  Characterized by at least four manic episodes (or some combination of at least four manic and major depressive episodes) within one year
• Hallucination


  A perceptual experience that occurs in the absence of external stimulation
• In the United States, 1 out of every 167 people meets the criteria for bipolar disorder each year, and 1 out of 100 meet the criteria within their lifetime (Merikangas et al., 2011)
• Auditory hallucinations (hearing voices) occur in roughly two-thirds of patients with schizophrenia and are by far the most common form of hallucination
• Depersonalization/derealization disorder


  Characterized by recurring episodes of depersonalization, derealization, or both
• Depersonalization


  Feelings of "unreality or detachment from, or unfamiliarity with, one's whole self or from aspects of the self"
• Around 90% of those with bipolar disorder have a comorbid disorder, most often an anxiety disorder or a substance abuse problem
• Disorganized thinking


  Disjointed and incoherent thought processes, usually detected by what a person says
• Suicide rates are extremely high among those with bipolar disorder: around 36% of individuals with this disorder attempt suicide at least once in their lifetime (Novick, Swartz, & Frank, 2010), and between 15%–19% die by suicide (Newman, 2004)
• Derealization


  A sense of "unreality or detachment from, or unfamiliarity with, the world, be it individuals, inanimate objects, or all surroundings"
• Dissociative identity disorder


  People with this disorder exhibit two or more separate personalities or identities, each well-defined and distinct from one another
• The rate of concordance for major depressive disorder is higher among identical twins than fraternal twins (50% vs. 38%, respectively), as is that of bipolar disorder (67% vs. 16%, respectively), suggesting that genetic factors play a stronger role in bipolar disorder than in major depressive disorder (Merikangas et al. 2011)
• Genetic basis of schizophrenia

  The risk of developing schizophrenia is nearly 6 times greater if one has a parent with schizophrenia than if one does not
• People with mood disorders often have imbalances in certain neurotransmitters, particularly norepinephrine and serotonin (Thase, 2009)
• About 1.5% of residents in communities in upstate New York experienced symptoms consistent with dissociative identity disorder in the previous year
• Medications that are used to treat major depressive disorder typically boost serotonin and norepinephrine activity, whereas lithium—used in the treatment of bipolar disorder—blocks norepinephrine activity at the synapses
• Depression is linked to abnormal activity in several regions of the brain including those important in assessing the emotional significance of stimuli and experiencing emotions (amygdala), and in regulating and controlling emotions (like the prefrontal cortex, or PFC)
• The story of Sybil, a popular 1970s book (and later film) about a woman with 16 different personalities, has been suggested to be largely fabricated
• People with depression show elevated amygdala activity, especially when presented with negative emotional stimuli, such as photos of sad faces
• Heightened amygdala activation to negative emotional stimuli among depressed persons occurs even when stimuli are presented outside of conscious awareness, and it persists even after the negative emotional stimuli are no longer present