class18 - What is Abnormality Clinical Psychology Mood...

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Unformatted text preview: What is Abnormality? Clinical Psychology: Mood Disorders Have an intuitive sense Would be nice if there was some objective criteria Is a subjective judgment call Heavily influenced by Social norms Susan Nolen-Hoeksema Professor of Psychology Yale University causes person or others significant distress Dysfunction Characteristics of target Context Current Consensus Abnormality characterized by: Distress behaviors or feelings highly unusual a man crying vs. a woman beating up on someone paranoia in Baghdad vs. a quiet little farm town How do we make a diagnosis? Diagnostic and Statistical Manual (DSM) prevents person from functioning in daily life Deviance woman wearing a veil in Muslim vs. non-Muslim culture Early editions subjective Since 1980, more objective Lists of symptoms, with required symptoms, criteria for number of symptoms Deviation, dysfunction, distress built into criteria 1 DSM Criteria for Major Depression Types of Mood Disorders Unipolar disorders Depression only Bipolar disorders Sadness or diminished interest or pleasure in usual activities (anhedonia) At least four of the following symptoms: 1. 2. 1. Cycles between depression and mania 2. 3. 4. 5. 6. 7. 3. DSM Criteria for Manic Episode Abnormally and persistently elevated, expansive or irritable mood for at least 1 week Three or more of the following 1. 2. 1. 2. 3. 4. 5. 6. 7. Inflated self-esteem or grandiosity Decreased need for sleep More talkative than usual, pressure to talk Flight of ideas, racing thoughts Distractibility Increase in goal-directed activity, agitation Excessive involvement in pleasurable but dangerous activities Significant weight or appetite change Insomnia or hypersomnia Psychomotor retardation or agitation Fatigue or loss of energy Feelings of worthlessness or excessive guilt Diminished ability to concentrate, indecisiveness Suicidal ideation or behavior Duration of at least 2 weeks Theories and Treatments Biological Theories and Treatments Cognitive and Behavioral Theories and Therapy Interpersonal Theories and Therapy 2 Genetics, Neurotransmitters, and Stress Neurotransmitters Implicated in Mood Disorders Monamines: Serotonin Norepinephrine Dopamine Several recent studies find that certain polymorphisms on serotonin transporter gene predict who will become depressed in the face of stress Drugs to Treat Mood Disorders Monoamine oxidase inhibitors Tricyclic antidepressants Selective serotonin reuptake inhibitors Selective serotonin/norepinephrine reuptake inhibitors Lithium Sometimes antipsychotic medications Caspi and colleagues (2003) - people with one or two short alleles on serotonin transporter gene more likely to be depressed if experienced childhood maltreatment Electroconvulsive Therapy Brain seizure induced by passing electrical current through the brain (612 sessions) Patients first anesthetized and given muscle relaxants High response rate but high relapse rate 3 Newer Biological Treatments Repetitive transcranial magnetic stimulation (rTMS) Beck’s Negative Cognitive Triad Negative view of the self Expose patient to repeated high-intensity magnetic pulses focused on particular brain structures in order to stimulate activity Vagus Nerve Stimulation Vagus nerve stimulated by small electronic device like cardiac pacemaker Negative view of the world Specific Cognitive Deficits or Biases Distortions in thinking Evidence for Cognitive Theories (Alloy et al., 1999) All-or-nothing thinking Emotional reasoning Personalization Causal attributions for negative events Internal - blame on oneself Stable - see it as lasting forever Global - see it affecting many areas of life Negative view of the future Identified first-year college students with negative attributional style Tracked for next 2 1/2 years 4 Cognitive-Behavioral Therapy Identify themes in negative thoughts and triggers for them. Challenge negative thoughts. 1. 2. 1. 2. 3. 3. 4. 5. What is the evidence for your interpretation? Are there other ways of looking at the situation? How could you cope if the worst did happen? DeRubeis, Hollon et al., 2005 Help clients recognize negative beliefs or assumptions. Change aspects of environment related to depressive symptoms. Teach person mood-management skills that can be used in unpleasant situations. Hollon, DeRubeis et al., 2005 240 patients with MDD 4 months acute treatment with CBT or Paxil (an SSRI) Followed same patients for additional 12 months Half of Paxil group left on full dose meds Half of Paxil group withdrawn to placebo Interpersonal Theories Negative views of self and expectations for relationships based on upbringing 5 Interpersonal Therapy Less structured form of therapy than CBT. Explore patterns of relationships and roots in childhood. Look for four types of interpersonal problems: Grief or loss Interpersonal role disputes Role transitions Interpersonal skills deficits Help clients understand connections between interpersonal problems and upbringing, and make choices for changing relationships. A few studies suggest it is as effective as CBT, but much less research has been done on IPT than on CBT. 6 ...
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This note was uploaded on 02/09/2012 for the course ECON 100B taught by Professor Wood during the Spring '08 term at Berkeley.

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