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Lecture 7

Psychology 46-228 Lecture 7: Lectures 7-9 on Mood Disorders

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Lecture 7-9 on Mood Disorders Mood Disorders  A group of emotional disturbances associated with serious and persistent difficulty maintaining an even, productive emotion state  Distinctive from anxiety disorders  always having that cue that triggers anxiety ; Mood disorder  mood state varying, without the sense of control of their own moods  Atypical variability in mood  Sustained atypical mood  Associated changes in physiological arousal and regulation (sleep, eating)  Atypical self evaluation (excessively negative, positive; ex. mania)  Diagnostic structure o Unipolar/bipolar o Depressive/manic o Manic/hypomanic o Dysthymia P. 224 Major Depressive Episode (MDE)  5 of 9 symptoms  Necessary symptoms (1 of 2) o Dysphoria (A1)  Depressed mood (low, poor mood) o Anhedonia (A2)  Loss of interest or pleasure in all or almost all activities  Additional symptoms o Decrease/increase in appetite; weight loss/gain o Insomnia/hypersomnia o Psychomotor agitation/retardation o Fatigue/loss of energy o Feelings of worthlessness or inappropriate guilt o Diminished ability to think/concentrate o Recurrent thoughts of death, recurrent suicidal ideation, attempt, or plan Major Depressive Disorder (MDD)  MDE is not diagnosed  Major depressive disorder, single episode  OR Major depressive disorder, recurrent Dysthymia 1. Depressed mood, at least 2 years 2. Two or more of: o Poor appetite/overeating o Insomnia/hypersomnia o Low energy/fatigue o Lose self-esteem o Poor concentration/decision making o Feelings of hopelessness Manic Episode 1. Abnormally and persistently elevated, expansive, or irritable mood for 1+ weeks (or hospitalization)  Substantial impairment  Difference between hypomanic and manic is severity 2. 3 of the following o Inflated esteem/grandiosity o Decreased need for sleep o Talkative/pressure to speak o Flight of ideas, racing thoughts o Distractibility o Increased goal-directed activity o Excessive involvement in pleasurable activities, potential to painful consequences Hypomanic Episode  Distinct period of persistently elevated, expansive, or irritable mood, lasting at least 4 days, clearly different from the person's usual mood  3 symptoms, same as mania  Much less impairment in functioning  Feel really effective and on top of the world Bipolar disorders  Manic and hypomanic episodes are not diagnosed  Bipolar I  full blown manic and depression  Bipolar II  hypomanic and depression  Cyclothymia  nearly parallel to dysthymic, hypomanic state (risk of having bipolar II)  **Pattern and timing of cycling determines the disorder (complexity of treatment and severity) Mixed episode  Mixture of manic symptoms and depression/anxiety at the same time Cyclothymia  Mild form of bipolar disorder  Variation between hypomania and mild depression Grief  The symptoms are not better accounted for by bereavement and persist for longer than two months or are characterized by marked functional impairment  Loss of companionship, material assistance, and emotional support  Mood symptoms are typical during the grieving process  Impaired grieving Guilt Suppression/avoidance of emotion (ex. getting angry at the person) Inability to "let go" (accept reality of the loss) Anxiety and/or Depression?  Considerable overlap in symptoms: o Not everyone who is anxious is depressed o Almost everyone who is depressed is anxious  Core symptoms of depression o Anhedonia: inability to experience pleasure, depressed mood o Slowing of motor and/or cognitive functioning o Negative bias in cognitive content o Suicidal ideation  Core symptoms of anxiety o Apprehension, excessive worry o Trembling, tension  Mixed symptoms ("negative affect", "demoralization", "general distress", "feeling bad") o Anticipating the worst, worry, hypervigilence (over sensitive) o Poor concentration, poor memory, fatigue, insomnia o Crying, irritability, guilt, sense of worthlessness  "both anxious and depressed individuals feel helpless and believe they lack control, but only in depression do they give up and become hopeless about ever regaining control." (P. 237) Biology of Stress Response  Recall that response can result in a fear/submit state which resembles depression  Biologically, the hippocampus is highly sensitive to cortisol Neurogenesis  Long term effects of stress activation may result in decreased production neurons in the hippocampus o Chronically stressed rats show shrinkage in hippocampus, which improves following stressor o Pruning of dendrites (rather than cell death) o Difficult to demonstrate in humans Psychological Causes of Mood Disorders  In general: o Belief in loss of ability to direct one's own life o Hopeless and demoralization o Eventually, one's actual power does diminish o Gives up many former productive or enjoyable activities o Perpetuating sense of loss of control, hopelessness, etc Stressors as Triggers of Depression  The stressor is not enough to predict depression  Need to consider the context and the meaning of the event o Supportive context with positive meaning vs. lack of support and catastrophic interpretations o Difficult
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