Abnormal Psych Chapter 6 Flashcards
Mood disorder
Involves persistent feelings of sadness or periods of feeling overly happy or fluctuations from extreme sadness to extreme happiness
Unipolar depression
Experience only depression
Bipolar disorder
Cycle between periods of depression and periods of mania
Reactive (exogenous) depression
Response to external stressors
Endogenous depression
Arises independent of external stressors
Unipolar depression symptoms
Emotional Symptoms:
*Sadness
*Anhedonia
Physiological/Behavioral Symptoms:
*Sleep disturbances
*Psychomotor retardation
*Fatigue and loss of energy
*Catatonia
Cognitive Symptoms:
*Poor concentration
*Difficulty making decisions
*Feelings of being worthless, hopeless
*Delusions and hallucinations with depressing themes
*Suicidal thoughts
How common is depression?
17% of Americans experience an acute episode at some point in their life
6% experience more chronic depression
What age group has the highest levels of depression? Lowest?
Highest: 15-21
Lowest: 55-70
Gender distribution of depression
Women are about twice as likely as men to experience depressive symptoms
What are the two categories of unipolar depression?
Major Depressive Disorder:
*5 or more symptoms including sadness or loss of interest, lasting at least two weeks
Persistent Depressive Disorder (chronic):
*With major depressive episodes
*With dysthymic syndrome
Manic symptoms of bipolar disorder
Emotional symptoms:
-Elation
-Irritability and agitation
Physiological symptoms:
-More talkative than usual
-Decreased need for sleep
-Increase of activity towards achieving goals
-Impulsive behaviors
Cognitive Symptoms:
-Inflated self-esteem, grandiosity
-Hallucinations
-Racing thoughts
-Distractibility
How common is bipolar disorder?
About 1 in 100 will experience at least one episode of bipolar disorder in their life
Gender distripution of BPD
Men and women seem to be equally likely to develop the disorder
Two categories of bipolar disorder
Bipolar I Disorder:
*elevated mood for at least one week
*plus 3 other symptoms
*depressive episodes can be mild or infrequent
Bipolar II Disorder
*milder episodes of mania (hypomania)
*fit criteria for Major Depression
Large scale brain networks in depression
Increased default mode network activity
Stronger connectivity between nodes of default mode network (long range connectivity)
Stronger connectivity within each node of the default mode network (short range connectivity)
The central executive network has less of an ability to downregulate default mode network
Default mode network
Active when a person is not focused on the outside world and the brain is at wakeful rest, such as during daydreaming and mind-wandering
Bipolar disorder in twins
72% concordance for identical twins, 14% for fraternal twins
Brain abnormalities in depression
Reduced metabolic activity in left prefrontal cortex (goal orientation and motivation), but not right side
Possible over- and under-activity in different emotion centers (e.g. amygdala)
Brain circuit responsible for unipolar depression emerging – prefrontal cortex, hippocampus, amygdala, cingulate cortex
Drug treatments for unipolar depression
Tricyclic Antidepressants e.g. Elavil:
*side effects
*fatal in overdose
*Monoamine Oxidase Inhibitors (MAOIs) e.g. Nardil:
*dietary restrictions to avoid fatal rise in blood pressure from foods containing tyramine
*interactions with drugs, even over-the-counter
*other side effects
Selective Serotonin Reuptake Inhibitors (SSRIs):
*e.g. Prozac, Zoloft, Paxil
Drug treatments for bipolar disorder
Lithium – mood stabilizer
Anticonvulsants
Antipsychotics
Calcium Channel Blockers
Electroconvulsive therapy
Electric current stimulates brief convulsion in temporal lobe of cortex
Used for intractable depression, very rarely for other conditions
Current practice to stimulate only one (usually right) lobe, with lower current and sedation
What are some other biological treatments for depression, other than electroconvulsive therapy?
Repetitive transcranial magnetic stimulation and vagus nerve stimulation, light therapy (for seasonal depression)
Behavioral theories of mood disorders
Reduced Positive Reinforcers:
*Life stress creates a reduction in positive reinforcers leading to withdrawal
Learned Helplessness
Cognitive theories of mood disorders
Beck’s negative cognitive triad theory:
*Negative views of self, world & future
Causal Attributions:
*Internal, stable & global = blame self for negative events
Ruminative Response style
Psychodynamic theories of mood disorders
Depression develops when a person perceives he or she has been abandoned or has failed
Freud’s theory of Introjected hostility
Therapeutic technique: Transference
Psychological treatments for depression
Behavior Therapy:
*Functional analysis:
*Change aspect of environment
*Teach skills to change person’s negative circumstances
*Teach mood-management skills
Cognitive Behavior Therapy:
*Change negative patterns of thinking
*Teach skills so no longer have deficits in reinforcers
Interpersonal Theory
Concerned with people’s close relationships and roles in relationships:
*Contingencies of self-worth
Interpersonal Therapy:
*Grief and loss
*Interpersonal role disputes
*Role transitions
*Interpersonal skill deficits
What percent of adults in the US suffer from a severe unipolar pattern of depression in any given year?
8%
What percent of adults in the US suffer from a mild unipolar pattern of depression in any given year?
5%
What percent of all adults in the US experience an episode of severe unipolar depression at some point in their lives?
20%
What percent of women vs men have an episode of depression at some point in their lives?
26% of women
12% of men
Anhedonia
Inability to experience any pleasure at all
Major depressive episode
Period of two or more weeks marked by at least 5 symptoms of depression, including sad mood and/or loss of pleasure
Major depressive disorder
A severe pattern of depression that is disabling and not caused by such factors as drug or a general medical condition
Seasonal depression
Changes with the seasons
Catatonic depression
Marked by either immobility or excessive activity
Peripartum depression
Occurs during pregnancy or within 4 weeks of giving birth
Melancholic depression
The person is almost totally unaffected by pleasurable events
Persistent depressive disorder
A chronic form of unipolar depression marked by ongoing and repeated symptoms of either major or mild depression
Premenstrual dysphoric disorder
A disorder marked by repeated episodes of significant depression and related symptoms during the week before menstruation
Disruptive mood dysregulation disorder
Characterized by a combination of persistent depressive symptoms and recurrent outbursts of severe temper
Family pedigree studies
Select people with unipolar depression, examine their relatives, and see whether depression also afflicts other members of the family
As many as 30% of those relatives are depressed, compared with fewer than 10% of the general population
Twin studies
When an identical twin has unipolar depression, there is a 38% chance that the other twin has already had or will eventually have the same disorder
When a fraternal twin has unipolar depression, the other twin has only a 20% chance of having the disorder
What fraction of genes have researchers found evidence that unipolar depression is tied to?
Genes on at least 2/3 of the body’s 23 chromosomes
Low activity of which neurotransmitters has been linked to depression?
Norepinephrine and serotonin
What does research indicate that depression is linked to biologically?
Interactions between serotonin and norepinephrine activity, or between them and additional key neurotransmitters, particularly glutamate, a neurotransmitter responsible for stimulating neurons and promoting connectivity and communication among neurons
Relationship between hormones and depression
The HPA axis of people with depression is overly reactive in the face of stress, causing excessive releases of cortisol and related hormones at times of stress
Depression-related brain circuit
Prefrontal cortex, hippocampus, amygdala, and subgenual cingulate (aka Brodmann Area 25)
How does the depression-related brain circuit act in those with depression?
Activity and blood flow are unusually low in certain parts and unusually high in other parts of the prefrontal cortex
The hippocampus is undersized and its production of new neurons is low
Activity and blood flow are high in the amygdala
The subgenual cingulate is particularly small and active
The communication, or interconnectivity, between these various structures is often problematic
Serotonin and norepinephrine is distinctly low
Immune system and depression
When people are under intense stress for a while, their immune systems may become dysregulated, leading to slower functioning of important white blood cells called lymphocytes and to increased production of pro-inflammatory cytokines, proteins that spread throughout the body and cause inflammation and various illnesses
There is a belief amongst researchers that immune system dysregulation of this kind helps produce depression
Drugs available to reduce the symptoms of depression
Monoamine oxidase (MAO) inhibitors
Tricyclics
Second-generation antidepressants
Ketamine-based drugs
MAO inhibitors
Slow the body’s production of monoamine oxidase (MAO), increasing the activity level of serotonin and norepinephrine
Tricyclics
Have a three-ring molecular structure
Act on the neurotransmitter reuptake mechanisms of key neurons-inhibit the overly vigorous reuptake processes of depressed individuals, thus allowing serotonin and norepinephrine to remain in their synapses longer and to, in turn, properly stimulate receiving neurons
Second-generation antidepressants
Most are selective serotonin reuptake inhibitors (SSRIs) increases serotonin activity specifically, without affecting norepinephrine or other neurotransmitters
Ketamine-based drugs
Increase the activity of the neurotransmitter glutamate in the brain
Brain stimulation
interventions that directly or indirectly stimulate certain areas of the brain
Electroconvulsive therapy (ECT)
A biological treatment in which a brain seizure is triggered when an electric current passes through electrodes attached to the patient’s forehead
65 to 140 volts of electricity are passed through the brain for half a second or less, resulting in a brain seizure that lasts from 15 to 70 seconds
Vagus nerve
The longest nerve in the human body
Runs from the brain stem through the neck down the chest and on to the abdomen
Vagus nerve stimulation
A treatment for depression in which an implanted pulse generator sends regular electrical signals to a person’s vagus nerve; the nerve then stimulates the brain
Surgeon implants a pulse generator under the skin of the chest, then guides a wire from the pulse generator up to the neck and attaches it to the vagus nerve
Electrical signals travel from the pulse generator through the wire to the vagus nerve
The stimulated vagus nerve then delivers electrical signals to the brain
Transcranial magnetic stimulation (TMS)
Clinician places an electromagnetic coil on or above the patient’s head
The coil sends a current into the prefrontal cortex
TMS increases neuron activity in that structure and may improve functioning throughout the rest of the brain’s depression-related circuit
Deep brain stimulation (DBS)
Drill two tiny holes into the patient’s skull and implant electrodes in the subgenual cingulate
The electrodes are connected to a battery (pacemaker) implanted in the patient’s chest (men) or stomach (women)
Pacemaker powers electrodes, sending a steady stream of low-voltage electricity to the brain structure
This repeated stimulation should reduce activity in the structure to a normal level and help “recalibrate” the depression-related brain circuit
Symbolic (imagined) loss
A person equates other kinds of events with the loss of a loved one
What series of unconscious processes is set in motion when a loved one dies?
Mourners at first regress to the oral stage of development, when infants can’t distinguish themselves from their parents - the mourners merge their own identity with that of the person they have lost, and so symbolically regain the lost person
They direct all their feelings for the loved one, including sadness and anger, toward themselves (introjection)
Object relations theorists theory of depression
Depression results when people’s relationships-especially their early relationships-leave them feeling unsafe, insecure, and dependent on others
What are the psychodynamic treatments for unipolar depression?
Psychodynamic therapists seek to help clients bring underlying issues to consciousness and work them through
They encourage the depressed client to associate freely during therapy, suggest interpretations or the client’s associations, dreams, and displays of resistance and transference, and help the person review past events and feelings
What features of the psychodynamic approach to treating depression may limit its effectiveness?
One, depressed clients may be too passive and feel too weary to join fully in the subtle therapy discussions
Two, they may become discouraged and end treatment too early when this long-term approach is unable to provide the quick relief that they desperately seek
Behavioral dimension of depression
Depression linked to significant changes in the number of rewards and punishments people receive in their lives
Beck’s view of depression
Maladaptive attitudes, a cognitive triad, errors in thinking, and automatic thoughts combine to produce unipolar depression
Beck’s cognitive triad
Individuals repeatedly interpret their experiences, themselves, and their futures in negative ways that lead them to feel depressed
Errors in thinking in depression
Draw negative conclusions based on little evidence
Automatic thoughts in depression
A steady train of unpleasant thoughts that keep suggesting to them that they are inadequate and their situation is hopeless
Ruminative responses
Repeatedly dwelling mentally on their mood without acting to change it
Learned helplessness theory of depression
People become depressed when they think that:
1) They no longer have control over the reinforcements in their lives
2) They themselves are responsible for this helpless state
Attribution-helplessness theory
When people view events as beyond their control, they ask themselves why this is so
If they attribute their present lack of control to some internal cause that is both global and stable, they may feel helpless to prevent future negative outcomes and they may experience depression
Behavioral activation
Therapists work systematically to increase the number of constructive and rewarding activities and events in a client’s life
The therapists:
1) Reintroduce depressed clients to pleasurable events and activities
2) Consistently reward nondepressive behaviors and withhold rewards for depressive behaviors
3) Help clients improve their social skills
Beck’s cognitive therapy
Phase 1: Increasing activities and elevating mood
Phase 2: Challenging automatic thoughts
Phase 3: Identifying negative thinking and biases
Phase 4: Changing primary attitudes
Interpersonal psychotherapy
Holds that any of four interpersonal problem areas may lead to depression and must be addressed: interpersonal loss (loss of a loved one), interpersonal role dispute (two people have different expectations of their relationship and the role each should play), interpersonal role transition (major life changes like divorce or birth), and interpersonal deficits (extreme shyness or social awkwardness)
Artifact theory
Holds that women and men are equally prone to depression but clinicians often fail to detect depression in men
Hormone explanation
Hormone changes trigger depression in many women, particularly during puberty, pregnancy, and menopause
Life stress theory
Suggests that women in our society are subjject to more stress than men
Body dissatisfaction explanation
States that females in western society are taught to seek a low body weight and slender body shape - goals that are unreasonable, unhealthy, and often unattainable
Lack of control theory
Proposes that women may be more prone to depression because they feel less control than men over their lives
Rumination theory
Women are more likely than men to ruminate when their mood darkens
Full manic episode
For at least one week, people display an abnormally high or irritable mood, increased activity or energy, and at least three other symptoms of mania
Hypomanic episode
Symptoms of mania are less severe (causing little impairment)
Bipolar I disorder
Full manic and major depressive episodes
Some experience an alternation of the episodes, some have mixed features
Bipolar II disorder
Hypomanic episodes alternate with major depressive episodes over the course of time
Rapid cycling
If a person has four or more episodes within a one-year period
What percent of all adults suffer from a bipolar disorder at any given time?
Between 1 and 2.8%
What percent of all adults experience one of the bipolar disorders at some point in their life?
4.4%
Cyclothymic disorder
Numerous periods of hypomanic symptoms and mild depressive symptoms
What percent of the population develops cyclothymic disorder
0.4%
What neurotransmitters have been found to have abnormal activity in some bipolar patients?
norepinephrine, serotonin, glutamate, and dopamine
What do ions do in the brain?
Play a critical role in relaying messages within a neuron
Ions help transmit messages down the neuron’s axon to the nerve endings
Sodium ions in the brain
When a neuron is at rest, more sodium ions sit outside the cell membrane
When the neuron receives an incoming message at its receptor sites, pores in the cell membrane open, allowing the sodium ions to flow to the inside of the membrane, thus increasing the positive charge inside the neuron
This starts a wave of electrical activity that travels down the length of the neuron and results in its “firing”
What do some studies suggest about ions in bipolar individuals?
Irregularities in the transport of ions may cause neurons to fire too easily (mania) or to stubbornly resist firing (depression)
Abnormal brain structures in people with bipolar disorders
The hippocampus, basal ganglia, and cerebellum tend to be smaller
Lower amounts of gray matter
Raphe nuclei, striatum, amygdala, and prefrontal cortex have some structural abnormalities
Twin studies of bipolar disorder
Identical twins of those with a bipolar disorder have a 40-70% likelihood of developing the same disorder
Fraternal twins, siblings, and other close relatives of such persons have a 5-10% likelihood
What have molecular biologists found about bipolar disorder?
It is linked to a variety of genes located on at least 13 different chromosomes
What was the breakthrough in treating BPD?
Lithium
Mood-stabilizing drugs
Psychotropic drugs that help stabilize the moods of people suffering from bipolar disorder
Prophylactic drugs
Drugs that help prevent symptoms from developing
What are some possibilities of how lithium and antiseizure drugs help people with BPD?
The drugs change synaptic activity by operating within neurons
Mood stabilizers affect a neuron’s second messengers
They also increase the production of a protein called brain-derived neurotrophic factor, whose job it is to prevent cell death
They could also improve the functioning of or communications between key structures in the brain
Adjunctive therapy
Clinicians provide individual, group, or family therapy as an adjunct to mood-stabilizing drugs
