Abnormal psych lecture ch07


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Abnormal psych lecture ch07

  1. 1. Chapter 7 Mood Disorders
  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 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>Depression Mania
  3. 3. Mood Disorders <ul><li>Most people with a mood disorder experience only 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>Some people experience periods of depression that alternate with periods of mania </li></ul><ul><ul><li>This pattern is called bipolar disorder </li></ul></ul>
  4. 4. Mood Disorders <ul><li>These disorders have always captured people’s interest </li></ul><ul><ul><li>Millions of people have mood disorders </li></ul></ul><ul><ul><li>Economic costs of mood disorders amount to more than $80 billion each year </li></ul></ul><ul><ul><li>Human suffering is incalculable </li></ul></ul>
  5. 5. Unipolar Depression <ul><li>The term “depression” is often used to describe general sadness or unhappiness </li></ul><ul><ul><li>This usage 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>
  6. 6. How Common Is Unipolar Depression? <ul><li>About 7% of the U.S. population experiences severe unipolar depression in any given year </li></ul><ul><ul><li>As many as 5% experience mild depression </li></ul></ul><ul><li>The prevalence is similar in Canada, England, France, and many other countries </li></ul><ul><li>Approximately 17% of all adults experience unipolar depression at some time in their lives </li></ul><ul><ul><li>Rates have been steadily increasing since 1915 </li></ul></ul>
  7. 7. How Common Is Unipolar Depression? <ul><li>In almost all countries, women are 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><li>These rates hold true across socioeconomic classes and ethnic groups </li></ul><ul><li>Approximately 50% recover within six weeks, some without treatment </li></ul><ul><ul><li>Most will experience another episode at some point </li></ul></ul>
  8. 8. What Are the Symptoms of Depression? <ul><li>Symptoms may differ 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 </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>
  9. 9. What Are the Symptoms of Unipolar 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>
  10. 10. 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>
  11. 11.
  12. 12. 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>
  13. 13. 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 prior to 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>The utility of this distinction is questionable and today’s clinicians usually concentrate on recognizing the situational and the internal aspects of any given case </li></ul></ul></ul>
  14. 14. What Causes Unipolar Depression? The Biological View <ul><li>Genetic factors </li></ul><ul><ul><li>Family pedigree, twin, adoption, and molecular biology gene studies suggest that some people inherit a 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>Rates for identical (MZ) twins = 46% </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Rates for fraternal (DZ) twins = 20% </li></ul></ul></ul></ul><ul><ul><ul><li>Molecular biology studies also have implicated a genetic factor in many cases of unipolar depression </li></ul></ul></ul>
  15. 15. What Causes Unipolar Depression? The Biological View <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>This led to the “discovery” of effective antidepressant medications which relieved depression by increasing either serotonin or norepinephrine </li></ul></ul></ul><ul><ul><ul><li>Depression likely involves not just serotonin nor norepinephrine… a complex interaction is at work, and other NTs may be involved </li></ul></ul></ul>
  16. 16. What Causes Unipolar Depression? The Biological View <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>
  17. 17. What Causes Unipolar Depression? The Biological View <ul><li>Biochemical factors </li></ul><ul><ul><li>Model has produced enthusiasm but has significant limitations: </li></ul></ul><ul><ul><ul><li>Relies 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 </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>
  18. 18. What Are the Biological Treatments for Unipolar Depression? <ul><li>Biological treatments can bring great relief to people with unipolar depression </li></ul><ul><li>Usually biological treatment means antidepressant drugs, but for severely depressed persons who do not respond to other forms of treatment, it sometimes includes electroconvulsive therapy </li></ul>
  19. 19. What Are the 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><ul><li>It is now used frequently but only in severe cases </li></ul></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 spaced over two to four weeks </li></ul></ul></ul><ul><ul><ul><li>Treatment may be bilateral or unilateral </li></ul></ul></ul>
  20. 20. What Are the Biological Treatments for Unipolar Depression? <ul><li>Electroconvulsive therapy (ECT) </li></ul><ul><ul><li>The discovery of the effectiveness of ECT was accidental and based on a fallacious link between psychosis and epilepsy </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. What Are the 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% – 70% 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><ul><ul><li>Although effective, the use of ECT has declined since the 1950s, because of the memory loss caused by the procedure and the emergence of effective antidepressant drugs </li></ul></ul>
  22. 22. What Are the 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. What Are the 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 the patients who take these drugs are helped by them </li></ul></ul></ul></ul>
  25. 25. What Are the 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 MAO inhibitors </li></ul></ul></ul>
  26. 26. What Are the 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. What Are the 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>About 60% – 65% of patients find symptom improvement </li></ul></ul></ul>
  28. 28. What Are the 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><ul><ul><ul><li>As a result, clinicians often keep their patients on the drugs indefinitely </li></ul></ul></ul>
  29. 29. What Are the 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 </li></ul></ul><ul><ul><ul><li>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 </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. 30.
  31. 31. What Are the 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) and sertraline (Zoloft) </li></ul></ul></ul><ul><ul><li>Selective norepinephrine reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are also now available </li></ul></ul>
  32. 32. What Are the 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 they boast enormous sales </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>There 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>
  33. 33. Psychological Models of Unipolar Depression <ul><li>Three main models: </li></ul><ul><ul><li>Psychodynamic model </li></ul></ul><ul><ul><ul><li>Not strongly supported by research </li></ul></ul></ul><ul><ul><li>Behavioral model </li></ul></ul><ul><ul><ul><li>Modestly supported by research </li></ul></ul></ul><ul><ul><li>Cognitive model </li></ul></ul><ul><ul><ul><li>Has considerable research support </li></ul></ul></ul>
  34. 34. Psychological Models of Unipolar Depression <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, the mourner regresses to the oral stage </li></ul></ul></ul><ul><ul><ul><ul><li>For most people, grief 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” (not actual) loss </li></ul></ul></ul><ul><ul><ul><li>Newer psychoanalysts focus on relationships with others (object relations theorists) </li></ul></ul></ul>
  35. 35. Psychological Models of Unipolar Depression <ul><li>Psychodynamic view </li></ul><ul><ul><li>Strengths: </li></ul></ul><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><ul><ul><li>Research supports the theory that early losses set the stage for later depression </li></ul></ul></ul><ul><ul><ul><li>Research also suggests that people whose childhood needs were improperly met are more likely to become depressed after suffering a loss </li></ul></ul></ul>
  36. 36. Psychological Models of Unipolar Depression <ul><li>Psychodynamic view </li></ul><ul><ul><li>Limitations: </li></ul></ul><ul><ul><ul><li>Early losses don’t inevitably lead to depression </li></ul></ul></ul><ul><ul><ul><ul><li>May not be typically responsible for development of depression </li></ul></ul></ul></ul><ul><ul><ul><li>Many research findings are inconsistent </li></ul></ul></ul><ul><ul><ul><li>Theory is largely untestable because of its reliance on unconscious processes </li></ul></ul></ul>
  37. 37. Psychological Models of Unipolar Depression <ul><li>Psychodynamic therapy </li></ul><ul><ul><li>Psychodynamic therapists use the same basic procedures for all psychological disorders: </li></ul></ul><ul><ul><ul><li>Free association </li></ul></ul></ul><ul><ul><ul><li>Therapist interpretation </li></ul></ul></ul>
  38. 38. Psychological Models of Unipolar Depression <ul><li>Psychodynamic therapy </li></ul><ul><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><ul><ul><li>Two features may be particularly limiting: </li></ul></ul><ul><ul><ul><li>Depressed clients may be too passive or weary to fully participate in clinical discussions </li></ul></ul></ul><ul><ul><ul><li>Depressed clients may become discouraged and end treatment too early when treatment doesn’t provide fast relief </li></ul></ul></ul><ul><ul><li>Short-term approaches have performed better than traditional approaches </li></ul></ul>
  39. 39. Psychological Models of Unipolar Depression <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>As life changes, we experience a change (loss) of rewards </li></ul></ul></ul><ul><ul><li>Research by Lewinsohn 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>
  40. 40. Treatments for Unipolar Depression: Psychological Approaches <ul><li>Behavioral therapy </li></ul><ul><ul><li>Lewinsohn developed a behavioral therapy for unipolar depression: </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><ul><li>Use a contingency management approach </li></ul></ul></ul></ul><ul><ul><ul><li>Help them improve their social skills </li></ul></ul></ul>
  41. 41. Treatments for Unipolar Depression: Psychological Approaches <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 three of the techniques, as Lewinsohn had envisioned, depressive symptoms (especially mild symptoms) seem to be reduced </li></ul></ul></ul>
  42. 42. Psychological Models of Unipolar Depression <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>
  43. 43. Psychological Models of Unipolar Depression <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 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>
  44. 44. Psychological Models of Unipolar Depression <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” and drew parallels to human depression </li></ul></ul></ul></ul>
  45. 45. Psychological Models of Unipolar Depression <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 demonstrate passivity in laboratory trials </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Animal subjects lose interest in sex and social activities </li></ul></ul></ul></ul><ul><ul><ul><ul><li>In rats, uncontrollable negative events result in lower serotonin and norepinephrine levels in the brain </li></ul></ul></ul></ul>
  46. 46. Psychological Models of Unipolar Depression <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: “It’s all my fault [internal]. I ruin everything I touch [global] and I always will [stable]” </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 of weeks blew this relationship [specific], I don’t know what got into me – I don’t usually act like that [unstable], and she never did know what she wanted [external]” </li></ul></ul></ul></ul></ul>
  47. 47. Psychological Models of Unipolar Depression <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>
  48. 48. Psychological Models of Unipolar Depression <ul><li>Cognitive views </li></ul><ul><ul><li>Learned helplessness </li></ul></ul><ul><ul><ul><li>Strengths: </li></ul></ul></ul><ul><ul><ul><ul><li>Hundreds of studies have supported the relationship between styles of attribution, helplessness, and depression </li></ul></ul></ul></ul><ul><ul><ul><li>Limitations: </li></ul></ul></ul><ul><ul><ul><ul><li>Laboratory helplessness does not parallel depression in every way </li></ul></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>
  49. 49. Psychological Models of Unipolar Depression <ul><li>Cognitive views </li></ul><ul><ul><li>Negative thinking </li></ul></ul><ul><ul><ul><li>According to Beck, four interrelated cognitive components combine to produce unipolar depression: </li></ul></ul></ul><ul><ul><ul><ul><li>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 further rounds of negative thinking </li></ul></ul></ul></ul></ul>
  50. 50. Psychological Models of Unipolar Depression <ul><li>Cognitive views </li></ul><ul><ul><li>This negative thinking often takes three forms, called the cognitive triad: </li></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>
  51. 51. Psychological Models of Unipolar Depression <ul><li>Cognitive views </li></ul><ul><ul><li>Negative thinking </li></ul></ul><ul><ul><ul><li>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>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>
  52. 52. Psychological Models of Unipolar Depression <ul><li>Cognitive views </li></ul><ul><ul><li>Strengths: </li></ul></ul><ul><ul><ul><li>There is significant research support for Beck’s model: </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><ul><ul><li>Limitations: </li></ul></ul><ul><ul><ul><li>Research fails to show that such cognitive patterns are the cause and core of unipolar depression </li></ul></ul></ul>
  53. 53. Psychological Models of Unipolar Depression <ul><li>Cognitive therapy </li></ul><ul><ul><li>Beck’s cognitive therapy – the leading cognitive treatment for unipolar depression – is designed to help clients recognize and change their negative cognitive processes </li></ul></ul><ul><ul><li>This approach follows four phases and usually lasts fewer than 20 sessions </li></ul></ul><ul><ul><li>Phases: </li></ul></ul><ul><ul><ul><li>Increasing activities and elevate mood </li></ul></ul></ul><ul><ul><ul><li>Challenging automatic thoughts </li></ul></ul></ul><ul><ul><ul><li>Identifying negative thinking and biases </li></ul></ul></ul><ul><ul><ul><li>Changing primary attitudes </li></ul></ul></ul>
  54. 54. Psychological Models of Unipolar Depression <ul><li>Cognitive therapy </li></ul><ul><ul><li>Over the past three decades, hundreds of studies have shown that cognitive therapy helps unipolar depression </li></ul></ul><ul><ul><li>Around 50% – 60% of clients show a near-total elimination of symptoms </li></ul></ul><ul><ul><li>This treatment has also been used in a group therapy format </li></ul></ul>
  55. 55. The Sociocultural Model of Unipolar Depression <ul><li>Sociocultural theorists propose that unipolar depression is greatly influenced by the social structure in which people live </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>Researchers have also found links between depression and culture, gender, race, and social support </li></ul></ul>
  56. 56. The Sociocultural Model of Unipolar Depression <ul><li>How are culture and depression related? </li></ul><ul><ul><li>Depression is a worldwide phenomena, but the experience of symptoms differs from culture to culture </li></ul></ul><ul><ul><ul><li>For example, non-Westerners report more physical (rather than psychological) symptoms </li></ul></ul></ul><ul><ul><ul><li>As cultures become more Western, symptoms shift </li></ul></ul></ul>
  57. 57. The Sociocultural Model of Unipolar Depression <ul><li>How do gender and race relate to depression? </li></ul><ul><ul><li>Rates of depression are much higher among women than men </li></ul></ul><ul><ul><ul><li>One sociocultural theory holds that the complexity of women’s roles in society leaves them particularly prone to depression </li></ul></ul></ul><ul><ul><li>Few differences have been seen overall among Caucasians, African Americans, and Hispanic Americans, but striking differences exist in specific subcultures: </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>
  58. 58. The Sociocultural Model of Unipolar Depression <ul><li>How does social support relate to depression? </li></ul><ul><ul><li>The availability of social support seems to influence the likelihood of depression </li></ul></ul><ul><ul><li>Rates of depression vary based on marital status </li></ul></ul><ul><ul><ul><li>Interpersonal conflict may be a factor </li></ul></ul></ul><ul><ul><li>Isolation and lack of intimacy also are key factors </li></ul></ul><ul><ul><ul><li>Research shows that depressed people who lack social support remain depressed longer than those who have a supportive spouse or warm friendships </li></ul></ul></ul>
  59. 59. The Sociocultural Model of Unipolar Depression <ul><li>The most effective sociocultural approaches to treating unipolar depression are interpersonal psychotherapy and couple therapy </li></ul><ul><ul><li>The techniques used in these approaches borrow from other models </li></ul></ul>
  60. 60. The Sociocultural Model of 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. 61. The Sociocultural Model of 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. 62. 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>They describe their life as an emotional roller coaster </li></ul></ul>
  63. 63. 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>Emotional symptoms </li></ul></ul><ul><ul><ul><li>Active, powerful emotions in search of outlet </li></ul></ul></ul><ul><ul><li>Motivational symptoms </li></ul></ul><ul><ul><ul><li>Need for constant excitement, involvement, companionship </li></ul></ul></ul>
  64. 64. 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>Key word: flamboyance! </li></ul></ul></ul></ul><ul><ul><li>4. Cognitive symptoms </li></ul></ul><ul><ul><ul><li>Show poor judgment or planning </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>
  65. 65. 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>
  66. 66. 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>
  67. 67.
  68. 68. Diagnosing Bipolar Disorders <ul><li>Without treatment, the mood episodes tend to recur for people with either type of bipolar disorder </li></ul><ul><li>Regardless of particular pattern, individuals with bipolar disorder tend to experience depression more than mania over the years </li></ul>
  69. 69. Diagnosing Bipolar Disorders <ul><li>Between 1% and 2.6% of 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 </li></ul><ul><ul><li>Women may experience more depressive episodes and fewer manic episodes than men </li></ul></ul>
  70. 70. Diagnosing Bipolar Disorders <ul><li>The prevalence of the disorders is the same across socioeconomic classes and ethnic groups </li></ul><ul><li>Onset usually occurs between 15 and 44 years of age </li></ul><ul><li>In most cases, the manic and depressive episodes eventually subside, only to recur at a later time </li></ul>
  71. 71. 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 0.4% of the population </li></ul></ul></ul><ul><ul><ul><li>May blossom into bipolar I or II disorder </li></ul></ul></ul>
  72. 72. 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>New insights have come from research into NT activity, ion activity, brain structure, and genetic factors </li></ul></ul>
  73. 73. 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>
  74. 74. 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>
  75. 75. 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>
  76. 76. 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>This improper transport may cause neurons to fire too easily (mania) or to resist firing (depression) </li></ul></ul><ul><ul><ul><li>There is some research support for this theory </li></ul></ul></ul>
  77. 77. What Causes Bipolar Disorders? <ul><li>Brain structure </li></ul><ul><ul><li>Brain imaging 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>
  78. 78. What Causes Bipolar Disorders? <ul><li>Genetic factors </li></ul><ul><ul><li>Many experts believe that people inherit a biological predisposition to develop bipolar disorders </li></ul></ul><ul><ul><ul><li>Family pedigree studies support this theory; 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>
  79. 79. What Causes Bipolar Disorders? <ul><li>Genetic factors </li></ul><ul><ul><li>Recently, genetic linkage studies have examined the possibility of “faulty” genes </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>
  80. 80. What Are the Treatments for Bipolar Disorders? <ul><li>Until the latter part of the 20 th 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><ul><ul><li>ECT only occasionally relieved either the depressive or the manic episodes of bipolar disorder </li></ul></ul>
  81. 81. What Are the Treatments for Bipolar Disorders? <ul><li>The use of lithium, a metallic element occurring as mineral salt, has dramatically changed this picture </li></ul><ul><ul><li>It is extraordinarily effective in treating bipolar disorders and mania </li></ul></ul><ul><ul><li>Determining the correct dosage for a given patient is a delicate process </li></ul></ul><ul><ul><ul><li>Too low = no effect </li></ul></ul></ul><ul><ul><ul><li>Too high = lithium intoxication (poisoning) </li></ul></ul></ul>
  82. 82. What Are the Treatments for Bipolar Disorders? <ul><li>Lithium provides improvement for more than 60% of patients with mania </li></ul><ul><ul><li>Most patients also experience fewer new episodes while on the drug </li></ul></ul><ul><ul><li>Lithium also is a prophylactic drug, one that actually prevents symptoms from developing </li></ul></ul><ul><li>Lithium also helps those with bipolar disorder overcome their depressive episodes </li></ul>
  83. 83. What Are the Treatments for Bipolar Disorders? <ul><li>Researchers do not fully understand how lithium operates </li></ul><ul><ul><li>They suspect that it changes synaptic activity in neurons, but in a different way than antidepressant drugs </li></ul></ul><ul><ul><ul><li>Although antidepressant drugs affect a neuron’s initial reception on NTs, lithium seems to affect a neuron’s second messengers </li></ul></ul></ul><ul><ul><li>Another theory is that lithium corrects bipolar functioning by directly changing sodium and potassium ion activity in neurons </li></ul></ul>
  84. 84. What Are the Treatments for Bipolar Disorders? <ul><li>Psychotherapy alone is rarely helpful for persons with bipolar disorder </li></ul><ul><li>Lithium therapy alone is also not always sufficient, either </li></ul><ul><ul><li>30% or more of patients don’t respond, may not receive the correct dose, or may relapse while taking it </li></ul></ul><ul><li>As a result, clinicians often use psychotherapy as an adjunct to lithium (or other medication-based) therapy </li></ul>
  85. 85. What Are the Treatments for Bipolar Disorders? <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, improve social functioning, and increase clients’ ability to obtain and hold a job </li></ul></ul>