Psychopathology (Final) Depressive and Bipolar Disorders

Features of Major Depressive Episode

Depressed mood (most common) = sadness (mild melancholy to
complete helplessness) Anhedonia (most common)= loss of
pleasure or interest in usual activities Disturbance of
appetite= appetite changes and/or weight change Sleep
disturbances= insomnia or hypersomnolence Psychomotor
retardation/ agitation= slow and deliberate movements/ incessant
activity Loss of energy= reduced energy, exhaustion

Features of a Manic Episode

Elevated, expansive, or irritable mood Inflated self
esteem Sleeplessness Hyperactivity reckless
behavior

Features of a hypomanic episodes

More brief and less severe than manic episode Doesn�t
require impairment but has similar symptoms as a manic ep
Requires change in functioning and must be observable by
others

Mixed episode

When a person meets criteria for major depression and manic/
hypomanic episodes simultaneously

Bipolar I

Manic episode is experienced May or not experience at
least one major depressive episode as well

Bipolar II

Hypomanic episode is experienced Individual has at
least one major depressive episode Never met criteria for a
manic episode

Rapid cycling

Less common form of bipolar Person (usually a woman)
switches back and forth between depressive and manic/ hypomanic
episodes (with at least 4 mood episodes per year), with little or no
�normal� functioning between mood eps

How are bipolar and unipolar depression different?

Bipolar= much less common; occurs in each sex with about equal
frequency; more common in high SES; likely to have history of
hyperactivity of ADHD; mood episodes are generally more brief and
more frequent; depressive episodes in bipolar include excess sleep
and weight/ appetite increase; associated with greater occupational
and social functioning; has higher risk for suicide; has worse
long-term outcomes; has a stronger genetic predisposition and more
likely to run in families Married people less likely to
experience major depression but no decreased risk for bipolar
dx Major depression= likely to have histories of low self
esteem, dependency, obsessive thinking;

Dimensions of a Mood disorder

psychotic vs no psychotic early vs late onset

Psychotic vs non-psychotic mood disorders

Some individual who have eps of major depression or mania may
experiences symptoms of psychosis Episodes of mania with
psychotic features are more prevalent than depressive episodes with
psychotic features

Early vs late onset mood disorders

People with earlier onset have poorer outcomes Earlier
onset of depression associated with higher risk for suicide

Suicide Risk factors

Age of onset (earlier onset= higher risk of suicide)
Gender (women more likely to have attempts but men are more
successful at completing suicide) Race/ ethnicity (American
Indian/ Alaskan natives have highest rates; lowest rates among
Hispanic and African Americans) Sexual orientation (LGB
more likely to attempt and commit suicide) Biology/
genetics (relative of suicide victims are 2-6x more timely to
complete suicide themselves) Mental disorders (attempts and
completed suicide very rare in absence of major mental dx)

CBT treatment with depression

Behavioral assignment, modification of dysfunctional thinking,
attempts to change schemata IDs, challenges, and modifies
negative schemata to generate less (-) info processing
Changing thoughts protects again future depression Aim=
symptom reduction

ACT treatment of depression

Acceptance and Commitment Therapy (ACT) Combines
cognitive and behavioral components But based on relational
frame theory (theory of language and cognition) 6
components: acceptance, defusion, contact with present moment, self
as context, values, committed action Aim= increased
psychological flexibility

Acute treatment of manic episodes in bipolar

Medications control mood swings, manage recurrences, and reduce
risk of suicide Lithium Valproate

Acute treatment of depressive episode in a bipolar context

Can be controversial= antidepressants can send person into
manic episodes; antidepressants may cause rapid cycling
Mood stabilizers are often used (lithium or valproate) in
combination with antidepressants. The dosage of the antidepressant
might be titrated down once the symptoms start to resolve (and will
eventually be discontinued( Antipsychotic meds may be used
if there are psychotic symptoms present

Phobic behavior

Vary widely in object, severity, generality Great
variation in the number, kinds, and patterning of individuals�
phobias Can be accompanied by sad mood, panic attacks,
somatic concerns, and many others

Compulsive behavior

Carried out one or more action far beyond reason and with a
feeling of being compelled to do so Include cleaning, hand
washing, repeating, checking, counting, arranging, hoarding
Can involve elaborate time-consuming rituals that have a
symbolic function (Rather than practical effect)
Accompanied by obsessions, feelings of fear/ discomfort that
declines with the behavior, idea that compulsions prevent harm,
recognitions that behavior is unreasonable

What are troubling thoughts and how do they fit in with anxiety disorders?

Aversive, intrusive thoughts that are difficult to control
Excessive worries, obsessive preoccupations Slow
elements of both worries and obsessions Some people engage
in compulsions in response to troubling thoughts And some
people are phobic of situations that may cause these troubling
thoughts and thus might require compulsions The compulsion
or neutralizing rituals might actually increase the thought�s
frequency