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PSY240H1 (234)


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Konstantine Zakzanis

Chapter 10: Mood Disorders General Characteristic of Mood Disorders Mood disorder: involve disabling disturbances in emotion from sadness of depression to the elation and irritability of mania Depression Signs and Symptoms Depression: emotional state marked by great sadness and feelings of worthlessness and guilt Symptoms: withdrawal from others and loss of sleep, appetite, sexual desire, and interest and pleasure in usual activities Associated with other problems panic attacks, substance abuse, sexual dysfunction, and personality disorder They may speak slowly, after long pauses, using few words, monotonous voice They prefer to sit alone and remain silent May neglect personal hygiene and appearance and make numerous complains of somatic symptoms with no apparent physical base Vary across the lifespan (symptoms) Children results in somatic complaints (headaches or stomach aches) Older adults (distractibility and complaints of memory loss) Some cross cultural variation because of difference in cultural standards of acceptable behaviour Psychologizers: people who emphasize the psychological aspects of depression o 15% of patients in Canada. More likely to be found in Canada than china o More non western cultures express physical symptoms rather than psychological Average untreated depression may stretch for 3-5 months or longer 1/3 suffer from chronic depression Mania Signs and Symptoms Mania: an emotional state or mood of intense but unfounded elation accompanied by irritability, hyperactivity, talkativeness, flight of ideas, distractibility, and impractical, grandiose plans Usually its a cycle between depression and mania. Mania alone is rare Last from several days to several months Symptoms loud stream of remarks, full of puns, jokes , rhyming, and interjections about objects and happening that have attracted the speakers attention Their speech is difficult to interrupt Usually comes on suddenly Formal Diagnostic Listing of Mood Disorders 2 major mood disorders major depression (unipolar depression) & bipolar depression Diagnosis of Depression Major depression/unipolar depression Requires the presence of 5 of the following symptoms for at least 2 weeks (but depressed mood or loss of interest and pleasure must be one of the 5 symptoms) o Sad, depressed mood, most of the day nearly every day o Loss of interests in usual activities o Insomnia or too much sleep o Shift in activity level becoming either lethargic (psychomotor retardation) or agitated o Poor appetite and weight loss or increased appetite and weight gain o Loss of energy/fatigue C h a p t e r 1 0 : M o o d D i s o r d e r s Page 8 o Negative self-concept, self reproach and self blame (worthlessness and guilt) o Difficulty concentrating o Recurrent thoughts of death or suicide Prevalence of 5.2 17.1% - American studies & 4-6% in Canadian studies but higher ones were also found 2x more common in women More often in younger ages than older and in low socio economic class Females are more likely to engage in ruminative coping (want to understand the meaning of why they feel that way) and males tend to do something that diverts their attention Male and females differ in the stressors they experience (ex. Single mothers vs. Married) Females are more likely than males to be exposed to various forms of victimization Depression is a recurrent disorder, 80% experience another episode lasting 3-5 months 12% of the cases become chronic Kindling hypothesis: the first episodes of depression have a stronger link w/ major life events stress than do subsequent bouts of depression. Once a depression has been experienced, it takes relatively less stress to induce a subsequent recurrence Diagnosis of Bipolar Disorder Bipolar I disorder: involves episodes of mania or mixed episodes that include symptoms of both mania and depression Requires the presence of elevated or irritable mood plus 3 additional symptoms (4 if the mood is irritable) The symptoms must be severe enough to impair social and occupational functioning o Increased activity level at work, socially or sexually o Unusual talkativeness, rapid speech o Flight of ideas or subjective impression that thoughts are racing o Less than usual amount of sleep needed o Inflated self esteem (belief that they have some special powers) o Distractibility: attention easily diverted o Excessive involvement in pleasurable activities that are likely to have undesirable consequences (reckless spending) Less often than major depression Prevalence 1% Average onset is 20s Occurs equally in men and women (women episodes of depression are more common and episodes of mania less common than among men) It also tends to reoccur 50% of cases have 4 or more episodes Heterogeneity within the Categories Heterogeneity: people with the same diagnosis can vary greatly from one another Mixed episode: some bipolar patients experience the full range of symptoms of both mania and depression almost every day Bipolar II disorder: patients have episodes of major depression accompanied by hypomania (a change in behaviour and mood that is less extreme than full blown mania) C h a p t e r 1 0 : M o o d D i s o r d e r s Page 8 The presence of delusions is a distinction among people with unipolar depression (they do not respond well to drug therapy also but respond to drugs treated for other psychotic disorders) this type of depression is more severe and less time between episodes Some patients have melancholic features (no pleasure in any activity and unable to feel better even temporarily when something good happens) o depressed mood is worse in the morning (wake up 2 hours too early, lose appetite and weight and are either lethargic or extremely agitated) Both manic and depressive episodes have catatonic features (motor immobility or excessive, purposeless activity) Postpartum depression: depressive episodes that occur within 4 weeks of childbirth Seasonal affect disorder (SAD): depression linked to a decrease in the number daylight hours o Therapies include exposing the patient to bright, white light o Phototherapy: exposure to bright, white light is highly effective Chronic Mood Disorders Must be evident for 2 years but are not severe enough to warrant a diagnosis of a major depressive or manic disorder Cyclothymic disorder: the person has frequent period of depressed mood and hypomania o Period may be mixed with or separated by periods of normal mood lasting as long as 2 months o During depression they feel inadequate, during hypomania, their self-esteem is inflated o They withdraw from people then seek them out in an uninhibited fashion o They sleep too much
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