chapter six Depressive and Bipolar Disorders Disorders of Mood There are two key emotions in mood disorders DEPRESSION Low, sad state in which life seems dark and its challenges overwhelming MANIA State of breathless euphoria or frenzied energy
Disorders of Mood Mood problems have always captured interest and impacted on many across time, culture, and situations UNIPOLAR DEPRESSION Only depression No history of mania Normal mood when depression lifts BIPOLAR DISORDERS Periods of mania alternate with periods of depression Unipolar Depression Definition
Prevalence Recovery What Are the Symptoms of Depression? Five main areas of affected functioning Emotional symptoms Motivational symptoms Behavioral symptoms
Cognitive symptoms Physical symptoms Symptoms may vary from person to person Diagnosing Unipolar Depression: DSM-5 MAJOR DEPRESSIVE DISORDER
Major Depressive Episode 1. For a 2-week period, person displays an increase in depressed mood for the majority of each day and/or a decrease in enjoyment or interest across most activities for the majority of each day. 2. For the same 2 weeks, person also experiences at least three or four of the following symptoms:
Considerable weight change or appetite change Daily insomnia or hypersomnia Daily agitation or decrease in motor activity Daily fatigue or lethargy Daily feelings of worthlessness or excessive guilt Daily reduction in concentration or decisiveness Repeated focus on death or suicide, a suicide plan, or a suicide attempt 3. Significant distress or impairment Dx Checklist Major Depressive Disorder 1. Presence of a major depressive episode 2. No pattern of mania or hypomania.
Persistent Depressive Disorder Person experiences the symptoms of Major Depressive Disorder or Dysthymic Disorder for at least 2 years. During the 2-year period, symptoms not absent for more than 2 months at a time. No history of mania or hypomania. Significant distress or impairment. Stress and Unipolar Depression Stress may be a trigger for depression Greater number of stressful life events during the month just before symptom onset
Reactive (exogenous) depression Endogenous depression Comparing Disorders of Mood Typical Age at Onset (Years) Prevalence Among FirstDegree Relatives Percentage Currently Receiving
Treatment 2:1 2429 Elevated 50.00% 1.55.0% Between 3:2 and 2:1
1025 Elevated 36.80% Bipolar I disorder 1.60% 1:1
1544 Elevated 33.80% Bipolar II disorder 1.00% 1:1 1544
Prevalence (Percent) Female-toMale Ratio 8.00% PSYCH WATCH SADNESS AT THE HAPPIEST OF TIMES For between 10 and 30 percent of new mothers, the weeks and months after childbirth bring clinical depression Postpartum depression Symptoms typically begin within 4 weeks and may last up to a year and
include extreme sadness, despair, tearfulness, insomnia, anxiety, intrusive thoughts, compulsions, panic attacks, feelings of inability to cope, and suicidal thoughts Cause Hormonal changes accompanying childbirth Psychological and sociological changes Treatment Self-help support group; antidepressants, cognitive therapy, interpersonal
psychotherapy, or combinations of these THE BIOLOGICAL MODEL OF UNIPOLAR DEPRESSION Immune system Anatomical Genetic Biochemical Research findings suggest that unipolar depression has
biological causes What Are the Biological Treatments for Unipolar Depression? ELECTROCONVULSIVE THERAPY (ECT) One of the most controversial forms of treatment Targeted electrical stimulation causes brain seizure Effective in unipolar treatment, especially severe
depression with delusions ECT today Today, patients are given drugs to help them sleep, muscle relaxants to prevent severe jerks of the body and broken bones, and oxygen to guard against brain damage. What Are the Biological Treatments for Unipolar Depression? Antidepressant drugs MAO inhibitors Tricyclics
Second-generation antidepressants Antidepressant drugs do not work for everyone Even the most successful ones fail to help at least 35 percent of clients with depression What Are the Biological Treatments for Unipolar Depression? Antidepressant drugs In the 1950s, two kinds of drugs were found to reduce the symptoms of depression MONOAMINE OXIDASE INHIBITORS (MAO INHIBITORS) TRICYCLICS
These drugs have been joined in recent years by a third group (Second-generation antidepressants) SELECTIVE SEROTONIN INHIBITORS (SSRIs) What Are the Biological Treatments for Unipolar Depression? Brain stimulation In recent years, three additional biological approaches have been developed VAGUS NERVE STIMULATION TRANSCRANIAL MAGNETIC STIMULATION DEEP BRAIN STIMULATION THE PSYCHOLOGICAL
MODELS OF UNIPOLAR DEPRESSION Cognitive Learned helplessness Negative thinking Psychodynamic Symbolic or imagined loss Behavioral Rewards
Varying levels of research support for each model. Psychological Models of Unipolar Depression Psychodynamic treatment Psychodynamic therapists use the same basic procedures for all psychological disorders Free association Therapist interpretation Review of past events and feelings Psychological Models of Unipolar
Depression Behavioral treatment Behavioral therapists use a variety of strategies to help increase the number of rewards experienced by their clients 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 Psychological Models of Unipolar Depression Behavioral treatment
The behavioral techniques seem to be of only limited help when just one of them is applied When two or more of the techniques are combined, behavioral treatment may reduce depressive symptoms, particularly if mild Lewinsohn has combined behavioral techniques with cognitive strategies in recent years Psychological Models of Unipolar Depression Cognitive treatment Many studies have produced evidence in support of Becks explanation High correlation between the level of depression
and the number of maladaptive attitudes held Both the cognitive triad and errors in logic are seen in people with depression Automatic thinking has been linked to depression Psychological Models of Unipolar Depression Cognitive treatments: BECKS COGNITIVE THERAPY Includes a number of behavioral techniques is designed to help clients recognize and change their negative cognitive processes Follows four phases and usually lasts fewer than 20 sessions
Increasing activities and elevating mood Challenging automatic thoughts Identifying negative thinking and biases Changing primary attitudes THE SOCIOCULTURAL MODELS OF UNIPOLAR DEPRESSION
Multicultural Rewards Variety of theories offered Family-social Symbolic or imagined loss Varying levels of research support for each model. The Sociocultural Model of Unipolar Depression Family-Social Treatments 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
The Sociocultural Model of Unipolar Depression Family-Social Treatments Depressed clients helped to change their approach to close relationships in their lives The most effective family-social approaches are INTERPERSONAL PSYCHOTHERAPY and COUPLE THERAPY The Sociocultural Model of Unipolar Depression Family-Social Treatments 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 filled with conflict, BMT is as effective as other therapies for reducing depression The Sociocultural Model of Unipolar Depression Multicultural perspective Issues related to gender and depression have captured the interest of multicultural theorists Women cross-culturally are twice as likely as men to receive a diagnosis of unipolar depression
A variety of theories has been offered Artifact theory Hormone explanation Life stress theory Body dissatisfaction theory Lack-of-control theory
Rumination theory The Sociocultural Model of Unipolar Depression The multicultural perspective: 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 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 Sociocultural Model of Unipolar Depression The multicultural perspective: Ethnic or racial differences Within the United States, researchers have found few differences in depression symptoms among members of different ethnic or racial groups or among overall rates of depression Often striking differences exist between racial/ethnic groups in the recurrence of depression Depression is distributed unevenly within some minority groups
The Sociocultural Model of Unipolar Depression Multicultural treatments Culture-sensitive clinicians seek to address the unique issues faced by members of cultural minority groups Special cultural training of therapists heightened awareness Culture-sensitive approaches increasingly are being combined with traditional forms of psychotherapy to help improve the likelihood of minority clients overcoming their disorders
Bipolar Disorders Symptoms of mania People in a state of mania typically experience dramatic and inappropriate rises in mood and activity Five main areas of functioning may be affected Emotional symptoms Motivational symptoms Behavioral symptoms Cognitive symptoms Physical symptoms Dx Checklist Manic Episode
For 1 week or more, person displays a continually abnormal, inflated, unrestrained, or irritable mood as well as continually heightened energy or activity, for most of every day. Person also experiences at least three of the following symptoms:
grandiosity or overblown self-esteem reduced sleep need increased talkativeness, or drive to continue talking rapidly shifting ideas or the sense that ones thoughts are moving very fast attention pulled in many directions heightened activity or agitated movements excessive pursuit of risky and potentially problematic activities Significant distress or impairment.
Bipolar I Disorder Occurrence of a manic episode Hypomanic or major depressive episodes may precede or follow the manic episode Bipolar II Disorder Presence or history of major depressive episode(s) Presence or history of hypomanic episode(s) No history of a manic episode
Diagnosing Bipolar Disorders Kinds of bipolar disorders (DSM-5) BIPOLAR I DISORDER BIPOLAR II DISORDER Diagnosing Bipolar Disorders Symptoms MANIC EPISODE HYPOMANIC EPISODE CYCLOTHYMIC DISORDER Recurrence RAPID CYCLING
Prevalence and onset PSYCH WATCH ABNORMALITY AND CREATIVITY: A DELICATE BALANCE Why might creative people be prone to psychological disorders? Predisposition before careers begin or family history of psychological problems Welcoming climate for psychological disturbances in creative professions Research findings Psychological disturbance is not requirement for creativity
Mild psychological disturbances relate to creative achievement much more strongly than severe disturbances do Successful treatment for severe disorders more often improves (rather than hinders) the creative process What Causes Bipolar Disorders? Research insights into cause come from a variety of sources Neurotransmitters Ion activity Brain structure Genetic factors Treatments for Bipolar Disorder
Until the latter part of the twentieth century Psychotherapists reported almost no success Antidepressant drugs were of limited help and sometimes triggered manic episodes In 1970 Use of LITHIUM was approved; followed by introduction of mood stabilizing drugs Treatments for Bipolar Disorder: Lithium and Other Mood Stabilizers Significant body of research to the effectiveness of lithium and other mood stabilizers in treating manic episodes
Provides improvement for 60 percent of patients with mania Contributes fewer new episodes while patient is on the drug Aids in overcoming depressive episodes to a lesser degree Researchers do not fully understand how mood stabilizing drugs operate Treatments for Bipolar Disorder: Adjunctive Psychotherapy Psychotherapy alone is rarely helpful for persons with bipolar disorder
Mood stabilizing drugs alone are also not always effective As a result, clinicians often use psychotherapy as an ADJUNCT to lithium or other medication-based therapy Treatments for Bipolar Disorder: Adjunctive Psychotherapy ADJUNCTIVE THERAPY Focuses on medication management, social skills, and relationship issues Growing research suggests that it helps reduce hospitalization, improves social
functioning, and increases clients ability to obtain and hold a job Few controlled studies have tested the effectiveness of this therapy
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