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Chapter 10

PSYB32_Chapter 10

18 Pages

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Konstantine Zakzanis

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Chapter 10-Mood Disorders General Characteristics of Mood Disorders Mood disorders are disturbances in emotion. From the sadness of depression to the elation of mania The presence of other disorders with mood disorders results in poor prognosis Depression: Signs and Symptoms Depression is marked by great sadness and feelings of worthlessness and guilt o Additional symptoms include sleep loss, appetite, interest in activities and social withdrawal Paying attention and engaging in conversations is difficult and exhausting o Speak slowly, using few words May make numerous complaints about somatic symptoms with no physiological basis Depression in children results in somatic complaints, In older adults it is characterized by distractibility and complaints of memory loss Symptoms of depression have cross cultural variation o Non-western cultures exhibit somatic symptoms (due to inappropriateness to display emotional symptoms) o Western cultures exhibit emotional symptoms Although Canadian cultures also exhibit somatic symptoms Psychologizers are people who emphasize the psychological symptoms of depression but most people tend to emphasize physical symptoms Mania: Signs and Symptoms Mania is a state or mood of intense elation and irritability. Hyperactivity, flight of ideas, jumping from topic to topic, and oblivious to the pitfalls of their endeavours o Interrupting them leads to quick anger Formal Diagnostic Listings of Mood Disorders Two major mood disorders are listed: Major depression (unipolar depression) and bipolar disorder Diagnosis of Depression The diagnosis of major depressive disorder requires the presence of five symptoms and two which must be deep sadness and lack of interest o Sad depressed mood most of the time (1) o Loss of interest and pleasure in usual activities (2) o Sleep disturbances o Shift in activity level Becoming lethargic (slow) Or agitated o Poor appetite and weight loss, or increased appetite and weight gain o Loss of energy o Negative self concept, self blame, worthlessness and guilt o Recurrent thoughts of death and suicide There is an issue to see if depression should be a continuum (dimensional) or a discrete diagnostic category Some symptoms were found to be not associated with diagnosis and thus MDD may need revision MDD increased after the 20 century Lifetime prevalence rate is higher among younger The gender gap begins at age 14 80% of those with depression experience another episode The first episodes of depression have a stronger link with life stressors than the other episodes preceding it Thus the kindling hypothesisonce depression is experienced, it takes less stress to induce a recurrence The reduced role of stress in subsequent depressions could be due to: o Depression has become autonomous and no longer requires stress (autonomy hypothesis) o Depression has become sensitive to stress, small amounts induce depression (sensitivity hypothesis) Depression in Females vs Males: Why is there a Gender Difference Major depression occurs twice as much in females. Why? Girls are more likely than boys to have certain risk factors Females are more likely than males to engage in ruminative copingfocus their attention on depressive symptoms Males tend to use distraction as a coping mechanism Studies show that ruminative coping is associated with more severe depressive symptoms and predicts the onset of episodes of depression Females also use brooding (moody pondering), the relationship between gender and depression could be due to this another explanation for the gender difference is that females differ in the stressors they experience aka more social challenges o Pressure to narrow to feminine activities, face restrictions etc. A related explanation is that females are more likely to be exposed to victimization (childhood sexual abuse) There is also evidence that the vulnerability to depression is due to hormones such as estrogen and progesterone Diagnosis of Bipolar Disorder Bipolar I disorder is episodes of mania or mixed episodes that include symptoms of both mania and depression. Can also experience episodes of depression The diagnosis requires an elevated or irritable mood plus three additional symptoms (5 in total) o Increase in activity at work o Rapid speech very talkative o Flight of ideas o Less than usual amount of sleep needed o Inflated self esteemhas special skills o Distractibility o Excessive involvement in pleasurable activities Occurs less than MDD and equally for both men and women Episodes of depression more common among women and episodes of mania more common among men Violent behaviours occur during manic episodes Epidemiology of Mood Disorders in Canada: Major Depression and Bipolar Disorder Mania and depression are more prevalent in western provinces of Canada MDD and substance abuse predicted a higher prevalence of suicide Young people (15-24) not being schooled and increased stress increased the likelihood of developing a depressive disorder Chronic medical disorders were associated with more severe bipolar disorder People having an increased risk for MDD were being female, widowed/divorced/separated and having two or more comorbid disorders There is a need for more evidence based treatments Heterogeneity Within the Categories A problem with mood disorders is that people with the same diagnosis can vary greatly Such as some bipolar patients who experience symptoms of both mania and depression called mixed episodes. Other patients have symptoms of only mania or depression People with bipolar II disorder have episodes of major depression accompanied by hypomania (a change that is less extreme than full blown mania) Some depressed people have delusions and hallucinations (psychotic). This is a useful distinction for people with unipolar depression o The do not respond to typical drug therapies for depression but respond well when they are combined with drugs used to treat psychotic disorders Some people with depression may have melancholic featuresfind no pleasure in any activity and are unable to feel better even if something good happens o Their depressed mood is worse in the morning o Loose appetite and are extremely lethargic or agitated Patients with melancholic features had more comorbidity, more frequent episodes,, and more severe impairment Manic and depressive episodes can have cationic features such as loss of motor ability or excess activity Manic and depressive episodes can occur 4 weeks after childbirth Unipolar and Bipolar disorders can be subdiagnosed as seasonal if there is a relationship between an episode and a particular time of the year o Hence, Seasonal affective disorderChanges in climate and reduced exposure to sunlight create patients symptoms of an episode (depression/mania) Some people may have adapted genetically to low sunlight exposure so are protected by SAD Postpartum Depression in Canadian Women Postpartum depression is episodes of mania and depression after childbirth PD was predicted by sever factors such as depression during pregnancy, negative life events and low socioeconomic status Telephone peer support reduced levels of PD Self-critical perfectionism is another factor One significant stressor is having an infant with an irritable temperament Emotion-oriented coping style is also linked with PD, stress of natural disasters may also play a role PD predicts poorer cognitive ability in the child, behavioural problems, and a physiological profile similar to the mother (low serotonin levels, high cortisol)
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