ABNORMAL PSYCHOLOGY THIRD EDITION Deborah C Beidel Cynthia M Bulik Melinda A Stanley Chapter 6 Bipolar and Depressive Disorders 2014 2012 2010 by Pearson Education Inc All rights reserved Chapter Outline What Are Bipolar and Depressive Disorders Bipolar and Related Disorders Depressive Disorders Suicide The Etiology of Bipolar and Depressive Disorders The Treatment of Bipolar and Depressive Disorders 2014 2012 2010 by Pearson Education Inc All rights reserved What Are Bipolar and Depressive Disorders Syndromes in which a disturbance in mood is the predominant feature Take the form of low or high mood Depression abnormally low mood Mania abnormally high mood 2014 2012 2010 by Pearson Education Inc All rights reserved Bipolar Disorder Both episodic depressed mood and episodic mania formerly manicdepressive disorder Mania Long term illness Mood shifts between two emotional poles Categories of Bipolar Bipolar I full blown mania alternates with episodes of major depression Bipolar II hypomania mood elevation that is abnormal yet not severe enough to impair functioning or require hospitalization 2014 2012 2010 by Pearson Education Inc All rights reserved Manic Hypomanic Episodes Notable change from usual behavior 2 or more Inflated self esteem or grandiosity Decreased need for sleep More talkative than usual or pressure to keep talking Flight of ideas or racing thoughts Distractible Increase goal directed activity Excessive involvement in risky or potential painful experiences e g buying sprees sexual indiscretions etc 1 week for mania 4 days for hypomania Causes marked impairment in mania and may need hospitalization minor impairment for hypomania 2014 2012 2010 by Pearson Education Inc All rights reserved Figure 6 1 The Different Types of Bipolar Illness Rapidly cycling bipolar disorder have four or more severe mood disturbances within a single year 2014 2012 2010 by Pearson Education Inc All rights reserved Cyclothymic Disorder A condition characterized by fluctuations that alternate between hypomania and depression Episodes not as severe as with mania or major depression Persist for at least two years 2014 2012 2010 by Pearson Education Inc All rights reserved Epidemiology of Bipolar Disorder Less common than major depression Affects people of all ages More common in Lower SES Anxiety disorder comorbidity Substance abuse disorder comorbidity Affects males and females equally 0 9 1 3 Merikangas 2007 2014 2012 2010 by Pearson Education Inc All rights reserved Bipolar Miscellaneous 1 prevalence rate Onset around 18 years old Bipolar 2 somewhat more common in women More common in White than African American Comorbid with migraines heart disease diabetes substance use anxiety eating disorders and ADHD 2014 2012 2010 by Pearson Education Inc All rights reserved Developmental Factors in Bipolar Disorder In children mania may be chronic irritability and temper tantrums Older adult population 1 over 60 report bipolar disorder Difficulty in differentiating bipolar disorder from ADHD conduct disorder ODD and schizophrenia After that age mania and depression symptoms result from medical illness especially stroke Van Gerpen et al 1999 Onset in childhood and adolescent more severe 2014 2012 2010 by Pearson Education Inc All rights reserved Major Depressive Disorder MDD Persistent sad or Disturbance in psychological emotional social and physical low mood that is functioning severe enough to Episodic illness single episode impair a person s lasts two weeks to several interest in or ability months can be recurrent to engage in 40 of people diagnosed with MDD actually sleep normally enjoyable and eat more than usual activities 2014 2012 2010 by Pearson Education Inc All rights reserved MDD symptoms During a 2 week period 5 or more at least 1 of first 2 Depressed mood most of the day nearly every day Loss of interest in most activities Weight loss or gain 5 in one month or appetite change Sleep disturbance hyper or insomnia Restlessness nearly every day Fatigue or loss of energy Worthlessness or guilt Lack of concentration or indecisiveness Thoughts of death or suicidal ideation or attempt Distress and impairment One episode or recurrent up to 18 experience it by age 40 Can last for months Different from bereavement disability natural disasters etc 2014 2012 2010 by Pearson Education Inc All rights reserved Persistent Depressive Disorder Dysthymia A chronic state of depression the symptoms are the same as those of major depression but they are less severe Persistent lasting two or more years and an individual is never without symptoms for more than two months Leads to severe outcomes social isolation high suicide risk and mislabeled as moody or difficult 2014 2012 2010 by Pearson Education Inc All rights reserved Figure 6 2 The Different Forms of Depressive Disorders 2014 2012 2010 by Pearson Education Inc All rights reserved Epidemiology of Depression Approximately 16 2 of people age 18 and older report major depressive disorder at some point Most common psychiatric disorder worldwide Median age of onset is 30 years Kessler et al 2005 Prevalence rates Major depression 35 million U S adults 16 Dysthymia 2 5 of general population Depression ranks fourth in Global Burden of Disease WHO 2011 2014 2012 2010 by Pearson Education Inc All rights reserved Sex Race and Ethnicity Women are twice as likely to suffer from major depression than men Common in lower SES Impact of unemployment and lack of education and financial resources Impact of reproductive events Higher rates of depression in Whites at 17 9 2014 2012 2010 by Pearson Education Inc All rights reserved But It s Not Just Depression Comorbidity Factors Can occur with medical conditions heart disease CNS disease cancer migraines Fleischhacker et al 2008 72 of people with major depressive disorder had additional disorders 59 2 anxiety disorder 24 substance abuse disorder 2014 2012 2010 by Pearson Education Inc All rights reserved Quick Recap 1 involves a persistent sad or low mood that is severe enough to impair a person s interest in or ability to engage in normally enjoyable activities a Borderline disorder b Bipolar disorder c Major depressive disorder d Manic depressive disorder 2014 2012 2010 by Pearson Education Inc All rights reserved Quick Recap 2 consists of a chronic state of depression the symptoms are the same as those of major depression but are less severe a Bipolar II b Hypomania c Bipolar I d Dysthymia 2014 2012 2010 by Pearson