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Lecture12 Psychopathalogy and Unipolar Depression

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Richard Ennis

Lecture 12: Psychopathology and Unipolar Depression Outline Intro to Psychopathology Models of abnormality Major classifications of mental disorders (DSM) Unipolar Depression Diagnosis and symptomology The Medical Model Four possible causes Treatment The Psychodynamic Model Causes and treatment The Cognitive-Behavioural Model Cognitive mechanisms of depression Treatments The Humanistic Model Client-centred and existential therapies The Socio-Cultural Model Group and family therapies Community psychology Clinical depression has been called the common cold of psychopathology. It affects at least 10% of the population at some point in their lives. Schizophrenia however is far less common, affecting 1.7%. Models of Abnormality 1. Medical: behaviour is symptomatic of physiological abnormality 2. Psychodynamic: behaviour is symptomatic of unresolved intrapsychic conflict 3. Behavioural: behaviour is maladaptive responding due to faulty learning; not symptomatic of underlying pathology; treat the behaviour itself 4. Cognitive: behaviour is symptomatic of faulty thinking or beliefs about self and the world 5. Humanistic: behaviour is symptomatic of inability to fulfill human needs and capabilities 6. Socio-Cultural: behaviour is symptomatic of dysfunctional environments; such as family, society, or culture • The perspectives do not necessarily contradict each other; rather they seem to borrow ideas from one another. • The DSM (the diagnostic statistical manual): th o Now in its 4 edition, called  DSM-IV o Sought to bring the abnormality models together to agree on symptomology, and in turn helps to diagnose o Disorder classifications include:  Disorders first diagnosed in infancy, childhood, and adolescence  Delirium, dementia, and other cognitive  Substance related  Schizophrenia and other psychotics  Mood disorders  Anxiety disorders  Somatoform disorders  Factitious disorders  Dissociative  Sexual and gender identity  Eating  Sleep  Impulse control Unipolar Depression • Depressive episodes are common people have bad days, it is inevitable. We need to ensure that when depression is diagnosed, that it is actually abnormal and not a random occurrence. o Diagnostic criteria for major depressive episodes:  At least 5 symptoms must be present within a two week period in order to deem a person “clinically depressed”. This personality must be opposite from who you normally are.  Symptoms include: • Depressed most of the day • Diminished interest or pleasure in activities • Significant weight loss/gain when not dieting/decrease or increase in appetite • Insomnia/hypersomnia • Psychomotor agitation/retardation • Fatigue • Feelings of worthlessness/excessive guilt • Difficulty concentrating • Recurrent thoughts of death and suicide, without a specific plan/attempts at suicide  Most of these symptoms, such as suicidal tendencies and lack of motivation, tend to contradict each other. In this example, lack of motivation stops the patient from committing suicide while depressed. • The Medical Model o Four possible causes:  Germ: you can “catch” depression as though it were a virus  Genetics: You inherit a predisposition to the disorder. • i.e.: the 5HTT gene  Neuro-anatomical: a structural problem with your nervous system causes you to get the disorder.  Neuro-chemical: neuro-transmitters effected and in turn triggers the disorder. o The Catecholamine Hypothesis:  Includes norepinephrine, epinephrine, and dopamine.  A study was conducted initially to find a cure for the common cold, where instead they stumbled upon this theory. • This drug increases levels of norepinephrine, and in turn alleviates the symptoms of depression. • “Tricyclical Antidepressants” treatment of choice o Elevated levels of norepinephrine and serotonin o Serotonin was believed to be responsible for suicidal thoughts and norepinephrine for depression in general. o These antidepressants, while they alleviated the symptoms while on the pills, did not cure depression. o T.A’s were found to have a correlation with dependence and addiction. • SSRI’s (Selective Serotonin Re-uptake Inhibitors): o Scientists found most of the correlation between amines and depression resided in simply serotonin. o Now this is usually the first choice of treatment o Inhibits re-uptake of serotonin, thereby increasing levels without adding o Prozac o Has fewer side effects and is less addictive than the T.A’s o Tends to diminish reoccurrence of the disorder • The last resort MAO Inhibitors o Mono-amine oxidate inhibitors o Not selective, very risky o Side effects include:  Taken with alcohol, cheese, fish, etc. often results in death • Psychodynamic Model o Believe that it is the result of an unresolved conflict that results in anger being turned inwards, and thereby leading to depression.  i.e.: Debbie’s Electra Issues patient has to overcome her hatred towards her mother that she had been internalizing and directing at herself. o Treatment lasts 1-2 years (being that of therapy). o If left untreated, 50% of clinical episodes heal themselves. • Cognitive-Behavioural Model o The emphasis is placed on the pessimistic interpretation that the patients seem to engage in. o Cognitive Mechanisms  The Cognitive Triad: • Negative thoughts about: o Self o Ongoing experience (misinterpretations) o The future (hopelessness)  Treated with a combination of drugs and motivational techniques (self efficacy) to regain confidence in themselves and their situations. • i.e.: Frankie and the showers the patient had to do everything by himself in order to gain confidence that he
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