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Lecture

Psych 257 Chap 7 Psych 257 Psychopathology Barlow et Al: Abnormal Psychology 2nd CDN edition Chapter 7


Department
Psychology
Course Code
PSYCH257
Professor
Uzma Rehman

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Mood Disorders
-momentary emotional states, usually pass; depression: constant, debilitating sad mood
An Overview of Depression and Mania
-mood disorder: gross deviations in mood; most common: major depressive episode
-extremely depressed state; lasts for >2 weeks, cognitive symptoms + disturbed physical functioning
-if untreated, lasts for 9 months (avg); accompanied by loss of interest, interaction with loved ones
-mania: abnormally exaggerated elation, joy, euphoria; hyperactivity; rapid, incoherent speech
-usu. ~1 week or less if severe, if untreated: 2-6 months
-hypomanic episode: less severe, doesn’t cause marked impairment in social/occupational functioning
The Structure of Mood Disorders
-unipolar mood disorder: either having depression or mania (not both)
-bipolar disorder: both depression and mania; usu. alternating, not necessarily though
-dysphoric manic/mixed episode: can have manic symptoms but be internally depressed
-may differ b/w people in severity, course, accompanying inflated self-esteem/grandiosity; usu. mix
Depressive Disorders
Clinical Descriptions
-most recognized/common: major depressive disorder, single episode
-absence of manic/hypomanic episode before/during MDE;
-MDD, recurrent: 2+ episodes separated by min. 2 month period; recurrence: predicts course of disorder
-dysthymic disorder: sim. To MDD; diff course: milder symptoms, unchanged for long time period
-eg. constant depressed mode for at least two years, depression can’t subside for more than 2 months
-double depression: MDE+DD; usu. DD develops first at early age, followed by MDEs
-people recovering from MDE may not recover from underlying DD -> relapse in MDEs
Onset and Duration
-MDD untreated avg. onset is 25 yrs; treated is 29 yrs; prevalence of MD ^ in adolescence esp. girls
-length of MDE is variable (2 weeks to years); may have residual symptoms;
-adolescent onset assoc’d with greater chronicity, poor prognosis, likelihood of disorder in family
-dysthymia: may last ~20 yrs or more; adults: ~5 yrs, Child: ~ 4 yrs; ^ chance of suicide than MDEs
From Grief to Depression
-after death of loved one; disorder diagnosis only if severe psychotic/suicidal symptoms appear
-immediate attention if death -> incapability to function (extreme weight loss, no energy)
-usu. natural grieving process resolves w/n months; recovery from grief after 1 year is low
-pathological grief reaction/impacted grief reaction: predicted by history of past MDEs
-symptoms: intrusive memory, strong yearnings for loved one, avoiding places that remind them
-usu. best treated by specific PGR group therapy (not just depression therapy)
Bipolar Disorders
-key feature: tendency of manic episodes to alternate w/ MDE; big highs and lows
-bipolar II: MDEs alternate w/ hypomanic episodes (not full manic)
-bipolar I: MDE + Full manic; during hypo/full manic: patient denies problem, behavior seems reasonable
-cyclothymic disorder: chronic alternating in happy/depression; doesn’t reach severity of MDE/manic
-few periods of neutral; pattern usu. ~ 2 yrs; substantial enough mood states to interfere w/ functioning
Onset and Duration
-avg onset for BP1: ~18; BP2: ~22; can begin in childhood; 1/3 BDs start at adolescence; 10% BP2s->BP1
-rare to develop BD >40yrs; 5.2% of unipolar depressed people get BD;
-cyclothymia: chronic/lifelong; 1/3 of people ->BD; usu. onset ~12 yrs;
-people with cyclothymia usually just thought to be moody, high-strung, explosive, hyperactive etc.
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Postpartum Depression
-postpartum onset specifier (symptoms) can apply to both MDE and manic episodes
-PpD: severe manic/depressive episodes occurring w/n 4 weeks of childbirth usu. 2-3 days after
-very low (1/1000); having infant w/ spec. temperament may increase vulnerability to PpD
-specifiers describing course of mood disorders:
-i) longitudinal course specifiers: check if person fully recovered b/w episodes; if has DD or just MDE
-ii) rapid-cycling: only to BP1&2; moving very quickly from MDE and manic episode; eg. 4 MDEs/year
-20% of BPs have rapid cycling; usu. female; usu. start with MDE than manic; ^frequency over time
-iii) seasonal pattern: eg seasonal affective disorder: depression during winter, manic during summer
-cycling dependant on season; w/ SAD: sleep more in winter, weight gain, increased appetite
-prevalence of SAD higher in extreme north/southern latitudes (less winter sunlight)
Prevalence of Mood Disorders
-variable rates (4.1-10.3%); In Canada, prevalence rates seemingly decreasing (public knowledge etc)
-MDD: 4.9%; BP1: 0.8%; BP2: 05%; Dysthymia: 3.2%; higher in women than men
In Children and Adolescents
-infants of depressed mother more vulnerable to depression; depressed mom +genetic vulnerability
-less frequent in children but surge high in adolescence; peak annual prevalence =15-25yrs (5%)
-MDD: usu. female Dysthymia: higher w/ kids, lowered in adolescence; BP: rare in kids
-mood disorders in children -> serious consequences: psychopathology, impaired functioning, MDEs
In the Elderly
-18-20% of nursing home residents may experience MDE; chronic if >60yrs;
-comorbidity with dementia; anxiety disorders, (GAD, Panic disorder); no gender diff. after 65yrs
Across Cultures
-way people think of depression influence by cultural view of individual/role in society
-focus on determining prevalence in other cultures; eg. first nations: high lifetime prevalence rates
-highest MDEs in Netherlands and US; lowest in Japan, turkey
Among the Creative
-notion of correlation b/w creativity (artists, writers composers) and madness (bipolar disorder)
-possibly manic states -> increased creativity;
-study: found moderately ill patients more creative than severely ill (too severe leads to decline)
Anxiety and Depression
-more alike than different:
-Barlow idea: “almost all depressed patients are anxious, but not all anxious are depressed
-core symptoms of depression: inability to experience pleasure, slowing of motor/cognitive functions
-negative affect: mixed anxiety/depression symptoms
-people w/ comorbid depression + borderline personality disorder have ^ levels of depression
Causes
-equifinality: same end product resulting from possibly diff. causes
-eg. depression: SAD vs. Grief->depression; similar outcome, different cause
-still there are underlying bio/psych/social dimensions that interact to create etiology of mood disorders
Biological Dimensions
-familial and Genetic Influences: find studies that help determine genetic contribution to spec. disorder
-family studies: prevalence of disorder in first-degree relatives (proband: membr w/ orig. disorder)
-found: unipolar/bipolar depression run in families; unsure if genetic or psychosocial environment
-adoption studies: adopted probands w/ disorder should have more biological relatives w/ same
disorder than adopted proband w/o disorder (though mixed data)
-twin studies: examine frequency of disorder in identical twins than fraternal twins
-if genetic: more in identical than fraternal; study found identical=2-3x more likely; esp. w/ women
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