A particular inverting circuit uses an ideal op amp and two 10-k resistors. What closed-loop gain would you expect? If a dc voltage of +1.00 V is applied at the input, what output result? If the 10-k resistors are said to be 1% resistors, having values somewhere in the range (1 0.01) times the nominal value, what range of outputs would you expect to actually measure for an input of precisely 1.00 V?
Chapter 7 Mood Disorders and Suicide Understanding and Defining Mood Disorders Mood disorders “Depressive disorders” “Affective disorders” “Depressive neuroses” Gross deviations in mood Depression Mania An Overview of Depression and Mania Major depressive episode Extreme depression 2 weeks Cognitive symptoms Physical dysfunction Anhedonia Duration—4 to 9 months, untreated Manic episode Exaggerated elation, joy, euphoria 1 week, or less Cognitive symptoms Duration—3 to 4 months, untreated Hypomanic episode 1Structure of Mood Disorders Unipolar disorders Depression or mania alone Typically depression Bipolar disorders Depression and mania Dysphoric manic episode Mixed manic episode Depressive Disorders Major depressive disorder, single episode No mania/hypomania Single episode Rare Major depressive disorder, recurrent 4 – 7 episodes (lifetime) Duration—4 to 5 months Persistent Depressive Disorder (Dysthymia) Milder symptoms Chapter 7 Mood Disorders and Suicide 2+ years Chronic Persistent Double Depression Major depressive episodes and dysthymic disorder Dysthymia first Severe psychopathology Poor course Additional Defining Criteria for Depressive Disorders Symptom Specifiers Psychotic features Hallucinations Delusions Anxious distress Comorbid disorders or anxiety symptoms Mixed features At least 3 symptoms of mania Melancholic Severe somatic symptoms Additional Defining Criteria for Depressive Disorders Symptom specifiers Atypical features Oversleeping and overeating Catatonic features Catalepsy Additional Defining Criteria for Depressive Disorders Symptom specifiers Peripartum onset 13 19% meet criteria for depression Seasonal pattern Seasonal affective disorder (SAD) 2.7% of population Melatonin Phototherapy CBT Onset and duration Onset average 30 years old for depression 512 years 5% 1317 years 19% 1823 years 24% Chapter 7 Mood Disorders and Suicide 2430 years 16% Duration 2 weeks to several years for depression Early onset has poor prognosis in dysthymic disorder Dysthymic disorder may last 20 to 30 years From Grief to Depression Depression frequently follows loss Integrated grief Pathological or impacted grief reaction Severity of symptoms Dysfunction Persistence of symptoms Additional Defining Criteria for Depressive Disorders Other Depressive Disorders Premenstrual Dysphoric Disorder (PMDD) 2 5% of women meet criteria Disruptive Mood Dysregulation Disorder Children have increased diagnosis for bipolar 40% between 1995 and 2005 Bipolar (NOS) Premenstrual Dysphoric Disorder (PMDD) Disruptive Mood Dysregulation Disorder Bipolar I Disorder Alternating major depressive and manic episodes Single manic episode Recurrent Symptomfree for 2 months Bipolar II Disorder Cyclothymic Disorder Alternating manic and depressive episodes Chapter 7 Mood Disorders and Suicide Less severe Persists longer Chronic symptoms Adults = 2+ years Children and adolescents = 1+ year Statistics Chronic Risks for Bipolar I/II Additional Defining Criteria for Bipolar Disorders Rapid—cycling specifier 20 – 50% Onset Bipolar I age 1518 Onset Bipolar II age 1922 Prevalence of Mood Disorders Children and Adolescents Similar to adults Sex ratio 50:50 Prevalence Adolescence Female disorder Misdiagnosis ADHD Conduct disorder Older adults Prevalence 16% worldwide Over 65 years 1∕2 of general population Female : Male = 1:1 Diagnostic difficulty Across Cultures Similar prevalence among U.S. subcultures Exceptions Native Americans Physical or somatic symptoms Comparability Among the creative Higher prevalence Melancholia Mania Gender differences Chapter 7 Mood Disorders and Suicide Causes of Mood Disorders: Biological Familial and Genetic Influences Family Studies Twin Studies Bipolar Unipolar Higher heritability for females Depression and Anxiety: The Same Genes Shared genetic vulnerability High familial heritability Same genetic factors General predisposition Except mania Depression and Anxiety: Same Genes Causes of Mood Disorders: Biological Neurotransmitter Systems Serotonin—depression The “permissive” hypothesis Dopamine Norepinephrine Dopamine—mania Endocrine System “Stress hypothesis” Overactive HPA axis Neurohormones Elevated cortisol Suppressed hippocampal neurogenesis Dexamethasone suppression test (DST) Sleep and Circadian Rhythms REM sleep Reduced latency Increased intensity Decreased slow wave sleep Sleep deprivation effects Causes of Mood Disorders: Psychological Stressful life events Context Meaning Stressful life events are strongly related to the onset of mood disorders Chapter 7 Mood Disorders and Suicide Reciprocal model Stress and bipolar disorder A more positive set of stressful life events seems to trigger mania Episode develop a “life of their own” Loss of sleep and jet lag Learned Helplessness (Seligman) Lack of perceived control Depressive Attributional Style Internal Stable Global Sense of hopelessness Lack of perceived control W ill not regain control Pessimism Before or after Negative Cognitive Styles Cognitive Theory of Depression (Beck) Cognitive errors in depression Negative interpretations Types of Cognitive Errors Arbitrary inference Overgeneralization Depressive cognitive triad Cognitive Theory of Depression (Beck) Negative schemas Automatic thoughts Treatment implications Correcting the errors Cognitive Vulnerability for Depression Pessimistic explanatory style Negative cognitions Hopelessness attributions Interactions with: Biological vulnerabilities Stressful life events Social and Cultural Dimensions Marriage and Interpersonal Relationships Relationship disruption precedes depression Chapter 7 Mood Disorders and Suicide Strongest effects for males Martial conflict vs. marital support Gender differences in causal direction Mood Disorders in Women Prevalence: Females > males True for all mood disorders Except bipolar Mood Disorders in Women Gender roles Perceptions of uncontrollability Socialization Access to resources Social Support Related to depression Lack of support predicts late onset depression Substantial support predicts recovery for depression (not mania) An Integrative Theory An integrative theory Shared biological vulnerability Psychological vulnerability Exposure to Stress Social and interpersonal relationships Antidepressant Medications Tricyclics (Tofranil, Elavil) Frequently used for severe depression Block reuptake/down regulate Norepinephrine Serotonin 2 to 8 weeks to work Many negative side effects Lethality Monoamine Oxidase (MAO) Inhibitors Block MAO Higher efficacy Fewer side effects Interactions Foods Chapter 7 Mood Disorders and Suicide Medicines Selective MAOIs Selective Serotonin Reuptake Inhibitors (SSRI) Fluoxetine (Prozac) First treatment choice Block presynaptic reuptake No unique risks Suicide or violence Many negative side effects Mixed reuptake inhibitors Blocking reuptake of norepinephrine as well as serotonin Other medications Venlafaxine Similar to tricyclics Nefazodone Similar to SSRIs St. John’s Wort Questionable efficacy Other issues Efficacy in special populations Children Elderly Preventing relapse Maintaining benefits Lithium Moodstabilizing drug Common salt Primary treatment for bipolar disorders Unsure of mechanism of action Narrow therapeutic window Too little—ineffective Too much—toxic, lethal Treatment of Mood Disorders: Antimanics Other antimania drugs Carbamazepine Valproate Electroconvulsive Therapy and Transcranial Magnetic Stimulation Chapter 7 Mood Disorders and Suicide Electroconvulsive Therapy (ECT) Brief electrical current Temporary seizures 6 to 10 treatments High efficacy Severe depression Few side effects Relapse is common Transcranial magnetic stimulation (TMS) Localized electromagnetic pulse Fewer side effects Efficacy is likely good More studies needed Vagus nerve stimulation Psychological Treatments for Depression Cognitive Therapy Identify errors in thinking Correct cognitive errors Substitute more adaptive thoughts Correct negative cognitive schemas Behavioral therapy Increased positive events Exercise Interpersonal Psychotherapy (IPT) Address interpersonal issues in relationships Role disputes Loss New relationships Social skill deficits Stage of dispute Negotiation stage Impasse stage Resolution stage CBT and IPT Outcomes Comparable to medications More effective than: Placebo Brief psychodynamic treatment Chapter 7 Mood Disorders and Suicide Combined Treatments for Depression Possible benefits above individual treatments 48% benefit from meds or CBT 73% benefit from combined Preventing Relapse of Depression Preventing relapse Universal programs Selected interventions Indicated interventions Preventing relapse Psychological Treatment of Bipolar Disorders Psychological treatment Management of interpersonal problems Increase medication compliance Interpersonal and Social Rhythm Therapy Familyfocused treatment Suicide Population specific Caucasians Native Americans Increasing rates Adolescents Elderly Types of suicide (Durkheim) Altruistic Egoistic Anomic Fatalistic Risk Factors Risk factors Family history Neurobiology Preexisting disorder Alcohol Stressful life event Shameful/humiliating stressor Suicide publicity and media coverage Treatment Chapter 7 Mood Disorders and Suicide Importance of assessment Suicidal desire Ideation Suicidal capability – Past attempts Suicidal intent Plan Nosuicide contract Hospitalization Complete or partial CBT