Exam 3 Study Guide VII Ch 5 VIII Ch 10 IX Ch 11 Topic VII Chapter 5 Problems of Mood Suicide Mood Disorders functioning o Extremes of mood that cause distress and or disrupt o General types Unipolar depressive disorders Bipolar manic depression sometimes only involves o Feelings of sadness or depression are not uncommon o Feeling and acting excited is not uncommon Especially after a loss or setback Especially after realizing a dream or experiencing a mania victory Note Clinical depression and mania go well beyond these expected reactions Symptoms of Clinical Depression o Depressed Mood Emotional Most common obvious symptom Also referred to as dysphoria o Appetite Problems Somatic More common in women than men Can be high or low don t eat vs eat all the time o Sleep Disturbances Somatic High or Low more likely sleep too much vs May have difficulty staying asleep throughout the Early morning waking insomnia night o Loss of Energy Somatic Fatigue o Psychomotor Behavioral Psychomotor Retardation sleeping too much can hardly move around may even become completely immobile and stop speaking Psychomotor Agitation insomnia appear anxious o Loss of Interest Cognitive This must be present if depressed mood isn t a symptom o Sense of Worthlessness Inability to concentrate easily distracted Cognitive Guilt Pessimism Self denigration Worthlessness Thoughts of death o Additional symptoms Anxiety Emotional Common 60 of people with Neglect of personal hygiene appearance Somatic complaints e g aches pains illness Diminished sex drive Somatic Suicidal attempts Behavioral depression also have anxiety issues Behavioral DSM 5 Diagnosis of Major Depressive Episode Minimum of 2 weeks 5 or more symptoms not including additional symptoms Must have either depressed mood or loss of interest Causes significant distress of dysfunction Symptoms of Mania o Emotional o Cognitive Irritable Impatient Euphoria Racing thoughts flight of ideas Distractible Grandiose delusions inflated self esteem Desire for action Hyperactive increase in goal directed and or non Rapid speech pressure of speech goal directed behavior o Behavioral Extremely talkative Impulsive behavior Risky behaviors Tireless Decreased need for sleep can go for weeks w o much o Somatic sleep Increased sex drive Fluctuating appetite Manic Episode Most of day nearly every day minimum of 1 week Hypomanic Episode hypomania Same symptoms as Mania Shorter duration 4 days 1 week Less severe noticeable but doesn t impair social or occupation functioning What are the 2 issues that have been central in the debate regarding definitions of mood disorders 1 Broad vs narrow definition How extreme must the symptoms be people Narrow Includes only most severely disturbed Broad Include milder forms of depression Validity is in question of current diagnostic category How far beyond expected reactions 2 Heterogeneity Involve syndromes not single symptoms Symptoms differ for different people polythetic category Large number of different symptoms are possible May have different symptoms but still have same disorder courses over time DSM 5 Mood Disorders There are also different onset patterns and different Unipolar Depressive o Major Depressive Disorder Depressive episodes No manic episodes Most but not all cases follow an intermittent course with repeated episodes o Persistent Depressive Disorder Dysthymia No major depressive episode Less severe symptoms but more frequently Must have at least 2 of the following Insomnia or hypersomnia Poor appetite or overeating Low energy or fatigue Low self esteem Poor concentration or difficulty making Feelings of hopelessness o Premenstrual Dysphoric Disorder decisions Problems mood related symptoms before Must exhibit at least 5 of the following w at least menstruation one mood disturbance Mood liability Irritability Dysphoria Anxiety Cognitive problems Somatic problems Must be associated w clinically significant distress or interference w social or occupational functioning o Disruptive Mood Dysregulation Disorder Children with chronic severe irritability Bipolar o Bipolar 1 Disorder o Bipolar 2 Disorder Most have manic depressive episodes May only have manic episodes Hypomanic episodes At least one major depressive episode No full blown manic episodes Less severe but more continuous at least 2 Increased energy but not severe enough to be full blown mania o Cyclothymia years Have a good number of hypomanic episodes and frequent lower level depressive episodes Comorbidity o Anxiety Disorders greatest overlap o Depression o Substance Abuse o Eating Disorders Course and Outcome See Figure 5 1 and 5 2 o Major Depression Lifetime prevalence more common than others Females more likely to suffer Average age of onset 32 Average of lifetime episodes 5 or 6 Frequently chronic and recurring with periods of remission and relapse o Bipolar Disorders No real gender differences Onset between age 18 and 22 Average duration of manic episode 2 3 months Long term course is often intermittent Tend to have more episodes than depressive patients Approx half of people achieve sustained recovery Note Studies report comparable overall frequencies of mood disorders in various parts of the world cross cultural however symptoms are expressed differently Bio Psychosocial Model Perspective of Mood Disorders Diathesis predisposition heightened sensitivity to stress Stress current stressful life events Plus Leads to Problematic Responses maladaptive actions thoughts and emotions Symptoms Diagnosis of Mood Disorder Leads to 1 Diathesis o Genetics Biological Some genetic diathesis to both unipolar and bipolar Greater genetic diathesis for bipolar than unipolar Greater genetic diatheses for some individuals than for Polygenic diathesis not a single gene Genetic diathesis is not sufficient interacts with social others and psychological factors mood disorders o or Maladaptive Life conditions Psycho social Traumas and high exposure to stressors Maladaptive modeling and learning Genetics and or Maladaptive Life Conditions Cause o Dysfunctional neuroendocrine and neurotransmitters Biological Higher levels of cortisol during stress due to Effects of cortisol on limbic system effecting dysfunction of HPA axis emotions and prefrontal cortex effecting decision making Imbalance among serotonin dopamine and norepinephrine neurotransmitter system o Poor social and coping skills Psycho o Poor social support Social o Rejection Sensitivity Psycho o Dysfunctional belief systems
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