Mood Disorders <ul><li>Chapter 7 </li></ul>Slides & Handouts by Karen Clay Rhines, Ph.D. Northampton Community College Fun...
Mood Disorders <ul><li>Two key emotions on a continuum: </li></ul><ul><ul><li>Depression </li></ul></ul><ul><ul><ul><li>Lo...
Mood Disorders <ul><li>Most people with a mood disorder suffer only from depression </li></ul><ul><ul><li>This pattern is ...
Unipolar Depression <ul><li>The term “depression” is often used to describe general sadness or unhappiness </li></ul><ul><...
How Common Is Unipolar Depression? <ul><li>Almost 7% of adults in the U.S. suffer from severe unipolar depression in any g...
How Common Is Unipolar Depression? <ul><li>Women are at least twice as likely as men to experience severe unipolar depress...
What Are the Symptoms of Depression? <ul><li>Symptoms may vary from person to person </li></ul><ul><li>Five main areas of ...
What Are the Symptoms of Depression? <ul><li>Five main areas of functioning may be affected: </li></ul><ul><ul><li>Behavio...
Diagnosing Unipolar Depression <ul><li>Criteria 1: Major depressive episode </li></ul><ul><ul><li>Marked by five or more s...
Diagnosing Unipolar Depression <ul><li>Two diagnoses to consider: </li></ul><ul><ul><li>Major depressive disorder </li></u...
What Causes Unipolar Depression? <ul><li>Stress may be a trigger for depression </li></ul><ul><ul><li>People with depressi...
What Causes Unipolar Depression? The Biological Model <ul><li>Genetic factors </li></ul><ul><ul><li>Family pedigree, twin,...
What Causes Unipolar Depression? The Biological Model <ul><li>Biochemical factors </li></ul><ul><ul><li>NTs: serotonin and...
What Causes Unipolar Depression? The Biological Model <ul><li>Biochemical factors </li></ul><ul><ul><li>Endocrine system /...
What Causes Unipolar Depression? The Biological Model <ul><li>Biochemical factors </li></ul><ul><ul><li>These explanations...
What Causes Unipolar Depression? The Biological Model <ul><li>Brain anatomy and brain circuits </li></ul><ul><ul><li>Biolo...
Biological Treatments for Unipolar Depression <ul><li>Usually biological treatment means antidepressant drugs, but for sev...
Biological Treatments for Unipolar Depression <ul><li>Electroconvulsive therapy (ECT) </li></ul><ul><ul><li>The use of ECT...
Biological Treatments for Unipolar Depression <ul><li>Electroconvulsive therapy (ECT) </li></ul><ul><ul><li>The discovery ...
Biological Treatments for Unipolar Depression <ul><li>Electroconvulsive therapy (ECT) </li></ul><ul><ul><li>ECT is clearly...
Biological Treatments for Unipolar Depression <ul><li>Antidepressant drugs </li></ul><ul><ul><li>In the 1950s, two kinds o...
Biological Treatments for Unipolar Depression <ul><li>Antidepressant drugs: MAO inhibitors </li></ul><ul><ul><li>Originall...
Biological Treatments for Unipolar Depression <ul><li>Antidepressant drugs: MAO inhibitors </li></ul><ul><ul><li>MAO inhib...
Biological Treatments for Unipolar Depression <ul><li>Antidepressant drugs: Tricyclics </li></ul><ul><ul><li>In searching ...
Biological Treatments for Unipolar Depression <ul><li>Antidepressant drugs: Tricyclics  </li></ul><ul><ul><li>Hundreds of ...
Biological Treatments for Unipolar Depression <ul><li>Antidepressant drugs: Tricyclics  </li></ul><ul><ul><li>Most patient...
Biological Treatments for Unipolar Depression <ul><li>Antidepressant drugs: Tricyclics </li></ul><ul><ul><li>Tricyclics ar...
 
Biological Treatments for Unipolar Depression <ul><li>Second-generation antidepressant drugs </li></ul><ul><ul><li>A third...
Biological Treatments for Unipolar Depression <ul><li>Second-generation antidepressant drugs </li></ul><ul><ul><li>The eff...
Biological Treatments for Unipolar Depression <ul><li>Brain stimulation </li></ul><ul><ul><li>As one third or more of peop...
Biological Treatments for Unipolar Depression <ul><li>Vagus nerve stimulation </li></ul><ul><ul><li>Depression researchers...
Biological Treatments for Unipolar Depression <ul><li>Transcranial magnetic stimulation </li></ul><ul><ul><li>Another tech...
Biological Treatments for Unipolar Depression <ul><li>Brain stimulation </li></ul><ul><ul><li>While such positive initial ...
What Causes Unipolar Depression? The Psychological Models <ul><li>Three main models: </li></ul><ul><ul><li>Psychodynamic m...
What Causes Unipolar Depression? The Psychological Models <ul><li>Psychodynamic view </li></ul><ul><ul><li>Link between de...
What Causes Unipolar Depression? The Psychological Models <ul><li>Psychodynamic view </li></ul><ul><ul><li>Studies have of...
Psychodynamic Treatments for Unipolar Depression <ul><li>Psychodynamic therapists use the same basic procedures for all ps...
Psychodynamic Treatments for Unipolar Depression <ul><li>Despite successful case reports, researchers have found that long...
What Causes Unipolar Depression? The Psychological Models <ul><li>Behavioral view </li></ul><ul><ul><li>Depression results...
Behavioral Treatments for Unipolar Depression <ul><li>Behavioral therapy </li></ul><ul><ul><li>Lewinsohn developed a behav...
Behavioral Treatments for Unipolar Depression <ul><li>Behavioral therapy </li></ul><ul><ul><li>The behavioral techniques s...
What Causes Unipolar Depression? The Psychological Models <ul><li>Cognitive views </li></ul><ul><ul><li>Two main theories:...
What Causes Unipolar Depression? The Psychological Models <ul><li>Cognitive views </li></ul><ul><ul><li>Learned helplessne...
What Causes Unipolar Depression? The Psychological Models <ul><li>Cognitive views </li></ul><ul><ul><li>Learned helplessne...
What Causes Unipolar Depression? The Psychological Models <ul><li>Cognitive views </li></ul><ul><ul><li>Learned helplessne...
What Causes Unipolar Depression? The Psychological Models <ul><li>Cognitive views </li></ul><ul><ul><li>Learned helplessne...
What Causes Unipolar Depression? The Psychological Models <ul><li>Cognitive views </li></ul><ul><ul><li>Learned helplessne...
<ul><li>Cognitive views </li></ul><ul><ul><li>Learned helplessness  </li></ul></ul><ul><ul><ul><li>Although this theory ha...
<ul><li>Cognitive views </li></ul><ul><ul><li>Negative thinking </li></ul></ul><ul><ul><ul><li>Beck believes four interrel...
<ul><li>Cognitive views </li></ul><ul><ul><li>Negative thinking </li></ul></ul><ul><ul><ul><li>2.  This negative thinking ...
<ul><li>Cognitive views </li></ul><ul><ul><li>Negative thinking </li></ul></ul><ul><ul><ul><li>3.  Depressed people also m...
<ul><li>Cognitive views </li></ul><ul><ul><li>Negative thinking </li></ul></ul><ul><ul><ul><li>Many studies have produced ...
Cognitive Treatment for Unipolar Depression <ul><li>Beck’s cognitive therapy – which includes a number of behavioral techn...
Cognitive Treatment for Unipolar Depression <ul><li>Over the past several decades, hundreds of studies have shown that cog...
What Causes Unipolar Depression? The Sociocultural Model <ul><li>Sociocultural theorists propose that unipolar depression ...
What Causes Unipolar Depression? The Sociocultural Model <ul><li>The Family-Social Perspective </li></ul><ul><ul><li>The c...
What Causes Unipolar Depression? The Sociocultural Model <ul><li>The Family-Social Perspective </li></ul><ul><ul><li>Consi...
Family-Social Treatments for Unipolar Depression <ul><li>Interpersonal therapy (IPT) </li></ul><ul><ul><li>This model hold...
Family-Social Treatments for Unipolar Depression <ul><li>Couple therapy </li></ul><ul><ul><li>The main type of couple ther...
What Causes Unipolar Depression? The Sociocultural Model <ul><li>The Multicultural Perspective </li></ul><ul><ul><li>Two k...
What Causes Unipolar Depression? The Sociocultural Model <ul><li>The Multicultural Perspective </li></ul><ul><ul><li>Vario...
What Causes Unipolar Depression? The Sociocultural Model <ul><li>The Multicultural Perspective </li></ul><ul><ul><li>Vario...
What Causes Unipolar Depression? The Sociocultural Model <ul><li>The Multicultural Perspective </li></ul><ul><ul><li>Vario...
What Causes Unipolar Depression? The Sociocultural Model <ul><li>The Multicultural Perspective </li></ul><ul><ul><li>Each ...
What Causes Unipolar Depression? The Sociocultural Model <ul><li>The Multicultural Perspective </li></ul><ul><ul><li>Two k...
What Causes Unipolar Depression? The Sociocultural Model <ul><li>The Multicultural Perspective </li></ul><ul><ul><li>Depre...
What Causes Unipolar Depression? The Sociocultural Model <ul><li>The Multicultural Perspective </li></ul><ul><ul><li>Withi...
Multicultural Treatments for Unipolar Depression <ul><li>Culture-sensitive approaches are increasingly being combined with...
Bipolar Disorders <ul><li>People with a bipolar disorder experience both the lows of depression and the highs of mania </l...
What Are the Symptoms of Mania? <ul><li>Unlike those experiencing depression, people in a state of mania typically experie...
What Are the Symptoms of Mania? <ul><li>Five main areas of functioning may be affected: </li></ul><ul><ul><li>3. Behaviora...
Diagnosing Bipolar Disorders <ul><li>Criteria 1: Manic episode </li></ul><ul><ul><li>Three or more symptoms of mania lasti...
Diagnosing Bipolar Disorders <ul><li>DSM-IV-TR distinguishes between two kinds of bipolar disorder: </li></ul><ul><ul><li>...
Diagnosing Bipolar Disorders <ul><li>Without treatment, the mood episodes tend to recur for people with either type of bip...
Diagnosing Bipolar Disorders <ul><li>Between 1% and 2.6% of all adults in the world suffer from a bipolar disorder at any ...
Diagnosing Bipolar Disorders <ul><li>Onset usually occurs between 15 and 44 years of age </li></ul><ul><ul><li>In most cas...
Diagnosing Bipolar Disorders <ul><li>A final diagnostic option: </li></ul><ul><ul><li>If a person experiences numerous epi...
What Causes Bipolar Disorders? <ul><li>Throughout the first half of the 20th century, the search for the cause of bipolar ...
What Causes Bipolar Disorders? <ul><li>Neurotransmitters </li></ul><ul><ul><li>After finding a relationship between low no...
What Causes Bipolar Disorders? <ul><li>Neurotransmitters </li></ul><ul><ul><li>Because serotonin activity often parallels ...
What Causes Bipolar Disorders? <ul><li>Neurotransmitters  </li></ul><ul><ul><li>This apparent contradiction is addressed b...
What Causes Bipolar Disorders? <ul><li>Ion activity </li></ul><ul><ul><li>Ions, which are needed to send incoming messages...
What Causes Bipolar Disorders? <ul><li>Brain structure </li></ul><ul><ul><li>Brain imaging and postmortem studies have ide...
What Causes Bipolar Disorders? <ul><li>Genetic factors </li></ul><ul><ul><li>Many theorists believe that people inherit a ...
What Causes Bipolar Disorders? <ul><li>Genetic factors </li></ul><ul><ul><li>Recently, genetic linkage studies have tried ...
Treatments for Bipolar Disorder <ul><li>Until the latter part of the 20th century, people with bipolar disorders were dest...
Treatments for Bipolar Disorder: Lithium and Other Mood Stabilizers <ul><li>The use of lithium (a metallic element occurri...
<ul><li>Findings suggest that the mood stabilizers are also prophylactic drugs, ones that actually help prevent symptoms f...
<ul><li>Researchers do not fully understand how mood stabilizing drugs operate </li></ul><ul><ul><li>They suspect that the...
Treatments for Bipolar Disorder: Adjunctive Psychotherapy <ul><li>Psychotherapy alone is rarely helpful for persons with b...
Treatments for Bipolar Disorder: Adjunctive Psychotherapy <ul><li>Therapy focuses on medication management, social skills,...
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Abnorm psych lecture pwrpt ch07 spg. 2011

  1. 1. Mood Disorders <ul><li>Chapter 7 </li></ul>Slides & Handouts by Karen Clay Rhines, Ph.D. Northampton Community College Fundamentals of Abnormal Psychology, 6e Ronald Comer
  2. 2. Mood Disorders <ul><li>Two key emotions on a continuum: </li></ul><ul><ul><li>Depression </li></ul></ul><ul><ul><ul><li>Low, sad state in which life seems dark and its challenges overwhelming </li></ul></ul></ul><ul><ul><li>Mania </li></ul></ul><ul><ul><ul><li>State of breathless euphoria or frenzied energy </li></ul></ul></ul>
  3. 3. Mood Disorders <ul><li>Most people with a mood disorder suffer only from depression </li></ul><ul><ul><li>This pattern is called unipolar depression </li></ul></ul><ul><ul><ul><li>Person has no history of mania </li></ul></ul></ul><ul><ul><ul><li>Mood returns to normal when depression lifts </li></ul></ul></ul><ul><li>Others experience periods of mania that alternate with periods of depression </li></ul><ul><ul><li>This pattern is called bipolar disorder </li></ul></ul><ul><li>These disorders have always captured people’s interest </li></ul>
  4. 4. Unipolar Depression <ul><li>The term “depression” is often used to describe general sadness or unhappiness </li></ul><ul><ul><li>This loose use of the term confuses a normal mood swing with a clinical syndrome </li></ul></ul><ul><li>Clinical depression can bring severe and long-lasting psychological pain that may intensify over time </li></ul>
  5. 5. How Common Is Unipolar Depression? <ul><li>Almost 7% of adults in the U.S. suffer from severe unipolar depression in any given year </li></ul><ul><ul><li>As many as 5% suffer from mild forms </li></ul></ul><ul><li>Approximately 17% of all adults experience unipolar depression at some time in their lives </li></ul><ul><li>The prevalence is similar in Canada, England, France, and many other countries </li></ul>
  6. 6. How Common Is Unipolar Depression? <ul><li>Women are at least twice as likely as men to experience severe unipolar depression </li></ul><ul><ul><li>Lifetime prevalence: 26% of women vs. 12% of men </li></ul></ul><ul><ul><li>Among children, the prevalence is similar among boys and girls </li></ul></ul><ul><li>Approximately 50% recover within six weeks and 90% within a year, some without treatment </li></ul><ul><ul><li>Most will experience another episode at some point </li></ul></ul>
  7. 7. What Are the Symptoms of Depression? <ul><li>Symptoms may vary from person to person </li></ul><ul><li>Five main areas of functioning may be affected: </li></ul><ul><ul><li>Emotional symptoms </li></ul></ul><ul><ul><ul><li>Feeling “miserable,” “empty,” “humiliated” </li></ul></ul></ul><ul><ul><ul><li>Experiencing little pleasure (anhedonia) </li></ul></ul></ul><ul><ul><li>Motivational symptoms </li></ul></ul><ul><ul><ul><li>Lacking drive, initiative, spontaneity </li></ul></ul></ul><ul><ul><ul><li>Between 6% and 15% of those with severe depression commit suicide </li></ul></ul></ul>
  8. 8. What Are the Symptoms of Depression? <ul><li>Five main areas of functioning may be affected: </li></ul><ul><ul><li>Behavioral symptoms </li></ul></ul><ul><ul><ul><li>Less active, less productive </li></ul></ul></ul><ul><ul><li>Cognitive symptoms </li></ul></ul><ul><ul><ul><li>Hold negative views of themselves </li></ul></ul></ul><ul><ul><ul><li>Blame themselves for unfortunate events </li></ul></ul></ul><ul><ul><ul><li>Pessimism </li></ul></ul></ul><ul><ul><li>Physical symptoms </li></ul></ul><ul><ul><ul><li>Headaches, dizzy spells, general pain </li></ul></ul></ul>
  9. 9. Diagnosing Unipolar Depression <ul><li>Criteria 1: Major depressive episode </li></ul><ul><ul><li>Marked by five or more symptoms lasting two or more weeks </li></ul></ul><ul><ul><ul><li>In extreme cases, symptoms are psychotic, including </li></ul></ul></ul><ul><ul><ul><ul><li>Hallucinations </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Delusions </li></ul></ul></ul></ul><ul><li>Criteria 2: No history of mania </li></ul>
  10. 10.
  11. 11. Diagnosing Unipolar Depression <ul><li>Two diagnoses to consider: </li></ul><ul><ul><li>Major depressive disorder </li></ul></ul><ul><ul><ul><li>Criteria 1 and 2 are met </li></ul></ul></ul><ul><ul><li>Dysthymic disorder </li></ul></ul><ul><ul><ul><li>Symptoms are “mild but chronic” </li></ul></ul></ul><ul><ul><ul><ul><li>Depression is longer lasting but less disabling </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Consistent symptoms for at least two years </li></ul></ul></ul></ul><ul><ul><li>When dysthymic disorder leads to major depressive disorder, the sequence is called “double depression” </li></ul></ul>
  12. 12. What Causes Unipolar Depression? <ul><li>Stress may be a trigger for depression </li></ul><ul><ul><li>People with depression experience a greater number of stressful life events during the month just before the onset of their symptoms </li></ul></ul><ul><ul><li>Some clinicians distinguish reactive (exogenous) depression from endogenous depression, which seems to be a response to internal factors </li></ul></ul><ul><ul><ul><li>Today’s clinicians usually concentrate on recognizing both the situational and the internal aspects of any given case </li></ul></ul></ul>
  13. 13. What Causes Unipolar Depression? The Biological Model <ul><li>Genetic factors </li></ul><ul><ul><li>Family pedigree, twin, adoption, and molecular biology gene studies suggest that some people inherit a biological predisposition </li></ul></ul><ul><ul><ul><li>Researchers have found that as many as 20% of relatives of those with depression are themselves depressed, compared with fewer than 10% of the general population </li></ul></ul></ul><ul><ul><ul><li>Twin studies demonstrate a strong genetic component: </li></ul></ul></ul><ul><ul><ul><ul><li>Concordance rates for identical (MZ) twins = 46% </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Concordance rates for fraternal (DZ) twins = 20% </li></ul></ul></ul></ul><ul><ul><ul><li>Adoption studies also have implicated a genetic factor in cases of severe unipolar depression </li></ul></ul></ul><ul><ul><ul><li>Using techniques from the field of molecular biology, researchers have found evidence that unipolar depression may be tied to specific genes </li></ul></ul></ul>
  14. 14. What Causes Unipolar Depression? The Biological Model <ul><li>Biochemical factors </li></ul><ul><ul><li>NTs: serotonin and norepinephrine </li></ul></ul><ul><ul><ul><li>In the 1950s, medications for high blood pressure were found to cause depression </li></ul></ul></ul><ul><ul><ul><ul><li>Some lowered serotonin, others lowered norepinephrine </li></ul></ul></ul></ul><ul><ul><ul><li>The discovery of truly effective antidepressant medications, which relieved depression by increasing either serotonin or norepinephrine, further confirmed the NT role </li></ul></ul></ul><ul><ul><ul><li>Now, research suggests that interactions between these NTs and/or other NTs in the brain, rather than the operation of any one NT alone, may account for unipolar depression </li></ul></ul></ul>
  15. 15. What Causes Unipolar Depression? The Biological Model <ul><li>Biochemical factors </li></ul><ul><ul><li>Endocrine system / hormone release </li></ul></ul><ul><ul><ul><li>People with depression have been found to have abnormal levels of cortisol </li></ul></ul></ul><ul><ul><ul><ul><li>Released by the adrenal glands during times of stress </li></ul></ul></ul></ul><ul><ul><ul><li>People with depression have been found to have abnormal melatonin secretion </li></ul></ul></ul><ul><ul><ul><ul><li>“ Dracula hormone” </li></ul></ul></ul></ul><ul><ul><ul><li>Other researchers are investigating whether deficiencies of important proteins within neurons are tied to depression </li></ul></ul></ul>
  16. 16. What Causes Unipolar Depression? The Biological Model <ul><li>Biochemical factors </li></ul><ul><ul><li>These explanations have produced much enthusiasm but have certain limitations: </li></ul></ul><ul><ul><ul><li>Rely on analogue studies: depression-like symptoms created in lab animals </li></ul></ul></ul><ul><ul><ul><ul><li>Do these symptoms correlate with human emotions? </li></ul></ul></ul></ul><ul><ul><ul><li>Measuring brain activity has been difficult an indirect </li></ul></ul></ul><ul><ul><ul><ul><li>Current studies using modern technology are attempting to address this issue </li></ul></ul></ul></ul>
  17. 17. What Causes Unipolar Depression? The Biological Model <ul><li>Brain anatomy and brain circuits </li></ul><ul><ul><li>Biological researchers have determined that emotional reactions of various kinds are tied to brain circuits </li></ul></ul><ul><ul><ul><li>These are networks of brain structures that work together, triggering each other into action and producing a particular kind of emotional reaction </li></ul></ul></ul><ul><ul><ul><li>It appears that one circuit is tied to GAD, another to panic disorder, and yet another to OCD </li></ul></ul></ul><ul><ul><li>Although research is far from complete, a circuit responsible for unipolar depression has begun to emerge </li></ul></ul><ul><ul><ul><li>Likely brain areas in the circuit include the prefrontal cortex, hippocampus, amygdala, and Brodmann’s Area 25 </li></ul></ul></ul>
  18. 18. Biological Treatments for Unipolar Depression <ul><li>Usually biological treatment means antidepressant drugs, but for severely depressed individuals who do not respond to other forms of treatment, it sometimes includes electroconvulsive therapy or brain stimulation </li></ul>
  19. 19. Biological Treatments for Unipolar Depression <ul><li>Electroconvulsive therapy (ECT) </li></ul><ul><ul><li>The use of ECT was – and is – controversial </li></ul></ul><ul><ul><li>The procedure consists of targeted electrical stimulation to cause a brain seizure </li></ul></ul><ul><ul><ul><li>The usual course of treatment is 6 to 12 sessions </li></ul></ul></ul>
  20. 20. Biological Treatments for Unipolar Depression <ul><li>Electroconvulsive therapy (ECT) </li></ul><ul><ul><li>The discovery of the effectiveness of ECT was accidental </li></ul></ul><ul><ul><li>The procedure has been modified in recent years to reduce some of the negative effects </li></ul></ul><ul><ul><ul><li>For example, patients are given muscle relaxants and anesthetics before and during the procedure </li></ul></ul></ul><ul><ul><li>Patients generally report some memory loss </li></ul></ul>
  21. 21. Biological Treatments for Unipolar Depression <ul><li>Electroconvulsive therapy (ECT) </li></ul><ul><ul><li>ECT is clearly effective in treating unipolar depression </li></ul></ul><ul><ul><ul><li>Studies find improvement in 60%–80% of patients </li></ul></ul></ul><ul><ul><li>The procedure seems particularly effective in cases of severe depression with delusions, but it has been difficult to determine why ECT works so well </li></ul></ul>
  22. 22. Biological Treatments for Unipolar Depression <ul><li>Antidepressant drugs </li></ul><ul><ul><li>In the 1950s, two kinds of drugs were found to be effective: </li></ul></ul><ul><ul><ul><li>Monoamine oxidase inhibitors (MAO inhibitors) </li></ul></ul></ul><ul><ul><ul><li>Tricyclics </li></ul></ul></ul><ul><ul><li>These drugs have been joined in recent years by a third group, the second-generation antidepressants </li></ul></ul>
  23. 23.
  24. 24. Biological Treatments for Unipolar Depression <ul><li>Antidepressant drugs: MAO inhibitors </li></ul><ul><ul><li>Originally used to treat TB, doctors noticed that the medication seemed to make patients happier </li></ul></ul><ul><ul><li>The drug works biochemically by slowing down the body’s production of MAO </li></ul></ul><ul><ul><ul><li>MAO breaks down norepinephrine </li></ul></ul></ul><ul><ul><ul><li>MAO inhibitors stop this breakdown from occurring </li></ul></ul></ul><ul><ul><ul><li>This leads to a rise in norepinephrine activity and a reduction in depressive symptoms </li></ul></ul></ul><ul><ul><ul><ul><li>About half of patients who take these drugs are helped by them </li></ul></ul></ul></ul>
  25. 25. Biological Treatments for Unipolar Depression <ul><li>Antidepressant drugs: MAO inhibitors </li></ul><ul><ul><li>MAO inhibitors potentially pose a serious danger </li></ul></ul><ul><ul><ul><li>Blood pressure may rise to a potentially fatal level if one eats foods with tyramine (cheese, bananas, wine) while taking MAOIs </li></ul></ul></ul><ul><ul><ul><li>Thus, people on MAO inhibitors must stick to a rigid diet </li></ul></ul></ul>
  26. 26. Biological Treatments for Unipolar Depression <ul><li>Antidepressant drugs: Tricyclics </li></ul><ul><ul><li>In searching for medications for schizophrenia, researchers discovered that imipramine lessened depressive symptoms </li></ul></ul><ul><ul><ul><li>Imipramine and related drugs are known as tricyclics because they share a three-ring molecular structure </li></ul></ul></ul>
  27. 27. Biological Treatments for Unipolar Depression <ul><li>Antidepressant drugs: Tricyclics </li></ul><ul><ul><li>Hundreds of studies have found that depressed patients taking tricyclics have improved much more than similar patients taking placebos </li></ul></ul><ul><ul><ul><li>Drugs must be taken for at least 10 days before such improvement is seen </li></ul></ul></ul><ul><ul><ul><li>About 60%–65% of patients find symptom improvement </li></ul></ul></ul>
  28. 28. Biological Treatments for Unipolar Depression <ul><li>Antidepressant drugs: Tricyclics </li></ul><ul><ul><li>Most patients who immediately stop taking tricyclics upon relief of symptoms relapse within one year </li></ul></ul><ul><ul><ul><li>Patients who take tricyclics for five additional months (“continuation therapy”) have a significantly decreased risk of relapse </li></ul></ul></ul>
  29. 29. Biological Treatments for Unipolar Depression <ul><li>Antidepressant drugs: Tricyclics </li></ul><ul><ul><li>Tricyclics are believed to reduce depression by affecting neurotransmitter (NT) “reuptake” mechanisms </li></ul></ul><ul><ul><ul><li>To prevent a NT from remaining in the synapse too long, a pump-like mechanism recaptures the NT and draws it back into the presynaptic neuron </li></ul></ul></ul><ul><ul><ul><li>The reuptake process appears to be too effective in some people, drawing in too much of the NT from the synapse </li></ul></ul></ul><ul><ul><ul><li>This reduction in NT activity in the synapse is thought to result in clinical depression </li></ul></ul></ul><ul><ul><ul><li>Tricyclics block the reuptake process, thus increasing NT activity in the synapse </li></ul></ul></ul>
  30. 31. Biological Treatments for Unipolar Depression <ul><li>Second-generation antidepressant drugs </li></ul><ul><ul><li>A third group of effective antidepressant drugs is structurally different from the MAO inhibitors and tricyclics </li></ul></ul><ul><ul><ul><li>Most of the drugs in this group are labeled selective serotonin reuptake inhibitors (SSRIs) </li></ul></ul></ul><ul><ul><li>These drugs act only on serotonin (no other NTs are affected) </li></ul></ul><ul><ul><ul><li>This class includes fluoxetine (Prozac), sertraline (Zoloft), and escitalopram (Lexapro) </li></ul></ul></ul><ul><ul><li>Selective norepinephrine reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are also now available </li></ul></ul>
  31. 32. Biological Treatments for Unipolar Depression <ul><li>Second-generation antidepressant drugs </li></ul><ul><ul><li>The effectiveness and speed of action of these drugs is on par with the tricyclics, yet their sales have skyrocketed </li></ul></ul><ul><ul><ul><li>Clinicians often prefer these drugs because it is harder to overdose on them than on other kinds of antidepressants </li></ul></ul></ul><ul><ul><ul><li>There are no dietary restrictions like there are with MAO inhibitors </li></ul></ul></ul><ul><ul><ul><li>They have fewer side effects than the tricyclics </li></ul></ul></ul><ul><ul><li>These drugs may cause some undesired effects of their own, including a reduction in sex drive </li></ul></ul>
  32. 33. Biological Treatments for Unipolar Depression <ul><li>Brain stimulation </li></ul><ul><ul><li>As one third or more of people with unipolar depression are not helped by any of the treatments discussed previously, clinical investigators continue to search for alternative approaches, including: </li></ul></ul><ul><ul><ul><li>Vagus nerve stimulation </li></ul></ul></ul><ul><ul><ul><li>Transcranial magnetic stimulation </li></ul></ul></ul><ul><ul><ul><li>Deep brain stimulation </li></ul></ul></ul>
  33. 34. Biological Treatments for Unipolar Depression <ul><li>Vagus nerve stimulation </li></ul><ul><ul><li>Depression researchers surmised they might be able to stimulate the brain by electrically stimulating the vagus nerve through the use of a pulse generator implanted under the skin of the chest </li></ul></ul><ul><ul><li>Research has found that the procedure brings significant relief to as many as 40% of those with treatment-resistant depression </li></ul></ul>
  34. 35. Biological Treatments for Unipolar Depression <ul><li>Transcranial magnetic stimulation </li></ul><ul><ul><li>Another technique designed to stimulate the brain without the undesired effects of ECT, TMS has been found to reduce depression when administered daily for 2 to 4 weeks </li></ul></ul><ul><li>Deep brain stimulation </li></ul><ul><ul><li>Theorizing a “depression switch” located deep within the brain, researchers have successfully experimented with electrode implantation in the brain’s Brodman Area 25 </li></ul></ul>
  35. 36. Biological Treatments for Unipolar Depression <ul><li>Brain stimulation </li></ul><ul><ul><li>While such positive initial findings have produced considerable enthusiasm in the clinical field, it is important to recognize that research on DBS is in its earliest stages </li></ul></ul>
  36. 37. What Causes Unipolar Depression? The Psychological Models <ul><li>Three main models: </li></ul><ul><ul><li>Psychodynamic model </li></ul></ul><ul><ul><ul><li>No strong research support </li></ul></ul></ul><ul><ul><li>Behavioral model </li></ul></ul><ul><ul><ul><li>Modest research support </li></ul></ul></ul><ul><ul><li>Cognitive views </li></ul></ul><ul><ul><ul><li>Considerable research support </li></ul></ul></ul>
  37. 38. What Causes Unipolar Depression? The Psychological Models <ul><li>Psychodynamic view </li></ul><ul><ul><li>Link between depression and grief </li></ul></ul><ul><ul><ul><li>When a loved one dies, an unconscious process begins and the mourner regresses to the oral stage and experiences a merging of his/her own identity with that of the lost person </li></ul></ul></ul><ul><ul><ul><ul><li>For most people, this reaction is temporary </li></ul></ul></ul></ul><ul><ul><ul><ul><li>If grief is severe and long-lasting, depression results </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Those with oral stage issues (unmet or excessively met needs) are at greater risk for developing depression </li></ul></ul></ul></ul><ul><ul><ul><li>Some people experience “symbolic” (or imagined) loss </li></ul></ul></ul><ul><ul><ul><li>Newer psychoanalysts (object relations theorists) propose that depression results when people’s relationships leave them feeling unsafe and insecure </li></ul></ul></ul>
  38. 39. What Causes Unipolar Depression? The Psychological Models <ul><li>Psychodynamic view </li></ul><ul><ul><li>Studies have offered general support for the psychodynamic idea that depression may be triggered by a major loss </li></ul></ul><ul><ul><li>However, research does not indicate that loss is always at the core of depression </li></ul></ul>
  39. 40. Psychodynamic Treatments for Unipolar Depression <ul><li>Psychodynamic therapists use the same basic procedures for all psychological disorders: </li></ul><ul><ul><li>Free association </li></ul></ul><ul><ul><li>Therapist interpretation </li></ul></ul><ul><ul><li>Review of past events and feelings </li></ul></ul>
  40. 41. Psychodynamic Treatments for Unipolar Depression <ul><li>Despite successful case reports, researchers have found that long-term psychodynamic therapy is only occasionally helpful in cases of unipolar depression </li></ul><ul><li>Two features may be particularly limiting: </li></ul><ul><ul><li>Depressed clients may be too passive or weary to fully participate in therapy discussions </li></ul></ul><ul><ul><li>Depressed clients may become discouraged and end treatment too early when treatment is unable to provide quick relief </li></ul></ul><ul><li>Short-term approaches have performed better than traditional approaches </li></ul>
  41. 42. What Causes Unipolar Depression? The Psychological Models <ul><li>Behavioral view </li></ul><ul><ul><li>Depression results from changes in rewards and punishments people receive in their lives </li></ul></ul><ul><ul><ul><li>Lewinsohn suggests that the positive rewards in life dwindle for some people, leading them to perform fewer and fewer constructive behaviors and they spiral toward depression </li></ul></ul></ul><ul><ul><li>Research supports the relationship between the number of rewards received and the presence or absence of depression </li></ul></ul><ul><ul><ul><li>Social rewards are especially important </li></ul></ul></ul>
  42. 43. Behavioral Treatments for Unipolar Depression <ul><li>Behavioral therapy </li></ul><ul><ul><li>Lewinsohn developed a behavioral therapy for unipolar depression in the 1970s: </li></ul></ul><ul><ul><ul><li>Reintroduce clients to pleasurable activities and events, often using a weekly schedule </li></ul></ul></ul><ul><ul><ul><li>Appropriately reinforce their depressive and nondepressive behaviors </li></ul></ul></ul><ul><ul><ul><li>Help them improve their social skills </li></ul></ul></ul>
  43. 44. Behavioral Treatments for Unipolar Depression <ul><li>Behavioral therapy </li></ul><ul><ul><li>The behavioral techniques seem to be of only limited help when just one of them is applied </li></ul></ul><ul><ul><ul><li>When treatment programs combine two or more of the techniques, depressive symptoms (especially mild symptoms) seem to be reduced </li></ul></ul></ul><ul><ul><ul><li>It is worth noting that Lewinsohn himself has combined behavioral techniques with cognitive strategies in recent years </li></ul></ul></ul>
  44. 45. What Causes Unipolar Depression? The Psychological Models <ul><li>Cognitive views </li></ul><ul><ul><li>Two main theories: </li></ul></ul><ul><ul><ul><li>Learned helplessness </li></ul></ul></ul><ul><ul><ul><li>Negative thinking </li></ul></ul></ul>
  45. 46. What Causes Unipolar Depression? The Psychological Models <ul><li>Cognitive views </li></ul><ul><ul><li>Learned helplessness </li></ul></ul><ul><ul><ul><li>Theory holds that people become depressed when they think that: </li></ul></ul></ul><ul><ul><ul><ul><li>They no longer have control over the reinforcements (rewards and punishments) in their lives </li></ul></ul></ul></ul><ul><ul><ul><ul><li>They themselves are responsible for this helpless state </li></ul></ul></ul></ul>
  46. 47. What Causes Unipolar Depression? The Psychological Models <ul><li>Cognitive views </li></ul><ul><ul><li>Learned helplessness </li></ul></ul><ul><ul><ul><li>Theory is based on Seligman’s work with laboratory dogs </li></ul></ul></ul><ul><ul><ul><ul><li>Dogs subjected to uncontrollable shock were later placed in a shuttle box </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Even when presented with an opportunity to escape, dogs that had experienced uncontrollable shocks made no attempt to do so </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Seligman theorized that the dogs had “learned” to be “helpless” to do anything to change negative situations, and drew parallels to human depression </li></ul></ul></ul></ul>
  47. 48. What Causes Unipolar Depression? The Psychological Models <ul><li>Cognitive views </li></ul><ul><ul><li>Learned helplessness </li></ul></ul><ul><ul><ul><li>There has been significant research support for this model </li></ul></ul></ul><ul><ul><ul><ul><li>Human subjects who undergo helplessness training score higher on depression scales and display reactions similar to depressive symptoms </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Animal subjects lose interest in sex and social activities </li></ul></ul></ul></ul>
  48. 49. What Causes Unipolar Depression? The Psychological Models <ul><li>Cognitive views </li></ul><ul><ul><li>Learned helplessness </li></ul></ul><ul><ul><ul><li>Recent versions of the theory focus on attributions </li></ul></ul></ul><ul><ul><ul><ul><li>Internal attributions that are global and stable lead to greater feelings of helplessness and possibly depression </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Example: “I am inadequate at everything and I always will be” </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><li>If people make other kinds of attributions, this reaction is unlikely </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Example: “The way I’ve behaved the past couple weeks blew this relationship” [specific]. “I don’t know what got into me – I don’t usually act like that” [unstable]. “She never did know what she wanted” [external]. </li></ul></ul></ul></ul></ul>
  49. 50. What Causes Unipolar Depression? The Psychological Models <ul><li>Cognitive views </li></ul><ul><ul><li>Learned helplessness </li></ul></ul><ul><ul><ul><li>Some theorists have refined the helplessness model yet again in recent years; they suggest that attributions are likely to cause depression only when they further produce a sense of hopelessness in an individual </li></ul></ul></ul>
  50. 51. <ul><li>Cognitive views </li></ul><ul><ul><li>Learned helplessness </li></ul></ul><ul><ul><ul><li>Although this theory has been very influential, it has imperfections: </li></ul></ul></ul><ul><ul><ul><ul><li>Much of the research relies on animal subjects </li></ul></ul></ul></ul><ul><ul><ul><ul><li>The attributional component of the theory raises particularly difficult questions in terms of animal models of depression </li></ul></ul></ul></ul>What Causes Unipolar Depression? The Psychological Models
  51. 52. <ul><li>Cognitive views </li></ul><ul><ul><li>Negative thinking </li></ul></ul><ul><ul><ul><li>Beck believes four interrelated cognitive components combine to produce unipolar depression: </li></ul></ul></ul><ul><ul><ul><ul><li>1. Maladaptive attitudes </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Self-defeating attitudes are developed during childhood </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Beck suggests that upsetting situations later in life can trigger an extended round of negative thinking </li></ul></ul></ul></ul></ul>What Causes Unipolar Depression? The Psychological Models
  52. 53. <ul><li>Cognitive views </li></ul><ul><ul><li>Negative thinking </li></ul></ul><ul><ul><ul><li>2. This negative thinking typically takes three forms, called the cognitive triad: </li></ul></ul></ul><ul><ul><ul><ul><li>Individuals repeatedly interpret (1) their experiences, (2) themselves, and (3) their futures in negative ways, leading to depression </li></ul></ul></ul></ul>What Causes Unipolar Depression? The Psychological Models
  53. 54. <ul><li>Cognitive views </li></ul><ul><ul><li>Negative thinking </li></ul></ul><ul><ul><ul><li>3. Depressed people also make errors in their thinking, including: </li></ul></ul></ul><ul><ul><ul><ul><li>Arbitrary inferences </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Minimization of the positive and magnification of the negative </li></ul></ul></ul></ul><ul><ul><ul><li>4. Depressed people experience automatic thoughts </li></ul></ul></ul><ul><ul><ul><ul><li>A steady train of unpleasant thoughts that suggest inadequacy and hopelessness </li></ul></ul></ul></ul>What Causes Unipolar Depression? The Psychological Models
  54. 55. <ul><li>Cognitive views </li></ul><ul><ul><li>Negative thinking </li></ul></ul><ul><ul><ul><li>Many studies have produced evidence in support of Beck’s explanation: </li></ul></ul></ul><ul><ul><ul><ul><li>High correlation between the level of depression and the number of maladaptive attitudes </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Both the cognitive triad and errors in logic are seen in people with depression </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Automatic thinking has been linked to depression </li></ul></ul></ul></ul>What Causes Unipolar Depression? The Psychological Models
  55. 56. Cognitive Treatment for Unipolar Depression <ul><li>Beck’s cognitive therapy – which includes a number of behavioral techniques – is designed to help clients recognize and change their negative cognitive processes </li></ul><ul><li>This approach follows four phases and usually lasts fewer than 20 sessions </li></ul><ul><li>Phases: </li></ul><ul><ul><li>Increasing activities and elevating mood </li></ul></ul><ul><ul><li>Challenging automatic thoughts </li></ul></ul><ul><ul><li>Identifying negative thinking and biases </li></ul></ul><ul><ul><li>Changing primary attitudes </li></ul></ul>
  56. 57. Cognitive Treatment for Unipolar Depression <ul><li>Over the past several decades, hundreds of studies have shown that cognitive and cognitive-behavioral approaches help unipolar depression </li></ul><ul><ul><li>Around 50%–60% of clients show a near-total elimination of symptoms </li></ul></ul><ul><li>It is worth noting that a growing number of today’s cognitive-behavior therapists disagree with Beck’s proposition that individuals must fully disregard negative cognitions </li></ul>
  57. 58. What Causes Unipolar Depression? The Sociocultural Model <ul><li>Sociocultural theorists propose that unipolar depression is greatly influenced by the social context that surrounds people </li></ul><ul><ul><li>This belief is supported by the finding that depression is often triggered by outside stressors </li></ul></ul><ul><ul><li>There are two kinds of sociocultural views: </li></ul></ul><ul><ul><ul><li>The family-social perspective </li></ul></ul></ul><ul><ul><ul><li>The multicultural perspective </li></ul></ul></ul>
  58. 59. What Causes Unipolar Depression? The Sociocultural Model <ul><li>The Family-Social Perspective </li></ul><ul><ul><li>The connection between declining social rewards and depression (as discussed by the behaviorists) is a two-way street </li></ul></ul><ul><ul><ul><li>Depressed people often display social deficits that make other people uncomfortable and may cause them to avoid the depressed individuals </li></ul></ul></ul><ul><ul><ul><li>This leads to decreased social contact and a further deterioration of social skills </li></ul></ul></ul>
  59. 60. What Causes Unipolar Depression? The Sociocultural Model <ul><li>The Family-Social Perspective </li></ul><ul><ul><li>Consistent with these findings, depression has been tied repeatedly to the unavailability of social support such as that found in a happy marriage </li></ul></ul><ul><ul><ul><li>People who are separated or divorced display three times the depression rate of married or widowed persons and double the rate of people who have never been married </li></ul></ul></ul><ul><ul><li>People whose lives are isolated and without intimacy seem particularly likely to become depressed at times of stress </li></ul></ul>
  60. 61. Family-Social Treatments for Unipolar Depression <ul><li>Interpersonal therapy (IPT) </li></ul><ul><ul><li>This model holds that four interpersonal problems may lead to depression and must be addressed: </li></ul></ul><ul><ul><ul><li>Interpersonal loss </li></ul></ul></ul><ul><ul><ul><li>Interpersonal role dispute </li></ul></ul></ul><ul><ul><ul><li>Interpersonal role transition </li></ul></ul></ul><ul><ul><ul><li>Interpersonal deficits </li></ul></ul></ul><ul><ul><li>Studies suggest that IPT is as effective as cognitive therapy for treating depression </li></ul></ul>
  61. 62. Family-Social Treatments for Unipolar Depression <ul><li>Couple therapy </li></ul><ul><ul><li>The main type of couple therapy is behavioral marital therapy (BMT) </li></ul></ul><ul><ul><ul><li>Focus is on developing specific communication and problem-solving skills </li></ul></ul></ul><ul><ul><li>If marriage is conflictual, BMT is as effective as other therapies for reducing depression </li></ul></ul>
  62. 63. What Causes Unipolar Depression? The Sociocultural Model <ul><li>The Multicultural Perspective </li></ul><ul><ul><li>Two kinds of relationships have captured the interest of multicultural theorists: </li></ul></ul><ul><ul><ul><li>Gender and depression </li></ul></ul></ul><ul><ul><ul><ul><li>A strong link exists between gender and depression </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Women cross-culturally are twice as likely as men to receive a diagnosis of unipolar depression </li></ul></ul></ul></ul>
  63. 64. What Causes Unipolar Depression? The Sociocultural Model <ul><li>The Multicultural Perspective </li></ul><ul><ul><li>Various theories have been offered: </li></ul></ul><ul><ul><ul><li>The artifact theory holds that women and men are equally prone to depression, but that clinicians often fail to detect depression in men </li></ul></ul></ul><ul><ul><ul><li>The hormone explanation holds that hormone changes trigger depression in many women </li></ul></ul></ul><ul><ul><ul><li>The life stress theory suggests that women in our society experience more stress than men </li></ul></ul></ul>
  64. 65. What Causes Unipolar Depression? The Sociocultural Model <ul><li>The Multicultural Perspective </li></ul><ul><ul><li>Various theories have been offered: </li></ul></ul><ul><ul><ul><li>The body dissatisfaction theory state that females in Western society are taught, almost from birth, to seek a low body weight and slender body shape – goals that are unreasonable, unhealthy, and often unattainable </li></ul></ul></ul><ul><ul><ul><li>The lack-of-control theory picks up the learned helplessness research and argues that women may be more prone to depression because they feel less control than men over their lives </li></ul></ul></ul>
  65. 66. What Causes Unipolar Depression? The Sociocultural Model <ul><li>The Multicultural Perspective </li></ul><ul><ul><li>Various theories have been offered: </li></ul></ul><ul><ul><ul><li>The rumination theory holds that people who ruminate when sad – keep focusing on their feelings and repeatedly consider the causes and consequences of their depression – are more likely to become depressed and stay depressed longer </li></ul></ul></ul>
  66. 67. What Causes Unipolar Depression? The Sociocultural Model <ul><li>The Multicultural Perspective </li></ul><ul><ul><li>Each explanation offers food for thought and has gathered just enough supporting evidence to make it interesting (and just enough contrary evidence to raise question about its usefulness) </li></ul></ul>
  67. 68. What Causes Unipolar Depression? The Sociocultural Model <ul><li>The Multicultural Perspective </li></ul><ul><ul><li>Two kinds of relationships have captured the interest of multicultural theorists: </li></ul></ul><ul><ul><ul><li>Cultural background and depression </li></ul></ul></ul><ul><ul><ul><ul><li>Depression is a worldwide phenomenon, and certain symptoms seem to be constant across all countries, including sadness, joylessness, anxiety, tension, lack of energy, loss of interest, and thoughts of suicide </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Beyond such core symptoms, research suggests that the precise picture of depression varies from country to country </li></ul></ul></ul></ul>
  68. 69. What Causes Unipolar Depression? The Sociocultural Model <ul><li>The Multicultural Perspective </li></ul><ul><ul><li>Depressed people in non-Western countries are more likely to be troubled by physical symptoms of depression than by cognitive ones </li></ul></ul>
  69. 70. What Causes Unipolar Depression? The Sociocultural Model <ul><li>The Multicultural Perspective </li></ul><ul><ul><li>Within the United States, researchers have found few differences in depression symptoms among members of different ethnic or racial groups, however, sometimes striking differences exist in specific populations living under special circumstances </li></ul></ul><ul><ul><ul><li>In a study of one Native American village, lifetime risk was 37% among women, 19% among men, and 28% overall </li></ul></ul></ul><ul><ul><ul><li>These findings are thought to be the result of economic and social pressures </li></ul></ul></ul>
  70. 71. Multicultural Treatments for Unipolar Depression <ul><li>Culture-sensitive approaches are increasingly being combined with traditional forms of psychotherapy to help maximize the likelihood of minority clients overcoming their disorders </li></ul>
  71. 72. Bipolar Disorders <ul><li>People with a bipolar disorder experience both the lows of depression and the highs of mania </li></ul><ul><ul><li>Many describe their lives as an emotional roller coaster </li></ul></ul>
  72. 73. What Are the Symptoms of Mania? <ul><li>Unlike those experiencing depression, people in a state of mania typically experience dramatic and inappropriate rises in mood </li></ul><ul><li>Five main areas of functioning may be affected: </li></ul><ul><ul><li>1. Emotional symptoms </li></ul></ul><ul><ul><ul><li>Active, powerful emotions in search of outlet </li></ul></ul></ul><ul><ul><li>2. Motivational symptoms </li></ul></ul><ul><ul><ul><li>Need for constant excitement, involvement, companionship </li></ul></ul></ul>
  73. 74. What Are the Symptoms of Mania? <ul><li>Five main areas of functioning may be affected: </li></ul><ul><ul><li>3. Behavioral symptoms </li></ul></ul><ul><ul><ul><li>Very active – move quickly; talk loudly or rapidly </li></ul></ul></ul><ul><ul><ul><ul><li>Flamboyance is not uncommon </li></ul></ul></ul></ul><ul><ul><li>4. Cognitive symptoms </li></ul></ul><ul><ul><ul><li>Show poor judgment </li></ul></ul></ul><ul><ul><ul><ul><li>Especially prone to poor (or no) planning </li></ul></ul></ul></ul><ul><ul><li>5. Physical symptoms </li></ul></ul><ul><ul><ul><li>High energy level – often in the presence of little or no rest </li></ul></ul></ul>
  74. 75. Diagnosing Bipolar Disorders <ul><li>Criteria 1: Manic episode </li></ul><ul><ul><li>Three or more symptoms of mania lasting one week or more </li></ul></ul><ul><ul><ul><li>In extreme cases, symptoms are psychotic </li></ul></ul></ul><ul><ul><li>Criteria 2: History of mania </li></ul></ul><ul><ul><ul><li>If currently experiencing hypomania or depression </li></ul></ul></ul>
  75. 76.
  76. 77. Diagnosing Bipolar Disorders <ul><li>DSM-IV-TR distinguishes between two kinds of bipolar disorder: </li></ul><ul><ul><li>Bipolar I disorder </li></ul></ul><ul><ul><ul><li>Full manic and major depressive episodes </li></ul></ul></ul><ul><ul><ul><ul><li>Most sufferers experience an alternation of episodes </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Some experience mixed episodes </li></ul></ul></ul></ul><ul><ul><li>Bipolar II disorder </li></ul></ul><ul><ul><ul><li>Hypomanic episodes and major depressive episodes </li></ul></ul></ul>
  77. 78. Diagnosing Bipolar Disorders <ul><li>Without treatment, the mood episodes tend to recur for people with either type of bipolar disorder </li></ul><ul><ul><li>In most cases, the individual’s depressive episodes outnumber his or her manic episodes </li></ul></ul>
  78. 79. Diagnosing Bipolar Disorders <ul><li>Between 1% and 2.6% of all adults in the world suffer from a bipolar disorder at any given time </li></ul><ul><li>The disorders are equally common in women and men and among all socioeconomic classes and ethnic groups </li></ul>
  79. 80. Diagnosing Bipolar Disorders <ul><li>Onset usually occurs between 15 and 44 years of age </li></ul><ul><ul><li>In most cases, the manic and depressive episodes eventually subside, only to recur at a later time </li></ul></ul>
  80. 81. Diagnosing Bipolar Disorders <ul><li>A final diagnostic option: </li></ul><ul><ul><li>If a person experiences numerous episodes of hypomania and mild depressive symptoms, a diagnosis of cyclothymic disorder is appropriate </li></ul></ul><ul><ul><ul><li>Mild symptoms for two or more years, interrupted by periods of normal mood </li></ul></ul></ul><ul><ul><ul><li>Affects at least 0.4% of the population </li></ul></ul></ul><ul><ul><ul><li>May eventually blossom into bipolar I or II disorder </li></ul></ul></ul>
  81. 82. What Causes Bipolar Disorders? <ul><li>Throughout the first half of the 20th century, the search for the cause of bipolar disorders made little progress </li></ul><ul><li>More recently, biological research has produced some promising clues </li></ul><ul><ul><li>These insights have come from research into NT activity, ion activity, brain structure, and genetic factors </li></ul></ul>
  82. 83. What Causes Bipolar Disorders? <ul><li>Neurotransmitters </li></ul><ul><ul><li>After finding a relationship between low norepinephrine and unipolar depression, early researchers expected to find a link between high norepinephrine levels and mania </li></ul></ul><ul><ul><ul><li>This theory is supported by some research studies; bipolar disorders may be related to overactivity of norepinephrine </li></ul></ul></ul>
  83. 84. What Causes Bipolar Disorders? <ul><li>Neurotransmitters </li></ul><ul><ul><li>Because serotonin activity often parallels norepinephrine activity in unipolar depression, theorists expected that mania would also be related to high serotonin activity </li></ul></ul><ul><ul><ul><li>Although no relationship with HIGH serotonin has been found, bipolar disorder may be linked to LOW serotonin activity, which seems contradictory… </li></ul></ul></ul>
  84. 85. What Causes Bipolar Disorders? <ul><li>Neurotransmitters </li></ul><ul><ul><li>This apparent contradiction is addressed by the “permissive theory” about mood disorders: </li></ul></ul><ul><ul><ul><li>Low serotonin may “open the door” to a mood disorder and permit norepinephrine activity to define the particular form the disorder will take: </li></ul></ul></ul><ul><ul><ul><ul><li>Low serotonin + Low norepinephrine = Depression </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Low serotonin + High norepinephrine = Mania </li></ul></ul></ul></ul>
  85. 86. What Causes Bipolar Disorders? <ul><li>Ion activity </li></ul><ul><ul><li>Ions, which are needed to send incoming messages to nerve endings, may be improperly transported through the cells of individuals with bipolar disorder </li></ul></ul><ul><ul><li>Some theorists believe that irregularities in the transport of these ions may cause neurons to fire too easily (mania) or to stubbornly resist firing (depression) </li></ul></ul><ul><ul><ul><li>There is some research support for this theory </li></ul></ul></ul>
  86. 87. What Causes Bipolar Disorders? <ul><li>Brain structure </li></ul><ul><ul><li>Brain imaging and postmortem studies have identified a number of abnormal brain structures in people with bipolar disorder; in particular, the basal ganglia and cerebellum among others </li></ul></ul><ul><ul><ul><li>It is not clear what role such structural abnormalities play </li></ul></ul></ul>
  87. 88. What Causes Bipolar Disorders? <ul><li>Genetic factors </li></ul><ul><ul><li>Many theorists believe that people inherit a biological predisposition to develop bipolar disorders </li></ul></ul><ul><ul><ul><li>Family pedigree studies support this idea; when one twin or sibling has bipolar disorder, the likelihood for the other twin or sibling increases: </li></ul></ul></ul><ul><ul><ul><ul><li>Identical (MZ) twins = 40% likelihood </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Fraternal (DZ) twins and siblings = 5% to 10% likelihood </li></ul></ul></ul></ul><ul><ul><ul><ul><li>General population = 1 to 2.6% likelihood </li></ul></ul></ul></ul>
  88. 89. What Causes Bipolar Disorders? <ul><li>Genetic factors </li></ul><ul><ul><li>Recently, genetic linkage studies have tried to identify possible patterns in the inheritance of bipolar disorders </li></ul></ul><ul><ul><li>Other researchers are using techniques from molecular biology to further examine genetic patterns </li></ul></ul><ul><ul><li>Such wide-ranging findings suggest that a number of genetic abnormalities probably combine to help bring about bipolar disorders </li></ul></ul>
  89. 90. Treatments for Bipolar Disorder <ul><li>Until the latter part of the 20th century, people with bipolar disorders were destined to spend their lives on an emotional roller coaster </li></ul><ul><ul><li>Psychotherapists reported almost no success </li></ul></ul><ul><ul><li>Antidepressant drugs were of limited help </li></ul></ul><ul><ul><ul><li>These drugs sometimes triggered manic episodes </li></ul></ul></ul>
  90. 91. Treatments for Bipolar Disorder: Lithium and Other Mood Stabilizers <ul><li>The use of lithium (a metallic element occurring as mineral salt) and other mood-stabilizers has dramatically changed this picture </li></ul><ul><li>All manner of research has attested to the effectiveness of lithium and other mood stabilizers in treating manic episodes </li></ul><ul><ul><li>More than 60% of patients with mania improve on these medications </li></ul></ul><ul><ul><li>Most individuals experience fewer new episodes while on the drug </li></ul></ul>
  91. 92. <ul><li>Findings suggest that the mood stabilizers are also prophylactic drugs, ones that actually help prevent symptoms from developing </li></ul><ul><li>Mood stabilizers also help those with bipolar disorder overcome their depressive episodes to a lesser degree </li></ul>Treatments for Bipolar Disorder: Lithium and Other Mood Stabilizers
  92. 93. <ul><li>Researchers do not fully understand how mood stabilizing drugs operate </li></ul><ul><ul><li>They suspect that the drugs change synaptic activity in neurons, but in a different way from that of antidepressant drugs </li></ul></ul><ul><ul><ul><li>Although antidepressant drugs affect a neuron’s initial reception on NTs, mood stabilizers seem to affect a neuron’s second messengers </li></ul></ul></ul><ul><ul><li>These drugs also increase the production of neuroprotective proteins – key proteins within certain neurons whose job it is to prevent cell death, which may indirectly reduce bipolar symptoms </li></ul></ul>Treatments for Bipolar Disorder: Lithium and Other Mood Stabilizers
  93. 94. Treatments for Bipolar Disorder: Adjunctive Psychotherapy <ul><li>Psychotherapy alone is rarely helpful for persons with bipolar disorder </li></ul><ul><li>Mood stabilizing drugs alone are also not always sufficient </li></ul><ul><ul><li>30% or more of patients don’t respond, may not receive a proper dose, and/or may relapse while taking it </li></ul></ul><ul><li>As a result, clinicians often use psychotherapy as an adjunct to mood-stabilizing drugs </li></ul>
  94. 95. Treatments for Bipolar Disorder: Adjunctive Psychotherapy <ul><li>Therapy focuses on medication management, social skills, and relationship issues </li></ul><ul><li>Few controlled studies have tested the effectiveness of such adjunctive therapy </li></ul><ul><ul><li>Growing research suggests that it helps reduce hospitalization, improves social functioning, and increases clients’ ability to obtain and hold a job </li></ul></ul>
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