Transcript abnormal PSYCHOLOGY Third Canadian Edition

abnormal
PSYCHOLOGY
Third Canadian Edition
Chapter 10
Mood Disorders
Prepared by:
Tracy Vaillancourt, Ph.D.
Mood Disorders
• Involve disabling disturbances in emotion
• Often associated with other psychological
problems
– panic attacks
– substance abuse
– sexual dysfunction
– personality disorders
Depression: Signs and Symptoms
• Depression— 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
Mania: Signs and Symptoms
• Mania— emotional state or mood of
intense but unfounded elation
accompanied by irritability, hyperactivity,
talkativeness, flight of ideas, distractibility,
and impractical, grandiose plans.
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 range from 5.2% to 17.1%
– 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
• 2 X more common in women than in men
– difference does not appear in preadolescent children
– emerges consistently by mid-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 plus 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 <often than MDD
• Lifetime prevalence rate 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
– > than 50% of cases have 4+ episodes
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
– Dysthymic disorder
– 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 fixated 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
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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 (5-HTTLPR) 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
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
• 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 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
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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