Abnormal Psychology 9th Edition PDF

5/21/24 Because learning changes ever...

5/21/24 Because learning changes everything.® Abnormal Psychology 9th Edition Susan Nolen-Hoeksema Yale University © McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC. Chapter 7: Mood Disorders and Suicide © McGraw Hill LLC 2 1  5/21/24 Chapter Outline Characteristics of Depressive Disorders. Characteristics of Bipolar Disorder. Theories of Depression. Theories of Bipolar Disorder. Treatment of Mood Disorders. Suicide. © McGraw Hill LLC 3 Symptoms of Depression Depressed mood out of proportion to any cause. Anhedonia—Lost interest in everything in life. Changes in appetite, sleep, and activity levels. Psychomotor retardation or agitation. Excessive worthlessness, guilt, hopelessness, or thoughts of suicide. Problems concentrating. Losing touch with reality, experiencing delusions, and hallucinations. © McGraw Hill LLC 4 2  5/21/24 Diagnosing Depressive Disorders 1 Major depressive disorder: Depressive symptoms lasting 2 weeks or more. Major depressive disorder, single episode. Major depressive disorder, recurrent episodes. Persistent depressive disorder: Milder depressed mood for most of the day for at least 2 years. One year for children and adolescents. © McGraw Hill LLC 5 Diagnosing Depressive Disorders 2 Seasonal affective disorder (SAD): Experience and fully recover from major depressive episodes occurring seasonally for at least 2 years. Peripartum onset: Subtype of major depressive or manic episode used when the episode occurs during pregnancy or in the 4 weeks after childbirth. Premenstrual dysphoric disorder: Increase in distress during the premenstrual phase. © McGraw Hill LLC 6 3  5/21/24 Table Two Subtypes of Major Depressive Episodes Table Two Subtypes of Major Depressive Episodes Subtype Characteristic Symptoms Anxious distress Prominent anxiety symptoms Mixed features Presence of at least three manic/hypomanic symptoms but does not meet criteria for a manic episode Melancholic features Inability to experience pleasure, distinct depressed mood, depression regularly worse in morning, early morning awakening, marked psychomotor retardation or agitation, significant anorexia or weight loss, excessive guilt Psychotic features Presence of mood-congruent or mood-incongruent delusions or hallucinations Catatonic features Catatonic behaviors: not actively relating to environment, mutism, posturing, agitation, mimicking another's speech or movements Atypical features Positive mood reactions to some events, significant weight gain or increase in appetite, hypersomnia, heavy or leaden feelings in arms or legs, long-standing pattern of sensitivity to interpersonal rejection Seasonal pattern History of at least 2 years in which major depressive episodes occur during one season of the year (usually the winter) and remit when the season is over Peripartum onset Onset of major depressive episode during pregnancy or in the 4 weeks following delivery © McGraw Hill LLC 7 Prevalence and Course of Depressive Disorders High susceptibility in young adults. Rate of depression is low among adults over age 65 and is difficult to diagnose. Less common among children. Women are more susceptible to depressive symptoms. Long-lasting, recurrent problem for some people. Costly for both the individual and the society. People tend to recover with treatment. © McGraw Hill LLC 8 4  5/21/24 Symptoms of Mania Mania: A state of persistently elevated mood, feelings of grandiosity, overenthusiasm, racing thoughts, rapid speech, and impulsive actions. Bipolar I disorder: Elevated, expansive or irritable mood lasting more than 1 week and additional symptoms. Grandiosity, racing thoughts, impulsivity, rapid speech, increase in activities, decreased need for sleep. Bipolar II disorder: Severe depression. Hypomania: Mania with less severe symptoms. Cyclothymic disorder: Less severe but more chronic bipolar condition. © McGraw Hill LLC 9 Table 4 Criteria for Bipolar I and Bipolar II Disorders Table 4 Criteria for Bipolar I and Bipolar II Disorders Bipolar I and II disorders differ in the presence of major depressive episodes, episodes meeting the full criteria for mania, and hypomanic episodes. Criteria Bipolar I Bipolar II Major depressive episodes Can occur but are not necessary Are necessary for diagnosis for diagnosis Episodes meeting full criteria for Are necessary for diagnosis Cannot be present for diagnosis mania Hypomanic episodes Can occur between episodes of Are necessary for diagnosis severe mania or major depression but are not necessary for diagnosis © McGraw Hill LLC 10 5  5/21/24 Bipolar and Depressive Disorders Rapid cycling bipolar I or bipolar II disorder: Four or more mood episodes that meet criteria for manic, hypomanic, or major depressive episode within 1 year. Disruptive mood dysregulation disorder: Chronic irritability plus severe temper outbursts that are grossly out of proportion in intensity and duration to a situation and inconsistent with developmental level. In children of ages 6-18. Added to DSM-5-TR to distinguish children with this pattern from children with classic bipolar disorder. © McGraw Hill LLC 11 Prevalence and Course of Bipolar Disorder Less common than depressive disorders. Men and women are equally susceptible. No consistent differences in the prevalence among ethnic groups or across cultures. Develops mainly in late adolescence or early adulthood. People living with bipolar disorder face problems on the job and in their relationships. © McGraw Hill LLC 12 6  5/21/24 Creativity and the Mood Disorders Symptoms of mania can have benefits in certain settings. Writers, artists, and composers have a higher-than-normal prevalence of mania and depression. Mood disorders substantially impair thinking and productivity. © McGraw Hill LLC 13 Biological Theories of Depression Genetic theory—Genes predispose people to depression. Neurotransmitter theories—Dysregulation of neurotransmitters and their receptors. Norepinephrine, serotonin, and dopamine. Structural and functional brain abnormalities. Prefrontal cortex, anterior cingulate, hippocampus, and amygdala. Altered brain-wave activities in these areas affect mood. Neuroendocrine factors. Hormonal dysregulation including chronic hyperactivity in the HPA axis. Female hormone system. © McGraw Hill LLC 14 7  5/21/24 Figure 1 Neurotransmitter Abnormalities Implicated in Depression. Access the text alternative for slide images. © McGraw Hill LLC 15 Figure 2 Areas of the Brain Implicated in Major Depression. Access the text alternative for slide images. © McGraw Hill LLC 16 8  5/21/24 Figure 3 The Hypothalamic–Pituitary–Adrenal Axis. Access the text alternative for slide images. © McGraw Hill LLC 17 Psychological Theories of Depression 1 Behavioral theories. Life stress leads to depression because it reduces the positive reinforcers in a person’s life. Learned helplessness theory: Uncontrollable negative events may lead people to feel helpless. © McGraw Hill LLC 18 9  5/21/24 Psychological Theories of Depression 2 Cognitive theories. Negative cognitive triad: People have negative views of themselves, the world, and the future. Reformulated learned helplessness theory: Explains how cognitive factors might influence whether a person becomes helpless and depressed following a negative event. Rumination: Focusing on what is wrong and on negative emotions rather than problem-solving. © McGraw Hill LLC 19 Psychological Theories of Depression 3 Interpersonal theories. Interpersonal difficulties and losses are commonly reported stressors that trigger depression. Depression may engender interpersonal conflict. Rejection sensitivity: Easily perceiving rejection by others. Sociocultural theories. Cohort effects: Historical changes put recent generations at higher risk for depression. Gender differences. Ethnicity/race differences. © McGraw Hill LLC 20 10  5/21/24 Biological Theories of Bipolar Disorders Genetic factors. Strong and consistent linkage. Structural and functional brain abnormalities. Altered structure and functioning of the amygdala and prefrontal cortex. Basal ganglia shows abnormal response to rewards in the environment. Neurotransmitter factors. Dysregulation of the dopamine system. Psychosocial contributors. Greater sensitivity to rewards. Increased stress—both positive and negative. Disruptions in routines. © McGraw Hill LLC 21 Biological Treatments 1 Drug treatments for Depression. Selective serotonin reuptake inhibitors (SSRIs). Selective serotonin norepinephrine reuptake inhibitors (SNRIs). Norepinephrine-dopamine reuptake inhibitor. Tricyclic antidepressants. Monoamine oxidase inhibitors (MAOIs). Mood stabilizers used in bipolar disorders. Lithium and anticonvulsant and atypical antipsychotic medications. Electroconvulsive therapy (ECT). Brain seizure is induced by passing electrical current through the patient’s head. © McGraw Hill LLC 22 11  5/21/24 Biological Treatments 2 Repetitive transcranial magnetic stimulation (rTMS). Patients are exposed to repeated high-intensity magnetic pulses focused on particular brain structures. Vagus nerve stimulation. Vagus nerve is stimulated by a small electronic device that is surgically implanted under the patient’s skin in the left chest wall. Deep brain stimulation. Electrodes are surgically implanted in specific areas of the brain. Light therapy. Exposing people to bright light for a few hours everyday. © McGraw Hill LLC 23 Psychological Treatments for Mood Disorders Behavior therapy. Increasing positive reinforcers and decreasing aversive events. Teaching a person new skills for managing interpersonal situations and environment. Cognitive-behavioral therapy. Discover, understand, and change the negative, hopeless patterns of thinking. Help people solve concrete problems in their lives and develop skills for being more effective in their world. © McGraw Hill LLC 24 12  5/21/24 Interpersonal and Social Rhythm Therapy and Family- Focused Therapy Designed specifically for bipolar disorder. Interpersonal and social rhythm therapy (ISRT): Combines interpersonal therapy techniques with behavioral techniques and helps patients maintain: Regular routines of eating, sleeping, and activity. Stability in personal relationships. Family-focused therapy (FFT): Reduces interpersonal stress in the context of families. Education about the disorder. Improves communication patterns in family. © McGraw Hill LLC 25 Table 5 Interpersonal Therapy Table 5 Interpersonal Therapy Interpersonal therapists focus on four types of interpersonal problems as sources of depression. Type of Problem Therapeutic Approach Grief, loss Help the client accept feelings and evaluate a relationship with a lost person; help the client invest in new relationships Interpersonal role disputes Help the client make decisions about concessions willing to be made and learn better ways of communicating Role transitions Help the client develop more realistic perspectives toward roles that are lost and regard new roles in a more positive manner Interpersonal skills deficits Review the client's past relationships, helping the client understand these relationships and how they might be affecting current relationships; directly teach the client social skills, such as assertiveness Source: Hollon et al., 2005 © McGraw Hill LLC 26 13  5/21/24 Comparison of Treatments Different therapies are equally effective in treatment. Combination of psychotherapy and drug therapy is more effective than either type alone. Relapse rates in depression and bipolar disorder are high after discontinuing any treatment. © McGraw Hill LLC 27 Figure 8 Relapse Rates After Drug Versus Cognitive-Behavioral Therapy for Major Depression. Access the text alternative for slide images. © McGraw Hill LLC 28 14  5/21/24 Suicide 1 Death from injury, poisoning, or suffocation where there is evidence that the injury was self-inflicted. Deceased intended to kill himself/herself. Completed suicides—End in death. Suicide attempts: May or may not end in death. Suicidal ideation: Suicidal thoughts. © McGraw Hill LLC 29 Suicide and the DSM-5-TR DSM-5-TR has greater emphasis on suicide than previous editions. Highlights characteristics of people vulnerable to suicide. Describes suicidal patterns associated with a range of diagnoses. Encourages clinicians to attend to suicide risk early and often in treatment. Suicidal behavior disorder and nonsuicidal self-injury. Conditions to be further studied. Represent major problems on college campuses. © McGraw Hill LLC 30 15  5/21/24 Figure 9 Gender, Age, and Suicide. Access the text alternative for slide images. © McGraw Hill LLC 31 Ethnic and Cultural Considerations in Suicide Ethnic and cross-cultural differences. Non-Hispanic Whites have higher suicide rates followed by Native Americans. Rate among African American males has increased. Rates are high in Europe, the former Soviet Union, and China. Low in Latin America and South America. Australia, the United States, Canada, and England fall between these two extremes. © McGraw Hill LLC 32 16  5/21/24 Suicide in Children and Adolescents Children and adolescents. Relatively rare in young children but rate increases in early adolescence. Parallels increasing rates of psychological disorders. Girls are more likely to attempt suicide. Boys are more likely to complete. Hispanic females have high rates especially when there are acculturation differences between the adolescent and her parents. Bisexual and gay and lesbian adolescents are at an especially high risk. © McGraw Hill LLC 33 Suicide 2 College students. Risk factors: depression, hopelessness, conflict with parents, loneliness. Older adults. Older men remain at high risk of suicide. Highest in European American men over age 85. Reasons: Loss of spouse. Pain and suffering of debilitating illness. © McGraw Hill LLC 34 17  5/21/24 Nonsuicidal Self-Injury (NSSI) Significantly injuring oneself without the intention to die. People with NSSI are at increased risk of attempting suicide. May function as a way of regulating emotion. People report sense of calm upon feeling pain and seeing blood. May function as a way of influencing the environment. Gain attention and sympathy. Punish others. © McGraw Hill LLC 35 Risk Factors for Suicide Psychological disorders. Depression. Bipolar disease. Past suicidal thoughts and behavior. Stressful life events. Interpersonal violence and sexual abuse. Loss of a loved one. Economic hardship. Physical illness. © McGraw Hill LLC 36 18  5/21/24 Suicide Contagion Suicide cluster: Suicides or attempted suicides are nonrandomly bunched together in space or time. More likely to affect those who: Knew the person who committed suicide. Are linked to the suicide by media exposure. Suicide contagion: Survivors who become suicidal may be modeling the behavior of the friend or admired celebrity who committed suicide. © McGraw Hill LLC 37 Factors in Suicide Personality and cognitive factors. Impulsivity: Tendency to act on one’s impulses rather than inhibiting them. Hopelessness: Feeling that the future is bleak and there is no way to make it more positive. Biological factors. Genetic component. Low serotonin levels. © McGraw Hill LLC 38 19  5/21/24 Treatment of Suicidal Persons Hospitalization. Community-based crisis intervention programs. Drug therapy. Lithium. Selective serotonin reuptake inhibitors. Psychological therapies. Dialectical behavior therapy (DBT)—focuses on managing negative emotions and impulsive behaviors. © McGraw Hill LLC 39 Suicide Prevention Suicide hotlines. Crisis intervention centers. Prevention programs based in schools or colleges. Limitations. Targets general and at risk people together. Make suicide appear common. © McGraw Hill LLC 40 20  5/21/24 Guns and Suicide In the United States, 50% of suicides involve a gun. Presence of a firearm at home is a risk factor. Restricting the access to firearms lowers the chances of suicide. Reduces impulsive suicides. © McGraw Hill LLC 41 What to Do If a Friend Is Suicidal Take the person seriously. Get help. Express concern. Pay attention. Ask direct questions about whether the person has a plan for suicide. Acknowledge the person’s feelings without judgement. Reassure. Don’t promise confidentiality. Make sure means of self-harm are not available. If possible, don’t leave the person alone until in the hands of professionals. Take care of yourself. © McGraw Hill LLC 42 21  5/21/24 Figure 11 An Integrative Model of Depression. Access the text alternative for slide images. Source: Depression and Bipolar Support Alliance, Suicide prevention: Responding to an emergency situation, 2008. http://www.ndma.org, accessed May 15, 2008. Copyright ©2008 by Depression and Bipolar Support Alliance. All rights reserved. Used with permission. © McGraw Hill LLC 43 Because learning changes everything.® www.mheducation.com © McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC. 22