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Chapter Nine.docx

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PSYC 3140
Joel Goldberg

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Chapter Nine  Bipolar disorder and was once known as manic-depression  Mania: great energy and enthusiasm for everything  Bipolar disorder is one of the two major types of mood disorders. The other type is unipolar depression, in which people experience only depression, without mania.  experience delusions and hallucinations. Delusions are beliefs with no basis in reality, and hallucinations involve seeing, hearing, or feeling things that are not real.  The DSM-IV-TR recognizes two categories of unipolar depression: major depression and dysthymic disorder. The diagnosis of major depression requires that a person experience either depressed mood or loss of interest in usual activities, plus at least four other symptoms of depression chronically for at least two weeks. In addition, these symptoms have to be severe enough to interfere with the person's ability to function in everyday life.  Dysthymic disorder is a less severe form of depressive disorder than is major depression, but it is more chronic. Diagnosed: experiencing depressed mood plus two other symptoms of depression for at least two years. During these two years, the person must never have been without the symptoms of depression for more than a two-month period. Some people experience both major depression and dysthymic disorder. This has been referred to as double depression. People with double depression are chronically dysthymic, and then occasionally sink into episodes of major depression.  Most people with this have another psychological disorder, usually substance abuse, anxiety or eating disorders Subtype Characteristics of symptoms With melancholic features Inability to experience pleasure, distinct depressed mood, depression regularly worse in morning, early morning awakening, marked psychomotor retardation or agitation, significant anorexia or weight loss, excessive guilt With psychotic features Presence of depressing delusions or hallucinations With catatonic features Catatonic behaviors: catalepsy, excessive motor activity, severe disturbances in speech With atypical features Positive mood reactions to some events, significant weight gain or increase in appetite, hypersomnia, heavy or laden feelings in arms or legs, long- standing pattern of sensitivity to interpersonal rejection With postpartum onset Onset of major depressive episode within four weeks of delivery of child With seasonal pattern History of at least two years in which major depressive episodes occur during one season of the year (usually the winter) and remit when the season is over  People who experience manic episodes meeting these criteria are said to have bipolar I disorder. Most of these people eventually fall into a depressive episode. For some people with bipolar I disorder, the depressions are as severe as major depressive episodes, whereas others have episodes of depression that are relatively mild and infrequent. People with bipolar II disorder experience severe episodes of depression that meet the criteria for major depression, but their episodes of mania are milder and are known as Hypomania has the same symptoms as mania. The major difference is that, in hypomania, these symptoms are not severe enough to interfere with daily functioning and do not involve hallucinations or delusions.  dysthymic disorder is the less severe but more chronic form of unipolar depression, there is a less severe but more chronic form of bipolar disorder, known as cyclothymic disorder. A person with cyclothymic disorder alternates between episodes of hypomania and moderate depression chronically over at least a two-year period. During the hypomania, the person may be able to function reasonably well in daily life  If a person has four or more cycles of mania and depression within a year, this is known as rapid cycling bipolar disorder.  Genetic theory o Disordered genes predispose people to depression or bipolar disorder.  Neurotransmitter theories o Dysregulation of neurotransmitters and their receptors causes depression and mania. The monoamine neurotransmitters—norepinephrine, serotonin, and dopamine—have been most researched.  Neurophysiological abnormalities o Abnormalities occur in the structure and functioning of the prefrontal cortex, hippocampus, anterior cingulate cortex, and amygdala.  Neuroendocrine abnormalities o Depressed people show chronic hyperactivity in the hypothalamic-pituitary-adrenal axis and slow return to baseline after a stressor, which affects the functioning of neurotransmitters  The onset of bipolar disorder is most often in late adolescence or early adulthood. Most people with bipolar disorder have multiple episodes.  Biochemical theories of mood disorders have focused on neurotransmitters, , but the neurotransmitters that have been implicated most often are the monoamines.  The specific monoamines that have been implicated are norepinephrine, serotonin, and, to a lesser extent, dopamine. These neurotransmitters are found in large concentrations in the limbic system, a part of the brain associated with the regulation of sleep, appetite, and emotional processes. These neurotransmitters are thought to cause both depression and mania—imbalances in one direction may cause depression and imbalances in the other direction may cause mania.  The early theory of the roles of these neurotransmitters in mood disorders was that depression was caused by a reduction in the amount of norepinephrine or serotonin in the synapses between. This depletion could occur for numerous reasons: decreased synthesis of the neurotransmitter from its precursors, increased degradation of the neurotransmitter by enzymes, or impaired release or reuptake of the neurotransmitter. This was thought to be caused by an excess of the monoamines or perhaps dysregulation of the levels of these amines, especially dopamine. Taken together, these theories are known as the monoamine theories of mood disorders  Neuroimaging studies done by using computerized tomography (CT) scans, positron-emission tomography (PET), and magnetic resonance imaging (MRI) have found consistent abnormalities in at least four areas of the brain in people with mood disorders: the prefrontal cortex, the hippocampus, the anterior cingulate cortex, and the amygdala  The anterior cingulate plays an important role in the body's response to stress, in emotional expression, and in social behaviour, as well as in the processing of difficult information  he hippocampu
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