Discussion topic
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Discussion – Psychology of Abnormal Behavior
Please share your thoughts on the depression video? What are some takeaways you find interesting? Who do you find most interesting and why?
Course Materials
Kearney. C & Trull. T, Abnormal Psychology and Life: A Dimensional Approach, 3rd edition.
Cengage, 2018 -ISBN: 9781337273572( Mind Tap)
At least 275 words.
Depressive and Bipolar Disorders and Suicide: Features and Epidemiology
Depressive and Bipolar Disorders and Suicide: Causes and Prevention
Depressive and Bipolar Disorders and Suicide: Assessment and Treatment
Normal Mood Changes and Depression and Mania: What Are They?
Stigma Associated with Depressive and Bipolar Disorders
Depressive and bipolar disorders are sometimes referred to collectively as mood disorders because they involve extreme emotional states of sadness or euphoria.
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
Normal Mood Changes and Depression and Mania: What Are They?
Sadness
Depression
Happiness
Euphoria
Mania
For most people, sadness is a natural reaction to unfortunate events that happen in their lives. However, for other people, sadness
or a sense of hopelessness can become so intense that harming oneself or committing suicide seems like the only way to stop the pain. These symptoms refer to depression.
Sadness is an emotion or mood, and its natural opposite is happiness.
Other people sometimes experience an intense state of happiness called euphoria. Mania is at the far end of the happiness and euphoria continuum.
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
Major Depressive Episode
People with depression are often sad and isolated from others.
A major depressive episode is a period of two weeks or more during which a person experiences a sad or empty mood, changes in appetite, weight, and sleep; concentration difficulties, fatigue, sense of worthlessness, and suicidal thoughts or attempts.
DSM-5: Major Depressive Disorder (Part 1)
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
DSM-5: Major Depressive Disorder (Part 2)
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
Causes and
Prevention
Assessment
and Treatment
Emotions
Cognitions
Behaviors
Normal
Good mood.
Thoughts about what one has to do that day.
Thoughts about how to plan and organize the day.
Rising from bed, getting ready for the day,
and going to school or work.
Mild
Moderate
Depression – Less Severe
Depression – More Severe
Mild discomfort about the day, feeling
a bit irritable or down.
Thoughts about the difficulties of the day.
Concern that something will go wrong.
Taking a little longer than usual to rise from bed.
Slightly less concentration at school or work.
Feeling upset and sad, perhaps
becoming a bit teary-eyed.
Dwelling on the negative aspects of the day, such
as a couple of mistakes on a test or a cold shoulder
from a coworker.
Coming home to slump into bed without eating dinner.
Tossing and turning in bed, unable to sleep.
Some difficulty concentrating.
Intense sadness and frequent crying. Daily feelings
of “heaviness” and emptiness.
Thoughts about one’s personal deficiencies, strong
pessimism about the future, and thoughts about
harming oneself (with little intent to do so).
Inability to rise from bed many days, skipping
classes at school, and withdrawing from
contact with others.
Extreme sadness, very frequent crying, and
feelings of emptiness and loss. Strong sense
of hopelessness.
Thoughts about suicide, funerals, and
instructions to others in case of one’s death.
Strong intent to harm oneself.
Complete inability to interact with others or even
leave the house. Great changes in appetite and
weight. Suicide attempt or completion.
Continuum of Sadness and Depression
Features and
Epidemiology
Major Depressive Disorder
Major depressive disorder usually involves several major depressive episodes separated by periods of at least 2 months of normal mood, although it can be diagnosed upon the first major depressive episode.
DSM-5: Premenstrual Dysphoric Disorder (Part 1)
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
DSM-5: Premenstrual Dysphoric Disorder (Part 2)
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
Focus on College Students: Depression
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
Focus on College Students: Depression (cont’d.)
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
DSM-5: Persistent Depressive Disorder (Dysthymia) (Part 1)
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
DSM-5: Persistent Depressive Disorder (Dysthymia) (Part 2)
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
Causes and
Prevention
Assessment
and Treatment
Cycle of Major Depressive Disorder
Cycle of Persistent Depressive Disorder (Dysthymia)
Features and
Epidemiology
Persistent Depressive Disorder (Dysthymia)
Persistent depressive disorder is a chronic feeling of depression for at least 2 years. As you can see in these graphs, persistent depressive disorder (also known as dysthymia) involves lower grade symptoms than major depressive disorder, and often is chronic—these symptoms last two years or longer.
Double depression occurs when a patient with dysthymia experiences a major depressive episode.
DSM-5: Disruptive Mood Dysregulation Disorder (Part 1)
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
DSM-5: Disruptive Mood Dysregulation Disorder (Part 2)
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
DSM-5: Manic Episode
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
DSM-5: Hypomanic Episode (Part 1)
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
DSM-5: Hypomanic Episode (Part 2)
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
Causes and
Prevention
Assessment
and Treatment
Symptoms of a Manic Episode
Distractibility
Increase in goal-directed activity
Excessive involvement in activities with high potential for painful consequences
Inflated self-esteem or grandiosity
Decreased need for sleep, such as feeling rested after only 3 hours of sleep
More talkative than usual or pressure to keep talking
Subjective experience that one’s thoughts are racing, or flight of ideas
Features and
Epidemiology
Manic and Hypomanic Episodes
A manic episode is a period of uncontrollable euphoria and potentially self-destructive behavior. Hypomanic episodes are similar to manic episodes but with less impaired functioning.
DSM-5: Bipolar I Disorder
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
Bipolar I Disorder
Bipolar I disorder involves one or more manic episodes in a person, as represented in this graph of mood state over time.
DSM-5: Bipolar II Disorder
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
Bipolar II Disorder
Bipolar II disorder refers to hypomanic episodes that alternate with major depressive episodes. Notice in this graph how the manic mood states are less intense in bipolar II as compared to bipolar I, but the depressive states are equally intense.
DSM-5: Cyclothymic Disorder
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
Cyclothymic Disorder
Cyclothymic disorder does not involve full-blown episodes of depression, mania or hypomania, but refers to general symptoms of hypomania and depression that cycle back and forth over a period of two years or more.
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
Suicide
Suicide is commonly seen in people with depressive and bipolar disorders. Suicide also occurs in people with other mental disorders or no mental disorder.
Suicidality can be viewed along a spectrum ranging from thoughts of suicide (suicidal ideation), to suicidal behavior (self-destructive behavior, not necessarily with the intent to die), to suicide attempt to completion.
Features and
Epidemiology
Causes and
Prevention
Assessment
and Treatment
Epidemiology of Depressive and Bipolar Disorders
Women are more likely to have a first episode of depression, longer episodes of depression, and more recurrent episodes of depression than men.
Bipolar I and cyclothymic disorders seem equally present in men and women and among people of different cultures.
Mood disorders are common in the general population and often occur with anxiety-related, personality, eating, and substance use disorders.
Features and
Epidemiology
Causes and
Prevention
Assessment
and Treatment
Epidemiology of Suicide
An estimated 800,000 lives are lost due to suicide worldwide each year. Although women attempt suicide more frequently than men, men are far more likely to complete suicide than women.
As you can see here, suicide rates do vary substantially across cultures, with the highest rates in Eastern Europe, lower rates in the United States, Taiwan, Korea, Japan, China, and
Canada. The lowest rates are in the Latin American and Muslim countries. Within the U.S., African Americans, Asian/Pacific Islanders, and Hispanics tend to have the lowest rates of suicide.
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
Stigma Associated with Depressive and Bipolar Disorders
People with these disorders may experience substantial stigma
Programs to combat stigma can be effective
Education is a powerful antidote to stigma
Lasalvia and colleagues (2013) surveyed hundreds of people worldwide with depression. Most (79 percent) reported some form of discrimination in at least one domain.
According to Griffiths and colleagues (2014), perceived stigma was reduced significantly for participants who reviewed online educational materials about aspects of depression as compared to the study control group who did not review the online materials.
Features and
Epidemiology
Causes and
Prevention
Assessment
and Treatment
Biological Risk Factors for Depressive and Bipolar Disorders and Suicide
Biological risk factors for mood disorders include genetics, neurochemical and hormonal differences, sleep deficiencies, and brain changes.
The images comparing the brain of a control participant (top) with the brain of a clinically depressed person (bottom) illustrate the lower activity (less yellow coloring) of the cortex and other areas in the brain of someone who is depressed.
The cortex in general will show less activity in a person with major depression compared to a person without this disorder, and depressed patients show higher than normal cortisol levels hormonally.
Depression and bipolar disorders are associated with disruption to REM sleep and less slow-wave sleep.
Features and
Epidemiology
Causes and
Prevention
Assessment
and Treatment
Environmental Risk Factors
Stressful life events such as caring for two young children while working
full time can help trigger depressive or bipolar disorders.
Environmental risk factors for mood disorders include stressful life events and cognitive, interpersonal, and family factors. Cultural and evolutionary factors may also be influential.
Features and
Epidemiology
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
Assessment
and Treatment
Biological vulnerabilities/early predispositions: Genetic contributions, neurochemical and hormonal changes, brain changes
Early family problems: Poor attachment, disengaged parents,
expressed emotion, modeling of parental depression
Stressful life events: Family conflict, alienation from
others, academic and other challenges
Cognitive-stress and behavioral vulnerabilities: Sense of learned helplessness and hopelessness, intense negative emotions and arousal, escape-oriented behavior, lack of social support
Possible mood disorder
Causes of Depressive and Bipolar Disorders and Suicide
Evidence indicates that mood disorders result from a combination of (1) early biological vulnerability and (2) psychological vulnerability that develops out of environmental factors related to ability to cope, think rationally, and develop competent social and academic skills. This image shows one developmental pathway for depression that integrates both the biological and psychological vulnerabilities that result in development of a depressive disorder.
Features and
Epidemiology
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
Assessment
and Treatment
Prevention of Depressive and Bipolar Disorders and Suicide
Resourceful Adolescent Program-Adolescents (RAP-A) teaches:
Declaring existing strengths; managing stress
Modifying negative and irrational thoughts
Solving problems efficiently
Developing and using social support networks
Enhancing social skill and recognizing other perspectives
Preventing mood disorders involves building one’s ability to control situations that might lead to depression. This may involve helping people declare their strengths, manage stress, change unrealistic thoughts, solve problems, develop friendships, reduce conflict, enhance social skills, and maintain prescribed medication. For example, the Resourceful Adolescent Program-Adolescents (RAP-A) involves an 11-session group approach that teaches skills as listed here.
Features and
Epidemiology
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
Assessment
and Treatment
Interviews and Clinician Ratings
Primary methods to assess people with mood disorders include interviews, self-report questionnaires, self-monitoring, observations from others, and physiological measurement. Here is one item from a rating scale a therapist might use when interviewing a client known as the Hamilton Rating Scale for Depression.
Features and
Epidemiology
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
Assessment
and Treatment
Self-Report Questionnaires
The interview remains a dominant psychological approach for assessing people with bipolar-related disorders. However, some measures assess self-reported symptoms of mania and hypomania.
Features and
Epidemiology
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
Assessment
and Treatment
Self-Monitoring and Observations from Others
Self: monitor and log symptoms on a daily basis
Others: record more obvious mood symptoms, such as grandiosity
People with depressive and bipolar disorders can monitor and log their own symptoms on a daily basis.
A clinician who know a client well can also record more obvious mood symptoms, such as the grandiosity in the belief that one can fly.
.
Features and
Epidemiology
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
Assessment
and Treatment
Adrenal gland
Pituitary gland
Dexamethasone
Cortisol
ACTH
Copyright © Cengage Learning
Laboratory Assessment
Laboratory assessments for mood disorders include the dexamethasone test (DST), where people are injected with a corticosteroid to determine whether cortisol levels decline over time or remain high. In normal controls, cortisol levels from DST tend to decline over time, but not in people with depression.
Features and
Epidemiology
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
Assessment
and Treatment
Elderly
Unmarried
White
Male
Living alone
Assess sociodemographic risk factors
“How are things going in your marriage, in your family,
at home, at work?”
(Cover health, financial, marital, family, legal, and occupational factors)
“Have you experienced sad, blue, or empty feelings
and at least two of the following in the past two weeks?”
Trouble falling or staying asleep
Feeling tired or having little energy
Poor appetite or overeating
Little interest or pleasure in doing things
Feeling bad about yourself
Trouble concentrating
Feeling fidgety, restless, or unable to sit still
“Have you felt nervous, anxious, or on edge?”
“Have you had anxiety or panic attacks recently?”
Ask about stressors
Screen for depression and associated anxiety or agitation
“Have you ever felt you should cut down
on your drinking?”
“Have people annoyed you by criticizing your drinking?”
“Have you ever felt bad or guilty about your drinking?”
“Have you ever had a drink first thing in the morning
to steady your nerves or get rid of a hangover?”
Yes to two or more means probable alcohol abuse.
Screen for alcohol abuse
“Have you had thoughts about death, or about killing yourself?” If yes, ask:
“Do you have a plan for how you would do this?”
“Are there means available (e.g., a gun and bullets or poison)?”
“Have you actually rehearsed or practiced how you would kill yourself?”
“Do you tend to be impulsive?”
“How strong is your intent to do this?”
“Can you resist the impulse to do this?”
“Have you heard voices telling you to hurt or kill yourself?”
Ask about previous attempts, especially the degree of intent.
Ask about suicide of family members.
Assess risk of suicide
Assessment of Suicide
Assessing risk of suicide is critical in mood disorders and often focuses on recent symptoms of depression or anxiety and substance use, detail of suicide plan, access to weapons, and support from others.
Features and
Epidemiology
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
Assessment
and Treatment
Biological Treatment of Depressive and Bipolar Disorders and Suicide
Repetitive transcranial magnetic stimulation (rTMS) is a treatment for
people with depression.
Biological treatment of mood disorders includes selective serotonin reuptake inhibitors (SSRIs), tricyclics, monoamine oxidase inhibitors (MAOIs), and mood-stabilizing drugs.
Electroconvulsive therapy (ECT) involves deliberately inducing a brain seizure to improve very severe depression. Repetitive transcranial magnetic stimulation (rTMS), pictured here, involves placing an electromagnetic coil on a person’s scalp and introducing a current to relieve mood disorder symptoms.
Light therapy is often used for people with seasonal affective disorder.
Features and
Epidemiology
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
Assessment
and Treatment
Psychological Treatments
Marital therapy is an effective treatment for depression, especially in
women.
Psychological treatments are quite effective for mild and moderate mood problems.
Psychological treatment of mood disorders includes behavioral approaches to increase activity and reinforcement from others for prosocial behavior. Cognitive therapy is also a main staple for mood disorders. Mindfulness is a relatively new therapy to help people understand and accept their symptoms but still live a normal life and may be linked to mindfulness.
Interpersonal and marital and family therapists concentrate on improving a person’s relationships with others to alleviate symptoms of mood disorders.
Features and
Epidemiology
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
Assessment
and Treatment
What If I Am Sad or Have a Depressive or Bipolar Disorder?
The answers to some basic questions (Table 7.16) may help you decide if you wish further assessment or even treatment for a possible depressive or bipolar disorder.
Features and
Epidemiology
Causes and
Prevention
Assessment
and Treatment
Features and
Epidemiology
Assessment
and Treatment
Long-Term Outcome
Improved long-term outcome with:
Early treatment
Persistent medication use
Fewer comorbid diagnoses
Good support from family and others
Long-term outcome for people with mood disorders is best when they receive early treatment, remain on medication, have fewer comorbid diagnoses, and experience good support from others.
Chapter Reflections
What would you say to a friend who might be very sad or euphoric and who might be considering suicide?
What separates “normal” from “abnormal” mood?
How might friends help those with severe mood changes?
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