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Chapter 7

Abnormal Psychology CHAPTER 7 NOTES - I got a 4.0 in the course

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University of Miami
PSY 240

Chapter 7: Understanding and Defining Mood Disorders: An Overview of Depression and Mania: • Mood disorders include depressive disorders, affective disorders or depressive neuroses • Characterized by gross deviations in mood • The fundamental experiences of depression and mania contribute to all the mood disorders • The most commonly diagnose and most severe depression is called a major depressive episode o Lasts for at least 2 weeks o Cognitive symptoms (worthlessness, indecisiveness) o Disturbed Physical functions (altered sleep patterns, significant changes in appetite) o Slightest activity or movement requires an overwhelming effort • Most central indicators of a full major depressive episode are the physical changes, sometimes called somatic or vegetative symptoms, and the emotional shutdown as reflected by low scores on behavioral activation scales • Anhedonia-loss of energy and inability to engage in pleasurable activities or have any fun • The second fundamental state in mood disorders is abnormally exaggerated elation, joy, or euphoria • In mania, individuals find extreme pleasure in every activity • Become highly hyperactive, require little sleep, and may develop grandiose plans, believing they can accomplish anything they desire • Flight of ideas- trying to express many exciting ideas at once • Hypomanic episode- a less severe version of a manic episode that does not cause marked impairment in social or occupational functioning, and need only last 4 days rather than a full week The Structure of Mood Disorders: • Individuals who experience either depression or mania are said to suffer from a unipolar mood disorder, because their mood remains at one “pole” of the usual depression-mania continuum • Mania by itself does occur, but is rare • Someone who alternates from depression and mania is said to have bipolar mood disorder • However, mania and depression aren’t at completely opposite ends of the spectrum. Someone can have a manic episode but also feel extremely depressed or anxious. This combination is called dysphoric manic episode or a mixed manic episode Depressive Disorders: • The most easily recognized mood disorder is major depressive disorder, single episode, defined by the absence of manic or hypomanic episodes before or during the disorder • If two or more major depressive episodes occurred and were separated by at least 2 months during which the individual was not depressed, major depressive disorder, recurrent, is diagnosed • Dysthymic disorder- persistently depressed mood that continues at least 2 years, during which the patient cannot be symptom free for more than 2 months at a time. Differs from a major depressive episode only in severity, chronicity, and number of its symptoms, which are milder and fewer but last longer • Double Depression- patients who have both major depressive episodes and dysthymic disorder. Typically dysthymic disorder develops first and then one or more major depressive episodes occur later Additional Defining Criteria for Depressive Disorders: • Symptoms, or specifiers, may or may not accompany a depressive disorder, when they do, they are often helpful in determining the most effective treatment • The specifiers are of two broad types: those that describe the most recent episode of the disorder and those that describe its course • In addition to rating severity as mild, moderate, or severe, six basic specifiers describe the most recent episode of a depressive disorder: o Psychotic features specifiers- hallucinations or delusions o Chronic features specifiers- o Catatonic features specifier- absence of movement, catalepsy (muscles are waxy and semi-rigid so a patients arm or legs remain in any position in which they are placed) o Melancholic features specifier-more severe somatic symptoms: weight loss, loss of libido, diminished interest or pleasure, early morning awakenings o Atypical features specifier- oversleep and overeat o Postpartum onset specifier- 4 week period immediately following childbirth Differences in the Course of Mood Disorders: • Longitudinal course specifiers- whether the individual suffering from an episode has had major episodes in the past is important, as is whether the individual fully recovered between past episodes • Seasonal pattern specifier- this temporal specifier applies to recurrent major depressive disorder. It accompanies episodes that occur during certain seasons. The most usual pattern is a depressive episode that begins in the late fall and ends with the beginning of spring. This is called seasonal affective disorder (SAD). • Although some studies have reported seasonal cycling of manic episodes, the overwhelming majority of seasonal mood disorders involve winter depression • Tend toward excessive sleep and increased appetite and weight gain, symptoms shared with atypical depressive episodes • SAD may be related daily and seasonal changes in the production of melatonin, a hormone secreted by the pineal gland • Cognitive and behavioral factors are also associated with SAD Onset and Duration: • Risk for developing major depression is fairly low until the early teens, when it begins to rise in a linear fashion. Mean age for onset is 30 years old. But 10% of all people who develop MDD are 55 or older when they have their first episode • The incidence of depression and consequent suicide seem to be steadily increasing Premenstrual Dysphoric Disorder: • Starting the final week before menstrual period, better a few days into menstruation, ending the week after menstruation • Must be confirmed in 2 menstrual cycles, so that we can tell that it is associated with menstruation • Alittle less than 2% of women meet full criteria but without significant functional impairment, 1.3% with significant functional impairment • Causes not well investigated: may be about 50% genetic, stress, interpersonal trauma, social-cultural norms and attitudes Disruptive Mood Dysregulation Disorder: • Achild between ages of 6-10 who have severe verbal and/or physical temper outburst. With children younger than 6, extreme temper tantrums are sometimes part of development. • Must occur in different situations: home, school, with peers • Has to go on for at least 12 months, and cannot be a period of 3 consecutive months of no tantrums • Lots of kids were being diagnosed with bipolar disorder • Sometimes kids were diagnosed with oppositional defiant disorder—act out against authorities • If child qualifies for both DMDD and oppositional defiant disorder, you only diagnose the child with DMDD • Estimated 2%-5% in children and teens, more common in males • Relatively new disease, causes and cultural factors are to be determined Anxiety and Depression Overlap: • Almost all depressed people are anxious. But not all anxious people are depressed • Twin studies: same genetic factors contribute to both • Common symptoms are referred to as a negative affect: o Pessimistic o Irritable o Crying o Guilt o Hypervigilance o Poor memory o Poor concentration o Poor sleep • Core symptoms of depression: o Anhedonia o Slowing o Negative cognitions • Core symptoms of anxiety: o Apprehension o Tension o Extreme worry Causes of Major Depression: • Biological: o Familial and Genetic Influences  Family studies  Twin studies o Higher concordance with higher severity (the more severly depressed one twin is, the more likely it is for the other twin to be depressed) o Higher heritability for females o Neurotransmitter Systems  Serotonin-depression  The “permissive” hypothesis: • Dopamine • Norepinephrine  Dopamine-mania o Endocrine System  “Stress Hypothesis: • Overactive HPAaxis o Elevated Cortisol-stay in fight or flight stress system o Suppressed hippocampal neurogenesis • Dexamethasone suppression test (DST)  Postpartum • Huge increases in estrogen and progesterone in pregnancy suddenly drop after giving birth • Changes in some other hormones • Other possible causes: genetic effects, psychosocial changes o Sleep and Circadian Rhythms  REM sleep • Reduced latency-start dreaming much faster than normal people • Increased intensity  Decreased slow wave sleep  Sleep deprivation effects- wake a severely depressed person in the middle of deep sleep, can temporarily cure depression for a few days o Brain WaveActivity  Indicator of vulnerability • Greater right side brain activity • Less alpha wave activity • Psychological Causes: o Learned Helplessness (Seligman)  Lack of perceived control o Attributional Style  Internal-Stable-Global  Depressive Style vs. Normal Style (have a pessimistic or reasonable outlook) o Sense of hopelessness o Lack of perceived control
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