ABNORMAL PSYCHOLOGY SIXTEENTH EDITION James N Butcher Jill
ABNORMAL PSYCHOLOGY, SIXTEENTH EDITION James N. Butcher/ Jill M. Hooley/ Susan Mineka Chapter 7 Mood Disorders and Suicide © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
What Are Mood Disorders? Mood disorders (affective disorders) • Defining feature = abnormal mood • Extremes of emotion (affect) common to all MD: deep depression or soaring elation • Intense, persistent, and maladaptive disturbances • Other symptoms or co-occurring disorders may also be present © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
What Are Mood Disorders? Two key moods Mania Depression © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
What Are Mood Disorders? Unipolar depressive disorders Bipolar depressive disorders • Only depressive episodes • Manic and depressive episodes © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
The Prevalence of Mood Disorders Lifetime prevalence of unipolar depression is nearly 17% 12 -month prevalence rates are nearly 7% About twice as common in women than men Lifetime prevalence for bipolar disorder is near 1% © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
Unipolar Mood Disorders Mild, brief depression Can be normal and adaptive Sadness, hopelessness, and pessimism are common human experiences © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
Depressions That Are Not Mood Disorders When depression is not mood disorder Loss and grieving process Postpartum “blues” © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
Persistent Depressive Disorder (Dysthymic Disorder ) Mild to moderate version of depression • Lasts a long time. For diagnosis, symptoms must persist for at least 2 years (1 year in children) • Intermittent normal moods occur briefly • Lifetime prevalence of 2. 5 to 6% © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
Major Depressive Disorder Diagnostic criteria for major depressive disorder Person exhibits more symptoms than are required for dysthymia Symptoms are more persistent © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
Major Depressive Disorder Specifiers (p. 220) Major depressive episode with seasonal pattern Major depressive episode with melancholic features Severe major depressive episode with psychotic features Major depressive episode with atypical features Major depressive episode with catatonic features © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
Major Depressive Disorder Persistent major depressive disorder • Major depression does not remit for more than two years Seasonal affective disorder • Recurrent depressive episodes with a pattern © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
Causal Factors in Unipolar Mood Disorders Causal Factors Biological causal factors © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Psychological causal factors
Biological Causal Factors Hormones Heredity Biological factors Altered neurotransmitter activity © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
• Family studies and twin studies suggest a moderate genetic contribution • Altered neurotransmitter activity in several systems is clearly associated with major depression • The hormone cortisol also plays a role • Depression may be linked to low activity in the left anterior or prefrontal cortex © 2013 Pearson Education, Inc. All rights reserved.
Figure 7. 1: Number of Stressful Life Events vs. Probability of Major Depressive Episode © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
Biological Causal Factors Genes Serotonintransporter gene Three combinations © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Geneenvironment interaction research
• A specific gene that might be implicated in major depressive disorder is the serotonintransporter gene • This gene occurs in one of three combinations: • Two short alleles (ss) • Two long alleles (ll) • One of each (sl) • In 2003, Caspi and colleagues published a study in which they tested for a geneenvironment interaction involving this gene © 2013 Pearson Education, Inc. All rights reserved.
Caspi et al (2003) • Tested for the possibility of a geneenvironment interaction in NZ re: the 2 alleles (Fig 7. 1). If possessed the ss, then twice as likely to develop a major depressive episode following 4+ stressful life events in past 5 years as those who possessed the genotype with the ll alleles. Those with the sl alleles were intermediate © 2013 Pearson Education, Inc. All rights reserved.
Biological Causal Factors Sleep Circadian rhythms Disruptions © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Exposure to sunlight (seasonal)
Psychological Causal Factors Depression Stressful life events Risk-related vulnerability factors Neuroticism or negative affectivity Early adversity or parental loss © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
• Stressful life events are linked to depression • Diathesis-stress models propose that some people have vulnerability factors that may increase the risk for depression • Neuroticism or negative affectivity can predispose people to depression • Early adversity or parental loss can be a diathesis © 2013 Pearson Education, Inc. All rights reserved.
Theorists Psychological Causal Factors Freud: anger turned inward Behaviorists: conditioning Cognitive model: Beck’s model © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
Figure 7. 3: Beck’s Cognitive Model of Depression © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
Figure 7. 4: Negative Cognitive Triad © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
Theories Psychological Causal Factors Reformulated helplessness theory Hopelessness theory Excessive rumination © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
Reformulated Helplessness Theory • The reformulated helplessness theory proposes that a pessimistic attributional style is a diathesis for depression • The hopelessness theory proposes that a pessimistic attributional style and one or more negative life events will not produce depression unless one first experiences a state of hopelessness • Excessive rumination can be a diathesis © 2013 Pearson Education, Inc. All rights reserved.
Reformulated Helplessness Theory • 3 critical dimensions on which attributions are made: (1) internal/external, (2) global/specific, (3) stable/unstable. • Depressogenic/pessimistic attribution for a negative event is internal, stable, and a global one: If your boyfriend treats you badly then you conclude: “ it’s because and I am ugly and boring. ” © 2013 Pearson Education, Inc. All rights reserved.
Psychological Causal Factors Interpersonal effects Lack of social support or social skills Hostility and rejection from others Marital dissatisfaction © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
• Depression has significant interpersonal correlates: • Lack of social support or social skills can contribute to depression • Depression can elicit sympathy and care, but it can also elicit hostility and rejection from others • Depression and marital dissatisfaction correlate highly © 2013 Pearson Education, Inc. All rights reserved.
Bipolar Disorders Bipolar disorders • Distinguished from unipolar disorders by presence of manic or hypomanic symptoms © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
Cyclothymic Disorder Cyclical mood swings • Less severe than those of bipolar disorder • Symptoms present for at least 2 years • Lacking severe symptoms and psychotic features of bipolar disorder © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
Bipolar Disorders (I and II) Bipolar II disorder Bipolar I disorder • Includes at least one manic or mixed episode (includes both depressive and manic symptoms) • Includes hypomanic episodes but not full-blown manic or mixed episodes © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
Bipolar Disorders (I and II) Characteristics Occur equally in males and females Usually start in adolescence or young adulthood Average of onset is 18 to 22 years About three times as many days are depressed as manic/hypomanic © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
Figure 7. 6: The Manic-Depressive Spectrum © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
Causal Factors in Bipolar Disorder Causal factors Biological causal factors Psychological causal factors © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
Biological Causal Factors Heredity Norepinephrine, serotonin, and dopamine © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Abnormalities in transportation of ions across neural membrane
Bipolar Disorder (used to be known as manic-depressive) • There is a greater genetic contribution to bipolar disorder than to unipolar disorder • Norepinephrine, serotonin, and dopamine all appear to be involved in regulating our mood states • Bipolar patients may have abnormalities in the way ions are transported across the neural membranes © 2013 Pearson Education, Inc. All rights reserved.
Biological Causal Factors Cortisol levels Shifting patterns of blood flow to the left and right prefrontal cortex Other biological influences © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Disturbances in biological rhythms
Psychological Causal Factors Psychological causal factors Stressful life events Personality variables: neuroticism, Hi Ach Low social support Pessimistic attributional style © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
Sociocultural Factors Affecting Unipolar and Bipolar Disorders Symptoms of mood disorders • Can differ widely across cultures and demographic groups Prevalence of mood disorders • Also differs across cultures © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
Cross-Cultural Differences in Depressive Symptoms Examples • China and Japan • Other Asian beliefs © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
• In China and Japan, somatic and vegetative symptoms replace psychological symptoms such as guilt and suicidal ideation • May stem from Asian beliefs of the unity of body and mind, or stigma attached to mental illness © 2013 Pearson Education, Inc. All rights reserved.
Cross-Cultural Differences in Prevalence Rates of depression vary more than rates of bipolar disorder Lifetime prevalence of depression is 17 -19% in the U. S. , but only 1. 5% in Taiwan Reasons for different rates of depression are not yet clear © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
Figure 7. 7: Prevalence Rates for Depression across Several Nations © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
Demographic Differences in the United States Native Americans have relatively high rates of depression African-Americans have relatively low rates U. S. rates of unipolar depression inversely related to socioeconomic status. Mood disord. appear relatively common in artists © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
Figure 7. 8: Rates of Mood Disorders in Writers and Artists © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
Treatments and Outcomes Pharmacotherapy Alternative biological treatments Psychotherapy © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
Pharmacotherapy Antidepressants, moodstabilizing, antipsychotic drugs, SSRIs used to treat mood disorders (require weeks to take effect) Lithium common mood stabilizer for bipolar © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
Alternative Biological Treatments Electroconvulsive therapy Transcranial magnetic stimulation Deep brain stimulation Bright light therapy © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
Psychotherapy Forms of effective psychotherapy • Cognitive-behavioral therapy • Behavioral activation treatment • Interpersonal therapy • Family and marital therapy © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
Suicide risk significant factor in all types of depression Suicide ranks among the top ten leading causes of death © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
The Clinical Picture and the Causal Pattern Who Attempts and Who Commits Suicide? Suicide in Children Suicide in Adolescents and Young Adults Other Psychosocial Factors Associated with Suicide Biological Causal Factors Sociocultural Factors © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
Who Attempts and Who Commits Suicide? Suicide attempts and age Gender differences Completed suicides and age © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
• Suicide attempts are most common in people between 18 and 25 years old • Completed suicides are most common in the elderly (65 and older) • Women are more likely to attempt suicide, but men are more likely to complete suicide © 2013 Pearson Education, Inc. All rights reserved.
Suicide in Children Multiple risk factors: loss of parent, abuse, depression, antisocial behavior, and high impulsivity Rates very low but increasing Suicide in children age 10 -14 has increased by 70% since 1981 © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
Suicide in Adolescents and Young Adults (15 -24) Rates tripled between the mid-1950 s and mid-1980 s Multiple risk factors: mood disorders, conduct disorder, and substance abuse © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
Other Psychosocial Factors Associated with Suicide Impulsivity Aggression Psychosocial factors Pessimism Family psychopathology or instability Genetics Sociocultural factors © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
Biological Causal Factors Genetics © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Reduced serotonergic activity
Sociocultural Factors Ethnicity • Whites have higher rates of suicide than African Americans © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Rates of suicide • Vary across cultures and religions
Figure 7. 10: U. S. Suicide Rates by Age, Gender, and Racial Group © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
Suicidal Ambivalence Some people do not wish to die but instead want to communicate Actions arranged so that intervention by others is likely © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Methods are nonlethal
Communication of Suicidal Intent True or false? Research has clearly proved that those who threaten to take their lives seldom do so. © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
• False • Interviews with family and friends indicate that 40% of people who committed suicide specifically indicated suicidal intent • Another 30% had talked about death or dying in preceding weeks or months © 2013 Pearson Education, Inc. All rights reserved.
Suicide Notes Only 15 -25% of completed suicides leave notes Others include very hostile content © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Some notes include statement of love and concern
Suicide Prevention and Intervention Treatment of person’s current mental disorder(s) Current preventive efforts Crisis intervention Working with high -risk groups © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
Treatment of Mental Disorders Antidepressant medication or lithium Prevention of suicide can take the form of treatment of the underlying mental disorder(s) Benzodiazepines Cognitive-behavioral therapy © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
Crisis Intervention Examples Hotlines Primary objective Hotline efficacy Intervention © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
• Suicide hotlines have expanded since 1960 s • Good information about the effects of these hotlines is not available © 2013 Pearson Education, Inc. All rights reserved.
Unresolved Issues Is there a right to die? Not all societies agree that others should interfere with suicide Challenging ethical and legal questions remain © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.
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