Order 1364712: Essential Questions: Module 7

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ABNORMAL PSYCHOLOGY,

SIXTEENTH EDITION

James N. Butcher/Jill M.Hooley/Susan Mineka

Chapter 7

Mood Disorders

and Suicide

This new mother is experiencing postpartum blues; her mood is very labile and she cries easily.

A person with major depressive disorder may experience a loss of energy, too much or too little sleep, decreased appetite and weight loss, an increase or slowdown in mental and physical activity, difficulty concentrating, irrational guilt, and recurrent thoughts of death or suicide.

TABLE 7.1

Specifiers of Major Depressive Episodes

FIGURE 7.1

Number of Stressful Life Events Versus Probability of Major Depressive Episode. Results demonstrate the association between the number of stressful life events (between ages 21 and 26 years) and probability of a major depressive episode at age 26 as a function of 5-HTT genotype. Life events predicted a diagnosis of major depression among carriers of the s allele (ss or sl), but not among carriers of two l alleles (ll).

Source: Caspi et al., 2003. Influence of life stress on depression: Moderation by a polymorphism in the 5-HTT gene. Science, 301, 386–89. Reprinted with permission from Science, 18 July 2003, Vol. 301. Copyright © 2003 AAAS.

Functional MRI changes (see Chapter 4) in depressed patients in response to affective stimuli from pre- to posttreatment. These red and yellow images illustrate (in three different views) the increase in left prefrontal activation that occurred in a group of depressed patients following treatment compared to their activation pattern during an acute depressive episode. Thus, the red and yellow images depict the increase in cerebral blood in the left prefrontal area in response to affective stimuli from before and after successful antidepressant treatment. The second scan was obtained 8 weeks following the first scan. Patients were treated with an antidepressant medication during those 8 weeks. (This image courtesy of Richard Davidson.)

FIGURE 7.2

The key brain regions involved in affect and mood disorders are the (A) orbital prefrontal cortex and ventromedial prefrontal cortex, (B) dorsolateral prefrontal cortex, (C) hippocampus and amygdala, and (D) anterior cingulate cortex.

Source: From R. J. Davidson, Diego Pizzagalli, and Jack Nitschke. (2002). The representation and regulation of emotion in depression. In I. H. Gotlib and C. L. Hammen (Eds.), Handbook of Depression (pp. 219–44). New York: Guilford.

People who live in higher latitudes (northern climates for those in the northern hemisphere) are more likely to exhibit seasonal affective disorder, in which depression occurs primarily in the fall and winter months and tends to remit in the spring or summer months.

If a woman living in poverty is already genetically at risk for depression, the stresses associated with living in poverty may be especially likely to precipitate a major depression in her.

Children who have lost a parent through death or permanent separation may become vulnerable to depression if they receive poor subsequent care from another parent or guardian and if their environment and routine are disrupted.

FIGURE 7.3

Beck’s Cognitive Model of Depression. According to Beck’s cognitive model of depression, certain kinds of early experiences can lead to the ormation of dysfunctional assumptions that leave a person vulnerable to depression later in life if certain critical incidents (stressors) activate those assumptions. Once activated, these dysfunctional assumptions trigger automatic thoughts that in turn produce depressive symptoms, which further fuel the depressive automatic thoughts. (Adapted from Fennell, 1989.)

FIGURE 7.4

Negative Cognitive Triad. Beck’s cognitive model of depression describes a pattern of negative automatic thoughts. These pessimistic predictions center on three themes: the self, the world, and the future.

Woman are more likely than men to ruminate when they are depressed. Men, in contrast, tend to engage in distracting activities when they get into a depressed mood.

Why are people without social support networks more prone to depression when faced with major stressors?

FIGURE 7.5

Brain Activation in Response to Maternal Criticism. When healthy (never depressed) participants hear criticism from their own mothers they show significantly greater activation in dorsolateral prefrontal cortex and anterior cingulate cortex than do people who have a history of depression but who are currently fully recovered. Amgygala activation during criticism is significantly greater in formerly depressed participants than it is in controls. (Hooley et al., 2009.)

TABLE 7.2

Distinguishing between Bipolar I and Bipolar II Disorder

FIGURE 7.6

The Manic-Depressive Spectrum. There is a spectrum of bipolarity in moods. All of us have our ups and downs, which are indicated here as normal mood variation. People with a cyclothymic personality have more marked and regular mood swings, and people with cyclothymic disorder go through periods when they meet the criteria for dysthymia (except for the 2-year duration) and other periods when they meet the criteria for hypomania. People with bipolar II disorder have periods of major depression and periods of hypomania. Unipolar mania is an extremely rare condition. Finally, people with bipolar I disorder have periods of major depression and periods of mania. (Adapted from Goodwin & Jamison, 2009.)

Many highly creative people are believed to have had bipolar disorder, going through periods of intense creative productivity during manic phases, and often going through unproductive periods when clinically depressed. One such individual was the British novelist Virginia Woolf (1882–1941). Woolf committed suicide by drowning herself.

In some cultures the concept of depression as we know it simply does not exist. For example, Australian aborigines who are “depressed” show none of the guilt and self-abnegation commonly seen in more developed countries. They also do not show suicidal tendencies but instead are more likely to vent their hostilities onto others rather than onto themselves.

FIGURE 7.7

Prevalence Rates for Depression Across Several Nations. USA-NCS, United States according to the National Comorbidity Study; USA-ECA, United States according to the Epidemiological Catchment Area Study.

Source: Tsai, J. L., and Chentsova-Dutton, Y. (2002). “Understanding depression across cultures.” In I. H. Gotlib and C. L. Hammen (Eds.) Handbook of depression (p. 471). Copyright © 2002. The Guilford Press. Reprinted with permission.

FIGURE 7.8

Rates of Mood Disorders in Writers and Artists. Although it is difficult to determine a reliable diagnosis of influential writers, poets, and artists (many of whom are long ago deceased), a number of psychological historians have compiled figures such as these, which clearly indicate that such individuals are far more likely than the general population to have had a unipolar or bipolar mood disorder. (Adapted from Jamison, K. R., 1993. Touched with Fire. Free Press.)

FIGURE 7.9

Survival curve illustrating how many months following the end of treatment it took patients from the two groups before they had another episode of depression (recurrence). One group had previously received cognitive therapy (CT) and the other group had received antidepressant medication (ADM).

Source: From Hollon, et al. (2005, April). Prevention of relapse following cognitive therapy vs. medications in moderate to severe depression. Arch. Gen. Psychiat., 62(4), 417–26. © 2005 American Medical Association. Reprinted with permission.

Ernest Hemingway (left) committed suicide on July 2, 1961. Thirty-five years later to the day, his granddaughter Margaux (right) took her own life as well. The Hemingway family has endured five suicides over four generations—Ernest’s father Clarence, Ernest and his siblings Ursula and Leicester, and granddaughter Margaux.

Kurt Cobain, lead vocalist of the rock band Nirvana, died from a self-inflicted gunshot wound on April 8, 1994. He left behind his wife, Courtney Love, and their daughter, Frances, to deal with the emotional burden of his suicide. Forty to sixty percent of those who successfully commit suicide are depressed.

FIGURE 7.10

U.S. Suicide Rates by Age, Gender, and Racial Group Suicide rates are higher in males than in females and higher in whites than in African Americans.

Source: National Institute of Mental Health, October 20, 2002. Data: Centers for Disease Control and Prevention, National Center for Health Statistics.