PSYC30014 Lecture Notes - Lecture 7: William Styron, Major Depressive Episode, Psychomotor Agitation
18 Jun 2018
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Lecture 7
- Affect - mood or emotion
- Types of mood disorders:
- Unipolar - one polar mood i.e. depression → further divided into Major Depressive
Disorder or Dysthymia
- Bipolar - two polar moods fluctuating between periods of depression and mania →
further divided into Bipolar I, Bipolar II or Cyclothymia
-
- Mood tends to vary throughout course of day in response to what’s going on around
us, levels of fatigue, something we might ingest
- Our mood can fluctuate from feeling down to feeling happy to feeling 50/50 okay
- Most of the times: our mood is between range of normal happiness and normal
sadness, movement of mood can be rapid
- Depression: recognised by Egyptians; Hippocrates (people thought that mental
illnesses were due to having too much of certain types of bodily fluids; depression =
toxic overabundance of black bile, treatment = abstinence from all excesses)
- Depression: normal human emotion (characterised by feelings of sadness, despair,
or unhappiness)
- Grief [a type of depression or sadness]: appropriate affective sadness in response to
recognised external loss (realistic, appropriate to what has been lost, self-limiting
[aka uncomplicated bereavement]) [can be concerned if experience is prolonged, out
of proportion to what we think would be a normal response to loss]
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- Clinical vs ‘normal’ depression:
- → Intensity (the mood change pervades all aspects of the person and impairs social
and occupational function); “The pain is unrelenting, one does not abandon, even
briefly, one’s bed of nails but is attached to it wherever one goes” William Styron,
Darkness Visible; “You think of a day where you're really, really sad. Times that by
20. And that's what depression is. It's really, really horrifying.”; “If I had to choose
again, I would prefer to avoid the pain of depression. It is a surprisingly physical
sensation with a surprising resemblance to coronary pain, because it too is total. But
it cannot be relieved quickly. It even threatens life. It is oneself and not part of one’s
machinery, a form of total paralysis of desire, hope, capacity to decide what to do, to
think or to feel except pain and misery” Dr John Horder [had a number of physical
and mental health problems - renal colic, heart attack, episode of major depression]
- → Absence of precipitants: mood may develop in the absence of any discernible
precipitants or be grossly out of proportion to precipitants, [could be easily identified
precipitant]
- → Quality: the mood change is different from that experienced in normal sadness
[feeling of lack of energy, heaviness, murkiness, palpable difference]
- → Associated features: the mood change might be accompanied by a cluster of
signs and symptoms including somatic and cognitive features [changes to sleep,
fatigue easily and need to sleep a lot or can’t sleep, rumination (thinking about
something over and over again, is there something that needs to be shifted), appetite
change (not being able to eat or overeating accompanied by weight loss or weight ⇒
gain), feeling/thinking - not being able to make decisions, feeling like thinking is
slowed down (takes much longer to get to a point of being able to make resolution
about something), not thinking clearly (not following plot of something, drifting away
while watching tv), low self-esteem (nothing good ever happens to me, feel
worthless/hopeless, can’t do anything right), psychomotor changes (feel like limbs
are heavy, more physical effort to do things), agitation]
- William Styron (experienced periods of suicidality): “Depression is: A noun with bland
tonality and lacking any magisterial presence, used indifferently to describe an
economic decline or a rut in the ground, a true wimp of a word for such a major
illness.” Darkness Visible (1992)
- Sylvia Plath: “ [a] time of darkness, despair, and disillusion -- so black only as the
inferno of the human mind can be -- symbolic death, and numb shock -- then the
painful agony of slow rebirth and psychic regeneration.”
- DSM V: Disruptive Mood Dysregulation Disorder; Major Depressive Disorder;
Persistent Depressive Disorder (Dysthymia); Premenstrual Dysphoric Disorder;
Substance/Medication-induced Depressive Disorder; Depressive Disorder due to
Another Medical Condition; Other Specified Depressive Disorder; Unspecified
Depressive Disorder
- Disruptive Mood Dysregulation Disorder (new disorder in DSM V, can only be
diagnosed in children):
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-A.Severe recurrent temper outbursts manifested verbally (e.g., verbal rages) and/or
behaviorally (e.g., physical aggression toward people or property) that are grossly out
of proportion in intensity or duration to the situation or provocation.
-B.The temper outbursts are inconsistent with developmental level (2-3 yo are prone
to outbursts when frustrated or something is preventing them from doing what they
want, over and above in terms of intensity and frequency in comparison to such
outbursts; accompanied by low, irritable mood all the time, not seen in kids normally)
-C.The temper outbursts occur, on average, three or more times per week.
-D.The mood between temper outbursts is persistently irritable or angry most of the
day, nearly every day, and is observable by others (e.g., parents, teachers, peers).
- In DSM V because:
- Increase in diagnosis of bipolar disorder in children noticed in late 90’s through to ⇒
2000’s;
- No criteria for [bipolar disorder] diagnosis in children has been clearly established;⇒
- Researchers made up criteria - replacing manic or hypomanic episode (adult) with ⇒
irritability and anger
- At the same time - new antipsychotics released - thought to be beneficial for ⇒
bipolar [esp for adults] - so clinicians started prescribing
- Controversy: potentially pathologises normal children’s behaviour; diagnosis for
aggression and temper problems that will restrict clinicians from looking further than
the child being the source of behaviours; if label something → thought to do with
child instead of looking more broadly at environment around the child etc
- Major Depressive Disorder: Five (or more) of the following symptoms over a 2-week
period representing a change from previous functioning [episodic disorder; can’t be
applied to children under age of 6; extreme end in depression continuum]:
- ⇒Depressed mood most of the day, nearly every day;
- ⇒ Markedly diminished interest or pleasure in activities;
- ⇒ Significant weight loss when not dieting or weight gain [appetite change];
- Insomnia or hypersomnia nearly every day [sleep change];⇒
- Psychomotor agitation or retardation;⇒
- ⇒ Fatigue or loss of energy;
- ⇒ Feelings of worthlessness or excessive/inappropriate guilt;
- ⇒ Diminished ability to think or concentrate, or indecisiveness;
- ⇒ Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation, or
a suicide attempt or a specific plan for committing suicide.
- Persistent Depressive Disorder [can be associated with higher levels of dysfunction
and disability than episodic experiences of depression, used to be called dysthymic
disorder in DSM IV]:
- - Depressed mood for most of the day, for more days than not, as indicated by either
subjective account or observation by others, for at least 2 years
- - Presence, while depressed, of two (or more) of the following:
- Poor appetite or overeating↦
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