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Download Chapter 14, Mood Disorders
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Mood Disorders Core Concept • People with this diagnosis have an abnormal mood characterized by: Depression Mania, or Both symptoms in alternating fashion • The abnormal mood may or may not impair the person’s social or occupational functioning. Prevalence of Mood Disorders Depression accounts for more than 10 percent of all disabilities in the US Younger generations are experiencing higher rates of depression, and those who become depressed are doing so at an earlier age Depression affects 13-14 million people each year Prominent Feature • The prominent feature of mood disorders is the experience of … • Emotional extremes Types of Mood Disorders Unipolar Mood Disorders Major Depressive Disorder Dysthymic Disorder Bipolar Mood Disorders Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder Major Depressive Disorder Symptoms of major depressive disorder include feelings of sadness and emptiness, difficulties getting out of bed, loss of appetite, excessive feelings of guilt, difficulties concentrating, and suicidal thoughts or plans. Major depression is diagnosed when symptoms are present for at least two weeks, have a sudden onset and are significant enough to impact daily functioning. Dysthymia Symptoms of dysthymia include feelings of hopelessness; sleeping and eating too much or too little; fatigue; poor concentration; and low self-esteem. These symptoms cause distress but are not as severe as the symptoms of major depression. Dysthymia is a long-term condition and is diagnosed when these symptoms are present nearly every day during a period of two years. Bipolar I & Bipolar II If you have only average knowledge of bipolar disorder, you may not know that there are two major forms of the illness - bipolar I and bipolar II which are separate diagnoses Bipolar I & Bipolar II The main difference between mania and hypomania is a matter of severity. In the hypomania of bipolar 2, a person has a sustained mood that is elevated (heightened), expansive (grand, superior) or irritable. This mood has to be noticeably different from his or her normal mood when not depressed. In mania, that mood is extremely abnormal, and is also combined with increased activity or energy that is also abnormal. Bipolar I On the other hand, Hank's friend Robert, who has manic episodes, is out-of-control happy, even during serious events (he burst out laughing disruptively during a funeral) He ran around outside at midnight shouting how much he loved all his neighbors (along with other symptoms of mania). This is abnormal behavior for anyone. Bipolar II For example, Hank, when he has hypomanic episodes, is exceptionally cheerful, needs only three hours sleep instead of his usual seven, spends more money than he safely should and speaks far more rapidly than usual, along with other symptoms of hypomania. This behavior is noticeably different from his own stable mood, yet there are cheerful people who need little sleep, spend a lot and talk fast who don't have bipolar disorder, so while it's abnormal for him, it's not outside the range of possible behavior in general. Mood Disorders: Additional Facts and Statistics • Lifetime Prevalence • About 7.8% of United States population • Sex Differences • Females are twice as likely to have a mood disorder compared to men • The gender imbalance in depression disappears after age 65 • Bipolar disorders are distributed equally between males and females Gender Differences Women are two or three times more vulnerable to depression than men Sex hormones, stressful life events, childhood adversity, etc. May be more likely to seek treatment May be more likely to be labeled as depressed Children Statistics Up to 2.5% of children in the US suffer from depression Up to 8.3% of adolescents in the US suffer from depression Girls entering puberty are twice as likely to experience depression as boys Mood Disorders • Women tend to be • In depression, the twice as likely to get greatest risk of depression because suicide occurs when they are more likely people begin to to sense a lack of rebound from their personal control over depression their lives Mood Disorders • Severely depressed individuals are especially likely to show reduced brain activity in the left frontal lobe • In depression, the greatest risk of suicide occurs when people begin to rebound from their depression Mood Disorders • Linkage Analysis • Linkage is the serves as a way of tendency for genes gene-hunting and and other genetic genetic testing. markers to be inherited together because of their location near one another on the same chromosome. Biological Factors: Genetics There is a 1.5 to 3% greater chance for a person to develop a depressive disorder if a parent or sibling has it as well 50% of those with bipolar disorder have a parent with history of clinical depression 25% of children of a parent who is bipolar develop a depressive disorder 50-75% of children of two parents with bipolar disorder develop a depressive disorder Biological Factors: Twin Studies If one twin develops depression there is a 76% chance that the other twin will develop a disorder as well When raised apart the percentage is 67% Because this number is not closer to 100%, there is indication that other factors are also responsible Fraternal twins have a 19% chance of developing a depressive disorder if the other develops one Twin Studies & Depression • The greatest incidence for major depression are between monozygotic twins, where one twin suffers from the disorder Types of Causes Environmental Factors Psychological Factors Biological Factors Environmental Factors: Stress Levels of stress may vary from person to person. Depressive episodes can make a person more vulnerable to further episodes, so small amounts of stress can activate depression “Learned Helplessness”- after experiencing chronic or repeated stressful events, people can learn to feel helpless Environmental Factors: Substance Abuse Depression that is a result of drug abuse, medication, or toxin exposure Associated with use and withdrawal from: alcohol, amphetamine, cocaine, hallucinogens, inhalants, opioids, phencyclidine, sedatives, hypnotics and anxiolytics Exposure or habitual use of chemicals can alter brain structure and function resulting in depression Environmental Factors: Childhood Difficulties Depression can develop in children who have experienced a traumatic event including but not limited to: Death of family member or friend Natural disaster Divorce Loss of parent’s job, home, etc... Many of these children are emotionally damaged or lack emotional development and often have difficulties adjusting Traumatic Event may affect the development of the Limbic System Continued… The rate for depression occurring with medical illness*: Heart attack: 40-65% Coronary artery disease (without heart attack): 18-20% Parkinson's disease: 40% Multiple sclerosis: 40% Stroke: 10-27% Cancer: 25% Diabetes: 25% *Reviewed by the doctors at The Cleveland Clinic Department of Psychiatry and Psychology. Psychological Factors Cognitive Vulnerability People responding differently to the same negative experience involving loss, failure and disappointment Biological Factors Neurotransmitters and Neurons The signal enters the neuron through the dendrite and proceeds through the cell body to the axon where it is switched from a electric signal to a chemical one Theses chemical signals are called neurotransmitters Upon release the transmitter is broken down by monoamine oxidase (MAO) or its taken back in by the neuron that released it, called “reuptake” Biological Factors: Hormones About one half of all depressed persons have a high level of the hormone cortisol in their blood A person with a depressive mood disorder may not have their hypothalamus regulating the cortisol production in the adrenal gland correctly Normal cortisol levels peak at 8:00 a.m. and ebb at 2:00 a.m. for non-depressed people, while a person with depression may have the hormone released at a constant level How, Exactly, does Cortisol fit into this Picture? As we all know by now, cortisol levels are elevated in response to stress, so any stressful events encountered in the late afternoon to early evening will hamper a person's ability to relax and fall asleep that night. If you'll recall, one of the many effects of cortisol is to increase a person's level of alertness—which is exactly what you want to avoid right before bedtime. Social Cognitive Perspective • Women are more vulnerable to depression than men because they are more likely to • Sense a lack of personal control over their lives Suicide Suicide and SSRIs There is evidence that the use of antidepressants, especially SSRIs, can cause an increase in suicidal thoughts, however it does not show an increase in cases. A severely depressed patient, or those with bipolar syndrome in a “low” phase, usually only have the energy to focus on their low. As the medication begins to take affect they will have an increase in energy and suicidal thoughts as they transition from their “low” or depressed episode. Withdrawls: SNRIs Stopping treatment with SNRIs, especially when done suddenly, can cause withdrawal-like symptoms: nausea, vomiting, anxiety, diarrhea, agitation, confusion, headaches, nightmares, coordination changes, or skintingling or shock-like sensations Sometimes referred to as discontinuation syndrome Suicide Risk Factors 22% of adolescents with completed suicides had bipolar disorder Family history of suicide Substance abuse i.e. adolescent with impulse control disorder, depression, suicidality, substance use and access to a weapon is potential for lethality