PSY 421 Abnormal Psychology Chapter 7 Lecture Slides PDF

PSY 421 Abnormal Psychology Chapter 7 Depressive and Bipolar Disorders Mood Disorders Depression  Feelings of sadness, hopelessness and lack of energy & interest in life Mania MOOD  Excessive and unrealistic feelings of D...

PSY 421 Abnormal Psychology Chapter 7 Depressive and Bipolar Disorders Mood Disorders Depression  Feelings of sadness, hopelessness and lack of energy & interest in life Mania MOOD  Excessive and unrealistic feelings of DISORDERS excitement, euphoria and overactivity UNIPOLAR BIPOLAR -only depressive -both depressive episodes and manic episodes  Mood Disorders in DSM-5 Used to be both in same category of DSM-IV: Mood Disorders Now is broken up into two different categories Depressive Disorders  Disruptive Mood Dysregulation  Major Depressive  Persistent Depressive  Premenstrual Dysphoric  Unspecified Bipolar and Related Disorders  Bipolar I  Bipolar II  Cyclothymic  Unspecified  Epidemiology of Mood Disorders  Lifetime prevalence of major depressive disorder is nearly 17%  12-month prevalence rates are nearly 7%  About twice as common in women than men  Lifetime prevalence for bipolar I disorder is near 1%  Both kinds: 2-3%  Compared to white/ European descent and Latinx persons-  Native Americans have relatively high rates of depression  Black/ African-Americans have relatively low rates  U.S. rates of unipolar depression inversely related to socioeconomic status Mood Episodes Not meant to be diagnosed as separate entities Serve as building blocks for the specific disorder diagnoses Major Depressive Episode  2 week period, symptoms including depressed mood or loss of interest or pleasure Manic Episode  1 week, distinct period of elevated, expansive, or irritable mood Hypomanic Episode  4 days, distinct period of elevated, expansive, or irritable mood clearly different from usual nondepressed mood, not severe enough to cause marked impairment in functioning  Major Depressive Episode Diagnostic Criteria 5 or more of following symptoms present for 2 week period  **Depressed mood most of day, nearly every day  **Markedly diminished interest or pleasure in nearly all activities (Anhedonia)  Significant weight loss, or decreased appetite  Insomnia or hypersomnia  Psychomotor agitation or retardation  Fatigue or loss of energy  Feelings of worthlessness or excessive guilt  Diminished concentration or indecisiveness  Recurrent thoughts of death, suicide ideation, or plan Major Depressive Disorder Diagnostic Criteria Presence of a single Major Depressive Episode (MDE) Absence of a Manic or Hypomanic episode Not due to a substance Not due to a different disorder Causes clinically significant distress or impairment Prevalence of MDD Lifetime prevalence: 17% Length episodes: Average 6-9 12-month prevalence rates are nearly 7% months (untreated) Sex ratio= 2:1 Remission is common, but… so is  ~20% women diagnosed  ~13% men diagnosed relapse and recurrence  40-50% experience another MDE  In children and elderly about equal (recurrence) Age of onset: mid-20’s  Average of 4 depressive episodes in a  Age of onset steadily decreasing lifetime  Earlier age of onset predicts worse prognosis Some established differences across races and ethnicities  African Americans lower rates  Native Americans higher rates Persistent Depressive Disorder (Dysthymia) Diagnostic Criteria  Depressed mood for most of the day, more days than not for at least 2 years (1 year for children)  Presences of 2+  Poor appetite or overeating  Insomnia or hypersomnia  Low energy or fatigue  Low self-esteem  Poor concentration  Feelings of hopelessness  During 2 years, no more than 2 mos of normal functioning  Can meet criteria for MDD (“double depression”) AKA Dysthymic Disorder  No manic or hypomanic episodes Mild to moderate version of  Not due to another disorder or a substance depression that lasts a long time  Clinically significant distress or impairment Persistent Depressive Disorder (Dysthymia) Cycle of Major Depressive Disorder Cycle of Persistent Depressive Disorder (Dysthymia) Prevalence & Course  Lifetime: ~3%  Can be difficult to diagnose since people describe it as “how I have always felt”  Women diagnosed 2-3 times more often than men  1:1 sex ratio in children  Early and insidious onset  Childhood, adolescence, early adulthood  Early Onset → greater chronicity, poor response to treatment  Chronic course  Avg. 5 yrs, ranges to 20 yrs duration Biological Causal Factors in Unipolar Depression Genetic influences  3 times more common among blood relatives  Twin studies  MZ twin is twice as likely to develop unipolar depression as DZ twin  Heritability: 31% to 42% of the variance in unipolar depression due to genetics Neurochemical factors  Reduced dopaminergic activity  Dopamine pleasure experience Biological Causal Factors Sleep and other biological rhythms  In depressed patients, sleep problems range from early morning awakening, periodic awakening during the night, and difficulty falling asleep Research has found these patients enter the first period of REM after only 60 minutes (15- 20 mins sooner than nondepressed people) and show greater amounts of REM sleep  Psychological Causal Factors Psychodynamic theories  Response to real and symbolic loss anger turned inward Behavioral theories  Depression occurs in the absence of positive reinforcement; maintained through positive/ negative reinforcement  Research shows depressed people do receive less positive reinforcement from family and friends and experience more negative events than nondepressed people Psychological Causal Factors Cognitive theory  Tendency for depressed people to be primed for and remember negative events more easily and frequently  Beck’s Model of Depression  Psychological Causal Factors: Learned Helplessness Seligman: Attributing lack of control over stress leads to anxiety and depression Abramson’s Reformulated Helplessness Theory: Depressive attributional style  Internal (vs. external): attribute negative events to personal failing (my fault)  Stable (vs. unstable): even after a negative event passes, assumption of future failures (always will happen)  Global (vs. specific): generalizing of shortcomings to a wide range of circumstances (regardless of situation) Psychological Causal Factors Ruminative Response Styles  Rumination: a pattern of repetitive and passive mental activity (typically related to negative feelings about an event or situation) Research shows rumination is associated with longer and more severe episodes of depression Women are more likely to ruminate than men (more likely to engage in self-distracting activities as a response) Interpersonal Causal Factors Depressed individuals often:  have sparse social networks  perceive social network as providing little support Depression can elicit sympathy and care, but it can also elicit hostility and rejection from others Depression and marital dissatisfaction correlate highly Bipolar Disorders  Bipolar Disorders Bipolar disorders are distinguished from unipolar disorders by the presence of manic or hypomanic symptoms  Cyclothymic Disorder  Bipolar I Disorder  Bipolar II Disorder Bipolar Disorders Like Unipolar Disorders, the building blocks of Bipolar Disorders are:  Major Depressive Episodes  Manic Episodes  Hypomanic Episodes Manic Episode Diagnostic features:  Distinct period of elevated, expansive, or irritable mood; lasting at least 1 week  3 or more of the following symptoms present:  Inflated self-esteem or grandiosity  Decreased need for sleep  More talkative than usual / pressured speech  Flight of ideas / racing thoughts  Distractibility  Increase in goal-directed activity or psychomotor agitation  Excessive involvement in pleasurable activities that have high potential for negative consequences Hypomanic Episode Diagnostic features:  Distinct period of elevated, expansive, or irritable mood, lasting at least 4 days  3 or more manic symptoms are present  Episode is associated with definite change in person’s characteristic functioning  Disturbance in mood and change in functioning is observable by others  Not severe enough to cause marked impairment in functioning Mood Episodes Manic Episode Hypomanic Episode Duration: 1 week Duration: 4 days At least 3/7 symptoms At least 3/7 symptoms Significant impairment in functioning NO significant impairment in functioning Bipolar Disorders Bipolar I:  1+ Manic Episodes (required)  1+ Major Depressive Episode (not required but typically accompany manic episode) Bipolar II:  1+ Major Depressive Episodes  1+ Hypomanic Episodes Bipolar Disorders Bipolar I Bipolar II Cyclothymic Disorder Hypomanic & depressive symptoms that do not reach severity of manic or major depressive episodes  Tends to be predominantly one or the other for long periods of time with few periods of neutral mood states Duration at least 2 years Interferes with functioning ≈ 30% chance of developing Bipolar I or II Prevalence Lifetime: ~4.4% Occurs equally in men and women  Men typically have more intense manic episodes  Women experience rapid cycling more often High rate of suicide  Primarily during depressive episodes  10-30 times more likely than general population risk  Research indicates more ideation and more lethal attempt means Course of BDs Average age of onset: 18-22 years About 3 times as many days are depressed as manic  Depressive episodes typically last 3-4 mos in BD Some people experience rapid cycling  4+ episodes per year Very small chance of BD II developing into BD II Course is typically long term and chronic even with treatment Biological Causal Factors Heritability  80-90% variance in the vulnerability to develop Bipolar Disorder due to genes  Generally considered higher than any other adult psychiatric disorder (competes with SZ) Neurochemical Factors  Monoamine Hypothesis  Excess norepinephrine  Dopamine  Increased dopaminergic activity results in manic behaviors Psychological Causal Factors Psychological causal factors include:  Stressful life events  Personality variables (such as neuroticism and high levels of achievement striving)  Low social support Treatment of Mood Disorders Chapter 7 Cont’d Treatments and Outcomes Only about 40% of people with mood disorders receive minimally adequate treatment Psychotherapy Medication Pharmacotherapy First antidepressant drugs developed: monoamine oxidase inhibitors (MAOIs) Followed by:  Tricyclics (ex. Imipramine)  Selective Serotonin Reuptake Inhibitors (SSRIs; exs. Fluoxetine (Prozac) Paroxetine (Paxil) Sertraline (Zoloft))  Atypical antidepressants (exs. Wellbutrin, Remeron) have fewer side effects and can be more effective with mild depression Pharmacotherapy The course of treatment with antidepressant drugs  Usually take 3–5 weeks to take effect  50% do not respond to first drug tried  Discontinuing drug often leads to relapse Medication for Bipolar Disorder Lithium: mood stabilizing drugs Lithium  75% of patients show at least partial improvement on Lithium  Some unpleasant side effects: lethargy, decreased motor coordination, GI difficulties; long-term use can cause kidney damage  Compliance is a major problem Anticonvulsants (Depakote)  Often effective in those who do not respond to Lithium  Risk for attempted and completed suicide increases 2 to 3 times Alternative Biological Treatments Electroconvulsive Therapy  Most appropriate for severely depressed patients  High suicide risk  Psychotic symptoms  Typical treatment involves 6–12 sessions administered every other day  Varying levels of amnesia may persist Psychological Treatment Cognitive behavioral therapy  Relatively brief treatment  Involves exploring and challenging beliefs and negative automatic thoughts  Equally, or more, effective than antidepressants and more effective in preventing relapse Psychological Treatment Behavioral Activation  More behaviorally focused than CBT  Utilizes tenets of reinforcement  Focuses on getting patients more active and engaged with their environment and their interpersonal relationships  things they enjoy*  May be as effective, and easier to administer, than CBT Make a list of ideas Psychological Treatment: IPT Interpersonal therapy Focuses on interpersonal relationships as a means of bringing about change  Depression stems from dissatisfaction in relationships Goals: help patients improve their interpersonal relationships or change their expectations about them  Use the therapeutic relationship to address and alter interpersonal functioning Short term: usually involves up to 20 sessions (usually weekly meetings, 1 hour per session) and maintains a focus on 1-2 key issues that seem to be most closely related to the depression Clinical Outcomes Even without therapy, most individuals who experience mood episodes will get better within a year But again, estimated about half of people don’t receive adequate treatment Although relapse and recurrence is common, it can be prevented or reduced by treatment Improved long-term outcome with:  Early treatment  Persistent medication use  Fewer comorbid diagnoses  Good support from family and others