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PSY240 Lecture 4

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University of Toronto St. George
M.Mc Kay

PSY240 Lecture 4 May 30: Mood Disorders (Chapters 9 & 10) Learning objectives: 1. Unipolar depression (people experience only depression, without mania) 2. Bipolar 3. Suicide Major/Unipolar depression: MDD Common disorder Depression o Common Lifetime risk 7-12% males; 20-25% females Lifetime prevalence rates for Canadians range from 8.2% to 12.2% WHO prediction: by 2020, if current trends continue, major depressive disorder will be second most common disorder overall. Prevalence and prognosis Among adults, 15-to-24 year olds are most likely to have had a major depressive episode in the past month Women are more likely to experience both milder and more severe forms of depression than are men at about a 2:1 ratio Recurrent: o 30-50% residual symptoms (its important to look @ those symptoms because they are thought to predict the disorder) o Chronic course - Treatment resistant (if depression recurs within patients; this can present treatment complications so there is a big emphasis on relapse prevention in the field) Major depressive episode DSM-IV A. Five or more symptoms occurring within the same 2 week period o 1 MUST be either 1) depressed or 2) loss of pleasure [most of the day, nearly every day] o Appetite (loss or increase) resulting in weight loss or gain o Insomnia or hypersomnia o Psychomotor agitation or retardation o Fatigue, loss of energy o Feeling worthless, excessive or inappropriate guilt o Cognitive factors: diminished ability to think, concentrate, make a decision o Recurrent thoughts of death (suicidal ideation, plans, or attempts) B. Symptoms do not meet criteria for mixed episode C. Cause significant distress/impairment in social, occupational, or other important areas of functioning D. Not due to substance use, medication, or medical condition E. Not better accounted for by bereavement (longer than two months after the loss of a loved one) MDD Symptoms What do you notice about the symptoms of depression? A lot of symptoms are bidirectional (overeating/under-eating, oversleeping/under-sleeping) How would that translate into symptom presentation (if all these symptoms are bidirectional) o This symptoms add to the heterogeneity of the disorder; presentation is quite complex because different people will come in presenting very different symptoms for MDD 31 Symptoms of depression Cognitive: Poor concentration and attention, indecisiveness, poor self-esteem, hopelessness, suicidal thoughts, delusions (beliefs with no basis in reality) and hallucinations (involves seeing/hearing/feeling things that are not real) Physiological and behavioural: Sleep or appetite disturbances, psychomotor retardation (walk/talk/gesture more slowly/quietly) or agitation (cannot sit still), catatonia, fatigue, loss of energy, early morning awakening (they awaken at 3 or 4 a.m. and cannot get back to sleep) Emotional: Sadness, depressed mood, anhedonia (loss of interest or pleasure in usual activities), irritability (especially in children and adolescents) Major depressive disorder (MDD) Single episode presence of a single depressive episode Recurrent presence of 2 or more episodes (separate episode period of 2 months without depressive symptoms between episodes, otherwise partial remission) Chronic meet dx criteria for MDE consistently for 2 years Subtypes Atypical (actually quite common) MUST HAVE: Mood reactivity/positive mood reactions to some events (mood brightens in response to something good) And 2 of the following: o Weight gain or increased appetite o Hypersomnia o Leaden paralysis (heavy feelings in limbs) o Interpersonal rejection sensitivity that causes significant social or occupational impairment Melancholic MUST HAVE either: 1) Loss of pleasure in all activities; or 2) Lack of reactivity to pleasurable stimuli And 3 of the following: o Distinct quality of depressed mood (different from the kind of feeling experienced after the death of a loved one no one really knows what this means o Worse in the AM o Early morning awakening (2 hours before usual time) o Marked psychomotor retardation/agitation o Significant anorexia or weight loss o Excessive or inappropriate guilt Other subtypes and specifiers Depression with catatonic features: catatonic behaviours: catalepsy, excessive motor activity, severe disturbances in speech Depression with psychotic features: presence of delusions/hallucinations Seasonality (SAD): seasonal affective disorder; have history of at least 2 years of experiencing major depressive episodes and fully recovering from them. The symptoms seem to be tied to number of daylight hours in a day. People become depressed when daylight hours are short, and recover when they are long. Persons mood cannot be result of psychosocial events (such as being unemployed during winter). Postpartum: onset of major depressive episode within four weeks of delivery of child. As many as 30% of women experience postpartum blues, but for most women these symptoms are only annoying and pass completely within 2 weeks of birth. Only 10% go into postpartum depression. Severity (will also make judgment if it is mild/moderate/serious episode) Double depression MDE superimposed on dysthymic disorder (individuals dont meet criteria for MDD. they have some symptoms, but not full criteria) 32Two types of unipolar depression: Major depression and dysthymic disorder Major depression Dysthymic disorder Number of symptoms 5 or more symptoms including sadness or loss 3 or more symptoms including depressed of interest or pleasure mood Duration At least 2 weeks in duration At least 2 years in duration (and during these two years, must never have been without depression symptoms for more than 2 months) * People with double depression experience both they are chronically dysthymic and they occasionally sink into episodes of major depression. They are less likely to respond to treatments. * More than half the people diagnosed with major depression or dysthymia also have another psychological disorder (most common: substance abuse [alcohol], anxiety disorders [panic], eating disorders) Assessing for MDD Same rules apply: medical history, onset of symptoms, precipitating events, past episodes, comorbid conditions RULE OUT bipolar disorder, psychotic disorder, substance disorders, eating disorder, anxiety disorder Course mood chart Use to skip subtypes; important information Biological theories Genetic theory: disordered genes predispose people to depression/bipolar disorder Neurophysiological abnormalities: dysregulation of neu
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