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Lecture 21

Psychology 1000 Lecture 21: March 28

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Psychology 1000

March 28 Up to 682 Prior to the DSM, the distinction between a neurosis and a psychosis was based on problems of: - Anxiety vs. thought disturbance Mood Disorders - Characterized by disturbance in mood (affect) rather than thought - “high”  mania - “low”  depression - Unipolar or Major Depression o Patient experiences only the despair of depression o 10% of men, 20% of women - Bipolar (manic-depressive psychosis) o But it’s NOT a psychosis at all o Patient swings from one extreme to the other (1% of the population) o About 10 episodes of each state during life o Untreated, each phase can last for months o Some people are rapid cyclers (20% of those with bipolar disorder)  4 or more mood swings per year  An even smaller percentage have daily mood shifts Mania? - Why is it a problem? o Mild, maybe not o Mental high gear o Maybe that’s okay?! - People with disorder go above the mental high gear - They jump from one thing to another and cannot stay focused – unable to sit still o This can be both mentally and physically - Jumps from unbounded elation to intense irritation - In a very acute form: o Endless talk o No inhibitions o Grandiose plans – think that if they put their mind to it, they can solve anything o Insomnia – causes sleep-related problems as well o Ceaseless torrent of activity o Sedation – to bring them down - Consider: Clifford Beers o Suffered bipolar disorder and became a mental health reform champion o Wanted to write letters about everything that was happening to him - People with bipolar don’t like to admit it - Lithium is a drug that works very well What are the symptoms of major depression? Major Depression - Polar opposite - Patient appears utterly dejected, hopeless, worthless - May be hallucinations or delusions in severe case Symptoms - Loss of appetite - Sleep disturbance - Fatigue - Little, if any, interest in sex - Suicide Suicide - WHO: suicide every 40 seconds - Official North American rate: o 32,000 per year o 87.9 per day o 1 person every 16.5 minutes - Estimate: 100,000 per year - Rate of Indigenous is over double - Men are more likely to use guns and cars and women are more likely to use pills o Men’s methods are more likely to end in death - Risk for suicide low while patient is in worst depression  apathy o They don’t care about anything and don’t have the ability to kill themselves - Risk increases as patient comes out of depression - Rates highest on weekend leaves and shortly after discharge Etiology - Genetic o Bipolar Disorder  Concordance for identical twins is 4 times that of fraternals  Biological parents 3 times more likely to have disorder than adoptive parents  Egeland et al.  Gene disorder in Amish population  63% developed bipolar  Major depression… twins studies  Identical 76%  Fraternal 19% - Biochemical o Switch in bipolar often not related to external circumstances… probably internal o 1950s … reserpine (drug used for hypertension) induced depression
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