I.History/Overview
A.Origins
B.Kraepelin
II. The characteristics of clinical depression; Major Depressive Episode.
A. Case Example
B. DSM-IV diagnostic criteria for major depressive episode
1. At least 5 symptoms; at least 1 of the 5 must be either depressed mood or loss of interest or pleasure.
a. Depressed mood
b. Markedly diminished interest or pleasure in all or almost all activities
c. Significant weight loss or weight gain
d. Insomnia or hypersomnia
e. Psychomotor Agitation or Retardation
f. Fatigue or loss of energy
g. Feelings of worthlessness or excessive or inappropriate guilt
h. Diminished ability to think or concentrate
i. Recurrent thoughts of death
2. Symptoms do not meet for a mixed episode
3. Symptoms cause clinically-significant distress or impairment
4. Symptoms are not the direct physiological effects of a substance or a general medical condition
5. Symptoms are not a normal reaction to the death of a loved one (Uncomplicated Bereavement)
III. Manic episode
A. Case Example
B. DSM-IV diagnostic criteria
1. A distinct period of abnormally and persistently elevated, expansive, or irritable mood lasting at least one week
2. During this period of mood disturbance, at least 3 of the following symptoms (4 if mood is only irritable) and have been present to a significant degree.
a. Inflated self-esteem or grandiosity
b. Decreased need for sleep
c. More talkative than usual or pressure to keep talking.
d. Flight of ideas or subjective experience that thoughts are racing.
e. Distractibility
f. Increase in goal-directed activity or psychomotor agitation
g. Excessive involvement in pleasurable activities which have a high potential for painful consequences
3. Symptoms do not meet for a mixed episode
4. Mood disturbance sufficiently severe to cause marked impairment in functioning; if not met, then hypomanic episode.
5. Symptoms not due to the direct physiological effect of a substance or a general medical condition
IV. Mixed episode (new to DSM-IV)
A. Criteria are met both for a Manic Episode and for Major Depressive Episode nearly every day during a 1-week period
B. The mood disturbance is sufficiently severe to cause marked impairment
C. Symptoms not due to the direct physiological effect of a substance or a general medical condition
V. Hypomanic episode: Manic-like episode without impairment! (see above)
VI. DSM-IV classification scheme
A. Episodic vs. Chronic (2 + years)
1. Episodic
a. Bipolar
b. Major Depression
2.Chronic
a. Cyclothymia
b. Dysthymia
B. Review
VII. Epidemiology/Genetics
A. UP depression vs BP Disorder
B. BP is generally more disadvantageous
C. Genetics of Affective Disorders
1. Twin study:
2. Specificity?
VIII. Psychological Theories of Depression
A. Psychoanalytic theory
B. Lewinsohn's Reinforcement Model
1. Coyne (1976) telephone attraction study
C. Beck's cognitive model
D. Reformulated Learned-Helplessness Theory (Abramson, Seligman, & Teasdale, 1978)
IX. Physiological Theories of Affective Disorders
A. Abnormal levels of neurotransmitters.
B. Biological rhythms