PSY100H1 Chapter Notes - Chapter 9: Major Depressive Episode, Postpartum Depression, Premenstrual Dysphoric Disorder

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9 Feb 2013
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Chapter 9
Overview
Bipolar disorder: manic-depression; one of the two major types of mood
disorders
Mania: great energy and enthusiasm for everything; ideas, talking and thinking at
a great speed
Depression: energy and enthusiasm gone and slow to think, talk and move; joy
drained from life
Unipolar depression: one of the major types of mood disorders; experience only
depression, no mania; suicide a serious problem
Symptoms of depression
Emotional symptoms: sadness, deep unrelenting pain; no emotional reactions;
lose interest in everything in life (anhedonia)
Physiological symptoms: bodily functions disrupted; changes in appetite, sleep
and activity levels can take many forms; early morning wakening common,
where people awake at 3-4 AM and can’t go back to sleep
Behavioural symptoms: lack energy and feel chronically fatigues; walking,
gestures, reactions and speech slowed down (psychomotor retardation); subset
have psychomotor agitation and can’t sit sill and fidget aimlessly
Cognitive symptoms: thoughts filled with worthlessness, guilt, hopelessness and
even suicide; trouble concentrating and making decisions; can experience
delusions and hallucinations in some severe cases (depressing and negative in
content)
Diagnosis
Major depression: one DSM category of unipolar; diagnosis requires that a
person experience either depressed mood or loss of interest in usual activities,
plus at least four other symptoms chronically for at least two weeks; need to be
severe enough to interfere with daily functioning
Dysthymic disorder: less severe form of unipolar depression but more chronic;
must be experiencing depressed mood plus two other symptoms for at least two
years; must never have been without symptoms for more than a two month period
Double depression: experience both major depression and dysthymic disorder;
chronically dysthymic and occasionally sink into episodes of major depression;
even more debilitated; less likely to respond to treatments
Co-morbidity: over ½ of people with unipolar diagnosis have another
psychological disorder, commonly substance abuse, anxiety disorders and eating
disorders; can prefigure or be consequence of another disorder
Subtypes: apply both to major depression and depressive stage of bipolar
oWith melancholic features: physiological symptoms particularly
prominent
oWith psychotic features: experience delusions/hallucinations during
major depressive episode
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oWith catatonic features: strange behaviours collectively known as
catatonia, ranging from complete lack of movement to excited agitation
oWith atypical features: odd assortment of symptoms like positive mood
reactions to some events, significant weight gain or increase in appetite,
hypersomnia, heavy or laden feelings in limbs, long-standing pattern of
sensitivity to interpersonal rejection
oWith postpartum onset: onset of major depressive episode occurs within
four weeks of delivery of a child; can occasionally develop mania
postpartum and receive diagnosis of bipolar disorder with postpartum
onset; 30% of women experience postpartum blues (emotional lability,
frequent crying, irritability and fatigue) in the first few weeks after giving
birth; will pass within two weeks of birth for most; 1 in 10 will experience
postpartum seriously enough to warrant depressive diagnosis
oWith seasonal pattern: also called seasonal affective disorder; history
of at least two years of experiencing major depressive episodes and fully
recovering from them; seem to be tied to number of daylight hours; can
develop mild forms of mania or have full manic episodes during summer
months and are diagnosed with bipolar disorder with seasonal pattern;
mood change can’t be result of psychosocial events; lifetime prevalence of
2.9% but 11% in people with depression history; important role of genetic
adaptation to high latitudes
Prevalence and course
Prevalence: number one source of disability in Canadian workforce; between 8-
12% lifetime prevalence in Canada; less than in US; 15-24 year olds most likely
to have had major depressive episodes recently; lower rates in older people but go
up in those 85+ (severe, chronic and debilitating)
Depression and the elderly: lower rates perhaps due to lower willingness to
report symptoms, common occurrence in context of medical illness and likelihood
of pre-existent mild cognitive impairment OR depressives likelier to die before
reaching old age or can develop more adaptive coping skills and psychologically
healthier outlook as they age
Gender differences: women twice as likely as men to experience both mild
depressive symptoms and severe depressive disorders; found in many countries,
ethnicities and age groups; differences shrink with advancing age with
increasingly higher rates for men who never married
Course: long-lasting and recurrent for some; depressives spend an average of 16
weeks with significant symptoms; high risk for relapse; history of multiple
episodes means higher chance of staying depressed for longer periods
Cost: productivity losses as a result of short-term disability due to depression and
associated distress was $2.6 billion in 1998; once people undergo treatment for
their depression, then tend to recover much more quickly and their risk for relapse
is reduced; many depressives never seek care or wait too long; lingering scars and
enduring problems
Depression in childhood and adolescence
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Prevalence: less common among children than in adults; 2.5% of children and
8.3% of adolescents can be diagnosed with MD; between 15-20% of youth will
experience an episode of major depression before 20; depressive symptoms that
don’t quite meet the diagnostic criteria for MD common in adolescents; highest
rates in girls (25%) and American Indians (29%)
Scars of childhood depression: most likely to incur scars in childhood; long-
lasting effects if self-concept is developing; interfere with learning and social
relationships (kids more dependent on others); early formed negative self-view
can establish long standing vulnerability for developing depression; can also
increase negative thinking because it brings more negative events as stress-
generation models suggest that symptoms interfere with functioning in all
domains and so can increase stressors
Effects of puberty: girls’ rates of depression escalate dramatically over the
course of puberty but boys’ rates do not; observable physical changes of
adolescence have more do with emotional development than hormones as these
affect self-esteem; body dissatisfaction closely related to low self-
esteem/depression in girls; increase in depression may occur only among
European-American girls
Bipolar mood disorders
Symptoms of mania: elated mood often mixed with irritation and agitation;
grandiose self-esteem, thoughts and impulses that can be delusional and
accompanied by grandiose hallucinations; speak rapidly and forcefully; impulsive
behaviours; grand plans and goals; decreased need for sleep; distractibility
Diagnosis of mania: must show an elevated, expansive or irritable mod for at
least one week, plus at least three other symptoms; must impair ability to function
Bipolar I disorder: experience manic episodes meeting full criteria who
eventually fall into depressive episodes; can be as severe as major depressive
episodes or relatively mild and infrequent
Bipolar II disorder: experience severe episodes of depression that meet the
criteria for major depression but their episodes of mania are milder and known as
hypomania, which has the same symptoms of mania but is not severe enough to
interfere with daily functioning and does not involve hallucinations/delusions
Cylothymic disorder: less severe but more chronic form of bipolar; alternates
between episodes of hypomania and moderate depression chronically over at least
a two year periods; can function reasonable well during hypomania but depression
interferes with functioning
Cycles: about 90% of bipolars have multiple episodes/cycles during their lifetime;
length varies (weeks or months or days); common pattern for episodes to become
more frequent and closer together over time
Rapid cycling bipolar disorder: four or more cycles of mania and depression
within a year
Prevalence: less common than unipolar depression; 1.7 per 100 lifetime
prevalence; equal likelihood for genders and ethnic groups; developed in late
adolescence or early adulthood; 50% of sufferers will experience first episode by
early adulthood
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