Abnormal Psychology: Disorders: Depressive Disorders and Bipolar Disorder

Now,these used to be called mood disorders. I’ve gone ahead and changed it because I’m just going to have to make the changes with the DSM-5. You don’t need to know that term at all. You need to know these terms we’re going to talk about underneath this, which remain the same.
But what we’re talking about is marked by emotional disturbances. It
used to be called mood disorders because they all involve mood. Now they’ve
broken them out into two different classes where you have depressive
disorders and bipolar and related disorders. Now, this is a pet peeve for me because bipolar is oftentimes misdiagnosed. It’s not under diagnosed, it is quite
probably over diagnosed. There are some question as to whether dissociative
identity disorder is over diagnosed because it’s our rapid spike and diagnostic levels after some very popular movies and books came
out and became more and more subject on talk TV and things like that and the question was
whether there was actually an increase or
whether there were people who are now being made aware of it in clinical
realms and they’re being more sensitive in diagnosing it more
appropriately or whether they are now expecting to see it and some patients tend to fulfill the
expectations through self-fulfilling prophecy then you get misdiagnoses. But bipolar is a very real disorder and it affects less
than two percent of the population, right. That’s not that many people. It’s
too many people without a doubt but it’s not as many as you are going to see one out of every ten persons walking in to your clinic for example might have this disorder. Its it’s fairly
rare and unusual. And we’ll talk about a little bit why
it’s oftentimes misdiagnosed. One type that you’re very aware of
because you probably experienced it yourself to some degree is depression. Now we all have feelings of sadness at times. We don’t all necessarily have feelings of worthlessness. We all experience
loneliness at times Sometimes we have lethargy, we don’t feel
all energetic. Occasionally you’ll lose interest in something you thought pleasurable. Maybe you have issues where you eat a lot more than you usually do, or you eat a lot less than you usually do and maybe sometimes you have problems sleeping and can’t sleep as much. And sometimes more but but not usually a lot
of those things together persistently at such a level that it impairs your
ability to enjoy your life fully or engage in daily activities
functionally. And that’s what you are talking about when you are talking about clinical
depression.You have to have met criteria for a major depressive episode to be diagnosed with major depressive
disorder. And that is a two week period were a
number of symptoms are present out of a laundry list of
symptoms and what’s really interesting with these symptoms is they’re very different sometime between
different people but it manifest the same disorder. So
that some people have profound sadness but not
necessarily worthlessness and they’re lonely but they haven’t lost
interest in everything. And if you’ve got problems sleeping, so you look at these
as individual manifestations of this general disorder and you have to be very careful that you
go through these various symptoms to make sure that people had them for the
requisite criterion and amount of time and that they are at a level that is
clinically significantly impairing their lives. Because all of us deal with depression.
Sometimes it’s a natural response. It would be weird if you weren’t depressed
after certain kinds of events in our lives. But not so pro but that would be a
normal human experience not a clinical disorder, right. It would be a clinical disorder
if it persisted way beyond what most people require to get over such events or to
get past such events, maybe not over. But with some people let’s say eating.
Some people profoundly depressed eat a lot more. So what do you mean changes in eating like a change of 5 percent of body weight
without an attempt to do so. Gaining five percent of one’s body weight or
more. But, other people can’t eat. They actually don’t feel hungry while they’re depressed and they lose
weight. But they’re not dieting they’re not attempting to lose weight. And so in that sense 5 percent of body weight decrease in by the way or more would be significant and looked at. For other people when they
get really depressed they can’t hardly get out of bed. They don’t want to get out of bed and
they might sleep 10-12 hours a day or more. Other people can’t sleep at all
when they’re depressed, right. They have insomnia and it’s very
difficult to get to sleep. So here we are looking at opposite ends of the same
behavior being symptomatic of depression potentially. And so you
need to look through those systematically and talk to each person individually
before you make any kind of diagnostic claim. The flip side to this is
mania. This isn’t sad, this is WOOOOO, feeling good, feeling great, feeling too good, too great not due to a substance. Cocaine will do that WOOO. We’ll talk about that. But that’s due to a substance
and you’ll come back down, very quickly. As soon as the dose wears off. This is going up in staying up. These
have to be departures from normal experience. This isn’t just somebody who is really happy and chipper, right. This is going way beyond that.
We’re looking at feelings of excitement, elation, euphoria, granduer which means everything seems relevant to you,right and
you are relevant to everybody and everything. Unrealistic optimism, high-energy lack of logical thought, lack of a need
for sleep. Now, this is why it gets diagnosed
oftentimes incorrectly because racing thoughts is also a part of the
symptom profile and so somebody might go in to their
doctor and complain of having issues that are troubling them and the doctors
going to naturally ask you know what accompanies that. And you know I cant stop thinking. I’m
worried all the time. I have got all these racing racing thoughts. That’s one of the criterion and you go yeah man I can’t sleep. I really can’t sleep. Lack of asleep, that sounds like mania. But you’ve got to be careful. Differential diagnosis is important
because racing thoughts can be indicative of an
anxiety disorder, like generalized anxiety disorder. Lack of
sleep could be caused by racing thoughts one can’t stop thinking about things
that worry one, they can’t relax enough to go to sleep, or it might just be primary insomnia.Might just be trouble sleeping. In mania it’s lack of a
need for sleep. These people stay up and they don’t feel
like they’re tired. It’s like they’re on amphetamines. And if you know anything about amphetamines and abuse of amphetamines, you see that people don’t sleep sometimes
for days on end. Well, they’re not necessarily abusing any drugs although
the impulsive behavior might include drug use it might include dangerous reckless,
behavior, it might include indiscriminate sexual
activity, it might include spending money one doesn’t have, running credit cards up or gambling debts
up and things like that because in this period, distinct period of
major elevation of mood, people start doing things without regard
to consequences. And the longer they stay up there’s an
interesting parallel between amphetamine abuse and mania. You become more and more toward the psychotic end of the spectrum of reality and become less and less reality-based. People on amphetamines become very
paranoid and the longer you stay up eventually you’ll have what they call
sleep deprivation psychos. You’ll start seeing little flickering things in the peripheral
vision and you might even hallucinate. And eventually you’ll micro sleep because if it’s just
about, you’ll fall asleep. But they’re not falling asleep and the longer
they stay up the more departure you get from reality. And it’s dangerous. And so where
depression requires a two-week period of distinct change
from normal mood that meet full criteria for the episode, mania only requires one week unless
hospitalization is needed earlier. Because if somebody’s doing behaviors that can be putting themselves in danger or other people in danger, that becomes very problematic. There’s
also bipolar 1 and bipolar 2, that’s a distinction. We’ll talk about it. Major depressive disorder then is what I
said you have to have the excessive despair or
excessive sadness that has to be there. You have to have a lost of interest in
previously pleasurable activities and a whole other set of symptoms to go
with that. Those are fundamental but you need additional symptoms for at
least two weeks. Having had that episode diagnosed you could then be did
diagnosed with major depressive disorder. It’s about a 50-50 shot as to whether
you’ll have another episode of depression. Interestingly enough, when we talk about
treatment, about 85 percent of all depressions
will remit on their own, go away on their own if you do nothing within six months. But who should suffer
for six months if we have treatments that will bring relief quicker than that. And we do
have treatments but medical and psychological treatments that can
bring much quicker relief. And so in this sense having these core
symptoms departing from one’s normal mood to a
level that is clinically significant and causing
functional problems or suffering for the person bringing them in for treatment can be very, very, very helpful, right. And that criteria whatever that treatment might be, but we’ll talk about to read more extensively in the next part of this section of
material. The greatest risk is suicide and we are going to talk a little bit about suicide in a minute. Not something beyond…this is what you want to know for your test. that of these disorders we’re talking
about, the greatest risk here is for suicide. Now there’s a suicide risk that’s elevated
for schizophrenia and for bipolar because it also includes
depression. There’s also the suicide risk for all
kinds of other things like substance abuse and and other disorders but depression leads oftentimes to a despair that is so
profound that people wish themselves not to be
alive. And if they make that attempt it can
be devastating. If they make that attempt a completion that’s awful because you could treat this. You could almost always treat this if you
can get them to the resources they need to get to. Bipolar disorder used to be called manic
depression. Manic-depression is a frustrating
message if you familiar with Jimi Hendrix. So the old school term was manic
depression. Well that’s what it is. That’s a pretty
descriptive term. Bipolar is between mania and depression so now you have to
actually have met criteria for depressive episode and criteria for full-blown manic
episode and if you meet criteria for a full-blown manic episode and major depressive episode then you’re
bipolar 1, right. There’s another kind of mania that’s like less intense but is still an
elevation in mood that is going to include things like
excitement, elation, euphoria, not so much the grandeur necessarily,
lots of optimism but not necessarily unrealistic optimism high energy, not lack of sleep totally or
no need for sleep but less need for sleep, it’s a highly productive feeling. And, and
that’s kind of cool. For the people experiencing it they’re like
why would I want to not feel this way because it feels great. The problem in bipolar 2 is the
hypomania. You can get a lot done because you’re focused, you’re not unrealistic,
you’re not doing things that are highly risky and stuff
like that. You’re oftentimes highly productive. But it comes with the crash. It comes with
the depression. So the treatment is critical. Treatment
is to prevent the depression. You oftentimes will lose the mania that at lower levels may
not be, it’s called hypomania, may not be so bad in of itself but losing
the depression can be a lifesaver, literally.

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