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Psych 270 Exam 1 notes

by: Libby Schmit

Psych 270 Exam 1 notes 270

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Libby Schmit

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These notes are for the first exam of Abnormal Psychology for Allison Looby's class
Abnormal Psychology
Allison Looby
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This 22 page Bundle was uploaded by Libby Schmit on Saturday April 2, 2016. The Bundle belongs to 270 at University of North Dakota taught by Allison Looby in Spring 2016. Since its upload, it has received 13 views. For similar materials see Abnormal Psychology in Psychlogy at University of North Dakota.


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Date Created: 04/02/16
Day 2 Exam 1 Early views of abnormality: supernatural ideas Abnormal behavior attributed to possession by spirits Treated with trephining (drilling hole into skull) or exorcism :Biological ideas Hippocrates Father of modern medicine Psychological problems stemmed from the brain Doctrine of four humors (blood, flem, bile, black bile) Imbalance of fluid Treatment: removing excess fluid (vomit, bleeding, leeches) :More supernatural ideas Middle ages- 500-1500 AD Resurgence of spiritual causes Mass madness (witches, werewolves Lack of scientific thinking and humane treatment Asylums formed Early treatment of mentally Ill Reform Movement (1700s) Pinel: human treatment Found patients behaved better when people were treated humanely Moral Management (late 1700s-early 1800s) Moral and spiritual development and rehabilitation of character Manual labor and spiritual discussion Mental Hygiene Movement (1800s) Dorothea Dix- Humane treatment and living conditions for everyone Hospitals became overcrowded Emerging of Contemporary Treatment of Mentally Ill Early 1900s Mental hospitals grew exponentially By 1940 over 400,00 people in mental hospitals Little effective treatment, not entirely humane Deinstitutionalization Movement (60s-70s) Moving people out of institutions and into the general population Pros Treat people with respect, limits institutionalization Cons People were unable to adjust, became homeless, received no further treatment Emerging of Contemporary Views of Abnormality Biological model Psychodynamic model Humanistic Model ... Biological Model Viewed as diseases Abnormal behavior results from physical problems and could be treated as such Breakthrough in treating general paresis Causes Neurotransmitter/hormonal abnormalities Genetic vulnerabilities and temperament Brain structure abnormality Neurotransmitter Picture (Know reuptake) Excessive production of NT from axon creates abnormal behavior Dysfunction of reuptake of NT by presynaptic neuron, keeps binding to dendrite Blocked receptors on postsynapitic neuron (dendrite) Neurotransmitters (not tested on) Serotonin (5HT) Dopamine (DA) GABA Norephinephrine Glutamate Acetylcholine Agonist- Increase the amount of neurotransmitter, excessive neurotransmitter available in synapse (includes blocking reuptake) Antagonist- Decrease amount of neurotransmitter, (blocking on the dendrite) Genetic Vulnerability Many psychiatric disorders are heritable to some extent (never 100%) Behavior not determined exclusively by genes Temperament Childs characteristic emotional and arousal responses to stimuli (likely inheritied) 3 styles Easy Slow to warm- fearful, slow to adjust Difficult- Quick to experience intense emotions Temperament influences how child interacts with environment and how others interact with the child. Studying Genetic Influences Not yet able to isolate specific genes, so study family members instead Family history method People who share close genetic material with should have increased prevalence of disorder. If not the disorder is unlikely genetically inherited Twin Method Examine disorder rate for identical twin and fraternal twins Adoption Method See if rates of disorder are greater among biological parents of adopted individuals with the disorder. Only method able to remove environmental factors from genetics. Brain structure abnormalities Picture Biological Perspective Treatment: Medication Alters NT/hormonal functioning Psychosurgery Disconnecting/removing parts of brain (OCD) Electroconvulsive therapy (ECT) Inducing seizures (depression) Emerging of Contemporary views of abnormality Psychodynamic Model Stemmed from the use of hypnosis and the work of Sigmund Freud Basic Principle Importance of unconscious motivation Use of defense mechanisms Childhood experiences shape personality Psychic determinism Early Application of the Psychodynamic model Franz Anton Mesmer(1734-1815) Mental disorders result from imbalance in magnetic fluid in the body Treatment: "mesmerism" Proponents of the Psychodynamic Model Sigmund Freud(1856-1939) Developed psychoanalysis Psychic determinism- everything happens for a reason (Freudian Slips) Sex defines anything that feels good not just intercourse or sexual behaviors Day 3 Psychodynamic theory Id Pleasure principle (born with, unconscious) wants to feel good. Babies just have Id Ego Reality principle- Meet the needs of Id within reality (part conscious part unconscious) balance between Id and superego. Abnormal behavior happens when ego isn't in charge. Super ego Moral principle-Your Conscious. Opposes Id Ego defends itself against conflicts and anxiety by moving unpleasant thoughts to the unconscious Uses defense mechanisms Unconsciously distort reality to protect ego and reduce anxiety Defense Mechanisms Denial- Refusing acknowledgment Rationalization- Using contrived explanations to conceal unworthy motives Repression- Preventing painful thoughts from entering consciousness Regression- Retreating to an earlier developmental level Displacement- Shifting unacceptable feelings from the target of those thoughts to a less threatening object Projection- Attributing one's unacceptable characteristics to others (cheaters accusing others of cheating) Saying others have the thoughts or feelings you have Reaction Formation- Transforming unacceptable desires into the opposite behavior (A homosexual marring a woman, sexual urges and becomes a nun) Sublimation- Transforming unacceptable urges into socially acceptable behaviors Psychosexual Stages of Development Each Stage has a pleasure Oral stage (birth-18months) Pleasure center is mouth "Sexual interests" are sucking swallowing biting Smoking and drinking habits are from oral stage fixation Anal Stage (18-36months) Pleasure center from the anus and urethra Sexual interests: expelling and or retaining feces/urine Uptight personality- anal stage fixation Phallic Stage(3-6years) Pleasure center is the genitals Sexual interests: touching genitals Oedious complex and electra complex Boys lust after mother, fear castration anxiety Girls lust after father, penis envy Latency Period (6-puberty) Sexual interests are suppressed Freud thought not much development occurred during this stage Genital stage (adolescence to adulthood) Pleasure center is another person outside the family Sexual interest is contact with one outside the family Psychodynamic perspectives: Treatment Goal is to bring repressed unconscious material into conscious awareness Free association-Talk freely without inhibiting self, looking for Freudian slips Dream analysis- Reflect ones unconscious Catharsis- Express emotion fully, don't suppress anger or other emotion Hypnosis Transference- Being a blank slate to clients. Clients would interact with him like they would important people in their life Goal is usually not symptom reduction Restructure personality so ego is in charge Impact of the psychodynamic perspective First to show how psychological processes result in mental disorders Replaced brain pathology Criticisms Lack of scientific rigor and untestable assumptions Overemphasis on sex drive More relevant to men Pessimism about basic human nature Exaggerating the role of unconscious processes Humanistic perspective Humans are motivated by the need to understand themselves and strive for self-fulfillment and meaning in life Views humans as basically good Deemphasizes the unconscious Psychopathology stems from the blocking or distortion of.... Abraham Maslow Hierarchy of needs Psychopathology occurs when there are obstacles to self-actualization Physiological-safety-love-esteem-self actualization Carl Rogers Psychopathology stems form mismatch between self-concept and reality Development of client centered therapy Client centered therapy Therapist sets conditions for client to make changes Clinician helps clients discover their inherent goodness and potential Potential for self-improvement lies within person, NOT through therapists advice Techniques Unconditional positive regard- (Love no matter what, NOT love only if certain conditions are met Empathy Genuineness Nondirective style- No set direction or agenda for therapy sessions Reflective Listening- Indicate they understand what the client understands Criticisms of humanistic model Untestable terms Restricted in application and theory Behavioral Perspective Response to lack of scientific evidence for psychoanalysis All behavior is learned Psychopathology is the result of a failure to learn adaptive behaviors and or learning maladaptive responses Classical conditioning Operant conditioning Observational Learning Only considers observable behavior Classical conditioning Learning an association between two stimuli The presence of 1 stimulus signals the presence of an automatic stimulus Eventually, you will automatically respond to the neutral stimulus (CS) (first stimulus) as if it was the US (automatic or second stimulus) even when the US isn't present Ivan Pavlov and John Watson Pavlov's Dogs experiment (bell and salivation) FOOD=US (stimulus) SALIVATE= UR BELL=CS (stimulus) SALIVATE=CR CR and UR are always the same in this class Operant conditioning Learning association between BEHAVIOR AND CONSEQUENCE -positive reinforcement: ADDING something to INCREASE behavior (A dog doing more tricks by giving them treats) -negative reinforcement: REMOVING something to INCREASE behavior (Getting good grades means not having to do chores) -Positive punishment: ADDING something to DECREASE behavior (Reducing speeding problem by getting a ticket) -Negative punishment: REMOVING something to DECREASE behavior (Decrease behavior of not eating by taking away dessert) How to understand operant conditioning: 1. What is the original behavior of the main subject? -Must be something the subject has direct control over -Must be an observable behavior, not a feeling/mindset -Make note of this exactly as it is worded in the example! 2. At the end of the example, is the person more or less likely to engage in their original behavior? -More likely/ original behavior increases=REINFORCEMENT -Less likely/ original behavior decreases=PUNISHMENT Observational learning (Modeling) Acquiring new responses by observing and imitating behavior of others Bandura (Bobo doll) Behavioral treatments -Help clients unlearn maladaptive behaviors and replace them with adaptive ones (Exposure techniques) (replacing/adding reinforcements) -Behavior therapy is goal-oriented, action-oreinted, and directive (focus is on changing behaviors, not understanding underlying cause) Cognitive perspective (Beck) -Rose from lack of consideration of cognitive processes -Psychopathology arises from maladaptive thoughts/perceptions -Automatic thoughts (cognitive distortions) -Negative attributional style (internal= self stable= never getting better, global= everyone else has negative thoughts about me) -It’s all about our thoughts/ interpretations of events Event thought emotion -Need to challenge thoughts Common cognitive distortions  All-or-nothing thinking (thinking in absolute terms, “always” or “never”)  Catastrophizing (blowing an event out of proportion)  Mind reading (Believe we can know what a person thinks solely by examining someone’s behavior)  Fortune telling (Anticipating events will turn out badly)  Making “should” statements (Concentration on what ought to be, rather than the actual situation)  Disqualifying the positive (Discounting positive experiences for arbitrary reasons) Cognitive Therapy -Aaron Beck: founder of cognitive therapy -Cognitive therapy is directive and goal-oriented (focus on changing thoughts, not understanding the underlying reason) -Cognitive restructuring Cognitive-Behavioral Therapy -Combines cognitive therapy and behavioral therapy -Emphasis on reducing self-defeating thoughts and on setting explicit goals for changing behavior -Goal is symptom reduction -Benefits: 1. Well-tolerated by clients 2.Large empirical base 3. Can be used to treat a variety of disorders Current casual views of mental illness 1. Biological causes -Physical/physiological causes -Head trauma, neurotransmitter functioning, genetics, substance use 2. Psychological causes -Distorted perceptions/ maladaptive thoughts -Learned behaviors -Neglect/abuse/trauma -Inadequate parenting styles/parental psychopathology/family discard -Maladaptive peer relationships Effects of Culture 1. Certain disorders may be present differently among separate cultures (Native Americans report different symptoms of depression than Caucasian people) 2.Certain behaviors may be considered more “normal” in certain cultures (hearing the voices of dead relatives) 3.Culture-bound syndromes: -Taijin kyofusho (Japan) -Ataque de nervios (Caribbean) -Koro (Southeast Asia) -Eating disorders (Western cultures) Current Models of Mental illness 1.Biopsychosocial Perspective  Interaction between biological, psychological, and sociocultural factors  Must have all three in order to have a mental illness 2. Diathesis-stress Model  Must have a diathesis (vulnerability)  Sets you up/makes you more at risk for the disorder  Won’t get the disorder unless exposed to a stressful event earlier in life Who treats mental illness? 1. Psychiatrist (MD)  Biological perspective  Prescribing medications 2. Clinical Psychologist (MD)  Involved in psychotherapy  Assessments  Conduct research 3. Clinical Psychologist (PsyD)  Same clinical training  Not a research degree (practical) 4. Counseling Psychologist (MA or PhD)  Specialty includes adjustment issues 5. Clinical Social Worker (MA-LCSW)  Therapist  Work as part of other institutions Classification and Assessment Vocabulary: -Prevalence: How common something is (percentage of cases in the population) - Incidence: Number of new cases that occur over a certain time period (usually 1 year) - Etiology: Causal factors -Efficacy: How well something works Classification of Mental Disorders 1.Diagnostic and Statistical Manual of Mental Disorders, 5 Edition  DSM5  Published by the APA  Manual describing symptoms and associated features for over 400 psychological disorders 2. Advantages  Provides nomenclature  Organizes information  Used for insurance reimbursement  Diagnoses can be comforting 3.Disadvantages  Loss of information  Limited usefulness of diagnosis  Labeling and stigma  Many seemingly everyday problems are abnormal -Homosexuality -Hypoactive sexual desire disorder -Premenstural dysphoric disorder Assumptions of DSM-5 1.Atheoretical?  Descriptive, not explanatory 2.Largely categorical  Disorders are distinct from one another and from normal functioning (Problems of comorbidity= more than one diagnosis)  Introduction of some dimensional aspects with DSM-5 (mild, moderate, severe)  Unspecified diagnosis Risk Factors 1. Precede and are related to disorder  Doesn’t imply cause!  Examples? - Having one mental illness puts you at risk for another - Maternal/personal drug use - Environment (i.e. marital discord) - Discrimination - Race/gender/age/ethnicity Protective Factors  Make it less likely that a person will experience adverse consequences of risk factors/ stressors  Examples -Resilience - Financially stable -Stable support system Psychological Assessment  Process of evaluating a client using psychological tests, observation, and interviews -Understand client’s symptoms and problems -Form a diagnosis and develop treatment  Assessments depend upon theoretical Clinical interview  Structured -Predetermined set of questions -Most reliable and valid -Long and may include seemingly irrelevant questions  Semistructured -Use standardized questions, but interviewer has ability to ask follow- up questions and clarify responses  Unstructured -No predetermined questions -Least reliable -Most sensitive to a client’s needs Clinical Observation  Clinician’s description of client’s appearance and behavior  May include naturalistic or controlled observation  May include self-monitoring Intelligence/Neuropsychological Tests  Used to examine intelligence and brain functioning (indirectly)  Intelligence tests -Wechsler Intelligence Scales -WAIS (Adults 17+) -WISC (Kids under 17)  Neuropsychological Tests -Wechsler Memory Scales -Delis-Kaplan Executive Functioning System Test (DKEFS) -A developmental Neuropsychological Assessment (NEPSY) Personality and Diagnosis  Provides more info on person’s thoughts, behaviors, and emotions  Objects Tests (Behavioral and Cognitive) -Standardized scoring with no clinician judgment -Pro: cost effective, reliable, valid, often scored and interpreted by computer -Cons: too rigid, loss of info, require verbal abilities  Projective tests (Psycodynamic) -Unstructured and requires substantial clinician judgment -More subjective in nature -Pros: more flexible, gain info about personal conflicts, motivations, personality characteristics, etc. -Cons: Subjective in nature, don’t provide any more info than can be gained through objective means, unreliable, invalid? Objective Tests  Self-report inventories -Standardized questionnaires with fixed-responses categories -Completed independently by client  Minnesota Multiphasic Personality Inventory (MMPI) -567 T/F questions providing info on clinical disorders and personality traits -Pros: includes validity scales to detect lying and low effort, empirically devised (valid) -Cons: Takes a long time, doesn’t reflect complexities of individuals taking the test Projective Tests  Present ambiguous stimuli and ask client to provide his/her own meaning  Rorschach Inkblot test  Thematic Apperception Test (TAT) Studying Mental Disorders  Psychology is a science -Base on research rather than speculation  Important to learn symptoms, causes, prevalence, treatment, etc Descriptive Research  Involves studying people as they naturally are -CANNOT assert causation  Used to describe a behavior/characteristic -Observation -Case studies -Questionnaires/interviews Correlational Research  Involves studying people as they naturally are  Used to describe the relationship between 2 variables -Positive correlation (variables are moving in the same direction together) -Negative correlation (variables are going in opposite directions)  CANNOT assert causation Experimental Research  Involves the manipulation of a variable in order to determine causation  Independent variable -Variable that researcher MANIPULATES, which is thought to have differential effects on the outcome variable  Dependent variable -Variable of interest (outcome variable) -Should differ depending on level of the independent variable  Involves experimental control groups  Involves random assignment to groups Who do researchers study?  Not usually interested in the individual  Interested in the population, but study a sample  Results from the sample should generalize to the population Research in abnormal psychology  Most often correlational or descriptive -Unable to manipulate certain variables  Most often retrospective, rather than prospective -Retrospective: people report on past experiences -Prospective: follow people longitudinally (over time) before the disorder develops Mood disorders Mood Disorders What is a mood disorder?  Unipolar disorders  Major Depressive disorder (MDD)  Involves a disturbance of emotional state -Single or recurrent major depressive episodes -Significant unintentional weight loss or weight gain -Recurrent thoughts of death or suicide -Psychomotor agitation or retardation -Premenstrual dysphoric disorder -Persistent depressive disorder -Major depressive disorder -Loss of interest or pleasure in daily activities -Insomnia or hypersomnia -Feeling of worthlessness or inappropriate guilt -Fatigue or loss of energy -Depressed mood -Concentration difficulty or indecisiveness -Cognitive, behavioral, and somatic (bodily) symptoms -Symptoms present for 2+ weeks -Symptoms cause clinically significant distress or impairment MDD Specifiers  With melancholic features  With psychotic features  With atypical features (temporarily feel better)(less common spectrum experiences)  With seasonal patter (2+ episodes in past 2 years occurring at same time)  With peripartum onset (experience depression before giving birth to child)  Severity -Mild -Moderate -Severe MDD Prevalence  Lifetime prevalence=17% - 10-25% in women, 5-12% in women Past year prevalence= 7% Onset typically between adolescence and middle adulthood, though can occur at any age Sex differences emerge in adolescence Likelihood increases again among elderly MDD Course  Average duration of untreated episodes is 4-9 months  Very high likelihood of recurrent episodes -35-85% will have at least 2 episodes -Median number of episodes= 4-7 MDD vs. Grief  Grief predominantly includes -Feelings of emptiness and loss -Decreasing intensity over days to weeks -Preoccupation with thoughts of the deceased -Preserved self esteem  MDD predominantly includes  -Depressed mood an inability to anticipate happiness or pleasure -Persistent intensity -Self-critical or pessimistic ruminative thoughts Persistent Depressive Disorder  Depressed mood for most of the day, more days than not (must have this)  2+ Symptoms must be included -Poor appetite or overeating -Insomnia or hypersomnia -Low energy or fatigue -Low self-esteem -Feeling hopeless -Poor concentration or difficulty making decisions  Symptoms must last 2+ years  During the 2+ years , the person has never been without symptoms for more that 2 months  Same severity specifiers as MDD Prevalence for PDD  Lifetime prevalence= 2.5-6%  Past year prevalence= 1.5%  More common in women  Average duration is 4-5 years (can persist for 20 years or more)  Onset typically in teen years  Typically show poorer outcomes and as much impairment as those with MDD Premenstrual Dysphoric Disorder  1+ symptom  Mood symptoms -Affective lability (mood swings) -Irritability, anger, or increased interpersonal conflicts -Depressed mood, hopelessness, or self-deprecating thoughts -Anxiety, tension, or feelings on edge  Behavioral symptom -Decreased interest in usual activities -Difficulty concentrating -Fatigue or lack of energy  During most menstrual cycles in the last year, 5+ symptoms total present in final week before onset of menses, which start to improve within a few days after the onset of menses and become minimal/absent in the week post-menses  Causes distress or impairment Prevalence and Course  Past year prevalence= 2-6%  Can begin anytime after menarche Disruptive Mood Dysregulation Disorder  Severe recurrent temper outbursts manifested verbally and/or behaviorally that are grossly out of proportion in intensity or duration to the situation  Temper outbursts are inconsistent with developmental level  Mood between temper outbursts is persistently irritable or angry most of the day]  Disorder found in children  Temper outbursts occur on average 3+ times per week  Symptoms present for 12+ months  No longer than 3 consecutive months without symptoms  Symptoms present in 2+settings (home, school, with peers) and are severe in 1+  Child must be over age of 6 but younger than 18  Onset of symptoms must have occurred prior to age 10 Prevalence Rate of Mood Dysregulation disorder  More common among males  More common in grade school kids than adolescence Etiology of Unipolar Mood disorders  Genetics -Moderate genetic contribution  Inherited neuroticism  Neurotransmitters -Permissive Hypothesis -Low serotonin, which leads to disruption in other neurotransmitters, especially dopamine and NE  Hormones -Stress hypothesis -Overactivity of HPA axis, which produces cortisol  Melatonin and circadian rhythm disruption  Brain structures -Reduces activity in size and various brain structures (hippocampus) Psychological factors  Stressful life events as precipitators -Diathesis stress model -Reciprocal gene-environment model  Reciprocal gene-environment model -You inherit specific genes (personality or temperamental) and because of the inheritance, it most likely puts you in an environment that can trigger that gene to develop MDD  Behavioral theories -Results from reduction in positive reinforcers  Cognitive theories -Depressive cognitive triad and cognitive disorders -Learned helplessness -Ruminative response style (to think about something over and over without trying to solve the problem) Treatment for Unipolar Mood disorders  Antidepressants -Tricyclics (Tofranil,Elavil) -Block reuptake of various NT’s -Side effects (dry mouth, constipation, weight gain, drowsiness, sexual dysfunction) -Toxic at large doses  MAOI’s (Nardil, Parnate) -Block MAO -Potentially dangerous side effects=must avoid certain foods  SSRI’s (Paxil, Prozac, Zoloft) -Block reuptake of 5HT -Fewer side effects (sexual problems, headache, jitteriness) -Less toxic, but increased risk of suicide  Mixed Reuptake Inhibitors (Wellbutrin, Effexor) -Block reuptake of 5HT and NE -Best for atypical or severe depression Meds typically take 1-2 months to take effect, few differences in efficacy (Not a “cure-all”) ECT  Use in severe depression who have not responded to alternative treatments  Often complete remission of symptoms after 6-12 treatments  Side effects: confusion, memory loss Bright light therapy  Effective for SAD and other depressions CBT (Cognitive behavioral therapy)  Evaluate and dispute irrational thoughts, which should improve mood Behavioral Activation  Focus on getting clients active and engaged in environment and interpersonal relationships  Goal is to increase positive reinforcement IPT (Interpersonal therapy)  Focuses on relationship issues and learning to form new adaptive relationships All appear equally as effective as one another, and as meds. Better for relapse Bipolar I Disorder Criteria  1+ Manic episode (necessary) -Period of abnormally and persistently elevated, expansive, or irritable mood and abnormally increased goal-directed activity or energy  3+ of the following symptoms - Inflated self esteem - Decreased need for sleep - Increased talkativeness or pressured speech - Flight of ideas or racing thoughts - Distractibility - Increase in goal-directed activity or psychomotor agitation - Excessive involvement in pleasurable activities that have high potential for painful consequences  Causes significant impairment, necessitates hospitalization to prevent harm to self or others, or there are psychotic features (ABSOLUTELY HAS TO BE PRESENT)  Symptoms last 1+ week (or any duration if hospitalization necessary)  1+ Major Depressive Episode (not necessary) -Same criteria as in MDD Bipolar II Disorder Criteria 1+ Hypomaniac Episode (NECESSARY) -Period of abnormally and persistently elevated, expansive or irritable mood and abnormally increased goal-directed activity or energy  3+ of the following symptoms (4 if mood is only irritable) -Inflated self-esteem or grandiosity -Decreased need for sleep -Increased talkativeness or pressured speech -Flight of ideas or racing thoughts -Distractibility -Excessive involvement in pleasurable activities that have high potential for painful consequences  Change in mood and functioning is observable by others  No psychotic features and episode is not severe enough to cause marked by impairment or warrant hospitalization  Symptoms last 4+ days  No history of manic episodes 1+ Major depressive episode (necessary) Symptoms of depression or unpredictability caused by frequent alternation of moods causes significant distress or impairment Bipolar Disorder Specifiers  With rapid cycling (4 or more mood episodes in one year)  Severity -Mild -Moderate -Severe Bipolar Disorder Prevalence  Lifetime prevalence: 2-4%  Occur equally in males and females -Depressive episodes are more common in women -Women are more likely to be rapid cyclers -First episode for men more likely to be manic  Average age of onset= late adolescence or early adulthood  Recurrent: single episodes are rare -90% chance of another manic episode -60% of manic episodes occur immediately before an MDE (major depressive episode) Associated features  15x higher risk of suicide compared to general population -Cycles of episodes cause suicidal thoughts (depressed, then manic episode gives them the energy to commit suicide)  Often do not perceive self as ill while manic/hypomanic  Bipolar II associated with greater chronicity of illness and more time depressed Cyclothymic Disorder Criteria  The presence of numerous periods with hypomanic symptoms and numerous periods with depressive symptoms that do not meet criteria for a hypomanic or major depressive episode  Symptoms have lasted 2+ years, where hypomanic and depressive periods have been present at least half the time and the person hasn’t been without symptoms for more than 2 months at a time  No major depressive episode, manic episode, or hypomanic episode  Symptoms cause clinically significant distress or impairment in functioning  Never in a normal mood (neutral)  Not enough symptoms to be classified as Bipolar I or II Cyclothymia Features  Onset in adolescence or early adulthood  Course is typically chronic and lifelong (may become bipolar disorder)  Occurs equally in men and women  Lifetime prevalence= less than 1% Etiology of Bipolar Disorders-Biological factors  Genetics -Strong genetic contribution (more so than for most other disorders) -60% concordance rate for identical twins  Neurotransmitters -Permissive Hypothesis -Decreased 5HT but increased NE and DA  Overactivity of various brain structures  Circadian Rhythm Disruption Psychological Factors  Stressful life events as precipitators -Diathesis stress model Treatment of Bipolar Disorders  Mood stabilizers (lithium) -Treats both manic and depressive symptoms -May be no more effective at treating depressive symptoms than antidepressants, but doesn’t precipitate manic episodes -Side effects: lethargy, cognitive slowing, weight gain, gastrointestinal difficulties -Can be toxic  Anticonvulsants (Depakote) -Higher risk of suicide  Atypical antipsychotics (Abilify) -If psychotic features are present  Same as MDD to treat depressive episodes  Interpersonal and Social Rhythm Therapy (IPSRT) -Treats mania by recognizing and regulating effect of interpersonal events on sleep and daily schedules Suicide  Attempts -3x higher in women -Younger (ages 18-24) -Pills (most common)  Completions -Highest among elderly (over 65) -4x more common in men -Most common method is gunshot Risk factors for Suicide (Relates to completed suicides)  Being a young or elderly man  Being single  Mood disturbance (particularly bipolar)  Impusivity, aggression, pessimism/hopelessness  Access to means  Being Caucasian or Native American


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