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Psychology (9,443)
PSYB32H3 (1,174)
Chapter 10


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University of Toronto Scarborough
Konstantine Zakzanis

Chapter 10Mood DisordersGeneral Characteristics of Mood Disordersmood disordersdisorders 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 prognosisDepression Signs and Symptomsdepressiona 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 DSMIV and unipolar depression by others it can be an associated symptom of other disorderspaying 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 basis 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 loss depression is substantially less prevalent in China than in North America due in part to cultural mores customstraditions that make it less appropriate for Chinese people to display emotional symptoms although its commonly believed that people from nonwestern 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 13 of depressed people suffer from chronic depressionMania Signs and Symptomsmaniaan emotional state of intense but unfounded elation great happiness evidenced in talkativeness flight of ideas distractibility grandiose plans and spurts of purposeless activity manias an emotional state or mood of intense but unfounded elation accompanied by irritability hyperactivity talkativeness flight of ideas distractibility and impractical grandiose plans some people who experience episodic periods of depression may at times suddenly become manic 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 hisher loud and incessant stream of remarks sometimes full of puns jokes rhyming and interjections about objects and happenings that have attracted the speakers attentionFormal Diagnostic Listings of Mood Disorders 2 major mood disorders listed in the DSMIVTR major depression also referred to as unipolar depression and bipolar disorderDiagnosis of Depressionmajor depressive disorder MDDan extreme form of depression that satisfies the number of symptoms required for the category of depression to applyMDD 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 symptomssad depressed mood most of the day nearly everydayloss of interest and pleasure in usual activitiesdifficulties in sleeping insomnia not falling asleep initially not returning to sleep after awakening in the middle of the night and early morning awakenings or in some patients a desire to sleep a great deal of the timeshift in activity level becoming either lethargic psychomotor retardation or agitatedpoor appetite and weight loss or increased appetite and weight gainloss of energy great fatiguenegative selfconcept selfreproach and selfblame feelings of worthlessness and guiltcomplaints or evidence of difficulty in concentrating such as slowed thinking and indecisivenessrecurrent thoughts of death or suicide a study showed that even with fewer than 5 symptoms and a duration of less than 2 weeks cotwins were also likely to be diagnosed with depression and patients were likely to have recurrences 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 52171 in some studiesth in many countries the prevalence of MDD increased steadily during the latter part of the 20 century regardless of prevalence MDD is about 2 times more common in women than in menthe gender difference doesnt appear in preadolescent children but it emerges consistently by midadolescence 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 272 lost workdays per ill worker per year bipolar disorder was associated with 655 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 35 months is about 4 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
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