FInal psych

______ in mood are so common to the human condition that we think nothing of hearing someone saying, “I’m depressed because I have too much to do.”

Fluctuations

__ in mood can also be a response to misfortune; death of a friend or relative, financial problems, or loss of a job may cause a person to grieve

Sadness

At the other end of the mood spectrum are episodes of

exaggeratedly energetic behavior

This feeling of being “on top of the world” also recedes in a few days to a _____ mood

euthymic

These mood alterations are normal and do not interfere meaningfully with the person’s life.

euthymic mood

also called affective disorders

Mood disorders

re pervasive alterations in emotions that are manifested by depression or mania or both

Mood disorders

re pervasive alterations in emotions that are manifested by depression or mania or both

Mood disorders

Accompanying self-doubt, guilt, and anger alter life activities, especially those that involve self-esteem, occupation, and relationships.

Mood disorders

From early history, people have suffered from

mood disturbances

have found holes drilled into ancient skulls to relieve the “evil humors” of those suffering from sad feelings and strange behaviors

Archeologists

believed that overwhelming sadness and extreme behavior were sent to people through the will of God or other divine beings

Babylonians and ancient Hebrews

suffered overwhelming grief of heart, unclean spirits, and bitterness of soul, all of which are symptoms of depression.

Biblical notables King Saul, King Nebuchadnezzar, and Moses

had recurrent episodes of depression.

Abraham Lincoln and Queen Victoria

Until the mid-___s, no treatment was available to help people with serious depression or mania.

1950

hese people suffered through their altered moods, thinking they were hopelessly weak to succumb to these devastating symptoms. Family and mental health professionals tended to agree, seeing sufferers as egocentric or viewing life negatively. Although there are still no cures for mood disorders, effective treatments for both depression and mania are now available.

mid-1950s, no

are the most common psychiatric diagnoses associated with suicide; depression is one of the most important risk factors for it

Mood disorders

are major depressive disorder and bipolar disorder (formerly called manic-depressive illness).

primary mood disorders

episode lasts at least 2 weeks, during which the person experiences a depressed mood or loss of pleasure in nearly all activities

major depressive episode

Symptoms include changes in eating habits, resulting in unplanned weight gain or loss; hypersomnia or insomnia; impaired concentration, decision-making, or problem-solving abilities; inability to cope with daily life; feelings of worthlessness, hopelessness, guilt, or despair; thoughts of death and/or suicide; overwhelming fatigue; and rumination with pessimistic thinking with no hope of improvement

major depressive disorder

These symptoms result in significant distress or impairment of social, occupational, or other important areas of functioning.

major depressive episode

About 20% have delusions and hallucinations; this combination is referred to as

psychotic depression

is diagnosed when a person’s mood fluctuates to extremes of mania and/or depression, as described previously

Bipolar disorder

is a distinct period during which mood is abnormally and persistently elevated, expansive, or irritable

Mania

Typically, this period lasts about 1 week (unless the person is hospitalized and treated sooner), but it may be longer for some individuals.

Mania

include inflated self-esteem or grandiosity; decreased sleep; excessive and pressured speech (unrelenting, rapid, often loud talking without pauses); flight of ideas (racing, often unconnected, thoughts); distractibility; increased activity or psychomotor agitation; and excessive involvement in pleasure-seeking or risk-taking activities with a high potential for painful consequences

Manic episodes

unrelenting, rapid, often loud talking without pauses)

pressured speech

racing, often unconnected, thoughts); distractibility

flight of ideas

he person’s mood may be excessively cheerful, enthusiastic, and expansive, or the person may be irritable, especially when he or she is told no or has rules to follow.

manic episode.

The person often denies any problems, placing the blame on others for any difficulties he or she experiences

manic episode.

Some people also exhibit delusions and hallucinations during a

manic episode.

is a period of abnormally and persistently elevated, expansive, or irritable mood and some other milder symptoms of mania.

Hypomania

do not impair the person’s ability to function (in fact, he or she may be quite productive), and there are no psychotic features (delusions and hallucinations)

Hypomania

is diagnosed when the person experiences both mania and depression nearly every day for at least 1 week

mixed episode

are often called rapid cycling

mixed episode

• one or more manic or mixed episodes usually accompanied by major depressive episodes

• Bipolar I disorder

• one or more major depressive episodes accompanied by at least one hypomanic episode

• Bipolar II disorder

0. may experience a euthymic or normal mood and affect between extreme episodes, or they may have a depressed mood swing after a manic episode before returning to a euthymic mood

0. bipolar disorder

0. or some, ____ periods between extremes are quite short. For others, euthymia lasts months or even years.

0. euthymic

• is a chronic, persistent mood disturbance characterized by symptoms such as insomnia, loss of appetite, decreased energy, low self-esteem, difficulty concentrating, and feelings of

  sadness and hopelessness that are milder than those of depression.

• Persistent depressive (dysthymic) disorder

• is a persistent angry or irritable mood, punctuated by severe, recurrent temper outbursts that are not in

  keeping with the provocation or situation, beginning before age 10.

• Disruptive mood dysregulation disorder

• is characterized by mild mood swings between hypomania and depression without loss of social or occupational

  functioning.

• Cyclothymic disorder

• is characterized by a

  significant disturbance in mood that is a direct physiological consequence

  of ingested substances such as alcohol, other drugs, or toxins

• Substance-induced depressive or bipolar disorder

• has two subtypes

• Seasonal affective disorder (SAD)

• people experience increased sleep, appetite, and carbohydrate cravings; weight gain; interpersonal conflict; irritability; and heaviness in the extremities beginning in late autumn and abating in spring and summer

• winter depression or fall-onset SAD, people

• is less common, with symptoms of insomnia, weight loss, and poor appetite lasting from late spring or early summer until early fall

• spring-onset SAD

is often treated with light therapy

Seasonal affective disorder (SAD

is a mild, predictable mood disturbance occurring in the first several days after delivery of a baby

Postpartum or “maternity” blues

Symptoms include labile mood and affect, crying spells, sadness, insomnia, and anxiety.

Postpartum or “maternity” blues

The symptoms subside without treatment, but mothers do benefit from the support and understanding of friends and family

Postpartum or “maternity” blues

is the most common complication of pregnancy in developed countries

Postpartum depression

The symptoms are consistent with those of depression (described previously), with onset within 4 weeks of delivery.

Postpartum depression

is a severe and debilitating psychiatric illness, with acute onset in the days following childbirth

• Postpartum psychosis

Symptoms begin with fatigue, sadness, emotional lability, poor memory, and confusion and progress to delusions, hallucinations, poor insight and judgment, and loss of contact with reality.

• Postpartum psychosis

• This medical emergency requires immediate treatment.

• Postpartum psychosis

• Women who have a history of serious mental illness are at higher risk for a postpartum relapse, even if they were well during pregnancy

• Postpartum psychosis

• is a severe form of premenstrual syndrome and is defined as recurrent, moderate psychological and physical symptoms that occur during the week before menses and resolving with menstruation

• Premenstrual dysphoric disorder

• Approximately 20% to 30% of premenopausal women are affected by affective and/or somatic symptoms that can cause severe dysfunction in social or occupational functioning, such as labile mood, irritability, increased interpersonal conflict, difficulty concentrating, feeling overwhelmed or unable to cope, and feelings of anxiety, tension, or hopelessness

• Premenstrual dysphoric disorder

• involves deliberate, intentional cutting, burning, scraping, hitting, or interference with wound healing

• Nonsuicidal self-injury

• Some persons who engage in self-injury (sometimes called self-mutilation) report reasons of alleviation of negative emotions, self-punishment, seeking attention, or escaping a situation or responsibility.

• Nonsuicidal self-injury

• Others report the influence of peers or the need to “fit in” as contributing factors

• Nonsuicidal self-injury

0. Various theories for the etiology of mood disorders exist. The most recent research focuses on ______as the cause

0. chemical biologic imbalances

0. appear to trigger certain physiological and chemical changes in the brain, which significantly alter the balance of neurotransmitters.

0. psychosocial stressors and interpersonal events

implicate the transmission of major depression in first-degree relatives who are at twice the risk for developing depression compared with the general population

Genetic studies

First-degree relatives of people with bipolar disorder have a sevenfold risk for developing bipolar disorder compared with a —% risk in the general populatio

1

have a concordance rate (both twins having the disorder) two to four times higher than that of dizygotic (fraternal) twins

monozygotic (identical) twins

Although __ is a significant factor, the concordance rate for monozygotic twins is not 100%, so genetics alone do not account for all mood disorders

heredity

There are also indications of a genetic overlap between

early-onset bipolar disorder and early-onset alcoholism

displayed by these clients involves more agitation than elation

Mania

clients may respond better to anticonvulsants than to lithium

Mania

focus on serotonin and norepinephrine as the two major biogenic amines implicated in mood disorders

Neurochemical influences of neurotransmitters (chemical messengers)

has many roles in behavior: mood, activity, aggressiveness and irritability, cognition, pain, biorhythms, and neuroendocrine processes

Serotonin

Deficits of __, its precursor tryptophan, or a metabolite (5-hydroxyindole acetic acid) of serotonin found in the blood or cerebrospinal fluid occur in people with depression

serotonin

Deficits of serotonin, its precursor ___, or a metabolite (5-hydroxyindole acetic acid) of serotonin found in the blood or cerebrospinal fluid occur in people with depression

tryptophan

Deficits of serotonin, its precursor tryptophan, or a metabolite (5-hydroxyindole acetic acid) of serotonin found in the blood or cerebrospinal fluid occur in people with depression

depression

demonstrates reduced metabolism in the prefrontal cortex, which may promote depression

Positron emission tomography

may be deficient in depression and increased in mania.

Norepinephrine levels

energizes the body to mobilize during stress and inhibits kindling

catecholamine

is the process by which seizure activity in a specific area of the brain is initially stimulated by reaching a threshold of the cumulative effects of stress, low amounts of electric impulses, or chemicals such as cocaine that sensitize nerve cells and pathways.

Kindling

These highly sensitized pathways respond by no longer needing the stimulus to induce seizure activity, which now occurs spontaneously

Kindling

It is theorized that —— may underlie the cycling of mood disorders as well as addiction

Kindling

____ inhibit kindling; this may explain their efficacy in the treatment of bipolar disorder

Anticonvulsants

Anticonvulsants inhibit __; this may explain their efficacy in the treatment of bipolar disorder

kindling

Anticonvulsants inhibit kindling; this may explain their efficacy in the treatment of ____

bipolar disorder

Dysregulation of _____ is also being studied in relation to mood disorders

acetylcholine and dopamine

alter mood, sleep, neuroendocrine function, and the electroencephalographic pattern; therefore, acetylcholine seems to be implicated in depression and mania.

Cholinergic drugs

seems to be implicated in depression and mania

acetylcholine

The neurotransmitter problem may not be as simple as underproduction or depletion through overuse during

stress

are being studied in relation to depression

Hormonal fluctuations

have been documented in people with endocrine disorders, such as those of the thyroid, adrenal, parathyroid, and pituitary glands

Mood disturbances

Elevated ____ is associated with the stress response, and evidence of increased cortisol secretion is apparent in about 40% of clients with depression, with the highest rates found among older clients

glucocorticoid activity

Postpartum hormone alterations precipitate mood disorders such as

postpartum depression and psychosis

About 5% to 10% of people with depression have thyroid dysfunction, notably an elevated

thyroid-stimulating hormone.

about the cause of mood disorders seemed to “blame the victim” and his or her family

psychodynamic theories

The _____ of people with depression becomes self-reproach and “anger turned inward” related to either a real or perceived loss

self-depreciation

0. Feeling abandoned by this loss, people are then angry while both loving and hating the lost object.

• The self-depreciation of people with depression becomes self-reproach

• aspires to be ideal (i.e., good and loving, superior or strong), and that to be loved and worthy, must achieve these high standards

• person’s ego

• results when, in reality, the person is not able to achieve these ideals all the time.

• Depression

• is like a situation in which the ego is a powerless,

  helpless child who is victimized by the superego, much like a powerful and

  sadistic parent who takes delight in torturing the child.

• depression

• view manic episodes as a

  “defense” against underlying depression, with the ID taking over the ego

  and acting as an undisciplined hedonistic being (child).

• psychoanalytical theories of mania