1. Affective Disorders

2. Affective Disorders

3. Affective DisordersIssues  1. Emotional states: adaptive and non-adaptive negative emotionality 2. Feelings: the experience and expression ofemotional states 3. Misattribution: confusing content and cause of emotional states

4. Affective DisordersIssues •   Normal and clinical depression • Primary and secondary affective disorders (e.g. “dual diagnosis”) • Comorbidity (especially with Anxiety disorders)

5. Affective DisordersDifferential Diagnosis •   Mood disorder due to General Medical Condition • Substance-induced Mood Disorder • Adjustment Disorder with Depressed Mood • “Negative emotion disorder” • “Pseudodementia” • “Manic Depression”

6. Affective Disorders

7. Affective DisordersDysthymia • Clinical picture • Personality: from “neurosis” to “temperament” • “Double depression”

8. Affective DisordersMajor Depressive Disorder Descriptive features • symptoms • severity • single & recurrent episodes • incidence • course

9. Affective DisordersMajor Depressive Disorder Treatment • chemotherapy (“antidepressants”) • Spontaneous remission and ... • Old research • Newer research • Newest research

10. Affective DisordersMajor Depressive Disorder Distinctions • exogenous/endogenous (distal causes?) • major/minor (severity)? c. psychotic/neurotic (severity → cause)? • melancholic/non-melancholic (proximal causes) Note: depression with “psychotic” features depression with “atypical” features

11. Affective DisordersMajor Depressive Disorder Signs of “melancholia”: • family history • early onset • insidious onset • normally not

12. Affective DisordersMajor Depressive Disorder Symptoms of “melancholia”: • vegetative • appetite and weight loss • early morning wakening • pleasures of the chase and the feast

13. Affective DisordersExplanations • A. Biogenesis 1. Genetics • concordance rates, old and new • adoptions, old and new • prospective • retrospective • possibilities • direct influence of genes • indirect influence of genes • interactive influence of genes

14. Affective DisordersExplanations • A. Biogenesis 2. Biology of negative emotionality • The original theory • The monoamine hypotheses, old and new

15. Biology of negative emotionality:

16. Affective DisordersExplanations • A. Biogenesis 2. Biology of negative emotionality • The “first generation” antidepressants • tricyclics and their anticholinergic “side effects” • MAOIs and “the cheese effect • The “second generation” antidepressants • SSRIs (eg Prozac, Paxil, Zoloft • Atypicals (eg Asendin, Effexor, Wellbutrin) • Dual action (eg Serzone, Remeron) • Others (eg SNRIs, reversible MAOIs, herbs)

17. Affective DisordersExplanations • Do antidepressants work? • The controversy, revisited • The new numbers • The drug alternatives • Cocaine : dopamine reuptake • Ecstasy : serotonin release • Amphetamines : monoamine release • The suicide risk

18. Affective DisordersExplanations • Biological factors, continued • genes • age • experience • gene/experience interactions

19. Affective DisordersExplanations 3. Developments • Body: cortisol and the DST • Brain: lateralization of emotion • frontal involvement of glutamate • involvement of memory : hippocampus & amygdala • neurobiology of sleep

20. Affective DisordersExplanations • B. Psychogenesis 1. Psychodynamic theory • Freud’s “anaclitic” depression • Bowlby’s Attachment theory: “working models” • Klerman’s Interpersonal therapy (IPT)

21. Affective DisordersExplanations 2. Learning theory • Rewards : “Response contingent positive reinforcement” • rewards activities • Behavioural Activation Treatment

22. Affective DisordersExplanations Punishments: “Learned Helplessness” and beyond • Cognition : “Pessimistic Attributional Style” (internal, global, stable) • Learned Helplessness: “The negative triad” (helplessness and hopelessness) thoughts emotions • Psychological immunization (helplessness and hopelessness) • Modern Cognitive Therapy • “Mindfulness-based Cognitive Therapy”

23. Affective DisordersExplanations Some research: “The Dodo Bird Verdict” ... and beyond • drugs • IPT • cognitive therapy • placebo

24. Affective DisordersExplanations 2. Phenomenological theory • Humanistic perspective : actualization • The alternative (and the Existentialists) • Logotherapy

25. Affective DisordersExplanations • Sociocultural aspects • Cause: sociogenesis • Content: autonomous and sociotropic people • Course: interpersonal factors in prognosis

26. Affective DisordersSummary Major Depressive Disorders: melancholic and non-melancholic: personality factors & disorders? Dysthymia primary and secondary: melancholic and non-melancholic? Treatment drugs and the alternatives: specific patient-symptom & non-specific approaches

27. Affective DisordersNotes • ECT (“Shock Therapy”) • Transcranial Magnetic Stimulation • Deep Brain Stimulation • SAD (“Depression with a Seasonal Pattern”) • Melatonin and the Pineal Gland • Light Therapies • PDD (“Premenstrual Dysphoric Disorder”) • Premenstrual Syndrome • The controversy

28. Affective DisordersNotes • Post-Partum Syndromes: • “Maternity Blues” • “Post-Partum Depression” • “Psychotic Depression in the Postpartum Period” • The Sex Difference • Predisposing factors • Reinforcing factors

29. Affective DisordersBipolar Disorder and Cyclothymia • A. Descriptive factors: • Manic and depressed episodes • Mixed and rapid cycling • Bipolar I and II • Suicide • Cyclothymia • Personality • Controversy

30. Affective DisordersBipolar Disorder and Cyclothymia • Biogenesis • Genetic • Concordance rates, then and now • Adoptions, retrospective and prospective Possibilities: direct influence of genes? • Biology of mania • The hypotheses • Psychogenesis • cause and content

31. Affective DisordersBipolar Disorder and Cyclothymia • Therapy • Lithium and its alternatives • Anticonvulsants (e.g. Tegretol, Valproate, Lamictal) • Atypical Antipsychotics (e.g Risperadol, Zyprexa, Abilify) • What else?

32. Affective DisordersSchizoaffective Disorder Differential Diagnosis • Depression with “mood congruent delusions” • Schizophrenia with “secondary depression” • A perspective, and a treatment (Symbyax)

33. Affective DisordersSuicide • Social problems and psychiatric ones • Rates, worldwide and Canadian • Trends in Canada

34. Affective DisordersSuicide • Reasons: • Disinhibitors: “social involvement and identity” • egoistic • altruistic • anomic • Motivations: “escape from self” / ”psychache” • standards and expectations • stresses, setbacks and self-blame • unbearable self-awareness

35. Affective DisordersSuicide • Summary: “Why people die by suicide”: “Disconnectedness and Ineffectiveness” Issues: • Ambivalence • “to be” • “not to be” • “maybe” • Intervention • passive suicide • assisted suicide • euthanasia

36. Affective Disorders • Issues: • Prevention • societal solutions • imitation and contagion (“The Werther Effect”) • the biology of suicide • Prediction • predicting rare events • predicting in practice • the predictors • past attempts (the best predictor) • present plan (availability of lethal means) • person (social support)

37. Somatoform & Dissociative Disorders

38. Somatoform disorder What is happening here? 1. Conversion (“hysteria”) • Sensory and motor symptoms • Over and under-diagnosis • Purpose? • Compare: “self serving bias” and “self-handicapping” • Notes: “La belle indefference” and lateralizatoin • Conversion, selective attention and dissociation

39. Somatoform disorder • Somatization • Diagnosis • Theory • Therapy • Chronic Conversion?

40. Somatoform disorder • Hypochondriasis (and “cyberchondria”) • Medical preoccupations • Other needs (and “medical offset”)? “a disorder of cognition and perception”

41. Somatoform disorder • Somatoform pain • Painful preoccupations • Primary and secondary gains? • Body Dysmorphia • Physical preoccupations • Some possibilities (and “muscle dysmorphia”)? Group forms, old and new

42. Somatoform disorder Malingering: deceit with a purpose Factitious disorder: Munchausen syndrome Note: self-induced and “proxy” forms How do you know? What do you do?

43. Dissociative disorder What is happening here? Hypnosis and the study of “dual consciousness” “Pre-attentive Processing” 1. “Dry”: the research in the lab ... the how of “implicit perception and memory” 2. “Wet”: the experience of everyday life ... the why of “intentional not-thinking”

44. Dissociative disorder Autobiographies: “deep” and “superficial” memories ... the facts, feelings and fictions Demonstrations of dissociation: group & personal ones ... the Dissociative Experience Scale

45. Dissociative disorder 1. Dissociative Amnesia • Motivated lack of awareness • Recovered Memories 1. “Dry”: the learning theory view of memory ... how learning and memory serve external, adaptive needs 2. “Wet”: the psychodynamic view of memory . .. how learning and memory serve internal, personal needs The lesson from life: “the complexity of awareness about highly traumatic events”

46. Dissociative disorder 2. Dissociative Fugue • Motivated lack of awareness and movement • Episodic, declarative and procedural memory

47. Dissociative disorder 3. Dissociative Identity Disorder • Over and under-diagnosis: “Multiple Personality Disorder” and its problems • Post-traumatic Theory (and “asymmetrical amnesia”) • Sociocognitive view (and “iatrogenic illness”) • Notes: suggestibility and dissociation-proneness

48. Dissociative disorder 4. Depersonalization Disorder • Derealization: “where am I?” and “out-of-body” experiences • Depersonalization: “who am I?” and “partial dissociation” Note: The story of “Possession/trance disorder”

49. Eating Disorders and Obesity

50. Eating Disorders and Obesity 1. Anorexia Diagnosable and otherwise 2. Bulimia Purging and non-purging • “Binge-eating disorder” DSM – V controversies