Chapter 6_Part 2 Psy 303 Abnormal Psych

Bipolar Disorder Rapidly cycling bipolar disorder have four or more severe mood disturbances within a single year. Mixed state is symptoms of mania and depression that occur at the same time

Epidemiology of Bipolar Disorder Less common than major depression The average age of onset of the first manic episode is 18 years old. Unrelated to race, sex, and family income Affects people of all ages More common in: -Lower SES -Anxiety disorder (comorbidity) -Substance abuse disorder (comorbidity) -Affects males and females equally 0.9-1.3% (Merikangas, 2007)

Developmental Factors in Depression Age risk between 18 and 43, with the typical onset occurring at the age of 30 Typical warning signs In childhood both boys and girls are equally affected 2.5% of children 8.3% of adolescents After adolescence rates of depression increases for girls (2 to 1)

Can children show similar signs of mania as those in adulthood? According to NAMI (2011), children can be diagnosed with bipolar disorder as young as the age of 6, by giving the following typical symptoms: laughing hysterically, exhibit grandiose behaviors, flight of ideas, decreased need for sleep, hypersexuality, and tend to have multiple cycles during the day from being giddy one moment to gloomy the next. National Alliance on Mental Illness (NAMI, 2011). Fact sheet: Child and adolescent bipolar disorder (pp. 1-3). Retrieved on August 24th, 2011, from http://www.nami.org/Template.cfm?Section=By_Illness&template=/ContentManagement/ContentDisplay.cfm&ContentID=102859

Developmental Factors in Bipolar Disorder In children, mania may be chronic (irritability and temper tantrums) Difficulty in differentiating bipolar disorder from ADHD, conduct disorder, ODD, and schizophrenia Onset in childhood and adolescent more severe Older adult population 1% over 60 report bipolar disorder After that age, mania and depression symptoms result from medical illness especially stroke (Van Gerpen et al., 1999) Time span between mania and depression factors

But It’s Not Just Depression: Comorbidity Factors Can occur with medical conditions (heart disease, CNS disease, cancer, & migraines, Fleischhacker et al., 2008) 72.1% of people with major depressive disorder had additional disorders 59.2% anxiety disorder 24% substance abuse disorder 30% impulse disorders Genetic and environmental factors Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Suicide

CBT MODEL of SUICIDE View of self, others, future Decreased problem solving Suicide Dichotomous thinking Hopelessness Cognitive rigidity PAIN Inescapable Intolerable Interminabne Attentional bias Attentional fixation Overgeneralized memory

Suicide ranks as the eighth leading cause of death in United States—2 to 5% of people have attempted suicide (Moscicki, 1999). Males are more likely to commit suicide (usually by violent methods hanging or firearms) than females, even though females attempt suicide more often.

…the facts about suicide… Components of depression Eighth leading cause of death 2 to 5% of people in the United States attempt suicide (Moscicki, 1999) U.S. 17.7 per 100,000 males, 4.5 per 100,000 females Underreported due to misclassification of single- vehicle car accidents WHO estimates that one million people die from suicide every year, 16 per 100,000 Highest rate of male suicides in Belarus, Lithuania, 50 per 100,000

Suicidal Ideation, Suicide Attempts, and Completed Suicide Range from thoughts to detailed plans Suicidal ideation (SI) (thoughts of suicide) -Passive (wish to be dead without a plan) -Active (thoughts and includes a detailed plan) Parasuicides (superficial cutting and OD on nonlethal medications) Previous attempts at suicide increase the risk of suicide 30-40 times (Harris & Barraclough, 1997)

Who Is at Risk and/or Commits Suicide? Males vs. Females Methods used by males Risk factors for youth Events to spark SI for adolescents Events to spark SI for elderly Highest rates among whites and American Indian/Native Indians

Risk Factors for Suicide Family history (family members across generations have committed suicide) Psychiatric illness (90% of attempted or completed suicides are committed by people with mental illness) Approximately 50% of patients with bipolar disorders attempt suicide during their lifetime. If one is diagnosed with depression, there is an increased risk for suicide and suicidal ideation. Biological factors (very low levels of serotonin, impulsivity, and pathological aggression)

Understanding Suicide: The Aftermath Only 1/5 to 1/3 leave behind suicide notes Psychological autopsy (interviews with family, friends, coworkers, and health care providers in an attempt to identify psychological causes of suicide) Coroner (identifies the physical cause of death) Impact on those left behind Severity of suicidal ideation

Prevention of Suicide Crisis intervention (suicide hotlines) Focus on high-risk groups (children of parents with mood disorders who have attempted suicide themselves) Societal level prevention (using teacher and peer support) Preventing suicidal contagion (copycat suicides) Use of critical incident debriefing (CID)

Treatment after Suicide Attempts Deliberate self-harm risk factor for suicide Psychological intervention Psychosocial intervention Follow-up psychiatric care

The Etiology of Mood Disorders Biological -Genetics and family studies -Neuroimaging studies -Environmental factors and life events

The Etiology of Mood Disorders Psychological -Psychodynamic theory -Attachment theory -Behavioral theories -Learned helplessness -Cognitive theory

Automatic Thoughts 1.) I feel like I’m up against the world. 2.) I’m no good. 3.) Why can’t I ever succeed? 4.) No one understands me. 5.) I’ve let people down. 6.) I don’t think I can go on. 7.) I wish I were a better person. 8.) I’m so weak. 9.) My life’s not going the way I want it to. 10.) I’m so disappointed in myself. 11.) Nothing feels good anymore. 12.) I can’t stand this anymore. 13.) I can’t get started. 14.) What’s wrong with me? 15.) I wish I were somewhere else. 16.) I can’t get things together. 17.) I hate myself. 18.) I’m worthless. 19.) Wish I could just disappear. 20.) What’s the matter with me? 21.) I’m a loser. 22.) My life is a mess. 23.) I’m a failure. 24.) I’ll never make it. 25.) I feel so hopeless. 26.) Something has to change. 27.) There must be something wrong with me. 28.) My future is bleak. 29.) It’s just not worth it. 30.) I can’t finish anything.

Treatment of Mood Disorders: Major Depression Psychological - Focus on understanding how thoughts, perceptions, and behaviors influence depression - Cognitive-behavioral therapy (CBT) - Interpersonal psychotherapy (IPT) - Behavioral activation (focuses on increased contact with positive reinforcement for healthy behaviors which results in positive mood)

Treatment of Mood Disorders: Major Depression Biological - First-generation antidepressants (Tricyclic antidepressants and monoamine oxidase inhibitors, MAOIs) - Second-generations antidepressants (SSRIs) - Electroconvulsive Therapy (ECT) - Light therapy - Transcranial magnetic stimulation - Deep brain stimulation

Treatment of Mood Disorders: Bipolar Disorder Psychological -Cognitive-behavioral therapy (CBT to develop skills to change inappropriate or negative thought patterns) - Interpersonal and social rhythm therapy (IPSRT promotes adherence to regular daily routines)

Treatment of Mood Disorders: Bipolar Disorder Biological - Lithium (a naturally occurring metallic element used to treat bipolar disorder, which moderates glutamate levels in the brain) - Anticonvulsant - Atypical antipsychotics - Electroconvulsive Therapy (ECT)