PSYC 407 1at Edition Lecture 11 Outline of Last Lecture I. An Overview of Dissociative DisordersII. Depersonalization vs. Derealization DisorderIII. Introduction to Dissociative AmnesiaIV. Introduction to Dissociative FugueV. Causes of Dissociative Amnesia and Dissociative FudgeVI. Introduction to Dissociative Trance Disordera. Causes and TreatmentsVII. Introduction to Dissociative Identity Disorder (DID):a. Causes and Treatmentsb. What is the Autohypnotic Model?Outline of Current Lecture I. What is mood?II. What are mood disorders?III. Types of DSM-IV-TR mood disorders (unipolar)a. Major depressive disorder (MOST SERVERE)b. 2. Dysthymic disorder(LESS SERVERE)c. 3. Double depressionIV. Types of DSM-IV-TR mood disorders (bipolar)a. Bipolar I disorderb. Bipolar II disorderc. Cyclothymic disorderV. What is Severity?VI. Introduction to DysthymiaVII. Introduction to Double DepressionVIII. What is Bereavement?IX. Therapeutic Approach to GrievingX. The Bipolar Disordersa. Maniab. Bipolar 1 Disorder Current LectureWhat is a mood?• …a sustained emotion that colors the way we view lifeThese notes represent a detailed interpretation of the professor’s lecture. GradeBuddy is best used as a supplement to your own notes, not as a substitute.• We all experience fluctuations from sad and apathetic to happy and energetic.Normal Dejection• Experienced by all of us• Seldom so severe that it significantly affects daily functioning• Beneficial if healthy self-exploration occursApplied to yourself• What are you like when you down?• Symptoms: No motivation, overthinking, antisocial/introverted, change in appetite, physical fatigues/mental fatigue, irritable, loss of pleasure, crying• What are some reasons why you are down?• Reason: Grades/School, Finances, Love/Relationships, Job/work, family, life after college/future, money• What are some reasons why college students might get down?• Reason: Grades/School, Finances, Love/Relationships, Job/work, family, life after college/future, money• How do you cope?• Eat chocolate, workout, ruminate, drinking, sad music, sad movie, drugs, reach out for social support, retail therapy, sleep, find something happy, cry it outWhen down, what are your symptoms?• Emotional• Behavioral• Somatic• Cognitive• MotivationalMood Disorders- Gross deviations in mood, more intense, and lasting longer than normal.Building blocks of mood disorders1. Major depressive episodes2. Manic and hypomanic episodesTypes of DSM-IV-TR mood disorders (unipolar)1. Major depressive disorder (MOST SERVERE)2. Dysthymic disorder(LESS SERVERE)3. Double depressionTypes of DSM-IV-TR mood disorders (bipolar)4. Bipolar I disorder5. Bipolar II disorder6. Cyclothymic disorderBack to the building blocks….Major Depressive Episode• Lowering of mood from normal, “down-in-the-dumps”, unhappy• For at least two weeks, the patient feels depressed, cannot enjoy life, and most likely has trouble eating and sleeping. May have feelings of guilt, loss of E, trouble concentrating, and thoughts about deathMajor Depression Episode- Emotions: Extremely depressed mood lasting at least 2 weeks, most every day, for most of the day.- Anhedonia: loss of interest in usual activities and inability to experience pleasure.o Assoc. with low positive affect as well as negative affecto Negative affect: sad, down. - Cognitive symptoms – feel worthless, helpless, hopeless, indecisiveness, can’t concentrateo “There’s nothing I do that good. “ “Theres nothing I can do to change.”- Disturbed physical functioning:- Vegetative sx:- Sleep, too little, too much usually too little- Eating (weight gain or loss)- Psychomotor retardation (move slow, don’t move all of the muscles)- slowed movement, any activity requires effort- Fatigue. Loss of energy- All the above symptoms cause significant impairment1. Major Depressive Disorder- Major depressive disorder (unipolar)a. Single episode – highly unusual -296.2xb. Recurrent episodes – more common- 296.3xi. 2 or more episodes separated by at least 2 months during which individual not depressed- These sx. must cause social or occupational impairment- They don’t fit criteria for mixed episode- NOT because of medical condition, substance abuse, or - Bereavement (V62.82) within 2 months of loss of loved one and not as severe)Course- 35% to 85% of single episode experience 2nd episode. Often residual sx left (incomplete interepisodic recovery)• Median lifetime # episodes is 4• Median duration of an episode is 4-9 months (if untreated), May be 2 weeks to several years.• Probability of remission at one year as high as 90%Onset, duration• Mean age of onset for MDD is 30 years(can be in early teens)• About 10% are 55 years plus at first episode• Incidence of depression and suicide increasingMood disorders in general:• Used to be called affective disorders.• Often clinician may focus on more obvious sx of anxiety, drinking, or psychotic disorders and miss the underlying depression. ALWAYS look for a mood disorder even if the chief complaint is something else.• On the other hand, NEVER assume that the mood disorder is the only Axis I dx. • Severity • Determined by degree of impairment:• 5th digit- Mild: (1) still pursues obligations- Moderate: (2) doesn’t pursue obligations; trouble getting out of bed- Severe : (3) Number of sx exceeds minimum suicidal ideation and plans, extremely vegetative (PHYSICAL SYMPTOMS)Severe Category• Also may be qualified with or without psychotic features. (4)• Psychotic features may be mood-congruent or mood-incongruentOther specifiersChronicity- MDD symptoms last for more than 2 yearsPost-partum- 13% of all births Important to treat early to prevent post-partum psychosisPost-delivery blues- 10% Mo and 4% Fa show increased depressive sx. in the 8 weeks post-delivery.- Baby Blues- From day 1 day 5, 50-80% Mo show minor adjustment changes.Other specifiers, cont.Seasonal Affective Disorder-Usually a depressive episode that coincides with late fall to early spring season.Affects 2.7% population. (not getting enough sun, melintone)15 to 25% population may have some vulnerability here that does not reach full criteria. SAD cont.Related to changes in the production of melatonin, hormone secreted by the pineal gland.Secreted only ay night because light suppresses melatonin secretion, and it is believed that