RECAP
Somatic Symptom and Related
Disorders
➢
pathologically concerned with the
functioning of their bodies
➢
The causes of somatic symptom
disorder are not well understood.
Patients with this disorder are often
preoccupied with physical symptoms
that significantly distress or interfere
with their lives.
Dissociative Disorders
➢
characterized by alterations in
perceptions: a sense of detachment from
one’s own self, from the world, or from
memories
➢
Depersonalization, Derealization,
Dissociative Amnesia, Dissociative
Identity Disorder
➢
The causes of dissociative disorders are
not well understood but often seem
related to the tendency to escape
psychologically from stress or memories
of traumatic events
MOOD DISORDERS
MOOD DISORDERS
➢ The
fundamental experiences of depression and mania contribute, either
singly or together, to all mood disorders.
➢ The
most commonly diagnosed and most severe depression is called a
major depressive episode: an extremely depressed mood state that lasts
at least 2 weeks and includes cognitive symptoms and disturbed physical
functions to the point that even the slightest activity or movement requires
an overwhelming effort.
➢ The
second fundamental state in mood disorders is abnormally
exaggerated elation, joy, or euphoria. In mania, individuals find extreme
pleasure in every activity.
DEPRESSIVE DISORDERS
DSM 5 Criteria for Major Depressive Episode
A.
Five (or more) of the following symptoms have been present during the same 2-week period
and represent a change from previous functioning; at least one of the symptoms is either (1)
depressed mood or (2) loss of interest or pleasure.
1. Depressed mood most of the day, nearly every
day, as indicated by either subjective report (e.g.,
feels sad or empty) or observation made by
others (e.g., appears tearful). Note: in children
and adolescents can be irritable mood.
2. Markedly diminished interest or pleasure in all,
or almost all, activities most of the day, nearly
every day (as indicated by either subjective
account or observation made by others).
3. Significant weight loss when not dieting or
weight gain (e.g., a change of more than 5% of
body weight in a month), or decrease or increase
in appetite nearly every day. Note: in children,
consider failure to make expected weight gains.
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly
every day (observable by others, not merely
subjective feelings of restlessness or being
slowed down).
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or
inappropriate guilt (which may be delusional)
nearly every day (not merely self-reproach or
guilt about being sick).
8. Diminished ability to think or concentrate,
or indecisiveness, nearly every day (either by
subjective account or as observed by others).
9. Recurrent thoughts of death (not just fear of
dying), recurrent suicidal ideation without a
specific plan, or a suicide attempt or a specific
plan for committing suicide.
DEPRESSIVE
DISORDERS
DSM 5 Criteria for Major Depressive Episode
B.
The symptoms cause clinically
significant distress or impairment in
social, occupational, or other
important areas of functioning.
C.
The symptoms are not due to the
direct physiological effects of a
substance (e.g., a drug of abuse, a
medication) or a general medical
condition (e.g., hypothyroidism).
Persistent depressive disorder:
DEPRESSIVE
DISORDERS
depressed mood that continues for at least 2 years, during
which the patient cannot be symptom-free for more than 2
months at a time even though they may not experience all of
the symptoms of a major depressive episode.
DEPRESSIVE DISORDERS
➢ Individuals
who suffer from both major depressive episodes and persistent
depression with fewer symptoms are said to have double depression.
➢ Premenstrual
dysphoric disorder (PMDD): suffers from severe and
sometimes incapacitating emotional reactions during the premenstrual
period
➢ Disruptive
mood dysregulation disorder: chronic irritability, anger,
aggression, hyperarousal, and frequent temper tantrums that are not limited
to an occasional episode
BIPOLAR DISORDERS
➢ The
key identifying feature of bipolar disorders is the tendency of manic episodes to
alternate with major depressive episodes in an unending roller-coaster ride from the
peaks of elation to the depths of despair.
BIPOLAR DISORDERS
BIPOLAR DISORDERS
➢ The
key identifying feature of bipolar disorders is the tendency of manic episodes to
alternate with major depressive episodes in an unending roller-coaster ride from the
peaks of elation to the depths of despair.
➢ Bipolar
I: involves one or more manic episodes, with or without depressive episodes
occurring. The mania must be severe enough that hospitalization is required and
lasts a week or longer.
➢ Bipolar
II: characterized by the shifting between the less severe hypomanic
episodes and depressive episodes.
➢ Cyclothymic
disorder: or cyclothymia, involves repeated mood shifts between
depressive and hypomanic that persist for more than two years. The depressive and
mania episodes do not meet the diagnostic criteria for bipolar disorder episodes.
There may be periods of normal mood as well, but those periods last less than eight
weeks.
CAUSES OF MOOD DISORDERS
A.
Biological Dimensions
1. Family/Genetic
Influences: Increasing severity, recurrence of major
depression, and earlier age of onset in the proband is associated with the
highest rates of depression in relatives (genetic contributions to
depression: 40% (F) 20% (M))
2. Neurotransmitter
Systems: low levels of serotonin in relation to other
neurotransmitters
3. Endocrine
system: overactivity in the HPA axis which produces stress
hormones (elevated cortisol levels, low hippocampal volume)
CAUSES OF MOOD DISORDERS
B.
Psychological Dimensions
1. Stressful
2. Learned
life events
helplessness
The depressive attributional style is
(1)
internal, in that the individual attributes negative events to personal
failings (“it is all my fault”);
(2)
stable, in that, even after a particular negative event passes, the
attribution that “additional bad things will always be my fault”
remains; and,
(3)
global, in that the attributions extend across a variety of issues.
CAUSES OF
MOOD DISORDERS
B.
Psychological Dimensions
3.
Negative cognitive styles: result
from a tendency to interpret
everyday events in a negative way
Cognitive errors such as arbitrary
inference and overgeneralization
CAUSES OF
MOOD DISORDERS
C.
Social/Cultural Dimensions
1.
Gender
2.
Social support