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Lecture 6

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Psychology 2030A/B
David Vollick

Chapter 7: Mood Disorders huge part of mental disorders; more frequently diagnosed;  DSM Table 7.1, 7.2 & 7.3  Major Depression: An Overview  Major depressive Episode: Overview and defining features 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 (change of appetite, change of weight, change in sleep, cant concentrate) 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 (if you have more than one and if you don’t recover well in between, you are at greater risk of having another one)  Major Depressive Disorder o Single episode- highly unusual o Recurrent episodes- more common o Severe cases- residual symptoms and high likelihood of subsequent episodes (  Major Depressive Episode  If it lasts more than 5 years, increased risk of residual symptoms, another episode, and incomplete inter-episode recovery  DSM Table 7.4  Dysthymia Disorder: An Overview  Overview and Defining Features o Defined by persistently depressed mood that continues for at least 2 years o Symptoms of depression are milder that 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 20’s o Greater chronicity, poorer prognosis before 20’s  Double Depression  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- high relapse o Associated with sever psychopathology o Associated with problematic future course  Grief o Normal reaction to the loss of something or someone; hopelessness, helplessness o Pre-loss dependency predicts pathological grief response  Bipolar I Disorder  Overview and Defining Features o Alternations between full manic episodes and depressive episodes o One experiencing mania can also experience depression/anxiety  Facts and Statistics o Average onset is 18 years, but can begin in childhood (could have to do with child abuse and changing family systems i.e. parents spending more time at work than with the family unit) o Tends to be chronic o Suicide is a common consequences  DSM Table 7.5  Bipolar II Disorder  Overview and Defining Features o Alternations between major depressive episodes and hypomanic episodes o Less intense than BI  Facts and Statistics o Average onset of 22 ears, but can begin in childhood o Only 1—13% of cases progress to full bipolar I disorder o Tends to be chronic  DSM Table 7.6  Cyclothymic Disorder  Overview and Defining Features o More chronic version of bipolar disorder (can remain in either a manic or depressive state for years) o Manic and major depressive episodes are less severe o Manic or depressive mood states persist for long periods- never out of control (can be seen as very explosive, moody, high-strung) o Pattern must last for at least 2 years (1 year for children or adolescents)  Facts and Statistics o Age of onset 12- 14 years o Cyclothymia tends to be chronic and lifelong o Most are female o High risk for developing bipolar I and II  Additional Defining Criteria for Mood Disorders  Symptom Specifiers o Atypical- oversleep, overeat, gain weight and are anxious o Melancholic- severe somatic symptoms, more sever depression o Chronic- Major depression only, lasting 2 years o Catatonic- very serious condition, absence of movement i.e. for schizophrenia, might just stand with their arms out for half an hour for no reason o Psychotic- mood congruent/incongruent hallucinations/delusions o Postpartum- severe manic or depressive episodes post childbirth (2-3 days after)  McGill- low SES and high stress  Specifiers Describing Course of Mood Disorders  Course Specifiers o Longitudinal Course- past history and recovery from depression and/or mania; these people recover fully between episodes o Rapid cycling pattern- applies to bipolar I and II disorder only; 4 manic or depressive episodes in one year; severe; treatment not effective o Seasonal patters- SAD- weather episodes (mainly depression) are more likely  Increase in melatonin?? Lack of sunlight so exposure to special light bulbs has been proven to help  Phototherapy, CBT  Mood Disorders: Additional Facts and Statistics  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 males o Boys more depressed than girls in early childhood, females more depressed from then until 65, then gender imbalance in depression disappears o Bipolar disorders are equal between males and females (no childhood depressive episode in DSM IV)  Prevalence of depression similar across subcultures  Most depressed persons are anxious, not all anxious are depressed  Familial and Genetic Influences  Family Studies o Rate of mood disorders high in relatives of probands (person that has the disorder) o Relative 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 disorders have stronger genetic contributions o Heritability rates higher for females vs. males o Vulnerability fir unipolar or bipolar disorder appear to be inherited separately  Proband Diagnosis vs. concordance rate- in text graph  Neurobiological Influences  Neurotransmitters o Mood disorders are related to low levels of serotonin > permissive hypothesis (serotonin effects a lot of other areas in the brain & if low, other areas of the brain [neurotransmitters] can vary)> deregulation of other neurotransmitter systems> mood irregulation  Endocrine System o High cortisol and the dexamethasone suppression test o Dexamethasone depresses cortisol secretion o Persons with mood disorders show less suppression o No lab test to diagnose depression  Sleep Disturbance o Hallmark of most mood disorders  E.g. decreased delta (slow wave) sleep, the deepest stage of sleep  Neurobiological and Psychological Dimensions (stress)  Greater right-side anterior activation (alpha wave activation) of the cerebral hemispheres ( the stress itself activate this)  The role of Stress in Mood Disorders o Stressful life events are strongly related to mood disorders- more so in men o Recurrent episodes of depression, but not initial episodes are strongly predicted by major life s
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