Chapter 7 Handouts

Chapter 7 Handouts - Chapter 7 Handouts Chapter 7 Handouts...

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Unformatted text preview: Chapter 7 Handouts Chapter 7 Handouts Mood Disorders 0. Two key emotions on a continuum: 0. _________________________ 0. Low, sad state in which life seems dark and overwhelming 1. __________________________ 1. State of breathless euphoria or frenzied energy Unipolar Depression 1. The term “depression” is often used to describe general sadness or unhappiness 2. This usage confuses a normal mood swing with a clinical syndrome 2. Clinical depression can bring severe and long­lasting psychological pain that may intensify over time How Common Is Unipolar Depression? 3. About 7% of the U.S. population experiences severe unipolar depression each year 3. As many as 5% experience mild depression 4. The prevalence is similar in Canada, England, France, and many other countries 5. Approximately 17% of all adults experience unipolar depression at some time in their lives 4. Rates have been steadily increasing since 1915 How Common Is Unipolar Depression? 5. In almost all countries, women are _______ as likely as men to experience severe unipolar depression 2. Lifetime prevalence: 26% of women vs. 12% of men 6. These rates hold true across socioeconomic classes and ethnic groups 7. Approximately 50% recover within six weeks, some without treatment 3. Most will experience ____________ at some point What Are the Symptoms of Depression? 8. Symptoms may differ from person to person 9. Five main areas of functioning may be affected: 4. Emotional symptoms 0. Feeling “miserable,” “empty,” “humiliated” 1. Experiencing little pleasure 5. Motivational symptoms 2. Lacking drive, initiative, spontaneity 3. Between 6% and 15% of those with severe depression commit suicide 10. Five main areas of functioning may be affected: 6. ______________symptoms 7. ________________ symptoms 5. 6. 7. 4. Less active, less productive 4. Hold negative views of themselves Blame themselves for unfortunate events Pessimism 8. P_______________symptoms 8. Headaches, dizzy spells, general pain Diagnosing Unipolar Depression 6. Criteria 1: Major depressive episode 11. Marked by five or more symptoms lasting two or more weeks 9. In extreme cases, symptoms are psychotic, including 9. ___________________________ 10. __________________________ 7. Criteria 2: _______________________ Diagnosing Unipolar Depression 12. Two diagnoses to consider: 10. _______________________________ 11. Criteria 1 and 2 are met 11. _______________________________ 12. Symptoms are “mild but chronic” 13. Depression is longer lasting but less disabling 14. Consistent symptoms for at least 2 years 12. When dysthymic disorder leads to major depressive disorder, the sequence is called “___________________” What Causes Unipolar Depression? 8. Stress may be a trigger for depression 13. People with depression experience a greater number of stressful life events during the month just prior to the onset of their symptoms 14. Some clinicians distinguish _________________ depression from _________________ depression, which seems to be a response to internal factors 13. The utility of this distinction is questionable and today’s clinicians usually concentrate on recognizing the situational and the internal aspects of any given case What Causes Unipolar Depression? The Biological View 15. Genetic factors 14. Family pedigree, twin, adoption, and molecular biology gene studies suggest that some people inherit a _______________ 15. Researchers have found that as many as 20% of relatives of those with depression 15. are themselves depressed, compared with fewer than 10% of the general population 16. Twin studies demonstrate a ___________________________: 17. Rates for identical (MZ) twins = 46% 18. Rates for fraternal (DZ) twins = 20% 19. Molecular biology studies also have implicated a genetic factor in many cases of unipolar depression 16. Biochemical factors 15. NTs: ___________ and ______________ 20. In the 1950s, medications for high blood pressure were found to cause depression 0. Some lowered serotonin, others lowered norepinephrine 21. This led to “discovery” of effective antidepressant medications which relieved depression by increasing either serotonin or norepinephrine 22. Depression likely involves not just serotonin nor norepinephrine… a complex interaction is at work, and other NTs may be involved 9. Biochemical factors 16. People with depression have been found to have abnormal levels of _____________ 23. Released by the adrenal glands during times of stress 17. People with depression have been found to have _______________________________ 24. “Dracula hormone” 18. Other researchers are investigating whether deficiencies of important proteins within neurons are tied to depression 10. Biochemical factors 18. Model has produced enthusiasm but has significant limitations: 19. _______________________________________ 25. Do these symptoms correlate with human emotions? 20. _______________________________________ 26. Current studies using modern technology are attempting to address this issue What Are the Biological Treatments for Unipolar Depression? 11. Biological treatments can bring great relief to people with unipolar depression 12. Usually biological treatment means antidepressant drugs, but for severely depressed persons who do not respond to other forms of treatment, it sometimes includes electroconvulsive therapy 17. _______________________ / hormone release 13. _________________________________________ (ECT) 19. The use of ECT was ­­ and is ­­ controversial 21. It is now used frequently but only in severe cases 20. The procedure consists of targeted electrical stimulation to cause a brain seizure 20. 22. The usual course of treatment is 6 to 12 sessions spaced over two to four weeks 23. Treatment may be bilateral or unilateral 21. The discovery of the effectiveness of ECT was accidental and based on a fallacious link between __________ and _________ 22. The procedure has been modified in recent years to reduce some of the negative effects 24. For example, patients are given muscle relaxants and anesthetics before and during the procedure 23. Patients generally report some _________________ 25. ECT is clearly effective in treating unipolar depression 27. Studies find improvement in _____________ of patients 26. The procedure seems particularly effective in cases of ______________________________, but it has been difficult to determine why ECT works so well 27. Although effective, the use of ECT has declined since the 1950s, because of the memory loss caused by the procedure and the emergence of effective antidepressant drugs What Are the Biological Treatments for Unipolar Depression? 14. Antidepressant drugs 24. In the 1950s, two kinds of drugs were found to be effective: 28. ___________________________________ (MAO inhibitors) 29. Tricyclics 25. These drugs have been joined in recent years by a third group, the second­generation antidepressants 26. Antidepressant drugs: MAO inhibitors 30. Originally used to treat TB, doctors noticed that the medication seemed to make patients happier 31. The drug works biochemically by slowing down the body’s production of MAO 28. _____________________________________ 29. _____________________________________ 30. This leads to a rise in norepinephrine activity and a reduction in depressive symptoms 1. About half the patients who take these drugs are helped by them 27. MAO inhibitors potentially pose a serious danger! 32. Blood pressure may rise to a potentially fatal level if one eats foods with tyramine (cheese, bananas, wine) while taking MAO inhibitors 15. Antidepressant drugs: Tricyclics 28. In searching for medications for schizophrenia, researchers discovered that imipramine lessened depressive symptoms 33. Imipramine and related drugs are known as tricyclics because they share a three­ 33. ring molecular structure 16. Antidepressant drugs: Tricyclics 29. Hundreds of studies have found that depressed patients taking tricyclics have improved much more than similar patients taking placebos 34. ____________________________________________ 17. Antidepressant drugs: Tricyclics 30. Most patients who immediately stop taking tricyclics upon relief of symptoms _____________________________ 31. Patients who take tricyclics for five additional months (“____________________”) have a significantly decreased risk of relapse 32. As a result, clinicians often keep their patients on the drugs ______________ 33. Antidepressant drugs: Tricyclics 35. Tricyclics are believed to reduce depression by affecting neurotransmitter (NT) ____________ 31. To prevent an NT from remaining in the synapse too long, a pumplike mechanism recaptures the NT and draws it back into the presynaptic neuron 32. The reuptake process appears to be ________________ in some people, drawing in too much of the NT from the synapse 33. This reduction in NT activity in the synapse is thought to result in clinical depression 34. Tricyclics block the reuptake process, thus __________________ in the synapse What Are the Biological Treatments for Unipolar Depression? 34. Second­generation antidepressant drugs 36. A third group of effective antidepressant drugs is structurally different from the MAO inhibitors and tricyclics 35. Most of the drugs in this group are labeled __________________________________ 37. These drugs act only on serotonin (no other NTs are affected) 36. __________________________________________________ 38. Selective norepinephrine reuptake inhibitors and serotonin­norepinephrine reuptake inhibitors are also now available What Are the Biological Treatments for Unipolar Depression? 35. Second­generation antidepressant drugs 39. The effectiveness and speed of action of these drugs is on par with the tricyclics, yet they boast enormous sales 37. Clinicians often prefer these drugs because it is _________________ on them than on other kinds of antidepressants 38. There are _____________________________ 39. There have ____________________________ 40. These drugs may cause some undesired effects of their own, 40. __________________________________ Psychological Models of Unipolar Depression 18. Three main models: 36. Psychodynamic model 41. Not strongly supported by research 37. Behavioral model 42. Modestly supported by research 38. Cognitive model 43. Has considerable research support Psychological Models of Unipolar Depression 39. Psychodynamic view 44. Link between depression and ________ 40. When a loved one dies, the mourner regresses to the oral stage 41. For most people, grief is temporary 42. If grief is severe and long­lasting, depression results 43. Those with oral stage issues (unmet or excessively met needs) are at greater risk for developing depression 44. Some people experience “___________” (not actual) loss 45. Newer psychoanalysts focus on relationships with others (object relations theorists) Psychological Models of Unipolar Depression 40. Psychodynamic view 41. Strengths: 45. Studies have offered general support for the psychodynamic idea that depression may be triggered by a major loss 46. Research supports the theory that early losses set the stage for later depression 47. Research also suggests that people whose childhood needs were improperly met are more likely to become depressed after suffering a loss Psychological Models of Unipolar Depression 42. Psychodynamic view 43. Limitations: 48. Early losses don’t inevitably lead to depression 46. May not be typically responsible for development of depression 49. Many research findings are inconsistent 50. Theory is largely untestable because of its reliance on unconscious processes Psychological Models of Unipolar Depression 19. Psychodynamic therapy 44. Psychodynamic therapists use the same basic procedures for all psychological disorders: 51. ____________________________ 52. ____________________________ Psychological Models of Unipolar Depression 45. Psychodynamic therapy 45. 53. Despite successful case reports, researchers have found that long­term psychodynamic therapy is only occasionally helpful in cases of unipolar depression 54. Two features may be particularly limiting: 47. ____________________________________________________ 48. Depressed clients may become discouraged and end treatment too early when treatment doesn’t provide fast relief 55. ______________________________ have performed better than traditional approaches Psychological Models of Unipolar Depression 20. Behavioral view 46. Depression results from changes in ____________________________ people receive in their lives 56. As life changes, we experience a change (loss) of rewards 47. Research by Lewinsohn supports the relationship between the number of rewards received and the presence or absence of depression 57. _______________ are especially important Treatments for Unipolar Depression: Psychological Approaches 21. Behavioral therapy 48. Lewinsohn developed a behavioral therapy for unipolar depression: 58. ___________________________________________, often using a weekly schedule 59. ___________________________________________ 49. Use a contingency management approach 60. ___________________________________________ Treatments for Unipolar Depression: Psychological Approaches 22. Behavioral therapy 49. The behavioral techniques seem to be of only limited help when just one of them is applied 61. When treatment programs combine two or three of the techniques, as Lewinsohn had envisioned, depressive symptoms (especially mild symptoms) seem to be reduced Psychological Models of Unipolar Depression 23. Cognitive views 50. Two main theories: 62. Learned helplessness 63. Negative thinking Psychological Models of Unipolar Depression 24. Cognitive views 51. Learned helplessness 64. Theory holds that people become depressed when they think that: 50. They no longer have control over the reinforcements in their lives 51. They themselves are responsible for this helpless state 25. Cognitive views 52. Learned helplessness 65. Theory is based on Seligman’s work with laboratory dogs 52. Dogs subjected to uncontrollable shock were later placed in a shuttle box 53. Even when presented with an opportunity to escape, dogs that had experienced uncontrollable shocks made no attempt to do so 54. Seligman theorized that the dogs had “learned” to be “helpless” and drew parallels to human depression Psychological Models of Unipolar Depression 26. Cognitive views 53. Learned helplessness 66. There has been _______________ research support for this model 55. Human subjects who undergo helplessness training score higher on depression scales and demonstrate passivity in laboratory trials 56. Animal subjects lose interest in sex and social activities 57. In rats, uncontrollable negative events result in lower serotonin and norepinephrine levels in the brain Psychological Models of Unipolar Depression 54. Cognitive views 67. Learned helplessness 58. Recent versions of the theory focus on _____________ 2. __________ attributions that are _______ and ______ lead to greater feelings of helplessness and possibly depression 3. Example: “It’s all my fault [internal]. I ruin everything I touch [global] and I always will [stable]” 4. If they make other kinds of attributions, this reaction is unlikely 5. Example: “The way I’ve behaved the past couple of weeks blew this relationship [specific], I don’t know what got into me – I don’t usually act like that [unstable], and she never did know what she wanted [external]” Psychological Models of Unipolar Depression 27. Cognitive views 55. Learned helplessness 68. Some theorists have refined the helplessness model yet again in recent years; they suggest that attributions are likely to cause depression only when they further produce a sense of hopelessness in an individual Psychological Models of Unipolar Depression 28. Cognitive views 56. Learned helplessness 69. Strengths: Psychological Models of Unipolar Depression Psychological Models of Unipolar Depression 59. Hundreds of studies have supported the relationship between styles of 59. attribution, helplessness, and depression 70. Limitations: 60. Laboratory helplessness does not parallel depression in every way 61. Much of the research relies on animal subjects 62. The attributional component of the theory raises particularly difficult questions in terms of animal models of depression Psychological Models of Unipolar Depression 29. Cognitive views 57. Negative thinking 71. Beck theorizes four interrelated cognitive components combine to produce unipolar depression: 0. _________________________________ 63. Self­defeating attitudes are developed during childhood 64. Beck suggests that upsetting situations later in life can trigger further rounds of negative thinking Psychological Models of Unipolar Depression 30. Cognitive views 58. This negative thinking often takes three forms, called the ____________________: 72. Individuals repeatedly interpret (1) their experiences, (2) themselves, and (3) their futures in negative ways, leading to depression Psychological Models of Unipolar Depression 59. Cognitive views 73. Negative thinking 65. Depressed people also make ___________________, including: 6. Arbitrary inferences 7. Minimization of the positive and magnification of the negative 66. Depressed people experience _________________ 8. A steady train of unpleasant thoughts that suggest inadequacy and hopelessness Psychological Models of Unipolar Depression 60. Cognitive views 74. Strengths: 67. There is significant research support for Beck’s model: 68. High correlation between the level of depression and the number of maladaptive attitudes 69. Both the cognitive triad and errors in logic are seen in people with depression 70. Automatic thinking has been linked to depression 75. Limitations: 71. Research fails to show that such cognitive patterns are the cause and core of unipolar depression 61. Cognitive therapy 76. Beck’s cognitive therapy – the leading cognitive treatment for unipolar depression – is designed to help clients recognize and change their negative cognitive processes 77. This approach follows four phases and usually lasts fewer than 20 sessions 78. Phases: 1. __________________________________ 2. __________________________________ 3. __________________________________ 4. __________________________________ Psychological Models of Unipolar Depression 31. Cognitive therapy 62. Over the past three decades, hundreds of studies have shown that cognitive therapy helps unipolar depression 63. Around _________ of clients show __________ _________________ of symptoms 64. This treatment has also been used in a group therapy format The Sociocultural Model of Unipolar Depression 32. Sociocultural theorists propose that unipolar depression is greatly influenced by the social structure in which people live 65. This belief is supported by the finding that depression is often triggered by outside stressors 66. Researchers have also found links between depression and culture, gender, race, and social support The Sociocultural Model of Unipolar Depression 33. How are culture and depression related? 67. Depression is a worldwide phenomena, but the experience of symptoms differs from culture to culture 79. For example, non­Westerners report more __________ (rather than psychological) symptoms 80. As cultures become more Western, symptoms shift The Sociocultural Model of Unipolar Depression 81. How do gender and race relate to depression? 72. Rates of depression are much higher among women than men 73. One sociocultural theory holds that the ______________ _________________ in society leaves them particularly prone to depression Psychological Models of Unipolar Depression Psychological Models of Unipolar Depression 74. Few differences have been seen overall among Caucasians, African Americans, and Hispanic Americans, _______________________________________________: 75. In a study of one Native American village, lifetime risk was 37% among women, 19% among men, and 28% overall 76. These findings are thought to be the result of economic and social pressures The Sociocultural Model of Unipolar Depression 34. How does social support relate to depression? 34. 68. The availability of social support seems to influence the likelihood of depression 69. Rates of depression vary based on marital status 82. Interpersonal conflict may be a factor 70. Isolation and lack of intimacy also are key factors 83. Research shows that depressed people who lack social support remain depressed longer than those who have a supportive spouse or warm friendships The Sociocultural Model of Unipolar Depression 35. The most effective sociocultural approaches to treating unipolar depression are _____________ and __________________ 71. The techniques used in these approaches borrow from other models The Sociocultural Model of Unipolar Depression 72. Interpersonal therapy (IPT) 73. This model holds that four interpersonal problems may lead to depression and must be addressed: 84. Interpersonal loss 85. Interpersonal role dispute 86. Interpersonal role transition 87. Interpersonal deficits 74. Studies suggest that IPT is as effective as cognitive therapy for treating depression The Sociocultural Model of Unipolar Depression 36. Couple therapy 75. The main type of couple therapy is behavioral marital therapy (BMT) 88. Focus is on developing specific communication and problem­solving skills 76. If marriage is conflictual, BMT is as effective as other therapies for reducing depression Bipolar Disorders 37. People with a bipolar disorder experience both the __________________ and the _______________________________ 77. They describe their life as an emotional roller coaster What Are the Symptoms of Mania? 78. Unlike those experiencing depression, people in a state of mania typically experience dramatic and inappropriate rises in mood 79. Five main areas of functioning may be affected: 89. Emotional symptoms 77. Active, powerful emotions in search of outlet 90. Motivational symptoms 78. Need for constant excitement, involvement, companionship What Are the Symptoms of Mania? 80. Five main areas of functioning may be affected: 3. Behavioral symptoms 79. Very active – move quickly; talk loudly or rapidly 4. Cognitive symptoms 81. Show poor judgment or planning 82. Especially prone to poor (or no) planning 5. Physical symptoms 83. High energy level – often in the presence of little or no rest Diagnosing Bipolar Disorders 38. Criteria 1: Manic episode 81. Three or more symptoms of mania lasting one week or more 91. In extreme cases, symptoms are psychotic 82. Criteria 2: History of mania 92. If currently experiencing hypomania or depression Diagnosing Bipolar Disorders 39. DSM­IV­TR distinguishes between two kinds of bipolar disorder: 83. Bipolar I disorder 93. Full manic and major depressive episodes 94. Most sufferers experience an alternation of episodes 95. Some experience mixed episodes 84. Bipolar II disorder 96. Hypomanic episodes and major depressive episodes Diagnosing Bipolar Disorders 40. Without treatment, the mood episodes tend to recur for people with either type of bipolar disorder 41. Regardless of particular pattern, individuals with bipolar disorder tend to experience depression more than mania over the years Diagnosing Bipolar Disorders 42. Between 1% and 2.6% of adults in the world suffer from a bipolar disorder at any given time 43. The disorders are equally common in women and men 85. Women may experience more depressive episodes and fewer manic episodes than men Diagnosing Bipolar Disorders 44. The prevalence of the disorders is the same across socioeconomic classes and ethnic groups 45. Onset usually occurs between 15 and 44 years of age 46. In most cases, the manic and depressive episodes eventually subside, only to recur at a later time Diagnosing Bipolar Disorders 47. A final diagnostic option: 86. If a person experiences numerous episodes of hypomania and mild depressive symptoms, a diagnosis of cyclothymic disorder is appropriate 97. Mild symptoms for two or more years, interrupted by periods of normal mood 98. Affects 0.4% of the population 99. May blossom into bipolar I or II disorder What Causes Bipolar Disorders? 80. Key word: ____________! 80. 48. Throughout the first half of the 20th century, the search for the cause of bipolar disorders made 48. little progress 49. More recently, biological research has produced some promising clues 87. New insights have come from research into NT activity, ion activity, brain structure, and genetic factors What Causes Bipolar Disorders? 50. Neurotransmitters 88. After finding a relationship between low norepinephrine and unipolar depression, early researchers expected to find a link between high norepinephrine levels and mania 100. This theory is supported by some research studies; bipolar disorders may be related to overactivity of norepinephrine What Causes Bipolar Disorders? 51. Neurotransmitters 89. Because serotonin activity often parallels norepinephrine activity in unipolar depression, theorists expected that mania would also be related to high serotonin activity 101. Although no relationship with HIGH serotonin has been found, bipolar disorder may be linked to LOW serotonin activity, which seems contradictory… What Causes Bipolar Disorders? 52. Neurotransmitters 90. This apparent contradiction is addressed by the “____________________” about mood disorders: 102. Low serotonin may “open the door” to a mood disorder and permit norepinephrine activity to define the particular form the disorder will take: 84. Low serotonin + Low norepinephrine = ________________ 85. Low serotonin + High norepinephrine = ________________ What Causes Bipolar Disorders? 53. Ion activity 91. Ions, which are needed to send incoming messages to nerve endings, may be improperly transported through the cells of individuals with bipolar disorder 92. This improper transport may cause neurons to fire too easily (mania) or to resist firing (depression) 103. There is some research support for this theory What Causes Bipolar Disorders? 54. Brain structure 93. Brain imaging studies have identified a number of abnormal brain structures in people with bipolar disorder; in particular, the basal ganglia and cerebellum among others 104. It is not clear what role such structural abnormalities play What Causes Bipolar Disorders? 94. Genetic factors 105. Many experts believe that people __________________ _______________________ to develop bipolar disorders 86. Family pedigree studies support this theory; when one twin or sibling has bipolar 86. disorder, the likelihood for the other twin or sibling increases: 87. Identical (MZ) twins = 40% likelihood 88. Fraternal (DZ) twins and siblings = 5% to 10% likelihood 89. General population = 1% to 2.6% likelihood What Causes Bipolar Disorders? 55. Genetic factors 95. Recently, genetic linkage studies have examined the possibility of “faulty” genes 96. Other researchers are using techniques from molecular biology to further examine genetic patterns 97. Such wide­ranging findings suggest that a number of genetic abnormalities probably combine to help bring about bipolar disorders What Are the Treatments for Bipolar Disorders? lives on an emotional roller coaster 98. Psychotherapists reported almost no success 99. Antidepressant drugs were of limited help 106. These drugs sometimes triggered manic episodes 100. ECT only occasionally relieved either the depressive or the manic episodes of bipolar disorder What Are the Treatments for Bipolar Disorders? 57. The use of lithium, a metallic element occurring as mineral salt, has dramatically changed this picture 101. It is extraordinarily effective in treating bipolar disorders and mania 102. Determining the correct dosage for a given patient is a delicate process 107. Too low = ______________________________ 108. Too high = ______________________________ What Are the Treatments for Bipolar Disorders? 58. Lithium provides improvement ________________________________ 103. Most patients also experience ______________ while on the drug 104. Lithium also is a _________________, one that actually prevents symptoms from developing 59. Lithium also helps those with bipolar disorder overcome their depressive episodes What Are the Treatments for Bipolar Disorders? 105. Researchers do not fully understand how lithium operates 109. They suspect that it changes synaptic activity in neurons, but in a different way than antidepressant drugs 90. Although antidepressant drugs affect a neuron’s initial reception on NTs, ____________________________________________ 110. Another theory is that lithium corrects bipolar functioning by directly changing sodium and potassium ion activity in neurons 56. Until the latter part of the 20th century, people with bipolar disorders were destined to spend their What Are the Treatments for Bipolar Disorders? What Are the Treatments for Bipolar Disorders? 106. _____________________________________ 107. Lithium therapy alone is also not always sufficient, either 111. 30% or more of patients ______________________, ________________, or _________________ 108. As a result, clinicians often use psychotherapy as an adjunct to lithium (or other medication­ based) therapy What Are the Treatments for Bipolar Disorders? 60. Therapy focuses on medication management, social skills, and relationship issues 61. Few controlled studies have tested the effectiveness of such adjunctive therapy 109. Growing research suggests that it helps ______ ________________, ___________________, and _____________________________________ ...
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