Chapter 7: Depressive and Bipolar Disorders
Chapter 7: Depressive and Bipolar Disorders PSY 4343
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Date Created: 02/21/16
ABNORMAL PSYCHOLOGY CHAPTER 7: DEPRESSIVE AND BIPOLAR DISORDERS This general outline is meant as a supplement to the Abnormal Psychology (4343) course taught at the University of Texas at Dallas and should not be taken as a standalone study guide for the overall curriculum. However, I do hope that this broad summary of the textbook (where most of this information comes from) helps you all in becoming successful undergraduate students here at UTD. Justin Sequerra, “Normal people scare me.” – American Horror Story 1 DEPRESSIVE AND BIPOLAR DISORDERS UNIPOLAR DEPRESSION: THE DEPRESSIVE DISORDERS How Common is Unipolar Depression? Depressive Disorders: Unipolar Depression—Bipolar Disorder—Unipolar Mania (This spectrum illustrates that on one side depression is dominant while on the other pole, mania is dominant; Bipolar Disorder has both bouts of mania and depression) What Are the Symptoms of Depression? Emotional “miserable”, “empty”, or “humiliated” May lead to anhedonia (inability to experience any pleasure), crying spells, or anxiety/anger/agitation Motivational “paralysis of will” (lack of drive, initiative or spontaneity) Suicide (6%15%) seems like an escape from an “uninteresting life” for many people with depression Behavioral More time alone and in bed (overall less active or productive) Cognitive Hold very negative views of themselves Pessimism Procrastination Suicidal Vulnerability Perform poorly on memory, attention, and reasoning skills (might be due to motivation and not cognitive) Physical Depressions are often misdiagnosed as medical problems (headaches, indigestion, dizzy spells, etc.) Disturbances of appetite and sleep patterns=common Diagnosing Unipolar Depression? Major Depressive Episode Period: 2 or more weeks; Symptoms: At least 5 Extreme: Delusions (bizarre ideas w/o foundation) or hallucinations (perception of things that are nonpresent) Major Depressive Disorder (no history of mania) May be seasonal, catatonic (immobile/excessive activity), peripartum (during pregnancy; most commonly called postpartum), and melancholic (anhedonia) Persistent Depressive Disorder Duration: At least 2 years May be w/ major depressive episodes, or w/ dysthymic syndrome (less severe; able to go through daily functions) Note: Psychology professors prefer to see the exact definitions of specific terminology whenever they are grading essays. DEPRESSIVE AND BIPOLAR DISORDERS WHAT CAUSES UNIPOLAR DEPRESSION? Often triggered by stressful events (more so than any other disorder) May be reactive (exogenous) depression (result of stressful events) or endogenous depression (response to internal factors) The Biological View: Genetic Factors 4 Kinds of research state that people inherit depression: Family Pedigree, Twin, Adoption, and Molecular Biology Gene studies Family Pedigree: Compare probands (depressed person=focus of genetic study) to relatives Adoptions Studies: Concluded that at least severe depression is more likely to be caused by genetic factors than more mild cases Molecular Biology Gene: Abnormality of serotonin transporter gene (5HTT) low serotonin level prone to depressive symptoms Biochemical Factors Linked depression to epinephrine and serotonin (now believe it is caused by these NT’s interactions with other NTs rather than just the individual serotonin/epinephrine levels) Endocrine: Caused by high levels of cortisol (stress reactions) or melatonin, (Dracula hormone) which is only released in the dark (explains why people are more depressed at night) Also may be due to deficiencies of chemicals within some neurons, especially brainderived neurotrophic factor (BDNF) which impairs the health of neurons Limits: Relies on analogue studies which creates depressionlike symptoms in lab animals Brain Anatomy and Brain Circuits Brain Circuit responsible for depression involves: prefrontal cortex (high or low activity), hippocampus, amygdala, Brodmann Area 25 (under cingulate cortex) (full of serotonin and 5 HTTs) Hippocampus: Involved in neurogenesis (formation of new neurons); decreases with depression Amygdala: negative emotions and memory (increased activity due to depression) Brodmann Area 25: “depression switch”; tends to be small/more active with depression The Immune System Induced stress immune system dysregulation low function of lymphocytes and increased production of Creactive protein (CRP) (causes inflammation and other illnesses) The Psychological Views: The Psychodynamic View (no strong support) Freud/Abraham note similarities between depression and grief Loved one dies regress to oral stage (total dependency on others) introjection (direct all feelings toward the loved one; even merge into their identity) For some, introjection is temporary, but for others it is longlasting (due to the lack of or excessive treatment by parents during the oral stage) Become depressed w/o losing someone: Freud equated a stressor event with the loss of a loved one with the term Symbolic Loss Influenced object relations theorists who emphasize how relationships may affect ones depression Anaclitic depression studies (separation from mother) and early childhood losses have offered general support to the idea Limits: parenting is not typically responsible for the disorder, inconsistent findings between studies, and some are impossible to test (symbolic loss) The Behavioral View (moderate support) Peter Lewinsohn: positive rewards dwindle over time fewer constructive behaviors depression spiral (social rewards are particularly important) Limits: Relies too heavily on selfreports (biased); also correlational (≠causation) Cognitive Views (considerable support) Two leading explanations: theories of negative thinking and learned helplessness Negative Thinking (most influential): Aaron Beck believes that maladaptive attitudes, a cognitive triad (definition in sidebar), errors in thinking, and automatic thoughts lead to unipolar depression Maladaptive attitudes: made as a kid; “If I fail, others will be repelled by me” Common error of logic: draw arbitrary inferences with little evidence (“She’s trying not to look at me”); Minimizes successes and magnifies failures Automatic Thoughts: like obsessions (they are intrusive thoughts) but they suggest that the person is inadequate Studies have found that ruminative responses (repeatedly dwell on their depressed mood w/o trying to change it) are more likely to develop clinical depression Learned Helplessness: Created by Martin Seligman after his experiment with dogs, where he continually shocked these dogs no matter what they did. By putting them into a state of learned helplessness (one’s belief that he/she cannot change his/her situation), Seligman found out that they couldn’t pass any other tests since they gave up with minimal effort. New version of theory (Attributionhelplessness theory) where when people view events as beyond their control, they ask why this is so. If they attribute it to internal, global, and stable factors (rather than to external, 4 specific, or unstable factors), they are more likely going to develop depression. Sociocultural Views: The FamilySocial Perspective Lack of social rewards from behavioral explanations also ties in with this perspective Researchers have found that depressed people often have poor social skills and unavailable social supports (especially when it comes to marriage). Those w/ isolated lives and a lack of intimacy are also prone to depression. The Multicultural Perspective Gender and Depression Young women are twice as likely than men to experience unipolar depression (reasons following) Artifact Theory: men and women are equally prone to depression but clinicians detect it more easily in women (more emotional vs. more socially guarded); not consistent with many findings Hormone Explanation: Women experience more frequent changes in hormone levels (criticized for being sexist) Life Stress Theory: Women experience more stress than men (due to sexual discrimination) Body Dissatisfaction Explanation: Western cultural goals have set unreasonably high standards for women (doesn’t cause it but it may be a result of depression) LackofControl Theory: Have less control over their lives than men (learned helplessness), especially after victimization. Rumination Theory: Those who ruminate on their depressed mood more and longer, are the ones who tend to stay depressed (women ruminate more than men). Cultural Background Most nonWesternized societies are more troubled by the physical symptoms of depression while more Westernized ones take on more of the cognitive afflictions (selfblame). No overall differences in the rate or symptoms of depression could be found between ethnic lines, but chronicity (likelihood of recurrence) was higher in 5 African Americans and Hispanics (due to limited treatment or socioeconomic conditions) Note: Psychology professors prefer to see the exact definitions of specific terminology whenever they are grading essays. DEPRESSIVE AND BIPOLAR DISORDERS BIPOLAR DISORDERS What Are the Symptoms of Mania? Emotional Powerful emotions range from euphoric joy to irritability Motivational They seek out constant excitement and involvement, not realizing that their social style might feel excessive Behavioral Their manner is usually active in talk and flamboyant style; have inflated sense of self (grandiosity) Cognitive Show poor judgment or planning (move too fast to consider dangers); may lose their touch with reality Physical Little sleep and always energetic even w/o sleep Diagnosing Bipolar Disorders Manic Episode (at least one week with 5 symptoms) May be extreme (delusions/hallucinations) but they may also be mild (called hypomanic episode) Bipolar I Disorder (see definition in sidebar) May experience alternation of episodes (week of mania, week of wellness, week of depression) or mixed where they experience both mania and depression in the same period (racing thoughts with feelings of sadness) Bipolar II Disorder (see definition in sidebar) Finish huge amounts of work during hypomanic periods Overall, the depression periods occur more often and are longer than manic episodes; bipolar I is more common than bipolar II; all have more medical issues More than 4 episodes in a year = rapid cycling Cyclothymic Disorder (see definition in sidebar) 2 or more years to be diagnosed, interrupted by normal periods, and begins during adolescence What Causes Bipolar Disorders? Neurotransmitters Often linked to the overactivity of epinephrine (unlike depression) as well as the low activity of serotonin (like depression) Ion Activity Irregularities in the transportation of ions across the neural membrane (which helps conduct the electrical impulses that traces its way down a neurons axons) may cause neurons to fire too easily (mania) or not (depression) Brain Structure Basal ganglia and cerebellum tend to be smaller, lower volumes of gray matter, and more structural abnormalities Genetic Factors Family pedigree, genetic linkage, and molecular biology techniques have found that some X chromosome genes have been linked to bipolar disorders DEPRESSIVE AND BIPOLAR DISORDERS *PRACTICE QUESTIONS* 1. According to Freud’s psychodynamic theory, the first stage of response to loss is called introjection where the individuals regresses to the: A) Anal Stage B) Oral Stage C) Phallic Stage D) Latency Stage 2. Which of the following is one of the most influential theories of depression? A) Beck’s Cognitive Theory B) Freud’s Psychodynamic Theory C) Seligman’s Learned Helplessness Theory D) Lewinsohn’s Positive Rewards Theory 3. The attributionhelplessness theory of depression proposes that those who are likely to become depressed attribute negative life events in which of the following ways? A) Internal, Stable, Specific B) Internal, Unstable, Specific C) External, Stable, Global D) Internal, Stable, Global 4. In major depression, hippocampal abnormalities are regularly linked with which of the following? A) High Levels of Cortisol B) Low Levels of Cortisol C) High Levels of Dopamine D) Low Levels of Dopamine 5. Researchers believe that the brain circuit involved in unipolar depression includes: A) Hypothalamus, Brodmann Area 25, Corpus Collosum, Anterior Cingulate Cortex 7 B) Prefrontal Cortex, Anterior Cingulate Cortex, Amygdala, Basal Ganglia C) Prefrontal Cortex, Hippocampus, Amygdala, Brodmann Area 25 D) Hippocampus, Brodmann Area 25, Corpus Collosum, Hypothalamus
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