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Test 2 Study Guide

by: Kirsten Notetaker

Test 2 Study Guide

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Chapters 4-7
Abnormal Psychology
Dr. Ann Jordan
Study Guide
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This 18 page Study Guide was uploaded by Kirsten Notetaker on Tuesday October 18, 2016. The Study Guide belongs to at Lewis University taught by Dr. Ann Jordan in Fall 2016. Since its upload, it has received 4 views.


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Date Created: 10/18/16
Study Guide Abnormal Psychology Exam #2 Anxiety Disorders anxiety All anxiety disorders share features of excessive fear and anxiety and related behavioral disturbances Fear - an emotional response to real of perceived threat; associated with fight or flight response Anxiety - anticipation of future threat; associated with tension and avoidance behaviors stress vs. anxiety Stress results from external factors Anxiety can occur without external factors and can be due to maladaptive learning symptoms of anxiety Anxiety is an emotional state that produces tension, worry, and physiological reactivity Anxiety can range from mild to terrifying, and form an attack to an ongoing state Thoughts range from vague worries to the fear that death is imminent Anxiety disorders produces significant distress and interfere with daily functioning fear vs. anxiety physiological arousal generalized anxiety disorder (GAD) An anxiety state of chronic free-floating anxiety and hyperactivity of the autonomic nervous system within a broad range of normally nonthreatening situations Develops gradually, often beginning in childhood or adolescence Essential feature is a physiological stress syndrome known as chronic ANS over- activity: sweating, heart palpitations, etc. The autonomic nervous system controls cardiovascular, digestive and respiratory functions; divided into the sympathetic and parasympathetic divisions GAD is fairly common: prevalence is about 3%; twice as common in women GAD tends to be chronic, but fluctuating; worsens during times of stress Diagnostic criteria: Excessive anxiety and worry, more days than not, for at least 6 months, about several activities Difficulty controlling the worry At least 3 of the following symptoms: Restlessness, felling keyed up on edge Easily fatigues Difficulty concentrating or mind going blank Irritability Muscle tension Sleep disturbance (insomnia, restlessness) anxiety disorder free-floating anxiety autonomic nervous system symptoms of GAD treatment for GAD Drug therapy: Benzodiazepines - issues with dependence - Xanax, Valium Antidepressants - safer alternative - SSRI's Cognitive-behavioral therapy: Effective for GAD; 60% showed significant symptom reduction that persisted 12 months after treatment phobic disorders Phobic disorders are patterns in which chronic avoidance behaviors occur with an irrational fear of a particular object or situation Extreme anxiety is expressed when phobic stimulus is encountered Prevalence - 8.7% of population; twice as common in women than men, but depends on phobia Phobias are intense, persistent, and disproportionate fear Two types of phobic disorders: Specific phobias Social phobia specific phobia Involve marked fears of specific objects or situations Learned through classical conditioning Onset is usually childhood or early adolescence Categories: living creatures, environmental conditions, blood/needles or injury, situational factors causes of specific phobias symptoms of specific phobias Involve marked fears of specific objects or situations Learned through classical conditioning Onset is usually childhood or early adolescence Categories: living creatures, environmental conditions, blood/needles or injury, situational factors social anxiety disorder (social phobia) Fear of embarrassment in social situations; avoidance of situations where one is the focus of attention Fear is out of proportion and persistent, causing significant distress; can be chronic and disabling Typical situations - eating/speaking in public, small group discussions, being observed, using public restrooms, performing in front of others Often comorbid with major depressive disorder and substance-use disorders Prevalence is about 8%; twice as common in women than in men - onset: mid-teens situations that trigger social phobia The object or situation: Provokes immediate fear or anxiety Is actively avoided or endured with intense anxiety The fear, anxiety, or avoidance: Is persistent (6 months or more) Causes distress in social, occupational, or other areas of functioning treatment for phobias Medications: Benzodiazepines (like Ativan, Xanax, Valium) SSRI's (for chronic anxiety) Beta-blockers Behavior therapy of CBT: Systematic desensitization Exposure Cognitive restructuring: identifying and changing irrational thoughts Modeling therapy systematic desensitization exposure therapy panic disorder Anxiety state characterized by random episodes of intense anxiety (panic attacks), accompanied by a sense of doom Anxiety is free-floating and has no external cause Prevalence is about 2-3% twice as common in women, but this may be due to under-diagnosis in men Average age of onset is late adolescence/early adulthood; may begin in childhood or over age 45, but that is more unusual Causes include biochemical, genetic, and psychosocial factors Most common treatment is medication (benzodiazepines and SSRI's) and cognitive- behavior therapy panic attacks Panic attacks are sudden and unpredictable; cold sweats, dizziness, trembling, sensations of fainting, and feelings of impending doom symptoms of panic attacks Four or more of the following symptoms: Palpitations, pounding heart, or accelerated heart rate Sweating Trembling or shaking Sensations of shortness of breath or smothering Feelings of chocking Chest pain or discomfort Nausea or abdominal distress Feeling dizzy, unsteady, light-headed, or faint Chills or heat sensation Parasthesias (numbness or tingling) Derealization or depersonalization Fear of losing control or "going crazy" Fear of dying agoraphobia Intense fear of at least two of the following: Being outside of the home alone Traveling via public transportation Being in open spaces (parking lots, bridges) Being in enclosed spaces (stores or theaters) Standing in line or being in a crowd Situations are feared because escape or help may not be readily available Often accompanies panic disorder; rarely occurs on its own (prevalence 1.7%) drug treatments for anxiety disorders Medication Benzodiazepines, antidepressants (SSRI's), beta-blockers High relapse rates after cessation of drug therapy treatment of panic disorder Cognitive-behavior therapy Promotes self-efficacy Involves educating the client about panic disorder, identifying and correcting catastrophic thinking, encouraging client to face the symptoms OCD and Related Disorders obsessive-compulsive disorder Anxiety state characterized by: Obsessions - persistent or uncontrollable anxiety-producing thoughts or images Compulsions - an irresistible impulse to perform certain actions repeatedly to counteract anxiety or prevent a dreaded event Does not include compulsions that people find pleasurable (overeating) People with OCD may be embarrassed, but are reluctant to give up symptoms They see behavior and thoughts as distressing, but do not experience panic Obsession Obsessions - persistent or uncontrollable anxiety-producing thoughts or images cultural differences in OCD May be linked to cultural factors; less common in less complex and advanced societies, more common in suburbs than in rural or urban areas Prevalence or 1-2% (fairly rare); equally common in men and women Average age of onset is 20 years, but can begin in childhood (25% before age 14) compulsion Compulsions - an irresistible impulse to perform certain actions repeatedly to counteract anxiety or prevent a dreaded event causes of OCD Biological Heredity is 4x higher in close relatives Over-activity in orbitofrontal cortex (increased interpretation of danger) Decreased levels of serotonin Behavioral OCD behaviors develop to reduce anxiety Cognitive Exaggerated estimates of probability of harm, control, intolerance of uncertainty Family Controlling parenting styles, low parental warmth Culture may affect how symptoms are expressed common compulsions treatment of OCD OCD is difficult to treat Highly resistant to psychotherapy, but behavior therapy and CBT can be very effective Medication (SSRI's and clomipramine) is helpful for about 60% of patients Best outcome is medication combined with behavior treatments (flooding, response prevention) body dysmorphic disorder A strong belief in the absence of evidence, that a body part is defective or deformed in some way Appears early adolescence to early adulthood; may persist for years Affected by culture; equally common in men and women Prevalence is about 2.4%; difficult to assess hoarding disorder The essential feature is persistent difficulties discarding or parting with possessions, regardless of value Due to a perceived need to save the items and distress associated with discarding them Results in the accumulation of possessions that clutter living areas Causes significant distress or impairment Prevalence estimate is 2-6%; more common in older people, but is universal in all cultures Onset in late adolescence; worsening by age 30 Individuals with hoarding disorder believe that the items collected are valuable and resist having them removed, even when the possessions are worthless or unsanitary or create a fire danger. Trichotillomania The essential feature is the recurrent pulling out of one's own hair (scalp, eyebrows, eyelids) Repeated attempts to stop; significant distress Prevalence: 1-2%; 10 times more common in adult women; equal in young boys and girls Onset by age 17 Causes - not entirely known; most likely biological Treatment - habit reversal training (HRT); redirecting the impulse to pull hair excoriation disorder The essential feature is recurrent picking at one's own face, arms, hands, or multiple body sites, resulting in lesions Prevalence is about 1.4% more common in women; usually begins in adolescence Cause - may be a coping mechanism to deal with anxiety (compulsion) Treatment - habit reversal training, CBT, and other behavior treatments that try to change behavior Trauma and Stressor-Related Disorders posttraumatic stress disorder (PTSD) Symptoms persist for more than one moth Prevalence rate is 8.7% highest levels are seen in combat veterans and rape survivors are 30-50% Cause - exposure to a traumatic event that is outside the range of normal human functioning diagnostic criteria for PTSD Exposure to actual or threat of death, serious injury, or sexual violence that: Is directly experience or witnessed Occurred to a close family member/friend Event is re-experienced: Recurrent and intrusive recollections Recurrent distressing dreams Acting/feeling as if the event were recurring Distress and physiological reactivity at reminder cues Persistent avoidance of reminder stimuli (thoughts, places, people, feelings) Alterations in cognitions and mood: Memory lapses involving trauma Detachment from others Restricted affect Sense of foreshortened future Symptoms of altered arousal and reactivity (sleep disturbances, irritability, hypervigilance, exaggerated startle response) definition of traumatic stressor flashback causes of PTSD Combat Sexual harassment and assault Violent crime or domestic violence Natural disasters Car accidents or work-related accidents treatments for PTSD Medications: SSRI's - modest effect in less than 60% of individuals D-cycloserine - an antibiotic used to treat tuberculosis, has been investigated as an aid to facilitate exposure therapy in people with PTSD and anxiety disorders Prazosin - hypertension medication used to lower blood pressure, effective in treating severe nightmares in PTSD Propranolol - beta-blocker used to reduce heart rate and blood pressure, inhibits the actions of norepinephrine, which enhances memory consolidation, giving propranolol immediately after a trauma reduces rates of PTSD Therapy for trauma-related disorders Prolonged exposure therapy (PE) - involved exposure to trauma-related cues Cognitive-behavioral therapy (CBT) - involved identifying and challenging dysfunctional cognitions Trauma-focused cognitive-behavioral therapy (TF-CBT) - combines traditional CBT with trauma sensitive strategies Eye movement desensitization and reprocessing (EMDR) - involves visualizing traumatic experience while moving eyes side to side and replacing negative cognitions with positive ones acute stress disorder duration of symptoms in acute stress disorder Similar to PTSD, but duration is 3 days to 4 weeks Trauma must have sane emotional impact as with PTSD Prevalence rates vary with the type of traumatic event adjustment disorder Difficulty coping with or adjusting to a specific life stressor, such as ending a relationship or marriage, losing a job, death of a loved one, major life change (marriage, having a baby, retiring) DSM-5 diagnostic criteria: Exposure to an identifiable stressor that results in onset of symptoms Symptoms are out of proportion to the severity of the stressor Symptoms persist no longer than six months after exposure to stressor has ended stress vs. stressors Stressors - external events or situations that place physical or psychological demands on a person Stress - internal psychological or physiological response to a stressor intrusive recollections psychological factors affecting medical conditions Stress causes physiological, psychological, and social changes that influence health Finances, work, economy, family issues, relationships Psychophysiological disorder - a physical disorder with a strong psychological basis coronary heart disease Atherosclerosis - narrowing of arteries which blocks the flow of blood and oxygen to heart Some risk factors for CHD Poor eating habits Obesity and lack of physical activity Hypertension - high blood pressure Stress Depression Hypertension headaches: migraine, cluster, tension Migraine headaches - causes are poorly understood Interaction between brainstem and trigeminal nerve, a major pain pathway Imbalances in serotonin, which helps regulate pain in the nervous system Release of neuropeptides, which travel to the brain's outer covering (meninges), resulting in migraine pain Tension headaches - caused by prolonged contraction of scalp and neck muscles Cluster headaches - rapid onset of stabbing or burning sensations located in the eye or cheek; lasts 15 min to 3 hours and end abruptly Asthma Chronic inflammatory disease of the lungs Stress or other triggers cause excessive mucus secretion producing spasms and swelling of the airways, which reduces the amount of air that can be inhaled Symptoms range from mild to severe immune system effects Stress does not cause infections, but it decreases the efficiency of the immune system Stress response involves release of hormones (such as cortisol) that impair immune functioning Chronic stress accelerates disease progression, but brief exposure to stressors enhances immune functioning treatments for stress—biofeedback, relaxation Relaxation training - learn to relax muscles of the body under different circumstances Biofeedback training - learn to voluntarily control physiological processes (heart rate, blood pressure) in order to improve physical or mental health Cognitive-behavioral therapy - designed to improve coping skills and manage stress Somatic Symptom and Related Disorders somatic symptoms Gastrointestinal Vomiting Abdominal pain Nausea Bloating and excessive gas Pseudoneurological Amnesia Difficulty swallowing Loss of voice Difficulty walking Seizures Pain Diffuse pain Pain in extremities Joint pain Headaches Reproductive organ Burning sensation in sex organs Pain during intercourse Irregular menstrual cycles Excessive menstrual bleeding Cardiopulmonary Shortness of breath at rest Palpitations Chest pain Dizziness Other Vague food allergies Hypoglycemia Chronic fatigue Chemical sensitivity malingering Malingering - intentional production of psychological or physical symptoms with an external incentive somatic symptom disorder Multiple persistent (more than 6 months) physical complains for which no medical cause can be found Persistent thoughts about the seriousness of one's symptoms Excessive time and energy devoted to the symptoms Symptoms can include pain, fatigue, nausea, weakness, etc. More common in women; prevalence about 7% Seems to be more common in children and older people Person may seek care from multiple doctors but seem unresponsive to treatment illness anxiety disorder Preoccupation with having or acquiring a serious illness; physical (somatic) symptoms are not present or only mild High level of anxiety about health; person performs excessive health-related behaviors Duration of symptoms is at least 6 months Illness becomes a central feature of the person's identity Incessant worrying becomes stressful for others Prevalence is about 5%; equally common in men and women The former diagnosis of hypochondriasis is not split between somatic symptom and illness anxiety disorders conversion disorder Characterized by one or more symptoms of altered voluntary motor or sensory function No physical cause can be found Symptoms can include weakness or paralysis, tremors, numbness, blindness, loss of hearing, non-epileptic seizures, loss of speech, etc. Individuals are not consciously faking symptoms; they believe the problem is genuine Formerly known as hysteria; called "mass psychogenic illness" when it occurs in groups More common in women, in rural populations, and in lower SES groups Prevalence is about 2% Onset - across the life-span hysteria mass psychogenic illness factitious disorder (imposed on self vs. other) Imposed on self Presentation of oneself to others as ill or impaired; recurrent lying or inducing physical symptoms May sabotage or interfere with medical care Imposed on another Pattern of falsification or physical or psychological symptoms in another individual Often a mother who appears loving and attentive while simultaneously sabotaging child's health Relatively new diagnostic category Diagnosis of this condition is difficult causes of factitious disorders Underlying issue appears to be a need to be the center of attention or to feel superior to authority figure Supportive psychotherapy and family therapy may help families understand patients and their need for attention "A mother's betrayal" causes/treatment for somatic symptom disorders Biological Antidepressant medications such as SSRI's reduce anxiety and depression; rarely successfully by itself Psychological treatments Empathy, accepting symptoms as genuine Providing information about stress Mindfulness strategies help patients accept physiological sensations features of factitious disorder legal issues in assessment of factitious disorder Dissociative Disorders Dissociation Psychological state in which some part of identity, memory or consciousness is altered Results in severe disruption of personality functioning Used to escape anxiety and conflict Usually related to trauma dissociative disorders Involve some sort of dissociation (separation) of a part of a person's consciousness, memory, or identity Types of dissociative disorders: Dissociative amnesia Depersonalization/derealization disorder Dissociative identity disorder (multiple personality) Relatively rare dissociative trait Some people appear to easily fantasize, divide their attention, engage in daydreaming, and have a good imagination If this "trait" is present, and a trauma occurs, the dissociation can become pathological Several measures exist for dissociation the role of childhood trauma difference between organic and dissociative amnesia dissociative amnesia Dissociative amnesia Not due to organic cause Sudden inability to remember important personal information Usually pertains to a trauma Prevalence is difficult to establish Types of amnesia: Localized - inability to recall a specific event or events Systematized - loss of memory for certain categories of information Selective amnesia - inability to remember certain details of an incident dissociative identity disorder (DID) Formerly known as multiple personality disorder Chronic disorder usually beginning in childhood as a result of physical or sexual abuse Two or more distinct personality states; alterations in behaviors, attitudes, and emotions Personality change in complete and not tied to context Diagnosed about age 30, but symptoms are usually present before that symptoms of DID Depression, anxiety, phobias, panic attacks; often co-occurs with other disorders Physical symptoms (severe headaches or other bodily pain) Fluctuating levels of function, from highly effective to disabled Time distortions, substance abuse, suicidal preoccupation and attempts Prevalence reports vary - may be very rare or underdiagnosed causes of dissociative amnesia multiple personality disorder localized, selective, systematized amnesia “waking”/core personality depersonalization disorder Most common dissociative disorder; characterized by feelings of unreality of being detached from oneself and the environment Consciousness is never split Feel like separate observers of themselves; own reality feels temporarily lost Common phenomenon - needs to be persistent, recurrent, and distressing to be diagnosed Onset between ages 15 and 30 symptoms of depersonalization Memory is disrupted due to acute stress Permanent structural changes in amygdala due to trauma may play a role Repression protects the individual from painful memories or conflicts Severe internal conflict, guilt, unresolvable interpersonal difficulties, criminal behaviors Dissociative symptoms develop because of the traumatic experience and inability to cope Repressed memories Amnesia may come to light only after recalling details of a traumatic event Not all researchers believe in the validity of repressed memories Parents or therapists may unintentionally plant memories treatments for dissociative disorders Dissociative amnesia and depersonalization seem to resolve on their own, so treatment is aimed at alleviating depression and stress (medication, CBT, stress management) DID is treated with trauma-focused therapy to help the individual develop healthier ways of dealing with stressors, major goal is integration of personalities Depressive Disorders Major depressive episode Primary symptoms Depressed mood (dysphoria) Loss of pleasure (anhedonia) Secondary symptoms Physical - sleep disturbance, eating disturbance, weight loss or gain, aches and pains Emotional - self-blame, worthlessness, guilt, suicidal thoughts, emptiness, hopelessness, worthlessness, or low self-esteem Cognitive - slowed thinking, lack of concentration, rumination, memory problems, inability to make decisions Social -withdrawal from others Behavioral - psychomotor agitation or retardation, crying, fatigue, daily activities take immense effort and feel overwhelming Symptoms are not due to grief, substance use of medical condition Symptoms persist for at least 2 weeks major depressive disorder Single or recurrent major depressive episodes; no history of mania Depressed mood must be present most of the day, every day, for 2 weeks or more Insomnia or fatigue is often presenting complaint Prevalence: US overall: 7% 3 times higher in women (up to 20-25%) 3 times higher in 18-29 year olds Onset - can occur at any age, but peak in the 20's Course is quite variable; some remit completely, others have chronic depression Persistent depressive disorder (dysthymia) Depressed mood most days for at least 2 years Moderate level of disorder Symptoms - appetite changes, sleep disturbances, low energy, low self esteem, poor concentration, hopelessness Symptoms are never absent for more than two months in two years Prevalence is about 2% Premenstrual dysphoric disorder Pattern of symptoms that is present one week before the onset of menses, then improves and becomes minimal post-menses Symptoms include mood swings, irritability, depressed mood, anxiety, decreased concentration, fatigue, feeling overwhelmed, physical symptoms Symptoms are associated with clinically significant distress or interference with work, school, social activities, or relationships Prevalence: 2-3% culture, gender, age variables in depression—differences, onset, etc. Prevalence of depressive disorders One of the most common psychiatric disorders, second leading cause of disability worldwide Women at significantly greater risk Chronic disorder for many people About 15% fail to show significant symptom reduction primary symptoms of major depressive episode Depressed mood (dysphoria) Loss of pleasure (anhedonia) anhedonia Loss of pleasure dysphoria Depressed mood secondary symptoms of major depressive episode (physical, emotional, cognitive, behavioral, social) Secondary symptoms Physical - sleep disturbance, eating disturbance, weight loss or gain, aches and pains Emotional - self-blame, worthlessness, guilt, suicidal thoughts, emptiness, hopelessness, worthlessness, or low self-esteem Cognitive - slowed thinking, lack of concentration, rumination, memory problems, inability to make decisions Social -withdrawal from others Behavioral - psychomotor agitation or retardation, crying, fatigue, daily activities take immense effort and feel overwhelming Symptoms are not due to grief, substance use of medical condition Symptoms persist for at least 2 weeks persistence of symptoms in depression specifiers With anxious distress With mixed features With melancholic features - profound loss of pleasure, early waking, weight loss, guilt, suicidal ideation With atypical features - overeating, oversleeping With psychotic features - presence of delusions or hallucinations, poor prognosis With catatonic features - stupor, flat affect, withdrawal slowness With peripartum onset - during pregnancy or postpartum; can be very serious and include psychotic symptoms With seasonal pattern - pattern of onset of mood episode is in fall or winter with remission in spring peripartum depression With peripartum onset - during pregnancy or postpartum; can be very serious and include psychotic symptoms biological causes Low levels of norepinephrine, serotonin, and dopamine Depression tends to run in families (genetic component) Genes interact with environmental factors to produce depression (short allele of the serotonin transporter gene) Overproduction of stress-related hormones (cortisol) appear to play a role in depression; causes neuron damage to the hippocampus Exposure to stress during early development affects cortisol levels psychological causes Behavior view - depression results from insufficient social reinforcement Cognitive factors - dysfunctional thoughts cause depression Pessimism Damaging self-views Feelings of helplessness Co-rumination - constantly talking of problems or negative experiences with others learned helplessness Learned helplessness - the belief that we have little influences over what happens light therapy Light therapy Used for seasonal depression transcranial magnetic stimulation New treatment used for depression not responding to more traditional treatments psychological and behavioral therapies Behavioral activation therapy - focus on increasing exposure to pleasurable events and activities and social interactions Interpersonal therapy (IPT) - focus on current interpersonal problems in order to improve communication and increase social skills Cognitive behavioral therapy (CBT) - altering negative thought patterns associated with depression Mindfulness based cognitive therapy - disrupt the cycle of negative thinking by focusing on present with an attitude of acceptance seasonal pattern SAD Prozac, Zoloft, Paxil, etc. SSRIs Many medications take 3-8 weeks to take full effect; medication is taken daily Selective serotonin reuptake inhibitors (SSRI's): Zoloft, Lexapro, Prozac, Paxil, Celexa - mild side effects and broad effect on the symptoms of depression and anxiety tricyclic antidepressants Atypical antidepressants - Wellbutrin, Effexor Tricyclic antidepressants - Elavil, Tofranil, older medications with more side effects MAOI's - older class of drugs rarely used today, side effects can be severe Lithium Used to treat bipolar ECT Procedure done under anesthesia Small electric currents are passed through the brain, intentionally triggering a seizure of about 60 seconds ECT seems to cause changes in brain chemistry that reverse symptoms of severe depression Side effects - confusion for minutes or hours, retrograde amnesia, physical side effects (nausea, headache, jaw pain, muscle ache) A series of 6-12 treatments over 3-4 weeks is typical Bipolar Disorders manic episode Hypomanic episode Persistently elevated mood and other manic symptoms for at least 4 days Inflated sense of self-esteem Decreased need for sleep, increased energy Talkative, racing thoughts, distracted Self-important, expansive mood or irritable, agitated mood; impulsivity and risk taking may appear Uncharacteristic of how person normally functions Not as intense as mania, no psychosis Does not impair social or occupational functional symptoms of manic episode Symptoms Hyperactive motor behavior - inexhaustible energy, short attention span, pressured speech, frantic behavior Labile euphoria or irritability Flight of ideas - rapid progression of thoughts, odd speech pattern, grandiose Decreased need for sleep, excessive talkativeness and pleasure seeking Symptoms must persist for at least one week Cause marked impairment in social of occupational functioning, may involve loss of contact with reality (psychosis) persistence of symptoms in mania Hyperactive motor behavior Labile euphoria Flight of ideas pressured speech Mania vs. schizophrenia rapid cycling Four or more mood episodes per year Increases chances that disorder will be chronic symptoms more severe bipolar I disorder Criteria have been met for at least one manic episode, often preceded by or following a major depressive episode Mood can shift rapidly to anger or depression Can be coded as mild, moderate, sever, or with psychotic features Severe level of disorder (often psychotic) Fairly rare disorder, prevalence rate 0.6% Average of onset - 18 Course - 90% of people who have a manic episode will have a recurrence; 60% of manic episodes occur before a major depressive episode biological causes Complex genetic basis involving interactions among multiple genes Neurological abnormalities Some SSRI's and stimulants can trigger mania Hormonal influences (especially cortisol) Onset of bipolar sometimes directly follows major stressful event, but biological factors appear to play a much more prominent role than other factors Psychosis with mania bipolar II disorder Characterized by one or more major depressive episodes accompanied by at least one hypomanic episode There has never been a manic episode Prevalence rate: 0.8% in the US Average age of onset - mid 20's Usually begins with a major depressive episode followed by hypomanic episode where it is recognized as bipolar II Cyclothymia Chronic mood disorder, combines manic and depressive components, but at moderate levels Symptoms do not meet criteria for manic of major depressive episodes Escalates to bipolar I or II in 15059% of cases Begins adolescence to early adulthood Duration must be at least 2 years No psychotic symptoms Prevalence rate .5-1% specifiers for bipolar disorder Flight of ideas treatments for bipolar disorder Goal - eliminate symptoms to greatest degree possible and prevent future episodes Combination of mood-stabilizing medications, psychotherapy, and psychoeducation Bipolar I disorder Lithium, Depakota, Zyprexa, Tegretol, Neurontin, Lanictal for mania Bipolar II disorder Antidepressants may trigger mania; treatment is less clear Failure to take medication is a major issue


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