Unit 11: Mental Illness and Therapies

1. 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.

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

3. Mood Disorders - Emotional disturbances that interfere with normal life functioning (Axis 1) Single Major Depressive Disorder Recurrent Bipolar II – no mania Bipolar I Bipolar disorders Depressive disorders Dysthymia

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. Mood Episodes Mixed Episode Mania Hypomania Normal Mood Depression

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

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

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

15. 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

16. 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

17. Blue Mood Dysthymic Disorder Major Depressive Disorder 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.

18. Major Depression vs. Dysthymia Recurrent Major Depressive Episodes Dysthymia

19. 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

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

21. 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

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

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

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

25. 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: • Behavioral and cognitive changes • Common causes of depression

26. Theory of Depression • Gender differences

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

28. 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

29. 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. Jerry Irwin Photography

30. 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

31. 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

32. Mood Disorders Psychological Views of Depression • 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 Psychodynamic Views

33. Mood Disorders Psychological Views of Depression • 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? Behavioral Views

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

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

36. Mood Disorders Psychological Views of Depression 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 Cognitive Views

37. Mood Disorders Psychological Views of Depression 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” Cognitive Views

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

39. Systems Approach

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

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

42. 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

43. 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

44. 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

45. Suicide • Prevention • 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