1. Chapter 6_Part 2 Psy 303 Abnormal Psych

2. 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

3. 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 % (Merikangas, 2007)

4. 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)

5. 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

6. 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

7. 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
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8. Suicide

9. 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

10. 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.

11. …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 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

12. 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 times (Harris & Barraclough, 1997)

13. 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

14. 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)

15. 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

16. 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)

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

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

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

20. 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.

21. 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)

22. 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

23. 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)

24. 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)