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Chapter 10

PSYB32H3 Chapter Notes - Chapter 10: Major Depressive Episode, Bipolar Ii Disorder, Psychomotor Retardation

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Konstantine Zakzanis

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mood disorders: involve disabling disturbances in emotion, from the sadness of depression to the
elation and irritability of mania.
depression: an emotional state marked by great sadness and feelings of worthlessness and guilt
Depression in children often result ins in somatic complains. In older adults, depression is often
characterized by distractibility and complaints of memory loss.
Symptoms of depression exhibit some cross-cultural variation, probably resulting from differences
in cultural standards of acceptable behaviour.
Although it is commonly believed that people from non-western cultures emphasize somatic
symptoms of depression, while people from western cultures emphasize emotional symptoms,
studies suggest that people from various cultures tend to emphasize somatic symptoms rather than
the emotional symptoms.
psychologizers: people who emphasize the psychological aspects of depression.
Most depression, although recurrent, tends to dissipate with time. About one third of depressed
people suffer from chronic depression.
Mania: an emotional state or mood of intense but unfounded elation accompanied by irritability
and impractical grandiose plans.
The person in the throes of a manic episode, which last from several days to several months, is
readily recognized by his loud and incessant stream of remarks, sometimes full of puns, jokes and
Diagnosis of Depression:
The formal diagnosis of a major depressive disorder MDD) requires the presence of five of the
following symptoms for at least two weeks.
sad, depressed mood, most of the day, nearly every day
loss of interest and pleasure in usual activities
difficulties in sleeping (insomnia), or a desire to sleep a great deal of 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 of evidence of difficulty in concentrating such as slowed thinking and
recurrent thoughts of death or suicide
what is controversial s whether a patient with five symptoms and a two-week duration is distinctly
different from one who has only three symptoms for 10 days.
Even with fewer than five symptoms and duration of less than two weeks, co-twins were also likely
to be diagnosed with depression and patients were likely to have recurrences.
Five symptoms – increased weight, decreased weight, psychomotor retardation, indecisiveness and
suicidal thoughts were not independently associated with the diagnosis. These findings have
implications for the possible revision of the diagnosis criteria for MDD.

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MDD is one of the most prevalent of the disorders. Lifetime prevalence rates range from 5.2% to
MDD is abut two times more common in women than in men. The gender difference does not
appear in preadolescent children, but it emerges at age 14 and seems to be maintained across the
Current and lifetime prevalence rates are higher among younger than older persons.
Participants with MDD who had certain coexisting personality disorders had a significantly longer
time to remission of symptoms than did MDD patients without any personality disorder.
kindling hypothesis: the notion that nce a depression has already been experiences, it takes
relatively less stress to induce a subsequent recurrence.
What is not clear is whether the apparent reduced role of life events stress in subsequent
depressions 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.
Diagnosis of Bipolar Disorder:
Bipolar I Disorder: 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.
Some clinicians do not regard euphoria as a core symptom of mania and report that irritable mood
and even depressive features are more common.
The following symptoms must be sufficiently severe to impair social and occupational functioning:
increase in activity level at work, socially or sexually
unusual talkativeness; rapid speech
flight of ideas or subjective impression that thoughts are racing
less than the usual amount of sleep needed
inflated self-esteem, belief that one has special talents, powers and abilities
distractibility, attention easily diverted
excessive involvement in pleasurable activities that are likely to have undesirable
consequences, such as reckless spending.
occurs less often than MDD, occurs equally often in men and women, like MDD, tends to recur
Some bipolar patients experience the full range of symptoms f both mania and depression almost
everyday, termed a mixed episode. Other patients have symptoms of only mania or only depression
during a clinical episode.
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.
Some depressed people may be diagnosed as having psychotic features if they are subject to a
delusions and hallucinations, a useful distinction among people with unipolar depression.
Depression with psychotic features is more severe than depression without delusions and involves
more social impairment and less time between episodes.
Some patients with depression may have melancholic features where people find no pleasure in
any activity and are unable to feel better.
Patients with melancholic features had more co-morbidity i.e. with anxiety, more frequent
episodes, and more impairment, suggesting it may be more severe type of depression.
Both manic and depressive episodes may be characterized as having catatonic features, such as
motor immobility or excessive, purposeless activity. Both may also occur within four weeks
childbirth; in this case PTSD (Postpartum).
Both bipolar and unipolar disorders can be sub-diagnosed as seasonal if there is a regular
relationship between an episode and a particular time of the year.

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The most prevalent explanation is that it is linked to a decrease in the number of daylight hours;
seasonal affective disorder (SAD).
A Study found that one in five people in an Inuit community were depressed.
Icelanders go without light for many months in the winter, yet as a group, they have surprisingly
low levels of SAD, 1.2%. Might have lower rate because they have adapted genetically to reduce
sunlight and are somehow protected against SAD.
Cyclothymic disorder: the person has frequent periods 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.
during depression, they feel inadequate; during hypomania, their self-esteem is inflated. They
withdraw from people, then seek them out in an uninhibited fashion. They sleep too much and then
too little.
The person with dysthymic disorder is chronically depressed more than half the time for at
least two years.
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. Women are 2-3 times more likely than men.
Many people with it have episodes of major depression, as well, a condition known as double
Freud; during the oral period, a child’s needs may be insufficiently or oversufficiently gratified,
causing the person to become fixated in this stage. With this arrest in psychosexual maturation, the
person may develop a tendency to be excessively dependent on other people for the maintenance of
Freud hypothesized that after the loss of a loved one, the mourner first interjects, or incorporates,
the lost person he identifies with the lost one, perhaps in a fruitless attempt to undo the loss.
Because we unconsciously harbour negative feelings toward those we love, the mourner then
becomes the object of his own hate and anger.
The period of introjections is followed by a period of mourning work, separates himself from the
person who has died or has died or disappointed him and loosens the bonds imposed by introjections.
But the mourning work can go astray and develop into an ongoing process of self-abuse, self-blame
and depression in overly dependent individuals.
Beck’s Theory of Depression:
depressed individuals feel as they do because their thinking is biased toward negative
The negative schemata acquired by depressed persons are activated whenever they encounter
new situations that resemble in some way, perhaps only remotely, the conditions in which the
schemata were learned.
An ineptness schema can make depressed individuals expect to tail most of the time, a self-blame
schema burdens them with responsibility for all misfortunes and a negative self-evaluation schema
constantly reminds them of their worthlessness.
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.
The following describes the principal cognitive biases:
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