chapter 7 Depressive and Bipolar Disorders

unipolar depression

depression without a history of mania

bipolar disorder

marked by alternating or intermixed periods of mania and depression

depression

low sad state marked by significant level of sadness—low energy, low self-worth, guilt

mania

state or episode of euphoria in which people will have exaggerated belief that the world is theirs for taking

depressive disorders

group of disorders marked by unipolar depression

how common is unipolar depression?

-8% severe unipolar depression

5% mild forms

over lifetime 20% of adults experience unipolar depression

average onset is 19yrs old

-pre-puberty equal for boys and girls

emotional symptoms

feeling miserable “empty”, “humiliated”

experiencing little pleasure when engaging in activity

motivational symptoms

lacking drive, initiative, spontaneity

between 6 and 15% of those with severe depression die by suicideb

behavioral symptoms

less active, less productive

cognitive symptoms

hold negative views of themselves

blame themselves for unfortunate events

physical symptoms

headaches, dizzy spells, general pain

major depressive disorder

sever pattern of depression that is disabling and not caused by a medical issue

persistent depressive disorder

chronic form of unipolar depression where person has episodes and feels generally low at all times

premenstrual dysphoric disorder

related symptoms to depression the week before they menstruate

diagnosing unipolar depression

presence of major depressive episode with no history of mania

diagnosing persistent depressive disorder

experiences symptoms of major or mild depression or at least 2 years

symptoms not absent for more than 2 months at a time

no history of mania

stress or impairment

dysthymic disorder

previous term for depression

dysthymia

depressed/low mood

anhedonia

loss of pleasure in things

exogenous

situational factors

endogenous factors

internal factors

post partum depression

Extreme sadness, despair, tearfulness,
insomnia, anxiety, intrusive thoughts,
compulsions, panic attacks, inability
to cope, suicidal thought

hormonal changes of childbirth

impact on mother-infant relationship

genetic factors

some people inherit biological pre-disposition

up to 20% of relatives with depression are also deprressed

cortisol

excessively releasing in times of stress could be implicated in depressive disorder

brain circuit

pre-frontal cortex, hippocampus, amygdala, subgenual cingulate

subgenual cingulate

makes distinction contribution to depressive symptoms

biological causes

interconnectivity issues

reuptake process being too quick

biological treatments or unipolar depression

antidepressants, brain stimulation, ect

tricyclic in reuptake process

inhibitor

causes seretonin to sit in the synapse longer

MOA inhibitor

ncreases activity level of
neurotransmitters serotonin
and norepinephrine
• Iproniazid; tyramine

tricycyclics

Acts on neurotransmitter
repuptake mechanism of key
neurons; biological
corrections
• Imipramine; Tofranil

ketamine based treatments

increases activity of glutamate in the brain

may aid new neural pathway deveopment’

alleviates depression quickly

brain stiulation

biological treatments that directly or indirectly
stimulate certain areas of the brain

ect 

electrical current sent through brain causing convulsions

vagus nerve stimualtion

pulse generator implanted in chest and sends signal to vagus nerve to stimulate the brain

transcranial magnetic stimulation

electromagnetic coil placed above clients head to induce brain stimulation

deep brain stimulation

sends electrical signal directly to brain to recalibrate depression related circuit

selective seretonin reuptake inhibitor

Fluoxetine/Prozac; sertraline/Zoloft; escitalopram/Lexapro

selective norepinephrine reuptake inhibitor

Atomoxetine/Strattera

seretonin norephinephrine reuptake inhitor

venlafaxine/effexor

causes of unipolar depression: psychodynamic views

link between depression and greif

introjection

symbolic loss

introjection

a directing of feelings for the loved on onto oneself

symbolic loss

break up, divorce, prison, moving away

oral stage

those who had oral stage issues would be at greater risk for depression

psychodynamic treatment

free association

therapist interpretation

review of past events and feelings

unipolar cognitive behavioral

problematic behaviors and dysfunctional thinking

negative thinking

complex cognitive and behavioral factor interplay

Lewinsohn

decrease positive reeward—> fewer constructuve behaviors—> spiral to depression

when i experience less reward from my environment than i would engage in fewer constructive behaviors

cognitive triad

negative view of the self, the world, and the future

Aaron Beck

combination of 4 interrelated cognitive components

-cognitive triad

errors in thinking

automatic thoughts

errors in thinking

tendency to think about the negative situation

automatic thoughts

make negative conclusions based on little evidence

maladaptive attitude

about our self efficacy 

“we cant fix the world” “cant do anything to change surroundings”

behavioral approaches

-reintroduction to pleasureable events/activities

-consistently reward nondepressive behaviors

withold rewards for depressive behaviors

becks cognitive therapy phases

increasing activities and elevating moods

challenging automatic thoughts

identifying negative thinking and biases

changing primary attitudes

act

recognition and acceptance of negative cognitions and commit to not acting on the negative thoughts

learned helplessness theory

one had lost control over lifes reinforcements

people who repeatedly experience uncontrollable negative events come to believe they are powerless to change their situation

attribution-helplessness theory

global and stable internal attribution

posits that the attributions, or explanations, people make for negative events can lead to learned helplessnessinter

interpersonal role dispute

talk about role they play in interpersonal role

interpersonal deficits

are social skills of an individual useful to what they are getting from the world around them

life stress theory

women and underresourced populations experience more stress

family- social approach

couples therapy

gender and dperession

women recieve depression 2x as more than men

women respond less successfully to treatment

diagnosing bipolar disorder

3+ symptoms of mania lasting one week or more

history of mania

bipolar 1 disorder symptoms

occurence of manic episode

hypomanic or major depressive episodes may preced or follow the manic episode

bipolar ii disorder

presence or history of major depressive episodes

presence or history of hypomanic episodes

no history of a manic episode

mania: emotional symptoms

active, powerful emotions in sear of outlet

motivational symptoms :mania

need for constant excitement, involvement, companionship

mania: behavioral symptoms

very active—-move quickly, talk loudly, flamboyant

mania:cognitive symptoms

show poor judgement or planning

may have trouble remaining coherent or in touch with reality

mania: physical symptoms

high energy level—often in the presence of little or no rest

cyclothymic disorder

mild symptoms for two or more ears, interrupted by periods of normal mood

no gender differenced

may precede bipolar 1 or bipolar 2

rapid cycling

4+ episodes within a year

what is the leading theory of bipolar disorder?

biological theory

neurotransmitter activity

-link btwn norepinephrine levels and mania

-no relationship found with high seretoning and mania

permissive theory

seretonin playing a role to open the door to mood

norepinephrine determined the particular form the episode will take at that time

mania

low seretonin + high norepinephrine

depression

low serotonin + low norepinephrine