Class Notes (836,210)
Canada (509,690)
Psychology (2,094)
PSYC 208 (100)
Paul Wehr (4)
Lecture

Ch. 11 - Affective Disorders.docx

16 Pages
135 Views
Unlock Document

Department
Psychology
Course
PSYC 208
Professor
Paul Wehr
Semester
Fall

Description
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
More Less

Related notes for PSYC 208

Log In


OR

Join OneClass

Access over 10 million pages of study
documents for 1.3 million courses.

Sign up

Join to view


OR

By registering, I agree to the Terms and Privacy Policies
Already have an account?
Just a few more details

So we can recommend you notes for your school.

Reset Password

Please enter below the email address you registered with and we will send you a link to reset your password.

Add your courses

Get notes from the top students in your class.


Submit