Abnormal Psychology: An Integrative Approach, 4th Edition, David H.

Barlow
Chapter 7: Mood Disorders and Suicide

Chapter 7
Mood Disorders and Suicide

Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow

Chapter 7: Mood Disorders and Suicide

An Overview of Mood Disorders

Mood Disorders
Gross deviations in mood
Major depressive episodes
Manic and hypomanic episodes
Types of DSM-IV-TR Depressive Disorders
Major depressive disorder
Dysthymic disorder
Double depression
Types of DSM-IV-TR Bipolar Disorders
Bipolar I disorder
Bipolar II disorder
Cyclothymic disorder

Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow

Chapter 7: Mood Disorders and Suicide

Major Depression: An Overview

Major Depressive Episode: Overview and Defining
Features
Extremely depressed mood Lasting at least 2
weeks
Cognitive symptoms (e.g., feeling worthless or
indecisive)
Disturbed physical functioning
Anhedonia Loss of pleasure/interest in usual
activities
Major Depressive Disorder
Single episode Highly unusual
Recurrent episodes More common

Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow

Chapter 7: Mood Disorders and Suicide

Dysthymia: An Overview
Overview and Defining Features
Milder symptoms of depression than major
depression
Persists for at least 2 years
Can persist unchanged over long periods > 20
years
Facts and Statistics
Late onset Typically in the early 20s
Early onset Before age 21
Greater chronicity, poorer prognosis

Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow

Chapter 7: Mood Disorders and Suicide

Double Depression: An Overview

Overview and Defining Features
Major depressive episodes and dysthymic disorder
Dysthymic disorder often develops first
Facts and Statistics
Associated with severe psychopathology
Associated with a problematic future course
High recurrence rates when dysthymia is left
untreated

Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow

Chapter 7: Mood Disorders and Suicide

Bipolar I Disorder: An Overview

Overview and Defining Features
Alternating full major depressive and manic
episodes
Facts and Statistics
Average age on onset is 18 years
Can begin in childhood
Tends to be chronic
Suicide is a common consequence

Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow

Chapter 7: Mood Disorders and Suicide

Depression Treatment

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Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow

Chapter 7: Mood Disorders and Suicide

Bipolar II Disorder: An Overview

Overview and Defining Features
Alternating major depressive and hypomanic
episodes
Facts and Statistics
Average age of onset is 22 years
Can begin in childhood
10 to 13% of cases progress to full Bipolar I
disorder
Tends to be chronic

Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow

Chapter 7: Mood Disorders and Suicide

Cyclothymic Disorder: An Overview

Overview and Defining Features
More chronic version of bipolar disorder
Manic and major depressive episodes are less
severe
Manic or depressive mood states persist for long
periods
Pattern must last for at least 2 years for adults
Must last at least 1 year for children and
adolescents
Facts and Statistics
Average age of onset is about 12 or 14 years
Cyclothymia tends to be chronic and lifelong
Most are female
High risk for developing Bipolar I or II disorder

Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow

Chapter 7: Mood Disorders and Suicide

Additional Defining Criteria

for Mood Disorders: Symptom Specifiers
Symptom Specifiers
Atypical Oversleep, overeat, weight gain, anxiety
Melancholic Severe depressive and somatic
symptoms
Chronic Major depression only, lasting 2 years
Catatonic Absence of movement, very serious
Psychotic Mood congruent hallucinations/delusions
Mood incongruent features possible, but rare
Postpartum Manic or depressive episodes after
childbirth

Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow

Chapter 7: Mood Disorders and Suicide

Additional Defining Criteria for

Mood Disorders: Course Specifiers
Course Specifiers
Longitudinal course
Past history of mood disturbance
History of recovery from depression and/or
mania
Rapid cycling pattern For Bipolar I and II
disorder only
Seasonal pattern
Depressive symptoms likely during a certain
seasons

Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow

Chapter 7: Mood Disorders and Suicide

Figure 7.2 Mood disorders and specifiers for the most recent episode of the disorder.

Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow

Chapter 7: Mood Disorders and Suicide

Mood Disorders: Additional Facts and Statistics

Worldwide Lifetime Prevalence
16.1% for Major Depression
3.6% for Dysthymia
1.3% for Bipolar
Sex Differences
Females are more likely to suffer from major depression
Difference in depression disappear at age 65
Bipolar disorders equally affect males and females
Fundamentally Similar in Children and Adults
Prevalence of Depression Does not Vary Across Subcultures
Relation Between Anxiety and Depression
Most depressed persons are anxious
Not all anxious persons are depressed

Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow

Chapter 7: Mood Disorders and Suicide

Mood Disorders: Familial and Genetic Influences

Family Studies
Rate is high in relatives of probands
Relatives of bipolar probands Risk for unipolar
depression
Adoption Studies
Data are mixed
Twin Studies
Concordance rates are high in identical twins
Severe cases have a stronger genetic contribution
Heritability rates are higher for females
Vulnerability for unipolar or bipolar disorder
Appear to be inherited separately

Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow

Chapter 7: Mood Disorders and Suicide

Mood Disorders: Neurobiological Influences

Neurotransmitters
Serotonin and its relation with other neurotransmitters
Mood disorders are related to low levels of serotonin
The permissive hypothesis
Endocrine System
Elevated cortisol
Dexamethasone suppression test (DST)
Dexamethasone depresses cortisol secretion
Persons with mood disorders show less suppression
Sleep Disturbance
Hallmark of most mood disorders
Relation between depression and sleep

Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow

Chapter 7: Mood Disorders and Suicide

Mood Disorders: Psychological Influences (Stress)

The Role of Stress in Mood Disorders
Stress is strongly related to mood disorders
Poorer response to treatment
Longer time before remission
The relation between context of life events and
mood
Whats good for you may not be good for others
Reciprocal-gene environment model

Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow

Chapter 7: Mood Disorders and Suicide

Mood Disorders: Psychological Influences

(Learned Helplessness)
The Learned Helplessness Theory of Depression
Related to lack of perceived control over life events
Depressive Attributional Style
Internal attributions
Negative outcomes are ones own fault
Stable attributions
Believing future negative outcomes will be ones fault
Global attribution
Believing negative events disrupt many life activities
All three domains contribute to a sense of hopelessness

Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow

Chapter 7: Mood Disorders and Suicide

Mood Disorders: Psychological Influences

(Cognitive Theory)
Aaron T. Becks Cognitive Theory of Depression
Depressed persons engage in cognitive errors
A tendency to interpret life events negatively
Types of Cognitive Errors
Arbitrary inference Overemphasize the negative
Overgeneralization Negatives apply to all
situations
Cognitive Errors and the Depressive Cognitive Triad
Think negatively about oneself
Think negatively about the world
Think negatively about the future

Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow

Chapter 7: Mood Disorders and Suicide

Beck Triad

Figure 7.5 Becks cognitive triad for depression.

Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow

Chapter 7: Mood Disorders and Suicide

Mood Disorders: Social and Cultural Dimensions

Marriage and Interpersonal Relationships
Marital dissatisfaction is strongly related to depression
This link is particularly strong in males
Gender Imbalances
Females over males
Found in all mood disorders, except bipolar disorders
Gender imbalance likely due to socialization
Social Support
Related to depression
Lack of support predicts late onset depression
Substantial support predicts recovery from depression

Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow

Chapter 7: Mood Disorders and Suicide

Integrative Model of Mood Disorders

Shared Biological Vulnerability
Overactive neurobiological response to stress
Exposure to Stress
Activates hormones that affect neurotransmitter systems
Turns on certain genes
Affects circadian rhythms
Activates dormant psychological vulnerabilities
Contributes to sense of uncontrollability
Fosters a sense of helplessness and hopelessness
Social and Interpersonal Relationships are Moderators

Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow

Chapter 7: Mood Disorders and Suicide

Figure 7.7 An integrative model of mood disorders.

Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow

Chapter 7: Mood Disorders and Suicide

Treatment of Mood Disorders: Tricyclic Medications

Widely Used Examples include Tofranil, Elavil
Block Reuptake
Norepinephrine and Other Neurotransmitters
Takes 2 to 8 Weeks for the Effects to be Known
Negative Side Effects Are Common
May be Lethal in Excessive Doses

Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow

Chapter 7: Mood Disorders and Suicide

Treatment of Mood Disorders:

Monoamine Oxidase (MAO) Inhibitors
Monoamine Oxidase (MAO)
Enzyme that breaks down
serotonin/norepinephrine
MAO Inhibitors Block Monoamine Oxidase
MAO Inhibitors Are Slightly More Effective Than
Tricyclics
Must Avoid Foods
Containing Tyramine (e.g., beer, red wine, cheese)

Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow

Chapter 7: Mood Disorders and Suicide

Treatment of Mood Disorders:

Selective Serotonergic Re-uptake Inhibitors (SSRIs)

Specifically Block Reuptake of Serotonin

Fluoxetine (Prozac) is the most popular SSRI
SSRIs Pose No Unique Risk of Suicide or Violence
Negative Side Effects Are Common

Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow

Chapter 7: Mood Disorders and Suicide

Table 7.7 Efficacy of Various Antidepressant Drugs for Major Depressive Disorder

Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow

Chapter 7: Mood Disorders and Suicide

Treatment of Mood Disorders: Lithium

Lithium Is a Common Salt
Primary drug of choice for bipolar disorders
Side Effects May Be Severe
Dosage must be carefully monitored
How Lithium Works Remains Unclear

Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow

Chapter 7: Mood Disorders and Suicide

Treatment of Mood Disorders:

Electroconvulsive Therapy (ECT)
ECT
Involves applying brief electrical current to the
brain
Results in temporary seizures
Usually 6 to 10 treatments are required
ECT Is Effective for Cases of Severe Depression
Side Effects Are Few and Include Short-Term
Memory Loss
Unclear Why ECT Works
Relapse Following ECT Is Common

Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow

Chapter 7: Mood Disorders and Suicide

Electroconvulsive Therapy

CNN Movie Removed Due to Copyright

Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow

Chapter 7: Mood Disorders and Suicide

Psychological Treatment of Mood Disorders

Cognitive Therapy
Addresses cognitive errors in thinking
Also includes behavioral components
Behavioral Activation
Involves increased contact with reinforcing events
Interpersonal Psychotherapy
Focuses on problematic interpersonal
relationships
Outcomes with Psychological Treatments
Are comparable to medications

Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow

Chapter 7: Mood Disorders and Suicide

The Nature of Suicide: Facts and Statistics

Eighth Leading Cause of Death in the United States
Overwhelmingly a White and Native American
Phenomenon
Suicide Rates Are Increasing, Particularly in the
Young
Gender Differences
Males are more likely to commit suicide
Females are more likely to attempt suicide
Indices of Suicidal Behavior
Suicidal attempts
Suicidal ideations

Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow

Chapter 7: Mood Disorders and Suicide

The Nature of Suicide: Risk Factors

Suicide in the Family

Low Serotonin Levels
Evidence of a Preexisting Psychological Disorder
Alcohol Use and Abuse
Past Suicidal Behavior
Experiencing of a Shameful/Humiliating Stressor
Publicity About Suicide and Media Coverage

Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow

Chapter 7: Mood Disorders and Suicide

Summary of Mood Disorders

All Mood Disorders Share
Gross deviations in mood
Unipolar or bipolar deviations in mood
Common biological and psychological vulnerability
Occur in Children, Adults, and the Elderly
Onset, Maintenance, and Treatment are affected by
Stress
Social Support
Suicide Is an Increasing Problem
Not Unique to Mood Disorders
Medications and Psychotherapy Produce Similar Results
Relapse Rates for Mood Disorders Are High

Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow

Chapter 7: Mood Disorders and Suicide

Exploring Mood Disorders

Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow

Chapter 7: Mood Disorders and Suicide

Exploring Mood Disorders

Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow

Chapter 7: Mood Disorders and Suicide

Exploring Mood Disorders

Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow

Chapter 7: Mood Disorders and Suicide

Exploring Mood Disorders

Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow

Chapter 7: Mood Disorders and Suicide

Exploring Mood Disorders (cont.)

Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow

Chapter 7: Mood Disorders and Suicide

Exploring Mood Disorders (cont.)

Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow

Chapter 7: Mood Disorders and Suicide

Exploring Mood Disorders (cont.)

Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow

Chapter 7: Mood Disorders and Suicide

Exploring Mood Disorders (cont.)