Download - Chapter 8
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Chapter 8
Mood Disorders
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Slide 2
Mood Disorders
Two key emotions on a continuum:
• Depression
• Low, sad state in which life seems dark and overwhelming
• Mania
• State of breathless euphoria and frenzied energy
Depression Mania
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Slide 3
Mood Disorders
Most people with a mood disorder experience only depression
• This pattern is called unipolar depression
• Person has no history of mania
• Mood returns to normal when depression lifts
Some people experience periods of depression that alternate with periods of mania
• This pattern is called bipolar disorder
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Slide 4
Mood Disorders
These disorders have always captured people’s interest
• Millions of people have mood disorders
• Economic costs of mood disorders amount to more than $40 billion each year
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Slide 5
Unipolar Depression
The term “depression” is often used to describe general sadness or unhappiness
• This usage confuses a normal mood swing with a clinical syndrome
Clinical depression can bring severe and long-lasting psychological pain that may intensify over time
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Slide 6
How Common Is Unipolar Depression?
5 to 10% of the U.S. population experiences severe unipolar depression each year
• An additional 3 to 5% experience mild depression
~17% of the world population experiences unipolar depression at some time in their lives
• Rates have been steadily increasing since 1915
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Slide 7
How Common Is Unipolar Depression?
In almost all countries, women are twice as likely as men to experience severe unipolar depression
• Lifetime prevalence: 26% of women vs. 12% of men
These rates hold true across socioeconomic classes and ethnic groups
~50% recover within six weeks, some without treatment
• Most will experience another episode at some point
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Slide 8
What Are the Symptoms of Depression?
Symptoms may differ dramatically from person to person
Five main areas of functioning may be affected:
• Emotional symptoms
• feeling “miserable,” “empty,” “humiliated”
• Motivational symptoms
• lack drive, initiative, spontaneity
• 6 to 15% of those with severe depression commit suicide
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Slide 9
What Are the Symptoms of Unipolar Depression?
Five main areas of functioning may be affected:
• Behavioral symptoms
• less active, less productive
• Cognitive symptoms
• hold negative opinion of themselves
• blame themselves for unfortunate events
• Physical symptoms
• headaches, dizzy spells, general pain
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Slide 10
Diagnosing Unipolar Depression
Criteria 1: Major depressive episode
• Marked by five or more symptoms lasting two or more weeks
• In extreme cases, symptoms are psychotic, including
• Hallucinations
• Delusions
Criteria 2: No history of mania
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Slide 11
Diagnosing Unipolar Depression
Two diagnoses to consider:
• Major depressive disorder
• Criteria 1 and 2 are met
• Dysthymic disorder
• Symptoms are “mild but chronic”
• Experience longer-lasting but less disabling depression
• Consistent symptoms for at least two years
• When dysthymic disorder leads to major depressive disorder, the sequence is called “double depression”
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Slide 12
What Causes Unipolar Depression?
Stress may be a trigger for depression
• People with depression experience a greater number of stressful life events during the month just prior to the onset of their symptoms
• Some clinicians distinguish reactive (exogenous) depression from endogenous depression, which seems to be a response to internal factors
• The utility of this distinction is questionable
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Slide 13
What Causes Unipolar Depression?The Biological View
Genetic factors
• Family pedigree, twin, and adoption studies suggest that some people inherit a biological predisposition
• Relatives of those with depression have higher rates of depression compared with members of the general population
• Twin studies demonstrate a strong genetic component:
• Rates for identical (MZ) twins = 46%
• Rates for fraternal (DZ) twins = 20%
• Adoption studies have also implicated a genetic factor in cases of severe unipolar depression
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Slide 14
What Causes Unipolar Depression?The Biological View
Biochemical factors
• NTs: serotonin and norepinephrine
• In the 1950s, medications for high blood pressure were found to increase depression
• Some lowered serotonin, others lowered norepinephrine
• Led to “discovery” of effective antidepressant medications
• It is likely not just one NT or the other – a complex interaction is at work
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Slide 15
What Causes Unipolar Depression?The Psychological Views
Three main models:
• Psychodynamic model
• Not strongly supported by research
• Behavioral model
• Modestly supported by research
• Cognitive model
• Has considerable research support
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Slide 16
What Causes Unipolar Depression?The Psychological Views
Cognitive views
• Two main theories:
• Negative thinking
• Learned helplessness
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Slide 17
What Causes Unipolar Depression?The Psychological Views
Cognitive views
• Negative thinking
• Beck theorizes four interrelated cognitive components of depression:
1. Maladaptive attitudes
• Self-defeating attitudes are developed during childhood
• Beck suggests that upsetting situations later in life can trigger further rounds of negative thinking
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Slide 18
What Causes Unipolar Depression?The Psychological Views
Cognitive views
• Negative thinking often takes three forms
1. This is called the cognitive triad:
• Individuals repeatedly interpret (1) their experiences, (2) themselves, and (3) their futures in negative ways, leading to depression
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Slide 19
What Causes Unipolar Depression?The Psychological Views
Cognitive views• Strengths:
• There is significant research support for Beck’s model:
• High correlation between the level of depression and the number of maladaptive attitudes held
• Both the cognitive triad and errors in logic are seen in people with depression
• Automatic thinking has been linked to depression
• Limitations:• Research fails to show that such cognitive patterns are the cause
and core of unipolar depression
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Slide 20
What Causes Unipolar Depression?The Psychological Views
Cognitive views
• Learned helplessness • Theory is based on Seligman’s work with laboratory
dogs• Dogs subjected to uncontrollable shock were later placed in a
shuttle box
• Even when presented with an opportunity to escape, dogs that had experienced uncontrollable shocks made no attempt to do so
• Seligman theorized that the dogs had “learned” to be “helpless” and drew parallels to human depression
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Slide 21
What Causes Unipolar Depression?The Sociocultural View
How do gender and race relate to depression?• Rates of depression are much higher among women than men
• One sociocultural theory holds that the complexity of women’s roles in society leaves them particularly prone to depression (see Box 8-4)
• Few differences have been seen among Caucasians, African Americans, and Hispanic Americans, but striking differences exist in specific subcultures:
• In a study of one Native American village, lifetime risk was 37% among women, 19% among men, and 28% overall
• These findings are thought to be the result of economic and social pressures
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Slide 22
Bipolar Disorders
People with a bipolar disorder experience both the lows of depression and the highs of mania
• They describe their life as an emotional roller coaster
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Slide 23
What Are the Symptoms of Mania?
Five main areas of functioning may be affected:
• Behavioral symptoms
• very active – move quickly; talk loudly or rapidly
• Key word: flamboyance!
• Cognitive symptoms
• show poor judgement or planning
• Especially prone to poor (or no) planning
• Physical symptoms
• high energy level – often in the presence of little or no rest
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Slide 24
Diagnosing Bipolar Disorders
Two kinds of bipolar disorder:
• Bipolar I disorder
• Full manic and major depressive episodes
• Most sufferers experience an alternation of episodes
• Some experience mixed episodes
• Bipolar II disorder
• Hypomanic episodes and major depressive episodes
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Slide 25
Diagnosing Bipolar Disorders
Between 1 and 1.5% of adults in the world suffer from a bipolar disorder at any given time
The disorders are equally common in women and men
• Women may experience more depressive and fewer manic episodes than men
• Rapid cycling is more common in women
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Slide 26
What Causes Bipolar Disorders?
Neurotransmitters (NTs)
• This apparent contradiction is addressed by the “permissive theory” about mood disorders:
• Low serotonin may “open the door” to a mood disorder and permit norepinephrine activity to define the particular form the disorder will take:
• Low serotonin + Low norepinephrine = Depression
• Low serotonin + High norepinephrine = Mania
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Slide 27
What Causes Bipolar Disorders?
Genetic factors• Many experts believe that people inherit a biological predisposition to
develop bipolar disorders
• Findings from family pedigree studies support this theory; when one twin or sibling has bipolar disorder, the likelihood for the other twin or sibling increases:
• Identical (MZ) twins = 40% likelihood
• Fraternal (DZ) twins and siblings = 5 to 10% likelihood
• General population = 1% likelihood
• Recently, genetic linkage studies have examined the possibility of “faulty” genes
• Other researchers are using techniques from molecular biology to further examine genetic patterns