PSYCH 270 Chapter Notes - Chapter 5: Premenstrual Dysphoric Disorder, Major Depressive Episode, Bipolar I Disorder

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Abnormal Psychology Chapter 5
Overview
Depression leading cause of disability (10%)
Emotion: state of arousal that is defined by subjective states of feeling
Affect: pattern of observable behaviors (facial expression) associated with feelings
Mood: pervasive and sustained emotional response
Depressed mood: disappointment and despair
Clinical depression: depressed mood along with other symptoms (fatigue, loss of
energy), cognitive symptoms, behavioral symptoms, etc.
Mania: flip side of depression
Euphoria: elated mood, exaggerated feeling of physical and emotional well-being
Mood disorders: defined in terms of episodes (periods of time when a person’s behavior
is dominated by depressed/manic mood)
Depressive disorders: only depressive episodes
Bipolar disorders: depressive and manic episodes
An Attorney’s Major Depressive Episode
Depression
Extent to which the low mood remains consistent
Inability to occasionally enjoy activities that would otherwise provide some relief
Feelings of guilt, lack of energy, difficulty sleeping
Pervasive sadness
Debbie’s Manic Episode
Symptoms
Emotional Symptoms
Dysphoric mood (depression)
Euphoria (Mania): Bipolar disorder tends to alternate between these moods
Anxiety is common among people with mood disorders, as depression is common with
those with anxiety disorders
Cognitive Symptoms
Depression: slowed down thinking, trouble concentrating, guilt and worthlessness.
“Depressive triad
Self destructive ideas and impulses
Manic: speed up ideas, easily distracted, respond to random stimuli in unpredictable
fashion. Grandiosity and inflated self-esteem
Somatic Symptoms
Related to basic physiological or bodily functions
Depression: fatigue, aches and pains, serious change in appetite and sleep
patterns
Difficulties falling asleep, staying asleep, and early-morning waking
(severe depression)
Eating too much, or not eating enough
Loss of desire for fulfilling activities
Mania: reduction of need to sleep, but feel energized.
Behavioral Symptoms
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Depression-Psychomotor retardation: slowed movement
Mania: gregarious and energetic
Excessive pursuit of life goals
Other Problems Commonly Associated with Depression
Comorbidity: simultaneous manifestation of mood disorder and other syndromes
(suggest person exhibits symptoms of more than one disorder)
Alcoholism and depression
Depression and anxiety
Diagnosis
Issues:
Should mood disorders be defined in a more broad or narrow fashion?
Focus on most severely disturbed people
Broader approach would include milder forms of depression
Is depression normal if it follows a stressful event?
Are differences in disorders distinct forms of mood disorders, or are they different
expressions of the same underlying problem?
Depressive Disorders
Major Depressive disorder, persistent depressive disorder (dysthymia), and
premenstrual dysphoric disorder (+ disruptive mood dysregulation disorder)
Must experience one major depressive episode in the absence of any history of manic
episodes
Persistent depressive disorders
Chronic mild depression present for many years (at least two)
Must exhibit depressed mood for most of the day on more days than not, and two
or more of the following symptoms:
Poor appetite/overeating
Insomnia/hypersomnia
Low energy or fatigue
Low self esteem
Oor concentration or difficulty making decisions
Feelings of hopelessness
Must not be absent for more than two months at a time during the two year
period
Premenstrual dysphoric disorder
Mood related symptoms that occur repeatedly during premenstrual phase of the
cycle
Must exhibit five symptoms, with one causing a disturbance in mood
Must have been present for most of the woman's menstrual cycle for the past
year
Bipolar Disorders
Bipolar I disorder: experienced at least one maniax episode (vast majority also have
episodes of depression)
Hypomania: Increased energy that cannot qualify as manic episodes
Must be present for a minimum of four days (one week manic episode)
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Must be noticeable to others, but does not cause impairment
Bipolar II: experienced at least one major depressive episode at least one hypomanic
episode, and no full blown manic episodes
Cyclothymia: chronic, less severe form of bipolar disorder
Several periods of time with hypomanic symptoms and frequent periods of
depression during a two year periods
No history of major depressive episodes and no clear evidence of manic episode
Further Descriptions and Subtype
More specific descriptions of symptoms that were present during the most recent
episode of depression (episode specifiers)
More extensive description of the pattern that the disorder follows over time (course
specifiers)
Can subdivide depressed patients
Validity of subdivisions under question
Melancholia: severe depression
Good response to biological forms of treatment
Must either:
Lose feeling of pleasure associate with all or almost all activities
Lose capacity to feel better when something good happens
Three of the following:
Depressed Mood feel distinctly different from depression a person would
feel after death of a loved one
Worst in morning
Awakens early, at least two hours before usual
Marked psychomotor retardation or agitation
Loss of appetite
Excessive or inappropriate guilt
Psychotic features: hallucinations or delusions
Can be consistent or inconsistent with mood
Postpartum onset
Four weeks after childbirth
(Bipolar disorder) Rapid cycling
Experiences at least four episodes of major depression, mania, or hypomania
within a 12 month period
Poor response to treatment
Seasonal pattern
Regular relationship between onset of a person’s episode and particular times of
the year
Seasonal affective disorder
Associated with changes in seasons
Characterized by somatic symptoms
Course and Outcome
Depressive Disorders
Average onset is 32
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