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Lecture 7

Lecture 7.pdf

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Psychology 2030A/B
David Vollick

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Abnormal  Psychology  Chapter  7:   Mood  Disorders  (pp.212-­‐261)     Major  Depression:  An  Overview  (pp.216)   • Major  Depressive  Episode:  Overview  and  Defining  Feature   o Extremely  depressed  mood  state  for  at  least  2  weeks   o No  Mania   o Cognitive  symptoms  (feeling  worthless,  indecisive)   o Vegetative  or  somatic  symptoms  –  central  to  the  disorder   o Anhedonia  –  loss  of  pleasure/interest  in  usual  activities   o Decreased  delta  slow  wave,  deepest  stage  of  sleep   o Average  duration  if  untreated  is  9  months   • Major  Depressive  Disorder   o Single  episode  –  highly  unusual   o Recurrent  episodes  –  more  common   o Severe  cases  –  residual  symptoms  and  highly  likelihood  of  subsequent   episode     Dysthymia:  An  Overview  (pp.  216)   • Overview  and  Defining  Features   o Defined  by  persistently  depressed  mod  that  continues  for  at  least  2   years   o Symptoms  of  depression  are  milder  than  major  depression   o Symptoms  can  persist  unchanged  over  long  periods  (e.g.  20  years  or   more)   • Facts  and  Statistics   o Late  onset  –  typically  in  the  early  20s    before  age  20,  greater  chronicity,  poorer  prognosis     Double  Depression  (pp.216-­‐220)   • Overview  and  Defining  Features   o Person  experiences  major  depressive  episodes  and  dysthymic   disorder   o Dysthymic  disorder  often  develops  first   • Facts  and  Statistics   o Quite  common   o Associated  with  severe  psychopathology   o Associated  with  a  problematic  future  course     Grief   • Pre-­‐loss  dependency  predicts  pathological  grief  response     Bipolar  I  Disorder  (pp.220-­‐223)   • Overview  and  Defining  Features   o Alternations  between  fill  manic  episodes  and  depressive  episodes   o One  experiencing  mania  can  also  experience  depression/anxiety   o Symptoms  of  mania  include  feeling  on  top  of  the  world  and  little  sleep   o A  lot  of  creative  people  have  mania  and  they  tend  not  to  take   medications  because  it  decreases  their  creativity   • Facts  and  Statistics   o Average  age  on  onset  is  18  years,  but  can  begin  in  childhood   o Tends  to  be  chronic   o Suicide  is  a  common  consequence       Bipolar  II  Disorder  (pp.220-­‐223)   • Overview  and  Defining  Features   o Alterations  between  major  depressive  episodes  and  hypomanic   episodes   • Facts  and  Statistics   o Average  age  of  onset  is  22,  but  can  begin  in  childhood   o Only  10-­‐13%  of  cases  progress  to  full  bipolar  I  disorder   o Tends  to  be  chronic     Cyclothymic  Disorder  (pp.  222)   • Overview  and  Defining  Features   o More  chronic  version  of  bipolar  disorder   o Manic  and  major  depressive  episodes  are  less  severe   o Manic  or  depressive  mood  states  persist  for  long  periods   o Pattern  must  last  for  at  least  2  years  (1  year  for  children  and   adolescents)   • Facts  and  Statistics   o Average  age  of  onset  is  about  12  or  14  years   o Cyclothymia  tends  to  be  chronic  and  lifelong   o Most  are  female   o High  risk  for  developing  bipolar  I  or  II  disorder     Additional  Defining  Criteria  for  Mood  Disorders  (pp.  223)   • Symptom  Specifiers   o Atypical  –  oversleep,  overeat,  gain  weight,  and  are  anxious   o Melancholic  –  severe  somatic  symptoms,  more  severe  depression   o Chronic  –  major  depression  only,  lasting  2  years   o Catatonic  –  very  serious  condition,  absence  of  movement   o Psychotic  –  mood  congruent/incongruent  hallucinations/delusions   o Postpartum  –  severe  manic  or  depressive  episodes  post  childbirth      McGill  –  low  SES  and  high  stress     Specifiers  Describing  Course  of  Mood  Disorders  (pp.223-­‐224)   • Course  Speicifers   o Longitudinal  Course  –  Past  history  and  recovery  from  depression   and/or  mania   o Rapid  cycling  pattern  –  applies  to  bipolar  I  and  II  disorder  only  –  4   manic  or  depressive  episodes  in  1  year  –  severe,  treatment  not   effective   o Seasonal  Pattern  –  SAD  –  weather  episodes  (mainly  depression)  are   more  likely    Increase  in  melatonin  ??    Phototherapy,  CBT     Mood  Disorders:  Additional  Facts  and  Statistics  (pp.226-­‐230)   • Lifetime  Prevalence   o Rates  in  Canadian  studies  variable  ranging  from  4.1&  in  the  Ontario   Health  Survey  to  11%  in  surveys  in  Toronto  and  Calgary   • Sex  Differences   o Females  are  twice  as  likely  to  have  a  mood  disorder  compared  to  men   o Boys  more  depressed  than  girls  in  early  childhood,  females  more   depressed  then  until  65,  then  gender  imbalance  in  depression   disappears   o Bipolar  disorders  are  equal  between  males  and  females   • Prevalence  of  depression  similar  across  subcultures   • Most  depressed  persons  are  anxious,  not  all  anxious  persons  are  depressed     Familial  and  Genetic  Influences  (pp.232-­‐233)   • Family  Studies   o Rate  of  mood  disorders  high  in  relatives  of  probands   o Relatives  of  bipolar  probands  are  more  likely  to  have  unipolar   depression   • Adoption  Studies   o Data  are  mixed   • Twin  Studies   o Concordance  rates  for  mood  disorders  high  in  MZ  twins   o Severe  mood  disorder  have  a  stronger  genetic  contribution   o Heritability  rates  higher  for  females  vs  males   o Vulnerability  for  unipolar  or  bipolar  disorder  appear  to  be  inherited   separately     Neurobiological  Influences  (pp.233-­‐235)   • Neurotransmitters   o Mood  disorders  are  related  to  low  levels  of  serotonin    permissive   hypothesis   o Dopamine  and  mania   • Endocrine  System   o High  cortisol  and  the  dexamethasone  suppression  test  (doesn’t   suppress  cortisol  as  well  as  is  should)   o Dexamethasone  depresses  cortisol  secretion   o Persons  with  mood  disorders  show  less  suppression   o No  lab  test  to  diagnose  depression   • Sleep  Disturbances   o Hallmark  of  most  mood  disorders   o Relation  between  depression,  sleep  (REM;  SWS)  and  biological   circadian  rhythms   o People  with  bipolar  disorder  are  overly  sensitive  to  light     Neurobiological  and  Psychological  Dimensions  (Stress)  (pp.235-­‐236)   • Greater  right-­‐side  anterior  activation  (alpha  wave  activation)  of  the  cerebral   hemisphere   • The  Role  of  Stress  in  Mood  Disorders   o Stressful  life  events  are  strongly  related  to  mood  disorders  
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