Psychopathology: An Integrative Approach, 9th Edition PDF

Psychopathology: An Integrative Approach, 9th Edition Mood Disorders and Suicide Barlow & Durand, Psychopathology: An Integrative Approach, 9th Editi...

Psychopathology: An Integrative Approach, 9th Edition Mood Disorders and Suicide Barlow & Durand, Psychopathology: An Integrative Approach, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 1 1. Definition: Overview + Mood Thermometer 2. 3 Types of Episodes (Major depressive, manic, hypomanic episode) 3. Structure of Mood Disorder (Unipolar, Bipolar) 4. Types of Depressive Disorder (Major depressive disorder, Dysthymic disorder) 5. Diagnostic Specifiers 6. Onset & Duration 7. Other Depressive Disorders 8. Bipolar (Bipolar type I, Bipolar type II, Cyclothymic) 9. Prevalence 10. Causes (Family & Genetic, Neurobiological, Psychological, Social Support) 11. Treatments (Medication, ECT/Transcranial, Psychosocial Treatments 12. Suicide (Statistics, Risk Factors, Prevention) Barlow & Durand, Psychopathology: An Integrative Approach, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 2  A Mood Thermometer Mood states can be conceptualized as varying along a spectrum or continuum. One end represents severe depression and the other end severe mania, which is a cardinal feature of bipolar disorder. Mild or moderate depression is often called “the blues” but is classified as “dysthymia” when it becomes chronic. In the middle of the spectrum is normal or balanced mood. Mild or moderate mania is called hypomania, which characterizes cyclothymic disorder.  An Overview of Depression and Mania Mood disorders* (terms marked with an asterisk are key terms) involve gross deviations in mood Composed of different types of mood “episodes” Periods of depressed or elevated mood lasting days or weeks, including: Major depressive episode* Mania* Hypomanic episode* Barlow & Durand, Psychopathology: An Integrative Approach, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 5  Major Depressive Episode Extremely depressed mood and/or loss of pleasure (anhedonia) Lasts most of the day, nearly every day, for at least two weeks At least four additional physical or cognitive symptoms: Indecisiveness, feelings of worthlessness, fatigue, appetite change, restlessness or feeling slowed down, sleep disturbance Barlow & Durand, Psychopathology: An Integrative Approach, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 6  Manic Episode Elevated, expansive mood for at least one week Examples of symptoms: Inflated self-esteem, decreased need for sleep, excessive talkativeness, flight of ideas or sense that thoughts are racing, easy distractibility, increase in goal-directed activity or psychomotor agitation, excessive involvement in pleasurable but risky behaviors Impairment in normal functioning Barlow & Durand, Psychopathology: An Integrative Approach, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 7  Other Types of Mood Episodes Hypomanic episode Shorter, less severe version of manic episodes Last at least four days Have fewer and milder symptoms Associated with less impairment than a manic episode (e.g., less risky behavior) May not be problematic in and of itself, but usually occurs in the context of a more problematic mood disorder Mixed features Mood episode with symptoms reflecting both manic and depressive. Example: Depressive episode with some manic features/manic episode with some depressed/anxious features Barlow & Durand, Psychopathology: An Integrative Approach, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 8  The Structure of Mood Disorders Unipolar mood disorder: Only one extreme of mood is experienced −E.g., only depression or only mania −Depression alone is much more common than mania alone Bipolar mood disorder: Both depressed and elevated moods are experienced −E.g., some depressive episodes and some manic or hypomanic episodes Barlow & Durand, Psychopathology: An Integrative Approach, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 9  DSM-5 (Unipolar) Depressive Disorders Major depressive disorder Persistent depressive disorder* (used to be called as dysthymia*) New to DSM-5: Premenstrual dysphoric disorder-Significant depressive symptoms occurring prior to menses during the majority of cycles, leading to distress or impairment Disruptive mood dysregulation disorder- Severe temper outbursts occurring frequently, against a backdrop of angry or irritable mood. Diagnosed only in children 6 to 18. Barlow & Durand, Psychopathology: An Integrative Approach, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 10  Major Depressive Disorder: An Overview Clinical features One or more major depressive episodes separated by periods of remission Recurrent* episodes more common than single episodes Specifiers include: Peripartum onset: Depression occurring around the time of giving birth Seasonal pattern specifier: Depression occurring primarily in certain seasons (usually winter) − Sometimes called seasonal affective disorder (SAD) − Result of phase-delayed circadian misalignment, meaning that the patient’s circadian rhythm is misaligned with the environmental day-night cycle − May be treated effectively with light therapy Barlow & Durand, Psychopathology: An Integrative Approach, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 11 Persistent Depressive Disorder: An Overview At least two years of depressive symptoms Depressed mood most of the day on more than 50% of days No more than two months symptom free Double depression* An individual experiences both persistent depressive disorder and episodes of major depression. Starts off more severe, recovers from its major depressive episode, but remains the most severely depressed after 10 years. Barlow & Durand, Psychopathology: An Integrative Approach, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 12  Epidemiology of Depressive Disorders Risk increases in adolescence and young adulthood, decreases in middle adulthood, increases again in old age (U-shaped pattern) Depressive episodes are variable in length Usually last several months untreated, but may last several years Barlow & Durand, Psychopathology: An Integrative Approach, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 13  Poll Activity (1 of 2) This survey asks you about how you have felt in the past two weeks. Indicate whether you have been bothered by each item “not at all,” “several days,” “more than half the days,” or “nearly every day.” 1. Little interest or pleasure in doing things 2. Feeling down, depressed or hopeless 3. Trouble falling asleep, staying asleep, or sleeping too much 4. Feeling tired or having little energy 5. Poor appetite or overeating 6. Feeling bad about yourself - or that you’re a failure or have let yourself or your family down Source: https://pubmed.ncbi.nlm.nih.gov/11556941/ Barlow & Durand, Psychopathology: An Integrative Approach, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 14  Poll Activity (2 of 2) 7. Trouble concentrating on things, such as reading the newspaper or watching television 8. Moving or speaking so slowly that other people could have noticed. Or, the opposite - being so fidgety or restless that you have been moving around a lot more than usual 9. Thoughts that you would be better off dead or of hurting yourself in some way Give yourself 0 points for every “not at all,” 1 point for every “several days,” 2 points for every “more than half the days,” and 3 points for every “nearly every day.” If you have a score of 5 or higher, you may want to consider meeting with a mental health professional to discuss your situation. Barlow & Durand, Psychopathology: An Integrative Approach, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 15  DSM-5 Bipolar Disorders Bipolar I disorder Alternations between major depressive episodes and manic episodes Bipolar II disorder Alternations between major depressive episodes and hypomanic episodes Cyclothymic disorder Alternations between less severe depressive and hypomanic periods Barlow & Durand, Psychopathology: An Integrative Approach, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 16  Prevalence of Mood Disorders Worldwide lifetime prevalence of major depressive disorder is 16% 6% have experienced major depression in last year Sex differences Women are twice as likely to have major depression Bipolar disorders approximately equally affect men and women Similar prevalence among U.S. subcultures, but experience of symptoms may vary Some cultures more likely to express depression as somatic concern e.g. stomachaches, chest pain, headaches etc. Higher prevalence among Native Americans: Four times the rate of the general population Barlow & Durand, Psychopathology: An Integrative Approach, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 17 Life Span Developmental Influences on Mood Disorders There is some evidence that 3-month-old babies can become depressed! Infants of depressed mothers display marked depressive behaviors (sad faces, slow movement, lack of responsiveness) Young children typically don’t show classic mania or bipolar symptoms Mood disorder may be misdiagnosed as ADHD Children are being diagnosed with bipolar disorders at increasingly high rates Depression in elderly between 14% and 42% Co-occurrence with anxiety disorders Less gender imbalance after 65 years of age Barlow & Durand, Psychopathology: An Integrative Approach, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 18 Causes of Mood Disorders: Familial and Genetic Influences Family studies Risk is higher if relative has a mood disorder First-degree relatives of an individual known to have the disorder (probands) are more likely to have unipolar depression Twin studies Concordance rates are high in identical twins Two to three times more likely to present with mood disorders than a fraternal twin of a depressed co-twin Severe mood disorders have a strong genetic contribution Heritability rates are higher for females compared to males Some genetic factors confer risk for both anxiety and depression Barlow & Durand, Psychopathology: An Integrative Approach, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19 Causes of Mood Disorders: Neurobiological Influences Serotonin Regulates norepinephrine and dopamine Mood disorders are related to low levels of serotonin Permissive hypothesis: Low serotonin “permits” other neurotransmitters to vary more widely, increasing vulnerability to depression The endocrine system Elevated cortisol Decreases neurogenesis in the hippocampus -> less able to make new neurons Sleep disturbance Hallmark of most mood disorders Depressed patients have quicker and more intense REM sleep Barlow & Durand, Psychopathology: An Integrative Approach, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 20  Psychological Dimensions (1 of 4) Stressful life events Stress is strongly related to mood disorders Context of life events matters Gene-environment correlation: People who are vulnerable to depression might be more likely to enter situations that will lead to stress The learned helplessness theory* of depression Lack of perceived control over life events leads to decreased attempts to improve own situation Barlow & Durand, Psychopathology: An Integrative Approach, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 21  Psychological Dimensions (2 of 4) Attributional style of people with depression Internal attributions Negative outcomes are one’s own fault Stable attributions Believing future negative outcomes will be one’s fault Global attribution Believing negative events will disrupt many life activities All three domains contribute to a sense of hopelessness Barlow & Durand, Psychopathology: An Integrative Approach, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 22  Psychological Dimensions (3 of 4) Negative coping styles Depressed persons engage in cognitive errors Tendency to interpret life events negatively Arbitrary inference – overemphasize the negative aspects of a mixed situation Overgeneralization – negatives apply to all situations Cognitive errors and the depressive cognitive triad* Think negatively about oneself Think negatively about the world Think negatively about the future Barlow & Durand, Psychopathology: An Integrative Approach, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 23 Psychological Dimensions (4 of 4) Barlow & Durand, Psychopathology: An Integrative Approach, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 24  Social and Cultural Dimensions Marital relations Marital dissatisfaction is strongly related to depression This relation is particularly strong in males Social support Extent of social support is related to depression Lack of social support predicts late onset depression Substantial social support predicts recovery from depression Barlow & Durand, Psychopathology: An Integrative Approach, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 25  Gender Differences in Mood Disorders Women account for seven out of ten cases of major depressive disorder. Possible explanations for gender disparity relate differences in socialization and differences in disadvantage including the experience of discrimination, poverty, sexual harassment, and abuse. Barlow & Durand, Psychopathology: An Integrative Approach, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 26 Figure 07.06 An Integrative Model of Mood Disorders Barlow & Durand, Psychopathology: An Integrative Approach, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 27  Antidepressant Medication Classes of antidepressants Selective serotonin reuptake inhibitors Tricyclic antidepressants Monoamine oxidase inhibitors Mixed reuptake inhibitors: serotonin/norepinephrine reuptake inhibitors Approximately equally effective About 50% of patients benefit Only 25% achieve normal functioning Barlow & Durand, Psychopathology: An Integrative Approach, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 28  Medication for Bipolar Disorder Lithium carbonate Treatment of choice for bipolar disorder Considered a mood stabilizer* because it treats depressive and manic symptoms Toxic in large amounts Dose must be carefully monitored Effective for 50% of patients Anticonvulsants and calcium channel blockers may be used if lithium not effective Barlow & Durand, Psychopathology: An Integrative Approach, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 29  Other Medical Treatments Electroconvulsive therapy* effective for severe medication-resistant depression Brief electrical current applied to the brain leading to seizure Side effects: Headaches, memory loss that may be permanent Transcranial magnetic stimulation uses magnets to generate a precise localized electromagnetic pulse Few side effects; occasional headaches Less effective than ECT for medication-resistant depression Barlow & Durand, Psychopathology: An Integrative Approach, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 30  Psychosocial Treatments for Depression Cognitive-behavioral therapy* Addresses errors in thinking Also includes behavioral components including behavioral activation (scheduling valued activities) Interpersonal psychotherapy* Focus: Improving problematic relationships Relapse prevention: May include both medication and psychosocial approaches Prevention Preemptive psychosocial care for people at risk Psychosocial treatment may have longer-lasting effectiveness than medication Barlow & Durand, Psychopathology: An Integrative Approach, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 31  Psychosocial Treatment for Bipolar Disorders Psychotherapy helpful in managing the problems (e.g., interpersonal, occupational) that accompany bipolar disorder Family therapy can be helpful Medication (usually Lithium) is first line of treatment Barlow & Durand, Psychopathology: An Integrative Approach, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 32  Suicide: Facts and Statistics (1 of 2) Tenth leading cause of death in USA Underreported; actual rate may be two to three times higher Most common among white and Native Americans Recent increases in death by suicide among adolescents Rates have also increased in people 65 and Suicide Attempt: Katie Stubblefield Shares Her Life-changing older Story/Regrets Barlow & Durand, Psychopathology: An Integrative Approach, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 33  Suicide: Facts and Statistics (2 of 2) Gender differences Men complete more suicides than women Women attempt suicide more often than men Disparity is due to men using more lethal methods Exception: Suicide more common among women in China May reflect cultural acceptability; suicide is seen as an honorable solution to problems Barlow & Durand, Psychopathology: An Integrative Approach, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 34  RISK OF SUICIDE  Working with suicide risk is an inherently unpredictable endeavour  The World Health Organisation (WHO) defines suicide simply as: ‘Suicide is the act of deliberately killing oneself’ (World Health Organisation, 2016a).  Suicide itself is not a single process of deciding to end one’s life with subsequent action, but rather can present in different ways. Hanley, T., & Winter, L. A. (2023). The SAGE Handbook of Counselling and Psychotherapy (5th ed.). Sage Publications. Figure 07.10 Threshold Model for Suicidal Behavior Barlow & Durand, Psychopathology: An Integrative Approach, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 36 Indices of Suicidal Behavior Suicidal ideation*: serious thoughts about suicide Suicidal plans*: a detailed method for killing oneself Suicidal attempts* that are nonfatal Barlow & Durand, Psychopathology: An Integrative Approach, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 37  Suicide Contagion Suicide contagion*: Some research indicates that a person is more likely kill themselves after hearing about someone else committing suicide Media accounts may worsen the problem by Sensationalizing or romanticizing suicide Describing lethal methods of killing oneself Barlow & Durand, Psychopathology: An Integrative Approach, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 38 RISK MITIGATION: RESPONDING TO CONCERNS  Risk mitigation does not necessarily mean the eradication of risk, but rather for risk to be lessened sufficiently so that the threat of harm is reduced and the opportunity for change increased.  A suicide safety plan is regarded as a widely accepted protocol, particularly when an individual is in danger of self-harm, has the intention to self-injure, or is contemplating suicide. A safety plan is in direct contrast to a "no-harm 'contract'" or a "no-suicide 'contract.’”  Sample of suicide safety plan: https://acrobat.adobe.com/link/track?uri=urn:aaid:scds:US:5852e8ac- a6da-31e6-831f-a3420ad6a7a0  Sample of no suicide contract: https://acrobat.adobe.com/link/track?uri=urn:aaid:scds:US:129087be- d9a7-38af-8691-da25e6d2e7b6 Hanley, T., & Winter, L. A. (2023). The SAGE Handbook of Counselling and Psychotherapy (5th ed.). Sage Publications.  Additional Resources – Video Links Profile: Mike V., Living with Major Depression: https://www.youtube.com/watch?v=LaPwuaw_Rz0 Living Through Depression: Julia's Story: https://www.youtube.com/watch?v=a1Y1ocyudjs&t=1s Persistent Depressive Disorder (Dysthymia) | Risk Factors, Symptoms, Diagnosis, Treatment: https://www.youtube.com/watch?v=chjqcYMnW98 What It's Like To Have Premenstrual Dysphoric Disorder: https://www.youtube.com/watch?v=URxPPKzAk5E Profile: Phil Y., Living with Bipolar Disorder: https://www.youtube.com/watch?v=zj4s532wTxE TEDxTerryTalks - Laura Bain - Living with Bipolar Type II: https://www.youtube.com/watch?v=8Ki9dgG3P5M NIMH Experts Discuss Suicide Prevention Strategies: https://www.youtube.com/watch?v=Yh0QLP- Jim8 Barlow & Durand, Psychopathology: An Integrative Approach, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 40  Additional Resources – Video Links The truth about electroconvulsive therapy (ECT) - Helen M. Farrell: https://www.youtube.com/watch?v=AcmarVpo2xE Bipolar Disorder and The Arts: Mark Vonnegut's Story: https://www.youtube.com/watch?v=QcqmcXVuqYk Barlow & Durand, Psychopathology: An Integrative Approach, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 41  Evaluation from Islamic Perspective Please refer to these articles: Saged, A. A. G., Sa'ari, C. Z., Abdullah, M. B., Al-Rahmi, W. M., Ismail, W. M., Zain, M. I. A., & alShehri, N. B. A. B. M. (2022). The Effect of an Islamic-Based Intervention on Depression and Anxiety in Malaysia. Journal of religion and health, 61(1), 79–92. https://doi.org/10.1007/s10943-021-01484-3 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8722650/pdf/10943_2021_Article _1484.pdf Shoib, S., Armiya'u, A. Y., Nahidi, M., Arif, N., & Saeed, F. (2022). Suicide in Muslim world and way forward. Health science reports, 5(4), e665. https://doi.org/10.1002/hsr2.665 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9178353/pdf/HSR2-5-e665.pdf Barlow & Durand, Psychopathology: An Integrative Approach, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 42