abnormal psych - ch. 7

Cognitive-Behavioral Therapy Helps depressed people:

learn to replace negative depressive thoughts and attributions with more positive ones develop more effective coping behaviors and skills

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. For severe depression, ECT is used when other treatments have been ineffective. It usually has temporary side effects, such as memory loss and lethargy. In some patients, certain intellectual and/or memory functions may be permanently lost.

The experience of anxiety across ___________ varies, and it can be difficult to make comparisons—especially, for example, when we attempt to compare subjective feelings of ____________.

cultures; depression

Interpersonal Psychotherapy Helps depressed people:

focus on the social and interpersonal triggers for their depression (such as the loss of a loved one) develop skills to resolve interpersonal conflicts and build new relationships

light therapy

for seasonal affective disorder

learned helplessness theory of depression

The theory according to which depression is the result of perceived or real absence of control over the outcome of an undesirable situation.

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

-marital dissatifaction -gender -few social supports

delusions

(strongly held but inaccurate beliefs)

Children of depressed mothers may show depressive behavior at

less than a year old.

· What biological risk factor most commonly associated to suicide?

serotonin

· The stress response 2 types of chemicals

1. Neurotransmitters (released from other neurons) 2. Hormones (secreted from by glands)

Anomic suicides

are the result of marked disruptions, such as the sudden loss of a high-prestige job. (Anomie is feeling lost and confused.)

what is the "gold standard" medication for bipolar disorder?

lithium most ppl dont wanna take bc it makes u gain weight

Negative cognitive styles

-Cognitive Theory of Depression (Beck) -Cognitive errors in depression (glass half empty) ---Negative interpretations -Types of cognitive errors ---Arbitrary inference o See it as negative ---Overgeneralization o All the situations are bad

Cognitive Theory of Depression (Beck)

-Negative schema -Automatic thoughts -Treatment implications ---Correcting the errors

symptoms of major depressive disorder

-begin suddenly, often triggered toy a crisis, change, or loss -are extremely severe, interfering with normal functioning -can be long term, lasting months or years if untreated Some people have only one episode, but the pattern usually involves repeated episodes or lasting symptoms.

5 biological sources that can contribute to mood disorders

-genetics -nuerotransmitter system abnormalities -endocrine system -circadian or sleep rhythms -neurohormones

what psychological factors can have an impact on mood disorders?

-stressful life events -learned helplessness -depressive cognitive triad -a sense of uncontrollability

· How long do symptoms have to be presents to be diagnosed w DMDD

1 year

In addition to rating severity of the episode as mild, moderate, or severe, clinicians use eight basic specifiers to describe depressive disorders. These are

1. with psychotic features (mood-congruent or mood-incongruent), 2. with anxious distress (mild to severe), 3. with mixed features, 4. with melancholic features, 5. with atypical features, 6. with catatonic features, 7. with peripartum onset, and 8. with seasonal pattern.

Suicide is often associated with mood disorders but can occur in their absence or in the presence of other disorders. It is the _____ leading cause of death among all people in the United States, but among adolescents, it is the _____ leading cause of death.

10th; 3rd

Approximately ____% of bereaved individuals may experience a complicated grief reaction in which the normal grief response develops into a full-blown mood disorder

20%

mood stabilizing drugs

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

Men often choose violent methods of committing suicide.

Actor Robin Williams, shown here, hanged himself. Singer Kurt Cobain shot himself.

bipolar I disorder

Alternation of major depressive episodes with full manic episodes.

bipolar II disorder

Alternation of major depressive episodes with hypomanic episodes (not full manic episodes).

interpersonal psychotherapy (IPT)

Brief treatment approach that emphasizes resolution of interpersonal problems and stressors, such as role disputes, in marital conflict or forming relationships in marriage or a new job. It has demonstrated effectiveness for such problems as depression.

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.

premenstrual dysphoric disorder

Clinically significant emotional problems that can occur during the premenstrual phase of the reproductive cycle of a woman.

_______________________________ has been shown to decrease suicidal behavior in individuals who have previously attempted suicide.

Cognitive behavioral group therapy

maintenance treatment

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

Disruption Mood Dysregulation Disorder

Condition in which a child has chronic negative moods such as anger and irritability without any accompanying mania.

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.

suicidal attempts

Efforts made to kill oneself

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.

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.

mood disorders

Group of disorders involving severe and enduring disturbances in emotionality ranging from elation to severe depression.

neurohormones

Hormones that affect the brain and are increasingly the focus of study in psychopathology.

major depressive disorder

Involving one (single episode) or more (separated by at least 2 months without depression, recurrent) major depressive episodes.

hypomanic episode

Less severe and less disruptive version of a manic episode that is one of the criteria for several mood disorders.

people with mood disorders experience one or both of the following:

Mania: A frantic "high" with extreme overconfidence and energy, often leading to reckless behavior Depression: A devastating "low" with extreme lack of energy, interest, confidence, and enjoyment of life

seasonal affective disorder (SAD)

Mood disorder involving a cycling of episodes corresponding to the seasons of the year, typically with depression occurring during the winter.

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.

catalepsy

Motor movement disturbance seen in people with some psychoses and mood disordersin which body postures are waxy and can be "sculpted" to remain fixed for long periods.

(IPT) After helping identify the dispute, the next step is to bring it to a resolution. First, the therapist helps the patient determine the stage of the dispute.

Negotiation stage. Both partners are aware it is a dispute, and they are trying to renegotiate it. Impasse stage. The dispute smolders beneath the surface and results in low-level resentment, but no attempts are made to resolve it. Resolution stage. The partners are taking some action, such as divorce, separation, or recommitting to the marriage.

· Causes of mood disorders: biological

Neurotransmitter systems (SDN) Endocrine system (greater attention than neurotransmitters) sleep and circadian rhythms *sleep is hallmark of most mood disorders*

Endocrine system (greater attention than neurotransmitters) Stress hypothesis

Overactive HPA axis which produces stress hormones: epinephrine/adrenaline, cortisol OR Neurohormones (serotonin, dopamine or norepinephrine)

mania

Period of abnormally excessive elation or euphoria, associated with some mood disorders.

psychological autopsy

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

hallucinations

Psychotic symptoms of perceptual disturbance in which things are seen, heard, or otherwise sensed although they are not actually present.

recurrent

Repeatedly occurring.

suicidal ideation

Serious thoughts about committing suicide.

double depression

Severe mood disorder typified by major depressive episodes superimposed over a background of persistent dysthymic mood. Also called "Persistent depressive disorder with intermittent major depressive episodes.

suicidal plans

The formulation of a specific method of killing oneself.

depressive cognitive triad

Thinking errors in depressed people negatively focused in three areas: themselves, their immediate world, and their future.

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.

common types of antidepressants

Tricyclics (Tofranil, Elavil) Monamine oxidase inhibitors (MAO inhibitors): (Nardil, Parnate); MAO inhabitors can have severe sidle effects, especially when combined with certain foods or over-the-counter medications Selective-serotonin reuputake inhabitors or SSRIs (Prozac, Zoloft) are newer and cause fewer side effects than tricyclics or MAO inhabitors Lithium is the preferred drug for bipolar disorder; side effects can be serious; and dosage must be carefully regulated

Two fundamental experiences can contribute either singly or in combination to all specific mood disorders:

a major depressive episode and mania. A less severe episode of mania that does not cause impairment in social or occupational functioning is known as a hypomanic episode. An episode of mania coupled with anxiety or depression is known as a mixed episode or mixed state

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

The key identifying feature of bipolar disorders is

an alternation of manic episodes and major depressive episodes. Cyclothymic disorder is a milder but more chronic version of bipolar disorder.

types of bipolar disorders

bipolar I bipolar II cyclothymia

___________ and _____________ may contribute to the higher rates of mood disorders among women compared with men.

self-blame; rumination

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.)

Symptoms of depression are increasing dramatically in our

elderly population

A variety of treatments, both biological and psychological, have proved effective for the mood disorders, at least in the short term. For those individuals who do not respond to antidepressant drugs or psychosocial treatments, a more dramatic physical treatment,

electroconvulsive therapy, is sometimes used. Two psychological treatments—cognitive therapy and interpersonal psychotherapy—seem effective in treating depressive disorders

Remember HPA regulates the ___________ system

endocrine

____________ suicides result from a loss of control over one's own destiny

fatalistic

during the manic phase, the person may

feel extreme pleasure and joy from every activity be extraordinarly active, planning excessive daily activities sleep little without getting tired develop grandiose plans leading to reckless behavior: unrestrained buying sprees, sexual indiscretions, foolish business investments, etc. have "racing thoughts" and talk on and on be easily irritated and distracted

Of the synthetic drugs for depression, ____________ (________) is the most widely used

fluoxetine (Prozac)

the depressive attributional style is

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

Persistent Depressive Disorder (Dysthymia)

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. Long-term unchanging symptoms of mild depression, sometimes lasting 20 to 30 years if untreated. Daily functioning not as severely affected, but over time impairment is cumulative.

Light therapy is a promising treatment for seasonal affective disorder, often providing relief from depressive symptoms in

just a few days

during the depressive phase, the person may:

lose all interest in pleasurable activities and friends feel worthless, helpless, and hopeless have trouble concentrating lose or gain weight without trying have trouble sleeping or sleep more than usual feel tired all the time feel physical aches and pains that have no medical cause think about death or attempt suicide

Relapse and recurrence of mood disorders are common in the long term, and treatment efforts must focus on

maintenance treatment, that is, on preventing relapse or recurrence.

In interpersonal psychotherapy, the therapist and patient identify strategies for

mitigating social conflict and forming new relationships.

Mood disorders in children are fundamentally similar to

mood disorders in adults.

Antidepressants can help to control symptoms and restore

neurotransmitter functioning

· Treatment of mood disorders

o Changing the chemistry of the brain § Medications § ECT § Psychological treatments

· Sense of hopelessness (Abramsom et al. 1989) · Mechanism: sense of hopelessness not attributional style

o Lack of perceived control o Will not regain control o Pessimism

· Causes of mood disorders: psychological

o Stress and trauma lead to all forms of psychopathology (stress portion of Diathesis-Stress Model) o Stressful life events o Stress and bipolar disorder o Learned helplessness (Seligman) <--dude on exam o Depressive attributional style o Negative cognitive styles o Cognitive Theory of Depression (Beck)

· Antidepressant medications

o Tricyclics (Tofranil, Elavil) --Frequently used for severe depression --Block reuptake/down regulate · Norepinephrine · Serotonin --2 to 8 weeks to work --Many negative side effects --Lethality (if taken in excessive doses) o Selective serotonin reuptake inhibitors (SSRI) --Fluoxetine (Prozac) --First treatment choice --Block presynaptic

Patterns of additional features that sometimes accompany mood disorders, called ___________, may predict the course or patient response to treatment, as does the temporal patterning or course of mood disorders. One pattern, seasonal affective disorder, most often occurs in _________.

specifiers; winter

suicide In summary, the clinician must assess for

suicidal desire (ideation, hopelessness, burdensomeness, feeling trapped); suicidal capability (past attempts, high anxiety and/or rage, available means); and suicidal intent (available plan, expressed intent to die, preparatory behavior). If all three conditions are present, immediate action is required.

In understanding suicidal behavior, three indices are important:

suicidal ideation (serious thoughts about committing suicide), suicidal plans (a detailed method for killing oneself), and suicidal attempts (that are not successful). Important, too, in learning about risk factors for suicides is the psychological autopsy, in which the psychological profile of an individual who has committed suicide is reconstructed and examined for clues.

The causes of mood disorders lie in a complex interaction of biological, psychological, and social factors. From a biological perspective, researchers are particularly interested in ___________________________ and the role of ________________________. Psychological theories of depression focus on ___________________________ and the _____________________________, as well as interpersonal disruptions.

the stress hypothesis; neurohormones; learned helplessness; depressive cognitive schemas

According to the learned helplessness theory of depression, people become depressed when

they believe they have no control over the stress in their lives

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

true

An individual who suffers from episodes of depression only is said to have a ____________ disorder. An individual who alternates between depression and mania has a __________ disorder.

unipolar; bipolar

Mood disorders are among the most common psychological disorders, and the risk of developing them is increasing worldwide, particularly in

younger people

sleep and circadian rhythms sleep is hallmark of most mood disorders

§ REM (rapid eye movement) sleep § After 90 mins REM begins (dream) § Depressed individuals enter REM before non-depressed § *increased intensity § *decreased slow wave sleep (deep sleep) § Sleep deprivation effects (increased problems with elderly)

The "permissive" hypothesis (low levels lead to dysregulation of 2 neurotransmitters:

· Dopamine · Norepinephrine ---Dopamine - mania (increases in dopamine)