Abnm psy ch 7 2011

1Slides & Handouts by Karen Clay Rhines, Ph.D.Northampton Community College

Fundamentals of Abnormal Psychology, 6e

Ronald Comer

Mood DisordersMood DisordersChapter 7

Mood DisordersMood Disorders

Two key emotions on a continuum:

◦ Depression

Low, sad state in which life seems dark and its challenges overwhelming

◦ Mania

State of breathless euphoria or frenzied energy

Mood DisordersMood Disorders

Most people with a mood disorder suffer only from depression

◦ This pattern is called unipolar depression

Person has no history of mania

Mood returns to normal when depression lifts

Others experience periods of mania that alternate with periods of depression

◦ This pattern is called bipolar disorder

These disorders have always captured people’s interest

Unipolar DepressionUnipolar Depression

The term “depression” is often used to describe general sadness or unhappiness

◦ This loose use of the term confuses a normal mood swing with a clinical syndrome

Clinical depression can bring severe and long-lasting psychological pain that may intensify over time

How Common Is Unipolar How Common Is Unipolar Depression?Depression? Almost 7% of adults in the U.S. suffer from

severe unipolar depression in any given year

◦ As many as 5% suffer from mild forms

Approximately 17% of all adults experience unipolar depression at some time in their lives

The prevalence is similar in Canada, England, France, and many other countries

How Common Is Unipolar How Common Is Unipolar Depression?Depression?

Women are at least twice as likely as men to experience severe unipolar depression◦ Lifetime prevalence: 26% of women vs. 12% of men

◦ Among children, the prevalence is similar among boys and girls

Approximately 50% recover within six weeks and 90% within a year, some without treatment◦ Most will experience another episode at some point

What Are the Symptoms of What Are the Symptoms of Depression?Depression?

Symptoms may vary from person to person Five main areas of functioning may be affected:◦ Emotional symptoms Feeling “miserable,” “empty,” “humiliated”

Experiencing little pleasure (anhedonia)

◦ Motivational symptoms Lacking drive, initiative, spontaneity

Between 6% and 15% of those with severe depression commit suicide

What Are the Symptoms of What Are the Symptoms of Depression?Depression? Five main areas of functioning may be affected:

◦ Behavioral symptoms

Less active, less productive

◦ Cognitive symptoms

Hold negative views of themselves

Blame themselves for unfortunate events

Pessimism

◦ Physical symptoms

Headaches, dizzy spells, general pain

Diagnosing Unipolar DepressionDiagnosing Unipolar Depression

Criteria 1: Major depressive episode

◦ Marked by five or more symptoms lasting two or more weeks

In extreme cases, symptoms are psychotic, including

Hallucinations

Delusions

Criteria 2: No history of mania

Diagnosing Unipolar DepressionDiagnosing Unipolar Depression

Two diagnoses to consider:◦ Major depressive disorder Criteria 1 and 2 are met

◦ Dysthymic disorder Symptoms are “mild but chronic”

Depression is longer lasting but less disabling

Consistent symptoms for at least two years

◦ When dysthymic disorder leads to major depressive disorder, the sequence is called “double depression”

What Causes Unipolar Depression?What Causes Unipolar Depression?

Stress may be a trigger for depression

◦ People with depression experience a greater number of stressful life events during the month just before the onset of their symptoms

◦ Some clinicians distinguish reactive (exogenous) depression from endogenous depression, which seems to be a response to internal factors

Today’s clinicians usually concentrate on recognizing both the situational and the internal aspects of any given case

What Causes Unipolar Depression?What Causes Unipolar Depression?The Biological ModelThe Biological Model

Genetic factors

◦ Family pedigree, twin, adoption, and molecular biology gene studies suggest that some people inherit a biological predisposition

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

Twin studies demonstrate a strong genetic component:

Concordance rates for identical (MZ) twins = 46%

Concordance rates for fraternal (DZ) twins = 20%

Adoption studies also have implicated a genetic factor in cases of severe unipolar depression

Using techniques from the field of molecular biology, researchers have found evidence that unipolar depression may be tied to specific genes

Biochemical factors

◦ NTs: serotonin and norepinephrine

In the 1950s, medications for high blood pressure were found to cause depression

Some lowered serotonin, others lowered norepinephrine

The discovery of truly effective antidepressant medications, which relieved depression by increasing either serotonin or norepinephrine, further confirmed the NT role

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

Biochemical factors◦ Endocrine system / hormone release People with depression have been found to have

abnormal levels of cortisol

Released by the adrenal glands during times of stress

People with depression have been found to have abnormal melatonin secretion

“Dracula hormone”

Other researchers are investigating whether deficiencies of important proteins within neurons are tied to depression

Biochemical factors

◦ These explanations have produced much enthusiasm but have certain limitations:

Rely on analogue studies: depression-like symptoms created in lab animals

Do these symptoms correlate with human emotions?

Measuring brain activity has been difficult an indirect

Current studies using modern technology are attempting to address this issue

Brain anatomy and brain circuits

◦ Biological researchers have determined that emotional reactions of various kinds are tied to brain circuits

These are networks of brain structures that work together, triggering each other into action and producing a particular kind of emotional reaction

It appears that one circuit is tied to GAD, another to panic disorder, and yet another to OCD

◦ Although research is far from complete, a circuit responsible for unipolar depression has begun to emerge

Likely brain areas in the circuit include the prefrontal cortex, hippocampus, amygdala, and Brodmann’s Area 25

Biological Treatments for Unipolar Biological Treatments for Unipolar DepressionDepression 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

Biological Treatments for Unipolar Biological Treatments for Unipolar DepressionDepression Electroconvulsive therapy (ECT)

◦ The use of ECT was – and is – controversial

◦ The procedure consists of targeted electrical stimulation to cause a brain seizure

The usual course of treatment is 6 to 12 sessions

◦ The discovery of the effectiveness of ECT was accidental

◦ The procedure has been modified in recent years to reduce some of the negative effects

For example, patients are given muscle relaxants and anesthetics before and during the procedure

◦ Patients generally report some memory loss

◦ ECT is clearly effective in treating unipolar depression

Studies find improvement in 60%–80% of patients

◦ The procedure seems particularly effective in cases of severe depression with delusions, but it has been difficult to determine why ECT works so well

Biological Treatments for Unipolar Biological Treatments for Unipolar DepressionDepression Antidepressant drugs

◦ In the 1950s, two kinds of drugs were found to be effective:

Monoamine oxidase inhibitors (MAO inhibitors)

Tricyclics

◦ These drugs have been joined in recent years by a third group, the second-generation antidepressants

Biological Treatments for Unipolar Biological Treatments for Unipolar DepressionDepression Antidepressant drugs: MAO inhibitors◦ Originally used to treat TB, doctors noticed that

the medication seemed to make patients happier

◦ The drug works biochemically by slowing down the body’s production of MAO MAO breaks down norepinephrine

MAO inhibitors stop this breakdown from occurring

This leads to a rise in norepinephrine activity and a reduction in depressive symptoms

About half of patients who take these drugs are helped by them

Biological Treatments for Unipolar Biological Treatments for Unipolar DepressionDepression Antidepressant drugs: MAO inhibitors

◦ MAO inhibitors potentially pose a serious danger

Blood pressure may rise to a potentially fatal level if one eats foods with tyramine (cheese, bananas, wine) while taking MAOIs

Thus, people on MAO inhibitors must stick to a rigid diet

Biological Treatments for Unipolar Biological Treatments for Unipolar DepressionDepression Antidepressant drugs: Tricyclics

◦ In searching for medications for schizophrenia, researchers discovered that imipramine lessened depressive symptoms

Imipramine and related drugs are known as tricyclics because they share a three-ring molecular structure

◦ Hundreds of studies have found that depressed patients taking tricyclics have improved much more than similar patients taking placebos

Drugs must be taken for at least 10 days before such improvement is seen

About 60%–65% of patients find symptom improvement

◦ Most patients who immediately stop taking tricyclics upon relief of symptoms relapse within one year

Patients who take tricyclics for five additional months (“continuation therapy”) have a significantly decreased risk of relapse

◦ Tricyclics are believed to reduce depression by affecting neurotransmitter (NT) “reuptake” mechanisms

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

The reuptake process appears to be too effective in some people, drawing in too much of the NT from the synapse

This reduction in NT activity in the synapse is thought to result in clinical depression

Tricyclics block the reuptake process, thus increasing NT activity in the synapse

Biological Treatments for Unipolar Biological Treatments for Unipolar DepressionDepression Second-generation antidepressant drugs

◦ A third group of effective antidepressant drugs is structurally different from the MAO inhibitors and tricyclics

Most of the drugs in this group are labeled selective serotonin reuptake inhibitors (SSRIs)

◦ These drugs act only on serotonin (no other NTs are affected)

This class includes fluoxetine (Prozac), sertraline (Zoloft), and escitalopram (Lexapro)

◦ Selective norepinephrine reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are also now available

Biological Treatments for Unipolar Biological Treatments for Unipolar DepressionDepression Second-generation antidepressant drugs◦ The effectiveness and speed of action of these

drugs is on par with the tricyclics, yet their sales have skyrocketed Clinicians often prefer these drugs because it is harder

to overdose on them than on other kinds of antidepressants

There are no dietary restrictions like there are with MAO inhibitors

They have fewer side effects than the tricyclics

◦ These drugs may cause some undesired effects of their own, including a reduction in sex drive

Biological Treatments for Unipolar Biological Treatments for Unipolar DepressionDepression Brain stimulation

◦ 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:

Vagus nerve stimulation

Transcranial magnetic stimulation

Deep brain stimulation

Biological Treatments for Unipolar Biological Treatments for Unipolar DepressionDepression Vagus nerve stimulation

◦ 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

◦ Research has found that the procedure brings significant relief to as many as 40% of those with treatment-resistant depression

Biological Treatments for Unipolar Biological Treatments for Unipolar DepressionDepression

Transcranial magnetic stimulation

◦ 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

Deep brain stimulation

◦ Theorizing a “depression switch” located deep within the brain, researchers have successfully experimented with electrode implantation in the brain’s Brodman Area 25

Biological Treatments for Unipolar Biological Treatments for Unipolar DepressionDepression Brain stimulation

◦ 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

What Causes Unipolar Depression?What Causes Unipolar Depression?The Psychological ModelsThe Psychological Models

Three main models:

◦ Psychodynamic model

No strong research support

◦ Behavioral model

Modest research support

◦ Cognitive views

Considerable research support

Psychodynamic view

◦ Link between depression and grief

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

For most people, this reaction is temporary

If grief is severe and long-lasting, depression results

Those with oral stage issues (unmet or excessively met needs) are at greater risk for developing depression

Some people experience “symbolic” (or imagined) loss

Newer psychoanalysts (object relations theorists) propose that depression results when people’s relationships leave them feeling unsafe and insecure

Psychodynamic view

◦ Studies have offered general support for the psychodynamic idea that depression may be triggered by a major loss

◦ However, research does not indicate that loss is always at the core of depression

Psychodynamic Treatments for Psychodynamic Treatments for Unipolar DepressionUnipolar Depression Psychodynamic therapists use the same

basic procedures for all psychological disorders:

◦ Free association

◦ Therapist interpretation

◦ Review of past events and feelings

Psychodynamic Treatments for Psychodynamic Treatments for Unipolar DepressionUnipolar Depression Despite successful case reports, researchers have

found that long-term psychodynamic therapy is only occasionally helpful in cases of unipolar depression

Two features may be particularly limiting:

◦ Depressed clients may be too passive or weary to fully participate in therapy discussions

◦ Depressed clients may become discouraged and end treatment too early when treatment is unable to provide quick relief

Short-term approaches have performed better than traditional approaches

What Causes Unipolar Depression?What Causes Unipolar Depression?The Psychological ModelsThe Psychological Models Behavioral view

◦ Depression results from changes in rewards and punishments people receive in their lives

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

◦ Research supports the relationship between the number of rewards received and the presence or absence of depression

Social rewards are especially important

Behavioral Treatments for Unipolar Behavioral Treatments for Unipolar DepressionDepression Behavioral therapy

◦ Lewinsohn developed a behavioral therapy for unipolar depression in the 1970s:

Reintroduce clients to pleasurable activities and events, often using a weekly schedule

Appropriately reinforce their depressive and nondepressive behaviors

Help them improve their social skills

Behavioral Treatments for Unipolar Behavioral Treatments for Unipolar DepressionDepression

Behavioral therapy

◦ The behavioral techniques seem to be of only limited help when just one of them is applied

When treatment programs combine two or more of the techniques, depressive symptoms (especially mild symptoms) seem to be reduced

It is worth noting that Lewinsohn himself has combined behavioral techniques with cognitive strategies in recent years

Cognitive views

◦ Two main theories:

Learned helplessness

Negative thinking

Cognitive views

◦ Learned helplessness

Theory holds that people become depressed when they think that:

They no longer have control over the reinforcements (rewards and punishments) in their lives

They themselves are responsible for this helpless state

Cognitive views

Theory is based on Seligman’s work with laboratory dogs

Dogs subjected to uncontrollable shock were later placed in a shuttle box

Even when presented with an opportunity to escape, dogs that had experienced uncontrollable shocks made no attempt to do so

Seligman theorized that the dogs had “learned” to be “helpless” to do anything to change negative situations, and drew parallels to human depression

Cognitive views

There has been significant research support for this model

Human subjects who undergo helplessness training score higher on depression scales and display reactions similar to depressive symptoms

Animal subjects lose interest in sex and social activities

Cognitive views◦ Learned helplessness Recent versions of the theory focus on attributions

Internal attributions that are global and stable lead to greater feelings of helplessness and possibly depression

Example: “I am inadequate at everything and I always will be”

If people make other kinds of attributions, this reaction is unlikely

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].

Cognitive views

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

Cognitive views

Although this theory has been very influential, it has imperfections:

Much of the research relies on animal subjects

The attributional component of the theory raises particularly difficult questions in terms of animal models of depression

Cognitive views

◦ Negative thinking

Beck believes four interrelated cognitive components combine to produce unipolar depression:

1. Maladaptive attitudes

Self-defeating attitudes are developed during childhood

Beck suggests that upsetting situations later in life can trigger an extended round of negative thinking

Cognitive views

2. This negative thinking typically takes three forms, called the cognitive triad:

Individuals repeatedly interpret (1) their experiences, (2) themselves, and (3) their futures in negative ways, leading to depression

Cognitive views

3. Depressed people also make errors in their thinking, including:

Arbitrary inferences

Minimization of the positive and magnification of the negative

4. Depressed people experience automatic thoughts

A steady train of unpleasant thoughts that suggest inadequacy and hopelessness

Cognitive views

Many studies have produced evidence in support of Beck’s explanation:

High correlation between the level of depression and the number of maladaptive attitudes

Both the cognitive triad and errors in logic are seen in people with depression

Automatic thinking has been linked to depression

Cognitive Treatment for Unipolar Cognitive Treatment for Unipolar DepressionDepression Beck’s cognitive therapy – which includes a number

of behavioral techniques – is designed to help clients recognize and change their negative cognitive processes

This approach follows four phases and usually lasts fewer than 20 sessions

Phases:

◦ Increasing activities and elevating mood

◦ Challenging automatic thoughts

◦ Identifying negative thinking and biases

◦ Changing primary attitudes

Cognitive Treatment for Unipolar Cognitive Treatment for Unipolar DepressionDepression Over the past several decades, hundreds of

studies have shown that cognitive and cognitive-behavioral approaches help unipolar depression

◦ Around 50%–60% of clients show a near-total elimination of symptoms

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

What Causes Unipolar Depression?What Causes Unipolar Depression?The Sociocultural ModelThe Sociocultural Model

Sociocultural theorists propose that unipolar depression is greatly influenced by the social context that surrounds people

◦ This belief is supported by the finding that depression is often triggered by outside stressors

◦ There are two kinds of sociocultural views:

The family-social perspective

The multicultural perspective

The Family-Social Perspective

◦ The connection between declining social rewards and depression (as discussed by the behaviorists) is a two-way street

Depressed people often display social deficits that make other people uncomfortable and may cause them to avoid the depressed individuals

This leads to decreased social contact and a further deterioration of social skills

The Family-Social Perspective

◦ Consistent with these findings, depression has been tied repeatedly to the unavailability of social support such as that found in a happy marriage

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

◦ People whose lives are isolated and without intimacy seem particularly likely to become depressed at times of stress

Family-Social Treatments for Family-Social Treatments for Unipolar DepressionUnipolar Depression Interpersonal therapy (IPT)◦ This model holds that four interpersonal

problems may lead to depression and must be addressed: Interpersonal loss

Interpersonal role dispute

Interpersonal role transition

Interpersonal deficits

◦ Studies suggest that IPT is as effective as cognitive therapy for treating depression

Family-Social Treatments for Family-Social Treatments for Unipolar DepressionUnipolar Depression Couple therapy

◦ The main type of couple therapy is behavioral marital therapy (BMT)

Focus is on developing specific communication and problem-solving skills

◦ If marriage is conflictual, BMT is as effective as other therapies for reducing depression

The Multicultural Perspective

◦ Two kinds of relationships have captured the interest of multicultural theorists:

Gender and depression

A strong link exists between gender and depression

Women cross-culturally are twice as likely as men to receive a diagnosis of unipolar depression

◦ Various theories have been offered:

The artifact theory holds that women and men are equally prone to depression, but that clinicians often fail to detect depression in men

The hormone explanation holds that hormone changes trigger depression in many women

The life stress theory suggests that women in our society experience more stress than men

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

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

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

◦ 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)

◦ Two kinds of relationships have captured the interest of multicultural theorists:

Cultural background and depression

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

Beyond such core symptoms, research suggests that the precise picture of depression varies from country to country

◦ Depressed people in non-Western countries are more likely to be troubled by physical symptoms of depression than by cognitive ones

The Multicultural Perspective◦ 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 In a study of one Native American village, lifetime risk

was 37% among women, 19% among men, and 28% overall

These findings are thought to be the result of economic and social pressures

Multicultural Treatments for Multicultural Treatments for Unipolar DepressionUnipolar Depression Culture-sensitive approaches are

increasingly being combined with traditional forms of psychotherapy to help maximize the likelihood of minority clients overcoming their disorders

Bipolar DisordersBipolar Disorders

People with a bipolar disorder experience both the lows of depression and the highs of mania

◦ Many describe their lives as an emotional roller coaster

What Are the Symptoms of Mania?What Are the Symptoms of Mania?

Unlike those experiencing depression, people in a state of mania typically experience dramatic and inappropriate rises in mood

Five main areas of functioning may be affected:

◦ 1. Emotional symptoms

Active, powerful emotions in search of outlet

◦ 2. Motivational symptoms

Need for constant excitement, involvement, companionship

What Are the Symptoms of Mania?What Are the Symptoms of Mania?

Five main areas of functioning may be affected:

◦ 3. Behavioral symptoms

Very active – move quickly; talk loudly or rapidly

Flamboyance is not uncommon

◦ 4. Cognitive symptoms

Show poor judgment

Especially prone to poor (or no) planning

◦ 5. Physical symptoms

High energy level – often in the presence of little or no rest

Diagnosing Bipolar DisordersDiagnosing Bipolar Disorders

Criteria 1: Manic episode

◦ Three or more symptoms of mania lasting one week or more

In extreme cases, symptoms are psychotic

◦ Criteria 2: History of mania

If currently experiencing hypomania or depression

DSM-IV-TR distinguishes between two kinds of bipolar disorder:

◦ Bipolar I disorder

Full manic and major depressive episodes

Most sufferers experience an alternation of episodes

Some experience mixed episodes

◦ Bipolar II disorder

Hypomanic episodes and major depressive episodes

Without treatment, the mood episodes tend to recur for people with either type of bipolar disorder

◦ In most cases, the individual’s depressive episodes outnumber his or her manic episodes

Between 1% and 2.6% of all adults in the world suffer from a bipolar disorder at any given time

The disorders are equally common in women and men and among all socioeconomic classes and ethnic groups

Onset usually occurs between 15 and 44 years of age

◦ In most cases, the manic and depressive episodes eventually subside, only to recur at a later time

A final diagnostic option:

◦ If a person experiences numerous episodes of hypomania and mild depressive symptoms, a diagnosis of cyclothymic disorder is appropriate

Mild symptoms for two or more years, interrupted by periods of normal mood

Affects at least 0.4% of the population

May eventually blossom into bipolar I or II disorder

What Causes Bipolar Disorders?What Causes Bipolar Disorders?

Throughout the first half of the 20th century, the search for the cause of bipolar disorders made little progress

More recently, biological research has produced some promising clues

◦ These insights have come from research into NT activity, ion activity, brain structure, and genetic factors

Neurotransmitters

◦ After finding a relationship between low norepinephrine and unipolar depression, early researchers expected to find a link between high norepinephrine levels and mania

This theory is supported by some research studies; bipolar disorders may be related to overactivity of norepinephrine

Neurotransmitters

◦ Because serotonin activity often parallels norepinephrine activity in unipolar depression, theorists expected that mania would also be related to high serotonin activity

Although no relationship with HIGH serotonin has been found, bipolar disorder may be linked to LOW serotonin activity, which seems contradictory…

Neurotransmitters

◦ This apparent contradiction is addressed by the “permissive theory” about mood disorders:

Low serotonin may “open the door” to a mood disorder and permit norepinephrine activity to define the particular form the disorder will take:

Low serotonin + Low norepinephrine = Depression

Low serotonin + High norepinephrine = Mania

Ion activity

◦ Ions, which are needed to send incoming messages to nerve endings, may be improperly transported through the cells of individuals with bipolar disorder

◦ 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)

There is some research support for this theory

Brain structure

◦ 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

It is not clear what role such structural abnormalities play

Genetic factors

◦ Many theorists believe that people inherit a biological predisposition to develop bipolar disorders

Family pedigree studies support this idea; when one twin or sibling has bipolar disorder, the likelihood for the other twin or sibling increases:

Identical (MZ) twins = 40% likelihood

Fraternal (DZ) twins and siblings = 5% to 10% likelihood

General population = 1 to 2.6% likelihood

Genetic factors

◦ Recently, genetic linkage studies have tried to identify possible patterns in the inheritance of bipolar disorders

◦ Other researchers are using techniques from molecular biology to further examine genetic patterns

◦ Such wide-ranging findings suggest that a number of genetic abnormalities probably combine to help bring about bipolar disorders

Treatments for Bipolar DisorderTreatments for Bipolar Disorder

Until the latter part of the 20th century, people with bipolar disorders were destined to spend their lives on an emotional roller coaster

◦ Psychotherapists reported almost no success

◦ Antidepressant drugs were of limited help

These drugs sometimes triggered manic episodes

Treatments for Bipolar Disorder: Treatments for Bipolar Disorder: Lithium and Other Mood StabilizersLithium and Other Mood Stabilizers

The use of lithium (a metallic element occurring as mineral salt) and other mood-stabilizers has dramatically changed this picture

All manner of research has attested to the effectiveness of lithium and other mood stabilizers in treating manic episodes◦ More than 60% of patients with mania improve

on these medications

◦ Most individuals experience fewer new episodes while on the drug

Findings suggest that the mood stabilizers are also prophylactic drugs, ones that actually help prevent symptoms from developing

Mood stabilizers also help those with bipolar disorder overcome their depressive episodes to a lesser degree

Researchers do not fully understand how mood stabilizing drugs operate

◦ They suspect that the drugs change synaptic activity in neurons, but in a different way from that of antidepressant drugs

Although antidepressant drugs affect a neuron’s initial reception on NTs, mood stabilizers seem to affect a neuron’s second messengers

◦ 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

Treatments for Bipolar Disorder: Treatments for Bipolar Disorder: Adjunctive PsychotherapyAdjunctive Psychotherapy Psychotherapy alone is rarely helpful for

persons with bipolar disorder

Mood stabilizing drugs alone are also not always sufficient

◦ 30% or more of patients don’t respond, may not receive a proper dose, and/or may relapse while taking it

As a result, clinicians often use psychotherapy as an adjunct to mood-stabilizing drugs

Treatments for Bipolar Disorder: Treatments for Bipolar Disorder: Adjunctive PsychotherapyAdjunctive Psychotherapy

Therapy focuses on medication management, social skills, and relationship issues

Few controlled studies have tested the effectiveness of such adjunctive therapy

◦ Growing research suggests that it helps reduce hospitalization, improves social functioning, and increases clients’ ability to obtain and hold a job

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