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Chapter 7

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Psychology 2320A/B
Alvin Segal

Mood Disorders Chapter 7 Psych - Moods extreme or persistent or interfere with functioning then labeled as depression/mania - Depression viewed as phenomenon of superego and mature ego - Masked depression: disorder of childhood depression, sad mood and other features considered depression = not present o Masked by other problems (hyperactivity or delinquency) - Behaviours that led to diagnoses (appetite, reserve) might be only signs - Depression as a symptom and depression as a syndrome DSM APPROACH - depression and mania described in category of Mood Disorders - diagnostic categories same for children, adolescents and adults - Mood disorders = described as unipolar (one mood (depression)) o Versus bipolar (both moods experienced (mania/depression)) - Mood episodes (4) not diagnoses but serve as building blocks for diagnosis o Major Depressive Episode  Period of depressed mood/loss of interest & pleasure o Manic Episode  Abnormally elevated irritable mood o Mixed Episode  Symptoms of manic and depressive episode o Hypomanic Episode  Manic, but symptoms are not as severe, do not cause impairment in functioning Defining Depression - CDI (childrens depression inventory) , DSM, parent CDI - Depression o Hoplessness, low self-esteem, internal attributions, locus of control (external factors), total behaviour problems Major Depressive Disorder (MDD) - one or more major depressive episodes o one exception: children/adolescents, irritable mood can be substituted for depressive episodes 1. depressed or irritable mood 2. loss of interest or pleasure 3. change in weight or appetite 4. sleep problems 5. motor agitation or retardation 6. fatigue or loss of energy 7. feelings of worthlessness or guilt 8. difficulty thinking, concentrating or making decisions 9. thoughts of death or suicidal behaviours - to diagnose MDE, DSM requires five or more symptoms must be present - symptoms must be present for two weeks - one symptoms must be either depressed (irritable) mood or loss of interest/pleasure - symptoms must cause significant distress or impairment in important areas of youth’s functioning (social, school) Dysthymic Disorder - other depressive disorder included in DSM - many of the symptoms of MDE are present in less severe form but are more chronic –persist for a longer period of time - depressed mood (irritable) present for at least 1 year along with two or more of other symptoms o depressed irritable mood o poor appetite of overeating o sleep disturbances o low energy or fatigue o loss of self-esteem o concentration or decision making problems o feelings of hopelessness - must cause clinically significant distress or impairment - double depression = describe instances which both dysthymia and major depressive episode are present - dysthymia described as prior to occurrence of MDE - youths who are depressed can be given the diagnosis of Adjustment Disorder with Depressed Mood - response to a stressor in which depressive symptoms do not meet criteria for other depressive disorders - depression mixed with anxiety and withdrawn behaviour - classify depression o determining sensitive criteria , experience depression differently at various points in development o dimensional rather than categorical - NICK, father left, curved spine, shoplift, gained weight, argues, Epidemiology of Depression - MDD most frequently diagnosed mood disorder - 80% MDD, 10% dysthymia without MDD and 10% double depression - ¼ people in general pop experiences a depressive disorder sometime during childhood Age and Sex - depression less prevalent in young people - no gender differences are reported for children less than 12 years of age o boys more common (11) - 13 no differences; develops around 12-14 ; adolescents(15-18): girls more common, approach 2:1 female to male ratio reported for adults ...Level off around 19 Culture and Ethics and Socioeconomic - lower socioeconomic status (SES) reported to be associated with higher rates of depression- through lower income, limited parental education etc - high rates among latina American girls? - Comparable rates for African American and European American Co-occurring - 40-70% youths diagnosed with MDD also meet criteria for another disorder and 20-50% have two or more additional disorders - common = anxiety disorders, eating disorders and substance abuse disorders Depression and Development - median onset for MDD is 15.5 - infants show withdrawn behaviour, sad facial, excess crying - preschool same, 6-12 still do not verbalize, 9-12 do - prepubescent = crime in family; postpubscent = manic relatives - adolescent onset closer to adult; different from earlier onset - median duration of episode of MDD = 8 weeks; range from 2-520 - reccurent episode = twice as likely - bipolar within 5 years of onset? Etiology Biological Influences - genetic and biochemical dysfunction - genetic influences may be greater for adolescent depression than prepuberty - evidence for large contribution of nonshared environment - same genes that affect early anxiety later increase exposure to environmental influences - genetic influence operates through factors such as temperament, cognitive style, stress reactivity Brain Functioning and Neuro - role of neurotransmitters such as serotonin, norepinephrine, and acetylcholine - dysregulation of neuroendocrine systems (involving pituitary gland, adrenal, hypothalamus, thyroid glands) - depressed adults have more time in REM sleep - cortisol = stress hormone produced in adrenal glands o dysregulation of stress response including higher basal levels of cortisol o not seen in young people Tempermant - genetic or biological basis, environmental influences are thought to affect its development - two aspects of temperament o negative affectivity (NA) = tendency to experience negative emotions, be sensitive to negative stimuli and be wary/vigilant o positive affectivity (PA)= qualities such as approach, energy, sociability and sensitivity to reward cues - high levels of NA associated with both anxiety and depression but low levels of PA associated with just depression - relation between temperament and parenting (other envio influences such as peer rejection and recent live events) = bidirectional - positive temperament serve as buffer against parental rejection to depression - temperament and environment = parents who are harsh and discipline Social –Psychological Influences Separation and loss - results from separation, loss or rejection cognitive-behavioural/interpersonal perspectives - combination of lowered activity level and inadequate interpersonal skills plays a role in the development and maintenance of depression - learned helplessness = explanation of depression , as a result of learning histories perceive themselves as having little control of their environment o associated with mood/behaviours of depression - attributional/explanatory style = blame themselves (internal) for negative events and view causes of events as being stable over time/global o postitive= external, unstable, specific - hopelessness theory: attribution style acts as moderator between negative life event (stress) and hopelessness o hopelessness in turn leads to depression - cognitive distortions : self-blame and failure - cognitive restructuring - low levels of perceived competence and noncontingency (not on behaviour) o related to depression in children - lower levels of active coping (problem so
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