ABNORMAL PSYCHOLOGY, THIRD EDITION Deborah C. Beidel/ Cynthia M. Bulik/ Melinda A. StanleyChapter OutlineWhat Are Bipolar and Depressive Disorders?Bipolar DisorderManic/Hypomanic EpisodesSlide 6Cyclothymic DisorderEpidemiology of Bipolar DisorderBipolar MiscellaneousDevelopmental Factors in Bipolar DisorderMajor Depressive Disorder (MDD)(MDD symptoms)Persistent Depressive Disorder (Dysthymia)Slide 14Epidemiology of DepressionSex, Race, and EthnicityBut It’s Not Just Depression: Comorbidity FactorsQuick RecapSlide 19Slide 20And the facts about suicide…Suicidal Ideation, Suicide Attempts, and Completed SuicideWho Is at Risk and/or Commits Suicide?Risk Factors for SuicideUnderstanding Suicide: The AftermathPrevention of SuicideSuicide ProtocolSlide 28Suicide ProtocolSlide 30Slide 31The Etiology of Bipolar and Depressive DisordersSlide 33Slide 34Distortions in thoughtsTreatment of Bipolar and Depressive Disorders: Bipolar DisorderSlide 37Treatment of Bipolar and Depressive Disorders: Major DepressionTreatment of Mood Disorders: Major DepressionSelecting a TreatmentReviewing Learning ObjectivesSlide 42ABNORMAL PSYCHOLOGY, THIRD EDITIONDeborah C. Beidel/ Cynthia M. Bulik/ Melinda A. StanleyChapter 6Bipolar 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 manic-depressive 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.Rapidly cycling bipolar disorder have four or more severe mood disturbances within a single year.Figure 6.1 The Different Types of Bipolar Illness© 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)Difficulty in differentiating bipolar disorder from ADHD, conduct disorder, ODD, and schizophreniaOnset in childhood and adolescent more severeOlder adult population 1% over 60 report bipolar disorderAfter that age, mania and depression symptoms result from medical illness especially stroke (Van Gerpen et al., 1999)© 2014, 2012, 2010 by Pearson Education, Inc. All rights reserved.Major Depressive Disorder (MDD)Persistent sad or low mood that is severe enough to impair a person’s interest in or ability to engage in normally enjoyable activities-Disturbance in psychological, emotional, social, and physical functioning-Episodic illness (single episode lasts two weeks to several months; can be recurrent)40% of people diagnosed with MDD actually sleep and eat more than usual.© 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Most common psychiatric disorder worldwideMedian age of onset is 30 years (Kessler et al., 2005)Prevalence rates:-Major depression 35 million