Disorders of Mood Lecture Slides PSYCH 255

7/26/2019 Disorders of Mood Lecture Slides PSYCH 255

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Comer, Fundamentals ofAbnormal Psychology, 7e

Disorders of Mood

Chapter 6

Slides & Handouts by Karen Clay Rhines, Ph.D.


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2Comer, Fundamentals of bnormal

Psy!holo"y, 7e

Disorders of Mood

#here are t$o %ey emotions in mooddisorders

Depression 'o$, sad state in $hi!h life seems dar% and

its !hallen"es o(er$helmin"

)ania State of breathless euphoria or fren*ied

ener"y


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Disorders of Mood

People $ith depressi(e disorders su+eronly from depression, a pattern !alledunipolar depression

Person has no history of mania

)ood returns to normal $hen depressionlifts

n !ontrast, those $ho display bipolardisorders e-perien!e periods of maniathat alternate $ith periods of depression


Psy!holo"y, 7e


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Psy!holo"y, 7e

Disorders of Mood

)ood problems ha(e al$ays!aptured peoples interest

)illions of people ha(e mood disorders /!onomi! !osts of mood disorders

amount to many billions of dollars ea!h

year #he human su+erin" is beyond

!al!ulation


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Psy!holo"y, 7e

Unipolar Depression

#he term 0depression1 is often usedto des!ribe "eneral sadness orunhappiness

#his loose use of the term !onfuses anormal mood s$in" $ith a !lini!alsyndrome

Clini!al depression !an brin" se(ereand lon"2lastin" psy!holo"i!al painthat may intensify as time "oes by


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How Common IsUnipolar Depression?

round 34 of adults in the 5.S. su+er fromse(ere unipolar depression in any "i(en year s many as 4 su+er from mild forms

round 84 of all adults e-perien!e unipolardepression at some time in their li(es

#he pre(alen!e is similar in Canada,/n"land, Fran!e, and many other !ountries

#he rate of depression is hi"her amon" poorpeople than $ealthier people


Psy!holo"y, 7e


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How Common Is UnipolarDepression?

9omen are at least t$i!e as li%ely as men toe-perien!e se(ere unipolar depression

'ifetime pre(alen!e :64 of $omen (s. :4 of

men mon" !hildren, the pre(alen!e is similar amon"

boys and "irls

ppro-imately 34 of people $ith unipolar

depression re!o(er, some $ithout treatment round ;


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What Are the Symptoms ofDepression?

Symptoms may (ary from person to person

Fi(e main areas of fun!tionin" may bea+e!ted /motional symptoms

Feelin" 0miserable,1 0empty,1 0humiliated1

/-perien!in" little pleasure

)oti(ational symptoms 'a!%in" dri(e, initiati(e, spontaneity

=et$een 64 and 4 of those $ith se(eredepression die by sui!ide


Psy!holo"y, 7e


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What Are the Symptoms ofDepression?

Fi(e main areas of fun!tionin" may bea+e!ted =eha(ioral symptoms

'ess a!ti(e, less produ!ti(e

Co"niti(e symptoms Hold ne"ati(e (ie$s of themsel(es

=lame themsel(es for unfortunate e(ents

Pessimisti!

Physi!al symptoms Heada!hes, di**y spells, "eneral pain


Psy!holo"y, 7e


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Diagnosing UnipolarDepression

major depressive episode is aperiod of t$o or more $ee%s mar%ed

by >(e or more symptoms ofdepression

n e-treme !ases, symptoms arepsy!hoti!, in!ludin"

Hallu!inations

Delusions


Psy!holo"y, 7e


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DS)2 lists se(eral types ofdepressi(e disorders

)a?or depressi(e disorder People $ho e-perien!e a ma?or depressi(e

episode $ith no history of mania

Dysthymi! disorder

ndi(iduals $ho e-perien!e a lon"er2lastin"@at least t$o yearsA but less disablin" patternof depression


Psy!holo"y, 7e


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DS)2 lists se(eral types of depressi(edisorders

Premenstrual dysphori! disorder

dia"nosis "i(en to $omen $ho repeatedlye-perien!e !lini!ally si"ni>!ant depressi(esymptoms durin" the $ee% before menstruation

Disrupti(e mood re"ulation disorder

Chara!teri*ed by a !ombination of persistentdepressi(e symptoms and re!urrent outbursts ofse(ere temper


Psy!holo"y, 7e


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Stress andUnipolar Depression

Stress may be a tri""er for depression

People $ith depression e-perien!e a

"reater number of stressful life e(entsdurin" the month ?ust before the onset oftheir symptoms

Some !lini!ians distin"uish rea!ti(e

@e-o"enousA depression from endo"enousdepression, $hi!h seems to be a responseto internal fa!tors


Psy!holo"y, 7e


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Stress andUnipolar Depression

#odays !lini!ians usually !on!entrateon re!o"ni*in" both the situational

and the internal aspe!ts of any "i(en!ase


Psy!holo"y, 7e


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The Biological Model ofUnipolar Depression

/(iden!e from "eneti!, bio!hemi!al,anatomi!al, and immune system

studies su""ests that unipolardepression has biolo"i!al !auses


Psy!holo"y, 7e


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Beneti! fa!tors

Family pedi"ree, t$in, adoption, and

mole!ular biolo"y "ene studies su""estthat some people inherit a biolo"i!alpredisposition

Resear!hers ha(e found that as many as

:


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Beneti! fa!tors

#$in studies demonstrate a stron" "eneti!!omponent

Con!ordan!e rates for identi!al @)A t$ins ;64

Con!ordan!e rates for fraternal @DA t$ins :! "enes


Psy!holo"y, 7e


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=io!hemi!al fa!tors #s serotonin and norepinephrine

n the 8rmed the # role

Depression li%ely in(ol(es not ?ust serotonin nornorepinephrineG a !ompli!ated intera!tion is at$or%, and other #s may be in(ol(ed

18Comer, Fundamentals of bnormalPsy!holo"y, 7e


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=io!hemi!al fa!tors

/ndo!rine system hormone release

People $ith depression ha(e been found to ha(e

abnormal le(els of !ortisol Hormone released by the adrenal "lands durin" times of

stress

People $ith depression ha(e been found to ha(eabnormal melatonin se!retion

0Dra!ula hormone1

Ither resear!hers are in(esti"atin" de>!ien!ies ofimportant proteins $ithin neurons as tied todepression



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=io!hemi!al fa!tors

)odel has produ!ed mu!h enthusiasm buthas !ertain limitations

Relies on analo"ue studies depression2li%esymptoms !reated in lab animals

Do these symptoms !orrelate $ith human emotionsJ

)easurin" brain a!ti(ity has been di!ult andindire!t

Current studies usin" ne$er te!hnolo"y areattemptin" to address this issue



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=rain anatomy and brain !ir!uits =iolo"i!al resear!hers ha(e determined that

emotional rea!tions of (arious %inds are tied to

brain !ir!uits #hese are net$or%s of brain stru!tures that $or%

to"ether, tri""erin" ea!h other into a!tion andprodu!in" a parti!ular %ind of emotional rea!tion

lthou"h resear!h is far from !omplete, a

!ir!uit responsible for unipolar depression hasbe"un to emer"e 'i%ely brain areas in the !ir!uit in!lude the prefrontal

!orte-, hippo!ampus, amy"dala, and =rodmann rea:



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mmune System

#his system is the bodys net$or% of

a!ti(ities and !ells that >"ht o+ ba!teriaand other forei"n in(aders

9hen stressed, the immune system maybe!ome dysre"ulated, $hi!h somebelie(e may help produ!e depression


What Are the Biological


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What Are the BiologicalTreatments for Unipolar

Depression?

5sually biolo"i!al treatment meansantidepressant dru"s, but for

se(erely depressed indi(iduals $hodo not respond to other forms oftreatment, it sometimes in!ludesele!tro!on(ulsi(e therapy or brain

stimulation




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Depression?

/le!tro!on(ulsi(e therapy @/C#A

Ine of the most !ontro(ersial forms of

treatment #he pro!edure !onsists of tar"eted

ele!tri!al stimulation to !ause a brainsei*ure

#he usual !ourse of treatment is 6 to :sessions spa!ed o(er : to ; $ee%s




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Depression?


#he dis!o(ery of the e+e!ti(eness of /C# $asa!!idental

#he pro!edure has been modi>ed in re!entyears to redu!e some of the ne"ati(e e+e!ts

For e-ample, patients are "i(en mus!le rela-ants

and anestheti!s before and durin" the pro!edure Patients "enerally report some memory loss




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Depression?


/C# is !learly e+e!ti(e in treatin" unipolar

depression, but it has been di!ult todetermine $hy /C# $or%s so $ell

Studies >nd impro(ement in 6


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Depression?

ntidepressant dru"s

n the 8


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Depression?

ntidepressant dru"s )I inhibitors Iri"inally used to treat #=, do!tors noti!ed

that the medi!ation seemed to ma%e patients

happier #he dru" $or%s bio!hemi!ally by slo$in"

do$n the bodys produ!tion of )I )I brea%s do$n norepinephrine

)I inhibitors stop this brea%do$n from o!!urrin"

#his leads to a rise in norepinephrine a!ti(ity and aredu!tion in depressi(e symptoms

ppro-imately half of patients $ho ta%e these dru"s arehelped by them




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Depression?

ntidepressant dru"s )I inhibitors

)I inhibitors pose a potential dan"er

People $ho ta%e )Is e-perien!e adan"erous rise in blood pressure if they eatfoods !ontainin" tyramine @!heese, bananas,$ineA




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Depression?

ntidepressant dru"s #ri!y!li!s

n sear!hin" for medi!ations for

s!hi*ophrenia, resear!hers dis!o(eredthat imipramine relie(ed depressi(esymptoms

mipramine and related dru"s are %no$n as

tri!y!li!s be!ause they share a three2rin"mole!ular stru!ture




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Depression?


Hundreds of studies ha(e found that

depressed patients ta%in" tri!y!li!s ha(eimpro(ed mu!h more than similarpatients ta%in" pla!ebos

Dru"s must be ta%en for at least < days

before su!h impro(ement is seen

bout 6nd symptomimpro(ement




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Depression?


)ost patients $ho immediately stop

ta%in" tri!y!li!s upon relief of symptomsrelapse $ithin one year

Patients $ho ta%e tri!y!li!s for >(eadditional months @0maintenan!e therapy1A

ha(e a si"ni>!antly de!reased ris% of relapse




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Depression? ntidepressant dru"s #ri!y!li!s

#ri!y!li!s are belie(ed to redu!e depression bya+e!tin" neurotransmitter @#A reupta%eme!hanisms

#o pre(ent an # from remainin" in the synapse too lon",a pumpli%e me!hanism re!aptures the # and dra$s itba!% into the presynapti! neuron

#he reupta%e pro!ess appears to be too e!ient in somepeople, dra$in" in too mu!h of the # from the synapse

#his redu!tion in # a!ti(ity in the synapse is thou"ht toresult in !lini!al depression

#ri!y!li!s blo!% the reupta%e pro!ess, thus in!reasin" #a!ti(ity in the synapse



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Depression? Se!ond2"eneration antidepressants

third "roup of e+e!ti(e antidepressant dru"s isstru!turally di+erent from the )I inhibitors andtri!y!li!s

)ost of the dru"s in this "roup are labeled sele!ti(eserotonin reupta%e inhibitors @SSRsA

#hese dru"s in!rease serotonin a!ti(ity spe!i>!ally@no other #s are a+e!tedA

#his !lass in!ludes Muo-etine @Pro*a!A, sertraline @oloftA,

and es!italopram @'e-aproA Sele!ti(e norepinephrine reupta%e inhibitors and

serotonin2norepinephrine reupta%e inhibitors arealso no$ a(ailable




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Depression?

Se!ond2"eneration antidepressant dru"s n e+e!ti(eness and speed of a!tion of these

dru"s are on a par $ith the tri!y!li!s, yet theirsales ha(e s%yro!%eted Clini!ians often prefer these dru"s be!ause it is harder

to o(erdose on them than on other %inds ofantidepressants

#here are no dietary restri!tions li%e there are $ith)I inhibitors

#hey ha(e fe$er side e+e!ts than the tri!y!li!s

#hese dru"s may !ause some undesired e+e!tsof their o$n, in!ludin" a redu!tion in se- dri(e




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Depression?

s popular as antidepressant dru"sare, it is important to re!o"ni*e thatthey do not $or% for e(eryone

/(en the most su!!essful of them failsto help at least N per!ent of !lients$ith depression




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Depression?

=rain stimulation

n re!ent years, three additional

biolo"i!al approa!hes ha(e beende(eloped

Oa"us ner(e stimulation

#rans!ranial ma"neti! stimulation

Deep brain stimulation

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Comer, Fundamentals of bnormalPsy!holo"y, 7e



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Depression?

Oa"us ner(e stimulation

Depression resear!hers surmised they mi"htbe able to stimulate the brain by ele!tri!allystimulatin" the (a"us ner(e throu"h the useof a pulse "enerator implanted under thes%in of the !hest

Resear!h has found that the pro!edurebrin"s si"ni>!ant relief to as many as ;


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Depression?

#rans!ranial ma"neti! stimulation nother te!hniEue desi"ned to stimulate the

brain $ithout the undesired e+e!ts of /C#,

#)S has been found to redu!e depression$hen administered daily for : to ; $ee%s

Deep brain stimulation #heori*in" a 0depression s$it!h1 lo!ated

deep $ithin the brain, resear!hers ha(esu!!essfully e-perimented $ith ele!trodeimplantation in the brains =rodman rea : Resear!h is in its earliest sta"es

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sychological Models ofUnipolar Depression

#hree main models

Psy!hodynami! model

o stron" resear!h support

=eha(ioral model

)odest resear!h support

Co"niti(e (ie$s Considerable resear!h support

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Psy!hodynami! model 'in% bet$een depression and "rief

9hen a lo(ed one dies, an un!ons!ious pro!essbe"ins and the mourner re"resses to the oral sta"eand mer"es his or her identity $ith that of the lostperson, symboli!ally re"ainin" the lost person

For most people, this rea!tion is temporary

For some, "rief $orsens o(er time if "rief is se(ere andlon"2lastin", depression results

nstead of a!tual loss, some people e-perien!e0symboli!1 @or ima"inedA loss instead

e$er psy!hoanalysts @ob?e!t relations theoristsApropose that depression results $hen peoplesrelationships lea(e them feelin" unsafe and inse!ure

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Psy!hodynami! model

Studies ha(e o+ered "eneral support forthe psy!hodynami! idea that depression

may be tri""ered by a ma?or loss Resear!h supports the theory that early

losses set the sta"e for later depression

Ho$e(er, resear!h does not indi!ate thatloss is al$ays at the !ore of depression andnot all studies >nd e(iden!e bet$een!hildhood loss and later depression

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Psy!hodynami! treatment

Psy!hodynami! therapists use the same

basi! pro!edures for all psy!holo"i!aldisorders

Free asso!iation

#herapist interpretation

Re(ie$ of past e(ents and feelin"s

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Psy!hodynami! treatment

Despite su!!essful !ase reports, resear!hers ha(efound that lon"2term psy!hodynami! therapy is onlyo!!asionally helpful in !ases of unipolar depression

#$o features may be parti!ularly limitin"

Depressed !lients may be too passi(e or $eary to fullyparti!ipate in subtle therapy dis!ussions

Depressed !lients may be!ome dis!oura"ed and end

treatment too early $hen treatment is unable to pro(ideEui!% relief

Short2term approa!hes ha(e performed better thantraditional approa!hes

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=eha(ioral model Depression results from !han"es in re$ards

and punishments people re!ei(e in their

li(es 'e$insohn su""ests that the positi(e re$ards in

life d$indle for some people, leadin" them toperform fe$er and fe$er !sonstru!ti(e beha(iors,and they spiral to$ard depression

Resear!h supports the relationship bet$eenthe number of re$ards re!ei(ed and thepresen!e or absen!e of depression So!ial re$ards are espe!ially important

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=eha(ioral treatment

=eha(ioral therapists use a (ariety of

strate"ies to help in!rease the numberof re$ards e-perien!ed by their !lients

Reintrodu!e !lients to pleasurable a!ti(itiesand e(ents, often usin" a $ee%ly s!hedule

ppropriately reinfor!e their depressi(e andnondepressi(e beha(iors

Help them impro(e their so!ial s%ills

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=eha(ioral treatment

#he beha(ioral te!hniEues seem to be ofonly limited help $hen ?ust one of them isapplied

9hen t$o or more of the te!hniEues are!ombined, beha(ioral treatment does seem toredu!e depressi(e symptoms, parti!ularly if mild

t is $orth notin" that 'e$insohn himself has!ombined beha(ioral te!hniEues $ith !o"niti(estrate"ies in re!ent years

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Co"niti(e model

#$o main theories

'earned helplessness e"ati(e thin%in"

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Co"niti(e model

'earned helplessness

#his theory asserts that people be!omedepressed $hen they thin% that

#hey no lon"er ha(e !ontrol o(er thereinfor!ements @re$ards and punishmentsA intheir li(es

#hey themsel(es are responsible for this helplessstate

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Co"niti(e model


#heory is based on Seli"mans $or% $ith laboratory

do"s

Do"s sub?e!ted to un!ontrollable sho!% $ere later pla!edin a shuttle bo-

/(en $hen presented $ith an opportunity to es!ape,do"s that had e-perien!ed un!ontrollable sho!%s madeno attempt to do so

Seli"man theori*ed that the do"s had 0learned1 to be0helpless1 to do anythin" to !han"e ne"ati(e situations,and dre$ parallels to human depression

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Co"niti(e model


#here has been si"ni>!ant resear!h supportfor this model

Human sub?e!ts $ho under"o helplessnesstrainin" s!ore hi"her on depression sur(eys

nimal sub?e!ts lose interest in se- and so!iala!ti(ities

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sychological Models of


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Co"niti(e model 'earned helplessness

Re!ent (ersions of the theory fo!us on attributions

Internalattributions that are globaland stablelead to"reater feelin"s of helplessness and possibly depression

/-ample 0 am inadeEuate at e(erythin" and al$ays $ill be.1

f people ma%e other %inds of attributions, this rea!tionis unli%ely

/-ample 0She ne(er did %no$ $hat she $anted1Qe-ternal, but 0#he $ay (e beha(ed the past!ouple $ee%s ble$ this relationship1 Qspe!i>!. 0dont usually a!t li%e that1 Qunstable.

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Co"niti(e model


Some theorists ha(e re>ned thehelplessness model yet a"ain in re!entyears they su""est that attributions areli%ely to !ause depression only $hen theyfurther produ!e a sense of hopelessnessinan indi(idual

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Co"niti(e model


lthou"h this theory has been (eryinMuential, it has imperfe!tions

)u!h of the resear!h relies on animal sub?e!ts

#he attributional !omponent of the theory raises

parti!ularly di!ult Euestions, espe!ially in termsof animal models of depression

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Co"niti(e model

e"ati(e thin%in"

=e!% theori*es four interrelated !o"niti(e!omponents !ombine to produ!e unipolardepression

. )aladapti(e attitudes

Self2defeatin" attitudes are de(eloped durin"

!hildhood

=e!% su""ests that upsettin" situations later in life!an tri""er an e-tended round of ne"ati(e thin%in"

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Co"niti(e model

:. #his ne"ati(e thin%in" typi!ally ta%es

three forms, !alled the !o"niti(e triad ndi(iduals repeatedly interpret @A their

e-perien!es, @:A themsel(es, and @NA theirfutures in ne"ati(e $ays, leadin" to

depression

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Co"niti(e model

e"ati(e thin%in"

N. Depressed people also ma%e errors in their

thin%in", in!ludin"

rbitrary inferen!es

)inimi*ation of the positi(e and ma"ni>!ation of thene"ati(e

;. Depressed people also e-perien!e automati!thou"hts

steady train of unpleasant thou"hts that su""estinadeEua!y and hopelessness

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Co"niti(e model

)any studies ha(e produ!ed e(iden!e in

support of=e!%s e-planation

Hi"h !orrelation bet$een the le(el of depressionand the number of maladapti(e attitudes held

=oth the !o"niti(e triad and errors in lo"i! are

seen in people $ith depression utomati! thin%in" has been lin%ed to

depression

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Co"niti(e treatments

=e!%s !o"niti(e therapy L $hi!h in!ludes a numberof beha(ioral te!hniEues L is desi"ned to help!lients re!o"ni*e and !han"e their ne"ati(e

!o"niti(e pro!esses #his approa!h follo$s four phases and usually lasts

fe$er than :< sessions

Phases

. n!reasin" a!ti(ities and ele(atin" mood

:. Challen"in" automati! thou"hts

N. dentifyin" ne"ati(e thin%in" and biases

;. Chan"in" primary attitudes

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Co"niti(e treatments I(er the past se(eral de!ades, hundreds of

studies ha(e sho$n that !o"niti(e therapyhelps unipolar depression round


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The Socioc!lt!ral Model ofUnipolar Depression

So!io!ultural theorists propose thatunipolar depression is "reatly inMuen!edby the so!ial !onte-t that surrounds

people #his belief is supported by the >ndin" that

depression is often tri""ered by outsidestressors

#here are t$o %inds of so!io!ultural (ie$s #he family2so!ial perspe!ti(e

#he multi!ultural perspe!ti(e

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Psy!holo"y, 7e

The Socioc!lt!ral Model of


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#he Family2So!ial Perspe!ti(e #he belief in the !onne!tion bet$een de!linin"

so!ial re$ards and depression @as dis!ussedby the beha(ioristsA is !onsistent $ith theFamily2So!ial Perspe!ti(e Depression has been tied repeatedly to the

una(ailability of so!ial support People $ho are separated or di(or!ed display three

times the depression rate of married or $ido$ed persons

and double the rate of people $ho ha(e ne(er beenmarried

t also appears that people $ho are isolated and $ithoutintima!y are parti!ularly li%ely to be!ome depressed intimes of stress

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Family2So!ial #reatments

#herapists $ho use family and so!ialapproa!hes help depressed !lients!han"e their approa!h to !loserelationships in their li(es

#he most e+e!ti(e family2so!ial

approa!hes are interpersonalpsy!hotherapy and !ouple therapy

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nterpersonal therapy @P#A

#his model holds that four interpersonal

problems may lead to depression and must beaddressed

nterpersonal loss

nterpersonal role dispute

nterpersonal role transition nterpersonal de>!its

Studies su""est that P# is as e+e!ti(e as!o"niti(e therapy for treatin" depression

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Couple therapy

#he main type of !ouple therapy isbeha(ioral marital therapy @=)#A

Fo!us is on de(elopin" spe!i>! !ommuni!ationand problem2sol(in" s%ills

f marria"e is >lled $ith !onMi!t, =)# is ase+e!ti(e as other therapies for redu!in"depression

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#he )ulti!ultural Perspe!ti(e

#$o issues ha(e !aptured the interest ofmulti!ultural theorists

Bender and depression

stron" lin% e-ists bet$een "ender anddepression

9omen !ross2!ulturally are t$i!e as li%ely as mento re!ei(e a dia"nosis of unipolar depression

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(ariety of theories has been o+ered

#he artifact theory holds that $omen and menare eEually prone to depression, but that!lini!ians often fail to dete!t depression in men

#he hormone explanation holds that hormone!han"es tri""er depression in many $omen

#he life stress theory su""ests that $omen inour so!iety e-perien!e more stress than men

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#he body dissatisfaction explanation states that

females in 9estern so!iety are tau"ht, almostfrom birth, to see% a lo$ body $ei"ht andslender body shape L "oals that areunreasonable, unhealthy, and often unattainable

#he lack-of-control theory pi!%s up the learnedhelplessness resear!h and ar"ues that $omenmay be more prone to depression be!ause theyfeel less !ontrol than men o(er their li(es

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#he rumination theory holds that people$ho ruminate $hen sad L %eep fo!usin" ontheir feelin"s and repeatedly !onsider the!auses and !onseEuen!es of theirdepression L are more li%ely to be!omedepressed and stay depressed lon"er

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/a!h e-planation o+ers food for thou"htand has "athered ?ust enou"hsupportin" e(iden!e to ma%e itinterestin" @and ?ust enou"h !ontrarye(iden!e to raise Euestion about its

usefulnessA

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#$o issues ha(e !aptured the interest ofmulti!ultural theorists

Cultural ba!%"round and depression

Depression is a $orld$ide phenomenon, and!ertain symptoms seem to be !onstant a!ross all!ountries, in!ludin" sadness, ?oylessness, an-iety,tension, la!% of ener"y, loss of interest, and

thou"hts of sui!ide

=eyond su!h !ore symptoms, resear!h su""eststhat the pre!ise pi!ture of depression (aries from!ountry to !ountry

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Depressed people in non29estern!ountries are more li%ely to be troubledby physi!al symptoms of depressionthan by !o"niti(e ones

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#he )ulti!ultural Perspe!ti(e 9ithin the 5nited States, resear!hers ha(e

found fe$ di+eren!es in depression symptomsamon" members of di+erent ethni! or ra!ial

"roups or amon" o(erall rates of depression Ho$e(er, often stri%in" di+eren!es e-ist

bet$een ra!ialethni! "roups in the recurrenceof depression

Hispani! meri!ans and fri!an meri!ans are ndin" possibly related tolimited treatment opportunities

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Resear!h also has re(ealed thatdepression is distributed une(enly$ithin some minority "roups

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)ulti!ultural treatments

Culture2sensiti(e see% to address theuniEue issues fa!ed by members of!ultural minority "roups

#hey in!lude spe!ial !ultural trainin" oftherapists, hei"htened a$areness of !ultural(alues, stressors, and pre?udi!es fa!ed by!lients, and e+orts by therapists to help!lients re!o"ni*e the impa!t of !ulture ontheir self2(ie$s

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)ulti!ultural treatments

Culture2sensiti(e approa!hesin!reasin"ly are bein" !ombined $ithtraditional forms of psy!hotherapy tohelp impro(e the li%elihood of minority!lients o(er!omin" their disorders

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Bi l Di d


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Bipolar Disorders

People $ith a bipolar disordere-perien!e both the lo$s ofdepression and the hi"hs of mania

)any des!ribe their li(es as anemotional roller !oaster

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What Are the Symptoms ofMania?

5nli%e those e-perien!in" depression, peoplein a state of mania typi!ally e-perien!edramati! and inappropriate rises in mood anda!ti(ity

Fi(e main areas of fun!tionin" may be a+e!ted

/motional symptoms

!ti(e, po$erful emotions in sear!h of outlet

)oti(ational symptoms eed for !onstant e-!itement, in(ol(ement,

!ompanionship

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What Are the Symptoms ofMania?

Fi(e main areas of fun!tionin" may bea+e!ted

=eha(ioral symptoms

Oery a!ti(e L mo(e Eui!%ly tal% loudly or rapidly Flamboyan!e is not un!ommon

Co"niti(e symptoms

Sho$ poor ?ud"ment or plannin"

)ay ha(e trouble remainin" !oherent or in tou!h $ith reality

Physi!al symptoms

Hi"h ener"y le(el L often in the presen!e of little or norest

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ag os g po aDisorders

People are !onsidered to be in a fullmanic episode $hen, for at least one$ee%, they display an abnormally hi"h or

irritable mood, in!reased a!ti(ity orener"y, and at least three othersymptoms of mania

n e-treme !ases, symptoms are psy!hoti!

9hen symptoms are less se(ere, theperson is said to be e-perien!in" ahypomanic episode

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g g pDisorders

DS)2 distin"uishes t$o %inds ofbipolar disorder

=ipolar disorder

Full mani! and ma?or depressi(e episodes

)ost e-perien!e an alternation of episodes

Some ha(e mi-ed episodes

=ipolar disorder Hypomani! episodes alternate $ith ma?or

depressi(e episodes

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g g pDisorders

9ithout treatment, mood episodestend to re!ur for people $ith eithertype of bipolar disorder

f people e-perien!e four or moreepisodes $ithin a one2year period, theirdisorder is further !lassi>ed as rapid

cycling

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g g pDisorders

=et$een 4 and :.64 of all adults inthe $orld su+er from a bipolardisorder at any "i(en time

#he disorders are eEually !ommon in$omen and men

#he disorders are more !ommonamon" people $ith lo$ in!omes thanthose $ith hi"h in!omes

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g g pDisorders

Inset usually o!!urs bet$een thea"es of and ;; years

n most untreated !ases, the mani! anddepressi(e episodes e(entually subside,only to re!ur at a later time

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g g pDisorders

9hen a person e-perien!es numerousperiods of hypomani! symptoms andmild depression, DS)2 assi"ns a

dia"nosis of !y!lothymi! disorder Symptoms !ontinue for t$o or more years,

interrupted by periods of normal mood

#he disorder usually be"ins in adoles!en!e

and a+e!ts at least


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pDisorders?

#hrou"hout the >rst half of the :


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pDisorders?

eurotransmitters

fter >ndin" a relationship bet$een lo$norepinephrine and unipolar depression,early resear!hers e-pe!ted to >nd a lin%bet$een hi"h norepinephrine le(els andmania

#his theory is supported by some resear!hstudies bipolar disorders may be related too(era!ti(ity of norepinephrine

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What Ca!ses Bipolar


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pDisorders?

eurotransmitters

=e!ause serotonin a!ti(ity oftenparallels norepinephrine a!ti(ity inunipolar depression, theorists e-pe!tedthat mania $ould also be related to hi"hserotonin a!ti(ity

lthou"h no relationship $ith hi"h serotoninhas been found, bipolar disorder may belin%ed to lowserotonin a!ti(ityG

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pDisorders?

eurotransmitters

#his apparent !ontradi!tion is addressedby the 0permissi(e theory1 about mood

disorders

'o$ serotonin may 0open the door1 to a mooddisorder andpermitnorepinephrine a!ti(ity tode>ne the parti!ular form the disorder $ill

ta%e 'o$ serotonin 'o$ norepinephrine Depression

'o$ serotonin Hi"h norepinephrine )ania

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pDisorders?

on a!ti(ity

ons, $hi!h are needed to send in!omin"messa"es to ner(e endin"s, may beimproperly transported throu"h the !ellsof indi(iduals $ith bipolar disorder

Some theorists belie(e that irre"ularities

in the transport of these ions may !auseneurons to >re too easily @maniaA or tostubbornly resist >rin" @depressionA

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pDisorders?

=rain stru!ture

=rain ima"in" and postmortem studiesha(e identi>ed a number of abnormalbrain stru!tures in people $ith bipolardisorder in parti!ular, the basal "an"liaand !erebellum amon" others

t is not !lear $hat role su!h stru!turalabnormalities play

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Disorders?

Beneti! fa!tors

)any theorists belie(e that peopleinherit a biolo"i!al predisposition tode(elop bipolar disorders

Family pedi"ree studies support this theory

denti!al @)A t$ins ;


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Disorders?

Beneti! fa!tors

Resear!hers ha(e !ondu!ted genetic linkagestudies to identify possible patterns of

inheritan!e Ither resear!hers are usin" te!hniEues from

mole!ular biolo"y to further e-amine "eneti!patterns in lar"e families

Su!h $ide2ran"in" >ndin"s su""est that anumber of "eneti! abnormalities probably!ombine to help brin" about bipolar disorders

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Disorder

5ntil the latter part of the :


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Disorder" #ithi!m and $therMood Sta%ili&ers

#he use of lithium @a metalli!element naturally o!!urrin" asmineral saltA and other mood2

stabili*ers has dramati!ally !han"edthis pi!ture

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Treatments for BipolarDisorder" #ithi!m and $ther


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ll manner of resear!h has attested to thee+e!ti(eness of lithium and other moodstabili*ers in treatin" mani! episodes

)ore than 6


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Resear!hers do not fully understand ho$mood stabili*in" dru"s operate #hey suspe!t that the dru"s !han"e

synapti! a!ti(ity in neurons, but in adi+erent $ay from that of antidepressantdru"s lthou"h antidepressant dru"s a+e!t a neurons

initial re!eption on #s, mood stabili*ers seem toa+e!t a neurons se!ond messen"ers

#hese dru"s also in!rease the produ!tion ofneuroprote!ti(e proteins, $hi!h mayde!rease bipolar symptoms

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Treatments for BipolarDisorder" Ad'!ncti(e


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Disorder" Ad'!ncti(esychotherapy

Psy!hotherapy alone is rarely helpful forpersons $ith bipolar disorder

)ood stabili*in" dru"s alone are also

not al$ays su!ient N


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Disorder" Ad'!ncti(esychotherapy

#herapy fo!uses on medi!ationmana"ement, so!ial s%ills, andrelationship issues

Fe$ !ontrolled studies ha(e tested thee+e!ti(eness of su!h ad?un!ti(e therapy

Bro$in" resear!h su""ests that it helpsredu!e hospitali*ation, impro(es so!ialfun!tionin", and in!reases !lients ability toobtain and hold a ?ob

Documents

Disorders of Mood Lecture Slides PSYCH 255