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01:830:340 (47)
Chapter 6

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Department
Psychology
Course
01:830:340
Professor
Sara Campbell
Semester
Fall

Description
Chapter 6: Mood Disorders mood disorders: involves severe and enduring disturbances in emotionally ranging from elevation to severe depression Depression and Mania- to some extent contribute to all mood disorders major depressive episode- most common and severe experience of depression including feelings of worthlessness, disturbances in bodily activities (ex sleep), loss of interest, inability to experience pleasure, lasting at least two weeks most important indicating factors are the physical shutdown (somatic/vegetative) and behavioral/emotional changes in person ■ anhedonia- loss of energy and ability to engage in pleasurable activities, good indicator of depression rather than feeling generally “sad” which occurs equally as likely in non depressed people ■ duration- if untreated episode can last 4-9 months mania- period of abnormally excessive elevation or euphoria associated with some mood disorders, become hyperactive and find pleasure in all activity ■ flight of ideas- thoughts come to quickly and when try to express them the person does not make sense ■ hypomanic episode- less severe version of a manic episode that does not cause marked impairment in social or occupational fx unipolar- individuals who experience either depression or mania (most commonly continuous depression) bipolar- individual can experience both mood states, sometimes mood states overlap, individual can experience manic symptoms and feel depressed or anxious at the same time dysphoric or mixed manic episode- individual experiences both elation and depression or anxiety at the same time ■ usually mania leads person to feel out of control leading to feelings of anxiety or depression ■ individual who experiences both is more dangerous and cannot fx socially ■ more common to have mixed actually uncommon to have separated mania and depression DEPRESSIVE DISORDERS major depressive disorder single episode- occurrence of one isolated depressive episode without any mania pr hypomania before or during the disorder, rare major depressive disorder recurrent episode- when two or more major depressive episodes occur and were separated by at least two months during which the individual was not depressed, median duration of an episode is 4-5 months the first is typically the longest then become more frequent dysthymic disorder- similar to major depressive disorder but differs in its course symptoms are milder but last much longer, duration around 20-30 years or more, avg duration of 5 years in adults, four years in children, diagnosis patient must have a persistent depressed mood that is continuous for at least two years and cannot go without depressive symptoms for more than two months typical age of onset is early 20’s, studies showed that onset before this age is associated with three characteristics: 1. disorder lasts longer 2. poor prognosis and poor response to treatment 3. strong heredity, lower prevalence in children than adults, symptoms in children tend to be more stable however more likely to lead to major depressive episode (76%), patients are more likely to attempt suicide than major depressive patients double depression- individuals who suffer from both major depressive episodes and dysthymic disorder episodes, dysthymic usually develops first then later have major episodes, individuals suffer high relapse rates in treatment, 79% of dysthymic patients will have a major depressive episode in their lifetime I. onset and duration ■ risk for developing depression is low until the early teens after this point risk begins to inc linearly ■ mean age of onset is 30 ■ consequence of suicide in depressive patients is steadily inc ■ kessler study- found individuals ages 18-29 are much more likely to be depressed than older adults when they were that age ■ typical duration is 4-9 months if untreated but this varies ■ if don’t completely cure symptoms rate of having another episode is higher II. grief vs depression ■ frequency of depression after death of a loved one is 62% but not considered a disorder unless severe psychopathology is also present such as suicidal thoughts or if it last longer than 6 months ■ typical duration of grieving process is 6 months peak ■ after a year the chance of recovering from severe grief dec 10-20% ■ areas of the brain associated with close relationships and attachment are active in grieving people ■ treatment focuses on talking about death and memories and focusing on the positive not loss pathological or impaired grief reaction- extreme reaction to the death of a loved one that involves psychotic features suicidal severe loss of weight and energy that lasts for more than two months, history of past episodes may make a person more susceptible, delusions psychotic symptoms involving disorder of thought content and presence of strong beliefs that are misinterpretations of reality catalepsy- motor movement disturbance seen in people with some psychoses and mood disorders in which body postures are sculptured to remain fixed for long periods of time seasonal affective disorder- cycling of episodes corresponding to the seasons of the year typically with depression occurring during the winter BIPOLAR DISORDERS bipolar II disorder- alternation of of major depressive episodes with hypomanic episodes (not full mania), avg ago of onset is 19-22 years criteria: ■ presence/ history of one or more major depressive episodes ■ presence/ history of at least one hypomanic episodes ■ no history of a full manic episode or mixed episode ■ does not meet requirements of schizophrenia ■ significant distress and impairment of fx bipolar I disorder- alternation of major depressive episodes with full manic episodes, avg age of onset is 15-18 cyclothymic disorder- chronic (at least two years in adults 1 year in children) mood disorder characterized by alternating mood elevation and depression levels that are not as severe as manic or major depressive episodes (more chronic version of bipolar disorder), inc risk to develop bipolar I or II about a third to a half of people do, avg age of onset is during early teens (12-14), more common in girls I. onset and duration ■ develop more acutely (suddenly) than major depressive episodes, lower age of onset ■ 10-25 % of people with bipolar II will progress to bipolar I ■ chronic disorder work with therapist to manage symptoms ■ rare to have onset past age of 40 ■ common consequence is suicide (20 times higher rate than avg person and 4 times rate of those with major depression) PREVALENCE OF MOOD DISORDERS ■ 16 percent of people experience major depression over a lifetime (6% in the past year) ■ dysmanthia is 3.5% for lifetime and past year (chronic) ■ bipolar is 1% over lifetime and 0.8% in past year (chronic) ■ women are twice as likely to have mood disorders with the exception of bipolar disorder ■ much less prevalent in blacks than whites and native americans with exception of bipolar disorder ■ occurs less in prepubertal children and much more commonly in adolescents (as often as adults) ■ in children sex ratio is 50:50 but changes to women in adolescence and adulthood ■ less common over age of 65 bc less stressful life events but have more symptoms that do not meet the criteria for depression, associated with illness and life expectancy ■ bipolar disorder occurs equally in children adolescents and adults I. life span developmental influences ■ depression does not require presence of negative events in an individuals life to occur (infant example) ■ depression symptoms in children and adults are similar but depression “looks” different by age ○ symptoms become more severe in adulthood ■ “emotional swinging”- characteristic of children oscillating manic states less clear as they are in adults ■ childhood depression is often misdiagnosed as ADHD bc of comorbid aggression during mania or conduct disorder ■ conduct disorder and depression often comorbid with bipolar disorder ■ in children with bipolar disorder about 60-90% also meet criteria for ADHD II. is bipolar disorder in youth overdiagnosed? ■ as increased over the years have doubled in clinics and quadrupled in hospitals ■ bc using broader criteria (bipolar NOS not otherwise specialized as I or II) ■ diagnosed with bipolar but may really have ADHD or conduct disorder ■ multi site study Course and Outcome of Bipolar Youth (COBY) came up with the diagnosis of severe mood dysregulation (SMD) rather than bipolar disorder in children ■ ferguson and woodward study- found children with major depressive disorder are less likely to have a recurrent episode than adolescents who have major depression but are more likely to substance abuse ○ extent and severity of depressive symptoms as an adolescent predicted extent of depression and suicidal behavior as an adult III. age based influences on older adults ■ study of elderly depressed patients ages 56-85 80% were continuously depressed ■ late onset depression is associated with difficulty sleeping, hypochondriasis, and agitation ■ difficult to diagnose depression in elderly bc of dementia and attitudes about illness ■ 50 of alzheimers patients comorbidly have depression ■ anxiety disorders are also present in one third to half of depressed elderly patients ■ being depressed doubles the risk of death in someone who has had a heart attack or stroke ■ wallace and o'hara- over three year period older adults become increasingly depressed bc of increasing illness and reduced social support ■ strongest risk factors of older adults include- death of spouse, caregiving burden for ill spouse, and loss of independence because of illness ■ suicide rates are highest in older adults than any other age group but are steadily dec ■ gender imbalance dec after age 65 IV. across cultures ■ somatic symptoms that characterize mood are similar across cultures ■ thoughts of depression vary across culture and are subjective ○ ex society that emphasizes individual over group ■ mood disorders are similar in african and hispanic americans ■ location can affect mood disorders- native americans are much more likely unknown why CAUSES OF MOOD DISORDERS I. biological dimensions A. family and genetic influences ■ family studies- look at the prevalence of the disorder in first degree relatives who are known to have the disorder (the proband) ○ early onset, increased severity, and recurrence in proband is associated with very high risk in relatives ■ twin studies- measure frequency of the disorder in identical twins compared to frequency of the disorder in fraternal twins (suggest mood disorders are heritable) ○ identical twin is 2-3 times more likely to have bipolar disorder than fraternal ○ unipolar disorder chance is slim to none ○ women are more likely to inherit disorder and environmental factors play a greater role in depressed men than women (40% women 20% men) ■ genetic contributions are higher in bipolar disorder than depression (60-80 % depression is environmental) B. depression and anxiety: same genes? ■ study on female twins found that the same genetic factors contribute to anxiety and depression and there is a social and environmental component that differentiates anxiety from depression ■ mood disorders may possibly all be because of the same group of genes C. NT systems ■ serotonin influences norepinephrine and dopamine D. the endocrine system ■ associated with overactivity of the HPA axis ■ Hypothalamic-pituitary adrenocortical axis produces stress hormones ■ patients with an impaired HPA axis sometimes become depressed ■ neurohormones- hormones that affect the brain and the HPA axis focus of psychopathology ■ cortisol- stress H elevated during stressful life events ○ found to be elevated in depressed patients ○ thought that impaired fx of neurons is due to high levels of cortisol ○ can result in shrinking of the hippocampus which fx to keep stress H balanced ○ depression is associated with small hippocampus vol E. sleep and circadian rhythm ■ in depressed people there is a shorter period of time between after you fall asleep and REM sleep (rapid eye movement) ■ two major stages of sleep: REM and non-REM ■ depressed people experience more intense REM sleep and more activity and the stages of deepest sleep do not occur until later on if at all (slow wave sleep) ■ sleep pattern disturbances in children is less common than in adults ■ insomnia is more common in older adults ○ treatment for insomnia may also help depression ■ bipolar people experience insomnia and hypersomnia (excessive sleep) ■ study found that depriving depressed patient of sleep during the second half of the night may actually help them II. psychological dimensions A. stressful life events ■ knowledge of li
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