Unit 11: Mental Illness and Therapies WHS AP Psychology Unit 11: Mental Illness and Therapies Essential Task 11-2:Discuss the major diagnostic category of mood disorders with specific attention to the diagnoses of major depressive disorder, dysthymia, Bipolar I and Bipolar II, detail the defining symptoms of each and identify the best approach(es) for explaining the cause(es) of each. Logo Green is R=8 G=138 B=76 Blue is R= 0 G=110 B=184 Border Grey is R=74 G=69 B=64

Treatment of Psychological Disorders Classical Operant Unit 11: Treatment of Psychological Disorders Biological Treatments Insight Therapies Cognitive Therapies Behavior Therapies Psychosurgery Antipsychotic Drugs Electroconvulsive Therapy Psychoanalysis Stress Inoculation Beck’s Cognitive Therapy Aversion Therapy Behavior Contracting Flooding Systematic Desensitization Client-Centered Gestalt Rational Emotive Therapy Classical Operant Token Economy We are here

Bipolar I Bipolar II – no mania Bipolar disorders Mood Disorders - Emotional disturbances that interfere with normal life functioning (Axis 1) Depressive disorders OBJECTIVE 12| Define mood disorders, and contrast major depressive disorder and bipolar disorder. Major Depressive Disorder Single Recurrent Dysthymia

Major Depressive Episode (building block) A. During the same 2-week period, five or more of the following symptoms including either 1 or 2 have been present (must be a change in functioning) Depressed mood most of the day, nearly everyday Diminished interest or pleasure in all, or almost all, activities Significant changes in appetite and/or weight Significant changes in sleep patterns Psychomotor retardation or agitation Fatigue or loss of energy Feelings of worthlessness or inappropriate guilt Diminished ability to concentrate or make decisions Recurrent thoughts or death or suicide

Major Depressive Episode (building block) B. The criteria do not meet criteria for a Mixed Episode C. The symptoms cause clinically significant distress or impairment in functioning D. Not due to a General Medical Condition or substance E. The symptoms are not better accounted for by Bereavement

Manic Episode (building block) Distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week During the mood disturbance, 3 or more of the following symptoms have persisted (4 or more if the mood is only irritable) Inflated self-esteem or grandiosity Decreased need for sleep More talkative than usual, or pressure to keep talking Racing thoughts (“flight of ideas”) Distractibility Increase in goal-directed activity Excessive involvement in pleasurable activities that have the potential for negative consequences

Manic Episode (building block) C. The symptoms do not meet criteria for a Mixed Episode D. The symptoms cause significant impairment in functioning or necessitate hospitalization to prevent harm to self or others E. Not due to a GMC or substance

Mixed Episode (building block) A. The criteria are met for both a Manic Episode and a Major Depressive Episode (except duration) nearly every day during at least a 1-week period B. The symptoms cause significant distress or impairment in functioning C. Not due to a GMC or substance

Hypomanic Episode (building block) Distinct period of persistently elevated, expansive, or irritable mood lasting at least 4 days During the mood disturbance, 3 (or more) of the following symptoms have been present (4 or more if mood is only irritable) Inflated self-esteem or grandiosity Decreased need for sleep More talkative than usual, or pressure to keep talking Racing thoughts (“flight of ideas”) Distractibility Increase in goal-directed activity Excessive involvement in pleasurable activities that have the potential for negative consequences

Hypomanic Episode (building block) C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic D. The mood disturbance and change in functioning are observable to others E. The episode is not severe enough to cause marked distress or impairment in functioning and does not require hospitalization F. Not due to a GMC or substance

Mood Episodes Mixed Episode Mania Hypomania Normal Mood Depression

Major Depressive Disorder One or more Major Depressive Episodes AND No history of mania or hypomania Specify: Single Episode Recurrent

Major Depressive Disorder Episode Major Depressive Episode Major Depressive Episode Major Depressive Episode MDD, single episode MDD, recurrent episodes

Major Depressive Disorder: Types Melancholic Catatonic Seasonal Pattern Post-partum onset

Dysthymia A. Depressed mood most of the day, more days than not, for at least 2 years B. Presence, while depressed, of 2 (or more) of the following: 1. Poor appetite or overeating 2. Insomnia or hypersomnia 3. Low energy or fatigue 4. Low self-esteem 5. Poor concentration or difficulty making decisions 6. Feelings of hopelessness C. During the 2-year period, the person has never been without the symptoms for more than 2 months at a time

Dysthymia D. Not better accounted for by Major Depressive Disorder E. There has never been a Manic, Mixed, or Hypomanic episode F. Not better accounted for by another disorder G. Not due to a GMC or substance H. Symptoms cause clinically significant distress or impairment in functioning

Dysthymic Disorder Dysthymic disorder lies between a blue mood and major depressive disorder. It is a disorder characterized by daily depression lasting two years or more. Major Depressive Disorder Blue Mood Dysthymic

Major Depression vs. Dysthymia Recurrent Major Depressive Episodes Dysthymia

Bipolar Disorder Formerly called manic-depressive disorder. An alternation between depression and mania signals bipolar disorder. Depressive Symptoms Manic Symptoms Gloomy Elation Withdrawn Euphoria Inability to make decisions Desire for action Tired Hyperactive Slowness of thought Multiple ideas

Bipolar Disorder Many great writers, poets, and composers suffered from bipolar disorder. During their manic phase creativity surged, but not during their depressed phase. Whitman Wolfe Clemens Hemingway George C. Beresford/ Hulton Getty Pictures Library Earl Theissen/ Hulton Getty Pictures Library The Granger Collection Bettmann/ Corbis

Bipolar Disorder Two Main Distinctions Bipolar I Disorder: Technically, this should mean Mania/Mixed + Depression Actually, this means Mania/Mixed ± Depression Bipolar II Disorder: Hypomania +/- Depression (No mania ever) It is distinguished from Major Depressive Disorder by the lifetime history of at last one Manic or Mixed Episode

Bipolar I Disorder OR OR Depressed and manic episodes One or more Major Depressive Episode Manic or Mixed Episode Manic or Mixed Episode OR

Bipolar II Disorder OR OR One or more hypomanic episode Depressed and hypomanic episodes OR Major Depressive Episode Hypomanic Episode Hypomanic Episode OR

Unipolar vs. Bipolar Disorder Elevated Mood Bipolar Depressed Mood Elevated Mood Unipolar Depressed Mood

Explaining Mood Disorders Since depression is so prevalent worldwide, investigators want to develop a theory of depression that will suggest ways to treat it. Lewinsohn et al., (1985, 1995) note that a theory of depression should explain the following: OBJECTIVE 13| Discuss the facts that an acceptable theory of depression must explain. Behavioral and cognitive changes Common causes of depression

Theory of Depression Gender differences

Theory of Depression Depressive episodes self-terminate. Depression is increasing, especially in the teens. Desiree Navarro/ Getty Images Post-partum depression

Mood Disorders The Etiology of Depression Depression often triggered by stress However, unlikely that stress alone causes depression Some people are more vulnerable to depression – biological vulnerability; developmental vulnerability

Biological Perspective Genetic Influences: Mood disorders run in families. The rate of depression is higher in identical (50%) than fraternal twins (20%). Linkage analysis and association studies link possible genes and dispositions for depression. OBJECTIVE 14| Summarize the contribution of the biological perspective to the study of depression, and discuss the link between suicide and depression. Jerry Irwin Photography

Neurotransmitters & Depression A reduction of norepinephrine and serotonin has been found in depression. Drugs that alleviate mania reduce norepinephrine. Pre-synaptic Neuron Serotonin Norepinephrine Post-synaptic Neuron

The Depressed Brain PET scans show that brain energy consumption rises and falls with manic and depressive episodes. Courtesy of Lewis Baxter an Michael E. Phelps, UCLA School of Medicine

Mood Disorders Freud noted similarities between grief and depression Psychological Views of Depression Psychodynamic Views Freud noted similarities between grief and depression Theorized that depression is grief (anger & sadness) turned against the self Actual or symbolic loss can trigger depression Attachment theorists have expanded the theory Childhood losses/separations create vulnerability to later depression

Mood Disorders Psychological Views of Depression Behavioral Views When people experience a decline in rewards – particularly social rewards – they can enter a downward spiral of decreasing rewards that leads to depression. Theoretical Problem: Does decline in rewards cause depression, or does depression cause decline in rewards?

Explanatory Style Explanatory style plays a major role in becoming depressed.

Mood Disorders Psychological Views of Depression Cognitive Views Depression is the result of ingrained, negative thought patterns. Two main theories: Beck’s “Explanatory Style” Seligman’s “learned helplessness”

Mood Disorders Negative Thinking Psychological Views of Depression Cognitive Views Negative Thinking Maladaptive attitudes often rooted in childhood E.g.: “If I make a mistake, I’m worthless” These attitudes develop into entrenched schemas Stress triggers negative schemas

Mood Disorders Psychological Views of Depression Cognitive Views Negative Thinking Controlled by these schemas, self, present & future perceived negatively Schemas lead to “automatic thoughts” that continuously confirm negative perceptions Schemas lead to “thinking errors” E.g.: “Nobody cares about me”

Mood Disorders Psychological Views of Depression Cognitive Views Negative Thinking Considerable research supports the link between depression and: Maladaptive attitudes; negative schemas; thinking errors; & automatic thoughts However, do cognitive patterns cause depression – or are they caused by it?

Systems Approach OBJECTIVE 15| Summarize the contribution of the social-cognitive perspective to the study of depression, and describe the events in the cycle of depression.

Depression Cycle Negative stressful events. Pessimistic explanatory style. Hopeless depressed state. These hamper the way the individual thinks and acts, fueling personal rejection.

Suicide The most severe form of behavioral response to depression is suicide. Each year some 1 million people commit suicide worldwide.

Suicide Risk Factors: Best predictor = Prior attempt Living alone, especially if divorced/separated Retired/unemployed Elderly Loss of a loved one Chronic illness Financial troubles Feelings of hopelessness Impulsivity Sexual identity difficulties

Suicide Who attempts? Who completes? Women: 3-4 times more likely to attempt suicide Men: 3-4 times more likely to complete suicide Ages 18-24: Peak age for attempting suicide Ages 65+: Peak age for completing suicide

Suicide Common Warning Signs Symptoms of depression Talking about death, disappearing, “ending it all”, etc., even just in passing Writing letters, saying last goodbyes Getting rid of personal effects, making a will Arranging for the care of pets, plants, etc. Extravagant spending

Suicide Prevention Crisis hotlines Call 911/ER Help the person regain ability to cope with immediate stressors Maintaining supportive contact with the person Help the person realize that their distress is impairing their judgment Help the person realize that the distress is not endless Broad based programs focused on high-risk groups Crisis hotlines Call 911/ER