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WHS AP Psychology
Unit 11: Mental Illness and Therapies
Essential Task 11-2:Discuss the major diagnostic
category of mood disorders with specific attention to
the diagnoses of major depressive disorder,
dysthymia, Bipolar I and Bipolar II, detail the defining
symptoms of each and identify the best approach(es)
for explaining the cause(es) of each.
Electroconvulsive
Therapy
We are
here
Psychosurgery
Psychoanalysis
Biological
Insight
Therapies
Treatments
ClientCentered
Gestalt
Unit 11:
Treatment of
Psychological
Disorders
Antipsychotic
Drugs
Behavior
Token
Economy
Therapies
Stress
Inoculation
Cognitive
Therapies
Beck’s
Cognitive
Therapy
Rational
Emotive
Therapy
Aversion
Therapy
Classical
Systematic
Desensitization
Flooding
Operant
Behavior
Contracting
Bipolar II
– no mania
Bipolar I
Bipolar disorders
Mood Disorders - Emotional disturbances that
interfere with normal life functioning (Axis 1)
Depressive disorders
Dysthymia
Major Depressive Single
Recurrent
Disorder
Major Depressive Episode
(building block)
A. During the same 2-week period, five or more of
the following symptoms including either 1 or 2
have been present (must be a change in
functioning)
1. Depressed mood most of the day, nearly everyday
2. Diminished interest or pleasure in all, or almost all,
activities
3. Significant changes in appetite and/or weight
4. Significant changes in sleep patterns
5. Psychomotor retardation or agitation
6. Fatigue or loss of energy
7. Feelings of worthlessness or inappropriate guilt
8. Diminished ability to concentrate or make decisions
9. Recurrent thoughts or death or suicide
Major Depressive Episode
(building block)
B. The criteria do not meet criteria for a Mixed
Episode
C. The symptoms cause clinically significant distress
or impairment in functioning
D. Not due to a General Medical Condition or
substance
E. The symptoms are not better accounted for by
Bereavement
Manic Episode (building block)
A. Distinct period of abnormally and persistently
elevated, expansive, or irritable mood, lasting at
least 1 week
B. During the mood disturbance, 3 or more of the
following symptoms have persisted (4 or more if
the mood is only irritable)
1.
2.
3.
4.
5.
6.
7.
Inflated self-esteem or grandiosity
Decreased need for sleep
More talkative than usual, or pressure to keep talking
Racing thoughts (“flight of ideas”)
Distractibility
Increase in goal-directed activity
Excessive involvement in pleasurable activities that have the potential
for negative consequences
Manic Episode (building block)
C. The symptoms do not meet criteria for
a Mixed Episode
D. The symptoms cause significant
impairment in functioning or
necessitate hospitalization to prevent
harm to self or others
E. Not due to a GMC or substance
Mixed Episode (building block)
A. The criteria are met for both a Manic
Episode and a Major Depressive
Episode (except duration) nearly
every day during at least a 1-week
period
B. The symptoms cause significant
distress or impairment in functioning
C. Not due to a GMC or substance
Hypomanic Episode
(building block)
A. Distinct period of persistently elevated, expansive, or
irritable mood lasting at least 4 days
B. During the mood disturbance, 3 (or more) of the
following symptoms have been present (4 or more if
mood is only irritable)
1.
2.
3.
4.
5.
6.
7.
Inflated self-esteem or grandiosity
Decreased need for sleep
More talkative than usual, or pressure to keep talking
Racing thoughts (“flight of ideas”)
Distractibility
Increase in goal-directed activity
Excessive involvement in pleasurable activities that have the
potential for negative consequences
Hypomanic Episode
(building block)
C. The episode is associated with an unequivocal
change in functioning that is uncharacteristic of
the person when not symptomatic
D. The mood disturbance and change in
functioning are observable to others
E. The episode is not severe enough to cause
marked distress or impairment in functioning
and does not require hospitalization
F. Not due to a GMC or substance
Mood Episodes
Mixed Episode
Mania
Hypomania
Normal Mood
Depression
Major Depressive Disorder
• One or more Major Depressive
Episodes
AND
• No history of mania or hypomania
• Specify:
– Single Episode
– Recurrent
Major Depressive Disorder
Major
Depressive
Episode
Major
Depressive
Episode
MDD, single episode
Major
Depressive
Episode
Major
Depressive
Episode
MDD, recurrent episodes
Major Depressive Disorder: Types
• Melancholic
• Catatonic
• Seasonal Pattern
• Post-partum onset
Dysthymia
A. Depressed mood most of the day, more days than not, for
at least 2 years
B. Presence, while depressed, of 2 (or more) of the
following:
1. Poor appetite or overeating
2. Insomnia or hypersomnia
3. Low energy or fatigue
4. Low self-esteem
5. Poor concentration or difficulty making decisions
6. Feelings of hopelessness
C. During the 2-year period, the person has never been
without the symptoms for more than 2 months at a time
Dysthymia
D. Not better accounted for by Major Depressive
Disorder
E. There has never been a Manic, Mixed, or
Hypomanic episode
F. Not better accounted for by another disorder
G. Not due to a GMC or substance
H. Symptoms cause clinically significant distress
or impairment in functioning
Dysthymic Disorder
Dysthymic disorder lies between a blue
mood and major depressive disorder. It is
a disorder characterized by daily
depression lasting two years or more.
Blue
Mood
Dysthymic
Disorder
Major Depressive
Disorder
Major Depression vs. Dysthymia
Recurrent
Major
Depressive
Episodes
Dysthymia
Bipolar Disorder
Formerly called manic-depressive
disorder. An alternation between
depression and mania signals bipolar
disorder.
Depressive Symptoms
Manic Symptoms
Gloomy
Elation
Withdrawn
Euphoria
Inability to make decisions
Tired
Slowness of thought
Desire for action
Hyperactive
Multiple ideas
Bipolar Disorder
Many great writers, poets, and composers
suffered from bipolar disorder. During
their manic phase creativity surged, but
not during their depressed phase.
Earl Theissen/ Hulton Getty Pictures Library
The Granger Collection
Wolfe
George C. Beresford/ Hulton Getty Pictures Library
Bettmann/ Corbis
Whitman
Clemens
Hemingway
Bipolar Disorder
Two Main Distinctions
• Bipolar I Disorder:
– Technically, this should mean Mania/Mixed +
Depression
– Actually, this means Mania/Mixed ± Depression
• Bipolar II Disorder:
– Hypomania +/- Depression (No mania ever)
• It is distinguished from Major Depressive
Disorder by the lifetime history of at last one
Manic or Mixed Episode
Bipolar I Disorder
One or more
manic episode
Manic
or Mixed
Episode
OR
OR
Depressed and
manic episodes
Major
Depressive
Episode
Manic
or Mixed
Episode
Bipolar II Disorder
One or more
hypomanic episode
OR
OR
Hypomanic
Episode
Depressed and
hypomanic episodes
Major
Depressive
Episode
Hypomanic
Episode
Unipolar vs. Bipolar Disorder
Elevated
Mood
Bipolar
Depressed
Mood
Elevated
Mood
Unipolar
Depressed
Mood
Explaining Mood Disorders
Since depression is so prevalent
worldwide, investigators want to develop a
theory of depression that will suggest ways
to treat it.
Lewinsohn et al., (1985, 1995) note that a
theory of depression should explain the
following:
1. Behavioral and cognitive
changes
2. Common causes of depression
Theory of Depression
3. Gender differences
Theory of Depression
4. Depressive episodes self-terminate.
5. Depression is increasing, especially in
the teens.
Desiree Navarro/ Getty Images
Post-partum depression
Mood Disorders
The Etiology of Depression
• Depression often triggered by stress
• However, unlikely that stress alone
causes depression
• Some people are more vulnerable to
depression – biological vulnerability;
developmental vulnerability
Biological Perspective
Genetic Influences: Mood disorders run in
families. The rate of depression is higher
in identical (50%) than fraternal twins
(20%).
Jerry Irwin Photography
Linkage analysis and
association studies link
possible genes and
dispositions for
depression.
Neurotransmitters & Depression
A reduction of
norepinephrine and
serotonin has been
found in depression.
Norepinephrine
Drugs that alleviate
mania reduce
norepinephrine.
Pre-synaptic
Neuron
Serotonin
Post-synaptic
Neuron
The Depressed Brain
PET scans show that brain energy
consumption rises and falls with manic and
depressive episodes.
Courtesy of Lewis Baxter an Michael E.
Phelps, UCLA School of Medicine
Mood Disorders
Psychological Views of Depression
Psychodynamic Views
• Freud noted similarities between
grief and depression
–
–
–
–
Theorized that depression is grief (anger &
sadness) turned against the self
Actual or symbolic loss can trigger
depression
Attachment theorists have expanded the
theory
Childhood losses/separations create
vulnerability to later depression
Mood Disorders
Psychological Views of Depression
Behavioral Views
• When people experience a decline in
rewards – particularly social rewards –
they can enter a downward spiral of
decreasing rewards that leads to
depression.
• Theoretical Problem: Does decline in
rewards cause depression, or does
depression cause decline in rewards?
Explanatory Style
Explanatory style plays a major role in becoming depressed.
Mood Disorders
Psychological Views of Depression
Cognitive Views
• Depression is the result of
ingrained, negative thought
patterns.
• Two main theories:
– Beck’s “Explanatory Style”
– Seligman’s “learned helplessness”
Mood Disorders
Psychological Views of Depression
Cognitive Views
Negative Thinking
• Maladaptive attitudes often
rooted in childhood
–
E.g.: “If I make a mistake, I’m worthless”
• These attitudes develop into
entrenched schemas
• Stress triggers negative schemas
Mood Disorders
Psychological Views of Depression
Cognitive Views
Negative Thinking
• Controlled by these schemas, self,
present & future perceived negatively
• Schemas lead to “automatic thoughts”
that continuously confirm negative
perceptions
• Schemas lead to “thinking errors”
– E.g.: “Nobody cares about me”
Mood Disorders
Psychological Views of Depression
Cognitive Views
Negative Thinking
• Considerable research supports the link
between depression and:
–
•
Maladaptive attitudes; negative schemas;
thinking errors; & automatic thoughts
However, do cognitive patterns cause
depression – or are they caused by it?
Systems Approach
Depression Cycle
1.
2.
3.
4.
Negative stressful events.
Pessimistic explanatory style.
Hopeless depressed state.
These hamper the way the individual thinks and
acts, fueling personal rejection.
Suicide
The most severe form of behavioral
response to depression is suicide. Each
year some 1 million people commit
suicide worldwide.
Suicide
• Risk Factors:
–
–
–
–
–
–
–
–
–
–
Best predictor = Prior attempt
Living alone, especially if divorced/separated
Retired/unemployed
Elderly
Loss of a loved one
Chronic illness
Financial troubles
Feelings of hopelessness
Impulsivity
Sexual identity difficulties
Suicide
• Who attempts? Who completes?
– Women: 3-4 times more likely to
attempt suicide
– Men: 3-4 times more likely to complete
suicide
– Ages 18-24: Peak age for attempting
suicide
– Ages 65+: Peak age for completing
suicide
Suicide
• Common Warning Signs
– Symptoms of depression
– Talking about death, disappearing,
“ending it all”, etc., even just in passing
– Writing letters, saying last goodbyes
– Getting rid of personal effects, making a
will
– Arranging for the care of pets, plants,
etc.
– Extravagant spending
Suicide
• Prevention
– Help the person regain ability to cope with
immediate stressors
– Maintaining supportive contact with the person
– Help the person realize that their distress is impairing
their judgment
– Help the person realize that the distress is not
endless
– Broad based programs focused on high-risk groups
– Crisis hotlines
– Call 911/ER