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PSYC 410: Exam 2
Behavioral medicine
Health psychology
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Behavioral medicine
Health psychology
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Stress
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•Hammen’s Definition: an occurrence or ongoing situation that has the potential to affect the individuals life in negative ways, and typically some activity or behavior on the part of the individual is required to avoid, minimize, or counteract the negative consequences
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The nature of the stressor
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▫Involvement of important aspects of a person’s life
▫How distal or how proximal? (e.g. Egypt)
▫Duration of stressor
▫Cumulative effect of stressors (ex. last straw; kindling effect)
▫Chronic, or long-lasting stressors
▫Multiple concurrent stressors
•Life changes
•Experience of crisis:
▫When a stressor approaches or exceeds the adaptive capacities of a person or group
▫Typical coping resources are often insufficient
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Factors Predisposing a Person to Stress
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•A Person’s Perception of the Stressors
▫Anticipated vs. unexpected events
•Individual’s Stress Tolerance
▫A person’s ability to withstand stress without becoming seriously impaired
•Lack of External Resources and Social Supports
▫Social support may buffer the effects of stress
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Stress Response
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•Stress leads to increased production of cortisol
•High levels of cortisol:
▫Prepare the body for fight-or-flight
▫Always “on”
▫Decrease immune system activity
▫End result of HPA axis activation
•Allostatic load: the biological cost of adapting to stress
▫High allostatic load results in wear and tear on the body
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Coping with Stress
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•3 levels of coping:
1.Biological level
–Damage-repair mechanisms
2.Psychological and Interpersonal Level
–Learned coping responses
–Social support
3.Sociocultural Level
–Group resources
–Failure of any of these levels increases vulnerability to other levels!
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•Task-Oriented Coping
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▫Involves making changes to one’s self, one’s surroundings, or both
▫May be overt or covert action
▫Consistent with a CBT approach
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Defense-Oriented Coping
Coping with Stress 2
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•Hopeless and helpless attitudes can have devastating effects on organic functioning
•Learned Helplessness (Seligman)
•Physical and Psychological consequences
•Founding of Positive Psychology
•To provide empirical support for the theories of the Humanists
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Optimism and Stress
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•Optimism appears to
▫Serve as a buffer against disease
▫Accelerate recovery
▫But, potentially prevent a person from seeking necessary medical treatment
•Pollyanna-ism
•Negative affect and anxiety appear to increase our susceptibility to certain health problems
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Resilience
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•“We refer to resilience as maintaining or returning to a prior level of health during stressful circumstances. Resilience is an individual's capacity to adapt successfully and function competently despite exposure to stress, adversity, or chronic trauma” Kloos et al, 2010.
▫Combination of individual and environmental factors.
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Adjustment Disorder: Reactions to Common Life Stressors
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•A person is said to have an adjustment disorder if the person’s response to a common stressor:
▫Is maladaptive
▫Occurs within 3 months of the stressor
•In AD, maladjustment lessens when:
▫Stressor has subsided
▫Individual learns to adapt
•If symptoms continue beyond 6 months à Diagnosis must be changed
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Acute Stress Disorder
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▫Onset occurs within 4 weeks of traumatic event
The person has been exposed to a traumatic event in which both of the following were present:
◦the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others ANDthe person's response involved intense fear, helplessness, or horror
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Acute Stress Disorder Continued
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Either while experiencing or after experiencing the distressing event, the individual has three (or more) of the following dissociative symptoms
◦a subjective sense of numbing, detachment, or absence of emotional responsiveness
◦a reduction in awareness of his or her surroundings (e.g., "being in a daze")
◦derealization
◦Experiencing the external world as distorted and lacking a stable and palpable existence
◦depersonalization
◦Loss of sense of personal identity
dissociative amnesia
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Acute Stress Disorder Continued Continued
Post-Traumatic Stress Disorder: Reactions to Catastrophic Events
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•These severe symptoms can include:
▫Persistently re-experiencing the traumatic event
▫Persistently avoiding stimuli associated with the trauma
▫Chronic tension, irritability, and insomnia
▫Impaired concentration and memory
▫Feelings of depression
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Post-Traumatic Stress Disorder (PTSD)
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The person has been exposed to a traumatic event in which both of the following were present:
◦the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others AND
◦the person's response involved intense fear, helplessness, or horror
Persistent symptoms of increased arousal as indicated by two or more of the following:
▫Difficulty falling or staying asleep
▫Irritability or anger
▫Difficulty concentrating
▫Exaggerate startle response▫
E. Duration of > 1 month
F. Causes clinically significant impairment**
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Prevalence of PTSD
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•Prevalence
▫Half of all US adults will experience a traumatic event, but only 7.8% will develop PTSD
–Rates are lower in national populations with fewer disasters and lower crime
–Twice as prevalent in women as in males
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Casual Factors of PTSD
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•Causal factors
▫Post-traumatic stress disorder is can be common in soldiers especially:
–Soldiers involved in abusive violence
–Soldiers involved in graves registration
–Prisoners of war
▫Biological (hippocampal)
▫Sociocultural factors
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•Stress-inoculation Training
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▫Prepares people to tolerate an anticipated stressor by changing the things they say to themselves prior to the crisis
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Prevention of Stress Disorders: Three Stages
•Short-term Crisis Therapy
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▫Designed for individuals who were high-functioning prior to the trauma
▫Must have destabilization in the following areas:
–Affective
–Behavioral
–Cognitive
▫Goal: Resolve crisis, return to pre-crisis functioning
▫Very specific, can be very directive.
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Treatment for Stress Disorders
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•Debriefing Sessions
▫Controversial
▫Not always provided by mental health professionals*
•Telephone Hotlines
▫Aimed at individuals undergoing periods of severe stress
•Psychotropic Medications
▫Antidepressants/Antipsychotic
▫Some RCT with MDMA
•Direct-Exposure Therapy
▫Exposure to feared/avoided stimuli
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Prolonged Exposure Therapy
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•Failure to process traumatic event because of avoidance
▫Goal: to modify the fear structure, learn that anxiety will not last forever.
•Techniques:
▫Breathing (maybe we’ll do some)
▫Repeated In vivo exposure
▫Repeated imaginal exposure
Foa and Kozak (1986)
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Anxiety Disorders
Anxiety vs. Fear
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—Fear (or panic): A basic emotion that involves the activation of the fight-or-flight response of the sympathetic nervous system
—3 Components:
—Cognitive/Subjective
—Physiological/Affective
—Behavioral
—Anxiety:
—Also has all 3 components
—No activation of the fight-or-flight response, but can prepare for danger
—Many sources of fear and anxiety are learned, or conditioned
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Anxiety Disorders Continued
Phobia
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•Phobia: a persistent and disproportionate fear of some specific object or situation that presents little or no actual danger and yet leads to a great deal of avoidance
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Specific phobia
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•strong and persistent fear that is excessive or unreasonable and is triggered by the presence of some object or situation
▫Immediate fear response resembles a panic attack, except with a clear external trigger▫
•Subtypes of Specific Phobias in DSM-IV:
▫Animal
▫Natural Environment
▫Blood-Injection-Injury
▫Situational [being on top of a giant transmission tower]
▫Other
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DSM-IV Criteria: Specific Phobia
Specific Phobia Continued
Specific Phobia: Psychosocial Causal Factors
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—Psychoanalytic theory: phobias represent a defense against anxiety stemming from repressed impulses from the id
—Anxiety is displaced onto the feared object
—Classical conditioning of fear response
—Occurs when previously neutral stimuli are paired with traumatic or painful events
—Traumatic events can include un-cued panic attacks
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Specific Phobia: Psychosocial Causal Factors Continued
Treating Specific Phobia
Social Phobia
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•Social Phobia (also social anxiety disorder): characterized by disabling fears of one or more specific social situation)
▫Fear being exposed to scrutiny and potential negative evaluation by others and/or that he or she may act in an embarrassing or humiliating manner
•Common Social Phobias:
•public speaking, using public bathrooms, eating or writing in public
•Generalized social phobia: significant fears of most social situation (instead of just a few)
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DSM-IV Criteria:Social Phobia
Prevalence of Social Phobia
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•Lifetime prevalence rate à 12%
▫More women than men (60% women)
•Typically begins in adolescence or early adulthood
•Most common social phobia = public speaking
•Over ½ of people with social phobia have 1+ other anxiety disorders at some point in their lives
•50% have comorbid depressive disorders
•1/3 self-medicate using alcohol to reduce anxiety in social situations
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Social Phobia: Interacting Casual Factors
Treating Social Phobia
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•Behavior Therapy
▫Developed 1st
▫Involves prolonged and graduated exposure to social situations
•Cognitive-Behavioral Therapy
•Albert Ellis anecdote
▫Identify underlying negative automatic thoughts and cognitive distortions
▫Engaging in logical reanalysis
▫Videotaped feedback to help modify negatively distorted self-images
•Medication
▫Antidepressants
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Panic Disorder
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—the occurrence of “unexpected” panic attacks that often seem to come “out of the blue”
—Reach a peak within 10 minutes
—Usually subside in 20-30 minutes
—Rarely last more than 1 hour
—Must also experience persistent concern about the consequences of having another attack
—Can be unexpected/un-cued OR occur in particular stressful situations
—Many people go to the ER when they experience their 1st panic attack
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DSM-IV Criteria: Panic Attack
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—Palpitations or pounding heart
—Sweating
—Trembling or shaking
—Sensations of shortness of breath or being smothered
—Feelings of choking
—Chest pain or discomfort
—Paresthesias (numbness or tingling sensations)
—Chills or hot flashes
Nausea or abdominal distress
—Feeling dizzy, lightheaded, or faint
—Derealization (feelings of unreality) or depersonalization (being detached from oneself)
—Fear of losing control or going crazy
Fear of dying
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DSM-IV Criteria: Panic Disorder without Agoraphobia
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A.Both (1) and (2):
(1)recurrent, unexpected panic attacks
(2)At least one of the attacks followed by 1 month of more of:
(a)Concern about having another one
(b)Worry about the consequences of an attack
B.Absence of agoraphobia
C.Panic attack not due to physiological effects of a substance or medical condition
D.Panic attacks not better explained by another mental disorder such as social or specific phobia
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Agoraphobia
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—Fear of being in places or situations where a panic attack may occur – from which escape would be physically difficult or psychologically embarrassing
—Or where immediate help would be unavailable if something negative happened
—Commonly avoided places: streets, shopping malls, movie theatres, and stores
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Agoraphobia Continued
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—May develop as a result of having panic attacks in one or more of these places
—Often frightened by own bodily sensations (misintepret)
—Avoid activities that create arousal à exercising, watching scary movies, caffeine, sexual activity
—Can occur in the absence of panic disorder
—However this is extremely rare
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DSM-IV Criteria: Agoraphobia
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A.Anxiety about being in places from which escape might be difficult/embarrassing, or in which help may not be available in the event of a panic attack
B.Situations are avoided or endured with marked distress or anxiety about having a panic attack
C.Anxiety or avoidance not better accounted for by another anxiety disorder
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DSM-IV Criteria:Panic Disorder with Agoraphobia
Panic Disorder
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•Lifetime prevalence w/ and w/o agoraphobia à 4.7%
•Appears to be increasing over time
•Mean age of onset 15-24, esp. for men
•Often becomes chronic and disabling
•More frequent in women than men
▫Among people with severe agoraphobia, 80-90% are women
▫Possible explanation à sociocultural
•More than 50% of people with panic disorder have 1+ additional diagnoses
▫30-50% of people with panic disorder will experience a serious depression at some point
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1st Panic Attack
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—Frequently follow feelings of distress or highly stressful life circumstances
—80-90% of people report 1st panic attacks after one or more negative life events
—7-30% of adults have experienced at least 1 panic attack but NOT gone on to full-blown panic disorder—
—Panic attacks are much more frequent than panicdisorder
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Panic Disorder: Biological Causal Factors
Panic Disorder: Behavioral and Cognitive Causal Factors
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—The Cognitive Theory of Panic:
—Individuals who are hypersensitive to their bodily sensations tend to catastrophize the meaning of certain bodily sensations
—Ex. Dizziness, increases in HR
—These catastrophic thoughts then increase physical symptoms of anxiety
—These thoughts then increase negative automatic thoughts (catastrophic interpretations)
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Panic Disorder: Behavioral and Cognitive Causal Factors
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•Perceived control: Reduces anxiety and protects against panic attacks
•Safety behaviors à often prevent individual from determining that panic attacks are not harmful in and of themselves
▫Attribute lack of catastrophe to safety behaviors
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Panic Disorder: Treatment
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▫Panic Control Treatment (Barlow)
–Learn about panic and anxiety
–Learning to control breathing
–Identify automatic thoughts and logical errors àlogical reanalysis
–Interoceptive Exposure à deliberate exposure to feared internal sensations
–More specifically targets panic attacks
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Generalized Anxiety Disorder
DSM-IV Criteria: Generalized Anxiety Disorder
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A.Excessive anxiety and worry occurring more days than not for at least 6 months about a number of events or activities, person finds it difficult to control the worry.(1)Restlessness or feeling keyed up(2)Being easily fatigued(3)Difficulty concentrating(4)Irritability(5)Muscle tension (6)Sleep disturbance
_Not confined to features of another axis 1 disorder
_Symptoms cause clinically significant distress or impairment in functioning
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Generalized Anxiety Disorder
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—1 year prevalence = 3%
—Lifetime prevalence = 5.7%
—2x more common in women
—People with GAD are often high-functioning
—Age of onset à hard to say, many people report feeling anxious all their lives
—Often has a slow onset
—Frequently show up in physician's offices
—Often chronic over-users of health care resources
—Tend to overuse tranquilizers, sleeping pills, or alcohol
—Often co-occurs with depression, panic disorder, social phobia, specific phobia, and PTSD
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Generalized Anxiety Disorder: Psychosocial Causal Factors
Generalized Anxiety Disorder: Biological Causal Factors
Generalized Anxiety Disorder:Treatment
Obsessive-Compulsive Disorder
DSM-IV Criteria: Obsessive-Compulsive Disorder
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Either obsessions or compulsions
Obsessions as defined by all (all 4 required):
1)Recurrent and persistent thoughts, impulses, or images that are experienced at some time as intrusive and cause marked anxiety
2)Thoughts, impulses, or images are not simply excessive worries about real life problems
3)Person attempts to ignore or suppress or neutralize them with some other thought or action
4)Person recognizes they are a product of his or her own mind
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DSM-IV Criteria: Obsessive-Compulsive Disorder
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B.At least at some point person recognizes the obsessions or compulsions are excessive or unreasonable
C.Obsessions or compulsions causes marked distress, are time-consuming (more than 1 hour a day), or interfere significantly with normal functioning
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Obsessive-Compulsive Disorder
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—1 year prevalence rate = 1%
—Less prevalent than many other anxiety disorders
—Average lifetime prevalence = 1.6%
—More than 90% of people experience both obsessions and compulsions
—98% when mental rituals and mental compulsions such as counting are included
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Obsessive-Compulsive Disorder
Characteristics of OCD
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•Continuum of normal and abnormal obsessions and compulsive behaviors
•Types of Obsessive Thoughts
▫Contamination fears, harming self or others, pathological doubt, symmetry, sexual obsession, religious or aggression-related thoughts
▫Thoughts can be VERY intrusive
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•Types of Compulsions
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▫Cleaning, checking, repeating, ordering/arranging, and counting, hoarding
▫Many people show multiple types of rituals
•Consistent Characteristics
1.Anxiety is the affective symptom
2.Compulsions reduce anxiety to some degree (short term)
3.Fear something terrible with happen that they will be responsible for
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Obsessive-Compulsive Disorder:Psychosocial Causal Factors
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•Attempting to Suppress Obsessive Thoughts
▫May ultimately increase negative thoughts and link them to negative mood states
•Thought-action fusion
▫People with OCD often have a heightened sense of responsibility
▫Having a thought about doing something is equivalent to having actually done it
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Obsessive-Compulsive Disorder:Biological Causal Factors
Treatment of OCD
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—Behavioral Treatment: Exposure and Response Prevention
—Develop a hierarchy of fears/upsetting stimuli
—OCD patients repeatedly expose themselves to stimuli that provoke their obsession WHILE preventing themselves from engaging in compulsive behavior
—By preventing rituals, anxiety decreases on its own over time
—Must wait for anxiety to dissipate naturally!
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Treatment of OCD
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—Medications affecting serotonin system
—However, relapse rates are very high when medication is discontinued (50-90%)
—In some severe cases neurosurgery is considered
—Severe OCD for 5+ years
—No response to medication or behavior therapy
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•Broad Concepts: Mood Disorders
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•Depression: Emotional state characterized by extraordinary sadness and dejection
•Mania: Emotional state characterized by intense and unrealistic feelings of excitement and euphoria
*******************
•Unipolar Disorders: mood disorders in which someone experiences only depressive episodes
•Bipolar Disorders: mood disorders in with a person experiences both manic and depressive episodes
}
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Prevalence of Mood Disorders
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•Major Depressive Disorder
▫Lifetime prevalence rate = 17%
▫1 year prevalence rate = 7%
▫More common in women (2:1 ratio)
•Bipolar Disorder
▫Much less common
▫Lifetime risk = 0.4 - 1.6%
▫No discernable sex difference
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Costs of Mood Disorders
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•In 2000, depression was the #1 health condition in the US in terms of years lost to disability
▫Above heart disease and stoke
•Direct and Indirect costs of depression for the US totaled $83.1 billion
▫Over 60% of this cost stems from problems in the workplace
–Days missed from work, disability, premature death
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Unipolar Mood Disorders
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•Postpartum “Blues”
▫Different from postpartum Major Depression
▫Occur in as many as 50-70% of women within 10 days of birth
▫Symptoms include: emotional lability, crying easily, and irritability
These are often interspersed with happy feelings
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Dysthymic Disorder
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•Persistently depressed mood, more days than not, for a duration of at least 2 years
▫Periods of normal mood during this time lasting no more than 2 months
•Considered to be mild-moderate intensity
•Hallmark à duration/chronicity
•Lifetime prevalence = 2.5-6%
•Average duration = 5 years
▫Can be up to 20+ years! (Depressive PD)
▫High relapse rate
•Over 50% onset prior to age 21
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DSM-IV Criteria: Dysthymic Disorder
DSM-IV Criteria: Dysthymic Disorder
Major Depressive Disorder
DSM-IV Criteria: Major Depressive Episode
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•Must be present during the same 2-week period
•Must represent a change from normal functioning
•Criterial Symptoms à #1 or #2 must be present
•Symptoms must cause clinically significant distress or impairment
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Course of Major Depressive Disorder
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•Depression is a recurrent disorder
▫Episodes are usually time-limited
▫Average à 6 months for an untreated MDE
•Remission: Must be symptom free for at least 2 months
•Recurrence: New occurrence of a disorder after a remission of symptoms
▫80% of individual experience recurrence
–25-40% à 2 years
–60% à 5 years
–75% à 10 years
87 % à 15 years
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Course of Major Depressive Disorder
Unipolar Mood Disorders: Biological Causal Factors
Unipolar Mood Disorders: Biological Causal Factors
Unipolar Mood Disorders: Psychosocial Causal Factors
Exposure vs. Generation
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•Stress Exposure
▫Exposure to negative or stressful life events precedes and increases the risk for depression
▫Risk may be direct or indirect
▫Stress à Depression
•Stress Generation
▫Health-related problems (i.e. depression) precede and increase the likelihood of negative life events
▫Depressed individuals experience significantly higher levels of stressful life events than nondepressed individuals
–Often occurs within the domain of dependent stressors
▫Depression à Stress
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Unipolar Mood Disorders: Psychosocial Causal Factors
Unipolar Mood Disorders: Psychosocial Causal Factors
Vulnerabilities to Depression
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•Neuroticism or negative affectivity
▫Stable and heritable trait that involves a temperamental sensitivity to negative stimuli
▫Also predicts the occurrence of stressful life events
•Early adversity, including physical, sexual, or emotional abuse
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Psychodynamic Theories of Depression
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▫Freud et al, à when a loved one dies, the mourner regresses to the oral stage and incorporates the lost person, feeling the same feelings towards the self as towards the lost person
–Included anger and hostility
▫Depression = “anger turned inwards”
▫Individuals who have lost a parent or been unfulfilled by their parent are vulnerable to depression
–Will then be prone to depression when experience real or symbolic losses
▫Focus à The importance of loss
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Beck’s Cognitive Theory
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•Beck (1967) hypothesized that cognitive symptoms precede depressive symptoms and not vice versa
•Dysfunctional Beliefs:
▫Dysfunctional beliefs that are rigid, extreme, and counterproductive
▫Thought to leave one susceptible to depression when experiencing stress or rejection
•These are thought to develop during childhood as a function of negative experiences with significant others
▫Serve as a diathesis or vulnerability to develop depression
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Beck’s Cognitive Theory
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•When activated (by stress or depressed mood) ànegative automatic thoughts:
▫Below the surface of awareness and involve unpleasant pessimistic predictions
•Cognitive Triad:
▫Negative thoughts about the self
▫Negative thoughts about one’s experiences and the surrounding world
▫Negative thoughts about one’s future
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Beck’s Cognitive Theory
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•This cognitive triad is maintained by cognitive biases or cognitive errors
▫Dichotomous or all-or-none reasoning:
–Tendency to think in extremes
▫Selective Abstraction:
–Tendency to focus on one negative detail of a situation while ignoring other aspects
▫Arbitrary inference:
–Jumping to a conclusion based on minimal or no evidence
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Evaluating Beck’s Cognitive Theory
Interpersonal Effects on Depression
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•Social Support
▫Social isolation à risk factor
▫Social-skills deficits common in depressed individuals
•Excessive Reassurance-Seeking
▫Potential for social rejection
•Marital Discord
▫Marital discord à Depression
▫Depression à marital discord
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Unipolar Disorder: Treatment
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•Antidepressants à Course of Treatment
▫Require at least 3-5 weeks to take effect
▫50% of those who do not respond to 1 antidepressant will respond to another
▫Many physicians recommend long courses of antidepressants to prevent relapse or recurrence
•Alternative Biological Treatments
▫ECT – used with severely depressed patients
▫Bright Light Therapy
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Unipolar Disorder: Treatment
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•Pharmacotherapy
▫MAOIs (Parnate, Nardil)
–Effective, especially for severe depressions
–Serious side effects in combination with certain foods
–Rarely used now* Very old
▫Tricyclic Antidepressants (Elevil, Sinequan)
–Unpleasant side effects; OD possible
▫Selective Serotonin Reuptake Inhibitors (SSRIs)
–Prozac, Paxil, Zoloft, ec
–Not any more effective, but fewer side effects, better tolerated
Less risk for toxic overdose
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Unipolar Depression: Psychotherapy
Cognitive-Behavioral Therapy
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•Relatively brief (10-20 sessions)
•Focuses on here-and-now problems
•Teaches clients to:
▫Evaluate their beliefs and negative thoughts systematically
▫Uncover and challenge their underlyingdepressogenic assumptions
▫Treat their beliefs as hypotheses that can be tested through behavioral experiments
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Interpersonal Therapy
Bipolar Disorders
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•Bipolar disorders – presence of manic or hypomanic symptoms
•Manic episode
▫Markedly elevated and expansive mood for greater than 1 week
▫Often accompanied by explosive irritability
•Hypomanic episode
▫Abnormally elevated mood lasting for less than 4 days
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DSM-IV Criteria: Manic Episode
Cyclothymic Disorder
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•Considered a milder version of Bipolar Disorder
▫Depressive episodes are dysthymic-like
–Wouldn’t meet criteria for a full-blown depressive episode
▫Hypomanic episodes
–Increased physical and mental energy
–May be larger between episode gaps
•Less distress and impairment in functioning
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DSM-IV Criteria: Cyclothymic Disorder
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•For at least 2 years, presence of numerous periods ofhypomanic symptoms and numerous periods with depressive symptoms that do not meet criteria for MDE
•The person has not been symptoms free for more than 2 months
•No MDEs, manic episodes, or mixed episodes has been present during the 1st 2 years of the disturbance
•Not better accounted for by another disorder
•Clinical significant distress or impairment
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Bipolar Disorders (I and II)
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•Bipolar I Disorder
▫Distinguished from MDD by at least 1 episode of mania
▫Even if someone hasn’t had a full MDE, they can still be diagnosed Bipolar
▫Can also have a mixed episode:
–Symptoms of full-blown mania AND major depressive symptoms for at least 1 week
•Bipolar II Disorder
▫Has never experienced a full-blown manic episodes but has hypomanic episodes interspersed with MDEs
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DSM-IV Criteria: Bipolar I Disorder
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A.Presence (or history) of one or more Manic or Mixed episodes (necessary for Dx)
B.Presence (or history) of one or more MDE (not necessary for Dx)
C.Mood symptoms in A. and B. are not better accounted for by another disorder
D.Clinically significant distress or impairment
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Prevalence of Bipolar Disorders
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•Bipolar II à more common than Bipolar I
▫Combined about 3% of the US population
•Bipolar II develops into Bipolar I in only about 5-15% of cases
•Occurs equally in males and females
•Usually begins in adolescence or early adulthood
•2/3 of cases à manic episodes immediately precede or follow a depressive episode
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Bipolar Disorder: Biological Causal Factors
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•Highest heritability estimate of any of the major adult psychiatric disorders (80-90% variance)
▫If have 1st degree relative with bipolar disorder, risk = 8-9% (1% in the general population)
▫Likely polygenic
•NE, 5-HT, DA are likely involved
•Based on PET research, appears to be shifting pattern of brain activity during mania, and during depressed and normal moods
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Bipolar Disorder: Biological Causal Factors
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•Highest heritability estimate of any of the major adult psychiatric disorders (80-90% variance)
▫If have 1st degree relative with bipolar disorder, risk = 8-9% (1% in the general population)
▫Likely polygenic
•NE, 5-HT, DA are likely involved
•Based on PET research, appears to be shifting pattern of brain activity during mania, and during depressed and normal moods
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