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Chapter 7

Chapter 7 Texbook notes

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University of Toronto St. George

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 bc 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 UNIPOLAR MOOD DISORDERS -Depressions that arent mood disorders Loss & grieving process: More difficult for men, grief has 4 phases of normal response (Numbing & disbelief for weeks, yearningsearch 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 loss 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 26 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 symptomsfeatures MDD With Melancholic Features; MDD features + lost interest in activities + must experience 3 of following: early morning awakeningsdepression being worse in morningsmarked psychomotor retardation or agitationsignificant loss of appetite or weightinappropriate or excessive guiltdepressed mood Severe Major Depressive Episode with Psychotic Features; psychotic symptoms sometimes occur; any delusionshallucinations 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+ www.notesolution.com of symptoms: weight gain or losshypersonicleaden paralysissensitive 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 Norepinephrinedopamineserotonin 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 depressed -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 1 period of REM sleep within 60mins or less, rapid eye movements, lower than normal amount of deep sleep www.notesolution.com
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