Psychology 2320A/B Lecture Notes - Major Depressive Episode, Mania, Bipolar Disorder

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13 Nov 2012
Department
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Mood Disorders
Introduction
Depression versus Mania- euphoric (two different problems with moods)
- People who experience depression also experience mania in their life.
DSM-IV distinguishes two general patterns:
Unipolar depression only
Bipolar both mania and depression.
Unipolar Depression
―Normal‖ depression- why do we have depression? Anxiety that is an emotion that’s important but when it’s
excessive and uncontrollable then it becomes pathological, like depression
Psychological pain‖- we have pain cause its adaptive- and that pain is a signal o you to protect your
body. Depression has primarily to do with how we are social animals; small groups and we need
support for protection. Evolutionary point of view-depression is like pain when there is a break with
our social connectedness. As a result from broken relationship.
- Failure
DSM-IV categories:
- Major depression
- Dysthymic disorder (Dysthymia)
- Adjustment disorder with depressed mood** often used when people are experiencing a mild level
of depression following a stress hold event.
- Common cold‖
Depression is the leading cause of disability worldwide, according to WHO
Costs more in treatment and lost productivity than anything but heart disease
- Even cancer, depression costs more
Canada $14.4 billion per year
Treatment, lost productivity
DSM: Major Depressive Episode- the begin by defining the criteria for saying that someone is having
a depressive episode, not a diagnosis yet.
- 5 or more symptoms lasting 2+ weeks
- Most of the day nearly every day
- Mood symptoms (one must be present):
o Depressed mood- MODNED feeling blue, hopeless, discouraged down in the dumps,
negative mood.
o Loss of interest or pleasure in activities (anhedonia)- markly diminished enjoyment in
activities.
- Physical symptoms: - vegetative signs
o Significant weight loss or gain- comfort food
o Insomnia or hypersomnia- no sleeping or excessive
o Psychomotor agitation (person is very fidgety, cant stop moving) or retardation (everything
slows down, no expression, no energy to move a muscle)
o Fatigue, loss of energy. —Lack of motivation doesn’t feel like do anything, vicious cycle can
develop.
- Cognitive Symptoms:
o Feelings of worthlessness or guilt- neg. feeling about themselves- can come to a point of
delusion. A real loss of contact with reality. A belief that is clearly not true. A delusion of
guilt that they have done some terrible thing that they cant be forgiven for.
o Diminished ability to think or concentrate- distracted, their work gets inefficient,
indecisiveness
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o Recurrent thoughts of death, suicidal ideation
- Symptoms cause clinically significant distress or impairment in functioning
- NB depression is a ―syndrome‖. - Number of symptoms that all go together- include mood, bodily,
biological aspect (weight gain, no sleep) and cognitive symptoms.
Major Depressive Disorder
- Presence of Major Depressive Episode- at least one major depressive episode.
- No history of manic or hypomanic episodes
- Subtypes: Single episode vs. recurrent- they can recover, or it can be recurring that they’ll have
multiple episodes of depression from time to time, so in that case recurrent major depressive
disorder.
- Specifiers:
o Mild, (still able to function daily but takes lots of effort.) moderate, severe without
psychotic features, severe with psychotic features (psychotic symptoms: delusions and
hallucination, people with depression can have a loss of contact with reality. Delusion more
common then hallucinations. )
o Atypical oversleep, overeat, weight gain, anxiety- too typical
o With Catatonic features very immobile, rigid curling up in a ball, shutting off the world
around them.
o With Melancholic features- high biological basis for this where the person has extreme
anhedonia.
o With Postpartum onset- when a women because depressed after having a baby. - Within 4
weeks. Some hormonal changes? Reduction in the progesterone has an anti-anxiety effect
in the brain.
o With Seasonal pattern. - Depressed during specific times like winter. ** Melatonin
How common is clinical depression?
- In any given year: 1,500,000 Canadians (400,000 people in Ontario)
- At any one time: approximately 6% of women and 3% of men
- Lifetime prevalence: approximately 12% of women and 6% of men
- Prevalence has increased dramatically over the past century- twice as commonwestern culture**
- WHO: leading cause of disability worldwide
- 2:1 ratio Women: Men some suggest that it might have to do with hormone, genetics or
sociocultural factors, women are more vulnerable to stress, caregiver, lower income
Course
- First episodes usually adolescence or early adulthood, but can happen at any age
- Typically (episodes by depression) precipitated by a severe stressor
- Episodes typically last 6 months to 1 year avg 9 months, but untreated.
- A person who has one episode of depression will, on average, go on to have 5 or 6 episodes
o 1 episode: 50% risk of a second
o 2 episodes: 70% risk of a third
o 3+ episodes: 90% risk of more
- Variable course: full versus partial remission between episodes.
Associated features
- Elevated risk of suicide Approx. 15% of people with severe depression commit suicide
- Comorbidity
o Anxiety disorders (50%) eg, panic, OCD
o Eating disorders
o Substance abuse
o Borderline personality disorder. - A lot of behavioral and emotional
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