Major Depression – Module 46Major Depression – Module 46Bipolar Disorder – Module 46Bipolar Disorder – Module 46Phobias – Module 44Phobias – Module 44
General Psych 2
Class #28May 6, 2004
Depression: The "common cold" Depression: The "common cold" of mental health problemsof mental health problems An extreme condition persisting for most of each day for
a period of months or longer Lifetime prevalence rates ranging from 12-17% with
about 5-10% of the general population right now (over 19M in U.S.)
Sex difference: F > M (women are at least twice as likely to suffer from depression as men and this is has been the case for about 40 years)
Prevalence is unrelated to ethnicity, education, income, or marital status
The highest rates for this disorder are in the 25-44 year-old age group
SymptomsSymptoms
(1) Cognitive Negative beliefs about oneself (feelings of
worthlessness) Preoccupation with death and suicide Low motivation (loss of interest in anything – and no
point in trying anyway) Impaired thinking – problems solving intellectual and
social problems especially those involving memory (this problem doesn't seem to be because of the low motivation)
SymptomsSymptoms
(2) MotorPsychomotor retardation – appears to be a
slowdown in physical activity (they may just want to stay in bed; weight of the world on their shoulders, lethargy, etc.)
Psychomotor agitation – hyperactive fidgeting or pacing
SymptomsSymptoms
(3) Physical Disturbed sleep (insomnia and hypersomnia) Disturbed eating patterns (poor appetite and
significant Weight loss and in less often cases the opposite can
occur) Decreased sexual drive (in rare cases hypersexuality) Increased physical illnesses (immune system
declines)
Onset and DurationOnset and Duration Onset
– Average age at onset is 25, but this disorder may begin at any age
– Psychological stress appears to play a prominent role in triggering the first 1-2 episodes of this disorder, but not in subsequent episodes
Duration – An average episode lasts about 9 months to one
year – The risk of recurrence is about 70% at 5 year
follow up and at least 80% at 8 year follow-up
What triggers depression?What triggers depression?
Cognitive Explanation– Incorrect Negative Beliefs– Learned Helplessness
What triggers depression?What triggers depression? Physiological psychologists are not exactly
sure but several important factors have been identified…– Physiological Explanations
(1) Low levels of brain activity (2) Structural problems
(3) Familial Pattern And Genetics (4) Prenatal illness (5) Low levels of neurotransmitters
What triggers depression?What triggers depression? Low levels of brain activityLow levels of brain activityThese parts of the brain of depressed
individuals are underactive:– Left prefrontal cortext – an area responsible for
much of our thinking…where we decide what to do and feel.
– Cingulate Gyrus – reduced flow of information between parts of our brain
– Basal Ganglia – plays a role in motor activity
What triggers depression?What triggers depression? Structural problemsStructural problemsLeft prefrontal cortex is smaller
– May account for it being less active and slowed thinking and difficulty in problem solving as well
What triggers depression? What triggers depression? Familial Pattern And GeneticsFamilial Pattern And Genetics
There is strong evidence that major depression is, in part, a genetic disorder: – Individuals who have parents or siblings with Major
Depressive Disorder have a 1.5-3 times higher risk of developing this disorder • The concordance for major depression in
monozygotic twins is substantially higher than it is in dizygotic twins
• However, the concordance in monozygotic twins is in the order of about 50%, suggesting that factors other than genetic factors are also involved
What triggers depression? What triggers depression? Familial Pattern And GeneticsFamilial Pattern And Genetics Children adopted away at birth from biological
parents who have a depressive illness carry the same high risk as a child not adopted away, even if they are raised in a family where no depressive illness exists
Researchers suspect that there is a genetic connection, but to date, no "depressive gene" has been discovered
What triggers depression? What triggers depression? Low levels of neurotransmittersLow levels of neurotransmitters Unusually low levels of serotonin,
epinephrine and norepinephrine
Drug treatmentDrug treatment Antidepressant drugs attempt to elevate low levels of
neurotransmitters in the brain All antidepressants are equally effective in that they
elevate mood in 60%-80% of people They take at least 2-3 weeks to start showing subtle
improvements and up to 4-6 weeks to feel the full effect
Common drugs such as Prozac, Zoloft, Paxil, Celexa act to inhibit the reuptake of serotonin and norepinephrine thus increasing their availability in the brain
These are safe, non-addicting drugs and not found to be fatal in overdose
But don't stop taking them abruptly – you may experience a variety of flu-like symptoms – taper off slowly
How long?How long?
1st episode: 6-12 months or so2nd episode: 1-2 years3rd episode: likely for life
Side-EffectsSide-Effects Include several sexual side effects for both
men and women, sleep disruptions, headaches, excessive sweating, nausea, upset stomach, diarrhea, drowsiness, tremor, sometimes a decrease in weight and in lesser cases weight gains, occasionally will cause an over sensitivity to sunlight
• Good news – these all usually will subside after a few weeks
• Bad news – high relapse rates: drugs are a treatment for depression but not a cure
Bipolar DisorderBipolar Disorder Formerly referred to as manic-depression
disorder Prevalence: About 1% Onset: Usually begins between 15-25 No sex difference These people alternate between depression
and mania – manic phase is usually somewhat shorter– Like slow motion vs. fast-forward
Manic PhaseManic Phase
Symptoms– Cognitive symptoms
• Inflated self-esteem• Grandiosity – unrealistic optimism and delusions of
grandeur• Distractibility• Manic flight of ideas• Delusions• Over-talkative with loud speech, sometimes hard to
interrupt• Easily irritated if crossed• Over-involvement in activities• No or few sexual inhibitions• Increased thought processes
Manic PhaseManic Phase
Motor Symptoms– Constant running from one thing to another
Physical Symptoms– High energy– Little need for sleep
Important Note…Important Note…
Individuals experiencing mania need to be protected from the consequences of their own poor judgments…– Often, they will go on reckless spending sprees
or partake in extremely risky investments– Poor self-control
• But, be prepared…they will be irritated by those providing advice
One PositiveOne Positive
The energy and free-floating thinking characteristic of mania can fuel creativity
Unusually high rate of bipolar disorder among poets, artists, and creative writers
Bipolar DisorderBipolar Disorder Treatments
– Mood stabilizers such as:• Lithium• Depokote
Phobic DisordersPhobic Disorders
Fear has no justification in realityFear is greater than is justifiedIndividual is aware of irrationality of fear
Phobic DisordersPhobic Disorders
Social phobiaAgoraphobiaSpecific phobias
What is Social Phobia?What is Social Phobia? Irrational fear that they will behave in an
embarrassing way Is limited to situations in which the scrutiny of
others is likely Extreme form of shyness that interferes
significantly with an individual’s functioning These individuals avoid all social situations Recent study says over 13% of general
population but other studies say its about 4% Sex difference: Slightly more women than men Average onset: early adolescence
SymptomsSymptoms
Avoidance of all social situationsHigh anxiety if ever placed in a social
situationRapid heart rateElevated blood pressureHistory of phobia
What causes social phobia?What causes social phobia?
Basically unknown but…– Possible biological reasons: scarcity
of serotonin– Possible environmental factors…
Agoraphobia Agoraphobia “fear of the marketplace”“fear of the marketplace”These people suffer from intense anxiety
when in a place where escape would be difficult or embarrassing if they were to experience a panic attack
Fear being in a place where they can’t get help
In extreme cases, they may not leave their house
AgoraphobiaAgoraphobia
Key points: – They do not fear people per se, but rather
they fear being around people because they believe something will happen that they can’t control and will cause them embarrassment (for example: a panic attack)
– They are very good at concealing their problem
Prevalence and OnsetPrevalence and Onset Prevalence
– Estimated 5%-12% of general population will suffer from agoraphobia
Sex difference: – Women 7% – Men 3.5%
Onset: Usually occurs in their 20’s
Possible CausesPossible Causes
Unknown– Over the years there have been many
theories about the cause of agoraphobia ranging from inner ear dysfunction, genetic predisposition, social learning – observing the anxious behavior of a parents, chemical imbalances, etc.
TreatmentsTreatments
Usually a medication and psychotherapy combo
Commonly anti-depressants and anti-anxiety meds are used: – Prozac, Paxil, Zoloft, Elavil, etc.– Xanax, Klonipin, etc.
Cognitive-Behavioral TreatmentCognitive-Behavioral Treatment
Most common treatment is systematic desensitization…– Breathing and relaxation techniques are
sometimes used in conjunction with systematic desensitization
PrognosisPrognosis
Very good – 90% improve
Specific PhobiasSpecific Phobias DSM-IV classifies all other phobias (besides social
phobia and agoraphobia) as “specific phobias” We’re talking about specific objects or situations here Sex difference:
– Women 16% – Men 7%
Associated features: depressed mood and dependent personality
Exposure to the phobic stimulus may lead to a panic attack
As with other phobias, the person recognizes that the fear is excessive and unreasonable