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ABNORMAL PSYCHOLOGY, SIXTEENTH EDITION James N. Butcher/ Jill M. Hooley/ Susan Mineka Chapter 7 Mood Disorders and Suicide © 2014, 2013, 2010 by Pearson.

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Presentation on theme: "ABNORMAL PSYCHOLOGY, SIXTEENTH EDITION James N. Butcher/ Jill M. Hooley/ Susan Mineka Chapter 7 Mood Disorders and Suicide © 2014, 2013, 2010 by Pearson."— Presentation transcript:

1 ABNORMAL PSYCHOLOGY, SIXTEENTH EDITION James N. Butcher/ Jill M. Hooley/ Susan Mineka Chapter 7 Mood Disorders and Suicide © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

2 Range of Emotions A person with a mood disorder experiences emotions that are extreme and, therefore, abnormal.

3 What Are Mood Disorders? Unipolar depressive disorders Only depressive episodes Bipolar depressive disorders Manic and possibly depressive episodes (but not necessary) © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

4 The Prevalence of Mood Disorders © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

5 Mild, brief non-depression Can be normal and adaptive Sadness, hopelessness, and pessimism are common human experiences © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

6 Persistent Depressive Disorder (Dysthymic Disorder ) Mild to moderate version of depression Lasts a long time Intermittent normal moods occur briefly Lifetime prevalence of 2.5 to 6% © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

7 Major depressive episode: Overview and defining features –Extremely depressed mood lasting at least two weeks –Cognitive symptoms – feelings of worthlessness, indecisiveness –Disturbed physical functioning (sleep and eating) –Anhedonia – loss of pleasure/interest in usual activities

8 Major Depression: An Overview Major depressive disorder –Single episode – highly unusual –Recurrent episodes (2 or more major depressive episodes separated by at least 2 months of no depression) – more common From grief to depression –Pathological or impacted grief reaction

9 Major Depressive Disorder Specifiers Major depressive episode with melancholic features Severe major depressive episode with psychotic features Major depressive episode with atypical features Major depressive episode with catatonic features © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

10 Major Depressive Disorder Persistent major depressive disorder Major depression does not remit for more than two years Seasonal affective disorder Recurrent depressive episodes with a pattern © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

11 Causal Factors in Unipolar Mood Disorders Causal Factors Biological causal factors Psychological causal factors © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

12 Biological Causal Factors Biological factors Heredity Altered neuro- transmitter activity Hormones © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

13 Figure 7.1: Number of Stressful Life Events vs. Probability of Major Depressive Episode © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

14 Biological Causal Factors Genes Serotonin- transporter gene Three combinations Gene- environment interaction research © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

15 Biological Causal Factors Disruptions Sleep Circadian rhythms Exposure to sunlight (seasonal) © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

16 Psychological Causal Factors Depression Stressful life events Risk-related vulnerability factors Neuroticism or negative affectivity Early adversity or parental loss © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

17 Psychological Causal Factors Theorists Freud Behaviorists Cognitive model © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

18 Figure 7.3: Beck’s Cognitive Model of Depression © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

19 Cognitive distortions All-or-nothing thinking (splitting) – Conception in absolute terms, like "always", "every", "never", and "there is no alternative". (See also "false dilemma" or "false dichotomy".)All-or-nothing thinking (splitting)false dilemmadichotomy Overgeneralization – Extrapolating limited experiences and evidence to broad generalizations. (See also faulty generalization and misleading vividness.)faulty generalizationmisleading vividness Magical thinking - Expectation of specific outcomes based on performance of unrelated acts or utterances. (See also wishful thinking.)Magical thinking wishful thinking Mental filter (arbitrary inference)– Inability to view positive or negative features of an experience, for example, noticing only a tiny imperfection in a piece of otherwise useful clothing. Disqualifying the positive – Discounting positive experiences for arbitrary, ad hoc reasons. Jumping to conclusions – Reaching conclusions (usually negative) from little (if any) evidence. Two specific subtypes are also identified:Jumping to conclusions –Mind reading – Sense of access to special knowledge of the intentions or thoughts of others. –Fortune telling – Inflexible expectations for how things will turn out before they happen. Magnification and minimization – Magnifying or minimizing a memory or situation such that they no longer correspond to objective reality. This is common enough in the normal population to popularize idioms such as "make a mountain out of a molehill." In depressed clients, often the positive characteristics of other people are exaggerated and negative characteristics are understated. There is one subtype of magnification:Magnificationminimizationmake a mountain out of a molehill Catastrophizing – Inability to foresee anything other than the worst possible outcome, however unlikely, or experiencing a situation as unbearable or impossible when it is just uncomfortable. Emotional reasoning – Experiencing reality as a reflection of emotions, e.g. "I feel it, therefore it must be true."Emotional reasoning Should statements – Patterns of thought which imply the way things "should" or "ought" to be rather than the actual situation the person is faced with, or having rigid rules which the person believes will "always apply" no matter what the circumstances are. Albert Ellis termed this "Musturbation".Albert Ellis Labeling and mislabeling – Limited thinking about behaviors or events due to reliance on names; related to overgeneralization. Rather than describing the specific behavior, the person assigns a label to someone or himself that implies absolute and unalterable terms. Mislabeling involves describing an event with language that is highly colored and emotionally loaded.Labeling Personalization – Attribution of personal responsibility (or causal role or blame) for events over which a person has no controlAttributionblameno control

20 Figure 7.4: Negative Cognitive Triad © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

21 Psychological Causal Factors Theories Reformulated helplessness theory Hopelessness theory Excessive rumination © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

22 Psychological Causal Factors Interpersonal effects Lack of social support or social skills Hostility and rejection from others Marital dissatisfaction © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

23 The Structure of Mood Disorders Mania Hypomanic episode – less severe than manic episode that lasts at least 4 days

24 The Structure of Mood Disorders Features of a manic episode –Elevated, expansive mood for at least one week At least 3 of the following: –Inflated self-esteem, decreased need for sleep, excessive talkativeness, flight of ideas or sense that thoughts are racing, easy distractibility, increase in goal-directed activity or psychomotor agitation, excessive involvement in pleasurable but risky behaviors –Impairment in normal functioning

25 Bipolar I disorder Includes at least one manic or mixed episode Bipolar II disorder Includes hypomanic episodes but not full- blown manic or mixed episodes © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

26 Cyclothymic Disorder Cyclical mood swings Less severe than those of bipolar disorder Symptoms present for at least 2 years Lacking severe symptoms and psychotic features of bipolar disorder © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

27 Bipolar Disorders (I and II) © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

28 Figure 7.6: The Manic-Depressive Spectrum © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

29 Causal Factors in Bipolar Disorder Causal factors Biological causal factors Psychological causal factors © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

30 Biological Causal Factors Heredity Norepinephrine, serotonin, and dopamine Abnormalities in transportation of ions across neural membrane © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

31 Biological Causal Factors Other biological influences Cortisol levels Shifting patterns of blood flow to prefrontal cortex Disturbances in biological rhythms © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

32 Psychological Causal Factors Psychological causal factors Stressful life events Personality variables Low social support Pessimistic attributional style © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

33 Sociocultural Factors Affecting Unipolar and Bipolar Disorders Symptoms of mood disorders Can differ widely across cultures and demographic groups Prevalence of mood disorders Also differs across cultures © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

34 Cross-Cultural Differences in Depressive Symptoms Examples China and Japan Other Asian beliefs © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

35 Cross-Cultural Differences in Prevalence Rates of depression vary more than rates of bipolar disorder Lifetime prevalence of depression is % in the U.S., but only 1.5% in Taiwan Reasons for different rates of depression are not yet clear © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

36 Figure 7.7: Prevalence Rates for Depression across Several Nations © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

37 Demographic Differences in the United States Native Americans have relatively high rates of depression African-Americans have relatively low rates U.S. rates of unipolar depression inversely related to socioeconomic status © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

38 Figure 7.8: Rates of Mood Disorders in Writers and Artists © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

39 Treatments and Outcomes Pharmacotherapy Alternative biological treatments Psychotherapy © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

40 Pharmacotherapy Antidepressants, mood- stabilizing, antipsychotic drugs used to treat mood disorders Lithium common mood stabilizer for bipolar © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

41 Treatment of Mood Disorders: Selective Serotonergic Reuptake Inhibitors (SSRIs) Specifically block reuptake of serotonin –Fluoxetine (Prozac) is the most popular SSRI SSRIs pose some risk of suicide particularly in teenagers Negative side effects

42 Alternative Biological Treatments Electroconvulsive therapy Transcranial magnetic stimulation Deep brain stimulationBright light therapy © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

43 Treatment of Mood Disorders: Electroconvulsive Therapy (ECT) ECT is effective for cases of severe depression The nature of ECT –Involves applying brief electrical current to the brain –Results in temporary seizures –Usually six to 10 outpatient treatments are required –Side effects are few and include short-term memory loss –Uncertain why ECT works –Relapse is common (60%)

44 Psychotherapy Forms of effective psychotherapy Cognitive-behavioral therapy Behavioral activation treatment Interpersonal therapy Family and marital therapy © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

45 Suicide Suicide risk significant factor in all types of depression Suicide ranks among the top ten leading causes of death © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

46 The Clinical Picture and the Causal Pattern Who Attempts and Who Commits Suicide?Suicide in ChildrenSuicide in Adolescents and Young Adults Other Psychosocial Factors Associated with Suicide Biological Causal FactorsSociocultural Factors © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

47 Who Attempts and Who Commits Suicide? Suicide attempts and age Completed suicides and age Gender differences © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

48 Suicide in Children Rates very low but increasing Suicide in children age has increased by 70% since 1981 Multiple risk factors © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

49 Suicide in Adolescents and Young Adults Rates tripled between the mid- 1950s and mid- 1980s Multiple risk factors © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

50 Other Psychosocial Factors Associated with Suicide Psychosocial factors ImpulsivityAggressionPessimismFamily psychopathology or instabilityGeneticsSociocultural factors © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

51 Biological Causal Factors Genetics Reduced serotonergic activity © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

52 Sociocultural Factors Ethnicity Whites have higher rates of suicide than African Americans Rates of suicide Vary across cultures and religions © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

53 Figure 7.10: U.S. Suicide Rates by Age, Gender, and Racial Group © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

54 Suicidal Ambivalence Some people do not wish to die but instead want to communicate Methods are nonlethal Actions arranged so that intervention by others is likely © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

55 Suicide Notes Only 15-25% of completed suicides leave notes Some notes include statement of love and concern Others include very hostile content © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

56 Suicide Prevention and Intervention Current preventive efforts Treatment of person’s current mental disorder(s) Crisis intervention Working with high- risk groups © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

57 Treatment of Mental Disorders Prevention of suicide can take the form of treatment of the underlying mental disorder(s) Antidepressant medication or lithium Benzodiazepines Cognitive-behavioral therapy © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

58 Crisis Intervention Intervention Primary objective ExamplesHotlines Hotline efficacy © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

59 Unresolved Issues Is there a right to die? Not all societies agree that others should interfere with suicide Challenging ethical and legal questions remain © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.


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