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PSYB32H3 Lecture Notes - Major Depressive Disorder, Mania, Bipolar Disorder

Course Code
Konstantine Zakzanis

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Chapter 10 Mood Disorders
General Characteristics of Mood Disorders
mood disorders disorders in which there are disabling disturbances in emotion
- mood disorders are often associated with other psychological problems, such as panic attacks,
substance abuse, sexual dysfunction, and personality disorders
- the presence of other disorders can increase severity and result in poorer prognosis
Depression: Signs and Symptoms
depression a disorder marked by great sadness and apprehension, feelings of worthlessness and guilt,
withdrawal from others, loss of sleep, appetite, sexual desire, loss of interest and pleasure in usual
activities, and either lethargy or agitation; called “major depressionin DSM-IV andunipolar depression
by others; it can be an associated symptom of other disorders
- paying attention is exhausting for depressed people; conversation is a chore; they may speak slowly,
after long pauses, using few words and a low, monotonous voice; many prefer to sit alone and remain
silent; others are agitated and cannot sit still; they pace, wring their hands, continually sign and moan, or
complain; depressed people may neglect personal hygiene and appearance and make numerous
complaints of somatic symptoms with no apparent physical basis
- symptoms and signs of depression vary somewhat across the lifespan
- depression in children often results in somatic complaints, such as headaches or stomach aches
- in older adults, depression is often characterized by distractibility and complaints of memory loss
- depression is substantially less prevalent in China than in North America due in part to cultural mores
(customs/traditions) that make it less appropriate for Chinese people to display emotional symptoms
- although its commonly believed that people from non-western cultures (eg: Chinese) emphasize
somatic symptoms of depression, while people from Western cultures emphasize emotional symptoms,
studies suggest that people from various cultures, including Canadians, tend to emphasize somatic
symptoms rather than the emotional symptoms, especially when they’re being evaluated in a medical
- overall 15% of depressed primary care patients in Canada are referred to as psychologizers (people
who emphasize the psychological aspects of depression)
- people in most cultures tend to emphasize physical symptoms
- most depression, although recurrent, tends to dissipate with time
- about 1/3 of depressed people suffer from chronic depression
Mania: Signs and Symptoms
mania an emotional state of intense but unfounded elation (great happiness) evidenced in
talkativeness, flight of ideas, distractibility, grandiose plans, and spurts of purposeless activity
- mania's an emotional state or mood of intense but unfounded elation accompanied by
irritability, hyperactivity, talkativeness, flight of ideas, distractibility, and impractical, grandiose
- some people who experience episodic periods of depression may at times suddenly become manic

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- although there are clinical reports of individuals who experience mania but not depression, this condition
is quite rare
- the person in the throes (intense emotion) of a manic episode, which may last from several days to
several months, is readily recognized by his/her loud and incessant stream of remarks, sometimes full of
puns, jokes, rhyming, and interjections about objects and happenings that have attracted the speakers
Formal Diagnostic Listings of Mood Disorders
- 2 major mood disorders listed in the DSM-IV-TR: major depression, also referred to as unipolar
depression, and bipolar disorder
Diagnosis of Depression
major depressive disorder (MDD) an extreme form of depression that satisfies the number of
symptoms required for the category of depression to apply
- MDD requires the presence of 5 of the following symptoms for at least 2 weeks; either depressed mood
or loss of interest and pleasure must be 1 of the 5 symptoms:
sad, depressed mood, most of the day, nearly everyday
loss of interest and pleasure in usual activities
difficulties in sleeping (insomnia); not falling asleep initially, not returning to sleep after
awakening in the middle of the night, and early morning awakenings; or, in some patients, a
desire to sleep a great deal of the time
shift in activity level, becoming either lethargic (psychomotor retardation) or agitated
poor appetite and weight loss, or increased appetite and weight gain
loss of energy, great fatigue
negative self-concept, self-reproach and self-blame, feelings of worthlessness, and guilt
complaints or evidence of difficulty in concentrating, such as slowed thinking and
recurrent thoughts of death or suicide
- a study showed that even with fewer than 5 symptoms and a duration of less than 2 weeks, co-twins
were also likely to be diagnosed with depression and patients were likely to have recurrences
- other research suggests that depression exists on a continuum of severity
- the issue of whether depression is best seen as being on a continuum or as a discrete diagnostic
category is far from resolved
- MDD is one of the most prevalent of the disorders described in this book
- lifetime prevalence rates have ranged from 5.2% - 17.1% in some studies
- in many countries, the prevalence of MDD increased steadily during the latter part of the 20th century
- regardless of prevalence, MDD is about 2 times more common in women than in men
- the gender difference doesnt appear in preadolescent children, but it emerges consistently by mid-
- gender gaps emerge at age 14 and seem to be maintained across the lifespan
- this gender difference is clearly established by late adolescence, and is found in all adult age groups, in

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numerous countries, and in a majority of ethnic groups
- current and lifetime prevalence rates are higher among younger than older persons
- although MDD was associated with 27.2 lost workdays per ill worker per year, bipolar disorder was
associated with 65.5 lost workdays; they attributed the difference to more severe and persistent
depressive episodes in workers with bipolar disorder
- depression tends to be a recurrent disorder; about 80% of those with depression experience another
episode, and the average number of episode, which typically last for 3-5 months, is about 4
- patients with MDD who had certain coexisting personality disorders (schizotpal, borderline, or avoidant)
had a significantly longer time to remission of symptoms than did MDD patients without any personality
- it has been found that the 1st episodes of depression have a stronger link with major life events stress
than do subsequent bouts of depression; this has been explained by kindling hypothesis, which is a
concept derived from research on animals
kindling hypothesis the hypothesis that once a depression has been experienced, the person is
sensitized and it takes less stress to elicit a subsequent bout of depression
- what isnt clear at present, according to Monroe and Harkness, is whether the apparent reduced role of
life events stress in subsequent depression is because depression has become autonomous and no
longer requires stress (the autonomy hypothesis) or whether the person has become sensitized to stress
(the sensitivity hypothesis) and even small amounts of stress are sufficient to induce depression
Focus on Discovery 10.1 Depression in Females vs. Males: Why is There a Gender Difference?
- major depression generally occurs about twice as often in women than in men
- Nolen and Girgus concluded that girls are more likely than boys to have certain risk factors for
depression even before adolescence, but its only when these risk factors interact with the challenges of
adolescence that the gender differences in depression emerge
- females are more likely than males to engage in ruminative coping
ruminative coping a tendency to focus cognitively (perhaps to the point of obsession) on the causes of
depression and associated feelings rather than engaging in forms of distraction
- females focus their attention on their depressive symptoms; males are more likely to rely on distraction,
on doing something that diverts their attention
- a study confirmed that the ruminative coping style predicts the onset of episodes of depression and is
associated with more severe depressive symptoms
brooding a moody contemplation of depressive symptoms what am I doing to deserve this that is
more common in females than males
- brooding is like moody pondering; some people concluded that the relationship between gender and
depression could be due to the brooding component
- another possible explanation for the gender difference is that females and males differ in the stressors
they experience
- girls may face more social challenges than boys, including pressure to narrow their interests and pursue
feminine-typed activities
- thus, girls may face attitudes that devalue accomplishments and abilities in relation to boys, or face
restrictions on roles and activities deemed inappropriate for their gender
- another explanation is that females are more likely than males to be exposed to various forms of
victimization, including childhood sexual abuse
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