Abnormal Psychology, Thirteenth Edition, DSM-5 Update Chapter Outline Clinical Descriptions in addition to Epidemiology of Mood
McLaughlin, Sean, Meteorologist has reference to this Academic Journal, PHwiki organized this Journal PowerPoint Lecture Notes Presentation Chapter 5 Mood DisordersAbnormal Psychology, Thirteenth Edition, DSM-5 Update by Ann M. Kring,Sheri L. Johnson, Gerald C. Davison,& John M. Neale © 2015 John Wiley & Sons, Inc. All rights reserved.Chapter OutlineChapter 5: Mood Disorders I. Clinical Descriptions in addition to Epidemiology of Mood Disorders II. Etiology of Mood Disorders III. Treatment of Mood Disorders IV. Suicide© 2015 John Wiley & Sons, Inc. All rights reserved.Clinical Descriptions in addition to Epidemiology of Mood Disorders© 2015 John Wiley & Sons, Inc. All rights reserved.
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Mood DisordersTwo broad types:Involves only depressive symptomsInvolves manic symptoms (bipolar disorders)DSM-5 depressive disorders:Major depressive disorderPersistent depressive disorderPremenstrual dysphoric disorderDisruptive mood dysregulation disorderDSM-5 Bipolar Disorders:Bipolar I disorderBipolar II disorderCyclothymia© 2015 John Wiley & Sons, Inc. All rights reserved.Table 5.1: Overview of the DSM-5 Mood Disorders© 2015 John Wiley & Sons, Inc. All rights reserved.DSM-5 Criteria as long as Major Depressive DisorderSad mood OR loss of interest or pleasure (anhedonia)Symptoms are present nearly every day, most of the day, as long as at least 2 weeksSymptoms are distinct in addition to more severe than a normative response to significant lossPLUS four of the following symptoms:Sleeping too much or too littlePsychomotor retardation or agitationPoor appetite in addition to weight loss, or increased appetite in addition to weight gainLoss of energyFeelings of worthlessness or excessive guiltDifficulty concentrating, thinking, or making decisionsRecurrent thoughts of death or suicide© 2015 John Wiley & Sons, Inc. All rights reserved.
Major Depressive Disorder (MDD)EpisodicSymptoms tend to dissipate over timeRecurrentOnce depression occurs, future episodes likelyAverage number of episodes is 4 Subclinical depressionSadness plus 3 other symptoms as long as 10 daysSignificant impairments in functioning even though full diagnostic criteria are not met© 2015 John Wiley & Sons, Inc. All rights reserved. DSM-5 Criteria as long as Persistent Depressive DisorderDepressed mood as long as at least 2 years; 1 year as long as children/adolescentsPLUS 2 other symptoms:Poor appetite or overeatingSleeping too much or too littlePoor self-esteemTrouble concentrating or making decisionsFeelings of hopelessnessSymptoms do not clear as long as more than 2 months at a timeBipoloar disorders are not present© 2015 John Wiley & Sons, Inc. All rights reserved.DSM-5 Criteria as long as Premenstrual Dysphoric DisorderIn most menstrual cycles during the past year, at least five of the following symptoms were present in the final week be as long as e menses in addition to improved within a few days of menses onset:Affective labilityIrritability Depressed mood, hopelessness, or self-deprecating thoughtsAnxiety Diminished interest in usual activitiesDifficulty concentrating Lack of energyChanges in appetite, overeating, or food cravingSleeping too much or too littleSubjective sense of being overwhelmed or out of controlPhysical symptoms such as breast tenderness or swelling, joint or muscle pain, or bloating© 2015 John Wiley & Sons, Inc. All rights reserved.
DSM-5 Criteria as long as Disruptive Mood Dysregulation DisorderSevere recurrent temper outbursts, including verbal or behavioral expressions of temper that are out of proportion in intensity or duration to the provocation.Temper outbursts are inconsistent with developmental level.The temper outbursts tend to occur at least three times per week.Negative mood between temper outbursts most days.These symptoms have been present as long as at least 12 months in addition to do not clear as long as more than 3 months at a time.Temper outbursts in addition to negative mood are present in at least two settings (at home, at school, or with peers) in addition to are severe in at least one setting.Age 6 or older (or equivalent developmental level).Onset be as long as e age 10.There has never been a distinct period lasting more than 1 day during which elevated mood in addition to at least three other manic symptoms were present.The behaviors do not occur exclusively during the course of major depressive disorder in addition to are not better accounted as long as by another mental disorder.This diagnosis cannot coexist with oppositional defiant disorder, attention-deficit/hyperactivity disorder, intermittent explosive disorder, or bipolar disorder.© 2015 John Wiley & Sons, Inc. All rights reserved.Epidemiology in addition to ConsequencesDepression is commonLifetime prevalence (Kessler et al., 2005):16.2% MDD2.5% DysthymiaTwice as common in women as in menThree times as common among people in poverty Prevalence varies across culturesMDD1.5% in Taiwan19% in Beirut, Lebanon People who move to the U.S. from Mexico have lower rates than people of Mexican descent who were born in the United States © 2015 John Wiley & Sons, Inc. All rights reserved.Epidemiology in addition to ConsequencesSymptom variation across culturesLatino culturesComplaints of nerves in addition to headachesAsian culturesComplaints of weakness, fatigue, in addition to poor concentrationSmaller distance from equator (longer day length) in addition to higher fish consumption associated with lower rates of MDDSymptom variation across life spanChildrenStomach in addition to headachesOlder adultsDistractibility in addition to as long as getfulnessCo-morbidity2/3 of those with MDD will also meet criteria as long as anxiety disorder at some point© 2015 John Wiley & Sons, Inc. All rights reserved.
Figure 5.1: Median Age of MDD Onset by Generation© 2015 John Wiley & Sons, Inc. All rights reserved.Bipolar DisordersThree as long as ms:Bipolar I, Bipolar II, in addition to CyclothymiaMania defining feature of eachDifferentiated by severity in addition to duration of maniaUsually involve episodes of depression alternating with maniaDepressive episode required as long as Bipolar II, but not Bipolar IManiaState of intense elation or irritabilityHypomania (hypo = under; hyper = above)Symptoms of mania but less intenseDoes not involve significant impairment, mania does© 2015 John Wiley & Sons, Inc. All rights reserved.DSM-5 Criteria as long as Manic in addition to Hypomanic EpisodesDistinctly elevated or irritable mood as long as most of the day nearly every dayAbnormally increased activity in addition to energy At least three of the following are noticeably changed from baseline (four if mood is irritable): Increase in goal-directed activity or psychomotor agitationUnusual talkativeness; rapid speechFlight of ideas or subjective impression that thoughts are racingDecreased need as long as sleepIncreased self-esteem; belief that one has special talents, powers, or abilitiesDistractibility; attention easily divertedExcessive involvement in activities that are likely to have undesirable consequences, such as reckless spending, sexual behavior, or drivingFor a manic episode:Symptoms last as long as 1 week or require hospitalization or include psychosis Symptoms cause significant distress or functional impairmentFor a hypomanic episode:Symptoms last at least 4 daysClear changes in functioning that are observable to others, but impairment is not markedNo psychotic symptoms are present© 2015 John Wiley & Sons, Inc. All rights reserved.
DSM-5 Criteria as long as Bipolar DisordersBipolar IAt least one episode or maniaBipolar IIAt least one major depressive episode with at least one episode of hypomaniaCyclothymic disorder (Cyclothymia)Milder, chronic as long as m of bipolar disorderLasts at least 2 years in adults, 1 year in children/adolescentsNumerous periods with hypomanic in addition to depressive symptomsDoes not meet criteria as long as mania or major depressive episodeSymptoms do not clear as long as more than 2 months at a timeSymptoms cause significant distress or impairment© 2015 John Wiley & Sons, Inc. All rights reserved.Epidemiology in addition to ConsequencesPrevalence rates lower than MDD1% in U. S.; 0.6% worldwide as long as Bipolar I 0.4% 2% as long as Bipolar II4% as long as CyclothymiaAverage age of onset in 20sNo gender differences in rates of bipolar disorders Women experience more depressive episodesSevere mental illnessA third unemployed a year after hospitalization (Harrow et al., 1990)Suicide rates high (Angst et al., 2002)© 2015 John Wiley & Sons, Inc. All rights reserved.Table 5.2: Subtypes of Major Depressive Disorder in addition to Bipolar Disorders© 2015 John Wiley & Sons, Inc. All rights reserved.
Figure 5.2: Rapid Cycling Subtype of Bipolar Disorder© 2015 John Wiley & Sons, Inc. All rights reserved.Etiology of Mood Disorders© 2015 John Wiley & Sons, Inc. All rights reserved.Etiology of Mood DisordersWhat factors contribute to onset of mood disordersNeurobiological factorsPsychosocial factors© 2015 John Wiley & Sons, Inc. All rights reserved.
Etiology of Mood Disorders: Neurobiological FactorsGenetic factorsHeritability estimates37% MDD (Sullivan et al., 2000)93% Bipolar Disorder (Kieseppa et al., 2004)Much research in progress to identify specific genes involved but the results of most studies have not been replicated (Kato, 2007)DRD4.2 gene, which influences dopamine function, appears to be related to MDD (Lopez Leon et al., 2005). © 2015 John Wiley & Sons, Inc. All rights reserved.Neurobiological Hypotheses About Major Depression in addition to Bipolar Disorder © 2015 John Wiley & Sons, Inc. All rights reserved.Etiology of Mood Disorders: Neurobiological FactorsNeurotransmitters (NTs): norepinephrine, dopamine, in addition to serotoninOriginal models focused on absolute levels of NTsMDDLow levels of norepinephrine, dopamine, in addition to serotoninManiaHigh levels of norepinephrine in addition to dopamine, low levels of serotoninHowever, medication alters levels immediately, yet relief takes 2-3 weeksNew models focus on sensitivity of postsynaptic receptorsDopamine receptors may be overly sensitive in BD but lack sensitivity in MDDDepleting tryptophan, a precursor of serotonin, causes depressive symptoms in individuals with personal or family history of depressionIndividuals who are vulnerable to depression may have less sensitive serotonin receptors (Sobczak et al., 2002)© 2015 John Wiley & Sons, Inc. All rights reserved.
Figure 5.4: Serotonin in addition to Dopamine Pathways © 2015 John Wiley & Sons, Inc. All rights reserved.Figure 5.5: Drug Action on Synaptic Activity© 2015 John Wiley & Sons, Inc. All rights reserved.Etiology of Mood Disorders: Neurobiological FactorsBrain ImagingStructural studiesFocus on number of or connections among cellsFunctional activation studiesFocus on activity levels© 2015 John Wiley & Sons, Inc. All rights reserved.
Figure 5.6: Key Brain Structures Involved in Mood Disorders© 2015 John Wiley & Sons, Inc. All rights reserved.Etiology of Mood Disorders: Neuroendocrine SystemOveractivity of HPA axisTriggers release of cortisol, stress hormoneAmygdala overreactiveFindings that link depression to high cortisol levelsCushings syndromeCauses oversecretion of cortisolSymptoms include those of depressionInjecting cortisol in animals produces depressive symptomsDexamethasone suppression testLack of cortisol suppression in people with history of depression© 2015 John Wiley & Sons, Inc. All rights reserved.Etiology of Mood Disorders: Social FactorsLife eventsProspective research42-67% report a stressful life event in year prior to depression onset e.g., romantic breakup, loss of job, death of loved oneReplicated in 12 studies across 6 countries (Brown & Harris, 1989b)Lack of social support may be one reason a stressor triggers depression Interpersonal difficultiesHigh levels of expressed emotion by family member predict relapseMarital conflict also predicts depressionBehavior of depressed people often leads to rejection by othersExcessive reassurance seekingFew positive facial expressionsNegative self-disclosuresSlow speech in addition to long silences© 2015 John Wiley & Sons, Inc. All rights reserved.
Preventing SuicideTalk about suicide openly in addition to matter-of-factlyMost people are ambivalent about their suicidal intentionsTreat the associated mental disorder Treat suicidality directly Suicide prevention centers © 2015 John Wiley & Sons, Inc. All rights reserved.Suicide Hotlines on Bridges © 2015 John Wiley & Sons, Inc. All rights reserved.COPYRIGHT Copyright 2015 by John Wiley & Sons, Inc. All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any as long as m or by any means, electronic or mechanical, including photocopying, recording or by any in as long as mation storage in addition to retrieval system, without written permission of the copyright owner.© 2015 John Wiley & Sons, Inc. All rights reserved.
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