Major Depression – Module 46Major Depression – Module 46Bipolar Disorder – Module 46Bipolar Disorder – Module 46Phobias – Module 44Phobias – Module 44

General Psych 2

Class #28May 6, 2004

Depression: The "common cold" Depression: The "common cold" of mental health problemsof mental health problems An extreme condition persisting for most of each day

for a period of months or longer Lifetime prevalence rates ranging from 12-17% with

about 5-10% of the general population right now (over 19M in U.S.)

Sex difference: F > M (women are at least twice as likely to suffer from depression as men and this is has been the case for about 40 years)

Prevalence is unrelated to ethnicity, education, income, or marital status

The highest rates for this disorder are in the 25-44 year-old age group

SymptomsSymptoms

(1) Cognitive Negative beliefs about oneself (feelings of

worthlessness) Preoccupation with death and suicide Low motivation (loss of interest in anything – and

no point in trying anyway) Impaired thinking – problems solving intellectual

and social problems especially those involving memory (this problem doesn't seem to be because of the low motivation)

SymptomsSymptoms

(2) MotorPsychomotor retardation – appears to be a

slowdown in physical activity (they may just want to stay in bed; weight of the world on their shoulders, lethargy, etc.)

Psychomotor agitation – hyperactive fidgeting or pacing

SymptomsSymptoms

(3) Physical Disturbed sleep (insomnia and hypersomnia) Disturbed eating patterns (poor appetite and

significant Weight loss and in less often cases the opposite

can occur) Decreased sexual drive (in rare cases

hypersexuality) Increased physical illnesses (immune system

declines)

Onset and DurationOnset and Duration

Onset– Average age at onset is 25, but this disorder may

begin at any age– Psychological stress appears to play a prominent

role in triggering the first 1-2 episodes of this disorder, but not in subsequent episodes

Duration – An average episode lasts about 9 months to one

year – The risk of recurrence is about 70% at 5 year

follow up and at least 80% at 8 year follow-up

What triggers depression?What triggers depression?

Cognitive Explanation– Incorrect Negative Beliefs– Learned Helplessness

What triggers depression?What triggers depression?

Physiological psychologists are not exactly sure but several important factors have been identified…– Physiological Explanations

(1) Low levels of brain activity (2) Structural problems

  (3) Familial Pattern And Genetics (4) Prenatal illness (5) Low levels of neurotransmitters

What triggers depression?What triggers depression? Low levels of brain activityLow levels of brain activityThese parts of the brain of depressed

individuals are underactive:– Left prefrontal cortext – an area responsible for

much of our thinking…where we decide what to do and feel.

– Cingulate Gyrus – reduced flow of information between parts of our brain

– Basal Ganglia – plays a role in motor activity

What triggers depression?What triggers depression? Structural problemsStructural problems

Left prefrontal cortex is smaller – May account for it being less active and

slowed thinking and difficulty in problem solving as well

What triggers depression? What triggers depression? Familial Pattern And GeneticsFamilial Pattern And Genetics

There is strong evidence that major depression is, in part, a genetic disorder: – Individuals who have parents or siblings with Major

Depressive Disorder have a 1.5-3 times higher risk of developing this disorder • The concordance for major depression in

monozygotic twins is substantially higher than it is in dizygotic twins

• However, the concordance in monozygotic twins is in the order of about 50%, suggesting that factors other than genetic factors are also involved

What triggers depression? What triggers depression? Familial Pattern And GeneticsFamilial Pattern And Genetics Children adopted away at birth from biological

parents who have a depressive illness carry the same high risk as a child not adopted away, even if they are raised in a family where no depressive illness exists

Researchers suspect that there is a genetic connection, but to date, no "depressive gene" has been discovered

What triggers depression? What triggers depression? Low levels of neurotransmittersLow levels of neurotransmitters Unusually low levels of serotonin,

epinephrine and norepinephrine

Drug treatmentDrug treatment Antidepressant drugs attempt to elevate low levels of

neurotransmitters in the brain All antidepressants are equally effective in that they

elevate mood in 60%-80% of people They take at least 2-3 weeks to start showing subtle

improvements and up to 4-6 weeks to feel the full effect

Common drugs such as Prozac, Zoloft, Paxil, Celexa act to inhibit the reuptake of serotonin and norepinephrine thus increasing their availability in the brain

These are safe, non-addicting drugs and not found to be fatal in overdose

But don't stop taking them abruptly – you may experience a variety of flu-like symptoms – taper off slowly

How long?How long?

1st episode: 6-12 months or so2nd episode: 1-2 years3rd episode: likely for life

Side-EffectsSide-Effects

Include several sexual side effects for both men and women, sleep disruptions, headaches, excessive sweating, nausea, upset stomach, diarrhea, drowsiness, tremor, sometimes a decrease in weight and in lesser cases weight gains, occasionally will cause an over sensitivity to sunlight

• Good news – these all usually will subside after a few weeks

• Bad news – high relapse rates: drugs are a treatment for depression but not a cure

Bipolar DisorderBipolar Disorder

Formerly referred to as manic-depression disorder

Prevalence: About 1% Onset: Usually begins between 15-25 No sex difference These people alternate between depression

and mania – manic phase is usually somewhat shorter– Like slow motion vs. fast-forward

Manic PhaseManic Phase

Symptoms– Cognitive symptoms

• Inflated self-esteem• Grandiosity – unrealistic optimism and delusions of

grandeur• Distractibility• Manic flight of ideas• Delusions• Over-talkative with loud speech, sometimes hard to

interrupt• Easily irritated if crossed• Over-involvement in activities• No or few sexual inhibitions• Increased thought processes

Manic PhaseManic Phase

Motor Symptoms– Constant running from one thing to another

Physical Symptoms– High energy– Little need for sleep

Important Note…Important Note…

Individuals experiencing mania need to be protected from the consequences of their own poor judgments…– Often, they will go on reckless spending

sprees or partake in extremely risky investments

– Poor self-control• But, be prepared…they will be irritated by

those providing advice

One PositiveOne Positive

The energy and free-floating thinking characteristic of mania can fuel creativity

Unusually high rate of bipolar disorder among poets, artists, and creative writers

Bipolar DisorderBipolar Disorder

Treatments– Mood stabilizers such as:

• Lithium• Depokote

Phobic DisordersPhobic Disorders

Fear has no justification in realityFear is greater than is justifiedIndividual is aware of irrationality of fear

Phobic DisordersPhobic Disorders

Social phobiaAgoraphobiaSpecific phobias

What is Social Phobia?What is Social Phobia?

Irrational fear that they will behave in an embarrassing way

Is limited to situations in which the scrutiny of others is likely

Extreme form of shyness that interferes significantly with an individual’s functioning

These individuals avoid all social situations Recent study says over 13% of general

population but other studies say its about 4% Sex difference: Slightly more women than men Average onset: early adolescence

SymptomsSymptoms

Avoidance of all social situationsHigh anxiety if ever placed in a social

situationRapid heart rateElevated blood pressureHistory of phobia

What causes social phobia?What causes social phobia?

Basically unknown but…

– Possible biological reasons: scarcity of serotonin

– Possible environmental factors…

Agoraphobia Agoraphobia “fear of the marketplace”“fear of the marketplace”

These people suffer from intense anxiety when in a place where escape would be difficult or embarrassing if they were to experience a panic attack

Fear being in a place where they can’t get help

In extreme cases, they may not leave their house

AgoraphobiaAgoraphobia

Key points: – They do not fear people per se, but rather

they fear being around people because they believe something will happen that they can’t control and will cause them embarrassment (for example: a panic attack)

– They are very good at concealing their problem

Prevalence and OnsetPrevalence and Onset

Prevalence– Estimated 5%-12% of general population will suffer

from agoraphobia Sex difference:

– Women 7% – Men 3.5%

Onset: Usually occurs in their 20’s

Possible CausesPossible Causes

Unknown– Over the years there have been many

theories about the cause of agoraphobia ranging from inner ear dysfunction, genetic predisposition, social learning – observing the anxious behavior of a parents, chemical imbalances, etc.

TreatmentsTreatments

Usually a medication and psychotherapy combo

Commonly anti-depressants and anti-anxiety meds are used: – Prozac, Paxil, Zoloft, Elavil, etc.– Xanax, Klonipin, etc.

Cognitive-Behavioral TreatmentCognitive-Behavioral Treatment

Most common treatment is systematic desensitization…– Breathing and relaxation techniques are

sometimes used in conjunction with systematic desensitization

PrognosisPrognosis

Very good – 90% improve

Specific PhobiasSpecific Phobias

DSM-IV classifies all other phobias (besides social phobia and agoraphobia) as “specific phobias”

We’re talking about specific objects or situations here Sex difference:

– Women 16% – Men 7%

Associated features: depressed mood and dependent personality

Exposure to the phobic stimulus may lead to a panic attack

As with other phobias, the person recognizes that the fear is excessive and unreasonable