Major Depression – Module 46 Bipolar Disorder – Module 46 Phobias – Module 44

1. Major Depression – Module 46Bipolar Disorder – Module 46Phobias – Module 44 General Psych 2 Class #28 May 6, 2004

2. Depression: The "common cold" of 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

3. Symptoms (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)

4. Symptoms (2) Motor • Psychomotor 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

5. Symptoms (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)

6. Onset 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

7. What triggers depression? • Cognitive Explanation • Incorrect Negative Beliefs • Learned Helplessness

8. 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

9. What triggers depression?Low levels of brain activity • These 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

10. What triggers depression?Structural problems • Left prefrontal cortex is smaller • May account for it being less active and slowed thinking and difficulty in problem solving as well

11. What triggers depression? Familial 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

12. What triggers depression? Familial 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

13. What triggers depression? Low levels of neurotransmitters • Unusually low levels of serotonin, epinephrine and norepinephrine

14. Drug 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

15. How long? • 1st episode: 6-12 months or so • 2nd episode: 1-2 years • 3rd episode: likely for life

16. Side-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

17. Bipolar 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

18. Manic 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

19. Manic Phase • Motor Symptoms • Constant running from one thing to another • Physical Symptoms • High energy • Little need for sleep

20. 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

21. One 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

22. Bipolar Disorder • Treatments • Mood stabilizers such as: • Lithium • Depokote

23. Phobic Disorders • Fear has no justification in reality • Fear is greater than is justified • Individual is aware of irrationality of fear

24. Phobic Disorders • Social phobia • Agoraphobia • Specific phobias

25. 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

26. Symptoms • Avoidance of all social situations • High anxiety if ever placed in a social situation • Rapid heart rate • Elevated blood pressure • History of phobia

27. What causes social phobia? • Basically unknown but… • Possible biological reasons: scarcity of serotonin • Possible environmental factors…

28. Agoraphobia “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

29. Agoraphobia • 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

30. Prevalence 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

31. Possible 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.

32. Treatments • Usually a medication and psychotherapy combo • Commonly anti-depressants and anti-anxiety meds are used: • Prozac, Paxil, Zoloft, Elavil, etc. • Xanax, Klonipin, etc.

33. Cognitive-Behavioral Treatment • Most common treatment is systematic desensitization… • Breathing and relaxation techniques are sometimes used in conjunction with systematic desensitization

34. Prognosis • Very good – 90% improve

35. Specific 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