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Lecture 6

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PSYC 3390
Mary Manson

Unit 6 chapter Summary – Page 230-238, 238-252, 252-257, 257-267, 267-282 Mood disorders and suicide - Depression costs Canadians at leas4 14.4 billion annually in treatment, lost productivity and premature death What are mood disorders? - Two key moods involved in mood disorders are o Mania: intense and unrealistic feelings of excitement and euphoria o Depression: feelings of extraordinary sadness and dejection - Moods are at two different ends of the continuum with normal moods in the middle - Patients may show symptoms of mania and depression during the same time period - Unipolar disorders: only depressive episodes - Bipolar disorders: both manic and depressive episodes - Important to differentiate in terms of o Severity: number of dysfunctions experienced and the relative degree of impairment evidenced in those areas o Duration: whether the disorder is acute, chronic or intermittent - Major depressive episode: person must be markedly depressed for most of everyday and for most days for at least two weeks  also must show at least 3 or 4 other symptoms that range from cognitive symptoms to behavioural symptoms to physical symptoms o ** most common form of mood episode - Manic episode: markedly elevated, euphoric or expansive mood, often interrupted by occasional outbursts of intense irritability or even violence. o Must persist for at least a week for the diagnosis to be made o 3 or more additional symptoms must occur in the same time period, ranging from behavioural symptoms to mental symptoms where self-esteem is inflated and mental activity may speed up, to physical symptoms - Mild mood disturbances are on the same continuum as severe disorders (differences change to a degree, not of kind) - There are multiple different subtypes of both unipolar and bipolar disorders - Bipolar disorder is much less common Unipolar mood disorders - Mild and brief depression may actually be normal Depressions that are not mood disorders - Normal depressions are nearly always the result of recent stress Loss and grieving process - Psychological process one goes through following the death of a loved one o More difficult for men than for women - 4 phases of normal response to the loss of a spouse or close family member 1. Numbing and disbelief that may last from a few hours to a week and may be interrupted by outbursts of intense distress, anger or panic 2. Yearning and searching for the dead person which may last for weeks or months  restlessness, insomnia, and preoccupation with the dead person 3. Disorganization and despair that set in after yearning and searching diminish  finally accepts the loss as permanent and tried to establish a new identity 4. Some level of reorganization when people gradually begin to rebuild their lives, sadness abates, and zest for life returns Postpartum blues - Occurs in new mothers, following the birth of a child - Very common - Symptoms include o Emotional lability, crying easily, irritability, often liberally intermixed with happy feelings - Occurs in 50-70% of women within 10 days of the birth of their child - Does not represent a mental disorder - Hormonal readjustments may play a role in postpartum blues - Especially likely to occur if the new mother has a lack of social support and has difficulty adjusting to her new identity or who has a history of depression in their family Dysthymic disorder - Mild to moderate intensity primary hallmark is chronicity - Persistent depressed mood for most of the day, for more days than not for at least 2 years - Must have 2 of 6 symptoms when depressed - There are intermittent normal moods (distinguishes it from major depressive disorder - Quite common - Average duration is 5 years  could be up to 20 - Often begins in teenage years  over 50% have onset before the age of 21 Major depressive disorder - More symptoms than required for dysthymia and are more persistent - Must have depressed moods and loss of interest in pleasurable activities for most of the day  nearly everyday for at least two consecutive weeks - Must show 3 or 4 additional symptoms during the same period (listed in the DSM IV TR table) - Includes cognitive symptoms, behavioural symptoms and physical symptoms - ** there are very high levels of comorbidity between mood and anxiety disorders Depression throughout the life cycle - Previously thought that depression does not occur in children  more recent studies shows that it does (may even occur in infants if they are separated from their attachments figure) - 15-20% of adolescence experience a major depressive disorder at some point in their lives  may carry on to early adulthood - People who are disabled and living in nursing homes are significantly more depressed than older adults living at home Specifiers for major depression - Major depressive episode with melancholic features - Must experience 3 of the following o Lost interest in activities o Early morning awakenings o Depression being worse in the morning o Marked psychomotor retardation or agitation o Significant loss of appetite and weight o Inappropriate or excessive guilt o Depressed mood that is different from the sadness experienced during nonmelancholic depression - Severe major depressive episode with psychotic features o Any delusions or hallucinations present are mood congruent o Feelings of worthlessness and guilt o May be the delusional idea that ones internal organs are deteriorated o Likely to have porer long term prognosis o Reccuring episodes are also likely to be characterized by psychotic symptoms o Treatment = antipsycotic medication and antidepressants o Rare cases psychotic depression can be postpartum (mothers may kill their babies because of delusions that they have - Major depressive episode with atypical features o Mood reactivity  mood rises in response to potential positive events o Must show 2 or more of the following symptoms o Significant weight gain or increase in appetite o Hypersomnia (sleeping too much) o Leaden paralysis (heavy feelins in the arms and legs o Pattern of being acutely sensitive to interpersonal rejection o Mostly females o More likely to show suicidal thoughts - Double depression o Moderately depressed on a chronic basis but increased problems from time to time where they might meet the criteria of a major depressive episode o Nearly all individuals seem to recover , recurrence is common Depression as a recurrent disorder - Average duration of an untreated episode is about 6 months - When major depression does not remit for over two years chronic depressive disorder is diagnosed - Depressive episodes usually recur at some future point about 80% - Recurrence has been distinguished from relapse - Time period for recurrence is highly variable - Probability of recurrence increases with the number of prior episodes - Many people have lingering or residual depressive symptoms even though they no longer meet the criteria for a major depressive episode Seasonal affective disorder - Recurrent major depression with a seasonal pattern o The person must have had at least two episodes of depression in the past two years occurring at the same time of the year (most commonly fall or winter) o Remission must have also happened at the same time of the year o Person cannot have had other non-seasonal depressive episodes in the same two year period o More prevalent the farther you are from the equator Casual factors in unipolar mood disorders Biological casual factors - Variety of diseases and drugs can affect mood leading to depression and sometimes to alation or even hypomania Genetic influence - Prevalence of mood disorders is approximately three times higher among blood relatives of persons with clinically diagnosed depression than in the population at large - Shows with twin studies o Identical twins are twice as likely to develop depression if one of them has it when compared to fraternal twins o Although symptoms such as depressed mood do not seem to be heritable where are other symptoms such as loss of libido and loss of appetite have a heritable basis o Dysthymic disorder may be relatively less influenced by genetic factors than major depression - Adoption method o They could make a case for a moderate genetic contribution to the causal patterns of unipolar major depression  although not as large a genetic contribution as for bipolar disorder - Serotonin-transporter gene is involved in the transmission and reuptake of serotonin which is a key neurotransmitter involved in depression o Two verions of alleles involved  short allele and long allele o People have two short alleles, two long alleles or one of each o Individual’s who possess two short alleles were twice as likely to develop depression following four or more stressful life events compared to two long alleles Neurochemical factors - Monoamine hypothesis o Depression was at least sometimes due to an absolute or relative depletion of one or all of these neurotransmitters at important receptor cites in the brain - Some people have found opposite results for the monoamine hypothesis Abnormalities of hormonal regulatory systems - A potent suppressor of plasma cortisol in normal individuals, dexamethasone either fails entirely to suppress cortisol or fails to sustain its suppression - Depressed patients with elevated cortisol tend to show memory impairments and problems with abstract thinking and complex problem solving - Disturbances to the hypothalamic-pituitary-thyroid axis are linked to mood disorders o Ex. people with low levels of thyroid often become depressed Neurophysiological and neuroanatomical influences - Depression in people without brain damage may be linked to lower levels of brain activity in this same region - Depressed people show a relatively low activity in the left hemisphere and high activity in the right hemisphere - Children at risk for depression show the same pattern as well as patients in remission - Another area of the brain connected to depression is the anterior cingulate cortex which shows abnormally low levels of activation in depressed people - Orbitofrontal cortex = decreased volume in individuals with recurrent depression relaive to normal controls - Hippocampus = chronic depression is associated with smaller hippocampal volume  could be due to cell atrophy and cell death - Amygdala = increased activation in individuals with depression Sleep and other biological rhythms - Rem sleep: rapid eye movement and dreaming as well as other bodily changes o Happens about 75-80 mins into sleep - Depressed patients show sleeping problems (early morning awakening, periodic awakening during the night and for some difficulty falling asleep) - Many depressed people enter the first period of rem sleep after only 60 mins of sleep and show greater amounts of rem sleep early in the night - Gets a less amount of deep sleep - Circadian rhythms o Humans have many circadian rhythms other than sleep (body temp, propensity of rem sleep, sectretion of cortisol, thyroid stimulating hormone and growth hormone) o Controlled by central oscillators  act as a biological clock o Depressed patients show abnormalities in these rhythms but might not show in all of them o Two current theories  The size or magnitude of the circadian rhythms is blunted  The various circadian rhythms that are normally well synchronized with each other have become desynchronized - Sunlight and seasons o Patients seem to be responsive to the total quantity of available light in the environment o More common in winter and fall o Depressed patients who fit the seasonal pattern usually show increased appetite and hypersomnia o Clear disturbances in their circadian cycles o Serotonin may be dysregulated o Can be treated with fluoxetine which influences serotonin system Psychosocial causal factors - Psychosocial factors are at least as strong as biological factors Stressful life events as causal factors - Stressful life events act as precipitating factors for unipolar depression - Stressors may interact with one another to increase the persons risk of depression - Ex. separations through death or divorce are strongly associated with depression - Significant when stressful life events are independent of the persons behaviour  house getting hit by a hurricane - Then there is dependent life events  poor problem solving leads to higher levels of interpersonal stress  associated with depression - Depressed peoples pessimistic outlook may lead them to evaluate events as stressful that an independent (non-depressed friend) would not - Mildly stressful events and chronic stress o Not found minor stressful events to be associated with the onset of clinical depression o Minor events may play more of a role in the onset of recurrent episodes than the initial episode o Chronic strain: one or more forms of stress ongoing for at least several months - Individual differences in responses to stressors o Women and perhaps men at genetic risk for depression not only are more likely to experience more stressful life events, but also are more sensitive to them o Back to before two short alleles were twice as likely to develop depression following major stressful life events than those with two long alleles o Four factors associated with not coming depressed  Having an intimate relationship with a spouse or lover  Having no more than 3 children living at home  Having a job outside the home  Having a serious religious commitment Different types of vulnerability for unipolar depression - Personal and cognitive diathesis o Neuroticism serves as a vulnerability factor for depression o Neuroticism: stable and inheritable personality trait that involves a temperamental sensitivity to negative stimuli o Some limited evidence that high levels of introversion may be a vulnerable factor for depression - Early adversity and parental loss as a diathesis o Early parental loss through death or permanent separation seemed to create a vulnerability to depression in adulthood o What determines a child’s response to the loss has a lot to do with what happens following the loss Psychodynamic theories - Freud hypothesized that when a loved one died, the mourner regresses to the oral stage of development (when an infant cannot distinguish themselves from others) and introjects or incorporates the lost person, feeling all the same feelings toward the self as toward the lost person - The idea that depression in anger turned inward - Klein and Jacobson emphasized the importance of the early mother-infant relationship in establishing a vulnerability to depression  same with Bowlby with his attachment styles Behavioural theories - People become depressed when they no longer produce positive reinforcement or their rate of negative reinforcements increases - Depressed people need more positive verbal and social reinforcements Becks Cognitive theory - The cognitive symptoms of depression often precede and cause the affective or mood symptoms  rather than vice versa - Depressogenic schemas or dysfunctional beliefs: rigid, extreme and counterproductive o Ex. if everyone doesn’t love me, then my life is worthless - Negative automatic thoughts: thoughts that often occur just below the surface of aware
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