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Chapter 8

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Konstantine Zakzanis

Chapter 8: Mood Disorders General Characteristics of Mood Disorders  Mood disorders involve disabling disturbances and emotion, from the sadness of depression to deletion 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  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. Conversation is also a chore; depressed individuals may speak slowly, after long pauses, using few words and the low, monotonous voice.  Depressed people may make somatic complaints with no apparent physical basis.  Depression in children often results in somatic complaints. In older adults, depression is often characterized by distractibility and complaints of memory loss.  People from non-Western cultures emphasize somatic symptoms of depression while people from Western cultures emphasize emotional symptoms.  Only 15% of depressed primary care patients in Canada are psychologizers (people emphasized the psychological aspect of depression). Mania: Signs and Symptoms  Mania is an emotional state or mood of intense but unfounded elation accompanied by irritability, hyperactivity, talkativeness, and flight of ideas, distractibility, and impractical grandiose plans.  People who experience episodic periods of depression may at times suddenly become manic. Formal Diagnostic Listings of Mood Disorders  Two major mood disorders are listed in DSM-IV-TR; major depression also referred to as unipolar depression, and bipolar disorder. Diagnosis of Depression  The formal DSM-IV-TR diagnosis of a major depressive disorder requires the presence of five of the following symptoms for at least two weeks. (See page 239 for the list).  MDD is a very prevalent. Lifetime prevalence rates range from 5.2% to 17.1% and three large-scale American studies.  The large discrepancy possibly reflects differences between studies in diagnostic criteria used, and the amount of training of the interviewers, and in the use of interviewers for collecting symptom information.  Major depressive disorder is about two times more common in women than in men. The gender gap emerges at age 14 and is maintained across the lifespan.  The world health organization identified major depression as one of the leading causes of disability adjusted life years.  Participants with major depressive disorder with certain coexisting personality disorder had significantly longer time to remission of symptoms than did MDD participants without any personality disorder.  The first episode typically has a stronger link with major life event stress than do subsequent bouts of depression.  The kindling hypothesis – the notion that once the depression has already been experienced, it takes relatively less stress to induce a recurrence.  The autonomy hypothesis: that parent reduced role of life event stress and subsequent depression is because depression has become autonomous and no longer requires stress. Depression in Females Vs. Males: Why is there a Gender Difference?  Females are more likely than males to engage in ruminative coping, while males are more likely to engage in distracting activities such as watching a hockey game. Ruminators focus their attention on their depressive symptoms.  A more maladaptive rumination component is referred to as brooding. They concluded that the relationship between gender and depression could be due to the brooding component. Brooding it may be a nonspecific on ability for different forms of emotional distress.  An interpersonal form of rumination called co-rumination, in which friends typically female, discuss and brood over each other's problems as part of their friendship, has been linked with depression and adolecent girls but, on a positive note, it also fosters stronger friendship.  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.  Another explanation is objectification theory, Mason the premise that the tendency to be viewed as an object, scrutinized and appraised by others, including appraisal of physical appearance, has a greater negative influence on the self-esteem of girls than boys. Diagnosis of Bipolar Disorder  The DSM defines bipolar one disorder as involving episodes of mania or mixed episodes that include symptoms of both mania and depression. Most people with bipolar one disorder also experiences episodes of depression.  A formal diagnosis of a manic episode requires the presence of elevated or irritable mood this three additional symptoms. Irritable mood and even depressive features are more common.  The symptoms must sufficiently be severe to impair social and occupational functioning. See list on page 242 for symptoms.  Bipolar disorder occurs less often than major depressive disorder. Average age of onset is in the 20s and occurs equally often in men and women.  People with bipolar disorder often lose insight into their condition and this can result in treatment resistance, financial and legal difficulties, substance abuse, and marital and occupational failure.  Anxiety comorbidity is prevalent among bipolar individuals and has a great impact on quality of life. Comorbidity with personal disorders also predicts a poor outcome. Heterogeneity Within the Categories  A problem in the classification of mood disorders is their great heterogeneity. People with the same diagnosis can vary greatly from one another.  A mixed episode of bipolar disorder involves experiencing the full range of symptoms of both mania and depression almost every day.  Bipolar 2 disorder individuals have episodes of major depression accompanied by hypomania, a change in behavior and mood that is less extreme than a full-blown mania.  The presence of delusions appeared to be a useful distinction among people with unipolar depression; depressed people with delusions to not generally responded well to the usual drug therapies for depression, but they do respond favorably to these drugs when they are combined with the drugs commonly used to treat other psychotic disorders.  Some people with depression may have melancholic features. Melancholic refers to the specific pattern of depressive symptoms. People with melancholic features find no pleasure in an activity (anhedonia) and are unable to feel better even temporarily when something good happens.  People with melancholic features had more comorbidity, more frequent episodes, and more impairment, suggesting it may be a more severe type of depression.  Manic and depressive episodes may be characterized as having catatonic features, such as motor inability or excessive, purposeless activity.  Both bipolar and unipolar disorders can be summed diagnosed seasonal and if there is a regular relationship between an episode and a particular time of the year.  Reduced light does cause decreases in the activity of serotonin neurons in the hypothalamus and these neurons regulate some behaviors, such as sleep, that are part of the syndrome of SAD. (Read Canadian Perspective 8.2 page246) Chronic Mood Disorders  in cyclothymic disorder, the person has frequent periods of depressed mood and hypomania, which may be mixed with, may alternate with, or maybe separated by periods of normal mood lasting as last two months.  During hypomania, their self-esteem is inflated.  A person with a dysthymic disorder is chronically depressed – more than half the time for at least two years.  The person experiences several other signs of depression such as insomnia or sleeping too much; feeling of inadequacy; and effectiveness and lack of energy; pessimism; an inability to concentrate and to think clearly and a desire to avoid the company of others  Women are more likely than men to be diagnosed with dysthymia.  Many people with dysthymia have episodes of major depression as well as a condition known as double depression.  Mixed anxiety depression is a proposed new mood disorder. To receive the diagnosis, it was proposed that the client have three or four symptoms of major depression accompanied by two or more symptoms of anxious distress that have lasted at least two weeks.  Premenstrual dysphoric disorder is a controversial disorder that occurs a week or so before menstruation and is marked by depression, anxiety, anger, mood sinks and decrease interest in activities usually engage in pleasure and the symptoms are severe enough to interfere with social or occupational functioning. Psychological Theories of Mood Disorders Psychoanalytic View of Depression  Freud theorized that the potential for depression is graded in early childhood. During the oral period, a child needs may be insufficiently or over sufficiently gratified, causing the person to become fixated in this stage and dependent on the instinctual gratification particular to it. The person may develop a tendency to be excessively dependent on other people for the maintenance of self-esteem.  After the loss of a loved one, most commonly for child, through separation or withdrawal of affection, the more non-first interjects or incorporates the lost person; he or she identifies with the lost one, perhaps in a fruitless attempt to undo the last. We unconsciously harbor negative feelings toward those we love, the learner then becomes the object of his or her own hate and anger. The mourner resents being deserted and feels guilt for real or imagined sins against the lost person. Cognitive Theories of Depression  Cognitive processes play a decisive role in emotional behavior. Beck’s Theory of Depression  Depressed individuals feel as they do because their thinking is negatively biased toward negative interpretation.  In childhood and adolescence, depressed individuals acquire a negative schema-a tendency to see the world negatively- through loss of a parent, an unrelenting succession of tragedies.  The negative schemata acqui
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