3.4 Affective Disorders
Lecture 1 - Introduction and depression I
Learning goals of week 1 and 2
● Identify the characteristics of Major Depressive Disorder (MDD)
● Distinguish between depressive symptoms and other emotional states
● Identify various etiologies (causes) of MDD
○ Compare and distinguish different features of MDD including
- Prevalence and development of MDD
- Risk and prognostic factors in MDD
- Culture- and sex-/gender-related diagnostic issues in MDD
● Apply knowledge to clinical examples of MDD
● Evaluate, compare and distinguish various theoretical models explaining MDD
● Evaluate, compare and distinguish various treatment models for MDD
DSM-5 Criteria for Major Depressive Disorder (MDD)
● Five (or more) of the following symptoms have been present during the same 2-week period and
represent a change from previous functioning; at least one of the symptoms is either 1) depressed
mood or 2) loss of interest or pleasure
○ Significant weight loss when not dieting or weight gain or decrease/increase in appetite
nearly every day
○ Insomnia or hypersomnia nearly every day
○ Psychomotor agitation (being energetic) or retardation (very slow in movement) nearly every
day (observable by others, not merely subjective feelings of restlessness or being slowed
down)
○ Fatigue or loss of energy nearly every day
○ Feelings of worthlessness or excessive or inappropriate guilt nearly every day
○ Diminished ability to think or concentrate, or indecisiveness, nearly every day
○ Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide
attempt or a specific plan for committing suicide
- Always check for suicidality!
● The symptoms cause clinically significant distress or impairment in social, occupational, or other
important areas of functioning
● The episode is not attributable to the physiological effects of a substance or another medical
condition
● The occurrence of the episode is not better explained by another psychiatric condition
Symptom 9: Suicidal Identification
Recurrent thoughts of death and/or recurrent suicidal ideation without a specific plan
→ 1) Passive Suicidal Ideation
● Passive thoughts involve a general desire to not exist or to escape from life’s difficulties without any
specific plans or intentions to act on those thoughts
● It’s not a crisis situation yet; a lot of people experience these passive thoughts
● Example: philosophical or existential thoughts about the nature of life, but also wishing to fall asleep
and not wake up, feeling that life is not worth living, or thinking about disappearing or ceasing to exist
1
,A specific plan for commiting suicide and/or suicide attempt
→ 2) Active Suicidal Ideation
● Specific contemplation or planning about committing suicide → might include thinking about methods,
timing, or envisioning the act itself
● Example: thinking about ways to end one’s life, considering specific means (overdose, self-harm, etc.)
and planning how and when to carry it out
Persistent Depressive Disorder (Dysthymia)
Represents a consolidation of DSM-IV-defined chronic major depressive disorder and dysthymic disorder
● Depressed mood for most of the day, for more days than not, for at least 2 years
○ Children and adolescent: at least 1 year
● Presence, while depressed, of two (or more) of the following
○ Poor appetite or overeating
○ Insomnia or hypersomnia
○ Low energy or fatigue
○ Low self-esteem
○ Poor concentration or difficulty making decisions
○ Feelings of hopelessness
● During the 2-year period, the individual has never been without the symptoms in criteria A and B for
more than 2 months at a time
● Criteria for MDD may be continuously present for 2 years
● There has never been a manic episode or hypomanic episode, and criteria have never been met for
cyclothymic disorder
● The disturbance is not better explained by other psychotic disorders
● The symptoms are not attributable to the physiological effects of a substance or another medical
condition
● The symptoms cause clinically significant distress or impairment in social, occupational, or other
important areas of functioning
Differences between MDD and dysthymia
MDD Dysthymia
Duration of symptoms At least 2 weeks Lasting for at least two years
Severity More severe Chronic but milder form
Stronger impact on person’s life Less (but still significant) impact
on person’s life
Pattern/cause Distinct periods without Can fluctuate in intensity but are
symptoms consistently present
Episodes May experience recurrent Additional notes: individuals may
episodes throughout life also have periods of more severe
symptoms that meet the criteria
for MDD → “double depression”
Theories on depression
● Serotonin theory
● Contemporary Integrative Interpersonal Theory (CIIT)
● Beck’s Cognitive theory
2
, Contemporary Integrative Interpersonal Theory (CIIT)
● Humans are social creatures
○ Interpersonal dynamics
● Grounded in personality theory
● Many forms of psychopathology are associated with interpersonal impairment, not just depression
● Seeks to explain the emergence, expression, and maintenance of interpersonal functioning and
dysfunction
● The field of psychopathology is transitioning away from discrete categories of mental disorders and
shifting toward understanding psychopathology using dimensions that cut across traditional
diagnoses
● Interpersonal factors are associated with therapeutic alliance and therapeutic outcome
Interpersonal theory
1. The most important expressions of personality occur in interpersonal situations
2. Interpersonal functioning can be organized using the dimensions of agency and
communion
● Motives: want to be in control, want to be close to others, etc.
● Traits: personality
● Behaviors: day to day behaviour
→ They influence each other
3. The interpersonal circumplex model organizes interpersonal functioning across
levels of experience
4. Satisfying agentic and communal motives drives interpersonal behavior
5. The interpersonal transaction cycle provides expectations for and predictions about behavior
6. Sustained deviations from expected behavior reflect psychopathology
Agency (boven en onder) Communion (links en rechts)
Values/needs Achievement Connection
Motives Control Closeness
Traits Dominance Nurturance
Behaviors Directive/assertive Friendly/agreeable
Strength/abilities Lead Love
Problems Domineering Self-sacrificing
The top influences the bottom
However, cold influences cold and warm influences warm
3
Lecture 1 - Introduction and depression I
Learning goals of week 1 and 2
● Identify the characteristics of Major Depressive Disorder (MDD)
● Distinguish between depressive symptoms and other emotional states
● Identify various etiologies (causes) of MDD
○ Compare and distinguish different features of MDD including
- Prevalence and development of MDD
- Risk and prognostic factors in MDD
- Culture- and sex-/gender-related diagnostic issues in MDD
● Apply knowledge to clinical examples of MDD
● Evaluate, compare and distinguish various theoretical models explaining MDD
● Evaluate, compare and distinguish various treatment models for MDD
DSM-5 Criteria for Major Depressive Disorder (MDD)
● Five (or more) of the following symptoms have been present during the same 2-week period and
represent a change from previous functioning; at least one of the symptoms is either 1) depressed
mood or 2) loss of interest or pleasure
○ Significant weight loss when not dieting or weight gain or decrease/increase in appetite
nearly every day
○ Insomnia or hypersomnia nearly every day
○ Psychomotor agitation (being energetic) or retardation (very slow in movement) nearly every
day (observable by others, not merely subjective feelings of restlessness or being slowed
down)
○ Fatigue or loss of energy nearly every day
○ Feelings of worthlessness or excessive or inappropriate guilt nearly every day
○ Diminished ability to think or concentrate, or indecisiveness, nearly every day
○ Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide
attempt or a specific plan for committing suicide
- Always check for suicidality!
● The symptoms cause clinically significant distress or impairment in social, occupational, or other
important areas of functioning
● The episode is not attributable to the physiological effects of a substance or another medical
condition
● The occurrence of the episode is not better explained by another psychiatric condition
Symptom 9: Suicidal Identification
Recurrent thoughts of death and/or recurrent suicidal ideation without a specific plan
→ 1) Passive Suicidal Ideation
● Passive thoughts involve a general desire to not exist or to escape from life’s difficulties without any
specific plans or intentions to act on those thoughts
● It’s not a crisis situation yet; a lot of people experience these passive thoughts
● Example: philosophical or existential thoughts about the nature of life, but also wishing to fall asleep
and not wake up, feeling that life is not worth living, or thinking about disappearing or ceasing to exist
1
,A specific plan for commiting suicide and/or suicide attempt
→ 2) Active Suicidal Ideation
● Specific contemplation or planning about committing suicide → might include thinking about methods,
timing, or envisioning the act itself
● Example: thinking about ways to end one’s life, considering specific means (overdose, self-harm, etc.)
and planning how and when to carry it out
Persistent Depressive Disorder (Dysthymia)
Represents a consolidation of DSM-IV-defined chronic major depressive disorder and dysthymic disorder
● Depressed mood for most of the day, for more days than not, for at least 2 years
○ Children and adolescent: at least 1 year
● Presence, while depressed, of two (or more) of the following
○ Poor appetite or overeating
○ Insomnia or hypersomnia
○ Low energy or fatigue
○ Low self-esteem
○ Poor concentration or difficulty making decisions
○ Feelings of hopelessness
● During the 2-year period, the individual has never been without the symptoms in criteria A and B for
more than 2 months at a time
● Criteria for MDD may be continuously present for 2 years
● There has never been a manic episode or hypomanic episode, and criteria have never been met for
cyclothymic disorder
● The disturbance is not better explained by other psychotic disorders
● The symptoms are not attributable to the physiological effects of a substance or another medical
condition
● The symptoms cause clinically significant distress or impairment in social, occupational, or other
important areas of functioning
Differences between MDD and dysthymia
MDD Dysthymia
Duration of symptoms At least 2 weeks Lasting for at least two years
Severity More severe Chronic but milder form
Stronger impact on person’s life Less (but still significant) impact
on person’s life
Pattern/cause Distinct periods without Can fluctuate in intensity but are
symptoms consistently present
Episodes May experience recurrent Additional notes: individuals may
episodes throughout life also have periods of more severe
symptoms that meet the criteria
for MDD → “double depression”
Theories on depression
● Serotonin theory
● Contemporary Integrative Interpersonal Theory (CIIT)
● Beck’s Cognitive theory
2
, Contemporary Integrative Interpersonal Theory (CIIT)
● Humans are social creatures
○ Interpersonal dynamics
● Grounded in personality theory
● Many forms of psychopathology are associated with interpersonal impairment, not just depression
● Seeks to explain the emergence, expression, and maintenance of interpersonal functioning and
dysfunction
● The field of psychopathology is transitioning away from discrete categories of mental disorders and
shifting toward understanding psychopathology using dimensions that cut across traditional
diagnoses
● Interpersonal factors are associated with therapeutic alliance and therapeutic outcome
Interpersonal theory
1. The most important expressions of personality occur in interpersonal situations
2. Interpersonal functioning can be organized using the dimensions of agency and
communion
● Motives: want to be in control, want to be close to others, etc.
● Traits: personality
● Behaviors: day to day behaviour
→ They influence each other
3. The interpersonal circumplex model organizes interpersonal functioning across
levels of experience
4. Satisfying agentic and communal motives drives interpersonal behavior
5. The interpersonal transaction cycle provides expectations for and predictions about behavior
6. Sustained deviations from expected behavior reflect psychopathology
Agency (boven en onder) Communion (links en rechts)
Values/needs Achievement Connection
Motives Control Closeness
Traits Dominance Nurturance
Behaviors Directive/assertive Friendly/agreeable
Strength/abilities Lead Love
Problems Domineering Self-sacrificing
The top influences the bottom
However, cold influences cold and warm influences warm
3
