Abnormal Psychology Chapter 6 Exam 2

Mood-Stabilizing Drug

-A medication used in the treatment of mood disorders, particularly bipolar disorder, that is effective in preventing and treating pathological shifts in mood.

Bipolar I

-Alternation of major depressive episodes with full manic episodes. -Just need to have the experience of a full manic episode, and a hypomanic episode may follow -Can sometimes result in enough impairment in everyday functioning that results in hospitalization -Alternations between full manic episodes and major depressive episodes -Average age of onset is 15-18 years -Can begin in childhood -Tends to be chronic -Suicide is a common consequence -Occurrence of a manic episode -Hypomanic or major depressive episodes may precede or follow the manic episode -One Year Prevalence: 1.6% -Female to Male Ratio: 1:1 -Typical Age at Onset: 15-44 -Prevalence Among First Degree Relatives: Elevated -Percentage Currently Receiving Treatment: 33.8%

Bipolar II

-Alternation of major depressive episodes with hypomanic episodes (not full manic episodes). -No history of full manic episode -10% to 25% of cases progress to full bipolar I disorder -Alternations between major depressive and hypomanic episodes -Average age of onset is 19-22 years -Can begin in childhood -Tends to be chronic -Presence or history of major depressive episode(s) -Presence or history of hypomanic episode(s) -No history of a manic episode -One Year Prevalence: 1% -Female to Male Ratio: 1:1 -Typical Age at Onset: 15-44 -Prevalence Among First Degree Relatives: Elecated -Percentage Currently Receiving Treatment: 33.8%

Lithium

-Another type of antidepressant drug, lithium carbonate, is a common salt widely available in the natural environment. -It is found in our drinking water in amounts too small to have any effect. -The side effects of therapeutic doses of lithium are potentially more serious, however, than the side effects of other antidepressants. -Dosage has to be carefully regulated to prevent toxicity (poisoning) and lowered thyroid functioning, which might intensify the lack of energy associated with depression. -Substantial weight gain is also common. -Lithium, however, has one major advantage that distinguishes it from other antidepressants: It is also often effective in preventing and treating manic episodes. -Therefore, it is most often referred to as a mood-stabilizing drug. -Results indicate that 50% of bipolar patients respond well to lithium initially, meaning at least a 50% reduction in manic symptoms

Mixed Reuptake Inhibitors (SNRI)

-Best known is venlafaxine (Effexor) -Block reuptake of norepinephrine as well as serotonin -Have fewer side effects than SSRIs -Difficult to figure out the exact dose that an individual needs -We often know that the only way something is working is the decrease in symptoms that a patient is observing -The best known, venlafaxine (Effexor) is related to tricyclic antidepressants, but acts in a slightly different manner, blocking reuptake of norepinephrine as well as serotonin. Some side effects associated with the SSRIs are reduced with venlafaxine, as is the risk of damage to the cardiovascular system. Other typical side effects remain, including nausea and sexual dysfunction.

Electroconvulsive Therapy (ECT)

-Biological treatment for severe, chronic depression involving the application of electrical impulses through the brain to produce seizures. The reasons for its effectiveness are unknown. -May be last resort if body not responding to drugs -Brief electrical current applied to the brain -Results in temporary seizures -Usually 6-10 outpatient treatments are required -60-80% improve -Especially in patients with severe depression with delusions -Unipolar Treatment ECT today: -Today, patients are given drugs to help them sleep, muscle relaxants to prevent severe jerks of the body and broken bones, and oxygen to guard against brain damage.

Integrative theory

-Biological, psychological and social factors -Overactive neurobiological response to stress, cortisol effects the hippocampus, etc. -Inadequate coping and depressive cognitive style, putting oneself in situations that are more risky or negative -Exposure to stress -Consider multiple influences -Seligman and Beck developed their theories independently, and good evidence indicates their models are independent in that some people may have a negative outlook (dysfunctional attitudes), whereas others may explain things negatively (hopeless attributes) Good evidence supporting this conclusion comes from the Temple-Wisconsin study of cognitive vulnerability to depression conducted by Lauren Alloy and Lyn Abramson: -The really important results come from the prospective portion of the study. -Negative cognitive styles do indicate a vulnerability to later depression. -Even if participants had never suffered from depression before in their lives, high-risk participants (who scored high on the measures of cognitive vulnerability) were six to 12 times more likely than low-risk participants to experience a major depressive episode. -In addition, 16% of the high-risk participants versus only 2.7% of the low-risk participants experienced major depressive episodes, and 46% versus 14% experienced minor depressive symptoms

Full Manic Episode

-Bipolar I

Monoamine Oxidase (MAO) Inhibitors

-Block monoamine oxidase, which breaks down norepinephrine, which leads to an increased amount or availability in norepinephrine -As effective as tricyclics, with fewer side effects -Dangerous in combination with certain foods, in that they can lead to a dangerous raise in blood pressure -~50% of patients are helped -As their name suggests, they block the enzyme MAO that breaks down such neurotransmitters as norepinephrine and serotonin. -The result is roughly equivalent to the effect of the tricyclics. -Because they are not broken down, the neurotransmitters pool in the synapse, leading to a down-regulation. The MAO inhibitors seem to be as effective as the tricyclics -But MAO inhibitors are used far less often because of two potentially serious consequences: Eating and drinking foods and beverages containing tyramine, such as cheese, red wine, or beer, can lead to severe hypertensive episodes and, occasionally, death.

Interpersonal Psychotherapy (IPT)

-Brief treatment approach that emphasizes resolution of interpersonal problems and stressors, such as role disputes in marital conflict, forming relationships in marriage, or a new job. It has demonstrated effectiveness for such problems as depression. -Like cognitive-behavioral approaches, IPT is highly structured and seldom takes longer than 15 to 20 sessions, usually scheduled once a week -After identifying life stressors that seem to precipitate the depression, the therapist and patient work collaboratively on the patient's current interpersonal problems. Typically, these include one or more of four interpersonal issues: 1.) Dealing with interpersonal role disputes, such as marital conflict 2.) Adjusting to the loss of a relationship, such as grief over the death of a loved one 3.) Acquiring new relationships, such as getting married or establishing professional relationships 4.) Identifying and correcting deficits in social skills that prevent the person from initiating or maintaining important relationships. 3 Stages: 1.) Negotiation stage. Both partners are aware it is a dispute, and they are trying to renegotiate it. 2.) Impasse stage. The dispute smolders beneath the surface and results in low-level resentment, but no attempts are made to resolve it. 3.) Resolution stage. The partners are taking some action, such as divorce, separation, or recommitting to the marriage.

Cyclothymic Disorder

-Chronic (at least 2 years) mood disorder characterized by alternating mood elevation and depression levels that are not as severe as manic or major depressive episodes. -One Year Prevalence: 0.40% -Female to Male Ratio: 1:1 -Typical Age at Onset: 15-25 -Prevalence Among First Degree Relatives: Elevated -Percentage Currently Receiving Treatment: Unknown -For at least two years, numerous periods with hypomanic symptoms and numerous periods with depressive symptoms that do not meet the criteria for a major depressive episode. -Since onset, the person has not been without the symptoms for more than two months at a time. -No major depressive episode, manic episode, or hypomanic episode has been present during the first two years of the disturbance. -Mood symptoms are not better accounted for by another disorder, the physiological effects of a substance, or a general medical condition. -Clinically significant distress or impairment of functioning.

Maintence Treatment

-Combination of continued psychosocial treatment, medication, or both designed to prevent relapse following therapy.

Mixed Features

-Condition in which the individual experiences both elation and depression or anxiety at the same time. Also known as dysphoric manic episode or mixed manic episode.

Mindfulness-Based Therapy

-Effective in treating depression and preventing relapses -The late Neil Jacobson and colleagues have shown that increased activities alone can improve self-concept and lift depression -The new focus of this approach is on preventing avoidance of social and environmental cues that produce negative affect or depression and result in avoidance and inactivity. -Rather, the individual is helped to face the cues or triggers and work through them and the depression they produce, with the therapist, by developing better coping skills.

Selective Serotonin Reuptake Inhibitors (SSRI)

-Fluoxetine (Prozac) is most popular -SSRIs pose some risk of suicide particularly in teenagers -Negative side effects are common -Have fewer side effects than tricyclics -Increase the serotonin that is available in the synapse to act on the post synaptic neuron by blocking the reuptake to the serotonin -The class of drugs currently considered the first choice in drug treatment for depression - These selective-serotonin reuptake inhibitors (SSRIs) specifically block the presynaptic reuptake of serotonin. This temporarily increases levels of serotonin at the receptor site, but again the precise long-term mechanism of action is unknown, although levels of serotonin are eventually increased -Prozac and other SSRIs have their own set of side effects, the most prominent of which are physical agitation, sexual dysfunction, low sexual desire -But these side effects, on the whole, seem to bother most patients less than the side effects associated with tricyclic antidepressants, with the possible exception of the sexual dysfunction.

Exogenous/Reactive Depression

-Gene environment interaction -If someone is more sucseptiable to stress response, they will have more of an environmental effect on how they experience a given situation

Complicated Grief

-Grief characterized by debilitating feelings of loss and emotions so painful that a person has trouble resuming a normal life; designated for further study as a disorder by DSM-5. -Persistent intense symptoms of acute grief -The presence of thoughts, feelings, or behaviors reflecting excessive or distracting concerns about the circumstances or consequences of the death

Integrated Grief

-Grief that evolves from acute grief into a condition in which the individual accepts the finality of a death and adjusts to the loss. -Integrated grief often recurs at significant anniversaries, such as the birthday of the loved one, holidays, and other meaningful occasions, including the anniversary of the death. -This is all a very normal and positive reaction. In fact, mental health professionals are concerned when someone does not grieve after a death, because grieving is our natural way of confronting and handling loss. -When grief lasts beyond the typical time, mental health professionals again become concerned -Sense of having adjusted to the loss -Interest and sense of purpose, ability to function, and capacity for joy and satisfaction are restored -Feelings of emotional loneliness may persist -Thoughts and memories of the deceased person accessible and bittersweet but no longer dominate the mind -Occasional hallucinatory experiences of the deceased may occur -Surges of grief in response to calendar days or other periodic reminders of the loss may occur

Neurohormones

-Hormone that affects the brain and is increasingly the focus of study in psychopathology. - There are thousands of neurohormones. -Sorting out their relationship to antecedent neurotransmitter systems (as well as determining their independent effects on the central nervous system) is likely to be a complex task indeed. -One of the glands influenced by the pituitary is the cortical section of the adrenal gland, which produces the stress hormone cortisol that completes the HPA axis. -Cortisol is called a stress hormone because it is elevated during stressful life events.

Hypomanic Episode

-Hypo = less severe -Less severe and less disruptive version of a manic episode that is one of the criteria for several mood disorders. -Shorter, less severe version of manic episodes -Last at least four days, not necessarily a week or more -Have fewer and milder symptoms -Associated with less impairment than a manic episode (e.g., less risky behavior) -Less severe version of full manic episodes -Doesn't effect everyday behavior as much -In conjunction with what is going on with what is happening in the individual's everyday life -May not be problematic in and of itself, but usually occurs in the context of a more problematic mood disorder

Recurrent

-If two or more major depressive episodes occurred and were separated by at least two months during which the individual was not depressed, the major depressive disorder is noted as being recurrent.

Tricyclics

-Include Tofranil, Elavil -Mechanisms not well understood -Negative side effects are common -Can cause drowsiness, weight gain, blurred vision -Tricyclic antidepressants were the most widely used treatments for depression before the introduction of SSRIs, but are now used less commonly - It is not yet clear how these drugs work, but initially, at least, they block the reuptake of certain neurotransmitters, allowing them to pool in the synapse and, as the theory goes, desensitize or down-regulate the transmission of that particular neurotransmitter (so less of the neurochemical is transmitted). -Tricyclic antidepressants seem to have their greatest effect by down-regulating norepinephrine, although other neurotransmitter systems, particularly serotonin, are also affected. -This process then has a complex effect on both presynaptic and postsynaptic regulation of neurotransmitter activity, eventually restoring appropriate balance. -Side effects include blurred vision, dry mouth, constipation, difficulty urinating, drowsiness, weight gain (at least 13 pounds on average), and, sometimes, sexual dysfunction. -Therefore, as many as 40% of these patients may stop taking the drug, thinking the cure is worse than the disease.

Cases of Unipolar

-Individuals who experience either depression or mania are said to suffer from a unipolar mood disorder, because their mood remains at one "pole" of the usual depression-mania continuum. -Mania by itself (unipolar mania) probably does occur but seems to be rare, because most people with a unipolar mood disorder eventually develop depression.

Cognitive Behavioral Analysis System of Psychotherapy (CBASP)

-Integrates cognitive, behavioral, and interpersonal strategies and focuses on problem-solving skills, particularly in the context of important relationships. -This treatment was designed for individuals with persistent (chronic) depression and has been tested in a large clinical trial

Lifespan developmental influences

-It seems clear, however, that the "look" of depression changes with age. -For example, children under three years of age might manifest depression by sad facial expressions, irritability, fatigue, fussiness, and tantrums, as well as by problems with eating and sleeping. -In the extreme, this could develop into disruptive mood dysregulation disorder. In children between the ages of nine and 12, many of these features would not occur. -However, once depression develops, it cannot be expected that children simply "grow out of it". -For example, a recent study by Luby and colleagues found that preschool depression was a significant and robust predictor for later depression at the ages of six to 13. Preschool depression was also a risk factor for other problems, such as anxiety disorders and ADHD at school age -One developmental difference between children and adolescents compared with adults concerns patterns of comorbidity. For example, childhood depression (and mania) is often associated with and sometimes misdiagnosed as ADHD or, more often, conduct disorder in which aggression and even destructive behavior are common -It can be difficult to diagnose depression in older adults because elderly people who become physically ill or begin to show signs of dementia might become depressed about it, but the signs of depression or mood disorder would be attributed to the illness or dementia and thus missed -Depression can also contribute to physical disease and death in the elderly

Anhedoina

-Loss of energy and inability to engage in pleasurable activities or have any "fun") is more characteristic of these severe episodes of depression than are, for example, reports of sadness or distress -Nor does the tendency to cry, which occurs equally in depressed and non-depressed individuals (mostly women in both cases) reflect severity—or even the presence of a depressive episode -This anhedonia reflects that these episodes represent a state of low positive affect and not just high negative affect

DSM-5 (Unipolar) Depressive Disorders

-Major depressive disorder -Persistent depressive disorder New to DSM-5: (see book) -Premenstrual dysphoric disorder -Disruptive mood dysregulation disorder -Characterized by course and severity

Mood Disorders

-Mood Disorders = Gross deviations in mood -One of a group of disorders involving severe and enduring disturbances in emotionality ranging from elation to severe depression. There are two key emotions in mood disorders: 1.) Depression, a very low, sad state where people cannot face challenges in life, typically is accompanied by anhedonia (in ability to experience pleasure) 2.) Mania, eurphoric, frenzied energy Composed of different types of mood "episodes": -Major depressive episodes -Persistent depression -Manic and hypomanic episodes

Persistent Depressive Disorder

-Mood disorder involving persistently depressed mood, with low self-esteem, withdrawal, pessimism, or despair, present for at least 2 years, with no absence of symptoms for more than 2 months. -Persistent depressive disorder with major depressive episodes (double depression) -Persistent depressive disorder, not as severe ("pure dysthymic syndrome") -Person experiences depressed mood for at least 2 years. -Can last 20-30 years and experience this depressed mood 50% of the time -During the 2-year period, symptoms not absent for more than 2 months at a time. -No history of mania or hypomania. -Significant distress or impairment. -One Year Prevalence: 1.5-5% -Female to Male Ratio: Between 3:2 & 2:1 -Typical Age at Onset: 10-25 -Prevalence Among First Degree Relatives: Elevated -Percentages Currently Receiving Treatment: 36.8%

Major Depressive Episode

-Most common and severe experience of depression, including feelings of worthlessness, disturbances in bodily activities such as sleep, loss of interest, and inability to experience pleasure, persisting at least 2 weeks

Premenstrual Dysphoric Disorder

-New to DSM-5 -Clinically significant emotional problems that can occur during the premenstrual phase of the reproductive cycle of a woman. -Basically clinicians identified a small group of women, from 2% to 5%, who suffered from severe and sometimes incapacitating emotional reactions during the premenstrual period

Disruptive Mood Dysregulation Disorder

-New to DSM-5 -Condition in which a child has chronic negative moods such as anger and irritability without any accompanying mania. -But the most important observation is that these children show no evidence of periods of elevated mood (mania), which has been a requirement for a diagnosis of bipolar disorder -Though these broader definitions of symptoms do display some similarities with more classic bipolar disorder symptoms, the danger is that these children are being misdiagnosed when they might better meet criteria for more classic diagnostic categories, such as attention-deficit/hyperactivity disorder (ADHD) or conduct disorder

Mood Disorders: Cognitive Theory (Seligman)

-Nolen-Hoeksema, Girgus, and Seligman (1992) reported that negative attributional style did not predict later symptoms of depression in young children; rather, stressful life events seemed to be the major precipitant of symptoms. -As children under stress grew older, however, they tended to develop more negative cognitive styles, which did tend to predict symptoms of depression in reaction to additional negative events. -Nolen-Hoeksema and colleagues speculate that meaningful negative events early in childhood may lead to negative attributional styles, making these children more vulnerable to future depressive episodes when stressful events occur. Depressive attributional style: -Internal attributions, typically take the form of blaming oneself for issues in ones life -Internal, in that the individual attributes negative events to personal failings ("it is all my fault"); -Stable, in that, even after a particular negative event passes, the attribution that "additional bad things will always be my fault" remains; and -Global, in that the attributions extend across a variety of issues. -Stable attributions, believing that all future negative outcomes are going to be their fault -Global attribution, negative things will have a severe impact on their life as a whole -Ultimately they will approach and experience life differently -Sense of hopelessness -Some individuals are more prone to having attributes about themselves, their experiences, and the world, in a more negative way

Unipolar

-Only depression -No history in mania -Normal mood when depression lifts -Clinical depression can be very severe and bring a lot of psychological effects that me intensify and become chronic Prevalence: -8%/yr; 19% at least once in life -Lifetime: 26% of women; 12% of men -Among children, similar among boys and girls Recovery: -85% with and without treatment -40% will have another episode

Interpersonal and Social Rhythm Therapy

-Patients receiving IPSRT survived longer without a new manic or depressive episode compared with patients undergoing standard, intensive clinical management. -Initial results with adolescents are also promising

Bipolar

-Periods of mania alternate with periods of depression -Cycling between manic episodes and periods of depression

Psychological Autopsy

-Postmortem psychological profile of a suicide victim constructed from interviews with people who knew the person before death.

Treatments for Bipolar Disorder: Adjunctive Psychotherapy

-Psychotherapy alone is rarely helpful for persons with bipolar disorder -Mood stabilizing drugs alone are also not always effective -As a result, clinicians often use psychotherapy as an ADJUNCT to lithium or other medication-based therapy -30% or more of patients do not always respond, may not have the correct dose, so psychotherapy is needed when trying to find the best medication

Acute Grief

-Recurrent, strong feelings of yearning, wanting very much to be reunited with the person who died; possibly even a wish to die in order to be with deceased loved one -Pangs of deep sadness or remorse, episodes of crying or sobbing, typically interspersed with periods of respite and even positive emotions -Steady stream of thoughts or images of deceased, may be vivid or even entail hallucinatory experiences of seeing or hearing deceased person -Struggle to accept the reality of the death, wishing to protest against it; there may be some feelings of bitterness or anger about the death -Somatic distress, e.g., uncontrollable sighing, digestive symptoms, loss of appetite, dry mouth, feelings of hollowness, sleep disturbance, fatigue, exhaustion or weakness, restlessness, aimless activity, difficulty initiating or maintaining organized activities, and altered sensorium -Feeling disconnected from the world or other people, indifferent, not interested, or irritable with others

Endogenous Depression

-Response to internal changes in the body

Double Depression

-Severe mood disorder typified by major depressive episodes superimposed over a background of dysthymic disorder.

Freud & Suicide

-Sigmund Freud (1917/1957) believed that suicide (and depression, to some extent) indicated unconscious hostility directed inward to the self rather than outward to the person or situation causing the anger. -Indeed, suicide victims often seem to be psychologically "punishing" others who may have rejected them or caused some other personal hurt. -Current thinking considers social and psychological factors but also highlights the potential importance of biological contributions.

Emile Durkheim & Suicide

-The great sociologist Emile Durkheim (1951) defined a number of suicide types, based on the social or cultural conditions in which they occurred. -One type is "formalized" suicides that were approved of, such as the ancient custom of hara-kiri in Japan, in which an individual who brought dishonor to himself or his family was expected to impale himself on a sword. Durkheim referred to this as *altruistic suicide*. -Durkheim also recognized the loss of social supports as an important provocation for suicide; he called this *egoistic suicide*. (Older adults who kill themselves after losing touch with their friends or family fit into this category.) found that only 13% of 75 individuals who had seriously attempted suicide had an adequate social network of friends and relationships. Similarly, a recent study found that suicide attempters perceived themselves to have lower social support than did non-attempters -*Anomic suicides* are the result of marked disruptions, such as the sudden loss of a high-prestige job. (Anomie is feeling lost and confused.) -Finally, *fatalistic suicides* result from a loss of control over one's own destiny. The mass suicide of 39 Heaven's Gate cult members in 1997 is an example of this type because the lives of those people were largely in the hands of Marshall Applewhite, a supreme and charismatic leader. -Durkheim's work was important in alerting us to the social contribution to suicide.

Phototherapy

-Therapy that involves repeated exposure to bright light -Seasonal affective disorder

Gene-Environment Interaction

-Those who are predisposed to depression may tend to put themselves in more risky situations -One example would be people who tend to seek difficult relationships because of genetically based personality characteristics that then lead to depression.

Cognitive Therapy

-Treatment approach that involves identifying and altering negative thinking styles related to psychological disorders such as depression and anxiety and replacing them with more positive beliefs and attitudes—and, ultimately, more adaptive behavior and coping styles. -Clients are taught to examine carefully their thought processes while they are depressed and to recognize "depressive" errors in thinking.

Transcranial Magnetic Stimulation (TMS)

-Treatment for Unipolar Depression -AKA: Deep brain stimulation -Noninvasive -In a depressed patient there is a lot less activity than in a normal patient -Stimulates the magnetic fields to stimulate the nerve cells to increase the activity that should be happening -Good for those who do not respond well to drugs

DSM-5 Bipolar Disorders

1.) Bipolar I disorder 2.) Bipolar II disorder 3.) Cyclothymic disorder (see book)

List five biological sources that can contribute to mood disorders.

1.) Genetics 2.) Neurotransmitter System Abnormalities 3.) Endocrine System 4.) Circadian or Sleep Rhythms 5.) Neurohormones

Name several social and cultural dimensions that contribute to mood disorders.

1.) Marital Dissatisfaction 2.) Gender 3.) Few Social Supports

Major Depressive Disorder

1.) Presence of a major depressive episode 2.) No pattern of mania or hypomania. -Mood disorder involving one (single episode) or more (separated by at least 2 months without depression, recurrent) -Extremely depressed mood and/or loss of pleasure (anhedonia) -Lasts most of the day, nearly every day for at least two weeks -At least 4 additional physical or cognitive symptoms: E.g., indecisiveness, feelings of worthlessness, fatigue, appetite change, restlessness or feeling slowed down, sleep disturbance -One Year Prevalence: 8% -Famale to Male Ratio: 2:1 -Typical Age at Onset: 24-29 -Prevalence Among First Degree Relatives: Elevated -Percentage Currently Receiving Treatment: 50%

4 basic types of antidepressant medications used to treat depressive disorders:

1.) SSRI 2.) Mixed reuptake inhibitors 3.) Tricyclics 4.) MAO

What psychological factors can have an impact on mood disorders?

1.) Stressful Life Events 2.) Learned Helplessness 3.) Depressive Cognitive Triad 4.) A Sense of Uncontrollability

Which statement best characterizes the relationship between anxiety and depression? -Anxiety usually precedes the development of depression. -Depression usually precedes the development of anxiety. -Almost all depressed patients are anxious, but not all anxious patients are depressed. -Almost all anxious patients are depressed, but not all depressed patients are anxious.

Almost all depressed patients are anxious, but not all anxious patients are depressed.

Sheiba lives in a remote village in Africa. She was recently caught in an adulterous affair with a man in a nearby village. Her husband wants to kill her but won't have to because of a tribal custom that requires her to kill herself. She leaps from the nearby "sinful woman's cliff."

Altruistic

Ralph's wife left him and took the children. He is a well-known television personality, but, because of a conflict with the new station owners, he was recently fired. If Ralph kills himself, his suicide would be considered

Anomic

These come in three main types (tricyclics, MAO inhibitors, and SSRIs) and are often prescribed but have numerous side effects

Antidepressants

What is the general agreement among mental health professionals about the relationship between bereavement and depression?

Bereavement can lead to depression in many cases

Last week, as he does about every three months, Ryan went out with his friends, buying rounds of drinks, socializing until early morning, and feeling on top of the world. Today Ryan will not even get out of bed to go to work, see his friends, or even turn on the lights

Bipolar I Disorder

In treating depressed clients, a psychologist helps them think more positively about themselves, about their place in the world, and about the prospects for the future. This psychologist is basing her techniques on whose model of depression?

Carl Rogers

This teaches clients to carefully examine their thought process and recognize "depressive" styles in thinking.

Cognitive Therapy

Eusebio is always down and a bit blue, but occasionally he becomes so depressed that nothing pleases him

Double Depression

Treatments for Unipolar

Drugs: -MOA Inhibitors -Tricyclics -SSRI/SNRI

Suicidal Attempts

Effort made to kill oneself.

Mabel lived in a nursing home for many years. At first, her family and friends visited her often; now they come only at Christmas. Her two closest friends in the nursing home died recently. She has no hobbies or other interests. Mabel's suicide would be identified as what type?

Egoistic

The controversial but somewhat successful treatment involving the production of seizures through electrical current to the brain.

Electroconvulsive Therapy

Depression requires some life experience, indicating that babies and young children cannot experience the disorder. (T/F)

False - It does not require life experience

Mood Disorders: Familial and Genetic Influences

Family Studies: -Rate is high in relatives of probands -Relatives of bipolar probands are more likely to have unipolar depression -As many of 20% of relatives of those with depression are also depressed -In the general population, fewer than 10% of individuals without any relatives with depression will experience this Twin Studies: -Concordance rates are high in identical twins -Severe mood disorders have a strong genetic contribution -Heritability rates are higher for females compared to males -Vulnerability for unipolar or bipolar disorder -Appears to be inherited separately -Some genetic factors are common for mood and anxiety disorders -MZ = 46% concordance rate -DZ = 20% concordance rate -Unipolar depression may be tied to some gene -Doesn't seem to be a link between unipolar disorder and bipolar disorders and their genetic influences -However, if one identical twin has unipolar disorder, the chances of a co-twin having bipolar disorder are slim to none. -In a large meta-analysis of twin studies, Sullivan et al. (2000) estimated the heritability of depression to be 37%. Shared environmental factors have little influence, whereas 63% of the variance in depression can be attributed to non-shared environmental factors.

Sam killed himself while a prisoner of war in Vietnam.

Fatalistic

Treatment for bereavement often includes:

Finding meaning in the loss

Depression

Five main areas of affected functioning: 1.) Emotional symptoms 2.) Motivational symptoms, lose desire to pursue or engage in activities, withdrawal from relationships 3.) Behavioral symptoms, less active, less productive 4.) Cognitive symptoms, have negative views of themselves, self blame, pessimistic outlook 5.) Physical symptoms, dizziness, headaches, general physical pain -Key feature: Anhedonia. Unable to experience pleasure

Which of the following explains why some people refuse to take medications to treat their depression or take those medications and then stop? -The medications are in short supply and are unavailable. -The medications don't work for most people. -For some people the medications cause serious side effects. -The medications work in the short term but not the long term.

For some people the medications cause serious side effects.

Bipolar I disorder is characterized by ______, whereas bipolar II is characterized by ______.

Full manic episodes; hypomanic episodes

The Biological Model of Unipolar Depression

Genetic -> Biochemical (Serotonin, Norepinephrine, Too much secretion of cortisol and melatonin) -> Anatomical (Prefrontal cortex, hippocampus, amygdala, Brodmann Area 35) -> Immune System ->

Which of the following is a risk factor for suicide? -Having a relative who committed suicide -Playing aggressive, full-contact sports -A history of multiple marriages -An abstract, philosophical cognitive

Having a relative who committed suicide

This therapy focuses on resolving problems in existing relationships and learning to form new interpersonal relationships.

Interpersonal Psychotherapy

Mood Disorders: Psychological Models

LEARNED HELPLESSNESS model (Seligman): -Lack of perceived control over life events leads to decreased attempts to improve own situation -Jumping to safety. Experimental animals learn to escape or avoid shocks that are administered on one side of a shuttle box by jumping to the other (safe) side.

Which theory suggests that depression occurs when individuals believe that they have no control over the circumstances in their lives?: -Attribution theory -Learned helplessness -Social learning theory -Theory of equifinality.

Learned Helplessness

This antidepressant must be carefully regulated to avoid illness but has the advantage of affecting manic episodes.

Lithium

This is an effort to prevent relapse or recurrence over the long run.

Maintenance Treatment

For the past few weeks, Jennifer has been sleeping a lot. She feels worthless, can't get up the energy to leave the house, and has lost a lot of weight. Her problem is the most common and extreme mood disorder.

Major Depressive Episode

An individual who is experiencing an elevated mood, a decreased need for sleep, and distractibility is most likely experiencing:

Mania

Feeling certain he would win the lottery, Charles went on an all-night shopping spree, maxing out all his credit cards without a worry. We know he's done this several times, feeling abnormally extreme elation, joy, and euphoria.

Mania

Mania

Manic Episode DxChecklist: -For 1 week or more, person displays a continually abnormal, inflated, unrestrained, or irritable mood as well as continually heightened energy or activity, for most of every day. -Significant distress or impairment Person also experiences at least three of the following symptoms: -Grandiosity or overblown self-esteem -Reduced need for sleep -Increased talkativeness -Racing thoughts/shifting -Easily distractible -Psychomotor agitation -Excessive pursuit of risky and potentially problematic activities -Period of abnormally excessive elation or euphoria associated with some mood disorders. - In mania, individuals find extreme pleasure in every activity; some patients compare their daily experience of mania with a continuous sexual orgasm. -They become extraordinarily active (hyperactive), require little sleep, and may develop grandiose plans, believing they can accomplish anything they desire. -DSM-5 highlights this feature by adding "persistently increased goal-directed activity or energy" to the criteria -Speech is typically rapid and may become incoherent, because the individual is attempting to express so many exciting ideas at once; this feature is typically referred to as flight of ideas.

Treatments for bipolar-how are drugs different than for unipolar?

Many studies prove effectiveness of lithium and other mood stabilizers: -> 60 percent of patients -Fewer new episodes -Overcome depressive episodes to a lesser degree -Researchers do not fully understand how mood stabilizing drugs operate -Antidepressant drugs do not work for everyone -Only 50% of patients benefit -Only 25% achieve normal functioning

Mood Disorders: Cognitive Theory (Beck)

Negative coping styles: -Cognitive errors, that end up focusing on the negative -In 1967, Aaron T. Beck (1967, 1976) suggested that depression may result from a tendency to interpret everyday events in a negative way. -According to Beck, people with depression make the worst of everything; for them, the smallest setbacks are major catastrophes. -In his extensive clinical work, Beck observed that all of his depressed patients thought this way, and he began classifying the types of "cognitive errors" that characterized this style. Types of cognitive errors: -Arbitrary inference: Individuals with negative coping styles overemphasizes the negative aspects of a situation. Arbitrary inference is evident when a depressed individual emphasizes the negative rather than the positive aspects of a situation. -Overgeneralization: Individuals with negative coping styes will apply negative interpretations to all situations. As an example of overgeneralization, when your professor makes one critical remark on your paper, you then assume you will fail the class despite a long string of positive comments and good grades on other papers. You are overgeneralizing from one small remark. Depressive cognitive triad: -Thinking errors by depressed people negatively focused in three areas: themselves, their immediate world, and their future. BECK'S COGNITIVE THERAPY: -Includes a number of behavioral techniques -Help clients recognize and change their negative cognitive processes -Usually lasts fewer than 20 sessions -Longer-lasting effectiveness than medication -In addition, Beck theorized, after a series of negative events in childhood, individuals may develop a deep-seated *negative schema*, an enduring negative cognitive belief system about some aspect of life

Mood Disorders: Neurobiological Influences

Neurotransmitter Systems: -Serotonin and its relation to other neurotransmitters, low levels of serotonin are implicated in these disorders and depressive episodes -Mood disorders are related to low levels of serotonin -Permissive hypothesis and serotonin, with low serotonin permits other neurotransmitters to vary widely The Endocrine System: -Elevated cortisol -Stress hormones decrease neurogenesis in the hippocampus -Hippocampus is implicated in both unipolar and bipolar -Cortisol effects birth of new neurons in hippocampus Sleep Disturbance: -Depressed patients have quicker and more intense REM sleep -BUT: Sleep deprivation may temporarily improve depressive symptoms in bipolar patients

Ayana has had some mood disorder problems in the past, although some days she's better than others. Many days it seems like she has fallen into a rut. Although she manages to get by, she has trouble making decisions because she doesn't trust herself.

Persistent Depressive Disorder

Maintenance treatment for depression can be important because it can prevent:

Relapse

Causes of Bipolar

Research insights into causes come from a variety of sources: -Neurotransmitters, over activity of norepinephrine, depression that is experienced cold be linked to low seratonin -Ion activity, improper transport and irregularities in ions, which could lead to too much firings to neurons or not enough -Brain structure, amygdala, hippocampus, prefrontal campus, basal ganglia, cerebellum -Genetic factors, fairly high heritibality, MZ show 40% concordance, DZ and siblings show 5-10% concordance

Suicidal Ideation

Serious thoughts about committing suicide.

Stress can trigger depressive episode

Stress may be a trigger for depression: -Greater number of stressful life events during the month just before symptom onset -Reactive (exogenous) depression -Endogenous depression -Gene-environment interaction -Relationship b/w stress and bipolar also seen -Cortisol implicated in this

Suicide Risk and Prevention

Suicide: Facts and Statistics -11th leading cause of death in USA -Most common among white and native Americans -Particularly prevalent in young adults -Gender differences, It may be that gender differences in the development of emotional disorders are strongly influenced by perceptions of uncontrollability -12% of college students consider it, 2nd leading death of college students -3rd leading death in teenagers -Regardless of age, in every country around the world except China, males are four times more likely to commit suicide than females -Males generally choose far more violent methods, such as guns and hanging; females tend to rely on less violent options, such as drug overdose -More men commit suicide during old age and more women during middle age, partly because most attempts by older women are unsuccessful -Females attempt suicide more than males -Among depressed patients, the strongest predictor of suicidal behavior was having a family history of suicide, even higher if it was a sibling -As we have noted, extremely low levels of serotonin are associated with impulsivity, instability, and the tendency to overreact to situations. It is possible then that low levels of serotonin may contribute to creating a vulnerability to act impulsively. This may include killing oneself, which is sometimes an impulsive act. -The studies by Brent and colleagues (2002) and Mann and colleagues (2005) suggest that transmission of vulnerabilities for a mood disorder, including the trait of impulsivity, may mediate family transmission of suicide attempts. -More than 80% of people who kill themselves suffer from a psychological disorder, usually mood, substance use, or impulse control disorders -As many as 60% of suicides (75% of adolescent suicides) are associated with an existing mood disorder -An important step is limiting access to lethal weapons for anyone at risk for suicide The Institute of Medicine (IOM) delineated three types of programs: 1.) Universal programs, which are applied to everyone 2.) Selected interventions, which target individuals at risk for depression because of factors such as divorce, family alcoholism, and so on 3.) Indicated interventions, in which the individual is already showing mild symptoms of depression

Suicidal Plans

The formulation of a specific method of killing oneself.

It's often difficult to diagnose depression in the elderly because its symptoms are similar to those of medical ailments or dementia. (T/F)

True

Somatic symptoms characterizing mood disorders are nearly equivalent across cultures. (T/F)

True

Women are approximately twice as likely as men to be diagnosed with a mood disorder. (T/F)

True