1. 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= Blue is R= 0 G=110 B=184
Border Grey is R=74 G=69 B=64

2. I. Depressive Disorders
Psychological disorders characterized by extremely sad mood and lack of energy that disrupts the person’s normal ability to function in daily life

3. 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
Being lethargic

4. 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

5. Persistent Depressive Disorder
This used to be called Dysthmia!
A. Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years. Note: In children and adolescents, mood can be irritable and duration must be at least 1 year.

6. Major Depression vs. Dysthymia
Recurrent
Major
Depressive
Episodes
Persistent Depressive Disorder

7. Premenstrual dysphoric disorder (PMDD)
It causes emotional and physical symptoms, like PMS, but women with PMDD find their symptoms debilitating, and they often interfere with their daily lives, including work, school, social life, and relationships.
Occurs during menstrual bleeding
Fatigue or low energy
Suicidal thoughts
Binge eating
Headaches or muscle pain
Persisitent irritability
8 percent of women
No known cause. But when ovaries are removed symptoms go away.

8. II. Bipolar Disorder Manic episode Hypomanic episode
Depressive episode

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. Mood Episodes
Mixed Episode
Mania
Hypomania
Normal Mood
Depression

16. 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

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

18. 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

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

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

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

22. 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

23. Theory of Depression
Gender differences

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

25. 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
Relationship between anxiety and depression

26. 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

27. 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

28. 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

29. 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

30. 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?

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

32. 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”

33. 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

34. 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”

35. 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?

36. 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.

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

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

39. 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

40. 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

41. 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

42. 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