Chapter 7 Texbook notes

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22 Feb 2011
Chapter 7: Mood Disorders & Suicide
What are mood disorders?
-Mania: Intense & unrealistic feelings of excitement & depression
-Unipolar Disorders: Person experiences only depressive episodes
-Bipolar Disorders: Person experiences both mania & depressive episodes
They differ b/c of 1. Severity 2. Duration
-Major Depression Episode: Most common form of mood episode; Must be depressed for everyday or most
days for 2 weeks
-Manic Episode: Person shows markedly elevated euphoric, or expansive mood, often interrupted by occasional
outbursts of intense irritability or even violence, must last a week for diagnosis
The prevalence of mood disorders
-Unipolar Major Depression is much more common; 12%, higher for women
-Bipolar disorder much less common; 0.4-2.2%, no difference in sexes
-Depressions that arent mood disorders
Loss & grieving process : More difficult for men, grief has 4 phases of normal response (Numbing &
disbelief for weeks, yearning/search for dead for months, disorganization & despair accepting the loss
establishing a new identity, reorganization rebuild lives. MDD not diagnosed for first 2 months after a
Postpartum Blues: Occurs in new mothers following birth of child, symptoms of crying easily, irritability
intermixed w. happy feelings; 50-70% within 10 days; Hormones may play a role or lack of social
support, difficulty adjusting to new identity
-Dysthymic Disorder: Chronicity; to be diagnosed person must have a persistently depressed mood most of the
day for at least 2 years, must have at least 2/6 symptoms when depressed, normal mood lasts for a few days max
of 2 months; normal moods is what distinguishes dysthymic from MDD; 3-6%; duration of 5 years; half may
relapse in avg of 2 years; begins in teenage years over 50% inset before 21
-Major Depressive Disorder; More symptoms than dysthymia & more persistent; depressed moos loss of
interests in activities for 2 consecutive weeks +3-4 symptoms during same period; high degree of overlap btw
measures of depressive & anxious symptoms; 15-20% of adolescents
Depression Through The Lifecycle: infants may experience analytic depression if separated from
attachment figure
Specifiers For Major Depressions: Different patterns of symptoms/features
MDD With Melancholic Features; MDD features + lost interest in activities + must
experience 3 of following: early morning awakenings/depression being worse in
mornings/marked psychomotor retardation or agitation/significant loss of appetite or
weight/inappropriate or excessive guilt/depressed mood
Severe Major Depressive Episode with Psychotic Features; psychotic symptoms sometimes
occur; any delusions/hallucinations are mood-congruent; psychotically depressed more likely
than non to have a poorer longterm prognosis; treatment is antipsychotic meds & antidepressants
Major Depressive Episode With Atypical Features: Pattern of symptoms characterized by
mood reactivity; persons mood brightens in response to potential positive events; must show 2+
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of symptoms: weight gain or loss/hypersonic/leaden paralysis/sensitive to interpersonal rejection;
females more likely to show suicidal thoughts; monoamine oxidase inhibitors;
Double Depression: MD coexists with dysthymia; depressed on a chronic basis
Depression As a Recurrent Disorder
Chronic Major Depressive Disorder: Avg duration of untreated disorder is 6 months, happens
if MD for over 2 years; recurrence has been distinguished from relapse where its the return of
symptoms; relapse may commonly occur when pharmacotherapy is terminated prematurely after
symptoms have remitted but before the underlying episode is really over
Seasonal Affective Disorder: Must have at least 2 episodes of depression in past 2 years occurring in
same year
Causal Factors In Unipolar Mood Disorders
Biological Causal Factors
-Genetic Influences
Family studies shows mood disorders higher among blood relatives
Symptoms like mood & tearfulness not heritable but loss of appetite & libido is
Environmental influences very important; dysthymic disorder may be relatively less influenced by
genetic factors than MD adoption method found that unipolar depression 7X more often in biological
relatives if severely depressed adoptees than in bio parents
Serotonin-Transporter Gene: gene involved in transmission of reuptake & serotonin
Having SS alleles might predispose to depression relative (2X more likely) to having ll alleles
-Neurochemical Factors
Monoamine Hypothesis: depression was at least sometimes due to an absolute or relative depletion of
one or all of these neurotransmitters at important receptor sites in the brain
Only a minority of depressed patients has lowered serotonin activity & these tend to be patients with
high levels of suicidal ideation & behav.
-Abnormalities of Hormonal Regulatory Systems
Hypothalamic-Pituitary-Adrenal (HPA) axis: Human stress response is associated w. elevated activity of
the HPA axis which is partly controlled by norepinephrine & serotonin
In depressed patients blood plasma levels of cortisol are known to be elevated
In depressed patients dexamethasone either fails entirely to suppress cortisal or fails to sustain its
suppression, meaning HPA isnt operating properly
Depressed patients w. elevated corsitsol shows memory impairments & problems with abstract thinking
& complex problem solving
Hypothalamic-Pituitary-Thyroid Axis: links mood disorders with low thyroid levels who often become
-Neurophysicological & Neuroanatomical Influences
Depressed ppl show low activity in left hemisphere & relatively high activity in right hemisphere
Abnormalities of anterior cingualte cortex, orbifrontal cortex, hippocampus (chronic depression
associated with smaller hippocampal volume due to cell death), amygdala shows increased activation in
indiv. w. depression
-Sleep & Other Biological Rhythms
Sleep: Depressed patients have early morning wakings, difficulty sleeping, they enter 1st period of REM
sleep within 60mins or less, rapid eye movements, lower than normal amount of deep sleep
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Circadian Rhythms: Body temp, propensity to REM sleep & serotonin of cortisol, thyroid-stimulating
hormone & growth hormone, circadian rhythms controlled by 2 related central oscillators; abnormalities
in all rhythms
2 current theories are (1) Size/magnitude of circadian rhythms is blunted
(2) Various circadian rhythms that are normally well synchronized w.
each other become desynchronized or uncoupled
Sunlight & Seasons: Seasonal Affective Disorder; depressed in fall/winter; increased appetite &
hypersomnia; clear disturbances in their circadian cycles; serotonin may be dysregulated; therapeutic use
of controlled exposure to light; treated w. fluoxetine (prozac)
Psychosocial Factors
-Stressful Life Events As Causal Factors: Severely stressful life events serve as factors for unipolar depression;
childhood abuse & neglect increases risk; independent events (independent of persons beh & personality i.e
losing a job); dependent events (ie. Poor interpersonal problem solving) leading to higher stress; negative
cognitive symptoms of self
-Mildly Stressful Events & Chronic Stress: Havent found minor stressful events to be associated with the onset
of depression
Individual Differences In Responses to Stressors: Vulnerability & Invulnerability Factors: Women at higher
genetic risk to respond to severely stressful life events w. depression; 4 factors associated with not being
depressed (1) Having intimate relationship
(2) Having no more than 3 children @ home
(3) A job outside home
(4) Religious commitment
-Depression higher with ppl who live alone
-Different Types of Vulnerabilities For Unipolar Depression
Personality & Cognitive Diatheses: Neuroticism (Negative affectivity) primary personality variable
factor for depression; ppl with high levels of neuroticism experience broad range of negative moods;
Positive Affectivity refers to feeling joy, bold, proud, ppl low on it tend to feel unenthusiastic, dull
Early Adversity & parental Loss as a Diatheses: Death or permanent separation seemed to create
vulnerability in depression in adulthood
-Psychodynamic Theories: Depression is anger turned inward; Freud explains loss of a mother or whose parents
didnt fulfill infants needs for nurture & love develops a vulnerability to depression, child need for secure
attachment to be resistant to depression later in life
-Behavioral Theories: Ppl become depressed either when their responses no longer produce + reinforcement or
when rate of – reinforcements increases, pessimism & low levels of energy cause depressed person to
experience these lower rates of reinforcement
-Becks Cognitive Theory: Hypothesized that cognitive symptoms of depression often precede & cause affective
or mood symptoms, rather than vice-versa; Dysfunctional Belief/Depressogenic Schemas (unconsciously
aware of “If everyone doesnt love me my life is worthless such a belief predisposes a person to develop
depression; depression-producing beliefs developed during childhood & adolescence as a function of ones
experiences w. ones parents & significant others serve as underlying diatheses to developing depression;
dysfunctional beliefs activated by current stressors or depressed mood they tend to fuel thinking pattern creating
Negative Automatic Thoughts; Negative Cognitive Triad (- thoughts about self, world, future); Negative
cognitive triad maintained by a variety of negative cognitive biases/errors (Dichotomous/All-or-nothing
Reasoning: tendency to think in extremes, Selective Abstraction: Focus on 1 neg, detail ignoring other elements,
Arbitrary Inference: Jumping to conclusion based on min evidence); inducing a depressed mood in a previously
depressed indiv is generally sufficient to activate latent depressogenic schemas; depressed show better bias
recall of – events
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