PSYCHOPATHOLOGY UNIT 3

Depression

Major Depression, Persistent Depressive Disorder, Premenstrual Dysphoric Disorder, persistent feelings of sadness, loss of interest, and other emotional and physical symptoms.

Mania

Bipolar 1, Bipolar 2 and Cyclothymia are examples of mania, characterized by periods of abnormally elevated mood, increased activity, and other symptoms that may impair functioning.

Unipolar Depression Prevalence

20% of all adults experience unipolar depression at some time in their lives.

 26% of women

 12% of men

 Average age of onset is 19 years

Major Depression Disorder Checklist

Presence of a major depressive episode and no pattern of mania/ hypomania

Reactive (exogenous) depression

80% of severe episodes are triggered by identifiable stressors or life events, such as loss or trauma.

Endogenous Depression

Other 20% no triggering event

Depression Biological Model

Genetic: family pedigree/ twin/ gene studies

Biochemical: low activity of NT Serotonin and Norepinephrine

Brain Circuits: pre-frontal connection to limbic system off, irregular activity

Immune System: chronic stress, deregulate immune system, inflammation, slow activity

Depression Biological Treatment

Anti Depressant or Brain Stimulation

MAO Inhibitor

A type of antidepressant that inhibits the monoamine oxidase enzyme, increasing levels of neurotransmitters such as serotonin and norepinephrine in the brain by preventing degradation in synapse, worse side effects and least common

Tricyclic Antidepressant

Best, prevent NT Serotonin/ norepinephrine re uptake of key neurons

Second-generation antidepressants

Most common, SSRI (increase serotonin), SNRI (increase norepinephrine), serotonin-norepinephrine re uptake inhibitor

Ketamine-based antidepressant

Worst, increase glutamate activity, may make new neural pathway development, quick and short-term (suicidal)

Brain Stimulation for Depression

Biological treatments that directly or indirectly stimulate certain areas of the brain: Electroconvulsive therapy (ECT)**, Vagus nerve stimulation, Transcranial magnetic stimulation, Deep brain stimulation

Depression Psychodynamic Model

Real or Imagined (symbolic) Loss

Results when peoples relationships leave them feeling unsafe/ insecure (especially whenn young)

Depression Cognitive Behavioral Model

Result from problematic behavior and dysfunctional thinking (behavioral dimension, negative thinking, learned helplessness)

Behavioral Dimension

Lewinsohn, reward non depressive behavior to increase engagement and reduce depression symptoms. A component of the cognitive-behavioral model that focuses on reinforcing positive behaviors to counteract depressive symptoms.

Negative Thinking

Beck, unipolar depression and maladaptive thoughts that lead to cognitive triad of negative self-perception, negative interpretation of experiences, and negative view of the future.

Learned Helplessness

Seligman, Cognitive-behavioral interplay, think have no control over lifes reinforcements

Depression CBT

Behavioral activation- reward non depressive behavior, improve social skills, re-introduce pleasurable activity

**Becks CBT- increase activity and mood, challenge autonomic thoughts, identify negative thoughts/ biases, change primary attitude

Acceptance and commitment therapy (ATP)

Depression Sociocultural Model

Influenced by social context, outside stressors (family and cultural), lack of social rewards (separation/ divorce/ isolation), multicultural (depression around world slight differ), gender (women: men 2:1, women more when younger, frequent and longer)

Depression Sociocultural Treatment

Family-social treatment

**Interpersonal psychotherapy- interpersonal loss or role diffferences, improve communication, build social support.

Developmental Psychopathology Perspective

Unipolar depression- combo of biological predisposition, early life trauma, magnitude/ timing of factors, resilience- moderate/ manageable

Factors unfold and intersect in developmental sequence

Bipolar Disorders

Lows of depression and Highs of Mania, shift of extreme moods, dramatic impact on family and friends, biological condition

Mania Symptoms

elevated mood, increased energy, decreased need for sleep, impulsivity, and racing thoughts.

Bipolar Prevalence

1-2.8% all adults, 4.4% in life, onset btw 15-44 yr, no gender diff, more in low-income

Cyclothymic disorder

Numerous periods of hypomanic symptoms and mild depression, 2 or more years with periods of stable mood lasting less than two months. It is considered a milder form of bipolar disorder, could evolve

Bipolar Biological Model

NT activity, Ion activity, genetic factors, structural/ circuit brain changes- high norepinephrine, low serotonin, improper ion movement, irregular structure, biological predisposition

Bipolar Biological Treatment

Mood-stabalizing Drugs** (treat depression and mania)

lithium (classic, treat bipolar effective, narrow therapeutic window- btwn help and OD),

more often: antiseizure drug, antipsychotics

Bipolar Adjunctive Psychotherapy

aims to improve medication adherence, manage symptoms, and enhance coping strategies, doubles likelihood of taking drugs, individual/ group/ family

Suicide

not a psychological diagnosis or mental disorder, but can be an associate behavior

Risk Factor/ Associations with Suicide

Depression Being an older white male

Substance/gambling addiction Modeling of suicide

Suicidal ideation, talk,

preparation

Economic or work problems;

certain occupations

Prior suicide attempts Marital/family problems

Lethal methods Stress and stressful events

Loneliness, isolation Psychosis

Hopelessness Physical illness

Impulsivity and risk-taking Sleep problems

Suicide Assesment

Therapists must ask about suicidality, document when ask

Assessments include: Ideation (Passive- thought and Active- weighing pro/ con, active thought), Ask Plan- how specific, Intent- 24 hours? can use hospitalization against will if will harm self

Suicide Prevention

Establishing a positive relationship, Understanding and clarifying the problem, Assessing suicide potential, Assessing and mobilizing the caller's resources, Formulating a plan

Long Term: Referral, Therapy, Support, Hope, Reduction of access to

common suicide means: Gun control and Car emissions