PSYB32H3 Chapter Notes - Chapter 10: Seasonal Affective Disorder, Social Rejection, Jack Kevorkian

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1 Apr 2011
General Characteristics of Mood Disorders
mood disorders: disorders in which there are disabling disturbances in emotion
-mood disorders are often associated with other psychological problems, such as panic attacks,
substance abuse, sexual dysfunction, and personality disorders
-the presence of other disorders can increase severity and result in poorer prognosis
Depression: Signs and Symptoms
depression a disorder marked by great sadness and apprehension, feelings of worthlessness
and guilt, withdrawal from others, loss of sleep, appetite, sexual desire, loss of interest and
pleasure in usual activities, and either lethargy or agitation; called major depression in DSM-
IV and unipolar depression by others; it can be an associated symptom of other disorders
- paying attention is exhausting for depressed people; conversation is a chore; they may speak
slowly, after long pauses, using few words and a low, monotonous voice; many prefer to sit alone
and remain silent; others are agitated and cannot sit still; they pace, wring their hands,
continually sign and moan, or complain; depressed people may neglect personal hygiene and
appearance and make numerous complaints of somatic symptoms with no apparent physical
- symptoms and signs of depression vary somewhat across the lifespan
- 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
- depression is substantially less prevalent in China than in North America due in part to
cultural mores (customs/traditions) that make it less appropriate for Chinese people to display
emotional symptoms
- although its commonly believed that people from non-western cultures (eg: Chinese) emphasize
somatic symptoms of depression, while people from Western cultures emphasize emotional
symptoms, studies suggest that people from various cultures, including Canadians, tend to
emphasize somatic symptoms rather than the emotional symptoms, especially when theyre
being evaluated in a medical setting
- overall 15% of depressed primary care patients in Canada are referred to as psychologizers
(people who emphasize the psychological aspects of depression)
- people in most cultures tend to emphasize physical symptoms
- most depression, although recurrent, tends to dissipate with time
- about 1/3 of depressed people suffer from chronic depression
Mania: Signs and Symptoms
mania an emotional state of intense but unfounded elation (great happiness) evidenced in
talkativeness, flight of ideas, distractibility, grandiose plans, and spurts of purposeless activity
- mania's an emotional state or mood of intense but unfounded elation accompanied by
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irritability, hyperactivity, talkativeness, flight of ideas, distractibility, and impractical,
- some people who experience episodic periods of depression may at times suddenly become
- although there are clinical reports of individuals who experience mania but not depression, this
condition is quite rare
- the person in the throes (intense emotion) of a manic episode, which may last from several days
to several months, is readily recognized by his/her loud and incessant stream of remarks,
sometimes full of puns, jokes, rhyming, and interjections about objects and happenings that have
attracted the speakers attention
Formal Diagnostic Listings of Mood Disorders
- 2 major mood disorders listed in the DSM-IV-TR: major depression, also referred to as unipolar
depression, and bipolar disorder
Diagnosis of Depression
major depressive disorder (MDD) an extreme form of depression that satisfies the number
of symptoms required for the category of depression to apply
- MDD requires the presence of 5 of the following symptoms for at least 2 weeks; either
depressed mood or loss of interest and pleasure must be 1 of the 5 symptoms:
sad, depressed mood, most of the day, nearly everyday
loss of interest and pleasure in usual activities
difficulties in sleeping (insomnia); not falling asleep initially, not returning to sleep
awakening in the middle of the night, and early morning awakenings; or, in some patients,
desire to sleep a great deal of the time
shift in activity level, becoming either lethargic (psychomotor retardation) or agitated
poor appetite and weight loss, or increased appetite and weight gain
loss of energy, great fatigue
negative self-concept, self-reproach and self-blame, feelings of worthlessness, and guilt
complaints or evidence of difficulty in concentrating, such as slowed thinking and
recurrent thoughts of death or suicide
- a study showed that even with fewer than 5 symptoms and a duration of less than 2 weeks, co-
twins were also likely to be diagnosed with depression and patients were likely to have
- other research suggests that depression exists on a continuum of severity
- the issue of whether depression is best seen as being on a continuum or as a discrete diagnostic
category is far from resolved
- MDD is one of the most prevalent of the disorders described in this book
- lifetime prevalence rates have ranged from 5.2% - 17.1% in some studies
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- in many countries, the prevalence of MDD increased steadily during the latter part of the 20th
- regardless of prevalence, MDD is about 2 times more common in women than in men
- the gender difference doesnt appear in preadolescent children, but it emerges consistently by
- gender gaps emerge at age 14 and seem to be maintained across the lifespan
- this gender difference is clearly established by late adolescence, and is found in all adult age
groups, in numerous countries, and in a majority of ethnic groups
- current and lifetime prevalence rates are higher among younger than older persons
- although MDD was associated with 27.2 lost workdays per ill worker per year, bipolar disorder
was associated with 65.5 lost workdays; they attributed the difference to more severe and
persistent depressive episodes in workers with bipolar disorder
- depression tends to be a recurrent disorder; about 80% of those with depression experience
another episode, and the average number of episode, which typically last for 3-5 months, is about
- patients with MDD who had certain coexisting personality disorders (schizotpal, borderline, or
avoidant) had a significantly longer time to remission of symptoms than did MDD patients
without any personality disorder
- it has been found that the 1st episodes of depression have a stronger link with major life events
stress than do subsequent bouts of depression; this has been explained by kindling hypothesis,
which is a concept derived from research on animals
kindling hypothesis the hypothesis that once a depression has been experienced, the person
is sensitized and it takes less stress to elicit a subsequent bout of depression
- what isnt clear at present, according to Monroe and Harkness, is whether the apparent
reduced role of life events stress in subsequent depression is because depression has become
autonomous and no longer requires stress (the autonomy hypothesis) or whether the person has
become sensitized to stress (the sensitivity hypothesis) and even small amounts of stress are
sufficient to induce depression
Focus on Discovery 10.1 Depression in Females vs. Males: Why is There a Gender Difference?
- major depression generally occurs about twice as often in women than in men
- Nolen and Girgus concluded that girls are more likely than boys to have certain risk factors for
depression even before adolescence, but its only when these risk factors interact with the
challenges of adolescence that the gender differences in depression emerge
- females are more likely than males to engage in ruminative coping
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
- females focus their attention on their depressive symptoms; males are more likely to rely on
distraction, on doing something that diverts their attention
- a study confirmed that the ruminative coping style predicts the onset of episodes of depression
and is associated with more severe depressive symptoms
brooding a moody contemplation of depressive symptoms what am I doing to deserve this
that is more common in females than males
- brooding is like moody pondering; some people concluded that the relationship between gender
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