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Chapter 7 Lecture Notes Page Document Transcript

  • 1. Comer, Fundamentals of Abnormal Psychology, 4e — Chapter 7: Student Handout Answer Key 1 Chapter 7 — Mood Disorders Slides, handouts, and answers keys created by Karen Clay Rhines, Ph.D., Seton Hall University Handout 3: Mood Disorders Most people with a mood disorder experience only depression 0. This pattern is called unipolar depression • Person is no history of mania  Mood returns to normal when depression lifts Some people experience periods of depression that alternate with periods of mania This pattern is called bipolar disorder Handout 7: How Common Is Unipolar Depression? In almost all countries, women are twice as likely as men to experience severe unipolar depression 1. Lifetime prevalence: 26% of women vs. 12% of men These rates hold true across socioeconomic classes and ethnic groups ~50% recover within 6 weeks, some without treatment 2. Most will experience another episode at some point Handout 10: Diagnosing Unipolar Depression Criteria 1: Major depressive episode 3. Marked by five or more symptoms lasting two or more weeks • In extreme cases, symptoms are psychotic • Hallucinations 1. Delusions Criteria 2: No history of mania Handout 11: Diagnosing Unipolar Depression Two diagnoses to consider: Major depressive disorder  Criteria 1 and 2 are met Dysthymic disorder
  • 2. Comer, Fundamentals of Abnormal Psychology, 4e — Chapter 7: Student Handout Answer Key 2  Symptoms are “mild but chronic” 4. Experience longer-lasting but less disabling depression 5. Consistent symptoms for at least two years When dysthymic disorder leads to major depressive disorder, the sequence is called “double depression” Handout 12: Stress and Unipolar Depression Stress may be a trigger for depression 4. People with depression experience a greater number of stressful life events during the month just prior to the onset of their symptoms 5. Some clinicians distinguish reactive (exogenous) depression from endogenous depression Handout 14: Biological Model of Unipolar Depression Genetic factors 6. Family pedigree, twin, and adoption studies suggest that some people inherit a biological predisposition • Relatives of those with depression have higher rates of depression than members of the general population • Twin studies demonstrate a strong genetic component: 6. Rates for identical (MZ) twins = 46% 7. Rates for fraternal (DZ) twins = 20% • Adoption studies have also implicated a genetic factor in cases of severe unipolar depression Handout 15: Biological Model of Unipolar Depression Biochemical factors 7. NTs: serotonin and norepinephrine • In the 1950s, medications for high blood pressure were found to increase depression 8. Some lowered serotonin, others lowered norepinephrine 9. Led to “discovery” of effective antidepressant medications • It is likely not just one NT or the other – a complex interaction is at work Handout 16: Biological Model of Unipolar Depression Biochemical factors 8. Endocrine system hormone release • People with depression have been found to have abnormal levels of cortisol
  • 3. Comer, Fundamentals of Abnormal Psychology, 4e — Chapter 7: Student Handout Answer Key 3 •Released by the adrenal glands during times of stress • People with depression have been found to have abnormal melatonin secretion •“Dracula hormone” Handout 17: Biological Model of Unipolar Depression Biochemical factors 9. Model has significant limitations: • Depression-like symptoms created in lab animals •Do these symptoms correlate with human emotions? • Measuring brain activity has been difficult •Current studies using modern technology are attempting to address this issue Handout 20: Biological Treatment of Unipolar Depression Electroconvulsive therapy (ECT) 10. The discovery of ECT’s effectiveness was accidental and based on a fallacious link between psychosis and epilepsy • First major form of treatment 11. The procedure has been modified in recent years to reduce some of the negative effects • For example, patients are given muscle relaxants and anesthetics before and during the procedure 12. Patients generally report some memory loss Handout 21: Biological Treatment of Unipolar Depression Electroconvulsive therapy (ECT) 13. ECT is clearly effective in treating unipolar depression • Studies find improvement in 60–70% of patients 14. The procedure seems particularly effective in cases of severe depression with delusions 15. Although effective, the use of ECT has declined since the 1950s, due to the memory loss caused by the procedure and the emergence of effective antidepressant drugs Handout 24: Biological Treatment of Unipolar Depression Antidepressant drugs: monoamine oxidase inhibitors (MAOIs) 16. Originally used to treat TB 17. Doctors noticed that the medication seemed to make patients happier
  • 4. Comer, Fundamentals of Abnormal Psychology, 4e — Chapter 7: Student Handout Answer Key 4 18. The drug works by slowing down the body’s production of MAO • MAO breaks down norepinephrine • MAOIs stop this breakdown from occurring Handout 27: Biological Treatment of Unipolar Depression Antidepressant drugs: tricyclics 19. Hundreds of studies have found that depressed patients taking tricyclics have improved much more than similar patients taking placebos • Drugs must be taken for at least 10 days before such improvement is seen • About 60–65% of patients find symptom improvement Handout 28: Biological Treatment of Unipolar Depression Antidepressant drugs: tricyclics 20. 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 • Patients who take antidepressant drugs for three or more years after initial improvement (“maintenance therapy”) may reduce the risk of relapse even more Handout 29: Biological Treatment of Unipolar Depression Antidepressant drugs: tricyclics 21. Tricyclics are believed to reduce depression by affecting NT “reuptake” • In order to prevent an NT from remaining in the synapse too long, a pumplike mechanism recaptures the NT and draws it back into the presynaptic neuron • The reuptake process appears to be too effective in some people, drawing in too much of the NT from the synapse • This reduction in NT activity in the synapse is thought to result in clinical depression • Tricyclics block this process, thus increasing NT activity in the synapse Handout 31: Biological Treatment of Unipolar Depression Second-generation antidepressant drugs 22. A third group of effective antidepressant drugs is structurally different from the MAOIs and tricyclics
  • 5. Comer, Fundamentals of Abnormal Psychology, 4e — Chapter 7: Student Handout Answer Key 5 • Most of the drugs in this third group are selective serotonin reuptake inhibitors (SSRIs) 23. These drugs act only on serotonin; no other NTs are affected • This class includes fluoxetine (Prozac) and sertraline (Zoloft) 24. Selective norepinephrine reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are the newer second-generation antidepressants Handout 32: Biological Treatment of Unipolar Depression Second-generation antidepressant drugs 25. The effectiveness of these drugs is on par with the tricyclics, yet they boast ENORMOUS sales 10. 26. Clinicians often prefer these drugs because it is harder to overdose on them than on other kinds of antidepressants 27. There are no dietary restrictions like there are with MAOIs 28. They have fewer side effects than the tricyclics These drugs may cause some undesired effects of their own, including a reduction in sex drive Handout 34: Psychological Models of Unipolar Depression Link between depression and grief 29. When a loved one dies, the mourner regresses to the oral stage • For most people, grief is temporary • If grief is severe and long-lasting, depression results • Those with oral stage issues (unmet or excessively met needs) are at greater risk for developing depression 30. Some people experience “symbolic” (not actual) loss 31. Newer psychoanalysts focus on relationships with others (object relations theorists) Handout 37: Psychological Treatment of Unipolar Depression: Psychodynamic Therapy Psychodynamic therapists use the same basic procedures for all psychological disorders: 32. Free association 33. Therapist interpretation
  • 6. Comer, Fundamentals of Abnormal Psychology, 4e — Chapter 7: Student Handout Answer Key 6 Handout 38: Psychological Treatment 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: 34. Depressed clients may be too passive or fatigued to fully participate in clinical discussions 35. Depressed clients may become discouraged and end treatment too early when treatment doesn’t provide fast relief Short-term approaches have performed better than traditional approaches Handout 39: Psychological Models of Unipolar Depression: Behavioral View Depression results from changes in rewards and punishments As life changes, we experience a change (loss) of rewards Research supports the relationship between the number of rewards received and the presence of depression 36. Social rewards are especially important Handout 41: Psychological Treatment of Unipolar Depression: Behavioral Therapy Lewinsohn, whose theory tied a person’s mood to his/her life rewards, developed a behavioral therapy for unipolar depression: 37. Reintroduce clients to pleasurable activities and events 38. Appropriately reinforce their depressive and nondepressive behaviors 39. Use a contingency management approach 40. Help them improve their social skills Handout 46: Psychological Models of Unipolar Depression: Cognitive View Learned helplessness 41. 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
  • 7. Comer, Fundamentals of Abnormal Psychology, 4e — Chapter 7: Student Handout Answer Key 7 • In rats, uncontrollable negative events result in lower serotonin and norepinephrine levels in the brain Handout 47: Psychological Models of Unipolar Depression: Cognitive View Learned helplessness 42. Recent versions of the theory focus on attributions 43. Internal attributions that are global and stable lead to greater feelings of helplessness and possibly depression • Example: “It’s all my fault [internal]. I ruin everything [global] and I always will [stable]” 44. If people make other kinds of attributions, this reaction is unlikely • Example: “She had a role in this also [external], but I have been a jerk lately [specific], and I don’t usually act like that [unstable]” Handout 50: Psychological Models of Unipolar Depression: Cognitive View Negative thinking 45. Beck theorizes four interrelated cognitive components of depression:  Maladaptive attitudes • Self-defeating attitudes are developed during childhood • Beck suggests that upsetting situations later in life can trigger further rounds of negative thinking Handout 51: Psychological Models of Unipolar Depression: Cognitive View Negative thinking often takes three forms 46. This is called the cognitive triad: • Individuals repeatedly interpret (1) their experiences, (2) themselves, and (3) their futures in negative ways, leading to depression Handout 52: Psychological Models of Unipolar Depression: Cognitive View Negative thinking 47. Depressed people also make errors in their thinking, including: • Arbitrary inferences • Minimization of the positive and magnification of the negative • Overgeneralization 48. Depressed people experience automatic thoughts • A steady train of unpleasant thoughts that suggest inadequacy and hopelessness
  • 8. Comer, Fundamentals of Abnormal Psychology, 4e — Chapter 7: Student Handout Answer Key 8 Handout 55: Psychological Treatment of Unipolar Depression: Cognitive Therapy Beck’s 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. Increase activities and elevate mood 2. Challenge automatic thoughts 3. Identify negative thinking and biases 4. Change primary attitudes Handout 56: Psychological Treatment 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 near elimination of symptoms This treatment has also been used in a group therapy format 49. Handout 58: Sociocultural Model of Unipolar Depression How are culture and depression related? 50. Depression is a worldwide phenomena that varies from culture to culture, but the experience of symptoms differs • For example, non-Westerners report more physical (rather than psychological) symptoms • As cultures become more Western, symptoms shift Handout 59: Sociocultural Model of Unipolar Depression How do gender and race relate to depression? 51. Rates of depression are much higher among women than men One sociocultural theory holds that the complexity of women’s roles in society leaves them particularly prone to depression 52. Few differences have been seen among Caucasians, African Americans, and Hispanic Americans, but striking differences exist in specific subcultures:
  • 9. Comer, Fundamentals of Abnormal Psychology, 4e — Chapter 7: Student Handout Answer Key 9 • 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 Handout 61: Sociocultural Treatment of Unipolar Depression The most effective sociocultural approaches to treating unipolar depression are interpersonal psychotherapy and couple therapy 53. The techniques used in these approaches borrow from other models Handout 64: Bipolar Disorders People with a bipolar disorder experience both the lows of depression and the highs of mania 54. Many describe their lives as emotional roller coasters
  • 10. Comer, Fundamentals of Abnormal Psychology, 4e — Chapter 7: Student Handout Answer Key 10 Handout 66: What Are the Symptoms of Mania? Five main areas of functioning may be affected: Behavioral symptoms Very active – move quickly; talk loudly or rapidly Key word: flamboyance! Cognitive symptoms Show poor judgment or planning  Especially prone to poor (or no) planning Physical symptoms High energy level – often in the presence of little or no rest Handout 75: What Causes Bipolar Disorders? Neurotransmitters (NTs) 62. This apparent contradiction is addressed by the “permissive theory” about mood disorders: • Low serotonin may “open the door” to a mood disorder and permit norepinephrine activity to define the particular for the disorder will take: 13. Low serotonin + low norepinephrine = depression 14. Low serotonin + high norepinephrine = mania Handout 77: What Causes Bipolar Disorders? Genetic factors Many experts believe that people inherit a biological predisposition to develop bipolar disorders Findings from family pedigree studies support this theory; when one twin or sibling has bipolar disorder, the likelihood for the other twin or sibling increases: 16. Identical (MZ) twins = 40% likelihood 17. Fraternal (DZ) twins and siblings = 5 to 10% likelihood 18. General population = 1% likelihood Recently, genetic linkage studies have examined the possibility of “faulty” genes Other researchers are using techniques from molecular biology to further examine genetic patterns Handout 79: Treatments for Bipolar Disorder Lithium therapy
  • 11. Comer, Fundamentals of Abnormal Psychology, 4e — Chapter 7: Student Handout Answer Key 11 63. Discovered in 1949, lithium is a metallic element occurring as mineral salt • It is extraordinarily effective in treating bipolar disorders and mania • Determining correct dosage is a difficult process 19. Too low = no effect 20. Too high = lithium intoxication (poisoning) Handout 80: Treatments for Bipolar Disorder Lithium therapy 64. Lithium provides improvement for 60% of manic patients 65. Most patients also experience fewer new episodes while on the drug 66. Lithium may be a prophylactic drug, one that actually prevents symptoms from developing 67. Lithium also helps those with bipolar disorder overcome their depressive episodes Handout 81: Treatments for Bipolar Disorder Lithium therapy 68. Researchers do not fully understand how lithium operates • They suspect that it changes synaptic activity in neurons, but in a different way than antidepressant drugs 21. While antidepressant drugs affect a neuron’s initial reception on NTs, lithium seems to affect a neuron’s second messengers • Another theory is that lithium corrects bipolar functioning by directly changing sodium and potassium ion activity in neurons Handout 82: Treatments for Bipolar Disorder Adjunctive psychotherapy 69. Psychotherapy alone is rarely helpful for persons with bipolar disorder 70. Lithium therapy is also not always effective alone • 30% of patients don’t respond, may not receive the correct dose, or may relapse while taking it 71. As a result, clinicians often use psychotherapy to supplement lithium (or other medication-based) therapy Handout 83: Treatments for Bipolar Disorder Adjunctive psychotherapy 72. Therapy focuses on medication management, social skills, and relationship
  • 12. Comer, Fundamentals of Abnormal Psychology, 4e — Chapter 7: Student Handout Answer Key 12 issues 73. Few controlled studies have tested the effectiveness of psychotherapy as an adjunct to drug therapy for severe bipolar disorders • Growing research suggests that it helps reduce hospitalization, improves social functioning, and increases clients’ ability to obtain and hold a job 74.