Monday March 17 2014 Abnormal 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 Speci ers 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 1 Monday 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 2 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 Biological Theories of Depression Genetic Factor heredity genetic factors Serotonin Transporter Gene Neurotransmitters large concentration in limbic system Reduction of neurotransmitters in the synapses decreased synthesis increased degradation by synaptic enzymes impaired release or reuptake Brain structure abnormalities serotonin 5 ht Norepinephrine Dopamine prefrontal cortex anterior cingulate hippocampus amygdala Monday 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 3 Monday March 17 2014 fatal in overdose of only 3 4x prescribed amount Problems BAD side effects Take 3 4 weeks to work 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 Speci c 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 4 Bipolar I and Bipolar II differ in the presence or absence of speci c mood episodes Monday March 17 2014 2 years of alternating between mild hypomanic episodes moderate Cyclothymic Disorder depression Rapid Cycling 15 50 develop Bipolar I or II no longer a disorder in DSM 5 speci er 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 reduce vulnerability to depression and mania 5 Monday March 17 2014 IMPORTANT Bipolar disorders include maniac hypomanic or mixed episodes Hypomanic episodes less severe than manic episodes Men women have similar rates of bipolar disorder high genetic component effective treatment WITH medication Suicide impulsivity people who die by suicide have a general tendency toward impulsive acts cognitive theories hopelessness and dichotomous thinking increase risk for suicide biological theories genetics neurotransmitters Interpersonal Theory of Suicide desire for death Perceived Burdensomeness people in my life would be better off if i were
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