Psyc 3560 (abnormal psyc) lecture 7 notes
Psyc 3560 (abnormal psyc) lecture 7 notes PSYC 3560
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This 10 page Class Notes was uploaded by Kennedy Finister on Saturday June 11, 2016. The Class Notes belongs to PSYC 3560 at Auburn University taught by Dr. Fix in Spring 2016. Since its upload, it has received 9 views. For similar materials see Abnormal Psychology in Psychlogy at Auburn University.
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Date Created: 06/11/16
Chapter 7 lecture notes May 27, 2016 Mood Disorders & Suicide Outline ¨ Types of Moods (and Episodes) ¨ Unipolar (Depressive) disorders ¤ Major Depressive Disorder (MDD) ¤ Persistent Depressive Disorder (Dysthymia) ¤ Causal Factors ¤ Treatment ¤ Bipolar Disorders ¤ Bipolar I Disorder ¤ Bipolar II Disorder ¤ Cyclothymic Disorder ¤ Causal Factors ¤ Treatment ¨ Suicide ¤ Epidemiology ¤ Prevention Other forms of depression… ¨ Loss and the Grieving Process ¤ Normal Grief Response n Numbing and disbelief n Yearning for the deceased n i.e., restlessness, insomnia, preoccupation with deceased n Disorganization and despair (accepts the death) n Reorganization – rebuilding of their lives ¤ Most studies suggest that such a process can last 2-6 months n DSM-IV recommended not to diagnose within first 2 months n DSM-5 allows depression diagnosis even within first 2 months if person meets criteria ¨ Types of moods ¤ Depressive episodes n Extreme sadness and gloominess ¤ Manic/Hypomanic episodes n Intense/unrealistic feelings of excitement and euphoria What are mood disorders? ¨ The two key moods involved are mania and depression ¨ In unipolor depressive disorders, the person experiences only depressive episodes ¨ In bipolar disorders the person experiences both manic and depressive episodes Chapter 7 lecture notes May 27, 2016 Major Depressive Disorder (MDD) Characterized by persistent down or depressed mood occurring more days than not (intense & episodic) ¨ Major Depressive Episode ¤ Need a combination of 5 symptoms to be diagnosed ¨ Emotional ¤ Sad mood ¤ Anhedonia à numbness ¨ Physiological/Behavioral ¤ Appetite change ¤ Sleep disturbance à usually longer ¤ Psychomotor disturbance ¤ Fatigue ¨ Cognitive ¤ Inappropriate guilt/feeling worthless ¤ Concentration difficulty/indecisiveness ¤ Thoughts of death/suicide Course of Major Depressive Disorder ¨ Depressive Episodes are often time-limited ¤ 6-9 months on average ¨ Likelihood of recurrence increases as # of MDEs increase ¨ Epidemiology of Major Depressive Disorder Prevalence ¤ 17% lifetime, 7% 1-year ¤ Prevalence rates have increased over the last 2 decades. Why? ¨ Gender Ratio ¤ 2:1 female to male – during adolescence and adulthood ¤ 1:1 male to female – during childhood n socialization/different experiences ¨ 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 (Latino, African American, European American) n Comparable rates n Higher rates of MDD among racial/ethnic minorities n Racism, hyper-aggression ¨ Why? Chapter 7 lecture notes May 27, 2016 ¤ Bias during diagnosis ¤ Different stressors ¤ Different symptomatology Persistent Depressive Disorder (Dysthymia) Characterized by Chronicity ¨ Some people have mild depressed mood, some meet full criteria for major depressive episode the whole time ¨ For diagnosis, symptoms must persist for at least 2 years (1 year in children) ¨ Intermittent normal moods occur VERY briefly ¤ Never for more than 2 months Causal Factors ¨ Biological Factors ¤ Genetic Influences n 2-3x more prevalent among biological relatives ¤ Neurochemical n Monoamine theory (Seratonin, Norepinephrine drive all) n Dopamine (linked to anhedonia & low positive affect) ¤ Hormonal n Stress response (cortisol) ¤ Neurophysiological factors n Right PFC (negative emotions) versus left PFC (approach, positive emotions) ¨ Biological Rhythms ¤ Sleep n More REM, less deep sleep n Could be vulnerability factor ¤ Sunlight/Seasons n Seasonal affective disorder n Usually atypical features (increased sleep, increased appetite) Psychological Factors ¨ Stressful life events ¤ Independent n Unrelated to own behavior n Example: athlete getting a season or career ending injury. Or finding out you have aids when you’ve been married and committed to someone for the last 10 years either being cheated on or was never told ¤ Dependent n Partly generated by own behavior n Abusing substances, ruining interpersonal relationships n Stronger role Chapter 7 lecture notes May 27, 2016 ¨ Personality ¤ Neuroticism n Sadness, guilt, anxiety ¤ Low Positive Affectivity n Emotional expression/experience à not very expressive n 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 ¤ Very realistic view of the world ¨ Ruminative Response Styles Theory ¤ Rumination = “Stewing” – focus intensely on how they feel and why they feel this way. ¤ Different response models will influence how we respond ¤ Mood states will influence how you think/ what you think about MDD: Interpersonal Factors ¨ 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 Treatment: Other Biological ¨ Electroconvulsive Therapy (ECT) ¤ Severe depression, non-responders ¨ Transcranial Magnetic Stimulation ¤ Pulsating magnetic fields stimulate certain regions in the cortex (5 days/week 2-6 weeks) ¤ Mixed findings ¨ Bright light therapy ¤ Originally used for seasonal affective disorder ¤ Effective for depression and seasonal affective disorder Treatment: Psychotherapy ¨ 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. Chapter 7 lecture notes May 27, 2016 ¤ Treatment: Psychotherapy ¨ Behavioral Activation (BA) ¤ Refers to increasing activities and interactions ¤ Very effective, maybe as effective as CBT ¤ Treatment: Psychotherapy ¨ Interpersonal Therapy (IPT) ¤ Identify and change maladaptive interaction patterns with others. ¤ As effective as medications and CBT, but still early in the research ¤ Bipolar Disorders Bipolar Disorder Terminology ¨ Intense emotional states are often referred to as mood episodes. ¨ An overly joyful or overexcited state is called a manic episode. ¨ An extremely sad or hopeless state is called a depressive episode. ¨ Sometimes, a mood episode includes symptoms of both mania and depression. This is called a mixed state. ¨ People with bipolar disorder also may be explosive and irritable during a mood episode. Manic Episode ¨ Elevated, expansive, irritable mood lasting at least 1 week ¨ 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 ¨ Clinically significant distress, impairment, hospitalization, or psychotic features Hypomania ¨ Hypomanic Episode ¤ Same as Manic except: n At least 4 days n Noticeable by others, but not severe enough to cause marked impairment in functioning Bipolar I disorder ¨ 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 is present Chapter 7 lecture notes May 27, 2016 Bipolar II Disorder ¨ DSM-5 ¤ Presence or history of one or more Major Depressive Episodes ¤ Presence or history of one or more Hypomanic Episodes ¤ No history of Manic Episode ¤ Clinically significant distress/impairment Cyclothymic Disorder ¨ 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 ¨ Prevalence ¤ 2-3% lifetime prevalence (all bipolar disorders combined) ¨ Gender Ratio ¤ 1:1 women to men ¨ Average age of onset ¤ Late Adolescence -Early Adulthood – average 22 ¨ Course: Episodic ¨ Comorbidity: Substance use disorders Bipolar Disorder vs. MDD ¨ Manic Episodes ¤ Tend to be much shorter than depressive episodes ¨ Depressive Episodes ¤ Tend to be more severe than unipolar depression and often have: n Greater mood lability n More psychotic features n More substance abuse n Greater psychomotor retardation ¨ Overall episodes shorter than MDD, but more episodes during lifetime ¤ Rapid cycling: 3-4 episodes within one year Biological Factors ¨ Genetic Factors ¤ One of the most heritable disorders ¤ No single gene responsible ¨ Neurochemical Factors ¤ Elevated norepinephrine and dopaminergic activity ¨ Hormonal factors Chapter 7 lecture notes May 27, 2016 ¤ Elevated cortisol levels during depressive episodes ¤ Thyroid hormone can precipitate manic episodes ¨ Biological rhythms ¤ Disruptions in sleep patterns can trigger manic episodes ¤ Seasonal patterns also common Psychological Factors ¨ Similar to unipolar disorders ¤ Stressful life events ¤ Personality and cognitive variables ¨ Interpersonal processes very important ¤ Dysfunctional family interactions often linked to onset of manic episodes Cultural Considerations ¨ Prevalence rates of unipolar depression differ across countries ¤ Top three: France, United States, Netherlands, New Zealand ¤ China, Mexico, India, South Africa n Collectivistic societies have higher social support, easier to deal with issues ¨ Less variability in rates of bipolar disorder ¤ Due to stronger genetic vs. environment component? ¨ Differences in symptom expression ¤ e.g., depression manifests as physical symptoms in Asian and African cultures. ¤ Less likely to be diagnosed Treatment: Meds ¨ Mood stabilizers: ¤ Lithium ¤ Anticonvulsants (e.g., Depakote) n Effective, but not as effective for suicidal ideation ¨ Antidepressants ¤ SSRIs ¤ ***Antidepressants can trigger manic episode ¨ Electroconvulsive Therapy (ECT) ¤ Has been show to help with manic episodes ¨ Cognitive-Behavior Therapy ¤ Good for depressive symptoms, not as effective for manic symptoms ¨ 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 n Recognize when they’re about to have a manic episode Chapter 7 lecture notes May 27, 2016 Suicidal Behavior àSome definitions... ¨ Suicidal ideation = thoughts about suicide without physically harming oneself ¤ 1/3 of general population in lifetime thinks about suicide ¨ Suicide attempt = non-fatal injury that is self-inflicted with at least some degree of intent to die ¤ 900,000 attempts each year ¨ Suicide = self-inflicted death ¤ 38,000 people die each year ¤ 11 in 100,000 people in the U.S. n likely higher but some attempts are harder to tell n example: getting drunk and driving of the road on purpose ¨ A problem across the lifespan Chapter 7 lecture notes May 27, 2016 Self-injury Across the Lifespan Suicidal desire • I don’t belong • I’m not accepted Thwarted Belongingness Perceived I’m a drain on Burdensomeness other people, too much for my family to handle Fearlessness Acquired Capability • about death • Heightened physical pain Highest suicide risk tolerance Suicide Prevention... • 68% of people who die by suicide were not seen by a mental health professional in the year before death • 2 General prevention strategies Chapter 7 lecture notes May 27, 2016 • High-risk - focus efforts just on people who are already known to be at risk • Universal - prevent onset of disease/condition in everyone • You can help prevent suicide • What can you do? n Believe n Listen (non-judgmentally) n Urge them to seek help ¨ 1-800-273-TALK
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