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Chapter 10

Chapter 10 notes

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Ryerson University
PSY 606
Thomas Hart

Chapter 10: Mood Disorders General Characteristic of Mood Disorders • Mood disorder: involve disabling disturbances in emotion from sadness of depression to the elation and irritability of mania Depression – Signs and Symptoms • Depression: emotional state marked by great sadness and feelings of worthlessness and guilt • Symptoms: withdrawal from others and loss of sleep, appetite, sexual desire, and interest and pleasure in usual activities • Associated with other problems – panic attacks, substance abuse, sexual dysfunction, and personality disorder • They may speak slowly, after long pauses, using few words, monotonous voice • They prefer to sit alone and remain silent • May neglect personal hygiene and appearance and make numerous complains of somatic symptoms with no apparent physical base • Vary across the lifespan (symptoms) • Children – results in somatic complaints (headaches or stomach aches) • Older adults – (distractibility and complaints of memory loss) • Some cross cultural variation – because of difference in cultural standards of acceptable behaviour • Psychologizers: people who emphasize the psychological aspects of depression o 15% of patients in Canada o More non western cultures express physical symptoms rather than psychological • Average untreated depression may stretch for 3-5 months or longer • 1/3 suffer from chronic depression Mania – Signs and Symptoms • Mania: an emotional state or mood of intense but unfounded elation accompanied by irritability, hyperactivity, talkativeness, flight of ideas, distractibility, and impractical, grandiose plans • Usually it’s a cycle between depression and mania. Mania alone is rare • Last from several days to several months • Symptoms – loud stream of remarks, full of puns, jokes , rhyming, and interjections about objects and happening that have attracted the speaker’s attention • Their speech is difficult to interrupt • Usually comes on suddenly Formal Diagnostic Listing of Mood Disorders • 2 major mood disorders  major depression (unipolar depression) & bipolar depression Diagnosis of Depression • Major depression/unipolar depression • Requires the presence of 5 of the following symptoms for at least 2 weeks (but depressed mood or loss of interest and pleasure must be one of the 5 symptoms) o Sad, depressed mood, most of the day nearly every day o Loss of interests in usual activities o Insomnia or too much sleep o Shift in activity level  becoming either lethargic (psychomotor retardation) or agitated C h a p t e r 1 0 : M o o d D i s o r d e r s Page 1 o Poor appetite and weight loss of increased appetite and weight gain o Loss of energy/fatigue o Negative self-concept, self reproach and self blame (worthlessness and guilt) o Difficulty concentrating o Recurrent thoughts of death or suicide • Prevalence of 5.2 – 17.1% - American studies & 4-6% in Canadian studies but higher ones were also found • 2x more common in women • More often in younger ages than older and in low socio economic class • Females are more likely to engage in ruminative coping (want to understand the meaning of why they feel that way) and males tend to do something that diverts their attention • Male and females differ in the stressors they experience (ex. Single mothers vs. Married) • Females are more likely than males to be exposed to various forms of victimization • Depression is a recurrent disorder, 80% experience another episode lasting 3-5 months • 12% of the cases become chronic Diagnosis of Bipolar Disorder • Bipolar disorder: involves episodes of mania or mixed episodes that include symptoms of both mania and depression • Requires the presence of elevated or irritable mood plus 3 additional symptoms (4 if the mood is irritable) • The symptoms must be sever enough to impair social and occupational functioning o Increased activity level at work, socially or sexually o Unusual talkativeness, rapid speech o Flight of ideas or subjective impression that thoughts are racing o Less than usual amount of sleep needed o Inflated self esteem (belief that they have some special powers) o Distractibility: attention easily diverted o Excessive involvement in pleasurable activities that are likely to have undesirable consequences (reckless spending) • Less often than major depression • Prevalence – 1% • Average onset is 20s • Occurs equally in men and women (women – episodes of depression are more common and episodes of mania less common than among men) • It also tends to reoccur • 50% of cases have 4 or more episodes Heterogeneity within the Categories • Heterogeneity: people with the same diagnosis can vary greatly from one another • Mixed episode: some bipolar patients experience the full range of symptoms of both mania and depression almost every day • Bipolar II disorder: patients have episodes of major depression accompanied by hypomania (a change in behaviour and mood that is less extreme than full blown mania) • The presence of delusions is a distinction among people with unipolar depression (they do not respond well to drug therapy also but respond to drugs treated for other psychotic disorders)  this type of depression is more severe and less time between episodes C h a p t e r 1 0 : M o o d D i s o r d e r s Page 1 • Some patients have melancholic features (no pleasure in any activity and unable to feel better even temporarily when something good happens) o depressed mood is worse in the morning (wake up 2 hours too early, lose appetite and weight and are either lethargic or extremely agitated) • Both manic and depressive episodes have catatonic features (motor immobility or excessive, purposeless activity) • Postpartum depression: depressive episodes that occur within 4 weeks of childbirth • Seasonal affect disorder (SAD): depression linked to a decrease in the number daylight hours o Therapies include exposing the patient to bright, white light o Phototherapy: exposure to bright, white light is highly effective Chronic Mood Disorders • Must be evident for 2 years but are not severe enough to warrant a diagnosis of a major depressive or manic disorder • Cyclothymic disorder: the person has frequent period of depressed mood and hypomania o Period may be mixed with or separated by periods of normal mood lasting as long as 2 months o During depression they feel inadequate, during hypomania, their self-esteem is inflated o They withdraw from people then seek them out in an uninhibited fashion o They sleep too much than too little o They experience full blown mania and depression • Dysthymic disorder: chronically depressed o Feeling blue o Lose pleasure in usual activities and past times o Insomnia or sleeping too much o Feelings of inadequacy, ineffectiveness or lack of energy o Pessimism, inability to concentrate and to think clearly o Desire to avoid the company of others o Many of them have episodes of major depression as well as a condition known as double depression Psychological Theories of Mood Disorders Psychoanalytic Theory of Depression • Emphasize the unconscious conflicts associated with grief and loss; cognitive theories • Freud – potential for depression is created early in childhood. A fixation at the oral stage, the person may develop a tendency to be excessively dependent on other people for the maintenance of self esteem • Freud also says that after the loss of a loved one, (usually people harbour negative feelings towards the one they love) but then this hate turns inward, and feelings of guilt and sadness increases Cognitive Theories of Depression • Focus on the depressed person’s self defeating thought processes and interpersonal factors which emphasize how depressed people interact with others • Ellis – cognitive processes play a decisive role in emotional behaviour Beck’s Theory of Depression • Thought processes as causative factors in depression C h a p t e r 1 0 : M o o d D i s o r d e r s Page 1 • Depressed individuals feel as they do because their thinking is biased toward negative interpretations • Interactions among 3 levels of cognitive activity that underlie depression o Negative triad  negative schema, together with cognitive biases or distortions.  Negative views of the self, the world (persons’ judgment that he or she cannot cope with demands of the environment) and failure o Negative schema or beliefs o Cognitive Biases  Arbitrary inference: a conclusion drawn in the absence of sufficient evidence or of any evidence at all  Selective abstraction: a conclusion drawn on the basis of only one of many elements in a situation  Overgeneralization: an overall sweeping conclusion drawn on the bias of a single, perhaps trivial , event  Magnification and minimization: exaggerations in evaluating performance • Beck believes that our emotional reactions are a function of how we construe or worlds • The interpretations of depressed individuals are not the way most people view the world and they become the victims of their own illogical self judgments • Patients have an overall cognitive availability of negative vs. Positive thoughts about the self • Cognitive accessibility: they differ in cognitive processing, depressed people pay greater attention to negative stimuli an can more readily access negative as opposed to positive information • Stroop task: a way differences in cognitive processing are assessed o Words paired with colors  it asses the latency or length it takes to respond o Depressed patients take longer for the depressed related words Evaluation • Whether depressed patients actually think in the negative ways enumerated by Back • Whether it could be that negative beliefs of depressed people do not follow the depression but in fact cause the depressed mood • Sociotrophic individuals: dependent on others, concerned with pleasing others, avoiding disapproval and avoiding separation • Autonomy: achievement related construct that focuses on self critical goal striving, a desire for solitude, and freedom from control • Sociotrpy-Autonomy Scale: developed to asses these constructs • Introjective orientation: involves excessive levels of self criticism • Anaclitic orientation: involves excessive levels of dependency on others • Congruency hypothesis: reflects the diathesis stress approach o non depressed persons with a personality style that makes him or her vulnerable to depression also experiences a negative life event that is congruent with or matches their vulnerability in some way, then this person will become depressed Helplessness/Hopelessness Theories • Learned Helplessness theory: an individual’s passivity and sense of being unable to act and to control his or her life is acquired through unpleasant experiences and traumas that the individual tried unsuccessfully to control C h a p t e r 1 0 : M o o d D i s o r d e r s Page 1 o Began as a meditational learning theory formulated to explain the behaviour of dogs who receive inescapable electric shocks o They lose the ability and motivation to learn to respond in an effective way to painful stimulation • Attribution and Learned Helplessness Theory o Helplessness induced sometimes led to subsequent improvement of performance o Many depressed people hold themselves responsible for their failures o Depressive paradox: characteristics of feeling helpless yet blaming oneself o Attribution: the explanation a person has for his or her behaviour. When a person has experienced failure, he or she will try to attribute the failure to some cause o The way in which a person cognitively explains failure will determine its subsequent effects  Global attributions: I never do anything right; increase the generity of the effects of failure  Attributions to stable factors: I never test well; make them long term  Attributions to internal characteristics: I am stupid; are more likely to diminish self esteem o The theory suggests people become depressed when they attribute negative life events to stable and global causes • Hopelessness Theory o Latest version o Hopelessness depression are now regarded to be caused by a state of hopelessness, an expectation that desirable outcomes will not occur or that undesirable ones will occur and that the person has no response available to change this situation o Negative life events (stressors) are seen as interacting with diatheses to yield a state of hopelessness o Depressive predictive certainty: if the perceived probability of the future occurrences of negative events becomes certain, hopelessness depression develops • Problems with the theories o Which type of depression is being modelled? o Are the findings specific to depression? o Are attributions relevant? Interpersonal Theory of Depression • Relationships between the depressed person and others • Depressed people have little social support • Reduc
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