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Chapter 10

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CHAPTER 10 • Mood Disorders – also know as Affective Disorders. When mood swings become so prolonged and extreme that the person’s life is completely disrupted. A striking feature of mood disorders is its episodic quality. • Major Depressive Episode – may occur over night, but usually the onset of depression is gradual, occurring over a period of several weeks. The person undergoes profound changes in mood, motivation, thinking, and physical and motor functioning. DSM IV Characteristic features:  Depressed Mood – unhappiness (ranging from mild melancholy to total hopelessness). Deeply depressed people generally regard their condition as irreversible; they cannot help themselves, nor can anyone help them. This has been characterized as the helplessness-hopelessness syndrome.  Loss of Pleasure or Interest in Usual Activities – loss of pleasure is known as Anhedonia, it is usually far-reaching.  Disturbance of Appetite – poor appetite and weight loss. (some react oppositely)  Sleep Disturbance – Insomnia is extremely common.  Psychomotor Retardation or Agitation – adjustment in motor behavior or physical bearing. In the most common pattern, Retarded Depression, the patient seems overcome by a massive fatigue. More rarely, the symptoms take the opposite from, Agitated Depression, hand wringing, pacing, and moaning.  Loss of Energy – reduced energy level.  Feelings of Worthlessness and Guilt – dismayed by themselves. See themselves as deficient in whatever attributes they value most.  Difficulties in Thinking – mental processes are usually slowed down.  Recurring Thoughts of Death or Suicide - • Manic Episode – usually begins rather suddenly, and usually shorter than a depressive episode. DSM IV characteristics:  Elevated, Expansive, or Irritable Mood – mood change is the essential, ‘diagnostic’ feature.  Inflated Self-Esteem  Sleeplessness  Talkativeness  Flight of ideas  Distractibility  Hyperactivity  Reckless Behavior For a condition to be diagnosed as a manic episode, it must have lasted at least a week, and seriously interfered with the person’s functioning. A briefer and less severe manic condition is called Hypomanic Episode. A Mixed Episode is one in which a patient will meet criteria for manic episode and major depressive episode simulataneously. Mood Disorder Syndromes: • Major Depressive Disorder – when people undergo one or more major depressive episodes, with no intervening periods of mania. One of our society’s greatest mental health problems. (4% for men / 6% for women). Depression is second only to schizophrenia. Divorced people, and women are at higher risk. Peak age at onset is now 15-19 for women, and 25-29 for men. Premorbid adjustment – level of functioning prior to the onset of the disorder. 1 • Bipolar Disorder – involves both manic and depressive phases. Will usually first appear in adolescence in the form of a manic episode. Rapid-Cycling Type – person (usually a woman) switches back and forth between depressive and manic or mixed episodes over a long period, with little or no ‘normal’ functioning between. DSM IV has divided into two types: A) Bipolar I – where the person has had at least one manic (or mixed) episode and usually, but not necessarily, at least one major depressive episode as well. B) Bipolar II – where the person has had at least one major depressive episode and at least one hypomanic episode but has never met the diagnostic criteria for manic or mixed episode. Differences between Major Depression and Bipolar Disorder:  Bipolar is much less common than major depression.  The 2 disorders show different demographic profiles…with bipolar affecting gender equally, and being more prevalent among higher socio-economic groups.  People who are married are less prone to major depression, but not bipolar disorder.  People with bipolar are likely to have a history of hyperactivity.  Depressive episodes in Bipolar disorder are more likely to involve a pervasive slowing down – psychomotor retardation, excess sleep – than are those in major depression.  Bipolar is more likely to run in families. • People who are chronically depressed or who chronically pass through depressed and expansive periods but whose condition is nevertheless not debilitating enough to merit the diagnosis of major depressive disorder or bipolar disorder. The patterns must last for 2 years or more.  Dysthymic Disorder – involves a mild, persistent depression. Typically morose, introverted, over-conscientious, and incapable of fun. Show low energy levels, low self-esteem, suicidal ideation, and disturbances of eating, sleeping, and thinking. More common in women.  Cyclothymic Disorder – the person never goes longer than a few months without a phase of hypomanic or depressive behavior. It becomes a way of life. In their hypomanic periods, they will work long hours without fatigue – indeed, with their mental powers newly sharpened – before lapsing back into a normal or depressed state. Affects gender equally. Dimensions of Mood Disorders: • Psychotic vs. Neurotic: Neurotics do not lose their ability to interact with their environment in a reasonably efficient manner. Psychotics do, partly because their thinking processes are often disturbed by hallucinations, or false sensory perceptions, and delusions, or false beliefs. Some theorists use a theory known as Continuity Hypotheses, which rests on the idea that depression appears, above all, to be an
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