Transcript Slide 1
WHS AP Psychology
Unit 11: Mental Illness and Therapies
Essential Task 11-2: Discuss the major diagnostic category of mood disorders with specific attention to the diagnoses of major depressive disorder, dysthymia, Bipolar I and Bipolar II, detail the defining symptoms of each and identify the best approach(es) for explaining the cause(es) of each.
Electroconvulsive Therapy
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Psychosurgery Antipsychotic Drugs Biological Treatments Stress Inoculation Cognitive Therapies Psychoanalysis Client Centered Insight Therapies Gestalt
Unit 11:
Treatment of Psychological Disorders Aversion Therapy Classical Behavior Therapies Token Economy Operant Beck’s Cognitive Therapy Rational Emotive Therapy Systematic Desensitization Flooding Behavior Contracting
Bipolar I Bipolar disorders Bipolar II – no mania
Mood Disorders -
Emotional disturbances that interfere with normal life functioning (Axis 1) Depressive disorders Dysthymia Major Depressive Disorder Single Recurrent
Major Depressive Episode (building block)
A. During the same 2-week period, five or more of the following symptoms including either 1 or 2 have been present (must be a change in functioning)
1. Depressed mood most of the day, nearly everyday 2. Diminished interest or pleasure in all, or almost all, activities
3. Significant changes in appetite and/or weight 4. Significant changes in sleep patterns 5. Psychomotor retardation or agitation 6. Fatigue or loss of energy 7. Feelings of worthlessness or inappropriate guilt 8. Diminished ability to concentrate or make decisions 9. Recurrent thoughts or death or suicide
Major Depressive Episode (building block)
B. The criteria do not meet criteria for a Mixed Episode C. The symptoms cause clinically significant distress or impairment in functioning D. Not due to a General Medical Condition or substance E. The symptoms are not better accounted for by Bereavement
Manic Episode (building block)
A. Distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week B. During the mood disturbance, 3 or more of the following symptoms have persisted (4 or more if the mood is only irritable) 1.
2.
3.
4.
5.
6.
7.
Inflated self-esteem or grandiosity Decreased need for sleep More talkative than usual, or pressure to keep talking Racing thoughts (“flight of ideas”) Distractibility Increase in goal-directed activity Excessive involvement in pleasurable activities that have the potential for negative consequences
Manic Episode (building block)
C. The symptoms do not meet criteria for a Mixed Episode D. The symptoms cause significant impairment in functioning or necessitate hospitalization to prevent harm to self or others E. Not due to a GMC or substance
Mixed Episode (building block)
A. The criteria are met for both a Manic Episode and a Major Depressive Episode (except duration) nearly every day during at least a 1-week period B. The symptoms cause significant distress or impairment in functioning C. Not due to a GMC or substance
Hypomanic Episode (building block)
A. Distinct period of persistently elevated, expansive, or irritable mood lasting at least 4 days B. During the mood disturbance, 3 (or more) of the following symptoms have been present (4 or more if mood is only irritable) 1.
2.
3.
4.
Inflated self-esteem or grandiosity Decreased need for sleep More talkative than usual, or pressure to keep talking Racing thoughts (“flight of ideas”) 5.
6.
7.
Distractibility Increase in goal-directed activity Excessive involvement in pleasurable activities that have the potential for negative consequences
Hypomanic Episode (building block)
C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic D. The mood disturbance and change in functioning are observable to others
E. The episode is not severe enough to cause marked distress or impairment in functioning and does not require hospitalization
F. Not due to a GMC or substance
Mood Episodes
Mania Hypomania Mixed Episode Normal Mood Depression
Major Depressive Disorder
• One or more Major Depressive Episodes AND • No history of mania or hypomania • Specify: – Single Episode – Recurrent
Major Depressive Disorder
Major Depressive Episode MDD, single episode Major Depressive Episode Major Depressive Episode Major Depressive Episode MDD, recurrent episodes
Major Depressive Disorder: Types
• Melancholic • Catatonic • Seasonal Pattern • Post-partum onset
Dysthymia
A. Depressed mood most of the day, more days than not, for at least 2 years B. Presence, while depressed, of 2 (or more) of the following: 1. Poor appetite or overeating 2. Insomnia or hypersomnia 3. Low energy or fatigue 4. Low self-esteem 5. Poor concentration or difficulty making decisions 6. Feelings of hopelessness C. During the 2-year period, the person has never been without the symptoms for more than 2 months at a time
Dysthymia
D. Not better accounted for by Major Depressive Disorder E. There has never been a Manic, Mixed, or Hypomanic episode F. Not better accounted for by another disorder G. Not due to a GMC or substance H. Symptoms cause clinically significant distress or impairment in functioning
Dysthymic Disorder
Dysthymic disorder lies between a blue mood and major depressive disorder. It is a disorder characterized by daily depression lasting two years or more.
Blue Mood Dysthymic Disorder Major Depressive Disorder
Major Depression vs. Dysthymia
Recurrent Major Depressive Episodes Dysthymia
Bipolar Disorder
Formerly called manic-depressive disorder. An alternation between depression and mania signals bipolar disorder.
Depressive Symptoms Manic Symptoms Gloomy Withdrawn Inability to make decisions Tired Slowness of thought Elation Euphoria Desire for action Hyperactive Multiple ideas
Bipolar Disorder
Many great writers, poets, and composers suffered from bipolar disorder. During their manic phase creativity surged, but not during their depressed phase.
Whitman Wolfe Clemens Hemingway
Bipolar Disorder
Two Main Distinctions • Bipolar I Disorder: – Technically, this should mean Mania/Mixed + Depression – Actually, this means Mania/Mixed
±
Depression • Bipolar II Disorder: – Hypomania +/- Depression (No mania ever) • It is distinguished from Major Depressive Disorder by the lifetime history of at last one Manic or Mixed Episode
Bipolar I Disorder
One or more manic episode OR Manic or Mixed Episode Depressed and manic episodes
OR
Major Depressive Episode Manic or Mixed Episode
Bipolar II Disorder
One or more hypomanic episode OR Depressed and hypomanic episodes Hypomanic Episode
OR
Major Depressive Episode Hypomanic Episode
Unipolar vs. Bipolar Disorder
Elevated Mood Bipolar Depressed Mood Elevated Mood Unipolar Depressed Mood
Explaining Mood Disorders
Since depression is so prevalent worldwide, investigators want to develop a theory of depression that will suggest ways to treat it. Lewinsohn et al., (1985, 1995) note that a theory of depression should explain the following: 1. Behavioral and cognitive changes 2. Common causes of depression
Theory of Depression
3. Gender differences
Theory of Depression
4. Depressive episodes self-terminate.
5. Depression is increasing, especially in the teens.
Post-partum depression
Mood Disorders
The Etiology of Depression
• Depression often triggered by stress • •
However, unlikely that stress alone causes depression Some people are more vulnerable to depression – biological vulnerability; developmental vulnerability
Biological Perspective
Genetic Influences: Mood disorders run in families. The rate of depression is higher in identical (50%) than fraternal twins (20%).
Linkage analysis and association studies link possible genes and dispositions for depression.
Neurotransmitters & Depression
A reduction of norepinephrine and serotonin has been found in depression.
Norepinephrine Drugs that alleviate mania reduce norepinephrine.
Pre-synaptic Neuron Serotonin Post-synaptic Neuron
The Depressed Brain
PET scans show that brain energy consumption rises and falls with manic and depressive episodes.
Mood Disorders
Psychological Views of Depression
Psychodynamic Views
• Freud noted similarities between
grief and depression
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Theorized that depression is grief (anger & sadness) turned against the self Actual or symbolic loss can trigger depression Attachment theorists have expanded the theory Childhood losses/separations create vulnerability to later depression
Mood Disorders
Psychological Views of Depression
Behavioral Views
• When people experience a decline in
rewards – particularly social rewards – they can enter a downward spiral of decreasing rewards that leads to depression.
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Theoretical Problem: Does decline in rewards cause depression, or does depression cause decline in rewards?
Explanatory Style
Explanatory style plays a major role in becoming depressed.
Mood Disorders
Psychological Views of Depression
Cognitive Views
• Depression is the result of
ingrained, negative thought patterns.
• Two main theories: – Beck’s “Explanatory Style” – Seligman’s “learned helplessness”
Mood Disorders
Psychological Views of Depression
Cognitive Views
Negative Thinking
• Maladaptive attitudes often
rooted in childhood
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E.g.: “If I make a mistake, I’m worthless”
• These attitudes develop into
entrenched schemas
• Stress triggers negative schemas
Mood Disorders
Psychological Views of Depression
Cognitive Views
Negative Thinking
•
Controlled by these schemas, self, present & future perceived negatively
• •
Schemas lead to “automatic thoughts” that continuously confirm negative perceptions Schemas lead to “thinking errors”
– E.g.: “Nobody cares about me”
Mood Disorders
Psychological Views of Depression
Cognitive Views
Negative Thinking
• –
Considerable research supports the link between depression and: Maladaptive attitudes; negative schemas; thinking errors; & automatic thoughts
•
However, do cognitive patterns cause depression – or are they caused by it?
Systems Approach
Depression Cycle
1. Negative stressful events.
2. Pessimistic explanatory style.
3. Hopeless depressed state.
4. These hamper the way the individual thinks and acts, fueling personal rejection.
Suicide
The most severe form of behavioral response to depression is suicide. Each year some 1 million people commit suicide worldwide.
Suicide
• Risk Factors: – Best predictor = Prior attempt – Living alone, especially if divorced/separated – Retired/unemployed – Elderly – Loss of a loved one – Chronic illness – Financial troubles – Feelings of hopelessness – Impulsivity – Sexual identity difficulties
Suicide
• Who attempts? Who completes?
– Women: 3-4 times more likely to attempt suicide – Men: 3-4 times more likely to complete suicide – Ages 18-24: Peak age for attempting suicide – Ages 65+: Peak age for completing suicide
Suicide
• Common Warning Signs – Symptoms of depression – Talking about death, disappearing, “ending it all”, etc., even just in passing – Writing letters, saying last goodbyes – Getting rid of personal effects, making a will – Arranging for the care of pets, plants, etc.
– Extravagant spending
Suicide
• Prevention – Help the person regain ability to cope with immediate stressors – Maintaining supportive contact with the person – Help the person realize that their distress is impairing their judgment – Help the person realize that the distress is not endless – Broad based programs focused on high-risk groups – Crisis hotlines – Call 911/ER