Monday, March 17, 2014Abnormal Psychology!Unipolar Depressive Disorder -Unipolar Depressive Disorder: Major Depression (MDD), Dysthymia!-Major Depressive Episode:(Has at least 5 symptoms)!! 1. Depression mood!! 2. Anhedonia!! 3. Appetite or weight changes!! 4. Sleep problems!! 5. Psychomotor changes!! 6. Loss of energy!! 7. Feelings or Worthlessness or Inappropriate Guilt!! 8. Concentration problems!! 9. Suicidality!-Major Depression:!! -Presence of major depressive episode!! -Not better accounted for by another disorder!! -No history of maniac, mixed or hypomanic episode!-Specifiers (Subtypes)!-Anxious Distress- worrying, brooding!-Mixed- some evidence of mania/ hypomania!-Melancholic features- prominent physiological symptoms and anhedonia!-Psychotic features- delusions& hallucinations!-Catatonic features- lack of movement, disturbed speech!-Atypical features- assortment of odd symptoms!-Peripartum Onset- within 4 weeks of delivery of child!-Seasonal patterns- Seasonal Affective Disorder!-Dysthymia!! -less "severe" but more chronic!!-must of at least 2 symptoms for at lease TWO YEARS!!!1. appetite problems!! ! 2.sleep problems!! ! 3. low energy!! ! 4. low self esteem!1Monday, March 17, 2014! ! 5. poor concentration!! ! 6. feelings of hopelessness!! -most common disorder (~16% lifetime prevalence)!! -more common in ages 15-24 & 35-44!!-Demographic trends: gender(potential explanations for differences)!! ! -higher rates of sexual abuse/assault among women!! ! -socio-cultural strains!! ! -differences in functioning of hypothalamic-pituitary-adrenal (HPA) axis!! ! -self concept,!! ! -coping styles!! **higher in hispanics!-Depression!Important RISK FACTORS:!! -low social support!! -low self esteem!! -ruminative response style!! -physical/emotional illness!! -previous episode of depression!! -heredity (genetic factors -> Serotonin Transporter Gene)!Biological Theories of Depression:!!-Genetic Factor!!-Neurotransmitters (large concentration in limbic system).!! ! -serotonin (5-ht)!! ! -Norepinephrine!! ! -Dopamine!!-Reduction of neurotransmitters in the synapses!! ! -decreased synthesis!! ! -increased degradation by synaptic enzymes!! ! -impaired release or reuptake!!-Brain structure abnormalities!! ! -prefrontal cortex!! ! -anterior cingulate!! ! -hippocampus!! ! -amygdala!2Monday, March 17, 2014!-Neuroendocrine factors!! ! -hypothalamic-pituitary- adrenal axis (HPA)!! ! -"stress hypothesis" of depression!!-Behavioral Theories!! ! -Life stress reduces positive reinforcers, individual withdraws!! ! (Lewinsohn et al., 1995)!! ! -Learned helplessness( Selignman, 1975)!!-Cognitive Theories!! ! -reformulated learned helplessness theory!! ! ! -Believe causes of negative events are stable, internal, and global!! ! -negative cognitive triad (Beck, 1967)!! ! ! -depressed individuals exhibit errors in thinking that negatively!! ! ! negatively affect mood!! ! ! -self, world, future!Interpersonal theories of Depression!! -Rejection sensitivity: easily perceive rejection from others!! -Excessive reassurance seeking: constantly look for reassurance from others!! that they are accepted and loved. !! (Interacts w/ negative events predict depression: Katz, Beach &Joiner 1998)!Biological Treatments for Depression!-Selective Serotonin Reuptake Inhibitors (SSRIs)!! -relief in few weeks!! -not fatal overdose!! -less severe side effects!-Selective Serotonin and Norepinephrine Reuptake Inhibitors (SSNRIs)!! -similar advantages as SSRIs, but has more stimulant effects!-Monoamine Oxidase Inhibitors (MAOIs)!! Problems:!! ! -fatal interactions w/ other meds!! ! -take 3-4 weeks to work!! ! -fatal in overdose of only 3-4x prescribed amount!! ! -reasonably effective (~60%)!Drug Treatments!-Tricyclic antidepressants!3Monday, March 17, 2014! Problems:!! ! -BAD side effects!! ! -Take 3-4 weeks to work!! ! -fatal in overdose of only 3-4x prescribed amount!! ! -reasonable effective (~60%)!-Electroconvulsive Therapy (ECT)!! -given to patients who dont respond to medication!! -relieves depression in 50-60%, but 85% relapse!-Vagus Nerve Stimulation (VNS)!! -40-30% substantial relief, 30% minimal relief!-Repetitive Transcranial Magnetic Stimulation (rTMS)!!-few side effects!! -patients remain awake (unlike ECT)!Psychological Treatments for Depression!-Behavioral Therapy:!! Goal: increases positive reinforcers &decreases aversive experiences!! How: Individual, short-term therapy sessions. Identifying precipitants. Teaching!! skills.!! Specific Techniques: Functional analysis, behavioral activation, social rhythms!-Cognitive-Behavioral Therapy:!! Goals: 1. Cognitive-change negative thinking.!! ! 2. Behavioral- Solve problems, develop skills!! How: individual, short term, client-centered therapy sessions.!-Interpersonal Therapy (IPT)!**Medication &psychotherapy both effective treatments!!Bipolar I&II -Bipolar I: presence of Manic Episode!-Bipolar II: presence of Hypomanic Episode!-Manic Episode: distinct period of elevated or irritable mood!! *Plus at least 3 symptoms!-Hypomanic Episode: Distinct period of elevated mood or irritability for at least 4 days!! *Plus have at least 3 symptoms!4Monday, March 17, 2014**Bipolar I and Bipolar II differ in the presence (or absence) of specific mood episodes.!-Cyclothymic Disorder: !! -2 years of alternating between: mild hypomanic episodes & moderate! depression.!! -15-50% develop Bipolar I or II.!-Rapid Cycling:!! -no longer a disorder in DSM-5!! -specifier for Bipolar I and II!! ! - greater than and equal too distinct mood episodes in 12 mo. period!! -1-2% of population (develops in late adolescent or early childhood)!! -chronic course!! - men& women EQUALLY likely to be diagnosed.!Biological Theories of Bipolar Disorder!! -genetic factors!! -brain abnormalities!! -neurotransmitters!*Genetics &bipolar disorder HIGHER in MZ twins.!Phychosocial Theories!-greater sensitivity to reward!-stressful life events (may be trigger for new episodes)!-changes in bodily rhythms or usual routines!!Biological Treatments for Bipolar!-Mood Stabilizers!! -Lithium!! -Anticonvulsants!! -Atypical Antipsychotics!-Treated as chronic condition (patients remain on meds throughout life)!!Psychological Treatments for Bipolar!-interpersonal and social rhythm therapy: combine interpersonal and behavioral techniques to help maintain routine!-family focused therapy: focus on interpersonal stress (w/in context of family)!-Cognitive behavioral therapy: address problematic cognitions to
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