LECTURE NOTES 6: Mood/Affective - Disorder

Outline

1 These are considered emotional disturbances.

A. The Mood Disorders( known as Affective Disorders)

1. Interfere with work, relationships, family life, and good physical health.
2. Depression- characterized as feeling low and miserably unhappy.(referred to as unipolar)
3. Mania may accompany certain depressive disorders - the person feels excessively, unrealistically positive.
4. Manic Depressive or Bipolar disorder(both depression and mania)

B. - Overview of Depressive Disorders

1. What differentiates depression from the blues?
   1. Mood is not temporary, and could persist for weeks, months, and years
   2. Impairs one's ability to work, interact with friends or family
   3. Symptoms of reduced appetite, sleep disturbances, no interest in goals or pursuits.
2. Depression is accompanied by comorbid disorders(intermingled with other disorders)
   1. Depressed people abuse alcohol and drugs.
   2. Characterized by a negative affect

THE DEPRESSIVE DISORDERS

1-Major depressive disorder- subgroups of the depressive disorders:

( is different than Dysthymia which requires at least 2 years)

1. chronic( 2 years)
2. with atypical features- sleep, eat more than usual
3. with melancholic features- endogenous(within person )
4. with catatonic features
5. seasonal affective disorder(SAD)
6. With postpartum onset- begins birth of child

Most Major Depressive Disorders would not be a single episode

1. But are usually accompanied by a recurrent episode often separated by a least 2 months. - recurrence needs different treatment than single episodes
2. Always diagnosed with an absence of mania or hypomanic episodes-(sleepless, with grandiose misperceptions). Recurrent are almost always chromic

Predominant emotions:

1. Dull despair, constant sadness
2. Show bitterness, short temper, and guilt

Physical symptoms

1. Loss of appetite, variety of aches and pains
2. Persistent fatigue(near immobility)
3. Impairment in immune system functioning

Cognitive symptoms

1. Difficulty concentrating, even on simple things
2. Sense of guilt and worthlessness
3. Postpone decisions,fear of making mistakes
4. Self critical, pessimistic about future, unforgiving to oneself regarding the past

The most severely depressed experience psychotic symptoms- like delusions, hallucinations which may be congruent (consistent with persons mental state) or mood incongruent (inconsistent with persons mental state)

Course and recurrence

1. More common in women
2. Most clear up even without treatment
3. Major concern if and whether episodes continue (these people are at high risk)

typical onset mid-twenties, with _ being recurrent

I. accompanied by dysthymia full recovery less likely- higher chance of relapses.

2 Dysthymic Disorder

1. A persistently depressed mood that continues for at least 2 years, where the patient is not depression free for less than 2 months at a time
2. Have somewhat milder symptoms than major depression but can span 20 - 30 years.
3. In children seen as irritability rather than depression
4. Feelings a inadequacy
5. Bereavement does not constitute a dysthymic disorder- this would be a pathological grief type of disorder that could turn into a depression- requiring treatment specific techniques.

3-Double depression

1. people who suffer from major depressive episodes and dysthymia
2. typically dysthymia develops first perhaps at an early age and major depressive episodes occur later

General characteristics of Bipolar disorders

1. Mixed episodes- can even occur in the same day
2. Evenly divided between men and women- whereas major depression more in women
3. Bipolar starts in teens
4. More frequent in higher socioeconomic levels, greater genetic basis
5. Less likely trigger from stresses than depression
6. Women experience depression first, whereas men experience mania first
7. Highly recurrent disorder
8. Mania must last at least one week for the label of mania
9. Mania is an abnormal elevation, also accompanied by expansiveness and irritability
10. Show unlimited enthusiasm, and unrealistic goals.
11. Appear invincible and omnipotent one minute, with utter despair at other times
12. Can go for days with little or no sleep
13. Speech is rapid and "pressured"
14. Constant shifts in conversations and attention
15. Inflated sense of self-esteem
16. Confused and memory losses frequent, fear death as well
17. Psychotic features usually present- leads to hospitalization frequently
18. Mania can last from several days to three months

1. Bipolar I and Bipolar II

1. Bipolar I - severe, full blown manic symptoms usually accompanied by one or more major depressive episodes - 2/3 rds of bipolar patents
2. Bipolar II - do not experience full blown manic episode
3. Either can be rapid cycling- 4 or more full blown in one year
4. Or hypomanic( mild manic episodes) with some periods of normalcy.

2. Cyclothymic Disorder

1. Is chronic but neither manic or depressed mood not as severe as bipolar I or II
2. People who are cyclothymic will be in state for 2 years without neutral periods.