Module 23: Mood Disorders & Schizophrenia

1. Module 23: Mood Disorders & Schizophrenia Virginia Union University Introduction to Psychology

2. Mood Disorders • A prolonged and disturbed emotional state that affects almost all of the person’s thoughts, feelings & behaviors • 3 of the most common • Major depressive disorder • Bipolar I disorder • Dysthymic disorder

3. Mood Disorders • Major Depressive Disorders • About 16% of US adults report at least one episode of depression • Women outnumbering men, 2 to 1 • Marked by at least 2 weeks of continually being in a bad mood, having no interest in anything, and getting no pleasure from activities. • Person must have at least 4 of the following symptoms: • Problems with • Eating • Sleeping • Thinking • Concentrating • Making decisions • Lacking energy • Thinking about suicide • Feeling worthless or guilty

4. Mood Disorders • Bipolar I Disorder • About 1.3% of the population suffer from bipolar I disorder • 1.6% suffer from only manic episodes • Marked by fluctuations between episodes of depression and mania • A manic episode goes on for at least a week, during which a person is unusually euphoric, cheerful, and high and has at least 3 of the following symptoms: • Has great self-esteem • Has little need for sleep • Speaks rapidly and frequently • Has racing thoughts • Is easily distracted • Pursues pleasurable activities

5. Mood Disorders • Dysthymic Disorder • Affects about 6% of the population; less serious than major depression • Feeling “down in the dumps” • Characterized by being chronically but not continuously depressed for a period of two years • While depressed, a person experiences at least 2 of the following symptoms: • Poor appetite • Insomnia • Fatigue • Low self-esteem • Poor concentration • Feelings of hopelessness

6. Mood Disorders • SAD (Seasonal Affective Disorder) • Depression as a result of a decrease in the number of sunny days • Occurs in fall and winter months, recovery in the summer months

7. Mood Disorders • Causes • Biological Factors – genetic, neurological, chemical & physiological components that may predispose or put someone at risk for developing a mood disorder

8. Mood Disorders • Causes • Biological Factors • Genetic factor • 40-60% of susceptibility to depression is genetic • Not a single gene, but a combination of genes • Deficits in specific genes affect sensitivity to stress • Genes involved in regulating the brain’s neurotransmitters or chemical systems used in communication

9. Mood Disorders • Causes • Biological Factors • Neurological factors • Chemical imbalance in the brain • Group of neurotransmitters called monoamines (serotonin, norepinephrine, dopamine) involved in mood problems • Continued stress alters the brain & body’s stress management system, altering hormonal & neurotransmitter levels & can trigger depression

10. Mood Disorders • Causes • Biological Factors • Brain scans • Brain area called the anterior cingulate cortex shown to be overactive in depressed patients • Depression treated by stimulating (and reducing activity) in this brain region

11. Mood Disorders • Causes • Psychosocial Factors – such as personality traits, cognitive styles, social supports, and the ability to deal with stressors, interact with predisposing biological factors to put one at risk for developing a mood disorder

12. Mood Disorders • Causes • Psychosocial Factors • Stressful live events • Strongly related to the onset of mood disorders

13. Mood Disorders • Causes • Psychosocial Factors • Negative cognitive style(Negative way of thinking) • Depression may result from one’s perceiving the world in a negative way, which in turn leads to feeling depressed

14. Mood Disorders • Causes • Psychosocial Factors • Personality factors • Individuals who are especially sensitive to and overreact to negative events with feelings of fear, anxiety, guilt, sadness, and anger are at risk for developing a mood disorder • Socially dependent people or individuals who make their self worth contingent on what others say or think have increased risk of depression • Need for control also influences depression risk when uncontrollable stress encountered

15. Mood Disorders • Causes • Psychosocial Factors • Depressed mothers • Mother’s depression influences child’s susceptibility for depression, even if the child is adopted • Mother’s treatment produces positive outcomes for the child too

16. Mood Disorders • Treatment • Major depression & dysthymic disorder • Antidepressants – act by increasing the levels of a specific group of neurotransmitters (monoamines – serotonin, norepinephrine, and dopamine) that are involved in the regulation of emotions and moods • SSRIs (Selective Serotonin Reuptake Inhibitors) • 80% of antidepressants are SSRIs, raise the level of the neurotransmitter serotonin • Antidepressants – most commonly prescribed medication in the US, used by 10% of the population • Effectiveness of antidepressants • May take up to 8 weeks to work, symptoms for only 1/3 will go away • Some antidepressants work better than others, depends on the individual

17. Mood Disorders • Treatment • Major depression & dysthymic disorder • Psychotherapy • Less severe depression – psychotherapy as effective as antidepressants • More severe depression – combo of psychotherapy & antidepressants most effective • Relapse • 70% of patients relapsed 18 months after treatment, required additional treatment • Depression viewed as a chronic disease or long-term disease • 30% maintained recovery – patients treated with psychotherapy less likely to relapse

18. Mood Disorders • Treatment • Bipolar I disorder • Drugs • Mood stabilizer lithium combined with other drugs • Lithium thought to prevent manic episodes by preventing neurons from being overstimulated • 50% of patients who stop taking lithium experience a manic episode • Only 50% of patients are helped by the drug combo (30% partially helped, 20% little to no help) • Relapse • 10-30% of patients receive no help from current drugs • 30-70% initially improve but later relapse • Researchers continue to look for new ways to treat mood disorders • Electroconvulsive Therapy (ECT) – treatment of last resort

19. Electroconvulsive Therapy (ECT) Involves placing electrodes on the skull and administering a mild electric current that passes through the brain and causes a seizure. Usual treatment consists of a series of 10 to 12 ECT sessions, at the rate of about 3 per week Used as a last resort for the 40% of patients whose depression doesn’t decrease from the use of antidepressants In the US, ECT is currently used for 100,000 patients/year

20. Effectiveness of ECT • ECT as last resort • Risks: may cause varying degrees of memory loss • Gradual improvement in memory after ECT, for most memory returns to normal • ECT effective in reducing depressive symptoms in 70-90% of patients • Avg. relapse rate after ECT exceeds 50%, patients may need antidepressants after ECT or additional ECT treatments for depression • No evidence to suggest that ECT causes brain damage

21. Transcranial Magnetic Stimulation (TMS) • New treatment option for treatment-resistant depression • Transcranial Magnetic Stimulation (TMS) • Noninvasive technique that activates neurons by sending pulses of magnetic energy in the brain • Depressed patients who did not respond to antidepressants experienced improvement after 40 mins of TMS daily for 4 weeks • Side effects may occur (headache, lightheadness, scalp discomfort), less severe than ECT (unlikely to cause seizures & doesn’t require anesthesia)

22. Personality Disorders Consists of inflexible, long-standing, maladaptive traits that cause significantly impaired functioning or great distress in one’s personal & social life Found in about 9% of the population Affect men & women equally, gender influences which personality disorder develops

23. Personality Disorders • Seven most common personality disorders • Paranoid personality disorder • Pattern of distrust & suspiciousness & perceiving others as having evil motives (0.5-2.5% of the pop.) • Schizotypal personality disorder • Acute discomfort in close relationships, distortions in thinking & eccentric behavior (3-5% of the pop.) • Histrionic personality disorder • Excessive emotionality & attention seeking (2% of the pop.)

24. Personality Disorders • Seven most common personality disorders • Obsessive-compulsive personality disorder • Intense interest in being orderly, achieving perfection & having control (4% of the pop.) • Dependent personality disorder • Pattern of being submissive & clingy because of an excessive need to be taken care of (2% of the pop.) • Borderline personality disorder • Pattern of instability in personal relationships, self-image & emotions as well as impulsive behavior (2% of the pop.) • Antisocial personality disorder • Pattern of disregarding or violating the rights of others without feeling guilt or remorse (3% of pop., predominantly male)

25. Personality Disorders • Borderline Personality Disorder • Intense, unpredictable emotional outbursts & lack impulse control causing them to express inappropriate anger & engage in dangerous behaviors • Emotionally erratic – express love & rage simultaneously, emotionally volatile, unable to maintain stable relationships • 75% hurt themselves through self-mutilation • 10% eventually commit suicide

26. Personality Disorders • Borderline Personality Disorder • Causes • Environmental & genetic causes • Experienced trauma in childhood • Overactive amygdala (emotional center of brain) • Underactive area of brain that controls emotional responses • Impulsivity & aggression are heritable • Treatment • Dialectical behavior therapy most effective • A type of cognitive-behavioral therapy that helps patient identify thoughts, beliefs & assumptions that make their life challenging & teaches them different ways to think & react

27. Personality Disorders • Antisocial Personality Disorder • Killers from ‘Most Evil’ • 50-80% of prisoners meet criteria for antisocial personality disorder • Not all are alike, diagnostic symptoms vary along a continuum • One end: delinquents, bullies, lawbreakers • Other end: serial killers

28. Personality Disorders • Antisocial Personality Disorder • Causes • Psychosocial factors • Aggressive & antisocial children who are difficult to control • Early appearance of behavioral problems (temper tantrums, bullying, torturing animals, habitual lying) • Children who experience physical or sexual abuse

29. Personality Disorders • Antisocial Personality Disorder • Causes • Biological factors • Genetic factors • Genetics contribute 30-50% to the development of antisocial personality disorder • Neurological factors • Prefrontal cortex damage/impairment • Involved in important executive functioning, such as making decisions & planning

30. Personality Disorders • Antisocial Personality Disorder • Treatment • Psychotherapy not shown to be effective, patient does not see their behaviors as wrong • Drugs tried that raise brain serotonin levels • Serotonin may underline impulsive & aggressive behaviors • For 69% of patients, antisocial personality disorder is an ongoing & long-term problem