Abnormal notes week 5
Abnormal notes week 5 PSYC 3560
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This 11 page Class Notes was uploaded by Ashlyn Masters on Thursday February 18, 2016. The Class Notes belongs to PSYC 3560 at Auburn University taught by Dr. Fix in Spring 2016. Since its upload, it has received 20 views. For similar materials see Abnormal Psychology in Psychlogy at Auburn University.
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Date Created: 02/18/16
Mood Disorders and Suicide 2/9/16 (technically week 4) Types of Moods • Other forms of depression o Loss and the Grieving process § Normal grief response § Numbing and disbelief § Yearning for the deceased § Disorganization and despair (accepts the death) § Reorganization—rebuilding of their lives o Most studies suggest that such a process can last 2-6 months § DSM-IV recommended not to diagnose within first 2 months § DSM-5 allows depression diagnosis even within first 2 months if person meets criteria • Types of extreme moods o Depressive episodes: extreme sadness and gloominess o Manic/hypomaniac episodes: intense/unrealistic feelings of excitement and euphoria Unipolar (Depressive) Disorders • Major Depressive Disorder (MDD): characterized by persistent down or depressed mood occurring more days than not. Intense and episodic o Emotional § Sad mood § Anhedonia: lack of pleasure (not experiencing enjoyment from things they used to enjoy) o Physiological/Behavioral § Appetite change- can go either way § Sleep disturbance- usually need more sleep § Psychomotor disturbance- everything just slows down, very low motivation § Fatigue- very low energy, more sleep is “needed” o Cognitive § Inappropriate guilt/feeling worthless § Concentration difficulty/indecisiveness § Thoughts of death/suicide o Course of MDD § Depressive episodes are often time-limited (6-9 months on average) § Likelihood of recurrence increases as number of MDEs increase o Epidemiology of MDD § Prevalence • 17% lifetime, 7% 1-year • Prevalence rates have increased over the last 2 decades § Gender Ratio • 2:1 female to male – during adolescence and adulthood • 1:1 male to female – during childhood § Age of Onset • Late adolescence-early adulthood • Later onset (>60 years old) – difficult to determine due to other health related illnesses (e.g., dementia) § Comorbidity • Anxiety, substance use, eating disorders, personality disorders § Prevalence by race/ethnicity: mixed findings • Comparable rates • Higher rates of MDD among racial/ethnic minorities • Due to bias during diagnosis, different stressors and different symptomatology • Persistent Depressive Disorder (Dysthymia): characterized by chronicity o For diagnosis, symptoms must persist for at least 2 years (1 year in children) o Intermittent normal moods occur VERY briefly (never for more than 2 months) o Casual Factors of unipolar mood disorders (MDD and PDD) § Biological • Genetic influences (2-3x more prevalent among biological relatives) • Neurochemical (monoamine theory saying serotonin/norepinephrine drive all and dopamine is linked to adhedonia and low positive affect) • Hormonal (stress response- cortisol) • Neurophysiological factors (right PFC vs. left PFC) (negative vs. positive emotions) § Biological Rhythms • Sleep (more REM/less deep sleep could be a vulnerability factor) • Sunlight/seasons (seasonal affective disorder, usually atypical features [increased sleep and appetite]) § Psychological Factors • Stressful life events: can affect the individual more than basic things (death of a brother might have more of an affect than a stressful job) o Independent: unrelated to own behavior o Dependent: partly generated by own behavior, stronger role • Personality o Neuroticism: sadness, guilt, anxiety o Low Positive Affectivity: unenthusiastic, flat, bored § Cognitive Theories • Hopelessness theory: perception that one has no control over what is going to happen, and certainty that bad outcomes will occur • Ruminative Response Styles theory: rumination = “stewing” – focus intensely on how they feel and why they feel this way § Interpersonal Factors • Lack of social support, poor social skills, relationship distress • These factors both precede onset of depression and are worsened by depression • Related to high rates of relapse/recurrence o Treatment § Electroconvulsive Therapy (ECT) • Severe depression, non-responders § Transcranial Magnetic Stimulation • Pulsating magnetic fields stimulate certain regions in the cortex (5 days/week for 2-6 weeks) • Mixed findings § Bright light therapy • Originally used for seasonal affective disorder § Cognitive-behavioral therapy (CBT) • 10-12 sessions • Focus on here and now • Identify dysfunctional thoughts and challenge them • As effective as medications, and better at preventing relapses and recurrences § Behavioral Activation (BA) • Refers to increasing activities and interactions • Very effective, maybe as effective as CBT § Interpersonal therapy (IPT) • Identify and change maladaptive interaction patterns with others • As effective as medications and CBT, but still early in the research Mood Disorders and Suicide (continued) 2/16/16 Bipolar Disorders • Terminology o Mood episodes: intense emotional states o Manic episode: an overly joyful or overexcited state o Depressive episode: an extremely sad or hopeless state o Mixed state: a mood episode that includes symptoms of both mania and depression o People with bipolar disorder also may be explosive and irritable during a mood episode • Manic Episode o Elevated, expansive, irritable mood lasting at least 1 week o 3 or more of… § Inflated self-esteem/grandiosity § Decreased need for sleep § Talkativeness, pressured speech § Flight of ideas, racing thoughts § Distractibility § Increased goal directed activity or psychomotor agitation § Excessive involvement in pleasurable and risky behaviors o Clinically significant distress, impairment, hospitalization or psychotic features • Hypomania o Same as mania but lasts at least 4 days o Noticeable by others, but not severe enough to cause marked impairment in functioning • Bipolar I Disorder o DSM-5 criteria § Presence or history of one or more manic episodes § Clinically significant distress or impairment § Note: history of MDE not required but usually present • Bipolar II Disorder o DSM-5 criteria § Presence or history of one or more major depressive episodes (MDE) § Presence of history of one or more hypomanic episodes § No history of manic episode § Clinically significant distress/impairment • Cyclothymic Disorder o DSM-5 criteria § Numerous periods of hypomanic symptoms and sub-clinical depression symptoms for 2 years § No symptom-free periods of 2 months § No MDE or manic episodes § Clinically significant distress, impairment • Prevalence and course o Prevalence § 2-3% lifetime prevalence (all bipolar disorders combined) o Gender ratio § 1:1 women to men o Average age of onset § Late adolescence – early adulthood (average 22) o Course: episodic o Comorbidity: substance use disorders • Bipolar disorder vs. MDD (Major depressive disorder) o Manic episodes: tend to be much shorter than depressive episodes o Depressive episodes: tend to be more severe than unipolar depression and often have: § Greater mood lability § More psychotic features § More substance abuse § Greater psychomotor retardation o Overall episodes shorter than MDD, but more episodes during lifetime (rapid cycling: 3-4 episodes within one year) o MDD treatment can be very effective, but for bipolar, individuals aren’t quite as effective and the person must be on them their entire life, etc. • Biological Factors o Genetic: one of the most heritable disorders, no single gene responsible o Neurochemical: elevated norepinephrine and dopaminergic activity o Hormonal: elevated cortisol levels during depressive episodes, thyroid hormone can precipitate manic episodes o Biological rhythms: disruptions in sleep patterns can trigger manic episodes, seasonal patterns also common • Psychological Factors o Similar to unipolar disorders: stressful life events, personality and cognitive variables o Interpersonal processes very important: dysfunctional family interactions often linked to onset of manic episodes • Cultural considerations o Prevalence rates of unipolar disorders differ across countries § Top 3: France, US, Netherlands, New Zealand § Lowest: China, Mexico, India, South Africa o Less variability in rates of bipolar disorder o Differences in symptom expression (e.g., depression manifests as physical symptoms in Asian and African cultures) • Treatments o Mood stabilizers § Lithium § Anticonvulsants (e.g., Depakote): effective, but not as effective for suicidal ideation o Antidepressants: SSRIs; antidepressants can trigger manic episodes o Electroconvulsive therapy (ECT): shown to help with manic episodes o Cognitive-Behavioral Therapy (CBT): good for depressive symptoms, not as effective more manic symptoms o Interpersonal and social rhythm therapy: taught how to recognize the effect of interpersonal events on their social and circadian rhythms and to regularize these rhythms Suicide • Terminology o Suicidal ideation: thoughts about suicide without physically harming oneself (1/3 of general population in lifetime) o Suicide attempt: non-fatal injury that is self-inflicted with at least some degree of intent to die (900,000 attempts each year) o Suicide: self-inflicted death (38,000 people die each year/11 in 100,000 people in the US) • Women are more likely to attempt to suicide, but men are more likely to have death by suicide • Adolescents – highest suicide attempt rate • Older adults – highest death by suicide rate • Most at risk is European males and least at risk is African American females • Interpersonal Theory of Suicide o There are three things that are required for someone to successfully complete suicide o Thwarted belongingness: in some way, they don’t belong/they’re outcast o Perceived burdensomeness: they feel like they’re a burden on everyone around them o Acquired capability: fearlessness about death and heightened physical pain tolerance • Suicide Prevention o 68% of people who die by suicide were not seen by a mental health professional in the year before death o 2 general prevention strategies § High-risk: focus efforts just on people who are already known to be at risk § Universal: prevent onset of disease/condition in everyone Eating Disorders 2/16/16 Body Image in the US • Americans spend >$30 billion per year on weight loss products • The U.S. gov’t spends ~$30 billion per year on all education, employment, and social services programs combined • Most diets fail Eating Disorders • Eating disorder: characterized by a severe disturbance in eating behavior • Anorexia Nervosa (AN): characterized by an intense fear of gaining weight and being underweight o DSM-5 criteria § Restriction of energy intake relative to requirements that leads to significantly low weight § Intense fear of gaining weight or becoming fat, even though they’re underweight § Distorted perception of body shape and size, overvalue body weight/shape o Subtypes § Restricting subtype: persistent efforts to limit food intake • “Nothing tastes as good as skinny feels…” § Binge-eating/purging subtype • Binge: out of control consumption of food (1,500+ calories) o Far more food is consumed than what most people would eat in the same amount of time, under same circumstances • Purge: removal of the food eaten o Self-induced vomiting, misusing laxatives, diuretics and enemas • Other compensatory behaviors: excessive exercise or fasting • Bulimia Nervosa (BN): characterized by frequent episodes of uncontrollable binge eating and recurrent inappropriate behavior to prevent weight gain o DSM-5 criteria § Binge eating (large amount of food and lack of control) § Inappropriate compensatory behaviors § Must take place at least 1x a week for 3 months § Overvalue shape and weight § Not due to anorexia o Bulimia vs. Anorexia § Those diagnosed with bulimia tend to be of normal weight, or even overweight. They are not underweight § If both diagnoses are met, anorexia is diagnosed (i.e., last criteria of BN) • Binge Eating Disorder: binge eating without compensatory behaviors; often significantly overweight o Recurrent episodes of binge eating o 3 of more of the following: § Eating more rapidly than normal § Eating until feeling uncomfortably full § Eating large amounts when not hungry § Eating alone because of embarrassment § Feeling disgusted, depressed, or guilty afterward o Binge eating occurs at least 1x per week for 3 months o Person doesn’t meet criteria for BN or AN • Clicker questions o Anorexia (restrictive) + bulimia à both overvalue weight/shape o James binge eats, self-induced vomiting, SEVERELY UNDERWEIGHT, intensely afraid of becoming fat à anorexia nervosa • Epidemiology of Eating Disorders o Prevalence § BED is most common • Lifetime prevalence of 3.5% in women, 2% in men • 6-8% in obese individuals § Bulimia Nervosa • 1.5% for women, 0.5% for men § Anorexia Nervosa • 0.9% in women, 0.3% in men o Age of onset § AN: 15-19 § BN: 20-24 § BED: 30-50 § Some evidence that eating disorders in middle-aged women are on the rise and are more treatment-resistant (media influences) o Comorbidity § Eating disorders very commonly overlap with: • Depression (as many as 50%) • OCD • Substance abuse disorders • Personality disorders • Self-harm behaviors • Men and eating disorders o For existing ED diagnoses, males exhibit similar symptoms to females o More likely to have a history of being overweight before their ED developed o Gay men are more likely to be diagnosed with an ED than straight men § Lesbians and heterosexual women have equal risk o Other risk factors – activities that focus on the individual’s weight (e.g., being a jockey, wrestling, etc.) • Muscle dysmorphia: subtype of Body Dysmorphic Disorder in DSM-5 (don’t think we necessarily need to know this – she just thinks it’s interesting) • Physical consequences of AN o Death form heart arrhythmias o Kidney damage/renal failure o Amenorrhea (abnormal absence of menstruation)/low testosterone o Dry skin, brittle hair and nails o Yellow skin o Lanugo (downy hair) o Susceptibility to cold o Low blood pressure o Thiamin (vitamin B1) deficiency o Osteoporosis later in life o Infertility • Physical consequences of bulimia o Electrolyte imbalances o Hypokalemia (low potassium) § Muscles/BP o Damage to hands, throat, and teeth from induced vomiting • Course and outcome of AN o Löwe and colleagues (2001) – AN o 21 years after seeking treatment o 51% fully recovered, 21% partially recovered, 10% not recovered, 16% no longer alive • Course and outcome o Anorexia and suicide § Medical complications: suicide and cause of death § Up to 23% attempt suicide § Rates of suicide are 50x higher than among the general population o Better prognosis for BN and BED than AN § 70% with BN tend to recover, 60-70% with BED o However, residual symptoms often remain, and high rates of diagnostic crossover • Family influences on AN o Family dysfunction: rigidity, parental over-protectiveness, excessive control and marital discord o Parent attitudes regarding desirability of thinness, dieting, eating habits, physical appearance, perfectionism o Influences may be bidirectional • Family influences on BN o High parental expectations, low family cohesion o Other family members dieting or eating habits o Critical comments about shape, weight and eating • Individual risk factors o Internalizing the thin ideal: buying into the notion that being thin is highly desirable o Perfectionism: relentless pursuit of the perfect body o Negative body image: perceptions of how “fat” one is o Dieting § Most EDs start with “normal” dieting o Negative emotionality § E.g., Neuroticism § May be a causal factor for body dissatisfaction – distorted thinking § May maintain binge eating • Sociocultural factors o Eating disorders are not limited to Western culture BUT culture plays a role o Thin ideal body type: does not characterize all of US history or all cultures o Unrealistic ideal body types – photoshop o Evidence of media influence § Women’s self-esteem plummets right after reading a fashion magazine § Men’s body satisfaction decreases after watching TV commercials with muscular men o Becker and colleagues (2002)- Fiji study § Early 1990’s • High rates of overweight women • Associated with being strong, able to work, kind and generous (all valued traits in the culture) • Being thin viewed negatively (sickly, incompetent) § Emergence of TV and American shows such as Beverly Hills 90210 and Melrose Place • Young women began to express concerns about weight and dislike for their bodies • Dieting increased § o •
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