Abnorm psych handout ch07 spg. 2011
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Transcript of Abnorm psych handout ch07 spg. 2011
1Slides & Handouts by Karen Clay Rhines, Ph.D.Northampton Community College
Fundamentals of Abnormal Psychology, 6eRonald Comer
1
Mood DisordersMood DisordersChapter 7 Handouts
Insert pic of book cover here
22
Mood DisordersMood Disorders
Two key emotions on a continuum:◦Depression
Low, sad state in which life seems dark and its challenges overwhelming
◦Mania State of breathless euphoria or frenzied
energy
33
Mood DisordersMood Disorders
Most people with a mood disorder suffer only from depression◦ This pattern is called ____________________
Person has no history of mania Mood returns to normal when depression lifts
Others experience periods of mania that alternate with periods of depression◦ This pattern is called ____________________
These disorders have always captured people’s interest
44
Unipolar DepressionUnipolar Depression
The term “depression” is often used to describe general sadness or unhappiness◦_________________________________
_________________________________
Clinical depression can bring severe and long-lasting psychological pain that may intensify over time
55
How Common Is Unipolar How Common Is Unipolar Depression?Depression?Almost 7% of adults in the U.S. suffer
from severe unipolar depression in any given year◦ As many as 5% suffer from mild forms
Approximately 17% of all adults experience unipolar depression at some time in their lives
The prevalence is similar in Canada, England, France, and many other countries
66
How Common Is Unipolar How Common Is Unipolar Depression?Depression?Women are _______ as likely as men
to experience severe unipolar depression◦Lifetime prevalence: 26% of women vs.
12% of men◦Among children, the prevalence is
similar among boys and girlsApproximately 50% recover within
six weeks and 90% within a year, some without treatment◦Most will experience ____________ at
some point
77
What Are the Symptoms of What Are the Symptoms of Depression?Depression?Symptoms may vary from person to
personFive main areas of functioning may be
affected:◦ Emotional symptoms
Feeling “miserable,” “empty,” “humiliated”
Experiencing little pleasure (anhedonia)
◦ Motivational symptoms
Lacking drive, initiative, spontaneity
Between 6% and 15% of those with severe depression commit suicide
88
What Are the Symptoms of What Are the Symptoms of Depression?Depression?Five main areas of functioning may be
affected:◦ Behavioral symptoms
Less active, less productive
◦ Cognitive symptoms Hold negative views of themselves Blame themselves for unfortunate events Pessimism
◦ Physical symptoms Headaches, dizzy spells, general pain
99
Diagnosing Unipolar Diagnosing Unipolar DepressionDepressionCriteria 1: Major depressive
episode◦Marked by five or more symptoms
lasting two or more weeks In extreme cases, symptoms are
psychotic, including __________________________
__________________________
Criteria 2: _______________________
1010
1111
Diagnosing Unipolar Diagnosing Unipolar DepressionDepressionTwo diagnoses to consider:
◦_______________________________ Criteria 1 and 2 are met
◦_______________________________ Symptoms are “mild but chronic”
Depression is longer lasting but less disabling Consistent symptoms for at least 2 years
◦When dysthymic disorder leads to major depressive disorder, the sequence is called “___________________”
1212
What Causes Unipolar What Causes Unipolar Depression?Depression?Stress may be a trigger for
depression◦People with depression experience a
greater number of stressful life events during the month just before the onset of their symptoms
◦Some clinicians distinguish _________________ depression from _________________ depression, which seems to be a response to internal factors Today’s clinicians usually concentrate on
recognizing both the situational and the internal aspects of any given case
1313
What Causes Unipolar Depression?What Causes Unipolar Depression?The Biological ModelThe Biological Model Genetic factors
◦ Family pedigree, twin, adoption, and molecular biology gene studies suggest that some people inherit a _______________________ Researchers have found that as many as 20% of relatives
of those with depression are themselves depressed, compared with fewer than 10% of the general population
Twin studies demonstrate a ___________________________: Concordance rates for identical (MZ) twins = 46%
Concordance rates for fraternal (DZ) twins = 20%
Adoption studies also have implicated a genetic factor in cases of severe unipolar depression
Using techniques from the field of molecular biology, researchers have found evidence that unipolar depression may be tied to specific genes
1414
What Causes Unipolar Depression?What Causes Unipolar Depression?The Biological ModelThe Biological ModelBiochemical factors
◦ NTs: ___________ and ______________ In the 1950s, medications for high blood pressure
were found to cause depression Some lowered serotonin, others lowered norepinephrine
The discovery of truly effective antidepressant medications, which relieved depression by increasing either serotonin or norepinephrine, further confirmed the NT role
Now, research suggests that interactions between these NTs and/or other NTs in the brain, rather than the operation of any one NT alone, may account for unipolar depression
1515
What Causes Unipolar Depression?What Causes Unipolar Depression?The Biological ModelThe Biological Model
Biochemical factors◦Endocrine system / hormone release
People with depression have been found to have abnormal levels of _____________ Released by the adrenal glands during times of
stress
People with depression have been found to have _______________________________ “Dracula hormone”
Other researchers are investigating whether deficiencies of important proteins within neurons are tied to depression
1616
What Causes Unipolar Depression?What Causes Unipolar Depression?The Biological ModelThe Biological ModelBiochemical factors
◦These explanations have produced much enthusiasm but have certain limitations: _____________________________________
Do these symptoms correlate with human emotions?
_____________________________________ Current studies using modern technology are
attempting to address this issue
1717
What Causes Unipolar Depression?What Causes Unipolar Depression?The Biological ModelThe Biological Model
Brain anatomy and brain circuits◦ Biological researchers have determined that
emotional reactions of various kinds are tied to brain circuits These are networks of brain structures that work
together, triggering each other into action and producing a particular kind of emotional reaction
It appears that one circuit is tied to GAD, another to panic disorder, and yet another to OCD
◦ Although research is far from complete, a circuit responsible for unipolar depression has begun to emerge Likely brain areas in the circuit include the prefrontal
cortex, hippocampus, amygdala, and Brodmann’s Area 25
1818
Biological Treatments for Biological Treatments for Unipolar DepressionUnipolar DepressionUsually biological treatment
means antidepressant drugs, but for severely depressed individuals who do not respond to other forms of treatment, it sometimes includes electroconvulsive therapy or brain stimulation
1919
Biological Treatments for Biological Treatments for Unipolar DepressionUnipolar DepressionElectroconvulsive therapy (ECT)
◦The use of ECT was – and is – controversial
◦The procedure consists of targeted electrical stimulation to cause a brain seizure The usual course of treatment is 6 to 12
session
2020
Biological Treatments for Biological Treatments for Unipolar DepressionUnipolar DepressionElectroconvulsive therapy (ECT)
◦ The discovery of the effectiveness of ECT was _______________
◦ The procedure has been modified in recent years to reduce some of the negative effects For example, patients are given muscle relaxants
and anesthetics before and during the procedure
◦ Patients generally report some __________
2121
Biological Treatments for Biological Treatments for Unipolar DepressionUnipolar DepressionElectroconvulsive therapy (ECT)
◦ECT is clearly effective in treating unipolar depression Studies find improvement in
________________
◦The procedure seems particularly effective in cases of __________________________
2222
Biological Treatments for Biological Treatments for Unipolar DepressionUnipolar DepressionAntidepressant drugs
◦In the 1950s, two kinds of drugs were found to be effective: Monoamine oxidase inhibitors (MAO
inhibitors)
Tricyclics
◦These drugs have been joined in recent years by a third group, the second-generation antidepressants
2323
2424
Biological Treatments for Biological Treatments for Unipolar DepressionUnipolar DepressionAntidepressant drugs: MAO
inhibitors◦Originally used to treat TB, doctors
noticed that the medication seemed to make patients happier
◦The drug works biochemically by slowing down the body’s production of MAO _____________________________________ _____________________________________ This leads to a rise in norepinephrine activity
and a reduction in depressive symptoms About half of patients who take these drugs are
helped by them
2525
Biological Treatments for Biological Treatments for Unipolar DepressionUnipolar DepressionAntidepressant drugs: MAO
inhibitors◦MAO inhibitors potentially pose a
serious danger Blood pressure may rise to a potentially
fatal level if one eats foods with tyramine (cheese, bananas, wine) while taking MAOIs
Thus, people on MAO inhibitors must stick to a rigid diet
2626
Biological Treatments for Biological Treatments for Unipolar DepressionUnipolar DepressionAntidepressant drugs: Tricyclics
◦In searching for medications for schizophrenia, researchers discovered that imipramine lessened depressive symptoms Imipramine and related drugs are known
as tricyclics because they share a three-ring molecular structure
2727
Biological Treatments for Biological Treatments for Unipolar DepressionUnipolar DepressionAntidepressant drugs: Tricyclics
◦Hundreds of studies have found that depressed patients taking tricyclics have improved much more than similar patients taking placebos Drugs must be taken for at least ________
before such improvement is seen
_____________________________________
2828
Biological Treatments for Biological Treatments for Unipolar DepressionUnipolar DepressionAntidepressant drugs: Tricyclics
◦Most patients who immediately stop taking tricyclics upon relief of symptoms _____________________________
◦Patients who take tricyclics for five additional months (“____________________”) have a significantly decreased risk of relapse
2929
Biological Treatments for Biological Treatments for Unipolar DepressionUnipolar DepressionAntidepressant drugs: Tricyclics
◦ Tricyclics are believed to reduce depression by affecting neurotransmitter (NT) ____________ mechanisms To prevent a NT from remaining in the synapse too
long, a pump-like mechanism recaptures the NT and draws it back into the presynaptic neuron
The reuptake process appears to be ________________ in some people, drawing in too much of the NT from the synapse
This reduction in NT activity in the synapse is thought to result in clinical depression
Tricyclics block the reuptake process, thus __________________ in the synapse
3131
Biological Treatments for Biological Treatments for Unipolar DepressionUnipolar DepressionSecond-generation antidepressant drugs
◦ A third group of effective antidepressant drugs is structurally different from the MAO inhibitors and tricyclics Most of the drugs in this group are labeled
__________________________________
◦ These drugs act only on serotonin (no other NTs are affected) _______________________________________________
◦ Selective norepinephrine reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are also now available
3232
Biological Treatments for Biological Treatments for Unipolar DepressionUnipolar DepressionSecond-generation antidepressant
drugs◦ The effectiveness and speed of action of
these drugs is on par with the tricyclics, yet their sales have skyrocketed Clinicians often prefer these drugs because it is
_________________ on them than on other kinds of antidepressants
There are _____________________________ They have ____________________________
◦ These drugs may cause some undesired effects of their own, _______________________________
3333
Biological Treatments for Biological Treatments for Unipolar DepressionUnipolar DepressionBrain stimulation
◦As one third or more of people with unipolar depression are not helped by any of the treatments discussed previously, clinical investigators continue to search for alternative approaches, including: _________________________________
_________________________________
_________________________________
3434
Biological Treatments for Biological Treatments for Unipolar DepressionUnipolar DepressionVagus nerve stimulation
◦Depression researchers surmised they might be able to stimulate the brain by electrically stimulating the vagus nerve through the use of a pulse generator implanted under the skin of the chest
◦Research has found that the procedure brings significant relief to as many as 40% of those with treatment-resistant depression
3535
Biological Treatments for Biological Treatments for Unipolar DepressionUnipolar DepressionTranscranial magnetic stimulation
◦ Another technique designed to stimulate the brain without the undesired effects of ECT, TMS has been found to reduce depression when administered daily for 2 to 4 weeks
Deep brain stimulation◦ Theorizing a “depression switch” located
deep within the brain, researchers have successfully experimented with electrode implantation in the brain’s Brodman Area 25
3636
Biological Treatments for Biological Treatments for Unipolar DepressionUnipolar DepressionBrain stimulation
◦While such positive initial findings have produced considerable enthusiasm in the clinical field, it is important to recognize that research on DBS is in its earliest stages
3737
What Causes Unipolar Depression?What Causes Unipolar Depression?The Psychological ModelsThe Psychological Models
Three main models:◦Psychodynamic model
No strong research support
◦Behavioral model Modest research support
◦Cognitive views Considerable research support
3838
What Causes Unipolar Depression?What Causes Unipolar Depression?The Psychological ModelsThe Psychological ModelsPsychodynamic view
◦ Link between depression and ________ When a loved one dies, an unconscious process
begins and the mourner regresses to the oral stage and experiences a merging of his/her own identity with that of the lost person For most people, this reaction is temporary
If grief is severe and long-lasting, depression results
Those with oral stage issues (unmet or excessively met needs) are at greater risk for developing depression
Some people experience “___________” (or imagined) loss
Newer psychoanalysts (object relations theorists) propose that depression results when people’s relationships leave them feeling unsafe and insecure
3939
What Causes Unipolar Depression?What Causes Unipolar Depression?The Psychological ModelsThe Psychological Models
Psychodynamic view◦Studies have offered general support
for the psychodynamic idea that depression may be triggered by a major loss
◦However, research does not indicate that loss is always at the core of depression
4040
Psychodynamic Treatments Psychodynamic Treatments for Unipolar Depressionfor Unipolar DepressionPsychodynamic therapists use
the same basic procedures for all psychological disorders:◦____________________________
◦____________________________
◦____________________________
4141
Psychodynamic Treatments Psychodynamic Treatments for Unipolar Depressionfor Unipolar DepressionDespite successful case reports,
researchers have found that long-term psychodynamic therapy is only occasionally helpful in cases of unipolar depression
Two features may be particularly limiting:◦ _______________________________________◦ Depressed clients may become
discouraged and end treatment too early when treatment is unable to provide quick relief
_______________________ have performed better than traditional approaches
4242
What Causes Unipolar What Causes Unipolar Depression?Depression?The Psychological ModelsThe Psychological ModelsBehavioral view
◦Depression results from changes in _______________________ people receive in their lives Lewinsohn suggests that the positive
rewards in life dwindle for some people, leading them to perform fewer and fewer constructive behaviors and they spiral toward depression
◦Research supports the relationship between the number of rewards received and the presence or absence of depression _______________ are especially important
4343
Behavioral Treatments for Behavioral Treatments for Unipolar DepressionUnipolar DepressionBehavioral therapy
◦Lewinsohn developed a behavioral therapy for unipolar depression in the 1970s: _____________________________________,
often using a weekly schedule
_____________________________________
_____________________________________
4444
Behavioral Treatments for Behavioral Treatments for Unipolar DepressionUnipolar DepressionBehavioral therapy
◦The behavioral techniques seem to be of only limited help when just one of them is applied When treatment programs combine two
or more of the techniques, depressive symptoms (especially mild symptoms) seem to be reduced
It is worth noting that Lewinsohn himself has combined behavioral techniques with cognitive strategies in recent years
4545
What Causes Unipolar Depression?What Causes Unipolar Depression?The Psychological ModelsThe Psychological Models
Cognitive views◦Two main theories:
Learned helplessness
Negative thinking
4646
What Causes Unipolar Depression?What Causes Unipolar Depression?The Psychological ModelsThe Psychological Models
Cognitive views◦Learned helplessness
Theory holds that people become depressed when they think that: They no longer have control over the
reinforcements (rewards and punishments) in their lives
They themselves are responsible for this helpless state
4747
What Causes Unipolar Depression?What Causes Unipolar Depression?The Psychological ModelsThe Psychological Models
Cognitive views◦Learned helplessness
Theory is based on Seligman’s work with laboratory dogs Dogs subjected to uncontrollable shock were later
placed in a shuttle box
Even when presented with an opportunity to escape, dogs that had experienced uncontrollable shocks made no attempt to do so
Seligman theorized that the dogs had “learned” to be “helpless” to do anything to change negative situations, and drew parallels to human depression
4848
What Causes Unipolar Depression?What Causes Unipolar Depression?The Psychological ModelsThe Psychological Models
Cognitive views◦Learned helplessness
There has been _______________ research support for this model Human subjects who undergo helplessness
training score higher on depression scales and display reactions similar to depressive symptoms
Animal subjects lose interest in sex and social activities
4949
What Causes Unipolar Depression?What Causes Unipolar Depression?The Psychological ModelsThe Psychological ModelsCognitive views
◦ Learned helplessness
Recent versions of the theory focus on _____________ __________ attributions that are _______ and ______ lead to
greater feelings of helplessness and possibly depression
Example: “I am inadequate at everything and I always will be”
If people make other kinds of attributions, this reaction is unlikely
Example: “The way I’ve behaved the past couple weeks blew this relationship” [specific]. “I don’t know what got into me – I don’t usually act like that” [unstable]. “She never did know what she wanted” [external].
5050
What Causes Unipolar Depression?What Causes Unipolar Depression?The Psychological ModelsThe Psychological Models
Cognitive views◦Learned helplessness
Some theorists have refined the helplessness model yet again in recent years; they suggest that attributions are likely to cause depression only when they further produce a sense of hopelessness in an individual
5151
What Causes Unipolar Depression?What Causes Unipolar Depression?The Psychological ModelsThe Psychological Models
Cognitive views◦Learned helplessness
Although this theory has been very influential, it has imperfections: Much of the research relies on animal subjects
The attributional component of the theory raises particularly difficult questions in terms of animal models of depression
5252
What Causes Unipolar Depression?What Causes Unipolar Depression?The Psychological ModelsThe Psychological Models
Cognitive views◦Negative thinking
Beck believes four interrelated cognitive components combine to produce unipolar depression: 1. _________________________________
Self-defeating attitudes are developed during childhood
Beck suggests that upsetting situations later in life can trigger an extended round of negative thinking
5353
What Causes Unipolar Depression?What Causes Unipolar Depression?The Psychological ModelsThe Psychological Models
Cognitive views◦Negative thinking
2. This negative thinking typically takes three forms, called the ____________________: Individuals repeatedly interpret (1) their
experiences, (2) themselves, and (3) their futures in negative ways, leading to depression
5454
What Causes Unipolar Depression?What Causes Unipolar Depression?The Psychological ModelsThe Psychological Models
Cognitive views◦Negative thinking
3. Depressed people also make _________________, including:
Arbitrary inferences
Minimization of the positive and magnification of the negative
4. Depressed people experience _________________
A steady train of unpleasant thoughts that suggest inadequacy and hopelessness
5555
What Causes Unipolar Depression?What Causes Unipolar Depression?The Psychological ModelsThe Psychological Models
Cognitive views◦Negative thinking
Many studies have produced evidence in support of Beck’s explanation: High correlation between the level of
depression and the number of maladaptive attitudes
Both the cognitive triad and errors in logic are seen in people with depression
Automatic thinking has been linked to depression
5656
Cognitive Treatment for Cognitive Treatment for Unipolar DepressionUnipolar DepressionBeck’s cognitive therapy – which includes
a number of behavioral techniques – is designed to help clients recognize and change their negative cognitive processes
This approach follows four phases and usually lasts fewer than 20 sessions
Phases:◦ __________________________________◦ __________________________________◦ __________________________________◦ __________________________________
5757
Cognitive Treatment for Cognitive Treatment for Unipolar DepressionUnipolar DepressionOver the past several decades,
hundreds of studies have shown that cognitive and cognitive-behavioral approaches help unipolar depression◦Around _________ of clients show
___________________________ of symptoms
It is worth noting that a growing number of today’s cognitive-behavior therapists disagree with Beck’s proposition that individuals must fully disregard negative cognitions
5858
What Causes Unipolar Depression?What Causes Unipolar Depression?The Sociocultural ModelThe Sociocultural Model
Sociocultural theorists propose that unipolar depression is greatly influenced by the social context that surrounds people◦This belief is supported by the finding
that depression is often triggered by outside stressors
◦There are two kinds of sociocultural views: The family-social perspective
The multicultural perspective
5959
What Causes Unipolar Depression?What Causes Unipolar Depression?The Sociocultural ModelThe Sociocultural Model
The Family-Social Perspective◦The connection between declining
social rewards and depression (as discussed by the behaviorists) is a two-way street Depressed people often display social
deficits that make other people uncomfortable and may cause them to avoid the depressed individuals
This leads to decreased social contact and a further deterioration of social skills
6060
What Causes Unipolar Depression?What Causes Unipolar Depression?The Sociocultural ModelThe Sociocultural Model
The Family-Social Perspective◦Consistent with these findings,
depression has been tied repeatedly to the unavailability of social support such as that found in a happy marriage People who are separated or divorced display
three times the depression rate of married or widowed persons and double the rate of people who have never been married
◦People whose lives are isolated and without intimacy seem particularly likely to become depressed at times of stress
6161
Family-Social Treatments for Family-Social Treatments for Unipolar DepressionUnipolar DepressionInterpersonal therapy (IPT)
◦This model holds that four interpersonal problems may lead to depression and must be addressed: Interpersonal loss Interpersonal role dispute Interpersonal role transition Interpersonal deficits
◦Studies suggest that IPT is as effective as cognitive therapy for treating depression
6262
Family-Social Treatments for Family-Social Treatments for Unipolar DepressionUnipolar DepressionCouple therapy
◦The main type of couple therapy is behavioral marital therapy (BMT) Focus is on developing specific
communication and problem-solving skills
◦If marriage is conflictual, BMT is as effective as other therapies for reducing depression
6363
What Causes Unipolar Depression?What Causes Unipolar Depression?The Sociocultural ModelThe Sociocultural Model
The Multicultural Perspective◦Two kinds of relationships have
captured the interest of multicultural theorists: Gender and depression
A strong link exists between gender and depression
Women cross-culturally are __________________ as men to receive a diagnosis of unipolar depression
6464
What Causes Unipolar Depression?What Causes Unipolar Depression?The Sociocultural ModelThe Sociocultural Model
The Multicultural Perspective◦Various theories have been offered:
The ______________________ holds that women and men are equally prone to depression, but that clinicians often fail to detect depression in men
The ______________________ holds that hormone changes trigger depression in many women
The ______________________ suggests that women in our society experience more stress than men
6565
What Causes Unipolar Depression?What Causes Unipolar Depression?The Sociocultural ModelThe Sociocultural ModelThe Multicultural Perspective
◦Various theories have been offered: The ______________________ state that
females in Western society are taught, almost from birth, to seek a low body weight and slender body shape – goals that are unreasonable, unhealthy, and often unattainable
The ______________________ picks up the learned helplessness research and argues that women may be more prone to depression because they feel less control than men over their lives
6666
What Causes Unipolar Depression?What Causes Unipolar Depression?The Sociocultural ModelThe Sociocultural Model
The Multicultural Perspective◦Various theories have been offered:
The ______________________ holds that people who ruminate when sad – keep focusing on their feelings and repeatedly consider the causes and consequences of their depression – are more likely to become depressed and stay depressed longer
6767
What Causes Unipolar Depression?What Causes Unipolar Depression?The Sociocultural ModelThe Sociocultural Model
The Multicultural Perspective◦Each explanation offers food for
thought and has gathered just enough supporting evidence to make it interesting (and just enough contrary evidence to raise question about its usefulness)
6868
What Causes Unipolar Depression?What Causes Unipolar Depression?The Sociocultural ModelThe Sociocultural Model
The Multicultural Perspective◦Two kinds of relationships have
captured the interest of multicultural theorists: Cultural background and depression
Depression is a worldwide phenomenon, and certain symptoms seem to be constant across all countries, including sadness, joylessness, anxiety, tension, lack of energy, loss of interest, and thoughts of suicide
Beyond such core symptoms, research suggests that the precise picture of depression varies from country to country
6969
What Causes Unipolar Depression?What Causes Unipolar Depression?The Sociocultural ModelThe Sociocultural Model
The Multicultural Perspective◦Depressed people in non-Western
countries are more likely to be troubled by physical symptoms of depression than by cognitive ones
7070
What Causes Unipolar Depression?What Causes Unipolar Depression?The Sociocultural ModelThe Sociocultural Model
The Multicultural Perspective◦Within the United States, researchers
have found few differences in depression symptoms among members of different ethnic or racial groups, however, sometimes striking differences exist in specific populations living under special circumstances In a study of one Native American village,
lifetime risk was 37% among women, 19% among men, and 28% overall
These findings are thought to be the result of economic and social pressures
7171
Multicultural Treatments for Multicultural Treatments for Unipolar DepressionUnipolar DepressionCulture-sensitive approaches are
increasingly being combined with traditional forms of psychotherapy to help maximize the likelihood of minority clients overcoming their disorders
7272
Bipolar DisordersBipolar Disorders
People with a bipolar disorder experience both the __________________ and the _____________________________◦Many describe their lives as an
emotional roller coaster
7373
What Are the Symptoms of What Are the Symptoms of Mania?Mania?Unlike those experiencing depression,
people in a state of mania typically experience dramatic and inappropriate rises in mood
Five main areas of functioning may be affected:◦ 1. Emotional symptoms
Active, powerful emotions in search of outlet
◦ 2. Motivational symptoms Need for constant excitement, involvement,
companionship
7474
What Are the Symptoms of What Are the Symptoms of Mania?Mania?Five main areas of functioning may be
affected:◦ 3. Behavioral symptoms
Very active – move quickly; talk loudly or rapidly
_________________ is not uncommon
◦ 4. Cognitive symptoms
Show poor judgment
Especially prone to poor (or no) planning
◦ 5. Physical symptoms
High energy level – often in the presence of little or no rest
7575
Diagnosing Bipolar Diagnosing Bipolar DisordersDisordersCriteria 1: Manic episode
◦Three or more symptoms of mania lasting one week or more In extreme cases, symptoms are
psychotic
◦Criteria 2: History of mania If currently experiencing hypomania or
depression
7676
7777
Diagnosing Bipolar Diagnosing Bipolar DisordersDisordersDSM-IV-TR distinguishes between
two kinds of bipolar disorder:◦Bipolar I disorder
Full manic and major depressive episodes Most sufferers experience an alternation of
episodes
Some experience mixed episodes
◦Bipolar II disorder Hypomanic episodes and major
depressive episodes
7878
Diagnosing Bipolar Diagnosing Bipolar DisordersDisordersWithout treatment, the mood
episodes tend to recur for people with either type of bipolar disorder◦In most cases, the individual’s
depressive episodes outnumber his or her manic episodes
7979
Diagnosing Bipolar Diagnosing Bipolar DisordersDisordersBetween 1% and 2.6% of all
adults in the world suffer from a bipolar disorder at any given time
The disorders are equally common in women and men and among all socioeconomic classes and ethnic groups
8080
Diagnosing Bipolar Diagnosing Bipolar DisordersDisordersOnset usually occurs between 15
and 44 years of age◦In most cases, the manic and
depressive episodes eventually subside, only to recur at a later time
8181
Diagnosing Bipolar Diagnosing Bipolar DisordersDisordersA final diagnostic option:
◦If a person experiences numerous episodes of hypomania and mild depressive symptoms, a diagnosis of cyclothymic disorder is appropriate Mild symptoms for two or more years,
interrupted by periods of normal mood
Affects at least 0.4% of the population
May eventually blossom into bipolar I or II disorder
8282
What Causes Bipolar What Causes Bipolar Disorders?Disorders?Throughout the first half of the
20th century, the search for the cause of bipolar disorders made little progress
More recently, biological research has produced some promising clues◦These insights have come from
research into NT activity, ion activity, brain structure, and genetic factors
8383
What Causes Bipolar What Causes Bipolar Disorders?Disorders?Neurotransmitters
◦After finding a relationship between low norepinephrine and unipolar depression, early researchers expected to find a link between high norepinephrine levels and mania This theory is supported by some
research studies; bipolar disorders may be related to overactivity of norepinephrine
8484
What Causes Bipolar What Causes Bipolar Disorders?Disorders?Neurotransmitters
◦Because serotonin activity often parallels norepinephrine activity in unipolar depression, theorists expected that mania would also be related to high serotonin activity Although no relationship with HIGH
serotonin has been found, bipolar disorder may be linked to LOW serotonin activity, which seems contradictory…
8585
What Causes Bipolar What Causes Bipolar Disorders?Disorders?Neurotransmitters
◦ This apparent contradiction is addressed by the “____________________” about mood disorders: Low serotonin may “open the door” to a mood
disorder and permit norepinephrine activity to define the particular form the disorder will take:
Low serotonin + Low norepinephrine = _____________
Low serotonin + High norepinephrine = _____________
8686
What Causes Bipolar What Causes Bipolar Disorders?Disorders?Ion activity
◦Ions, which are needed to send incoming messages to nerve endings, may be improperly transported through the cells of individuals with bipolar disorder
◦Some theorists believe that irregularities in the transport of these ions may cause neurons to fire too easily (mania) or to stubbornly resist firing (depression) There is some research support for this
theory
8787
What Causes Bipolar What Causes Bipolar Disorders?Disorders?Brain structure
◦Brain imaging and postmortem studies have identified a number of abnormal brain structures in people with bipolar disorder; in particular, the basal ganglia and cerebellum among others It is not clear what role such structural
abnormalities play
8888
What Causes Bipolar What Causes Bipolar Disorders?Disorders?Genetic factors
◦ Many theorists believe that people _______ ________________________________ to develop bipolar disorders Family pedigree studies support this idea; when
one twin or sibling has bipolar disorder, the likelihood for the other twin or sibling increases:
Identical (MZ) twins = 40% likelihood
Fraternal (DZ) twins and siblings = 5% to 10% likelihood
General population = 1 to 2.6% likelihood
8989
What Causes Bipolar What Causes Bipolar Disorders?Disorders?Genetic factors
◦Recently, genetic linkage studies have tried to identify possible patterns in the inheritance of bipolar disorders
◦Other researchers are using techniques from molecular biology to further examine genetic patterns
◦Such wide-ranging findings suggest that a number of genetic abnormalities probably combine to help bring about bipolar disorders
9090
Treatments for Bipolar Treatments for Bipolar DisorderDisorderUntil the latter part of the 20th
century, people with bipolar disorders were destined to spend their lives on an emotional roller coaster◦Psychotherapists reported almost no
success
◦Antidepressant drugs were of limited help These drugs sometimes triggered manic
episodes
9191
Treatments for Bipolar Treatments for Bipolar Disorder: Lithium and Other Disorder: Lithium and Other Mood StabilizersMood StabilizersThe use of lithium (a metallic element
occurring as mineral salt) and other mood-stabilizers has dramatically changed this picture
All manner of research has attested to the effectiveness of lithium and other mood stabilizers in treating manic episodes◦ More than 60% of patients with mania improve
on these medications
◦ Most individuals experience fewer new episodes while on the drug
9292
Treatments for Bipolar Treatments for Bipolar Disorder: Lithium and Other Disorder: Lithium and Other Mood StabilizersMood StabilizersFindings suggest that the mood
stabilizers are also __________________ drugs, ones that actually help prevent symptoms from developing
Mood stabilizers also help those with bipolar disorder overcome their depressive episodes to a lesser degree
9393
Treatments for Bipolar Treatments for Bipolar Disorder: Lithium and Other Disorder: Lithium and Other Mood StabilizersMood StabilizersResearchers do not fully understand
how mood stabilizing drugs operate◦They suspect that the drugs change
synaptic activity in neurons, but in a different way from that of antidepressant drugs Although antidepressant drugs affect a
neuron’s initial reception on NTs, __________________________
◦These drugs also increase the production of neuroprotective proteins – key proteins within certain neurons whose job it is to prevent cell death, which may indirectly reduce bipolar symptoms
9494
Treatments for Bipolar Treatments for Bipolar Disorder: Adjunctive Disorder: Adjunctive PsychotherapyPsychotherapy________________________________Mood stabilizing drugs alone are
also not always sufficient◦ 30% or more of patients
________________, ________________, and/or _____________
As a result, clinicians often use psychotherapy as an adjunct to mood-stabilizing drugs
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Treatments for Bipolar Treatments for Bipolar Disorder: Adjunctive Disorder: Adjunctive PsychotherapyPsychotherapyTherapy focuses on medication
management, social skills, and relationship issues
Few controlled studies have tested the effectiveness of such adjunctive therapy◦Growing research suggests that it
___________________, ___________________, and _____ ____________________________