PSY340H5 Chapter Notes - Chapter 8: Paroxetine, Pharmacotherapy, Cardiac Arrhythmia

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8 Aug 2016
Chapter 8: Mood Disorder
General Characteristics of Mood Disorders
Mood disorders: involve disabling disturbances in emotion, from the sadness
of depression to the elation and irritability of mania. Mood disorders are
often associated with other psychological problems, such as panic attacks,
substance abuse, sexual dysfunction, and personality disorders.
Depression: Signs and Symptoms
As illustrated by the case of John Bentley Mays, depression is an emotional
state marked by great sadness and feelings of worthlessness and guilt.
Additional symptoms include withdrawal from others and loss of sleep,
appetite, sexual desire, and interest, and pleasure in usual activities.
Paying attention is exhausting for depressed people.
Depression in children often results in somatic complaints, such as
headaches or stomach aches. In older adults, depression is often
characterized by distractibility and complaints of memory loss.
Psychologizers: people who emphasize the psychological aspects of
Mania: Signs and Symptoms
Mania: is an emotional state or mood on intense but unfound elation
accompanied by irritability, hyperactivity, talkativeness, flight of ideas,
distractibility, and impractical, grandiose plans.
The individual shifts rapidly from topic to topic.
Formal Diagnosis Listing of Mood Disorders
Two major mood disorders listed in DSM-IV-TR: major depression, also
referred to as unipolar depression, and bipolar disorder.
Diagnosis of Depression
Major depressive disorder (MDD) requires the presence of five of the
following symptoms for at least two weeks. Either depressed mood or loss of
interest and pleasure must be one of the five symptoms:
- Sad, depressed mood
- Loss on interest and pleasure in usual activities
- Difficulties in sleeping
- Shift in activity level, becoming either lethargic or agitated
- Poor appetite and weight loss, on increased appetite and weight gain.
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- Loss of energy
- Negative self-concept
- Complaints or evidence of difficulty in concentrating such as slowed
thinking and indecisiveness.
- Recurrent thought of death or suicide.
Ruminative coping: A tendency to focus cognitively (perhaps to the point of
obsession) on the causes of depression and associated feelings rather than
engaging in forms of distraction.
Brooding: A moody contemplation of depressive symptoms – “what am I
doing to deserve this?” – that is more common in females than males.
An interpersonal form of rumination called corumination, in which friends,
typically female friends, discuss and brood over each other’s problems as
part of their friendship, has been linked with depression in adolescent girls
but, on a positive note it is also fosters stronger friendships.
Feminist scholar Dana Jack suggests that females are more likely than males
to engage in silencing the self – a passive style of keeping upsets and concerns
to oneself in order to maintain important relationships (akin to “suffering in
silence”). A definitive longitudinal test of the hypothesis remains to be
conduced. Another explanation is objectification theory, based on the premise
that the tendency to be viewed as an object, scrutinized and appraised by
others, including appraisals of physical appearance, has a greater negative,
influence on the self-esteem of girls than boys.
Kindling hypothesis: the notion that once a depression has already been
experienced, it takes relatively less stress to induce a recurrence.
Diagnosis of Bipolar Disorder
Bipolar I disorder: as involving episodes of mania or mixed episodes that
include symptoms of both mania and depression.
A formal diagnosis of a manic episode requires the presence of elevated or
irritable mood plus three additional symptoms (four if the mood is irritable)
The symptoms must be sufficiently severe to impair social and occupational
- Increase in activity level at work, socially, or sexually
- Unusual talkativeness; rapid speech
- Flight of ideas or subjective impression that thought are racing
- Less than the usual amount of sleep needed
- Inflated self-esteem
- Distractibility
- Excessive involvement in pleasurable activities that are likely to have
undesirable consequences, such as reckless spending.
Heterogeneity within the Categories
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Bipolar II disorder individuals have episodes of major depression
accompanied by hypomania (hypo comes from the Greek for “under”) a
change in behaviour and mood that is less extreme than full-blown mania.
The term melancholic refers to a specific pattern of depressive symptoms.
People with melancholic features find no pleasure in any activity (anhedonia)
and are unable to feel better even temporarily when something good
happens. Their depressed mood is worse in the morning.
Seasonal affective disorder (SAD): The “winter depressions” that stem from
reduced exposure to daylight.
Reduced light does cause decreases in the activity of serotonin neurons of the
hypothalamus, and these neurons regulate some behaviours, such as sleep.
Postpartum depression: The depression experienced by some mothers after
giving birth.
Chronic Mood Disorders
In cyclothymic disorders: the personal has frequent period of depressed
mood and hypomania, which may be mixed with, may alternate with, or may
be separated by periods of normal mood lasting as long as two months.
The person with dysthymic disorder, is chronically depressed – more than
half the time for at least two years – according to the DSM –IV-TR. Besides
feeling blue and losing pleasure in usual activities and pastimes, the person
experiences several other signs of depression, such as insomnia or sleeping
too much; feelings of inadequacy ineffectiveness, and lack of energy;
pessimism; an inability to concentrate and to think clearly; and a desire to
avoid the company of others.
Double depression: A comorbid condition that applies to someone
characterized by both dysthymia and major depression.
Psychological Theories of Mood Disorders
Cognitive Theories of Depression
Beck’s Theory of Depression
Aaron Beck is responsible for the most important contemporary theory that
regards thought processes as causative factors in depression. His central
thesis is the depressed individuals feel as they do because their thinking is
biased toward negative interpretations.
Negative schemata, together with cognitive biases or distortions, maintain
what Beck called the negative triad: negative views of the self, the world, and
the future.
Arbitrary inference – a conclusion drawn in the absence of sufficient
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