Transcript abnormal PSYCHOLOGY Third Canadian Edition

abnormal
PSYCHOLOGY
Fourth Canadian Edition
Chapter 8
Mood Disorders
Prepared by:
Tracy Vaillancourt, Ph.D.
Modified by: Réjeanne Dupuis, M.A.
Chapter Outline
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General Characteristics of Mood Disorders
Psychological Theories of Mood Disorders
Biological Theories of Mood Disorders
Therapies of Mood Disorders
Suicide
General Characteristics
• Involve disabling disturbances in emotion,
from sadness of depression and elevation
and irritability of mania
• Often associated with other psychological
problems
– Panic attacks
– Substance abuse
– Sexual dysfunction
– Personality disorders
Depression: Signs and Symptoms
• Depression: An emotional state marked by great
sadness and feelings of worthlessness and guilt
• Additional symptoms include:
– Withdrawal from others
– Loss of sleep, appetite, and sexual desire
– Loss of interest and pleasure in usual activities
• Symptoms vary between cultures
• Most depressed individuals focus on somatic
symptoms (~85%)
Mania: Signs and Symptoms
• Mania (NOT a diagnosis): An emotional state or
mood of intense but unfounded elation accompanied
by irritability, hyperactivity, talkativeness, flight of
ideas, distractibility, and impractical, grandiose plans
• Noticed by others due to loud and incessant
remarks, sometimes full of puns, jokes, rhyming,
etc., difficult to interrupt, shifting from topic to topic,
need for activity that can be annoying to others and
with poor planning
Diagnosis of Depression
• Presence of 5 of the following symptoms for at least 2
weeks.
– Note. Depressed mood or loss of interest and pleasure
must be 1 of the 5 symptoms
• Symptoms
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Sad, depressed mood, most of the day, nearly every day
Loss of interest and pleasure in usual activities
Difficulties in sleeping
Shift in activity level
Changes in appetite and weight
Loss of energy, great fatigue
Negative appraisal (feeling worthless)
Difficulty in concentrating
Recurrent thoughts of death or suicide
Depression (MDD)
• Lifetime prevalence rates in U.S.: from 5.2% to 17.1%
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Similar ranges were found in a cross-cultural study
In Canada could vary from 20% to 50%
About 80% of those with MDD experience another episode
Average # of episodes is 4 and lasts for 3 to 5 months
12% of MDD cases lasts more than 2 years
• May be explained by kindling hypothesis— once a depression has
already been experienced, it takes less stress to induce a
subsequent recurrence
– Between 60% and 80% of university students with a diagnosable
depression do not seek or receive treatment
• 2x more common in women than in men
– Difference appears in adolescence and is maintained across the
lifespan
• See Focus on Discovery 10.1
Diagnosis of Bipolar Disorder
• Bipolar I disorder– involves episodes of mania or mixed
episodes that include symptoms of both mania and
depression
– Diagnosis of a manic episode requires the presence of
elevated or irritable mood + 3 additional symptoms
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 in activity level at work, socially, or sexually
Unusual talkativeness; rapid speech
Flight of ideas or subjective impression that thoughts are racing
Less than the usual amount of sleep needed
Inflated self-esteem
Distractibility
Excessive involvement in pleasurable activities that are likely to
have undesirable consequences
Bipolar Disorder (cont.)
• Occurs less often than MDD
• Lifetime prevalence rate for BPI and BPII of
4.4% of the population
• Average age of onset is in the 20s
• Occurs equally often in men and women
– In women, episodes of depression are more common
and episodes of mania less common than among
men
• Tends to recur
– More than 50% have a recurrence w/in 12 months
– More than 50% of cases have 4+ episodes
Mood Disorders in Canada
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Lifetime prevalence of MDD: 12.2%
One-year prevalence of MDD: 4.5%
In all age groups, more women than men hade MDD
MDD almost doubles between adolescence and adulthood
Almost 90% of those w/ MDD or BP mentioned that it
interfered with their lives
• Almost 40% of youth (ages 15-24) met criteria for an
anxiety disorder
• MDD and BP are more prevalent in Western provinces
• Risk factors associated w/ mood disorders: alcohol use
and dependence, drug dependence
Heterogeneity
Examples
• Bipolar I Disorder with mixed episodes
• Bipolar II Disorder
– episodes of major depression accompanied by
hypomania
• MDD with psychotic features
• Bipolar and unipolar disorders can be subdiagnosed as seasonal
– Seasonal affective disorder (SAD)
Chronic Mood Disorders
• Symptoms of disorders must have been
evident for at least 2 years and are not
severe enough to warrant a diagnosis of
MDD or manic episode.
– Cyclothymic disorder
• Lifetime prevalence of 2.5%
– Dysthymic disorder
• Lifetime prevalence of 2.5%; 2-3 times more
frequent in women than in men
– Double depression
Psychological Theories
• Psychoanalytic Theory of Depression
– According to Freud depression is created
early in childhood. During the oral period,
child’s needs are insufficiently or oversufficiently gratified, causing fixation in this
stage
Psychological Theories (cont.)
• Beck’s Theory of Depression
– Thinking is biased toward
negative interpretations
• Negative triad
– Negative views of the self, the
world, and the future
• Principle Cognitive Biases
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Arbitrary inference
Selective abstraction
Overgeneralization
Magnification and minimization
Helplessness/Hopelessness
Theories
• Learned Helplessness
– Individual’s passivity and sense of being unable to act and
control own life is acquired through unpleasant
experiences and traumas that were unsuccessfully
controlled.
• Attribution and Learned Helplessness
– Revised theory is the concept of attribution
• Global attributions
• Attributions to stable factors
• Attributions to internal characteristics
• Hopelessness Theory
– Advantage of theory is that it can deal the comorbidity of
depression and anxiety disorders
Issues with Theories
1. Which type of depression is being
modeled?
2. Are the findings specific to depression?
3. Are attributions relevant?
4. Key assumption is that depressive
attributional style is a trait
– But research shows that depressive
attributional style disappears following
depressive episode
Other Theories of Depression
• Interpersonal Theory of Depression
– Sparse social networks that provide little support
•  an individual’s ability to handle negative life events
•  vulnerability to depression
– Depressed people also elicit negative reactions from
others and are low in social skills
– They also constantly seek the reassurance of others
• Psychological Theories of Bipolar Disorder
– Largely neglected by scholars and clinicians
Biological Theories
Genetic Data
• Bipolar
– Concordance rate is as high as 85%
– Adoption studies provide support for a strong heritable
component
– May be linked to a dominant gene on the 11th chromosome
– Brain-derived neurotrophic factor (BDNF) gene also
implicated
• MDD
– Heritability estimate= 35%
– Relatives of unipolar probands are at  risk for unipolar
depression
– Serotonin transporter gene-linked promoter region (5HTTLPR) is being considered
Biological Theories (cont.)
• Postulated that  levels of norepinephrine and dopamine lead to
depression and  levels to mania.
• Serotonin theory
– Serotonin produces depression and mania
• Clues for drugs
– Tricyclic drugs prevent some of the reuptake of norepinephrine,
serotonin, and/or dopamine by the presynaptic neuron after it has fired,
– Monoamine oxidase (MAO) inhibitors keep the enzyme monoamine
oxidase from deactivating neurotransmitters therefore  the levels of
serotonin, norepinephrine, and/or dopamine in the synapse.
– Selective serotonin reuptake inhibitors inhibit the reuptake of serotonin
• Drug actions suggest that depression and mania are related to
serotonin, norepinephrine, and dopamine.
– BUT mechanism not straightforward
Biological Theories (cont.)
• Neuroimaging studies
–  hippocampal volume and neurocognitive
impairment
• Cingulated area 25
– Induction of dysphoria in healthy people  glucose
metabolism in cingulated area 25
– Treatment with paroxetine showed a  reduction of
hypermetabolism in cingulated area 25
• MAO-A levels in the brain are elevated during
untreated depression.
Biological Theories (cont.)
Neuroendocrine System
• HPA axis may play a role in depression
–  levels of cortisol in depressed patients
• Disorders of thyroid function are often seen in
bipolar patients
– Thyroid hormones can induce mania
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Right hemisphere dysfunction
Summary of Biological
Theories
Beck’s Developmental
Model of Depression
Therapies for Mood Disorders
• Psychological Therapies
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Psychodynamic Therapies
Cognitive and Behaviour Therapies
Mindfulness-Based Cognitive Therapy
Social Skills Training
• Biological Therapies
– Electroconvulsive therapy (ECT)
– Drug therapy
Suicide
• Suicide was the 9th leading cause of death in
Canada in 2005
• Suicide is the 2nd cause of death (after accidents) in
youth ages 15 to 24 (Statistics Canada, 2009)
• Females have higher rates of suicide attempts but
lower rates of suicide as compared to males, a
phenomenon called gender paradox (see Canetto,
2008)
Suicide (cont.)
• 12-month prevalence estimates
of suicide ideation, plans, and
attempts
– 2.6, 0.7, and 0.4%, respectively.
• Ideators with a plan are more
likely to make an attempt (31.9%)
than those without a plan (9.6%)
– But 43% of attempts were
unplanned
• History of prior attempts the
strongest correlate of 12-month
attempts
Suicide - Terminology
• Suicidal ideation
– Thoughts and intentions of killing oneself.
• Suicide attempts
– Self-injury behaviours intended to cause death but
that do not lead to death
• Suicide gestures
– Self-injury in which there is no intent to die
• Suicide
– Behaviours intended to cause death and death occurs
Suicide in Canada
• 13.4% Canadians over age 15 reported having seriously
thought of suicide during their lifetime
– Number of women who report suicidal thoughts decrease w/ age
• 3.1% of adults reported having attempted suicide in their
lifetime
– Twice as many women (4.2%) attempt suicide as men (2.0%)
– Between ages 10 and 14, hospitalization among females is 5x as
that of males
• In 2003, almost 4x as many males completed suicide as
compared to females
• Overall mortality rates decreased from 1990 to 2003
• Alcohol is strongly related to suicide
Psychological Theories of Suicide
• A Risk Factor Model
– 4 categories of relevant factors:
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Predisposing factors
Precipitating factors
Contributing factors
Protective factors
Baumeister’s Escape Theory and Perfectionism
Shneidman’s Approach
Perfection and Moderator Hypotheses
Additional Psychological Factors
Neurobiology and Suicide
• MZ twins have a much  concordance for
suicidality than DZ twins
•  levels of 5-HIAA
• Postmortem studies of brains have revealed
 binding by serotonin receptors
Preventing Suicide
• Treating the underlying mental
disorder
• Treating Suicidality Directly
• Suicide Prevention Centres
• Government Suicide Prevention
Programs in Canada
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