PSYC 316 Book Notes Chapter 6
PSYC 316 Book Notes Chapter 6 PSYC 316
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Date Created: 10/02/15
Chapter 6 Disorders of Mood Depression sadness lack of interest and pleasure in activities that once were enjoyable signi cant weight loss gain insomniaexcessive sleeping lack of energy inability to concentrate feelings of worthlessness excessive guilt recurrent thoughts of deathdying possible suicide Mania abnormal and persistent elevated expansive or irritable mood To be considered a Manic Episode the period of abnormal mood would have to last at least a week Depressive Disorders persistent feelings of sadness and worthlessness lack of desire to participate in activities that once brought pleasure to the individual Unipolar Depression any mood disorder characterized by at least one major depressive episode or an extended period of time including depressive symptoms Does NOT include manic symptoms Bipolar Disorders ManicDepressive illness severe mood swings or a combination of depression anxiety and highenergy phases of delusion Manic Episodes 1 Unipolar Depression The Depressive Disorders A How Common is Unipolar Depression 1 Around 8 of US adults are suffering from a severe unipolar pattern of depression in any given year a 5 suffer from mild forms 2 Around 19 of all adults will experience a severe unipolar depressive episode at some point throughout their lives 3 Woman are twice as likely as men to experience severe unipolar depressive episodes a Up to 26 of women may experience an episode b 12 of men may experience an episode 4 85 of individuals with unipolar depression recover Some recover without treatment a 40 of these individuals experience at least one additional episode later in their lives B What Are the Symptoms of Depression 1 Emotional Svmntoms sadness dejection misery emptiness feelings of humiliation sometimes anger anxiety or agitation a Anhedonia inability to experience any pleasure 2 Motivational Svmntoms loss of initiative spontaneity and the drive to participate in daily activities losing interest in life 3 Behavioral Svmntoms lethargy decreased activity less productive 4 Cognitive Svmptoms holding negative views of themselves feelings of inadequacy undesirability inferiority selfblame pessimism helplessness hopelessness confusion memory problems easily distracted Physical Symptoms headaches indigestion constipation dizzy spells general pain decreased appetite sleep problems increased or decreased sleep fatigue C Diagnosing Unipolar Depression Maior Depressive Episode a period of 2 or more weeks characterized by at least 5 symptoms of l depression Some episodes may include psychotic symptoms a b Delusions loss of contact with reality Hallucinations perceiving things not actually present Depressive Disorders 3 b C d 6 Major Depressive Disorder diagnosis given to individuals who eXperience a major depressive episode without having any history of mania Persistent Depressive Disorder pattern of unipolar depression that lasts at least 2 years Dvsthvmic Disorder a form of persistent depressive disorder with less disabling symptoms Premenstrual Dysphoric Disorder repeated eXperiences of clinically signi cant depressive and related symptoms that occur the week before menstruation Disruptive Mood Dvsregulation Disorder persistent depressive symptoms and recurrent outbursts of severe temper D Stress and Unipolar Depression 1 Reactive Depression depression that follows a stressful event 2 Endoeenous Depression response to internal factors E The Biological Model of Unipolar Depression Genetic Factors Unipolar depression seems to have biological causes genetic biochemical l anatomical immune system studies support this belief 3 b Family Pedigree Studies individuals with unipolar depression their relatives are also examined to see whether depression is af icting other family members If an individual develops a predisposition to unipolar depression the individual s relatives would have a higher rate of depression than the rest of the general population Twin Studies 1 Identical Twins monozygotic if one twin has unipolar depression the other twin has a 46 chance of developing the disorder 2 Fraternal Twins dizygotic if one twin has unipolar depression the other has a 20 chance of developing the disorder 2 Biochemical Factors a Norepinephrine and Serotonin two neurotransmitter chemicals that have been strongly linked to unipolar depression b Endocrine Glands release hormones that affect the organs of the body Abnormally high levels of Cortisol a hormone released by the adrenal glands in response to stress in individuals with unipolar depression c Melatonin is also related to depression It is a hormone that released only in the dark 1 Seasonal Affective Disorder some individuals may experience recurrences of depression each winter when melatonin is secreted more during the long winter nights d Brain Activity certain neurotransmitters or hormones may lead to certain chemical and protein de ciencies which may impair neuronal health and lead to depression 1 Analogue Studies depressionlike symptoms are induced in laboratory animals Results have been inconclusive in determining whether or not the symptoms will re ect similarly in humans Due to improvements in technology it is now possible to more accurately measure brain biochemical activity 0 Links for Further Understanding 3 Brain Anatomv and Brain Circuits a Circuits networks of brain structures that work together trigger each other and produce particular emotional reactions Some research suggests that brain circuits can be responsible for unipolar depression b min Areas in Depressed Individuals 1 Prefrontal Cortex low activity and blood ow 2 Hippocampus may be undersized and low neuron productivity 3 Amygdala high activity and blood ow 4 Brodmann Area 25 undersized and overactive 4 Immune Svstem the body s cleanup system fights bacteria viruses foreign invaders etc Some studies suggest that a dysregulated immune system may play a part in an individual s development of depression a Immune Svstems In Depressed Individuals under extreme stress the immune system may become dysregulated which leads to lower functioning of Lymphocytes important white blood cells and increased production of CReactive Protein causes in ammation and various illnesses 5 What are the Bioloaical Treatments for Unipolar Depression a Electroconvulsive Therapy induced brain seizure lasting from anywhere between 25 seconds to a few minutes 612 treatments over 24 weeks Most patients report feeling less depressed b d 1 Early Techniques eventually found to be dangerous and even deadly techniques included a Metrazol i httpwwwfairfieldstatehospitalcommetrazolhtml b Insulin Coma Therapy i httpwwwpbsorgwgbhameXnash lmmorepsicthtml 2 To minimize convulsions practitioners give patients muscle relaxants or anesthetics to reduce potential harm or fear to the individual receiving the treatment Antidepressant Drugs while they are popular antidepressant drugs do not help everyone 35 of clients are not helped by antidepressants 1 How do Antidepressants Work a httpswwwyoutubecomwatchvG4r3quLUDQ 2 Monoamine OXidase Inhibitors MAOIs slows the body s production of the enzyme monoamine oxidase which breaks down norepinephrine This results in increased norepinephrine activity and thus a reduction in depressive symptoms Secondgeneration antidepressants are preferred 1 harder to overdose 2 do not require patients to have dietary restrictions 3 However those taking the new antidepressants have eXperienced weight gain and a reduced seX drive a MAOI Caution individuals taking MAOIs eXperience dangerously high blood pressure if they eat foods that contains tyramine How Do SSRls and MAOls Work 1 httpswwwyoutubecomwatchvm4PXHqunmE 2 Tricyclics threering molecular structure a Tricyclics reduce depression by acting on neurotransmitter reuptake mechanisms blocking reuptake processes which causes an increase in neurotransmitter activity b Up to 6065 of patients who take tricyclics have improved c Maintenance T herapy keeping a patient on the medication for at least ve months after being free of depressive symptoms 3 Selective Serotonin Reuptake Inhibitors SSRIs increase serotonin activity without affecting other neurotransmitters like norepinephrine Brain Stimulation l Vagus Nerve Stimulation pacemakerlike device is implanted under the skin of a patient s chest the device s wire attaches to the vagus nerve This nerve runs from the brainstem through the neck down the chest and to the abdomen Electrical signals stimulate the vagus nerve which sends signals to the brain areas believed to be involved in mood regulation a How Does Vagus Nerve Stimulation Work i httpswwwyoutubecomwatchvGthGwa3A 2 Transcranial Magnetic Stimulation TMS electromagnetic coils above or on a patient s head sends a current to the prefrontal cortex the area of the brain that is under active in depressed patients This treatment seems to increase neuron activity and has been successful in reducing depression when administered daily for two to four weeks a How Does TMS Work i httpswwwyoutubecomwatchvHTvZdjHQkE 3 Deep Brain Stimulation DBS electrodes are placed in Brodmann Area 25 and connected to a battery in the patient s chest or stomach Electrodes send lowvoltage electricity to the area in the hopes of reducing Area 25 activity to a normal level to recalibrate brain circuits associated with depression a How Does DBS Work i httpswwwyoutubecomwatchvJkOTGTdCXgQ F Psychological Models of Unipolar Depression 1 The Psychodynamic Model a Psvchodvnamic Explanations rst psychodynamic explanations and treatments were developed by Sigmund Freud and his student Karl Abraham 1 These two theorists made connections between depressed individuals and others that recently lost a loved one Mourners were believed to regress to the oral stage of development causing them to merge their identity with the one they have lost For some the reaction is temporary for others the grief may worsen and lead to depression 2 Symbolic or Imagined Loss an individual equates the loss of a loved one with other events that may have nothing to do with the loss a Object Relations T hearists psychodynamic theorists who believe that depression stems from situations in which an individual s relationships leave them feeling insecure or unsafe b What are the Psychodynamic Treatments for Unipolar Depression clinicians encourage clients to free associate in therapy suggest interpretations of the client s dreams associations displays of resistance and transference help the client review their emotions I Some researchers have found that longterm psychodynamic therapy is only somewhat helpful for unipolar depression Depressed clients may be too passive and weary to fully participate in therapy they may also feel discourage and stop treatment too early 2 The Behavioral Model a The Behavioral Explanation 1 Some behaviorists have found that the prevalence of depression is linked to positive life events awards Depressed individuals report having fewer positive rewards but when they begin to receive more awards their mood improves a Social rewards are especially important depressed individuals experience fewer social rewards and that as their mood increases their social rewards increase b What are the Behavioral Treatments for Unipolar Depression l Therapist recommends activities that the client nds pleasurable and suggests the client to schedule times to engage in the activities 2 Therapist ensures that the client s behaviors are rewarded properly as they engage in their pleasurable activities 3 Behavioral system helps clients work with effective social skills 3 The Coqnitive Model unipolar depression sufferers view life events in negative ways that lead to their depression a b Theorv of Learned Helplessness theory developed by Seligman Individuals become depressed when they believe that they have no control over their rewards and punishments and that they are responsible for their helplessness l Seligman s Shuttle Box Dogs were strapped to an apparatus upon which they experienced shocks regardless of their behavior Each dog was then placed in a shuttle box divided by a short barrier over which the dog could jump Shocks were applied to the dog in the box who were expected to jump to the other side of the box but most gave up and accepted the shock a AttributionHelplessness Theory individuals believe that their events are beyond their control i Global and Stable Internal Cause I am unsuccessful at everything global and I always will be stable and its my fault internal Theorv of Negative Thinking Aaron Beck believes that unipolar depression stems from negative thinking maladaptive attitudes a cognitive triad errors in thinking and automatic thoughts 1 Maladaptive Attitudes failure leads to negative thinkingselfimage 2 Cognitive Triad negatively interpreting three forms a an individual s experiences b themselves c their futures 3 Arbitrary Inferences Negative conclusions supported by little evidence a minimizing significance of positive experiences b magnifying significance of negative experiences 4 Automatic Thoughts depressed individual experiences constant unpleasant thoughts that suggest that they are inadequate and hopeless a Ruminative Responses repeatedly dwelling on the individual s mood without attempting to change it What are the Cognitive Treatments for Unipolar Depression developed by Beck 1 Phase 1 Increasing Activities and Elevating Mood a Cognitive treatment with behavioral techniques encouraging clients to build their confidence and become more active With increased activity the individual s mood is expected to improve 2 Phase 2 Challenging Automatic Thoughts a After client becomes more active and their mood improves they are educated about and instructed to recognize and record their negative automatic thoughts 3 Phase 3 Identifying Negative Thinking and Biases a Client begins to recognize their faulty automatic thinking Therapist shows them how illogical thinking processes contribute to their automatic thoughts and guides the client to understand that they have a negative perspective of almost all their interpretations of events 4 Phase 4 Changing Primary Attitudes a therapist helps client modify their maladaptive attitudes by encouraging clients to challenge their old ways d Acceptance and Commitment Therapy ACT 4 The Sociocultural Model of Unipolar Depression a The FamilySocial Perspective a decline in social rewards is important in the development of depression 1 The development of depression is linked to the absence of social support 2 Individuals whose lives are isolated and lacking in intimacy are more likely to develop depressive symptoms 3 Depressed individuals lacking social support remain depressed longer than the individuals with supportive spouses or friends b FamilySocial Treatments 1 Interpersonal Psychotherapy any four interpersonal problems may lead to depression a Interpersonal Loss loss of a loved one therapist guides patient to eXplore their relationship with the lost loved one encourages the client to eXpress any discovered feelings b Interpersonal Role Dispute two people have different explanations of the role they play in their relationship Therapist helps clients analyze and resolve the disagreements c Interpersonal Role Transition individual feels overwhelmed by the role changes they may experience due to major life events Therapists help the individual learn better social skills required by the new role d Interpersonal Deficits social awkwardness or shyness that prevents an individual from developing and maintaining an intimate relationship Therapist helps the client understand their deficits and guides them to learn better social skills to improve the quality of their relationships 2 Couple Therapy a Behavioral Marital T lzerapy helps couples change their hurtful behaviors through better communication and problemsolving c The Multicultural Perspective 1 Gender and Depression a Artifact Theory women and men are equally prone to depression but clinicians frequently to recognize depression in men who tend to hide their symptoms women display more emotional symptoms than men However research shows that men and women are just as willing to show their depressive symptoms and seek treatment b Hormone Explanation hormone changes trigger depression in many women whose lives are full of frequent hormone level changes Research shows that hormone changes are not solely to blame for the high levels of depression in women c Life Stress Theory women in our society eXperience more stress than men facing more poverty more menial jobs less adequate housing and more discrimination all factors have been linked to depression d Body Dissatisfaction Explanation women in western society learn about the ideal concepts of beauty low body weight slender skinny appearance while the male standards of beauty are less strict and not as unhealthy As young girls approach adolescence they eXperience more peer pressure and extreme dissatisfaction which leads to depression e LackofControl T heory women seem to be more prone to depression because they feel that they have less control over their lives Women are more likely to be victimized This causes a sense of helplessness and an increase in depression symptoms f Rumination Theory women are more likely to ruminate focusing on one s feelings when depressed and consider its causes and consequences when they feel sad making women more vulnerable to the development of depression 2 Cultural Background and Depression Core symptoms sadness joylessness tension lack of energy loss of interest loss of concentration feelings of insufficiency thoughts of suicide remain constant across countries but other aspects may vary a Non Western Depression individuals living in places like China and Nigeria are less bothered by physical symptoms but more affected by cognitive symptoms selfblame low selfesteem guilt d MulticulturalTreatments l CultureSensitive Approaches are combined with traditional forms of psychotherapy to increase the likelihood of improvement in minority clients 2 CognitiveBehavioral Therapy also focuses on the client s economic struggles their identity as part of a minority group and other related cultural issues a Studies have indicated that Hispanic American African American American Indian and Asian American clients are more successful in overcoming their depressive disorders when their psychotherapy is combined with a culturesensitive focus II Bipolar Disorders A What Are the Symptoms Of Mania extreme and inappropriate spikes in mood and activity 1 2 Emotional individual may experience extreme emotions such as euphoria or irritability and anger Motivational drive to nd excitement involvement companionship frequently unaware that they are acting inappropriately or overwhelmingly Behavioral highly active with quick movements rapid and loud speech humorous while others complain and have verbal outbursts Some may dress in attentiondrawing clothing give money away to strangers and participate in dangerous activities Cognitive poor judgement and planning overconfident optimistic higher selfesteem Physical more energetic feeling wide awake without having much sleep a What Does Mania Look Like 1 httpswwwyoutubecomwatchvKtHXquXy3w B Diagnosing Bipolar Disorders a Manic Episode abnormally high or irritable mood increased activity or energy and at least three additional symptoms of mania duration of symptoms last for at least one week b Hypomanic Episode symptoms of mania that are less severe and causes little impairment Bipolar I Disorder individual experiences full manic and depressive episodes most experience alterations switching between mania and depression some may have mixed episodes displaying both manic and depressive symptoms at the same time Bipolar II Disorder alternation between hypomanic and depressive symptoms a Rapid Cycling at least four mood episodes within one year Survev Results Between 1 and 26 of adults all over the world may suffer from bipolar disorder at some point in their lives Men and women are equally likely to develop a bipolar disorder This disorder is more common among people with low incomes than those with higher Onset occurs between 1544 years of age Cvclothvmic Disorder diagnosis given when the individual experiences multiple periods of hypomanic and mild depressive symptoms What Does Bipolar Disorder Look Like a httpswwwyoutubecomwatchvZleHkWKDwM b httpswwwyoutubecomwatchvlFH6AYx9aA C What Causes Bipolar Disorders 1 Neurotransmitters a In the 1960s clinicians believed that norepinephrine overactivity was related to mania since a relationship was found between low norepinephrine activity and unipolar depression b No relationship between mania and high serotonin activity was found however research suggests that mania may be linked to low serotonin activity c Low serotonin and norepinephrine activity may lead to depression while low serotonin activity with high norepinephrine activity may lead to mania 2 Ion Activity some studies have shown that in some bipolar individuals there are irregularities in the transport of ions This causes neurons to re too easily leading to mania or resist ring lead to depression Brain Structure Basal Ganglia and Cerebellum in bipolar individuals are smaller than those in other individuals The bipolar individuals also display structural abnormalities in their amygdala hippocampus and prefrontal cortex It is not clear what role the structural abnormalities play in bipolar disorder Genetic Factors Identical twins of people with a bipolar disorder have a 40 likelihood of developing it Fraternal twins siblings and other close family members of bipolar individuals have a 510 likelihood The general public is 126 likely to develop the disorder a Genetic Linkage Studies multiple generations of a family with high rates of bipolar disorder are examined for the pattern of bipolar disorder distribution in the family members Researchers try to determine if it follows a predictable pattern of inheritance b Molecular Biology bipolar disorder has been linked to genes on chromosomes 1 4 6 1013 15 18 21 and 22 D What Are the Treatments for Bipolar Disorder 1 Lithium and Other Mood Stabilizers a Lithium httpswwwyoutubecomwatchveYSiqu91SE b Mood Stabilizing Drugs Over 60 of patients with mania improve on these medications and many eXperience fewer episodes if they continue medication It has been found that patients face a risk of relapse that is 28 times greater if they stop taking their mood stabilizers c Second Messenger substances inside a neuron that carry out changes within the receiving neuron that start its firing mechanisms Second messengers relay a receptor site s original message to the neuron s firing mechanism Mood stabilizers affect the second messengers of neurons d Neuroprotective Proteins key proteins within neurons responsible for the prevention of cell death Lithium and other mood stabilizers increase the production of neuroprotective proteins thus improving the health and functioning of these cells thus reducing bipolar symptoms Adiunctive Psvchotheranv one form of treatment either mood stabilizers or psychotherapy is not always effective a At least 30 of bipolar disorder patients may not respond to lithium or other mood stabilizers may be taking an improper dose relapse while taking the medication or stop taking it altogether b In response to these issues individual group or family therapy is combined or adjunct to prescribing mood stabilizers
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