abnormal psychology ch 7

1) diagnosis of PMDD is intended to apply to women who experience a range of significant psychological symptoms in the week before menses (and improvement beginning within a few days following the onset of menses) 2) mood swings, sudden tearfulness or feelings of sadness, depressed mood or feelings of hopelessness, irritability or anger, feelings of anxiety, tension, being on edge, greater sensitivity to cues of rejection, and negative thoughts about oneself. *** These symptoms also need to be associated with significant emotional distress or interference with the woman's ability to function on the job, in school, or in usual social activities

1) Diagnosis of Premenstrual Dysphoric Disorder (PMDD) 2) Symptoms of PMDD

- Major depressive episodes - Manic episodes - Hypomanic episodes

3 different types of mood disorders

1. Antidepressants a. Selective serotonin reuptake inhibitors (SSRIs)(Prozac and Zoloft) b. Tricyclic antidepressants c. Monoamine oxidase inhibitors d. Mixed reuptake inhibitors (e.g. serotonin/norepinephrine reuptake inhibitors) 2. Approximately equally effective a Only 50% of pts benefit b Only 25% achieve normal functioning

BIOLOGICAL TREATMENT OF MOOD DISORDERS: 1. Antidepressants a. b. c. d. 2. Approximately equally effective a Only ____ of pts benefit b Only ____ achieve normal functioning

¡ Stress and depression ¡ Determines vulnerabilit y in mood disorders ¡ Can include: ¡ Death or loss of a loved one ¡ End of a relationship ¡ Unemployment ¡ Physical illness ¡ Low SES ¡ Exposure to racism and discrimination ¡ ....but not everyone exposed to stressors becomes depressed ¡ Resilency factors: ¡ Coping skills ¡ Genetic endowement ¡ Social support ¡ Diathesis-stress model

CAUSAL FACTORS IN DEPRESSIVE DISORDERS 1. Stress and depression - Determines vulnerability in mood disorders - Can include: ¡ Death or loss of a loved one ¡ End of a relationship ¡ Unemployment ¡ Physical illness ¡ Low SES ¡ Exposure to racism and discrimination 2. ....but not everyone exposed to stressors becomes depressed - Resilency factors: ¡ Coping skills ¡ Genetic endowement ¡ Social support ¡ Diathesis-stress model

**Cognitive distortions (Burns, 1980) - All-or-nothing thinking - Overgeneralization - Mental filter - Disqualifying the positive - Jumping to conclusions - Magnification and minimization - Emotional reasoning - "Should" statements - Labeling and mislabeling - Personalization

CAUSAL FACTORS: COGNITIVE THEORIES -Cognitive distortions (Burns, 1980)

*** Origin and maintenance of depression (Beck, 1976, 1979): 1. How a person views themselves and the world around them 2. Cognitive tirade - Negative views of oneself - Negative views of the world (e.g. one's own experiences) - Negative views of the future 3. Negative schemas - Habitual negative thought patterns - Originate in early experiences 4. Cognitive distortions - Skewed ways of thinking 5. Depressive realism - More accurate view of one's circumstances

CAUSAL FACTORS: COGNITIVE THEORY Origin and maintenance of depression (Beck, 1976, 1979)

**Family Studies -Severe mood disorders have a strong genetic contribution -Heritability rates are higher for females compared to males -Some genetic factors confer risk for both anxiety and depression 1) MDD: -2-4x higher if relative has mood disorder -40%heritability and personality trait neroticism accounts for substantial portion 2)Bipolar I: -10x increased risk if a relative has mood disorder

CAUSES OF MOOD DISORDERS: FAMILIAL AND GENETIC INFLUENCES: -Family Studies: 1) MDD: 2)Bipolar I:

1.) Neuroimaging studies a. Lower metabolic activity in prefrontal cortex b. Abnormalities in brain regions governing emotions 2.) Neurotransmitter systems a. Serotonin - Serotonin regulates norepinephrine and dopamine b. Mood disorders are related to low levels of serotonin c. Permissive hypothesis - Low serotonin "permits" other neurotransmitters to vary more widely, increasing vulnerability to depression

CAUSES OF MOOD DISORDERS: NEUROBIOLOGICAL INFLUENCES 1. Neuroimaging studies a. b. 2.Neurotransmitter systems a. b c

Premenstrual Dysphoric Disorder (PMDD)

Depressive Disorder where Marked changes in mood during the woman's premenstrual period -introduced as a diagnostic category in DSM-5

***Hypomanic episode*** 1) Shorter, less severe version of manic episode 2) Last at least four days 3) Has fewer and milder sx a) feel unusually charged with energy b) show a heightened level of activity c) have an inflated sense of self-esteem d) be more irritable than usual e) experience little fatigue or need for sleep. 4) Associated with less impairment than a manic episode (e.g. less risky behavior) 5) May not be problematic in and of itself, but usually occurs in the context of a more problematic mood disorder

Hypomanic Episode

men: starts with manic episode women: starts with major depressive episode

In Bipolar I Disorder, how does it usually begin in men and women:

** Reinforcement** 1. Lack of reinforcement for ones effort - Induce feelings of depression 2. Low rate of activity source of secondary reinforcement 3. Lack of reinforcement: - Social ( Loss ) ( Moving away from home ) - Occupational

LEARNING THEORIES

1. 3 month 2. Young children 3. anxiety 4. 65

LIFESPAN DEVELOPMENTAL INFLUENCES ON MOOD DISORDERS: -___1___ olds can show depressive sx -__2__ typically don't show classic mania or bipolar sx -Depression in elderly co-occur with ___3___ disorders and less gender imbalance after __4__years

A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. Note: Do not include symptoms that are clearly due to a general medical condition or mood-incongruent delusions or hallucinations. 1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: in children and adolescents can be irritable mood. 2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others) 3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: in children, consider failure to make expected weight gains 4. Insomnia or hypersomnia nearly every day 5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down) 6. Fatigue or loss of energy nearly every day 7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick) 8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others) 9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. C. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).

MAJOR DEPRESSIVE EPISODE: DSM CRITERIA

**** Specifiers are not mandatory; only assigned if appropriate 1) Psychotic features 2) Anxious distress 3) Mixed features 4) Melancholic features 5) Catatonic features 6) Atypical features 7) Peripartum onset 8) Seasonal Affective - change from fall into winter

Major Depressive Disorders Specifiers

A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary). B. During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior: 1. Inflated self-esteem or grandiosity 2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep) 3. More talkative than usual or pressure to keep talking 4. Flight of ideas or subjective experience that thoughts are racing 5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed. 6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (e.g., purposeless non-goal-directed activity). 7. Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments) C. The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features. D. The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment) or to another general medical condition. ***Note: A full manic episode that emerges during antidepressant treatment (e.g., medication, electroconvulsive therapy) but persists at a fully syndromal level beyond the physiological effect of that treatment is sufficient evidence of a manic episode and, therefore, a bipolar I diagnosis.

Manic Episode: DSM Criteria

1. The internal experience of depressive disorders: a.) Anaclitic depressive patterns "I'm empty, hungry, lonely" *** Associated with disruption of the relationship with the primary caregiver *** Feelings of helplessness, weakness, inadequacy and depletion *** Fears of being abandoned, isolated and unloved (Wishes to be soothed, helped, fed and protected) 2. Introjective depressive patterns "I'm no good, flawed, self-indulgent, evil" a.) Associated with harsh, punitive, unrelenting self-criticism b.) Feelings of inferiority, worthlessness and guilt c.) Feeling like one failed to live up to expectations and standards d.) Fears loss of approval, recognition and love, loss of acceptance e.) Issues with self-esteem due to self-criticism and fear

PSYCHODYNAMIC THEORIES (BLATT, 1993, 2008)

1. Freud + Klein's object relations theory 2. Frustration with early attachment leads to anger and guilt 3. Anger is turned back on the self in the form of self-criticism 4. In an attempt to salvage self-esteem a. Find and connect with others to rescue self-esteem through the love of a new, loving "parent" b. Idealizes them with high and unrealistic expectations

PSYCHODYNAMIC THEORIES: - Busch, Ruden and Shaprio, 2004

PSYCHODYNAMIC THEORIES: 1. Psychodynamic theorists focus on the role of loss in depression (Freud,1917, 1957; Abraham, 1916, 1948). 2. Depression represents anger "toward inward" - Anger direct at the self following actual or threatened loss - Connected with loss, mourning, and ambivalence ***Depression occurs when individuals experience a threatened or actual loss of a person toward whom they feel ambivalent *** Criticism and anger at the person for the loss triggers guilt ******** Prevents the expression of anger directly at the person (e.g., object) *** To preserve a connection to the lost person, one "introjects" ******** Internalizes the loved one ******** Anger turned inward at the internalized object, and subsequently at oneself ******** Produces self-hatred, which turns to depression

PSYCHODYNAMIC THEORIES: 1. Psychodynamic theorists focus on the role of loss in depression (Freud,1917, 1957; Abraham, 1916, 1948). 2. Depression represents anger "toward inward" - Anger direct at the self following actual or threatened loss - Connected with loss, mourning, and ambivalence ***Depression occurs when individuals experience a threatened or actual loss of a person toward whom they feel ambivalent *** Criticism and anger at the person for the loss triggers guilt ******** Prevents the expression of anger directly at the person (e.g., object) *** To preserve a connection to the lost person, one "introjects" ******** Internalizes the loved one ******** Anger turned inward at the internalized object, and subsequently at oneself ******** Produces self-hatred, which turns to depression

1. dysthymia mild and nagging lasting for years

People with People with ___1___ feel "bad spirited" or "down in the dumps" most of the time, but they are not as severely depressed as those with major depressive disorder. Whereas major depressive disorder tends to be severe and time limited, ___1___ is relatively ____ and _____, typically lasting for _____. The risk of relapse is quite high (Keller et al., 2000), as is the risk of major depressive disorder: 90% of people with ___1___ eventually develop major depression

1) puberty 2) 20s 3) major depression 4)Bipolar Disorder 5) 18

Prevalence of Mood Disorders: -Major Depressive Disorder onset increases in __1___ -incidence peaks in __2___ -Females two times likely to have ___3____ -____4____ equal across genders -Bipolar Age onset:___5___

1) Unipolar mood disorder ¡ Only one extreme of mood is experienced ****E.g., only depression or only mania ****Depression alone is much more common than mania alone 2) Bipolar mood disorder ¡ Both depressed and elevated mood are experienced ****E.g., some depressive episodes and some manic or hypomanic episodes

Structure of mood disorder: -Unipolar: -Bipolar:

1. Lithium carbonate = a common salt 2. Treatment of choice for bipolar disorder 3. Considered a mood stabilizer because it treats depressive and manic symptoms 4. Toxic in large amounts a. Dose must be carefully monitored 5. Effective for 50% of patients 6. Why/how exactly lithium works remains unclear *** Other mood stabilizers: - Carbamazepine (Tegretol) - Divaloproex (Depakote)

TREATMENT OF MOOD DISORDERS: LITHIUM 1. Lithium carbonate = a common _____ 2. Treatment of choice for ______ 3. Considered a mood stabilizer because it treats ____ and _____ symptoms 4. ____ in large amounts a. Dose must be carefully monitored 5. Effective for _____ of patients 6. Why/how exactly lithium works remains unclear **** Other mood stabilizers: - Carbamazepine (Tegretol) - Divaloproex (Depakote)

**CBT for depression: - 14-16 weekly sessions - Combo of behavioral + cognitive techniques - Recognize and correct dysfunctional thought patterns ( Self-monitoring through daily thought record or diary ) - Target distorted thinking - Increase awareness into how thoughts impact feelings

TREATMENT: COGNITIVE THERAPY CBT for depression:

** Behavioral Activation - Increase self-efficacy in social and interpersonal skills - Increase participation in pleasurable or rewarding activities

TREATMENT: LEARNING AND BEHAVIOR

1. Understand ambivalent feelings toward objects in their lives who they have lost or whose loss is threatened *** Working through anger 2. Modern psychodynamic approach: *** Focus on unconscious conflicts and ambivalence, past and present conflicted relationships *** More direct and brief 3. Tailored to type of depression *** E.g., anaclitic vs. introjective

TREATMENT: PSYCHODYNAMIC

1. Gain insight into resentment about the loss and conflict over the resentment 2. Decrease vulnerability to abandonment - Tolerate fears of abandonment 3. Decrease tendency for harsh self-criticism 4. Stability in relationships 5. Increase self-efficacy - Turn for himself for soothing - Set himself up less for hurt and disappointment

TREATMENT: PSYCHODYNAMIC: example treatment goals

1) Major Depressive Disorder a)Seasonal affective disorder(ex. summer-->fall=depression) 2) Persistent Depressive Disorder 3) New to DSM-5 a)Premenstrual dysphonic disorder

UNIPOLAR: DEPRESSIVE DISORDERS

-Bipolar I Disorder: Alternations between major depressive episodes and manic episodes(atleast ONE full blown manic episode at some point with intervening periods of normal mood) **can apply to person without a history of major depressive episode -Bipolar II Disorder: Alternations between major depressive episodes and hypomanic(under) episodes (had hypomanic episodes w/at least one major depressive episode but not having a full-blown manic attack) **hypomanic less severe than manic**can develop into Bipolar I Disorder -Cyclothymic disorder: Alternations between less severe depressive and hypomanic periods(mild mood swings for a least 2 years and 1 for adolescents) **numerous periods of hypomanic or depressive symptoms that are not severe enough to be considered hypomanic or major depressive episodes

What arethe differences between: -Bipolar I Disorder -Bipolar II Disorder -Cyclothymic disorder

***Definition: Persistent and severe mood changes that occur after childbirth a) Changes in appetite and sleep b) Low self-esteem c) Difficulties with attention and concentration *** Risk factors a) Hx(history) of mood disorders b) Single or first time mother c) Financial problems d) Relationship problems or domestic violence e) Lack social support f) Unwanted, sick, or temperamentally difficult infant

What is POSTPARTUM DEPRESSION and what are the risk factors

1 One or more major depressive episodes separated by periods of remission a) Single episodes are highly unusual b) Recurrent episodes are more common 2 Vary in intensity 3 Vary in experience a) Subtle experience to a severely disabling clinical disorder

What is major depressive disorder

Clinical description - At least two years of depressive sx **** Depressed mood most of the day on more than 50% of days **** No more than two months sx free **** Sx can persist unchanged over long periods of time (e.g. 20 years) **** May include periods of more severe major depressive sx a) Major depressive dx may be intermittent or last for the majority or entirety of the time period

What is the clinical description of Persistent Depressive Disorder (Dysthymia)

Bipolar Disorder

What is the disorder that is characterized by extreme swings of mood and changes in energy and activity levels. Mood swings typically shift between the heights of elation to the depths of depression. The first episode may be either manic or depressive. Manic episodes typically last a few weeks or perhaps a month or two and are generally much shorter and end more abruptly than major depressive episodes.

POSTPARTUM DEPRESSION

a mood disorder where women experience a major depressive episode within four weeks of child delivery

1. persistent depressive disorder 2. dysthymia

diagnosis of ______1_______ is used to classify cases of chronic lasting for at least two years. Persons with __________1______ may have either chronic major depressive disorder or a chronic but milder form of depression called ___2___. _____2___ typically begins in childhood or adolescence and tends to follow a chronic course through adulthood.

1.) Hypomanic episodes are less severe than manic episodes and are not accompanied by the extreme social or occupational problems associated with full-blown mania **During a hypomanic episode, a person might may feel unusually charged with energy and show a heightened level of activity and an inflated sense of self-esteem, and may be more alert, restless, and irritable than usual. The person may be able to work long hours with little fatigue or need for sleep. 2) manic episodes show Elevated, expansive mood for at least one week and Impairment in normal functioning **symptoms include: Inflated self-esteem, decreased need for sleep, excessive talkativeness, flight of ideas or racing thoughts, easily distractible, increase in goal-directed activity or psychomotor agitation, excessive involvement in pleasurable but risky behaviors

difference between hypomanic and manic episodes

major depressive episode

involves a clinically significant change in functioning involving a range of depressive symptoms, including depressed mood (feeling sad, hopeless, or "down in the dumps") and/or loss of interest or pleasure in all or virtually all activities for a period of at least two weeks

1) Extremely depressed mood and/or loss of pleasure (ahnedonia) ¡ Lasts most of the day, nearly every day for at least two weeks 2) At least 4 additional physical or cognitive sx a) Indecisiveness, feelings of worthlessness, fatigue, appetite change, restlessness or feeling slowed down, sleep disturbance b) Overall impacts ability to work, study, sleep, eatand enjoy life c) In children: irritable mood

major depressive episode

severe mania hypomania(mild/moderate mania) normal balanced mood(middle line) mild to moderate depression severe depression

order or disorders from red arrow going up to blue arrow going down