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Chapter 8

PS280 Chapter Notes - Chapter 8: Neuroimaging, Serotonin Transporter, Electroconvulsive Therapy


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Kathy Foxall

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PS280 Chapter 8
Mood Disorders & Suicide
Historical Perspective
Ancient Times All mental disorders were explained as possession by
supernatural forces
Classical Greek Era Attempts made to explain mental disorders using scientific
o I.e. Hippocrates The first to extend ideas on the relationship between
bodily fluids and emotional impairment (including depression)
Roman Times Recognized importance of emotional factors in causing
4th Century Christian church predominated Western thinking supernatural
explanations flourished
17th Century Natural theories of mental illness re-emerged
Emil Kraepelin (1855 1926) Began modern age of theories about etiology of
o Coined term manic-depression, described both depressive and manic
forms of this disorder
o Formed basis for definition of the mood disorders contained in DSM-5
Early 20th Century Resurgence of psychological explanations of mental
o Freud and Abraham
o Psychodynamic model drew parallel between depression and grief
o Individuals most likely to be depressed following a loss are those whose
needs either were not met, or were excessively met, during oral stage of
o Imagined Loss The individual interprets other types of events as severe
loss events
Diagnostic Issues
What distinguishes normal mood fluctuations from the changes seen in clinical
mood disorders are their duration (acute, chronic, or intermittent) and their
severity (the # of life areas that are impaired and the degree of impairment)
DSM-5 criteria for major depressive disorder states that the symptoms of
depression must be present for most of the day, more days than not, for at least
two weeks
o Require 1+ hour to fall asleep nearly every night
Mood disorders in DSM-5 are classified into 2 categories:
1. Unipolar Lowered mood followed by return to normal or baseline mood
2. Bipolar Alternating period of mood lowering and mood elevation
Depressive Disorders Involve a change in mood in the direction of depression
Bipolar and Related Disorders Involve periods of depression cycling with
periods of mania
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Depressive Disorders
Include common features such as presence of sad, empty, or irritable mood, along
with additional somatic and cognitive symptoms that significantly impact
Disorders differ from each other in terms of duration, timing, or cause
Major Depressive Disorder
According to WHO, is leading cause of disability worldwide
Involves abnormalities in all systems (biological, emotional, cognitive, and
behavioural) that can impair functioning an all areas of life
To meet criteria, must show a persistent sad mode and/or lack of pleasure or
enjoyment in activities for at least 2 weeks
o Must be accompanied by at least 4 or more of the following:
Weight loss, difficulty sleeping, psychomotor agitation or
retardation, fatigue, feelings of worthlessness or guilt, diminished
concentration, suicidal thoughts
Prevalence and Course
Prevalence about 8%
Approx. 50% of individuals who experience one episode of depression will have a
second, 90% of those that experience 2-3 episodes will have future recurrences
Periods of wellness between episodes become shorter and shorter as disorder
Episodes last between 6-9 months on average
Average age of onset is early/mid twenties
Rates of depression continue to increase dramatically throughout adolescence for
girls, but tend to level off for boys
o 2x more common in women than men
Estimated only 50% of people with depression receive a diagnosis (not seeking
help, misdiagnosis, stigma)
High comorbidity with anxiety (overlapping symptoms of poor concentration,
irritability, hypervigilance, fatigue, guilt, memory loss, sleep difficulties, worry)
and also with obsessions, phobias, relationship difficulties, and substance abuse
In DSM-5, can be diagnosed with MDD even if symptoms have come on after
death of a loved one
o In DSM-IV-TR, after death of a loved one, a descriptor of normal grief
rather than a diagnosis of depression was to be made
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Persistent Depressive Disorder (Dysthymia)
Chronic low mood, lasting for at least 2 years, along with at least 3 associated
symptoms (poor appetite/overeating, sleep disturbance, fatigue, low self-esteem,
poor concentration, hopelessness)
Only brief returns to normal mood
3% prevalence
Same symptoms as major depression but fewer of them
Higher levels of impairment, younger age of onset, higher rates of comorbidity,
stronger family history of psychiatric disorder, lower levels of social support,
higher levels of stress, higher levels of dysfunctional personality traits than does
episodic major depression
Less likely to respond to standard depression treatment than those with episodic
major depression
2-3x more women than men
Bipolar Mood Disorders
A distinct period of elevated, expansive, or irritable mood that lasts at least 1
week & is accompanied by at least 3 associated symptoms
Hallmarks are flamboyance and expansiveness; often display pressure of speech,
excessive self-esteem or grandiosity, risky physical feats, outlandish business
practices, increased sexual behaviour, decreased need for sleep
Psychotic states: break with reality
Some symptoms described as enjoyable and not personally distressing
Hospitalization normally required
May feel “chosen” or that they are on a special mission
Less severe than mania, no psychotic states, usually lasts no more than 4 days
Excited or irritable mood, high levels of energy, engagement in many activities
Does not normally require hospitalization
Mixed State
A person can have mania/hypomania and depressive symptoms all at the same
Bipolar I
Individual has history of one or more manic episodes with or without one or more
major depressive episodes
Depressive episode is not required for diagnosis
Bipolar II
One or more hypomanic episodes and one or more major depressive episodes
Can be more difficult to diagnose because hypomanic episodes are not as severe
as manic episodes
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