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Chapter 7.docx

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Psychology 2030A/B
David Vollick

Chapter 7: Mood disorders Major depression: an overview - Major depressive episode: overview and defining features o Extremely depressed mood state for at least 2 weeks o No mania (for bipolar!) o Cognitive symptoms (feelings worthless, indecisive, hopeless) o Vegetative or somatic symptoms: central to the disorder o Anhedonia: loss of pleasure or interest in usual activities o Decreased delta (slow wave), deepest stage of sleep, so you don’t get a good sleep! o Average duration if untreated is 9 months (sometimes might be 5 years!) o If you have more than one depression, if you don’t recovered between, you have residual leftover and this is increasing the risk to be depressed again. - Major depressive disorder (more than one depressive episode) o Single episode: highly unusual (really rare, typically doesn’t happen) o Recurrent episodes: more common o Severe cases: residual symptoms and high likelihood of subsequent episode o If lasts of 5 years, increase risk of residual symptoms, another episode and incomplete inter-episode recovery Dysthymia: 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 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  Early onset: before age 20, greater chronicity, poorer prognosis (pronostic!) Double depression - Overview and defining features o Person experiences major depressive episodes and dysthymic disorder (wavy) o Dysthymic disorder often develops first and after leads to a major depressive episode - Facts and statistics o Quite common: high relapse o Associated with severe psychopathology (mental problems) o Associated with a problematic future course - Grief: normal reaction to the loss of someone or something we loved o Pre-loss dependency predicts pathological grief response Bipolar I disorder - Overview and defining features o Alternations between full maniac episodes and depressive episodes o One experiencing mania can also experience depression/anxiety - 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 - Overview and defining features o Alternations between major depressive episodes and hypomanic episodes - Facts and statistics o Average age of onset is 22 years, but can begin in childhood o Only 10% to 13% of cases progress to full bipolar I disorder o Tends to be chronic Cyclothymic disorder (difference from bipolar: depressive episode are less severe) - Overview and defining features o More chronic version of bipolar disorder (very few periods of normal mood) o Manic and major depressive episodes are less severe o They switch between the 2 states, they have not the normal mood o Manic or depressive mood states persist for long periods: never out of control 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 - 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 (also see in schizophrenia) o Psychotic: mood congruent/incongruent hallucinations/delusions (if I stop repeating this word in my head, the world will go to war) o Postpartum: severe manic or depressive episodes post childbirth (more severe than the simple blues after delivery) (both maniac and depressive episode: generally two or three day after the delivery)  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 o Rapid cycling pattern: applies to bipolar I and II disorder only: 4 maniac o depressive episodes in 1 year! They recovered fully from each episode! It’s very severe and the treatments are not effective. o Seasonal pattern: SAD: weather episodes (mainly depression) are more likely:  Increase in melatonin??  Phototherapy, CBT (cognitive behavioral therapy) 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 men o Boys are 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 o In the DSM V there is no childhood depressive symptoms - Prevalence of depression similar across subcultures - Most depressed persons are anxious, not all anxious persons are depressed Familial and genetic influences - Family studies o Rates of mood disorders high relatives of probands (proband the one who have the disorders) o Relatives of bipolar probands are more likely to have unipolar depression - Adoption studies o Date are mixed - Twin studies: o Concordances rates for mood disorders high in monozygote twins o Severe mood disorders have a stronger genetic contribution o Heritability rates higher for females versus males o Vulnerability for unipolar or bipolar disorder appear to be inherited separately Neurobiological influences - Neurotransmitters: o Mood disorders are related to low levels of serotonin -> permissive hypothesis -> dysregulation of other neurotransmitter systems (so serotonin also affects the all NT systems, because all the NT are interconnected in the same path!) -> mood irregularities - Endocrine system: o High cortisol o The dexamethasone suppression test: help to see if the patient supress the cortisol release like a normal person (don’t help to diagnose depression) 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 & psychological dimensions (stress) - Greater right-side anterior activation (alpha wave activation) of the cerebral hemispheres - 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 maj
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