Is he mentally ill?

5 symptoms nearly everyday for 2 weeks

• 5 symptoms nearly everyday for 2 weeks

• Must have either sad, depressed mood or anhedonia

• Difficulties sleeping

• Shift in activity level

• Poor appetite with weight loss or increased appetite with weight gain

• Loss of energy or fatigue

• Negative self-concept

• Difficulty concentrating

• Recurrent thoughts of death or suicide

• Lifetime prevalence—about 17 %, though some estimates are as low as 4-5%

• 90% recover in a year, but ¾ of cases will recur (average duration of an untreated episode is 8-10 months)

• Typical onset is age 24-29

• Symptoms of anxiety are common (not factor analytically distinct in children)

Melancholic features—more severe type, loss of pleasure, more of a genetic loading

• Melancholic features—more severe type, loss of pleasure, more of a genetic loading

• Psychotic features—hallucinations and delusions tend to be content appropriate

• Atypical features—mood reactivity (brightens at times in response to events).

• May respond better to MAOIs than other subtypes

• Seasonal pattern (AKA Seasonal affective disorder)

Genetic influences

• Genetic influences

• 3x more common among blood relatives
• MZ concordance—46 %, DZ 20%

• Biochemical factors

• Low levels of norephinephrine and serotonin have been linked to depression
• Some theorists look to a balance of these two, dopamine and acetylcholine

• Hormonal regulatory systems

• Hypothalamic-pituitary-adrenal axis
• --elevated levels of cortisol in 60-80% of severely depressed hospitalized pts
• Hypothalamic-pituitary-thyroid axis
• --20-30% of depressed with normal thyroid show dysregulation here. Increasing thyroid hormone levels may help

• Sleep and other rhythms

• Greater amounts of REM sleep, enter it earlier in night
• Circadian rhythms may be out of sync, particularly in SAD

Psychoanalytic

• Psychoanalytic

• Freud
• More recent analytic work—Bowlby’s attachment theory

• Beck’s cognitive theory

• Depressogenic schemas/Dysfunctional beliefs
• Beliefs predispose a person to depression
• Develop in childhood and adolescences as a function of negative experiences with parents and sig others
• Activated by current stressors or depressed mood—create a pattern of automatic negative thoughts
• Negative cognitive triad—self, world and future
• Negative cognitive biases—
• Arbitrary inferences
• Selective abstraction
• Overgeneralization—overall, sweeping conclusions
• Magnification and minimization
• Dichotomous or all-or-none thinking
• Support for Beck’s theory—strong support as a descriptive theory, mixed but positive support as a causal theory

Helplessness and Hopelessness theories of depression

• Helplessness and Hopelessness theories of depression

• Learned helplessness—individual’s passivity and sense of being unable to act and control life is acquired through unpleasant experiences
• Revisions—attribution theory—Global, stable, internal

• Hopelessness-expectation that desirable outcomes will not occur. Has generated a

• lot of research.

• Interpersonal theory

• Social support
• Depressed people elicit negative reactions
• Depressed people seek other depressed people and bring others down, too

• Stressful life events

• Severely stressful life events play a causal role in 20-50% of cases
• Risk and resilience

• Personality risk factors

• Neuroticism
• Introversion
• Negative patterns of thinking

Cyclothymia—cycles between hypomania and depression

• Cyclothymia—cycles between hypomania and depression

• Mild form of major bipolar disorder

• Bipolar Disorders (I and II)

• Kraepelin 1899—manic-depressive insanity
• Bipolar I
• One episode of mania or mixed episode
• Bipolar II
• Hypomania
• More common than bipolar I

Symptoms of depression are almost identical to that of major depression

• Symptoms of depression are almost identical to that of major depression

• Suicide attempts may be more common in bipolar

• May be misdiagnosed (until first mania appears)

• Rapid cycling in 5-10%

• 24 % relapse in 6 mos, 77 % have a new episode in 4 yrs, 82 % by 7 yrs

• Onset typically in early 20s

Genetic influences

• Genetic influences

• Account for 80-90% of the variance
• About 70% of heritability is distinct from unipolar
• Polygenic

• Neurotransmitters

• Increased levels of dopamine may be related to mania
• Abnormalities in how ions are transported across neural membranes (this is where lithium helps)

• Some differences in brain structures—enlarged basal ganglia and amygdale

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