abnormal psych - mood disorders

11 Abnormal PsychologyDouglas A. HckerSocial and Behavioral Sciences

2 Chapter 7Mood Disorders

3 Mood Disorders Two key emotions on a continuum:

Depression Low, sad state in which life seems dark and overwhelming

Mania State of breathless euphoria or frenzied energy

4 How Common Is Unipolar Depression? About 7% of the U.S. population experiences severe unipolar depression in any given

year As many as 5% experience mild depression.

Prevalence similar in Canada, England, France, and many other countries

Approximately 17% of all adults experience unipolar depression at some time in their lives. Rates have been steadily increasing since 1915

5 How Common Is Unipolar Depression? In almost all countries, women are 2x as likely to experience severe unipolar

depression Lifetime prevalence: 26% of women vs. 12% of men

These rates hold true across socioeconomic classes and ethnic groups. Approximately 50% recover within six weeks, some without treatment

Most will experience another episode at some point

6 Symptoms of Depression? Symptoms may differ from person to person Five main areas of functioning may be affected:

Emotional symptoms Feeling miserable, empty, humiliated Experiencing little pleasure Frequent crying

Motivational symptoms Lacking drive, initiative, spontaneity. Decreased energy. No desire to participate in usual activities.

Between 6% and 15% of those with severe depression commit suicide.

27 Symptoms of Unipolar Depression Five main areas of functioning may be affected:

Behavioral symptoms Less active, less productive Frequent crying Slow movement, monotonous speech

Cognitive symptoms Hold negative views of themselves Blame themselves for unfortunate events Pessimism

Physical symptoms Headaches, dizzy spells, general pain

8 Agitated Depression Restless, unable to focus or sit still. Energetic, but unable to accomplish anything constructively.

- May be mistaken for mania

9 Diagnosing Unipolar Depression Criteria 1: Major depressive episode

Marked by five or more symptoms lasting two or more weeks In extreme cases, symptoms are psychotic, including

Hallucinations Delusions

Criteria 2: No history of mania

10

11 Diagnosing Unipolar Depression Two diagnoses to consider:

Major depressive disorder Criteria 1 and 2 are met

Dysthymic disorder Symptoms are mild but chronic

Depression is longer lasting but less disabling Consistent symptoms for at least two years

When dysthymic disorder leads to major depressive disorder, the sequence is called double depression

12 Diagnosing Unipolar Depression Major Depression, single episode Major Depression, recurrent

Depressive Disorder, seasonal (SAD) Depressive Disorder, postpartum

313 The Biological View Genetic factors

20% of relatives of those with depression are themselves depressed, compared with fewer than 10% of the general population

Twin studies demonstrate a strong genetic component: Rates for identical (MZ) twins = 46% Rates for fraternal (DZ) twins = 20%

Molecular biology studies also have implicated a genetic factor in many cases of unipolar depression

14 What Causes Unipolar Depression?The Biological View

Biochemical factors NTs: serotonin and norepinephrine

In the 1950s, medications for high blood pressure were found to cause depression Some lowered serotonin, others lowered norepinephrine

This led to the discovery of effective antidepressant medications which relieved depression by increasing either serotonin or norepinephrine

Depression likely involves not just serotonin nor norepinephrine a complex interaction is at work, and other NTsmay be involved

15 What Causes Unipolar Depression?The Biological View Biochemical factors

Endocrine system / hormone release People with depression have been found to have abnormal levels of cortisol

Released by the adrenal glands during times of stress People with depression have been found to have abnormal melatonin secretion

Dracula hormone Other researchers are investigating whether deficiencies of important proteins within neurons

are tied to depression

16 Biological Treatments Electroconvulsive therapy (ECT)

The use of ECT was -- and is -- controversial It is now used frequently but only in severe cases

The procedure consists of targeted electrical stimulation to cause a brain seizure The usual course of treatment is 6 to 12 sessions spaced over two to four weeks Treatment may be bilateral or unilateral

17 What Are the Biological Treatments for Unipolar Depression? Electroconvulsive therapy (ECT)

Accidental discovery of ECT based on a fallacious link between psychosis and epilepsy.

The procedure has been modified in recent years to reduce some of the negative effects. Ex., patients given muscle relaxants and anesthetics before and during the procedure.

Patients generally report some memory loss!

18 Biological Treatments Electroconvulsive therapy (ECT) Studies find improvement in 60%70% of

patients

4 Particularly effective in cases of severe depression with delusions, but it has been difficult to determine why ECT works so well

ECT has declined since the 1950s, because of memory loss caused and the emergence of effective antidepressant drugs

19 What Are the Biological Treatments for Unipolar Depression? Antidepressant drugs

In the 1950s, two kinds of drugs were found to be effective: Monoamine oxidase inhibitors (MAO inhibitors) Tricyclics

These drugs have been joined in recent years by a third group, the second-generation antidepressants

20

21 What Are the Biological Treatments for Unipolar Depression? Antidepressant drugs: MAO inhibitors

Originally used to treat TB, doctors noticed that the medication seemed to make patients happier The drug works biochemically by slowing down the bodys production of MAO

MAO breaks down norepinephrine MAO inhibitors stop this breakdown from occurring This leads to a rise in norepinephrine activity and a reduction in depressive symptoms

About half the patients who take these drugs are helped by them

22 What Are the Biological Treatments for Unipolar Depression? Antidepressant drugs: MAO inhibitors

MAO inhibitors potentially pose a serious danger! Blood pressure may rise to a potentially fatal level if one eats foods with tyramine (cheese,

bananas, wine) while taking MAO inhibitors

23 What Are the Biological Treatments for Unipolar Depression? Antidepressant drugs: Tricyclics

In searching for medications for schizophrenia, researchers discovered that imipramine lessened depressive symptoms

Slow reuptake of serotonin. Alter receptor sensitivity.

24 Biological Treatments Antidepressant drugs: Tricyclics

Hundreds of studies have found that depressed patients taking tricyclics have improved much more than similar patients taking placebos About 60%65% of patients find symptom improvement

25 What Are the Biological Treatments for Unipolar Depression? Antidepressant drugs: Tricyclics

Most patients who immediately stop taking tricyclics upon relief of symptoms relapse within one year Patients who take tricyclics for five additional months (continuation therapy) have a

significantly decreased risk of relapse As a result, clinicians often keep their patients on the drugs indefinitely

526

27 Biological Treatment: SSRIs Second-generation antidepressant drugs

These drugs act only on serotonin (no other NTs are affected) This class includes fluoxetine (Prozac) and sertraline (Zoloft)

Selective norepinephrine reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are also now available

28 Psychological Models of Unipolar Depression Three main models:

Psychodynamic model Not strongly supported by research

Behavioral model Modestly supported by research

Cognitive model Has considerable research support

29 Psychological Models of Unipolar Depression Psychodynamic view

Strengths: Studies have offered general support for the psychodynamic idea that depression may be

triggered by a major loss Research supports the theory that early losses set the stage for later depression Research also suggests that people whose childhood needs were improperly met are more

likely to become depressed after suffering a loss

30 Psychological Models of Unipolar Depression Psychodynamic therapy

Despite successful case reports, researchers have found that long-term psychodynamic therapy is only occasionally helpful in cases of unipolar depression

Two features may be particularly limiting: Too passive or weary to fully participate in clinical discussions. May become discouraged and end treatment too early when treatment doesnt provide fast relief

Short-term approaches have performed better than traditional approaches : Why?

31 Psychological Models of Unipolar Depression Behavioral view

Depression results from changes in rewards and punishments people receive in their lives As life changes, we experience a change (loss) of rewards

Research by Lewinsohn supports the relationship between the number of rewards received and the presence or absence of depression Social rewards are especially important

32 Treatments: Psychological Approaches Behavioral therapy

Lewinsohn developed a behavioral therapy for unipolar depression: Reintroduce clients to pleasurable activities and events, often using a weekly schedule Appropriately reinforce their depressive and nondepressive behaviors

Use a contingency management approach Help them improve their social skills

633 Treatments: Psychological Approaches Behavioral therapy

The behavioral techniques seem to be of only limited help when just one of them is applied When treatment programs combine two or three of the techniques, as Lewinsohn had

envisioned, depressive symptoms (especially mild symptoms) seem to be reduced

34 Psychological Models of Unipolar Depression Cognitive views

Two main theories: Learned helplessness Negative thinking


Learned helplessness Theory holds that people become depressed when they think that:

They no longer have control over the reinforcements in their lives They themselves are responsible for this helpless state


Learned helplessness Theory is based on Seligmans work with laboratory dogs. Recent versions of the theory focus on attributions

Internal attributions that are global and stable lead to greater feelings of helplessness and possibly depression Example: Its all my fault [internal]. I ruin everything I touch [global] and I always will [stable]


Learned helplessness There has been significant research support for this model

Human subjects who undergo helplessness training score higher on depression scales and demonstrate passivity in laboratory trials

Animal subjects lose interest in sex and social activities In rats, uncontrollable negative events result in lower serotonin and norepinephrine levels in the brain


Negative thinking According to Beck, four interrelated cognitive components combine to produce unipolar

depression:1. Maladaptive attitudes

Self-defeating attitudes are developed during childhood Beck suggests that upsetting situations later in life can trigger further rounds of negative thinking


2.This negative thinking often takes three forms, called the cognitive triad: Individuals repeatedly interpret (1) their experiences, (2) themselves, and (3) their futures in

negative ways, leading to depression


Negative thinking3. Depressed people also make errors in their thinking, including:

Arbitrary inferences Minimization of the positive and magnification of the negative

4. Depressed people experience automatic thoughts A steady train of unpleasant thoughts that suggest inadequacy and hopelessness


Strengths: There is significant research support for Becks model:

High correlation between the level of depression and the number of maladaptive attitudes Both the cognitive triad and errors in logic are seen in people with depression Automatic thinking has been linked to depression

Limitations: Research fails to show that such cognitive patterns are the cause and core of unipolar depression

42 Psychological Models of Unipolar Depression Cognitive therapy

Becks cognitive therapy the leading cognitive treatment for unipolar depression is designed to help clients recognize and change their negative cognitive processes

This approach follows four phases and usually lasts fewer than 20 sessions Phases:

1. Increasing activities and elevate mood2. Challenging automatic thoughts3. Identifying negative thinking and biases4. Changing primary attitudes

43 Psychological Models of Unipolar Depression Cognitive therapy

Over the past three decades, hundreds of studies have shown that cognitive therapy helps unipolar depression

Around 50%60% of clients show a near-total elimination of symptoms This treatment has also been used in a group therapy format

44 The Sociocultural Model of Unipolar Depression Sociocultural theorists propose that unipolar depression is greatly influenced

by the social structure in which people live This belief is supported by the finding that depression is often triggered by outside

stressors Researchers have also found links between depression and culture, gender, race,

and social support

45 The Sociocultural Model of Unipolar Depression How are culture and depression related?

Depression is a worldwide phenomena, but the experience of symptoms differs from culture to culture For example, non-Westerners report more physical (rather than psychological) symptoms As cultures become more Western, symptoms shift

46 The Sociocultural Model of Unipolar Depression

8 How do gender and race relate to depression? Higher among women than men

One sociocultural theory holds that the complexity of womens roles in society leaves them particularly prone to depression

Few differences have been seen overall among Caucasians, African Americans, and Hispanic Americans, but striking differences exist in specific subcultures:

In a study of one Native American village, lifetime risk was 37% among women, 19% among men, and 28% overall

These findings are thought to be the result of economic and social pressures

47 The Sociocultural Model of Unipolar Depression How does social support relate to depression?

The availability of social support seems to influence the likelihood of depression Rates of depression vary based on marital status

Interpersonal conflict may be a factor Isolation and lack of intimacy also are key factors

Research shows that depressed people who lack social support remain depressed longer than those who have a supportive spouse or warm friendships

48 The Sociocultural Model of Unipolar Depression Interpersonal therapy (IPT)

This model holds that four interpersonal problems may lead to depression and must be addressed: Interpersonal loss Interpersonal role dispute Interpersonal role transition Interpersonal deficits

Studies suggest that IPT is as effective as cognitive therapy for treating depression

49 The Sociocultural Model of Unipolar Depression The most effective sociocultural approaches to treating unipolar depression

are interpersonal psychotherapy and couple therapy The techniques used in these approaches borrow from other models

50 The Sociocultural Model of Unipolar Depression Couple therapy

The main type of couple therapy is behavioral marital therapy (BMT) Focus is on developing specific communication and problem-solving skills

If marriage is conflictual, BMT is as effective as other therapies for reducing depression

51 Bipolar DisorderKeyword: Drama

52 What Are the Symptoms of Mania? Dramatic and inappropriate rises in mood.

1.Emotional symptoms Active, powerful emotions in search of outlet

2.Motivational symptoms Need for constant excitement, involvement, companionship3. Behavioral symptoms

Very active move quickly; talk loudly or rapidly

9 Key word: flamboyance!

53 Manic Symptoms, cont. 4. Cognitive symptoms

Show poor judgment or planning Especially prone to poor (or no) planning

5. Physical symptoms High energy level often in the presence of little or no rest

54 Diagnosing Bipolar Disorders Criteria 1: Manic episode

Three or more symptoms of mania lasting one week or more In extreme cases, symptoms are psychotic

Criteria 2: History of mania If currently experiencing hypomania or depression

55 Diagnosing Bipolar Disorders Bipolar I disorder

Full manic and major depressive episodes Most experience an alternation of episodes Some experience mixed episodes

Bipolar II disorder Hypomanic episodes & major depressive episodes

Cyclothymic disorder- Hypomanic episodes & mild depression

56

57 Diagnosing Bipolar Disorders Between 1% and 2.6% of adults in the world suffer from a bipolar disorder at

any given time The disorders are equally common in women and men

Women may experience more depressive episodes and fewer manic episodes than men

58 Diagnosing Bipolar Disorders The prevalence of the disorders is the same across socioeconomic classes

and ethnic groups Onset usually occurs between 15 and 44 years of age In most cases, the manic and depressive episodes eventually subside, only

to recur at a later time

59 What Causes Bipolar Disorders? Neurotransmitters

If low norepinephrine = unipolar depression, maybe high norepinephrine levels = mania.

10

This theory is supported by some research studies; bipolar disorders may be related to overactivity of norepinephrine

60 What Causes Bipolar Disorders? Genetic factors

Many experts believe that people inherit a biological predisposition to develop bipolar disorders Family pedigree studies support this theory; when one twin or sibling has bipolar disorder, the likelihood for the

other twin or sibling increases: Identical (MZ) twins = 40% likelihood Fraternal (DZ) twins and siblings = 5% to 10% likelihood General population = 1% to 2.6% likelihood

61 What Causes Bipolar Disorders? Neurotransmitters

The permissive theory about mood disorders: Low serotonin may open the door to a mood disorder and permit norepinephrine activity to

define the particular form the disorder will take: Low serotonin + Low norepinephrine = Depression Low serotonin + High norepinephrine = Mania

62 Treatments for Bipolar Disorders Until the latter part of the 20th century, people with bipolar disorders were

destined to spend their lives on an emotional roller coaster Psychotherapists reported almost no success Antidepressant drugs were of limited help

These drugs sometimes triggered manic episodes ECT only occasionally relieved either the depressive or the manic episodes of

bipolar disorder

63 Treatments for Bipolar Disorders Lithium, a metallic element occurring as mineral salt, has dramatically

changed the picture: It is extraordinarily effective in treating bipolar disorders and mania Determining the correct dosage for a given patient is a delicate process

Too low = no effect Too high = lithium intoxication (poisoning)

64 What Are the Treatments for Bipolar Disorders? Lithium provides improvement for more than 60% of patients with mania

Most patients also experience fewer new episodes while on the drug Lithium also is a prophylactic drug, one that actually prevents symptoms from

developing Lithium also helps those with bipolar disorder overcome their depressive

episodes

65 What Are the Treatments for Bipolar Disorders? Researchers do not fully understand how lithium operates

Although antidepressant drugs affect a neurons initial reception on NTs, lithium seems to affect a neurons second messengers

Another theory is that lithium corrects bipolar functioning by directly changing sodium and potassium ion activity in neurons

abnormal psych - mood disorders

Documents