1. Mood Disorders

3. Mood Disorders Characterised by disturbances in emotion and mood. Can be relatively mild or extreme Most cases negative, but can also be dangerously positive – manic state During manic episodes, people feel excessively happy and believe they can do anything.

4. Mild Mood Disorders Dysthymia– Greek for “bad spirit” Moderate depression that lasts for two years or more with intervals of normal moods that never last more than a few weeks or months and is typically a reaction to some external stressor. Cyclothymia – “spirit that moves in circles” Disorder that consists of mood swings from moderate depression to hypomania and lasts two years or more. Both usually begins in childhood or adolescence and includes times of normal feelings that may last less than two months at a time.

5. Extreme/Severe Major Depression. Most common of the diagnosed mood disorders and is about twice as common in women as it is in men (APA, 2000). Possible explanations – hormonal structure of the female system (little support), different social roles played by women in the culture. Degree of differences between sexes is < and non existent in college students and single adults.

6. Major Depressive Disorder Most severe form of depression. Characterised by depressed mood and loss of interest in pleasurable activities (anhedonia). Includes disturbances in appetite, sleep, energy level and concentration, feelings of worthlessness, preoccupied with suicidal thoughts and so fatigued that they sleep day and night or cannot go to work or do chores. Major depressive episodes typically last about five months.

7. Prevalence 1 in 5 Australians experience from depression at some point in their lives At any given time, around 5.1% of Australians suffer from major depression (AIHW, 1999) – about 3.4% of men and 6.8% of women. Vast majority of patients who experience a major depressive episode will have one or more recurrences within 5-15 years. Prevalence decreases as we get older, however, those living in residential care experience twice the level of depressive symptoms as those living in the general community

8. Risk factors Social isolation, unemployment, loss of loved one, breakup of a relationship, school failure. Linked to tobacco use, illicit drug use, alcohol misuse and dependence, eating disorders and obesity (AIHW) In childhood: parents who suffer from depression, loss of a parent, abuse, neglect. Higher rates among Aboriginal and Torres Strait Islander people, those living in rural and remote areas, people with physical illnesses and among veterans and defence services personnel

9. Indigenous Australians Swan and Raphael (1995) highlighted trauma, loss and grief as the most significant problems identified by Indigenous Australians. Problems derived from history of invasion, incarceration, forced separation of children from parents, deaths in custody and a range of other traumas.

10. Bipolar Disorder Characterised by severe mood swings that go all the way from severe depression to manic episodes. Unlike cyclothymia, there is usually no external cause for the extremity of mood. Depressive phases are indistinguishable from major depression, but give way to manic episodes that may last from a few weeks to a few months. During the manic episodes, the person is often restless, irritable, have difficulty sitting still/inactive and seem to have unlimitted energy. Speech may be rapid.

11. ADHD link? Ongoing debate/controversy. Seems to be a connection between ADHD and onset of bipolar in adolescence, but only a small percentage of children with ADHD go on to develop bipolar. Symptoms of irrational thinking and other manic symptoms are not present in ADHD

12. Causes of Mood disorders Psychoanalytic theorists: depression as anger (originally aimed at parents/authority figures) turned inward on the person. The anger is repressed and later displaced to the self in the form of self-blame and self-hate

13. Causes: Cognitive Theory Links depression with learned helplessness. The helplessness theory suggests the way people feel depends on the way they explain events or outcomes to themselves, particularly aversive event. E.g. jilted lover conclude they are unlovable. Depressed people differ in how negative their ideas about themselves and the world are, and the ways they manipulate and use information.

14. Beck’s Negative Triad Theory Outlook on world Cognitive distortions: Cognitive mechanisms by which a depressed person negatively transforms neutral or positive information Mood, motivation, behaviour leading to depressed mood, avoidance, suicidal wishes Outlook on self Outlook on future

15. Consider the following interaction… PATIENT: I can’t go back to school. I’m just not smart enough. THERAPIST: How did you do the last time you were in school? PATIENT: Um… I got mostly As. But that was a long time ago. And what have I ever done career-wise that suggests I could handle being a lawyer? THERAPIST: That’s not really a fair question is it? Don’t you think your low image of yourself has something to do with why you haven’t done anything ‘spectacular’ career-wise? PATIENT: I guess you’re right. I’m as smart as my sister and she’s a lawyer. THERAPIST: Right. PATIENT: But what have I ever done career-wise that says I could handle being a lawyer?

16. Biological Causes Neural Transmission: Effects of brain chemicals such as serotonin, norepinephrine and dopamine; drugs that increase the activity of these neurotransmitters decrease the symptoms of depression. Genetics: Most heritability estimates for major depression are in the range of 30-40%. Twin studies estimates heritability for bipolar disorder to be as high as 84% (Cardno, Marshall et al., 1999). Roughly 80-90% of bipolar patients have a family history of some mood disorder.