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Terms in this set (83)
Involves disabling disturbances in emotion--from the extreme sadness& disengagement of depression to the extreme elation and irritability of mania.
The DSM-5 recognize two broad types of mood disorders.
1. Depressive Symtoms
2. Manic Symtoms
What are the 8 main symptoms of depression?
1. Profound sadness/or inability to experience pleasure.
2.sleeping too much or too little
3.psychomotor retardation or aragitation
4. weightloss or change in appetite
5. loss of energy
6. feeling of worthless or excessive guilt
7. Difficulty concentration, thinking or making decisions
8. recurrent thoughts of death or suicide.
Major Depressive Disorder
-It requires 5 depressive symptoms to be present for at least 2 weeks.
-it is an episodic disorder; because symptoms tend to be present for a period of time
Persistant Depressive disorder
More than half of the time for at least 2 years also they have at least 2 of the other symptoms
-a similar diagnosis to Dysthymia.
Symptoms of persistent depressive disorder--dysthymia
1. poor appetite or overeating
2.sleeping too much or too little
3.loss of energy
4. poor self-esteem
5. trouble concentrating or making decisions
6. feeling of hopelessness
DSM-5 include two depressive disorders that were not listed as mood disorders in the DSM-IV-TR
1. disruptive mood
2. premenstral dysphoric disorder
Disruptive mood disorder
sever recurrent temper outburst and persistent negative mood for at least 1 yrs beginning before age 10.
premenstral dysphoric disorder
mood symptoms n the week before menses.
Epidemiology of depressive disorders
1. MDD and persistent depressive disorder are both twice as common among women as among men.
2. MDD is three times as common among people who are poor(impoverished compared to those who are not)
**of depression varies considerably across culture which indicate a strong role of culture.
-distance from the equator,
rates of winter depression or seasonal affective disorders are higher farther from the equator.
- per-capita fish consumption with depression, countries with more fish consumption such as japan and ice land have lower rate of MDD and bipolar disorder.
4.family cohesion and wealth disparity.
The symptom profile of a *
* also varies across cultures, and one likely reason is
The difference in cultural standards regarding acceptable expressions of emotional distress.
example, people in south korea are less likely to describe a sad mood or sucidal thoughts that are people in the US.
The prevalence of MDD increased steadily during the mid-to late 20th century; at the same time, the age of onset decreased.
The age of onset( depression) has become lower for each recent generation.
**people in their 60s, less than 5% reported that the had experienced an episode of MDD by age 20. compared to people ages 18 to 29 almost 10% reported they had experienced episode of MDD by age 20.
What are the possible explanation for the increasing depression rate?
lies in the social changes have occurred over the pass 100 years.
-support structures--such as tightly knit extended families and marital stability, which are more widespread in the past--are often absent for people today.
-no clear data why depression is striking earlier and earlier
Serious consequences of depression
1. the depth of a depression, getting to work may be far too effortful, parenting van feel like a burden, and suicide can seem like an option.
2. The worlds leading cause of disability.
3.Assocated with $31 billion per pear on lost productivity in the US.
4.offsprings who are exposed to mother's MDD during early childhood are at high risk for developing depression.
5. High risk of other health problems including death from medical diseases, also related to the onset and more severs caused of cardiovascular disease.
6. 5 years or more of chronic depression can be functioning declined as the systems persisted for more years
7. people with chronic depressive symptoms were likely to require hospitalization, attempt suicide and to be impaired in their functioning than were people w/ MDD.
The three forms of Bipolar disorder
1. bipolar I disorder
2. bipolar II disorder
3. cyclothymic disorder
The bipolar disorder are differentiated by
1. how severe
2. long lasting the mania symptoms are
is a state of intense elation, irritability or activation accompanied by other symptoms
During a manic episode
~ People will act and think in ways that are highly unusual compared ti their "typical self"
~ Difficult to interrupt and may shift rapidly from topic to topic relection an underlaying flight of ideas.
~Sociable to the point of intrusiveness
-may stop sleeping but remain incredibly energetic.
DSM-5 also includes criteria for Hypomania.
-involves a change in functioning that does not cause serous problems.
-The person w/ hypomania may feel more social, energized, productive and sexually alluring.
Bipolar I disorder
-formerly known as manic-depressive disorder.
-It includes a single episode of mania during the course of a persons life.
- may or may not be experiencing current symptoms of *
*, In fact, even someone who experienced only 1 week of mani symptoms years ago us still diagnoses w/ biopolar 1 disorder.
-tend to recur
- experience 4 or more episodes in their life time.
Bipolar II disorder
-a person must have experienced at least one major depressive episode and at least one episode of *
- second chronic mood disorder
-symtoms must be present for at least one 2 yrs among adults.
- the person has frequent but mild symptoms of depression, alternating w/ mild symptoms of mania.
what are the two chronic mood disorders?
1. persistent depressive disorder
The DSM-5 criteria for Cyclothymic Disorder
1. At least 2 yrs
2. Numerous periods w/ hypomanic symptoms that do NOT meet the criterial for Hypomanic episode.
3.Numrous periods w/ depression symptoms but do NOT meet the criteria for a MDD episode.
*** The symptoms do NOT clears for more than 2 months at a time. Criterial for MDD, manic or hypomania episodes have never met. Symptoms cause significant distress or functional impairments.
The DSM Criteria for Manic and Hypomanic episodes:
Distinctly elevated or irritable mood. Abnormal increase activity or energy
-At least three of the following are noticeable change from baseline
1. increase in goal- directed activity or psychomotor agitation
2. unusal talkativeness; rapid speech
3. flight of ideas or subjective impression that thoughts are racing
4. decrease need for sleep
5. increase self-esteem; belief that one has special talents, power ot abilities
6. distractibility; attention easily diverted
7.Excessive involvement in activities that are likely to have painful consequences as reckless spending, sexual indiscretion or unwise business investments
8. symtoms are present most of the day , nearly every day
For manic episodes:
1. symptoms last 1 week, required hospitalization or include psychosis
2.Symtoms cause significant distress of functional impairment.
For a Hypomanic Episode
1. Symptoms last at least 4 days
2.clear changes in functioning are observable to others, but impairment is not marked
3.No psychotic symptoms are present.
The Epidemiology of Bipolar disorder:
** bipolar disorder is much rarer than MDD.
1. In a study, involves structure diagnostic interviews w/ N=61392 ppl across 11 countries, 6/1000 people met the criterial for bipolar 1 disorder.
2. rate of bipolar disorder are higher in the US
3. hard to estimate the prevalence of milder forms of bipolar disorder because most commonly use diagnostic interviews are not reliable.
4. More than half of these w/ bipolar spectrum disorder report onset before age 25. also has seen w/ increase frequency among children and adolescents.
5. occur equally in men and women, women diagnoses w/ bipolar disorder experience more episode of depression than do men with this diagnosis.
6.2/3 of ppl diagnoses w/ bipolar died meet diagnoses criteria for a comorbid anxiety disorder and many report history of substance abuse.
The consequence of Bipolar disorder:
1. 1/3 of ppl remain unemployed a fully yr after hospitalization for mania.
2. suicide rates are higher for both bipolar 1 and 2 disorders.
3. high risk for a range of other medical conditions including cardiovascular disease, diabetes, obesity and thyroid disease.
4. people who have been hospitalized for bipolar 1 are twice as likely to die from medical illnesses in a given year as are people w/o mood disorders.
5. people w/ cyclothymia are at elevated risk for developing episode of mania and major depression.
Major depressive disorder is diagnosed based on at least A)_________symptoms lasting at least B)_______weeks.
b) 2 weeks
Approximately______ percent of people will experience major depressive disorder during their lifetime.
16 to 17%
Worldwide, approximately____ out of every 1000 people will experience a manic episode during their lifetime.
What is the key difference between the diagnostic criteria for major
depressive disorder and persistent depressive disorder?
MDD is diagnosed on the basis of five symptoms lasting at least 2 weeks; persistent depressive disorder requires only two symptoms, but they must be present for 2 years (or 1 year in children and adolescents).
What is the key difference between the diagnostic criteria for bipolar I disorder and bipolar II disorder?
Bipolar I disorder is diagnosed on the basis of manic episodes, which are more severe than the hypomanic episodes that are the core criterion for bipolar II disorder
Episodes happen regularly at a particular time of the year.
At least four episodes within the past year
Mood-Congruent psychotic features
Delusions or hallucinations with themes that are consistent with the mood state(e.g guilt, disease or death themes accompanies depression)
Mood-Incongruent psychotic features
Delusions or hallucinations with themes that do NOT match the valence of the depressive or manic episode
At least three manic symptoms are present during a depressive episode, or at least three depressive symptoms are present during a manic episode
Extreme physical immobility or excessive peculiar physical movement
Lack of pleasure in any activity, inability to gain relief from positive events, and at least three other symptoms of depression, such as a distinct quality of mood, depressive symptoms that are worse in the morning, waking at least 2 hours too early, loss of appetite/weight, psychomotor retardation or agitation, or guilt
Symptoms that are unusual for depressive or manic episodes are present
Onset during pregnancy or within 4 weeks postpartum
With anxious distress
At least two symptoms of anxiety are present
Suicide risk severity
Suicidal ideation, plans, or other risk indicators are present
Subtypes of Depressive Disorders and Bipolar Disorders
1. Seasonal pattern
2. Rapid cycling
3. Mood-congruent psychotic features
5. Mixed features
7 .Melancholic features
8. Atypical features
9. Peripartum onset
10. With anxious distress
11. Suicide risk severity
Genetic Factors of depression
1. heritability estimates 37% for MDD, higher when researcher study sever samples
2. molecular research,related eventually to a set of genes, with each gene accounting for a minute proportion of risk. Not just one specific gene.
3.polymorphism of the serotonin transporter gene does appear to be related to MDD.
Genetic Factors of bipolar
1. Most heritable of disorders
2. molecular research, related eventually to a set of genes, with each gene accounting for a minute proportion of risk.
3. several genetic polymorphism related to bipolar disorder have been identified.
4.bipolar disorder may be related to diminished sensitivity of the serotonin receptors.
Community-based twin sample
-used structure interviews to verify diagnoses obtained a heritability of 93%
-adoptive studies also confirm the importance of heritability in bipolar disorder.
Three neurotransmitters have been studies that most in terms of their possible role in mood disorder.
etiology of mood disorders due to neurotransmitters
-the idea that mood disorders might involve changes in receptors that respond to the presence of neurotransmitters in the synaptic cleft
-If receptors are more or less sensitive, one might expect people to react differently to drugs that influence the level of a given neurotransmitter.
-People with depression are less responsive than other people are to drugs that increase dopamine levels, and it is thought that the functioning of the dopamine might be lowered in depression
Dopamine plays a major role
in the sensitivity of the reward system in the brain, which is believed to guide pleasure, motivation, and energy in the context of opportunities to obtain rewards.
diminished function of the dopamine system
help explain the deficits in pleasure, motivation, and energy in depression
Among people with bipolar disorder, several different drugs that increase dopamine levels have been found to
to trigger manic symptoms. One possibility is that dopamine receptors may be overly sensitive in bipolar disorder, which might help explain the excessive energy and enthusiasm seen during manic episodes.
To lower serotonin levels,
researchers deplete levels of tryptophan, the major precursor of serotonin.
depleting tryptophan causes
temporary depressive symptoms among people with a history of depression or a family history of depression
Brain Fuction: regions involved in emotion
studies suggest that episodes of MDD are associated with changes in many of the brain systems that are involved in experiencing and regulating emotion
five primary brain structures that have been most studied in depression
the amygdala, the anterior cingulate, the dorsolateral prefrontal cortex, the hippocampus, and the striatum
amygdala during MDD
-helps assess how salient and emotionally important a stimulus is.
-Functional brain activation studies show elevated activity of the amygdala among people with MDD.
-when shown negative words or pictures of sad or angry faces, people with current MDD have a more intense and sustained reaction in the amygdala than do people with no MDD
the anterior cingulate during MDD
-MDD is associated with greater activation of the anterior cingulate
hippocampus during MDD
-diminished activation of the hippocampus
dorsolateral prefrontal cortex Durin g MDD
-diminished dorsolateral prefrontal cortex when viewing negative stimuli
striatum during MDD
-diminished activation of the striatum during exposure to emotional stimuli, particularly when they are receiving positive feedback that they have earned a reward. A specific region of the striatum (called the nucleus accumbens) is a central component of the reward system in the brain and plays a key role in motivation to pursue rewards
-may help explain why people with depression feel less motivated by and less engaged in the positive events in their life.
Bipolar I disorder is associated with
elevated responsiveness in the amygdala, increased activity of the anterior cingulate during emotion regulation tasks, and diminished activity of the hippocampus and dorsolateral prefrontal cortex.one differ- ence emerges. People with bipolar disorder tend to show high activation of the striatum
The Neuroendocrine system: cortisol dysregulation In MDD
-The HPA axis (hypothalamic-pituitary-adrenocortical axis) may be overly active during episodes of MDD, which is consistent with the idea that stress reactivity is an important part of depression.
The link between the amygdala, MDD and HPA axis
the amygdala is overly reactive among people with MDD, and the amygdala sends signals that activate the HPA axis. The HPA axis triggers the release of cortisol, the main stress hormone.
is secreted at times of stress and increases the activity of the immune system to help the body prepare for threats.
causes oversecretion of cortisol, frequently experience depressive symptoms.
-suppresses cortisol secretion over the course of the night in healthy individuals.
The dexamethasone suppression test
an even more sensitive test of the HPA system in which researchers administer both dexamethasone and corticotrophin-releasing hormone (which increases cortisol levels).
-80 % of people hospitalized for depression show poor regulation of the HPA system on the dex/CRH
cortisol helps ___________, prolonged high levels of cortisol can cause______
-mobilize beneficial short-term stress responses,
-harm to body systems
like MDD, people with bipolar disorder fail to_______ and suggest that bipolar disorder is _________
-demonstrate the typical suppres- sion of cortisol after the dex/CRH test.
-also characterized by a poorly regulated cortisol system
Estimates of heritability are approximately a)___percent for MDD and b)____percent for bipolar I disorder.
Depression and mania both involve diminished receptor sensitivity of which of the following neurotransmitter systems?
In depression, dysregulation of the HPA axis is shown by:
failure to suppress cortisol by dexamethasone
One brain region that appears to be overly active among people with mood disorders is the:
Serotonin levels can be diminished by depleting the amino acid,__________
Social Factors in Depression:
and Interpersonal Difficulties
To show that interpersonal concerns are not just an effect of the depressive symptoms, longitudinal studies showing
that an interpersonal factor is present before onset are extremely important.we will focus on interpersonal variables that have been shown to precede and predict the onset of depressive episodes, including childhood adver-sity, negative life events, lack of social support, family criticism, and an excessive need for interpersonal reassurance.
Example of Childhood adversity:
early parental death, physical abuse, or sexual abuse,
Childhood adversity increase
the risk that later, in their adolescence or adulthood, the person will develop depression, and that the depressive symptoms will be chronic.
One aspect of childhood adversity, child abuse
Can set the stage for many of the other risk factors in depression, including:
1. a negative cognitive style
2. poorer marital relationship quality 3.increased rates of life stress
4.altered activity in brain regions involved in depression
Child abuse, though, appears even more strongly tied to_____ and suggest _____
-anxiety disorders than to depression
-child abuse may increase the risk for different disorders, whereas other factors may shape whether depression occurs.
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