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Abnormal Psychology Chapter 7, Lecture notes of Abnormal Psychology

This file covers Chapter 7, providing in-depth notes on mood disorders such as major depressive disorder, bipolar disorders, persistent depressive disorder, and cyclothymia. Includes diagnostic criteria, symptoms, causes (biological, psychological, and social), and treatment options. Ideal for review or in-depth study of affective disorders.

Typology: Lecture notes

2022/2023

Available from 07/05/2025

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ABNORMAL PSYCHOLOGY
WEEK 6 CHAPTER 7
CHAPTER 7: MOOD DISORDERS AND SUICIDE
Feelings of depression (and joy) are universal,
which makes it all the more difficult to understand
disorders of mooddisorders that can be so
incapacitating that violent suicide may seem by
far a better option than living.
An Overview of Depression and Mania
Problems have been grouped under the
heading mood disorders because they
are characterized by gross deviations in
mood.
MAJOR DEPRESSIVE EPISODE
- most commonly diagnosed and
most severe depression
FIRST FUNDAMENTAL STATE IN
MOOD DISORDERS
DSM-5 criteria describe it as :
o extremely depressed
mood state that lasts at
least 2 weeks and includes
cognitive symptoms (such
as feelings of
worthlessness and
indecisiveness) and
o disturbed physical
functions (such as altered
sleeping patterns,
significant changes in
appetite and weight, or a
notable loss of energy) to
the point that even the
slightest activity or
movement requires an
overwhelming effort.
- Typically accompanied by a
general loss of interest in
things and an inability to
experience any pleasure from
life, including interactions with
family or friends or
accomplishments at work or at
school.
- Most central indicators of a full
major depressive episode are
the physical changes (some-
times called somatic or
vegetative symptoms), along
with the behavioral and
emotional “shutdown,” as
reflected by low behavioral
activation
- people with depression show
dysfunctional reward
processing and anhedonia
(loss of energy and inability to
engage in pleasurable
activities or have any “fun”)
- This anhedonia reflects that
these episodes represent a
state of low positive affect and
not just high negative affect
- Duration:
o Major depressive
episode, if untreated,
is approximately 4 to
9 months
SECOND FUNDAMENTAL STATE
IN MOOD DISORDERS
o abnormally
exaggerated elation,
joy, or euphoria
o Mania
individuals find
extreme pleasure in
every activity
o DSM-5 highlights this
feature by adding
“persistently
increased goal-
directed activity or
energy” to the A
criteria
o Flight of Ideas
Speech is typically
rapid and may
become incoherent,
because the
individual is
attempting to express
so many exciting
ideas at once
o DSM-5 criteria for a
manic episode require
a duration of only 1
week, less if the
episode is severe
enough to require
hospitalization if
the individual was
engaging in a self-
destructive buying
spree
o Irritability is often
part of a manic
episode, usually near
the end
o Duration:
The duration of an
untreated manic
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ABNORMAL PSYCHOLOGY

WEEK 6 – CHAPTER 7 CHAPTER 7: MOOD DISORDERS AND SUICIDE Feelings of depression (and joy) are universal, which makes it all the more difficult to understand disorders of mood —disorders that can be so incapacitating that violent suicide may seem by far a better option than living. An Overview of Depression and Mania

  • Problems have been grouped under the heading mood disorders because they are characterized by gross deviations in mood.
  • MAJOR DEPRESSIVE EPISODE
    • most commonly diagnosed and most severe depression FIRST FUNDAMENTAL STATE IN MOOD DISORDERS DSM-5 criteria describe it as : o extremely depressed mood state that lasts at least 2 weeks and includes cognitive symptoms (such as feelings of worthlessness and indecisiveness) and o disturbed physical functions (such as altered sleeping patterns, significant changes in appetite and weight, or a notable loss of energy) to the point that even the slightest activity or movement requires an overwhelming effort.
    • Typically accompanied by a general loss of interest in things and an inability to experience any pleasure from life, including interactions with family or friends or accomplishments at work or at school.
    • Most central indicators of a full major depressive episode are the physical changes (some- times called somatic or vegetative symptoms), along with the behavioral and emotional “shutdown,” as reflected by low behavioral activation
    • people with depression show dysfunctional reward processing and anhedonia (loss of energy and inability to engage in pleasurable activities or have any “fun”)
  • This anhedonia reflects that these episodes represent a state of low positive affect and not just high negative affect
  • Duration: o Major depressive episode, if untreated, is approximately 4 to 9 months SECOND FUNDAMENTAL STATE IN MOOD DISORDERS o abnormally exaggerated elation, joy, or euphoria o Mania individuals find extreme pleasure in every activity o DSM-5 highlights this feature by adding “persistently increased goal- directed activity or energy” to the “ A ” criteria o Flight of Ideas Speech is typically rapid and may become incoherent, because the individual is attempting to express so many exciting ideas at once o DSM- 5 criteria for a manic episode require a duration of only 1 week, less if the episode is severe enough to require hospitalization — if the individual was engaging in a self- destructive buying spree o Irritability is often part of a manic episode, usually near the end o Duration : The duration of an untreated manic

episode is typically 3 to 4 months o Hypomanic Episode Less severe version of a manic episode that does not cause marked impairment in social or occupational functioning and need last only 4 days rather than a full week. o Hypo means “ below ”; thus the episode is below the level of a manic episode. o Hypomanic episode is not in itself necessarily problematic, but its presence does contribute to the definition of several mood disorders. The Structure of Mood Disorders

  • Unipolar Mood Disorder Individuals who experience either depression or mania because their mood remains at one “pole” of the usual depression–mania continuum
  • Bipolar Mood Disorder Someone who alternates between depression and mania traveling from one “pole” of the depression–elation continuum to the other and back again
  • Mixed features An episode where an individual can experience manic symptoms but feel somewhat depressed or anxious at the same time or be depressed with a few symptoms of mania
  • Research suggests that manic episodes are characterized by dysphoric (anxious or depressive) features more commonly than was thought, and dysphoria can be severe
  • In DSM-5, the term mixed features requires specifying whether a predominantly manic or predominantly depressive episode is present and then noting if enough symptoms of the opposite polarity are present to meet the mixed features criteria.
  • It is important to determine the course or temporal patterning of the depressive or manic episodes o Full Remission does the patient recover fully for at least 2 months between episodes o Partial Remission only partially recover retaining some depressive symptoms o Do the depressive episodes alternate with manic or hypomanic episodes or not? o Importance of temporal course (patterns of recurrence and remittance) makes the goals of treating mood disorders somewhat different from those for other psychological disorders Depressive Disorders Several types of depressive disorders: ❖ differ from one another in the frequency and severity with which depressive symptoms occur and the course of the symptoms (chronic— meaning almost continuous—or nonchronic) ❖ two most important factors that describe mood disorders are severity and chronicity Clinical Descriptions
  1. Major Depressive Episode o Most easily recognized mood disorder o Defined by the presence of depression and the absence of manic, or hypomanic episodes, before or during the disorder. o Recurrent two or more major depressive episodes occurred and were separated by at least 2 months during which the individual was not depressed. Important in predicting the future course of the disorder, as well as in choosing appropriate treatments. o Unipolar depression is often a chronic condition that waxes and wanes over time but seldom disappears o Median lifetime number of major depressive episodes is four to seven o Median duration of recurrent major depressive episodes is 4 to 5 months
  2. Persistent Depressive Disorder (dysthymia) o shares many of the symptoms of major depressive disorder but differs in its course.

Delusions of grandeur accompanying a manic episode are mood congruent psychotic symptoms accompany depressive episodes are relatively rare

  1. Anxious distress specifier
    • presence and severity of accompanying anxiety
    • the most important addition to specifiers for mood disorders in DSM- 5
    • the presence of anxiety indicates a more severe condition, makes suicidal thoughts and fatal suicide attempts more likely, and predicts a less effective outcome from treatment
  2. Mixed features specifier
    • Predominantly depressive episodes that have several (at least three) symptoms of mania
    • Applies to major depressive episodes both within major depressive disorder and persistent depressive disorder.
  3. Melancholic features specifier
    • Applies only if the full criteria for a major depressive episode have been met, whether in the context of a persistent depressive disorder or not.
    • Include some of the more severe somatic (physical) symptoms, such as early-morning awakenings, weight loss, loss of libido (sex drive), excessive or inappropriate guilt, and anhedonia (diminished interest or pleasure in activities)
  • seem to signify a severe type of depressive episode
  1. Catatonic features specifier
  • Can be applied to major depressive episodes whether they occur in the context of a persistent depressive order or not, and even to manic episodes, although it is rare— and rarer still in mania
  • Involves an absence of movement (a stuporous state)
  • Catalepsy , in which the muscles are waxy and semirigid, so a patient’s arms or legs remain in any position in which they are placed
  • Catatonic symptoms may also involve excessive but random or purposeless movement
  • Catalepsy was thought to be more commonly associated with schizophrenia, but some studies have suggested it may be more common in depression than in schizophrenia
  • This response may be a common “end state” reaction to feelings of imminent doom and is found in many animals about to be attacked by a predator
  1. Atypical features specifier
  • applies to both depressive episodes
  • individuals with this specifier consistently oversleep and overeat during their depression and therefore gain weight,

leading to a higher incidence of diabetes

  • can react with interest or pleasure to some things, unlike most depressed individuals.
  • Associated with a greater percentage of women and an earlier age of onset.
  • Has more symptoms, more severe symptoms, more suicide attempts, and higher rates of comorbid disorders including alcohol use disorder
  1. Peripartum onset specifier
  • Peri means “surrounding”—in this case, the period of time just before and just after the birth
  • apply to both major depressive and manic episodes
  • Peripartum Depression
  • Somewhat higher incidence of depression is found postpartum (after the birth) than during the period of pregnancy itself
  • Fathers don’t entirely escape the emotional consequences of birth
  • Depression in fathers was associated with adverse emotional and behavioral outcomes in children 3.5 years later
  • psychological interventions for paternal peripartum depression has a positive impact on the father and also on the father-child and the marital relationship
  • guidelines for treating and preventing peripartum depression include cognitive behavioral therapy and interpersonal therapy
  • baby blues — typically last a few days and occur in 40% to 80% of women between 1 and 5 days after delivery.
  • New mothers may be tearful and have some temporary mood swings, but these are normal responses to the stresses of childbirth and disappear quickly; the peripartum onset specifier does not apply to them
  • In peripartum depression, most people, including new mothers, have difficulty understanding why they are depressed because they assume this is a joyous time.
  • some evidence that women with a history of peripartum depression meeting full criteria for an episode of major depression may be affected differently by the rapid decline in reproductive hormones that occurs after deliver or may have elevated corticotrophin- releasing hormone in the placenta and that these factors may contribute to peripartum depression
  • But these findings need replication
  • peripartum depression did not require a separate category in DSM- 5 and is simply a specifier for a depressive disorder
  1. Seasonal pattern specifier
  • Applies to recurrent major depressive

optimism prevents depression after medical illnesses and promotes longevity Some cultures have their own idioms for depression: heartbroken; weakness or injury of the spirit CAUSES Genetics (Familial and Genetic Influences)

  • three separate genetic factors underlie the syndrome of major depression: o factor associated with cognitive and psychomotor symptoms o factor associated with mood o factor with neurovegetative (melancholic) symptoms Evidence supports the assumption of a close relationship among depression and anxiety (as well as other emotional disorders) Neurotransmitter Systems
  • we are more impulsive and our moods swing more widely when our levels of serotonin are low
  • one of the functions of serotonin is to regulate systems involving norepinephrine and dopamine
  • Permissive Hypothesis o When serotonin levels are low, other neurotransmitters are “permitted” to range more widely, become dysregulated, and contribute to mood irregularities, including depression
  • Chronic stress also reduces dopamine levels and produces depressive-like behavior The Endocrine System
  • Stress Hypothesis o focuses on overactivity in the hypothalamic–pituitary– adrenocortical (HPA) axis (discussed later), which produces stress hormones.
  • Investigators became interested in the endocrine system when they noticed that patients with diseases affecting this system sometimes became depressed
  • neurohormones o are an increasingly important focus of study in psychopathology
  • dexamethasone suppression test (DST) o Dexamethasone glucocorticoid that suppresses cortisol secretion in normal participants ▪ IF substance was given to patients who were depressed, much less suppression was noticed than in normal participants
  • Individuals experiencing heightened levels of stress hormones over a long period undergo some shrinkage of a brain structure called the hippocampus.
  • Long-term overproduction of stress hormones makes the organism unable to develop new neurons (neurogenesis) o some theorists suspect that the connection between high stress hormones and depression is the suppression of neurogenesis in the hippocampus. o Successful treatments for depression, including electroconvulsive therapy , seem to produce neurogenesis in the hippocampus, thereby reversing this process o Exercise increases neurogenesis, which could possibly be one mechanism of action in successful psychological treatments utilizing exercise, such as behavioral activation described below
  • Microbiota o the bacteria and other microorganisms residing in the human intestines Sleep and Circadian Rhythms
  • Sleep disturbances are a hallmark of most mood disorders
  • Most important, in people who are depressed, there is a significantly shorter period after falling asleep before rapid eye movement (REM) sleep begins.
  • When we first fall asleep, we go through several substages of progressively deeper sleep during which we achieve most of our rest.
  • After about 90 minutes, we begin to experience REM sleep, when the brain arouses, and we begin to dream
  • Rapid Eye Movement o Eyes move rapidly back and forth under our eyelids
  • Depressed patients experience REM activity that is more intense and the stages of deepest sleep, called slow- wave sleep , don’t occur until later, if at all
  • seems that some sleep characteristics occur only while we are depressed and not at other times
  • other evidence suggests that, at least in more severe cases with recurrent depression, disturbances in sleep continuity, as well as reduction of deep sleep, may be present even when the individual is not depressed
  • unusually short and long sleep durations were associated with an increased risk for depression in adults
  • Insomnia o frequently experienced by older adults, is a risk factor for both the onset and persistence of depression o found that treating insomnia directly in those patients who have both insomnia and depression may enhance the effects of treatment for depression
  • Negative mood predicted sleep disruptions, and sleep disruptions subsequently resulted in negative mood
  • seems that the relationship between sleep and mood may cut across different diagnoses and that treating sleep disruptions directly might positively affect mood not only in insomnia but also in mood disorders
  • because sleep patterns reflect a biological rhythm, there may be a relationship among SAD, sleep disturbances in depressed patients, and a more general disturbance in biological rhythms
  • substantial disruption in circadian rhythm might be particularly problematic for some vulnerable individuals
  • abnormal sleep profiles and, specifically, disturbances in REM sleep and poor sleep quality predict a somewhat poorer response to psychological treatment o Supports potential usefulness of treating disrupted sleep directly. Additional Studies if Brain Structures and Function
  • Alpha Waves o A type of brain wave activity that indicate calm, positive feelings
  • Brain function might also exist before the individual becomes depressed and represent a vulnerability to depression. Evidence: o Depressed individuals exhibit greater right-sided anterior activation of their brains, particularly in the prefrontal cortex o right-sided anterior activation was also found in patients who are no longer depressed
  • adolescent offspring of depressed mothers tend to show this pattern, compared with offspring of nondepressed mothers o this type of brain functioning could become an indicator of a biological vulnerability to depression
  • bipolar spectrum patients o show elevated rather than diminished relative left-frontal EEG activity and that this brain activity predicts the onset of a full bipolar I disorder
  • anterior cingulate cortex and the amygdala for clues to understanding brain function in depression o some areas are less active, and other areas more active, in people with depression Stress and Depressive
  • the significance of a major event is not easily discovered, so most investigators have stopped simply asking patients whether something bad (or good) happened and have begun to look at the context of the event, as well as the meaning it has for the individual. o This approach to studying life events, was developed by George W. Brown
  • Brown’s study of life events is difficult to carry out, and the methodology is still evolving
  • Scott Monroe and Constance Hammen have developed new methods.
  • Crucial issue is the bias inherent in remembering events: o Current moods distort memories, many investigators have concluded that the only useful way to study stressful life events is to follow people prospectively , to determine more accurately the precise
  • Tendency to interpret everyday events in a negative way
  • Types of Cognitive Errors : a. Arbitrary Inference is evident when a depressed individual emphasizes the negative rather than the positive aspects of a situation. b. Overgeneralization when your professor makes one critical remark on your paper, you then assume you will fail the class despite a long string of positive comments and good grades on other papers
  • Depressive Cognitive Triad o They make cognitive errors in thinking negatively about themselves, their immediate world, and their future
  • Negative Schema o an enduring negative cognitive belief system about some aspect of life 1. Self-blame Schema individuals feel personally responsible for every bad thing that happens 2. Negative Self- evaluation Schema they believe they can never do anything correctly
    • Minor negative events can lead to a major depressive episode.
    • People prone to depression are more likely to recall negative events when they are depressed than when they are not depressed or than are nondepressed individuals
    • By recognizing cognitive errors and the underlying schemas, we can correct them and alleviate depression and related emotional disorders An integration
  • Students at high risk because of dysfunctional attitudes reported higher rates of depression in the past compared with the low-risk group.
  • Negative cognitive styles do indicate a vulnerability to later depression
  • Children at high risk for depression because of a depressed mother showed depressive cognitive styles when under minor stress, unlike children not at risk.
  • This cognitive vulnerability to depression can be contagious (e.g. dorm mate)
  • Cognitive vulnerabilities to developing depression do exist and, when combined with biological vulnerabilities, create a slippery path to depression Social and Cultural Dimensions
  • disruptions in relationships often lead to depression
  • personality and failures in interpersonal relationships played a stronger etiologic role in major depression for women than for men
  • divorce, social support, marital satis- faction, parental warmth, and neuroticism had a greater impact in women
  • childhood sexual abuse, conduct disorder, drug abuse, prior history of major depression, and stressful life events (related to financial, occupational, and legal issues) had a greater impact on men An Integrative Theory
  • serotonin transporter gene-linked polymorphic region o this vulnerability is simply a general tendency to develop depression (or anxiety) rather than a specific vulnerability for depression or anxiety itself. Treatment
  • electroconvulsive therapy
  • Antidepressants
  1. selective-serotonin reuptake inhibitors (SSRIs)
  • Block the presynaptic reuptake of serotonin. Actual suicide rates were lower in sections of

the United States where prescriptions for SSRIs were higher. Correlational , we can’t conclude that increased prescriptions for SSRIs caused lower suicide rates.

  1. Mixed Reuptake inhibitors - blocking reuptake of norepinephri ne as well as serotonin
  2. Monomine oxidase (MAO) inhibitors - They block the enzyme MAO that breaks down such neurotransm itters as norepinephri ne and serotonin. - But MAO inhibitors are used far less often because of two potentially serious consequenc es: Eating and drinking foods and beverages containing tyramine— such as cheese, red wine, or beer—can lead to severe hypertensive episodes and, occasionally , death Many other drugs that people take daily, such as cold medications, are dangerous and even fatal in interaction with an MAO inhibitor.
  • Tricyclic antidepressants o the most widely used treatments for depression before the introduction of SSRIs but are now used less commonly o they block the reuptake of certain neurotransmitters, allowing them to pool in the synapse and, as the theory goes, desensitize or down- regulate the transmission of that particular neurotransmitter o seem to have their greatest effect by down-regulating norepinephrine, although other neurotransmitter systems, particularly serotonin, are also affected o tricyclics are lethal if taken in excessive doses
  • St. John’s wort (hypericum) o natural herb
  • Treatment-Resistant Depression o when depression does not respond adequately to drug treatment o Sequenced Treatment Alternatives to Relieve Depression (STAR*D) examined whether it is useful to offer those individuals who did not achieve remission the alternatives of either adding a second drug or switching to a second drug
  • All antidepressant medications work about the same in large clinical trials, but

depressed and to recognize “depressive” errors in thinking o Treatment involves correcting cognitive errors and substituting less depressing and (perhaps) more realistic thoughts and appraisals o Underlying negative cognitive schemas (characteristic ways of viewing the world) that trigger specific cognitive errors are targeted o Therapist purposefully takes a Socratic approach (teaching by asking questions making it clear that therapist and client are working as a team to uncover faulty thinking patterns and the underlying schemas from which they are generated o Advantage to this line of inquiry is that the therapist introduced Irene to the idea of looking at her own thoughts, which is central to cognitive therapy

  • Cognitive-Behavioral Analysis System of Psychotherapy (CBASP) o Which integrates cognitive, behavioral, and interpersonal strategies and focuses on problem-solving skills, particularly in the context of important relationships. o Designed for individuals with persistent (chronic) depression and has been tested in a large clinical trial
  • Mindfulness-based therapy o found to be effective for treating depression and preventing future depressive relapse and recurrence o These techniques have also been combined with cognitive therapy in mindfulness-based cognitive therapy ▪ Found effective for the most part in the context of preventing relapse or recurrence in patients who are in remission from their depressive episode. ▪ This approach seems particularly effective for individuals with more severe disorders, as indicated by a history of three or more prior depressive episodes - Neil Jacobson o increased activities alone can improve self-concept and lift depression Interpersonal Psychotherapy
  • major disruptions in our interpersonal relationships are an important category of stresses that can trigger mood disorders
  • people with few, if any, important social relationships seem at risk for developing and sustaining mood disorders
  • Interpersonal psychotherapy (IPT) o Focuses on resolving problems in existing relationships and learning to form important new interpersonal relationships. o Highly structured and seldom takes longer than 15 to 20 sessions, usually scheduled once a week o Identifying life stressors that seem to precipitate the depression o Patient’s current interpersonal problems ▪ Typically:
  1. Dealing with interpersona l role disputes
  2. Adjusting to the loss of a relationship
  3. Acquiring new relationships
  4. Identifying and correcting deficits in social skills o Next step is to bring it to a resolution ▪ Stage of the dispute 1. Negotiation stage Both partners are aware it is a dispute, and they are trying to renegotiate it. 2. Impasse stage The dispute smolders beneath the

surface and results in low-level resentment, but no attempts are made to resolve it.

3. Resolution stage The partners are taking some action, such as divorce, separation, or recommittin g to the marriage. o Marital therapy ▪ Applicable to the large numbers of depressed patients they see, particularly women, who are in the midst of dysfunctional marriages

  • Psychological approaches and medication are equally effective immediately following treatment, and all treatments are more effective than placebo conditions, brief psycho- dynamic treatments, or other appropriate control conditions for both major depressive disorder and persistent depressive disorder
  • Depending on how “success” is defined, approximately 50% or more of people benefit from treatment to a significant extent, compared with approximately 30% in placebo or control conditions
  • IPT should be the first choice for pregnant depressed women, although it is likely that CBT would produce similar results. Suicide
  • Suicide is not attempted only by adolescents and adults.
  • Several reports exist of children 2 to 5 years of age who had attempted suicide at least once, many injuring themselves severely
  • suicide is the fifth leading cause of death from ages 5 to 14
  • males are four times more likely to die by suicide than females
  • Males generally choose far more violent methods, such as guns and hanging; females tend to rely on less violent options, such as drug overdose
  • Three other important indices of suicidal behavior:
  1. Suicidal ideation (thinking seriously about suicide)
  2. Suicidal plans (the formulation of a specific method for killing oneself)
  3. Suicidal attempts (the person survives) (nonfatal)
  • Attempters o self-injurers with the intent to die
  • Gesturers o self-injurers who intend not to die but to influence or manipulate somebody or communicate a cry for help
  • depression is strongly related to suicide attempts Causes
  • Suicide types: o Formalized suicides Approved of, such as the ancient custom in Japan of hara-kiri (lit. stomach-cut) Hara-kiri
  • individuals slit open their stomach and another person beheaded them Altruistic suicide
  • purpose of hara-kiri, or seppuku, was to preserve one’s honor Egoistic suicide
  • loss of social supports as an important provocation for suicide Anomic
  • suicides are the result of marked disruptions, such as the sudden loss of a high- prestige job.
  • Anomie — feeling lost and confused Fatalistic suicides
  • result from a loss of control over one’s own destiny

burdensomeness, feeling trapped)

  1. Suicidal capability (past attempts, high anxiety and/ or rage, available means)
  2. Suicidal intent (available plan, expressed intent to die, preparatory behavior) If all three conditions are present, immediate action is required.
  • Empirical research indicates that cognitive-behavioral interventions can be efficacious in decreasing suicide risk.