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Ch. 11 - Affective Disorders.docx

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PSYC 208
Paul Wehr

Affective Disorders 11/16/2012 10:56:00 AM Announcements  Final Exam: Dec. 7 3:30pm – 6pm o Location CIRS 1250 o 50 multiple choice; 20 marks fill-in-the-blank, short-answer o Cumulative Introduction  Affective Disorders: heterogeneous group of disorders characterized by abnormal mood, drive, and cognition o Overlap with anxiety disorders o Overlap with psychotic symptoms  Hallucinations  Delusions (mood congruent or mood incongruent)  Catatonia  Unipolar affective disorders: depressed mood, either chronic or with remission  Bipolar affective disorders: episodes of depression and mania alternative; majority of patients experience more depressive episodes than manic episodes Major Depressive Episode  Symptomatology o Depressed mood o Indecisive and unable to concentrate o Unable to experience pleasure o Feelings of worthlessness or inappropriate guilt o Weight loss or weight gain o Insomnia or hypersomnia o Chronic fatigue o Psychomotor retardation or agitation o Suicidal ideation  Thinking about death; suicidal thoughts with no plan/with a plan; suicidal attempt  Impairment to social and occupational functioning  Not due to substance use or bereavement  Symptoms occur everyday, most of the day for at least 2 weeks Manic Episode  Symptomatology o Elevated and irritable mood o Inflated self-esteem o Decreased need for sleep o Talkative o Flight of ideas o Distractible o Intense goal-directed behavior o Hedonistic behavior; foolhardy spending and investments; sex and drug use  Impaired social or occupational functioning and not due to substance use Other Affective Conditions  Mixed Episode: features of both depression and mania are present simultaneously o Mood: low or elevated o Drive: low or elevated o Thought: reduced or accelerated o E.g. depressed mood and motivation with flight of ideas  Dysthymic Disorder: symptoms too mild to meet diagnosis for depression  Cyclothymic Disorder: symptoms too mild to meet diagnosis for bipolar disorders Epidemiology  Depression o Lifetime prevalence: 8% in Canada o One-year prevalence: 5% o Dysthymic Disorder: 3-5% o Many undiagnosed cases o Female to male ratio = 2:1 o Onset: as early as 15-19 yrs  Bipolar Disorder o Lifetime prevalence: 0.5-1.5% o Female to male ratio = 1:1 o Onset: as early as 10-14 yrs Environmental Risks for Depression  Loss of important biological relationships (death or separation) o Loss of primary caregiver before puberty o Not bereavement  Women o Post-partum depression o Higher in married women  Men o Higher in separated, divorced, widowed men o Higher in unemployed and retired men  Environmental influences become less important following third episode Pathophysiological Mechanisms  Dysregulation of neurotransmitter systems o Serotonin activity reduced in hippocampus and amygdala o Norepinephrine activity reduced overall; activity increase in hypothalamus and some frontal/temporal cortical centers o Dopamine activity reduced in depression; increased during mania  Dopamine: involved in motor activity and reward pathway  Early trauma/chronic stress can over-activate HPA (hypothalamus pituitary adrenal) axis stress response; increased corticosteroid activity  Chronic stress can lead to reduction in brain volume: o Hippocampus o Gray matter in prefrontal cortex PFC, orbitofrontal cortex OFC (decision-making), and anterior cingulate cortex ACC (autonomic functions like emotion and cognitive functions like reward and anticipation)  Autonomic: involuntary  Reward and anticipation: classically conditioned responses of pleasure  Bipolar Disorder: enlarged ventricles and reduced PFC o Schizoaffective disorder: bipolar and schizophrenia Comorbidity and Outcome  Differential diagnosis o Depression: organic causes such as frontotemporal dementia o Depression and bipolar: acute schizophrenia  Comorbidity o Anxiety disorders (most common), substance abuse/dependence, eating disorders, and personality disorders  Course and Outcome o Relapse rate: depressive episode: 25% within 6 months, 75% within 5 years o Recurrent depression and bipolar disorder tend to have increasing chronicity: incomplete remission and increasing duration of episodes o Major depression: 15% commit suicide Treatment  Psychopharmacology o Depression: selective serotonin reuptake inhibitors (SSRI); norepinephrine and dopamine reuptake inhibitors  Only affects serotonin  Clean drug: targets only one neurotransmitter, dirty targets many  Acute mania: antipsychotics  Mood stabilizers (prevent relapse): lithium o Reduces likelihood of future episodes of mania, not depression  Cognitive Behavioral Therapy o Reevaluate dysfunctional Schemas: negative views of self, world, and future o Reappraise overly pessimistic explanations  Lack self-serving bias: attribute negative outcomes to self  Lack positive illusions: accurately estimate their own abilities  They know exactly how good they are o Reduce rumination: tend to dwell on negative outcomes  Think about their failures more, don’t experience more failures  Need to think more about positive outcomes Evolutionary Synthesis  Affective disorders have high prevalence! Prevalence is increasing, doubling every ten years in developed nations  Behavior reduces fitness? o Depressive episode: less achievement, loss of social network o Manic episode: loss of resources, alienation of others o Genetic predisposition towards affective disorders o Experiences reduced fitness during the episodes  Evolutionary synthesis (why do the genes still exist?) o Status hierarchies in social species o Functions of self-esteem and mood o Rank hypothesis of affective disorders Social Status Hierarchies  Some individuals gain greater access to key resources through intra-sexual competition (social species) o Hierarchies in crickets (Alexander)  Made a model cricket on the end of the stick, beat the crap out of the dominant male  dominant male starts to avoid and lose competition  did not mate  If low status cricket wins the fight with the model cricket  starts to win and look for other fights o Hierarchies in Humans (Fisek and Ofshe)  Three person groups of male strangers  Hierarchy emerged in 50% of groups within 1 minute  Emerged in remaining 50% within 5 minutes o Dominance: status acquired through force or threat of force o Prestige: status acquired through voluntary deference o Hierarchies are transitive; stable but not static  Transitive: a has higher status than b, b has higher status than c, then a must have higher status than c o Males and females have separate hierarchies  Psychological level: men don’t see women as competitors, women don’t see men as competitors Status and Reproduction  Chimpanzees o Submissive male chimps  Low body position, bowing, pantgrunt greeting  Fewer copulations; usually during non-estrus periods o Dominant male chimps  Full height, hair standing on end, strutting, jumping  50%+ of copulations; usually during estrus period  Humans: high status men have more reproductive opportunities and produce more offspring o Polygynous mating systems (harems) o Serial monogamy, mistresses or affairs  Mistress: second wife o Mongol Ruler Genghis Khan: 16 million descendants Accepting Subordination  Higher position = more resources and more mating  Accepting subordination benefits low status person by avoiding costs associated with conflicts they are likely to lose o Expending energy and time; risk of injury or death o “Pecking order” in hens o Avoids ostracism and maintains cooperation in human groups o Opportunities might be better in the future  Selection should favor abilities to assess self and others in terms of position in hierarchies o Men and women can assess position within same-sex group based on non-verbal information  Hierarchies are emergent products of groups, not an individual characteristic  Hens squabble frequently until pecking order is established, then hostility decreases significantly Status-tracking Mechanism  Self-esteem: attitude towards yourself o High = positive attitude towards self o Low = negative attitude towards self o Programs designed to increase self-esteem in individualistic societies; less emphasis in collective societies  Sociometer Theory o Self-esteem tracks one’s status within the hierarchy, and motivates behavior accordingly  Repeat or increase successful behaviors; abandon or decrease unsuccessful behaviors  Important to know one’s place: treat superiors, equals and subordinates differently; evaluate one’s desirability as an ally or mate (assortative mating) o Is artificially raising self-esteem a good idea? Variations in Mood  Capacity for high and low mood is a mechanisms for adjusting allocation of resources as a function of current opportunities o Opportunities are good (e.g. high status)  High self-esteem  High mood, which increases effort o Opportunities are bad (e.g. low status)  Low self-esteem  Low mood, which decreases effort o Low mood elicited by cues indicating loss, usually of reproductive resources (e.g. romantic relationship, job, reputation, investment, health…); losses indicate maladaptive behavior; stop! o Realistic assessment required: loss of self-serving attribution bias  Self-esteem is a cognitive component; mood is emotional component  Depressed individuals are more thoughtful when making decisions, but also more indecisive Unobtainable Goals  Learned helplessness: passive behavior following unavoidable aversive events o Seligman & Maier: Dogs  Control: no shock  Escape: level ends shock  No escape: tandem with Escape group o 2/3 of dogs in group 3 failed to jump over partition  Low mood helps to disengage from unobtainable goals (e.g. bereavement); depression often resolved after giving up a long-sought goal  Resources subsequently reallocated to new goals  Experiencing loss of primary caregiver, insecure attachment, physical or emotional abuse early in life at greater risk of depression Rank Hypothesis  Depression represents an extreme appeasement strategy o Nonverbal cues of submission used to discourage attack  Avoiding eye contact, making oneself look small, motor retardation, reduced vocalization, waxy flexibility, imitation & obedience o Catatonia reflects aspects of ancient defense mechanisms o Juvenile traits tend to signal non-threat and reduce aggression; could explain regressive behavior (e.g. crying) o Somatic complaints to communicate helplessness and non-threat o Behavior changes with context: might show signs of aggression towards lower rank individuals (displacement) o Self-derogation and negative self-appraisals help to reinforce subordination through decreasing self-esteem o Depression helps to hide abilities that might potentially be threatening to superiors  Mania represents extreme dominance (intra-sexual competition) strategy o Nonverbal cues communicate dominance: constant eye contact, rapid verbalizing, salacious behavior with opposite sex, competitiveness with same-sex, irritability with others as if they were lower status o Elevated mood and unrealistically high self-esteem leads to foolish decisions and behavior (e.g. Impulsive investing) o Mild forms (hypomania) might be adaptive!  Elevated mood (not full-blown mania) towards the manic state  Explains why depression is more often diagnosed than manic depression  People don’t complain about manic episodes as much Serotonin and Rank  Serotonin activity varies with social rank in vervet monkeys o Serotonin level of alpha male is twice as high compared to other males o Serotonin level drop
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