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Comer, Fundamentals of Abnormal Psychology, 4e — Chapter 7: Student Handout Answer Key
Chapter 7 — Mood Disorders
Slides, handouts, and answers keys created by Karen Clay Rhines, Ph.D., Seton Hall University
Handout 3: Mood Disorders
Most people with a mood disorder experience only depression
This pattern is called unipolar depression
Person is 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
Handout 7: How Common Is Unipolar Depression?
In almost all countries, women are twiceas 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 6 weeks, some without treatment
Most will experience another episode at some point
Handout 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
Hallucinations
Delusions
Criteria 2: No history of mania
Handout 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”
Handout 12: Stress and 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
Handout 14: Biological Model of Unipolar Depression
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 than 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
Handout 15: Biological Model of Unipolar Depression
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
Handout 16: Biological Model of Unipolar Depression
Biochemical factors
Endocrine system hormone release
People with depression have been found to have abnormal levels of cortisol
•Released by the adrenal glands during times of stress
People with depression have been found to have abnormal melatonin secretion
•“Dracula hormone”
Handout 17: Biological Model of Unipolar Depression
Biochemical factors
Model has significant limitations:
Depression-like symptoms created in lab animals
•Do these symptoms correlate with human emotions?
Measuring brain activity has been difficult
•Current studies using modern technology are attempting to address this issue
Handout 20: Biological Treatment of Unipolar Depression
Electroconvulsive therapy (ECT)
The discovery of ECT’s effectiveness was accidental and based on a fallacious link between psychosis and epilepsy
First major form of treatment
The procedure has been modified in recent years to reduce some of the negative effects
For example, patients are given muscle relaxants and anesthetics before and during the procedure
Patients generally report some memory loss
Handout 21: Biological Treatment of Unipolar Depression
Electroconvulsive therapy (ECT)
ECT is clearly effective in treating unipolar depression
Studies find improvement in 60–70% of patients
The procedure seems particularly effective in cases of severe depression with delusions
Although effective, the use of ECT has declined since the 1950s, due to the memory loss caused by the procedure and the emergence of effective antidepressant drugs
Handout 24: Biological Treatment of Unipolar Depression
Antidepressant drugs: monoamine oxidase inhibitors (MAOIs)
Originally used to treat TB
Doctors noticed that the medication seemed to make patients happier
The drug works by slowing down the body’s production of MAO
MAO breaks down norepinephrine
MAOIs stop this breakdown from occurring
Handout 27: Biological Treatment of Unipolar Depression
Antidepressant drugs: tricyclics
Hundreds of studies have found that depressed patients taking tricyclics have improved much more than similar patients taking placebos
Drugs must be taken for at least 10 days before such improvement is seen
About 60–65% of patients find symptom improvement
Handout 28: Biological Treatment of Unipolar Depression
Antidepressant drugs: tricyclics
Most patients who immediately stop taking tricyclics upon relief of symptoms relapse within one year
Patients who take tricyclics for five additional months (“continuation therapy”) have a significantly decreased risk of relapse
Patients who take antidepressant drugs for three or more years after initial improvement (“maintenance therapy”) may reduce the risk of relapse even more
Handout 29: Biological Treatment of Unipolar Depression
Antidepressant drugs: tricyclics
Tricyclics are believed to reduce depression by affecting NT “reuptake”
In order 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
The reuptake process appears to be too effective in some people, drawing in too much of the NT from the synapse
This reduction in NT activity in the synapse is thought to result in clinical depression
Tricyclics block this process, thus increasing NT activity in the synapse
Handout 31: Biological Treatment of Unipolar Depression
Second-generation antidepressant drugs
A third group of effective antidepressant drugs is structurally different from the MAOIs and tricyclics
Most of the drugs in this third group are selective serotonin reuptake inhibitors (SSRIs)
These drugs act only on serotonin; no other NTs are affected
This class includes fluoxetine (Prozac) and sertraline (Zoloft)
Selective norepinephrine reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are the newer second-generation antidepressants
Handout 32: Biological Treatment of Unipolar Depression
Second-generation antidepressant drugs
The effectiveness of these drugs is on par with the tricyclics, yet they boast ENORMOUS sales
Clinicians often prefer these drugs because it is harder to overdose on them than on other kinds of antidepressants
There are no dietary restrictions like there are with MAOIs
They have fewer side effects than the tricyclics
These drugs may cause some undesired effects of their own, including a reduction in sex drive
Handout 34: Psychological Models of Unipolar Depression
Link between depression and grief
When a loved one dies, the mourner regresses to the oral stage
For most people, grief is temporary
If grief is severe and long-lasting, depression results
Those with oral stage issues (unmet or excessively met needs) are at greater risk for developing depression
Some people experience “symbolic” (not actual) loss
Newer psychoanalysts focus on relationships with others (object relations theorists)
Handout 37: Psychological Treatment of Unipolar Depression: Psychodynamic Therapy
Psychodynamic therapists use the same basic procedures for all psychological disorders:
Free association
Therapist interpretation
Handout 38: Psychological Treatment of Unipolar Depression: Psychodynamic Therapy
Despite successful case reports, researchers have found that long-term psychodynamic therapy is only occasionally helpful in cases of unipolar depression
Two features may be particularly limiting:
Depressed clients may be too passive or fatigued to fully participate in clinical discussions
Depressed clients may become discouraged and end treatment too early when treatment doesn’t provide fast relief
Short-term approaches have performed better than traditional approaches
Handout 39: Psychological Models of Unipolar Depression: Behavioral View
Depression results from changes in rewards and punishments
As life changes, we experience a change (loss) of rewards
Research supports the relationship between the number of rewards received and the presence of depression
Social rewards are especially important
Handout 41: Psychological Treatment of Unipolar Depression: Behavioral Therapy
Lewinsohn, whose theory tied a person’s mood to his/her life rewards, developed a behavioral therapy for unipolar depression:
Reintroduce clients to pleasurable activities and events
Appropriately reinforce their depressive and nondepressive behaviors
Use a contingency management approach
Help them improve their social skills
Handout 46: Psychological Models of Unipolar Depression: Cognitive View
Learned helplessness
There has been significant research support for this model
Human subjects who undergo helplessness training score higher on depression scales and demonstrate passivity in laboratory trials
Animal subjects lose interest in sex and social activities
In rats, uncontrollable negative events result in lower serotonin and norepinephrine levels in the brain
Handout 47: Psychological Models of Unipolar Depression: Cognitive View
Learned helplessness
Recent versions of the theory focus on attributions
Internal attributions that are global and stable lead to greater feelings of helplessness and possibly depression
Example: “It’s all my fault [internal]. I ruin everything [global] and I always will [stable]”
If people make other kinds of attributions, this reaction is unlikely
Example: “She had a role in this also [external], but I have been a jerk lately [specific], and I don’t usually act like that [unstable]”
Handout 50: Psychological Models of Unipolar Depression: Cognitive View
Negative thinking
Beck theorizes four interrelated cognitive components of depression:
Maladaptive attitudes
Self-defeating attitudes are developed during childhood
Beck suggests that upsetting situations later in life can trigger further rounds of negative thinking
Handout 51: Psychological Models of Unipolar Depression: Cognitive View
Negative thinking often takes three forms
This is called thecognitive triad:
Individuals repeatedly interpret (1) their experiences, (2) themselves, and (3) their futures in negative ways, leading to depression
Handout 52: Psychological Models of Unipolar Depression: Cognitive View
Negative thinking
Depressed people also make errors in their thinking, including:
Arbitrary inferences
Minimization of the positive and magnification of the negative
Overgeneralization
Depressed people experience automatic thoughts
A steady train of unpleasant thoughts that suggest inadequacy and hopelessness
Handout 55: Psychological Treatment of Unipolar Depression: Cognitive Therapy
Beck’s cognitive therapy—the leading cognitive treatment for unipolar depression—is designed to help clients recognize and change their negative cognitive processes
This approach follows four phases and usually lasts fewer than 20 sessions
Phases:
1. Increase activities and elevate mood
2. Challenge automatic thoughts
3. Identify negative thinking and biases
4. Change primary attitudes
Handout 56: Psychological Treatment of Unipolar Depression: Cognitive Therapy
Over the past three decades, hundreds of studies have shown that cognitive therapy helps unipolar depression
Around 50–60% of clients show near elimination of symptoms
This treatment has also been used in a group therapy format
Handout 58: Sociocultural Model of Unipolar Depression
How are culture and depression related?
Depression is a worldwide phenomena that varies from culture to culture, but the experience of symptoms differs
For example, non-Westerners report more physical (rather than psychological) symptoms
As cultures become more Western, symptoms shift
Handout 59: Sociocultural Model of Unipolar Depression
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
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
Handout 61: Sociocultural Treatment of Unipolar Depression
The most effective sociocultural approaches to treating unipolar depression are interpersonal psychotherapy and couple therapy
The techniques used in these approaches borrow from other models
Handout 64: Bipolar Disorders
People with a bipolar disorder experience both the lows of depression and the highs of mania
Many describe their lives as emotional roller coasters
Handout 66: 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 judgment or planning
Especially prone to poor (or no) planning
Physical symptoms
High energy level – often in the presence of little or no rest
Handout 75: 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 for the disorder will take:
Low serotonin + low norepinephrine = depression
Low serotonin + high norepinephrine = mania
Handout 77: 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
Handout 79: Treatments for Bipolar Disorder
Lithium therapy
Discovered in 1949, lithium is a metallic element occurring as mineral salt
It is extraordinarily effective in treating bipolar disorders and mania
Determining correct dosage is a difficult process
Too low = no effect
Too high = lithium intoxication (poisoning)
Handout 80: Treatments for Bipolar Disorder
Lithium therapy
Lithium provides improvement for 60% of manic patients
Most patients also experience fewer new episodes while on the drug
Lithium may be a prophylactic drug, one that actually prevents symptoms from developing
Lithium also helps those with bipolar disorder overcome their depressive episodes
Handout 81: Treatments for Bipolar Disorder
Lithium therapy
Researchers do not fully understand how lithium operates
They suspect that it changes synaptic activity in neurons, but in a different way than antidepressant drugs
While antidepressant drugs affect a neuron’s initial reception on NTs, lithium seems to affect a neuron’s second messengers
Another theory is that lithium corrects bipolar functioning by directly changing sodium and potassium ion activity in neurons
Handout 82: Treatments for Bipolar Disorder
Adjunctive psychotherapy
Psychotherapy alone is rarely helpful for persons with bipolar disorder
Lithium therapy is also not always effective alone
30% of patients don’t respond, may not receive the correct dose, or may relapse while taking it
As a result, clinicians often use psychotherapy to supplement lithium (or other medication-based) therapy
Handout 83: Treatments for Bipolar Disorder
Adjunctive psychotherapy
Therapy focuses on medication management, social skills, and relationship issues
Few controlled studies have tested the effectiveness of psychotherapy as an adjunct to drug therapy for severe bipolar disorders
Growing research suggests that it helps reduce hospitalization, improves social functioning, and increases clients’ ability to obtain and hold a job