Transcript Rieger Chapter Summaries PowerPoint 03

CHAPTER 3
MOOD DISORDERS
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
AIMS AND OBJECTIVES
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Provide overview of unipolar and bipolar depression
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Describe historical approaches, diagnostic criteria, and
epidemiology
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Discuss current biopsychosocial approaches to the aetiology
and treatment of mood disorders
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
UNIPOLAR DEPRESSION
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History of Classification
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In Ancient Greece, term “melancholia” to describe fear and
depression
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Kraeplin (1896) used the term manic depressive insanity, which
encompassed all mood disorders
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Since 1950s, classification system has distinguished between
bipolar and unipolar depression
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Two types of unipolar depression: major depressive disorder
and dysthymia
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
UNIPOLAR DEPRESSION
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DSM-IV-TR Diagnosis of Major Depressive Disorder (MDD)
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Characterized by the occurrence of > 1 Major Depressive
Episodes (MDEs)
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Criteria for an MDE
Depressed mood and/or loss of interest (anhedonia) for > 2 weeks
 At least 4 of these additional symptoms:
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Appetite disturbance
Sleep disturbance
Fatigue
Restlessness or slowed movements
Poor concentration
Feelings of worthlessness or guilt
Thoughts of death or suicide
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
UNIPOLAR DEPRESSION
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DSM-IV-TR Diagnosis of Dysthymia
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Diagnosed when depression is not severe to meet for MDD, but
is of longer duration (> 2 years)
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Dysthymia + MDD referred to as “double depression”
Other subtypes of depression
Melancholic depression
 Psychotic depression
 Postnatal depression
 Seasonal affective disorder
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
UNIPOLAR DEPRESSION
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Epidemiology of depression
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Prevalence
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Age of onset
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In Australia: 3.4% of men, 6.8% of women over 1-year period
Lifetime prevalence ~ 17%
Women 2x as likely to have depression – cause of gender difference
not completely known
As early as 3 years old, median age of onset = 30 years old
Course
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Up to 50% with depression recover within 6 months of treatment
10% experience a chronic course
Most who have an MDE will have another episode within 5 years
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
UNIPOLAR DEPRESSION
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Aetiology of unipolar depression
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Biological factors
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Genetic factors – family history  2-3x increased risk
Neurotransmitters – serotonin, norepinephrine, dopamine
Neuroendocrine – hyperactivity in HPA axis
Neurophysiological – abnormalities in brain structures, including
prefrontal cortex, hippocampus, anterior cingulate, and amygdala
Environmental factors
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Stressful life events
Interpersonal difficulties
High level of “expressed emotion” in families of depressed patients
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
UNIPOLAR DEPRESSION
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Aetiology of unipolar depression
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Psychological factors
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Cognitive theories
Seligman’s Learned Helplessness Model – depression linked with
expectancy of helplessness in face of adverse events
Beck - childhood experiences lead to dysfunctional beliefs, which
are triggered by relevant events
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Negative Cognitive Triad = Negative view of self, world, and future
Behavioural theories
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Influence of adverse events and/or lack of positive reinforcement
Poor coping skills to deal with stressors
Protective factors may reduce risk (e.g., good interpersonal skills,
optimism)
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
UNIPOLAR DEPRESSION
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Treatment
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Medical approaches
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Antidepressant medication
Repetitive transcranial magnetic stimulation / Vagus nerve
stimulation
Bright light therapy (seasonal affective disorder)
Electroconvulsive therapy (severe depression)
Psychological approaches
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Cognitive behaviour therapy
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Behavioural activation and problem-solving
Cognitive restructuring for dysfunctional thoughts
Interpersonal psychotherapy
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Focus on interpersonal problems related to the depression
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
BIPOLAR DISORDER
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History
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Descriptions of mania date back to ancient Greece
In 19th century, mania and melancholia began to be considered
as a single entity
Kraeplin distinguished between “manic depressive insanity”
and “dementia praecox”, e.g., schizophrenia
In 1949 Australian researcher John Cade discovered lithium,
which revolutionized the treatment of bipolar disorder
Bipolar Diagnoses:
Bipolar I, Bipolar II, and cyclothymia
 All 3 of these conditions involve mania or hypomania
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
BIPOLAR DISORDER
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DSM-IV-TR defines a manic episode:
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Elevated, expansive or irritable mood > 1 week, plus 3 of the following:
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Must be out of character for the individual
DSM-IV-TR defines a hypomanic episode:
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Inflated self-esteem
Grandiosity
Sleep disturbance
Pressured speech
Flight of ideas
Distractibility
Heightened activity
Excessive risk taking
Same symptom profile as mania, except
Symptoms not severe enough to interfere with functioning, necessitate
hospitalisation, or involve hallucinations/delusions
DSM-IV-TR also includes the controversial construct of a mixed
episode, in which both symptoms of a manic and major depressive
episode present for > 1 week
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
BIPOLAR DISORDER
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Bipolar I
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Bipolar II
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>1 MDE plus >1 hypomanic episode
Cyclothymia
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> 1 manic or mixed episodes (MDE can be present but not
necessary)
Lacks severity to meet for Bipolar I or II
Hypomanic episodes plus depressive symptoms that don’t meet
for an MDE
Relationship between schizophrenia and bipolar
Often a mixture between mania and psychotic features
 Bipolar can be initially misdiagnosed as schizophrenia
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
BIPOLAR DISORDER
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Epidemiology
Lifetime prevalence of Bipolar I and II = 3.9%
 Men and women equally likely to meet for Bipolar I
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Women more likely to meet for Bipolar II
High rates of relapse (73% over 5 years)
 Often problems with medication compliance
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Problems associated with bipolar disorders
High rates of anxiety disorders and substance abuse among
bipolar patients
 Substantial social and economic costs
 High rate of suicide (15x rate in general population)
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
BIPOLAR DISORDER
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Aetiology
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Biological Factors
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Strong genetic component
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Neurotransmitters play a role
Stressful Events
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13x increased risk among 1st degree relatives
85% heritability in large twin study
Diathesis-Stress Model – interaction between underlying vulnerability
and stressful life event
Goal Dysregulation Model – excessive goal engagement
Psychological factors
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Cognitive disturbances – cause or consequence?
Temperament – perfectionism and high need for social approval
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
BIPOLAR DISORDER
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Treatment
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Pharmacological
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Mood stabilisers
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lithium, chlorpromazine, valproate, zyprexor, lamictal
Psychological
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Psychoeducation for patients and families
Cognitive behaviour therapy
Interpersonal and social rhythm therapy
Family interventions
Relapse prevention
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd
SUMMARY
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Unipolar and Bipolar Depression
History
 Diagnostic criteria
 Epidemiology
 Aetiology
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Biological
Psychological
Environmental
Treatment
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Biological
Psychological
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PPTs t/a Abnormal Psychology 1e by Rieger - Copyright  2009 McGraw-Hill Australia Pty Ltd