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Unformatted text preview: The Mood Disorders The General layout: Mood disorders bipolar disorders bipolar disorder cyclothymia unipolar disorders major dep dysthymia Major Depression 0. Sxs 1. Emotional sxs 2. sadness 3. loss of interest and/or pleasure 4. Cognitive sxs 5. negative view of self, esp. low self esteem 6. self-blame and/or guilt 7. pessimism/hopelessness 8. difficulty making decisions 9. poor concentration 10. Motivational sxs 11. lack of response initiation 12. psychomotor retardation 13. psychomotor agitation 14. Somatic sxs 15. disturbance of appetite 16. loss of appetite 17. Increased appetite 18. sleep disturbance 19. insomnia 20. hypersomnia 21. reduced sex drive 22. Note: Symptoms may influence each other resulting in vicious cycle: sadness insomnia psychomotor retardation poor job performance low self esteem social withdrawal sadness poor concentration hopelessness suicidal thoughts Major depression higher severity - 5 out of 9 sxs shorter duration -2 weeks or longer reaction to stressor ‘ Dysthymia lower severity -3 out of 7 sxs longer duration -2 years or longer earlier, more gradual onset 23. Epidemiology 24. Lifetime prevalence 25. MDD 17% 26. Dysthymia 6% 27. Modernity and depression ("being down is on the rise") 28. Lifetime prevalence of Major. Dep. by age (Robins et al., 1984) 18-24 yrs. Born c.1960 N=1397 Means (across 3 major cities) 5.4% 25-44 yrs. Born c.1945 N=3722 8.6% 45-64 yrs. Born c.1925 N=2351 4.5% >65 yrs. Born c.1910 N=1654 1.3% ■12 month prevalence of Maj. Dep. (Kessler et al., 1994) Age range 15.24 25.34 35-44 45-54
▪ Increasing suicide rates 29. Sex differences in depression 30. gender ratio is 2:1 (F:M) gender 31. but why? 31. 32. women given more permission to express dep sxs 33. women rf for helpless and dependent behavior 34. women amplify depression by ruminating vs. men (NolenHoeksema, 1990) 35. women undergo more hormonal changes 12 mo. prevalence 1.67 1.32 1.35 1.00 premenstrual dysphoric disorder
limited opportunities greater victimization the thin ideal and pursuit of thinness 39. eating disorders 40. greater dislike for phys. changes accompanying puberty (Dornbush et al., 1984) (Dornbush 41. Social Class (Kessler, 1994) More depression in lower social classes 42. Mean age of onset- Age 27 43. Etiology 44. Cognitive models 45. assumptions: assumptions: 46. depression is due to faulty cognitions and cognitive 46. processes 47. these play a causal role in producing depression 47. these causal 48. example: role of “attributions” (Abramson et al., 1989) 49. when negative event occurs, person asks: "what caused this to happen?" caused 50. person then makes a "causal attribution" which determines emotional reaction determines 51. 3 dimensions of causal attribution 36. 36. 37. 38. Is the cause internal or external? Is the cause stable or unstable? Is Is the cause global or specific? Ex: Attributions for doing poorly on GRE math exam Global Stable Specific Internal Global Unstable Specific Global Stable Specific External Global Unstable Specific I lack intelligence I lack math intelligence I have the flu I feel tired today Exams are never fair Math GRE’s are unfair I don’t test well on Fri’s My math test was #13 52. theory further posits that people differ in their "attributional style" 53. high dep.-prone tend to make I-ST-G attributes for neg events 54. llow dep.-prone tend to make E-U_Sp attributions for neg events ow Diathesis Specific attributions Internal Specific cognitions “There’s something wrong with me” “I will fail again” “I will fail in other situations too” Sxs of dep. Negative self esteem Negative attributional style Stable Global Other dep. sxs negative event 55. results tend to confirm model, e.g., Metalsky et. al. (1987) 55. results tend Start of semester: administer attrib. style quest After 1st midterm: administer depression quest
56. high grade: attributional style doesn’t matter 57. low grade: students with neg. attribution style were more depressed depressed 58. Interpersonal (interactional) theories 59. depressed individuals have less social support, but why? 60. perhaps due to aversive interpersonal style 61. reactions of roommates of depressed college students (Hokanson, 1989) rate interactions as students being low in enjoyment being 62. rates of marital discord and divorce 63. Biological theories 64. genetics 65. concordance: MZ;48% DZ: 20% (McGuffin et al., 1996) 1996) 66. biogenic amine hypothesis: depression due to deficit of specific NT’s (“biogenic amines”) esp. norepinephrine and serotonin NT’s 67. support comes from drugs used to treat dep. which increase norep. and serot. in the brain and 68. tricyclics: prevent reuptake of norep. and serot., e.g., prevent imipramine, amitriptyline imipramine, 69. monoamine oxidase inhibitors (MAOI's): prevent breakdown of norep. and serot. in the synapse, e.g., breakdown Nardil, Parnate Nardil, 70. serotonin reuptake inhibitors (SSRI's): selectively prevent reuptake of serotonin, e.g., Prozac, Zoloft reuptake Bipolar disorder (Manic-dep.) Bipolar 71. Sxs extreme swings from depression to mania (lifetime prevalence=1%) 71. 72. manic component (1 wk or longer) 73. emotional 74. a euphoric, elevated mood 75. sometimes show "manic irritability“ 76. cognitive 77. grandiose, sometimes delusional 78. flight of ideas; pressured speech 79. distractible 80. motivational 81. hyperactive/unlimited energy 82. impulsive 83. somatic 84. decreased need for sleep 85. hypersexuality 86. cycling patterns 87. duration of manic episodes last from a few days to 3 months 88. cyclothymia--milder, more chronic, form of bipolar disorder cyclothymia--milder, 89. less extreme mood swings (mood swings from hypomania (mild 89. mania) to dysthymia mania) 90. duration criteria (experience highs and lows for at least two years) 91. relation to bipolar (increase risk of bipolar) 92. Epidemiology 93. lifetime prevalence bipolar: 1% cyclothymia: .4%
gender ratio 1:1 mean age of onset is age 20 social class: most likely to occur in high social class suicide rate (1/6 commit suicide) suicide link to creativity 99. Andreasen (1988) interviewed 30 creative writers 100. 80% with at least 1 episode of dep. vs 30% control group) group) 101. 43% reporting episodes of mania or hypomania (vs.10% control group) control 102. rates of mood disorder in family are higher 103. but it’s not all good (e.g., Robert Shumann) 104. but what is causal direction? 105. having mood disorder -> creativity having 106. being creative (e.g. open, sensitive and insightful) -> mood disorder 106. 107. neither: scientists, business people, politicians, ect, are also creative 108. Etiology 109. Genetic 110. twin concordance rates for bip. and unip. disorder (Allen, 1976) 94. 95. 96. 97. 98. 98. MZ twins Bipolar Disorder 72% DZ twins 14% 11% Unipolar Disorder 40% ▪ effect of trycyclics: can rigger manic episode
113. Treatment 114. Lithium is most effective treatment ("wonder drug") 115. speed of response: works within 2 weekds 116. improvement rate: 2/3 of M-D pts 117. when it must be taken: must use prophylactically 118. how it works: not sure how its works, perhaps stabilizes transmitters transmitters 119. Obsessive-Compulsive Disorder (OCD) 120. Sxs 121. obsessions-intrusive, uncontrollable, persistent thoughts or images images 111. Biological 112. excess of norepinephrine doesn’t not equal rumination
122. compulsions-behavioral reactions to obsessions intended to reduce anxiety reduce 123. most common sx patterns 124. obsession of contamination followed by compulsive washing washing 125. obsession of doubt followed by compulsive checking 126. Epidemiology 127. lifetime prevalence: 2-4% 128. mean age of onset: 20 128. 129. M:F 1:1 130. etiology 131. genetic factors 132. Turner et al. (1985): MZ vs. DZ twins 68% concordance for MZ twins 15% concordance for DZ twins
133. physiol. factors 134. serotonin 135. about 50% of OCD pts respond to antidepressants, esp. serotonin reuptake blockers antidepressants, (e.g., Prozac) (e.g., 136. OCD-serotonin connection also demonstrated in dogs (Rapoport et al., 1992) dogs Dogs given Prozac engages in 50% less “compulsive” licking compared to placebo group 137. Mowrer’s 2 factor model (learning theory) 138. fear acquired via class. cond.; maintained via operant cond. UCS (disease) CS (touching doorknob) UCR (fear) CR (fear)
Washing rf Relief Supported by research Supported *Exposure to CS increases autonomic activity *When compulsive act is performed. arousal 139. good theory for explaining maintenance, but doesn't explain origin of obsessions obsessions ...
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