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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 in emotion, from the sadness of depression to the elation and irritability of mania often associated with panic attacks, substance abuse, sexual dysfunction and personality disorders Depression: emotional state marked by great sadness and feelings of worthlessness and guilt withdrawal from others, loss of sleep, appetite, sexual desire, interest & pleasure in usual activities paying attention is exhausting, they can’t take in what they read and what other people say to them speak slowly, after a long pause, using few words and a low, monotonous voice some prefer to sit alone, others are agitated and can’t sit still (pace, wring their hands, continually sigh, moan, or complain) may neglect personal hygiene and appearance and make numerous complaints of somatic symptoms in children often result in somatic complaints (headaches or stomach aches) in adults, characterized by distractibility and complaints of memory loss symptoms of depression exhibit some cross cultural variation Psychologizers: people who emphasize the psychological aspects of depression Mania: emotional state or mood of intense but unfounded elation accompanied by irritability, hyperactivity, talkativeness, flight of ideas, distractibility, and impractical grandiose plans talks in puns, jokes, and rhyming, individual shifts rapidly from topic to topic need for activity causes him/her to be annoyingly sociable or purposefully busy comes on suddenly of a period of a day or 2 2 major mood disorders are listed in DSM-IV-TR: major depression, also referred to as: unipolar depression genetic diathesis low serotonin or serotonin-receptor dysfunction high levels of cortisol bipolar disorder genetic diathesis low serotonin or low norepinephrine in depressed phase high norepinephrine in depressed phase high norepinephrine in manic phase may be linked to G-proteins Diagnosis of major depressive disorder (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 one of the 5):  Sad, depressed mood most of the day, nearly every day  Loss of interest and pleasure in usual activities  Difficulties sleeping, not returning to sleep after waking up in the middle of the night, or desire to sleep a great deal of time  Shift in activity level, becoming either exhausted or agitated  Negative self-concept, self-reproach and self-blame, feelings of worthlessness and guilt  Complaints of evidence of difficulty in concentrating such as slow thinking and indecisiveness  Recurrent thoughts of death or suicide MDD is about 2x more common in women than men. The gender gap emerges at 14 and is maintained across the lifespan females are more likely to engage in ruminative (thinking) coping , while males are likely to engage in distracting activities such as watching a hockey game Brooding: a moody pondering (females) silencing the self: (females do this) passive style of keeping upsets and concerns to oneself in order to maintain important relationships (suffering in silence) Objectification theory: tendency to be viewed as an object, analysed & appraised by others, including appraisals of physical appearance, has a greater negative influence on the self-esteem of girls than boys young people (age 14-24) not being in school and extreme stress strongly increases the likelihood of depressive disorders people at increased risk are females; widowed, separated or divorced; having low income; and having 2 or more comorbid conditions Kindling hypothesis: notion that once a depression has already been experienced, it takes relatively less stress to induce a recurrence Bipolar I disorder: involving episodes of mania or mixed episodes that include symptoms of both mania and depression age of onset is in the 20`s occurs equally as often in men and women more than 50% of bipolar disorder cases experience a recurrence within 12 months violent behaviour (child or spousal abuse) can occur during severe manic episodes formal diagnosis requires the presence of elevated or irritable mood plus 3 additional symptoms:  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 talent, powers, and abilities  Distractibility; attention easily diverted  Excessive involvement in pleasurable activities that are likely to have undesirable consequences (reckless spending) Bipolar II disorder: individuals have episodes of major depression accompanied by hypomania- change in behaviour and mood that is less extreme than full-blown (hypo=under) Seasonal affective disorder (SAD): people`s symptoms varied in response to changes in climate and latitude in a manner than suggested that reduced exposure to sunlight was causing their depression (most of these people have been diagnosed with bipolar depression) Phototherapy: exposure to bright white light, is a highly effective treatment for SAD Postpartum depression: manic and depressive episodes occur within 4 weeks of childbirth Cyclothymic disorder: person has frequent periods of depressed mood and hypomania, which may be mixed with/alternate with/separated by periods of normal mood lasting as long as 2 months have paired sets of symptoms (during depression they alternate with/are separated by periods of normal mood lasting as long as 2 months have paired sets of symptoms (during depression they feel inadequate; during hypomania their self- esteem is inflated they sleep too much, have trouble concentrating, verbal productivity decreases during hypomania their thinking becomes sharp and creative and their productivity increases Dysthymic disorder: chronically depressed, more than half the time for at least 2 years feeling blue and losing pleasure in usual activities experiences insomnia or sleeping too much, feelings of inadequacy, ineffectiveness, and lack of energy; pessimism, inability to concentrate and think clearly women are 2-3x more likely to be diagnosed than men have episodes of major depression and a condition known as double depression To add dimensional assessments to diagnostic evaluations a work group proposed: An anxiety dimension across all mood disorder categories A suicide assessment dimension Substance abuse severity dimension PSYCHOLOGICAL THEORIES OF MOOD DISORDERS Psychoanalytic theory of depression: (Freud) potential for depression is created early in childhood During oral stage, child’s needs may be insufficiently or oversufficiently gratified causing the person to become fixated in this stage After the loss of a loved one (through death or separation or withdrawal of affection), the mourner resents being deserted and feels guilt for real or imagined sins against the lost person Cognitive theories of depression: Beck’s theory of depression  Central thesis is that depressed individuals feel as they do because their thinking is biased toward negative interpretations (through the loss of a parent, unrelenting succession of tragedies, social rejection of peers, criticism of teachers, of depressive attitude of a parent  Negative triad is negative views of the:  The self  The world (person’s judgement, can’t cope with the environment, NOT because of war and terrorist attacks)  The future  Principle cognitive biases of depressed individuals:  Arbitrary inference- conclusion drawn in the absence of sufficient evidence or any evidence at all Ex: man concludes he is worthless b/c it rains the day he hosts an outdoor party  Selective abstraction- conclusion drawn on the basis of only one of many elements in a situation Ex: worker feels worthless when a product fails to function, even though she wasn’t the only one who contributed to production  Overgeneralization- overall sweeping conclusion drawn on a basis of a single, perhaps trivial event Ex: student regards her poor performance in a single class on one particular day as final proof of her worthlessness and stupidity  Magnification and minimization- exaggerations in evaluating a performance Ex: man believes that he has completely ruined his car (magnification) when he notices a scratch on it. Woman believes herself worthless (minimization) in spite of a succession of praiseworthy achievements  Stroop test: where differences in cognitive processing are assessed  Depression can make thinking more negative, and negative thinking can probably cause and can certainly worsen depression  To extend his theory he suggested we need to focus on personality styles known as:  Sociotropy- dependent on others, especially concerned with pleasing others, avoiding disapproval, and avoiding separation
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