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Lecture

PSY 325 OCT 26 2012.doc

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Department
Psychology
Course
PSY 325
Professor
Karen Milligan
Semester
Fall

Description
PSY 325 L7 10/26/12 **ADDED IN LECTURE CLASS #7: MOOD DISORDERS PSY325, SECTION 2 LEARNING OBJECTIVES STUDENTS WILLLEARN: • DIFFERENCE BETWEEN DISTRESSAND MOOD DISORDERS • DIAGNOSTIC CRITERIAAND COURSE OF MOOD DISORDERS, NAMELY • MDD, DYSTHMIADISORDER, AND BIPOLAR DISORDER • BIOLOGICALTHEORIES OF MOOD DISORDERS AND THEIR ASSOCIATED TREATMENTS • PSYCHOLOGICAL(BEHAVIOURALAND COGNITIVE) THEORIES OF MOOD DISORDERAND THEIRASSOCIATED TREATMENTS • TYPES OF SUICIDE, WARNING SIGNS,AND DIFFERENCE WITH NON- SUICIDAL SELF-HARM BEHAVIOURS MOOD DISORDERS • DEVIATIONS IN MOOD ◦ DEPRESSION ◦ MANIA • UNIPOLAR DEPRESSION ◦ MAJOR DEPRESSIVE DISORDER ◦ DYSTHYMIC DISORDER • BIPOLAR DEPRESSION WATCH ELLIE'S DEPRESSION ON YOUTUBE FORANALOGY 1 PSY 325 L7 DSM-IV CRITERIA MAJOR DEPRESSIVE DISORDER • A. FIVE (OR MORE) OFTHE FOLLOWING SYMPTOMS HAVE BEEN PRESENT DURING THE SAME 2-WEEK PERIODAND REPRESENT ACHANGE FROM PREVIOUS FUNCTIONING;AT LEAST ONE OFTHE SYMPTOMS IS EITHER • (1) DEPRESSED MOOD MOST OF THE DAY, NEARLY EVERY DAY, AS INDICATED BY EITHER SUBJECTIVE REPORT (E.G., FEELS SAD OR EMPTY) OR OBSERVATION MADE BY OTHERS (E.G., APPEARS TEARFUL). NOTE: IN CHILDRENAND ADOLESCENTS, CAN BE IRRITABLE MOOD. (2) MARKEDLY DIMINISHED INTEREST OR PLEASURE INALL, ORALMOSTALL, ACTIVITIES MOST OFTHE DAY, NEARLY EVERY DAY (AS INDICATED BY EITHER SUBJECTIVE ACCOUNT OR OBSERVATION MADE BY OTHERS) • OTHER SYMPTOMS ARE COGNITIVE, BEHAVIOURAL,AND PHYSIOLOGICALIN NATURE DSM IV CRITERIACON’T ̈ • B. THE SYMPTOMS DO NOT MEET CRITERIAFORAMIXED EPISODE. C. THE SYMPTOMS CAUSE CLINICALLY SIGNIFICANT DISTRESS OR IMPAIRMENT IN SOCIAL, OCCUPATIONAL, OR OTHER IMPORTANTAREAS OF FUNCTIONING. D. THE SYMPTOMS ARE NOT DUE TO THE DIRECT PHYSIOLOGICALEFFECTS OFA SUBSTANCE (E.G., ADRUG OFABUSE, AMEDICATION) ORAGENERAL MEDICAL CONDITION (E.G., HYPOTHYROIDISM). E. THE SYMPTOMSARE NOT BETTERACCOUNTED FOR BY BEREAVEMENT, I.E., AFTER THE LOSS OFALOVED ONE, THE SYMPTOMS PERSIST FOR LONGER THAN 2 2 PSY 325 L7 MONTHS ORARE CHARACTERIZED BY MARKED FUNCTIONAL IMPAIRMENT, MORBID PREOCCUPATION WITH WORTHLESSNESS, SUICIDALIDEATION, PSYCHOTIC SYMPTOMS, OR PSYCHOMOTOR RETARDATION. COMMON COMORBID DISORDERS • MORE THAN HALF MEET CRITERIAFORANOTHER DISORDER • MAY BE PRIMARY OR SECONDARY • TWO MOST COMMON COMORBID DISORDERS ◦ SUBSTANCE ABUSE ◦ ANXIETY DISORDERS ( THOUGHT QUESTION POST PARTIUM DEPRESSION-1ST FOUR WEEKS AFTER HAVING BABY WHATARE THE EFFECTS OF PPD ON THE INFANT? WOULD PPD EFFECT MOTHER- INFANT RELATIONSHIP? COURSE OF DEPRESSION • LONG-LASTING • RECURRENT • PEOPLE WITH MDD SPENTAVERAGE OF 16 WEEKS WITH SIGNIFICANT SYMPTOMS (KESSLER ETAL, 2003) • PEOPLE WHO EXPERIENCE MULTIPLE EPISODESARE MORE LIKELYTO BE DEPRESSED FOR LONGER PERIODS OFTIME 3 PSY 325 L7 • COSTLY • DEPRESSION IN CHILDREN • LESS COMMON IN CHILDREN (2.5%, HIGHER IN ADOLESCENTS) • MAY SHOW IRRITABLE RATHER THAN SAD MOOD • IMPACT ON SELF-CONCEPTAND VIEW OF SELF • IMPACT ON LEARNINGANDACHIEVEMENT • STRESS GENERATION MODELS (E.G., HAMMEN, 1992) DYSTHYMIC DISORDER-NOT VERY COMMON BUT LONG LASTING THOUGHT QUESTION 2 DOES DEPRESSION CAUSE YOUTH/ YOUNG ADULTS TO SEEK OUTAN ESCAPE WITH DRUGS? TREATMENT CAN IMPACT ON COURSE OF MDD • TREATMENT = FASTER RECOVERY, REDUCED RISK OF RELAPSE (KESSLER ETAL., 2003). • ENDURING PROBLEMS IN MANYAREAS OFTHEIR LIVES (BOLAND & KELLER, 2002). 4 PSY 325 L7 BIPOLAR DEPRESSION ̈ • CASE STUDYVIDEO • IN CANADA1.7 /100 PEOPLE • TYPICALLY DEVELOPS IN LATE ADOLESENCE OR EARLYADULTHOOD • APPROXIMATELY 50% OFTHOSE DIAGNOSED SYMPTOMS OF MANIA ELEVATED, EXPANSIVE, OR IRRITABLE MOOD FORAT LEAST ONE WEEK, PLUSAT LEAST THREE OFTHE FOLLOWING: • ELEVATED, EXPANSIVE, OR IRRITABLE MOOD • INFLATED SELF-ESTEEM OR GRANDIOSITY • DECREASED NEED FOR SLEEP • MORE TALKATIVE THAN USUAL, APRESSURE TO KEEPTALKING • FLIGHT OF IDEAS OR SENSE THATYOUR THOUGHTSARE RACING • DISTRACTIBILITY • INCREASE INACTIVITY DIRECTEDATACHIEVING GOALS • EXCESSIVE INVOLVEMENT IN POTENTIALLY DANGEROUS ACTIVITIES TYPES OF BIPOLAR DISORDERS • BIPOLAR I DISORDER ◦ ALTERNATIVE BETWEEN MAJOR DEPRESSIVE EPISODES & MANIC EPISODES • BIPOLAR II DISORDER ◦ SIMILAR TO BIPOLAR 1 BUT EXPERIENCE HYPOMANIARATHER THAN MANIA • CYCLOTHYMIC DISORDER ◦ ALTERNATIVE BETWEEN SUB-THRESHHOLD DEPRESSIVE SYMPTOMS & HYPOMANIA ►RAPID CYCLING BIPOLAR DISORDER (4+ CYCLES/YEAR) COURSE • PREDICTORS OF RECOVERY – MEDICATION COMPLIANCE, SOCIALCLASS (ACCESS TO CARE AND SUPPORT). 5 PSY 325 L7 • ASSOCIATED WITH CHALLENGES IN OCCUPATIONALAND SOCIALFUNCTIONING (MARANGELL, 2004) • SUBSTANCE ABUSE IS COMMON (GOODWIN ETAL., 1998) BIPOLAR DISORDER IN CHILDREN • INCREASINGLY BEING DIAGNOSED • CONTROVERSIAL • LENGTH OFAN EPISODE • ADHD VS HYPOMANIA– NEEDS TO BEACHANGE FROM THE USUAL • DSM-V ISADDRESSING THROUGH NEW DIAGNOSTIC CATEGORY► TEMPER DYSREGULATION DISORER ► DISRUPTIVE MOOD DISREGULATION DISORDER MOOD DISORDERS: BIOLOGICALCONTRIBUTIONS • GENETICS • NEUROTRANSMITTERS • STRUCTURALABNORMALITIES • ENDOCRINE SYSTEM/HORMONES MOOD DISORDERSAND GENETICS • 2-3 X GREATER RISK FOR UNIPOLAR DEPRESSIONAND BIPOLAR DEPRESSION • FAMILY HISTORY OF DEPRESSION IS NOTASSOCIATED WITH GREATER RISK FOR BIPOLAR – DIFFERENT GENETIC BASIS. • BELIEVED TO BE MULTIFACTORIAL(NUMBER OF GENES INVOLVED) • SEROTONIN TRANSPORTER GENE (SOUTHWICK ETAL., 2005) • SYMPTOM SPECIFIC MONOAMINE THEORIES • DEPRESSIONAND MANIAIS RELATED TO THEAMOUNT OF NEUROTRANSMITTERSAT THE SYNAPSE OR THE NUMBERAND 6 PSY 325 L7 FUNCTIONING OFTHE RECEPTORS ◦ DEPRESSION ◦ MANIA – LOWER LEVELS OF SEROTONIN, NOREPINEPHRINE – HIGHER LEVELS OR DYSREGULATION, PARTICULARLY WITH DOPAMINE DEPRESSIONAND BRAIN STRUCTURE -STRESS CAUSES INCREASED RELEASE IN CORTISOL(CAUSES ISSUES WITH REUPTAKE) -THE MORE CORTISOLTHE MORE DEPRESSION -MAY CAUSE YOU TO BURN OUT PSYCHOLOGICALTHEORIES • BEHAVIOURALTHEORY OF DEPRESSION (LEWINSOHN & GOTLIB) • LEARNED HELPLESSNESS THEORY (SELIGMAN) • COGNITIVE THEORY (BECK) BEHAVIOURALTHEORY 7 PSY 325 L7 • AVAILABILITY OF POSITIVE REINFORCERS INAPERSON'S LIFE • STRESS REDUCES THESE REINFORCERS THEREBY INCREASING RISK LEARNED HELPLESSNESS THEORY (SELIGMAN, 1975) DOG EXPERIMENT REFORMULATED LEARNED HELPLESSNESS THEORY • FOCUS IN ON CAUSALATTRIBUTIONS – THOUGHTS ABOUT WHY A NEGATIVE EVENT HAPPENED. • INTERNAL/EXTERNAL • STABLE/UNSTABLE • GLOBAL/SPECIFIC • INCREASED RISK FOR MAJOR DEPRESSIVE DISORDER 8 PSY 325 L7 RUMINATIVE RESPONSE STYLES THEORY • FOCUS IS ON THE PROCESS RATHER THAN THE CONTENT OF THINKING • RUMINATION – MORE SERVERELY DEPRESSED OVER TIME • MAY CONTRIBUTE TO HIGHER RATES OF DEPRESSION IN WOMEN (NOLEN-HEOKSEMAETAL., 1999) INTERPERSONALTHEORIES OF DEPRESSION • STEMS FROMATTACHMENT THEORY • INSECURE ATTACHMENT LEADS TO NEGATIVE WORKING MODELS OF RELATIONSHIPS • ENGAGE IN EXCESSIVE REASSURANCE SEEKING •
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