Transcript Module 46 Bipolar Disorder

Major Depression – Module 46
Bipolar Disorder – Module 46
Phobias – Module 44
General Psych 2
Class #28
May 6, 2004
Depression: The "common cold"
of mental health problems

An extreme condition persisting for most of each day
for a period of months or longer
 Lifetime prevalence rates ranging from 12-17% with
about 5-10% of the general population right now
(over 19M in U.S.)
 Sex difference: F > M (women are at least twice as
likely to suffer from depression as men and this is
has been the case for about 40 years)
 Prevalence is unrelated to ethnicity, education,
income, or marital status
 The highest rates for this disorder are in the 25-44
year-old age group
Symptoms
(1) Cognitive
 Negative beliefs about oneself (feelings of
worthlessness)
 Preoccupation with death and suicide
 Low motivation (loss of interest in anything –
and no point in trying anyway)
 Impaired thinking – problems solving
intellectual and social problems especially
those involving memory (this problem doesn't
seem to be because of the low motivation)
Symptoms
(2) Motor
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Psychomotor retardation – appears to be a
slowdown in physical activity (they may
just want to stay in bed; weight of the
world on their shoulders, lethargy, etc.)
Psychomotor agitation – hyperactive
fidgeting or pacing
Symptoms
(3) Physical
 Disturbed sleep (insomnia and hypersomnia)
 Disturbed eating patterns (poor appetite and
significant
 Weight loss and in less often cases the
opposite can occur)
 Decreased sexual drive (in rare cases
hypersexuality)
 Increased physical illnesses (immune system
declines)
Onset and Duration

Onset
– Average age at onset is 25, but this disorder may
begin at any age
– Psychological stress appears to play a prominent
role in triggering the first 1-2 episodes of this
disorder, but not in subsequent episodes
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Duration
– An average episode lasts about 9 months to one
year
– The risk of recurrence is about 70% at 5 year
follow up and at least 80% at 8 year follow-up
What triggers depression?

Cognitive Explanation
– Incorrect Negative Beliefs
– Learned Helplessness
What triggers depression?

Physiological psychologists are not exactly
sure but several important factors have
been identified…
– Physiological Explanations
(1) Low levels of brain activity
(2) Structural problems
(3) Familial Pattern And Genetics
(4) Prenatal illness
(5) Low levels of neurotransmitters
What triggers depression?
Low levels of brain activity

These parts of the brain of depressed
individuals are underactive:
– Left prefrontal cortext – an area responsible for
much of our thinking…where we decide what
to do and feel.
– Cingulate Gyrus – reduced flow of information
between parts of our brain
– Basal Ganglia – plays a role in motor activity
What triggers depression?
Structural problems

Left prefrontal cortex is smaller
– May account for it being less active and slowed
thinking and difficulty in problem solving as
well
What triggers depression?
Familial Pattern And Genetics

There is strong evidence that major depression is, in
part, a genetic disorder:
– Individuals who have parents or siblings with Major
Depressive Disorder have a 1.5-3 times higher risk
of developing this disorder
• The concordance for major depression in
monozygotic twins is substantially higher than it
is in dizygotic twins
• However, the concordance in monozygotic twins
is in the order of about 50%, suggesting that
factors other than genetic factors are also
involved
What triggers depression?
Familial Pattern And Genetics

Children adopted away at birth from biological
parents who have a depressive illness carry
the same high risk as a child not adopted
away, even if they are raised in a family
where no depressive illness exists
 Researchers suspect that there is a genetic
connection, but to date, no "depressive gene"
has been discovered
What triggers depression?
Low levels of neurotransmitters

Unusually low levels of serotonin,
epinephrine and norepinephrine
Drug treatment

Antidepressant drugs attempt to elevate low levels of
neurotransmitters in the brain
 All antidepressants are equally effective in that they
elevate mood in 60%-80% of people
 They take at least 2-3 weeks to start showing subtle
improvements and up to 4-6 weeks to feel the full
effect
 Common drugs such as Prozac, Zoloft, Paxil, Celexa
act to inhibit the reuptake of serotonin and
norepinephrine thus increasing their availability in the
brain
 These are safe, non-addicting drugs and not found to
be fatal in overdose
 But don't stop taking them abruptly – you may
experience a variety of flu-like symptoms – taper off
slowly
How long?
1st episode: 6-12 months or so
 2nd episode: 1-2 years
 3rd episode: likely for life

Side-Effects

Include several sexual side effects for both
men and women, sleep disruptions,
headaches, excessive sweating, nausea,
upset stomach, diarrhea, drowsiness, tremor,
sometimes a decrease in weight and in lesser
cases weight gains, occasionally will cause
an over sensitivity to sunlight
• Good news – these all usually will subside after
a few weeks
• Bad news – high relapse rates: drugs are a
treatment for depression but not a cure
Bipolar Disorder

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Formerly referred to as manic-depression
disorder
Prevalence: About 1%
Onset: Usually begins between 15-25
No sex difference
These people alternate between depression
and mania – manic phase is usually
somewhat shorter
– Like slow motion vs. fast-forward
Manic Phase

Symptoms
– Cognitive symptoms
• Inflated self-esteem
• Grandiosity – unrealistic optimism and delusions of
grandeur
• Distractibility
• Manic flight of ideas
• Delusions
• Over-talkative with loud speech, sometimes hard to
interrupt
• Easily irritated if crossed
• Over-involvement in activities
• No or few sexual inhibitions
• Increased thought processes
Manic Phase

Motor Symptoms
– Constant running from one thing to another

Physical Symptoms
– High energy
– Little need for sleep
Important Note…

Individuals experiencing mania need to
be protected from the consequences of
their own poor judgments…
– Often, they will go on reckless spending
sprees or partake in extremely risky
investments
– Poor self-control
• But, be prepared…they will be irritated
by those providing advice
One Positive
The energy and free-floating thinking
characteristic of mania can fuel
creativity
 Unusually high rate of bipolar disorder
among poets, artists, and creative
writers

Bipolar Disorder

Treatments
– Mood stabilizers such as:
• Lithium
• Depokote
Phobic Disorders
Fear has no justification in reality
 Fear is greater than is justified
 Individual is aware of irrationality of fear

Phobic Disorders
 Social
phobia
 Agoraphobia
 Specific phobias
What is Social Phobia?
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Irrational fear that they will behave in an
embarrassing way
Is limited to situations in which the scrutiny of
others is likely
Extreme form of shyness that interferes
significantly with an individual’s functioning
These individuals avoid all social situations
Recent study says over 13% of general
population but other studies say its about 4%
Sex difference: Slightly more women than
men
Average onset: early adolescence
Symptoms
Avoidance of all social situations
 High anxiety if ever placed in a social
situation
 Rapid heart rate
 Elevated blood pressure
 History of phobia

What causes social phobia?

Basically unknown but…
– Possible biological reasons: scarcity
of serotonin
– Possible environmental factors…
Agoraphobia
“fear of the marketplace”
These people suffer from intense
anxiety when in a place where escape
would be difficult or embarrassing if they
were to experience a panic attack
 Fear being in a place where they can’t
get help
 In extreme cases, they may not leave
their house

Agoraphobia
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Key points:
– They do not fear people per se, but rather
they fear being around people because
they believe something will happen that
they can’t control and will cause them
embarrassment (for example: a panic
attack)
– They are very good at concealing their
problem
Prevalence and Onset

Prevalence
– Estimated 5%-12% of general population will
suffer from agoraphobia

Sex difference:
– Women 7%
– Men 3.5%

Onset:
Usually occurs in their 20’s
Possible Causes

Unknown
– Over the years there have been many
theories about the cause of agoraphobia
ranging from inner ear dysfunction, genetic
predisposition, social learning – observing
the anxious behavior of a parents, chemical
imbalances, etc.
Treatments
Usually a medication and
psychotherapy combo
 Commonly anti-depressants and antianxiety meds are used:

– Prozac, Paxil, Zoloft, Elavil, etc.
– Xanax, Klonipin, etc.
Cognitive-Behavioral Treatment

Most common treatment is systematic
desensitization…
– Breathing and relaxation techniques are
sometimes used in conjunction with
systematic desensitization
Prognosis

Very good – 90% improve
Specific Phobias
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DSM-IV classifies all other phobias (besides social
phobia and agoraphobia) as “specific phobias”
We’re talking about specific objects or situations here
Sex difference:
– Women 16%
– Men 7%
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Associated features: depressed mood and dependent
personality
Exposure to the phobic stimulus may lead to a panic
attack
As with other phobias, the person recognizes that the
fear is excessive and unreasonable