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Chapter IX.docx

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University of Toronto St. George
Martha Mc Kay

Chapter IX: Mood Disorders Unipolar Depression: Symptoms: emotional (anhedonia, sadness, irritability), physiological and behavioural (appetite and sleep disturbances, psychomotor retardation/agitation, catatonia, fatigue), cognitive (sense of worthlessness/guilt, suicidal thoughts, delusions (unrealistic beliefs), hallucinations (/)) Major depression: depressed mood/anhedonia + 4 other symptoms + 2 weeks Dysthymic disorder: less sever but more chronic form of depressive disorder; depressed mood + 2 other symptoms + 2 years Double depression: major + dysthymic Subtypes: With melancholic features: physiological symptoms of depression prominent With psychotic features: delusions and hallucinations With catatonic features: strange behaviours that range from complete lack of movement to excited agitation (catatonia) With atypical features: positive mood reactions to some event, weight gain/increase appetite, hypersomnia With postpartum onset: emotional lability (unstable) first few weeks after giving birth With seasonal pattern (Seasonal Affective Disorder, SAD): at least 2 years of experiencing major depressive episodes and fully recovering from them; tied to the number of daylight hours in a day (usually occur during winter)bipolar disorder with seasonal pattern One of the most common psychological problems; number one source of disability in the Canadian workforce Study: major depression rate in a one-month period, 15-24 highest, 45-54 lower, 55-70 lowest Women are twice as likely as men to experience depressive symptomsgender differences in prevalence rates of major depression smaller when older 1/4 of people with major depressive disorder experience chronic symptoms Depression in Childhood and Adolescence: Less common among children, 15%-20% will experience depression before 20 Subclinical depressive symptoms even more common in adolescents American Indians>Hispanics>Whites>Asian Americans>African Americans Most likely to leave psychological and social scars if occurs during childhood Negative self-viewvulnerability for depression across lifespan Stress-generation models: symptoms of depression interfere with youngsters; functioning in all domains of their livesincreases in many kinds of stressors Girls dislike the weight gain of puberty v. boys like the increase in muscle mass lower self-esteemhigher rates of depression May occur only among European-American girls and not African-American and Latino girls Bipolar Mood Disorders: Up v. down; depression v. mania Mania: elated mood often mixed with irritation and agitation; diagnosed if shows an elevated/expansive/irritable mood for 1 week + 3 symptoms: Filled with grandiose self-esteem Decreased need for sleep Racing thoughts and impulses Speak rapidly and forcefully Impulsive behaviours Grand plans and goals Hypomania: same symptoms as mania, but not sever enough to interfere with daily functioning, no hallucinations/delusions Bipolar I Bipolar II Experienced mania Never experienced mania Major depressive/hypomanic episodes Major depressive episodes + may occur, but not necessary Hypomanic episodes Cyclothymic disorder: less severe but more chronic form; alternates between episodes of hypomania and moderate depression over 2 years 90% of bipolar patients have multiple cycles during lifetime Rapid cycling bipolar disorder: 4 cycles (mania + depression) within a year Less common than depression Men and women equally likely to develop the disorder; no consistent differences among ethnic groups Most develop in late adolescence or early adulthood Judd: significant symptoms 47% of the weeks, depression 32%, mania 9% Mania can actually benefit people and depression is inspirational for artists? Abraham Lincoln, Winston Churchill, Napoleon Bonaparte Study: relatives of people with bipolar or cyclothymia were more creative Biological Theories of Mood Disorders: Genetic Disordered genespredisposition Physiologically based symptoms had the highest genetic component, mood and tearfulness components are least MZ twins: 60% concordance rate v. DZ twins 13% Neurotransmitter Monoamines (norepinephrine, serotonin, to a lesser extent dopamine) concentrated in the limbic system that regulates sleep, appetite, and emotional processes. (1) Monoamine theories: excess/deregulation of monoamines, especially dopamine)mania (2) Abnormal number and sensitivity of monoamine receptors: few/insensitivedepression(3) Meyor: same serotonin-binding potential, but different serotonin receptor density of depression patients (they have many dysfunctional beliefs) Neurophysiological Abnormalities (1) Reduction in metabolic activity and volume of grey matter in prefrontal cortex (particularly left side, associated with approach-related goals) (2) Decreased activity in anterior cingulate relative to controlsanhedonia, attention deficit (3) Chronic arousal of stress responsehigh cortisol levelinhibit development of new neurons in hippocampussmaller volume in hippocampus (critical in memory and fear-related learning) (4) Enlargement and increased activity of Amygdala (helps direct attention to stimuli that are emotionally salient/important) Cause or consequences? Initially environmental? Neuroendocrine Abnormalities Active HPA axisincreases cortisol (help body respond to stressor, fight-or-flight)HPA axis HPAAxis
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