PSY341H5 Lecture 8: Week 8 Depressive and Bipolar Disorders

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6 Nov 2018
School
Department
Course
Professor
Symptoms of depression
Cognitive
Physiological and behavioural
Emotional
Watch the video clip
Dr. Aaron beck on depression
Depressed people significantly differed from the non-depressed
Overview of mood disorders
The spectrum runs from severe depression to extreme mania
DSM-5 divides mood disorders into two general categories:
Depressive disorders: extreme sadness, loss of pleasure/interest
Bipolar disorder: mood swings, state of sadness to high euphoria
Depression
A pervasive unhappy mood disorder
Children who are depressed cannot shake their sadness - interferes with their daily
routines, social relationships, school performance, and overall functioning
History
In the past, it was mistakenly believed that depression did not exist in children in a
form comparable to that in adults
We now know:
Children do experience recurrent depression
Depression in children is not masked, but rather may be overlooked
Anatomy of depression
Depression (symptom): feeling sad or miserable
Depression (syndrome): a group of symptoms that occur together more often than by
chance
Depression (disorder):
Major depressive disorder (MDD)
Dysthymic disorder depressed mood is generally less severe but with longer-
lasting symptoms (a year or more) and significant impairment in functioning
Depression in young people
Almost all young people experience some symptoms of depression
Suicide among teens is a serious concern
90% of youngsters with depression show significant impairment in daily functions
More than sad: teen depression
What is different?
Watch the video clip
Depression and development
Experience and expression of depression change with age
In children under age 7 (as young as 3-5)
Tends to be diffuse and less easily identified Anaclitic depression (Spitz)
infants
Preschoolers
School-age children
Preteens - isolate themselves
Major depressive disorders
Diagnosis in children
Same criteria for school-age children and adolescents
Depression is easily overlooked because other behaviors attract more attention
Some features are more common in children and adolescents than in adults
Reacting irritibly to minor events
Prevalence
Between 2% and 8% of children age 4-18 experience MDD
Depression is rare among preschool and school-age children (1-2%)
The sharp increase in adolescence may result from biological maturation at puberty
interacting with developmental changes
Onset, course, and outcome
Onset may be gradual or sudden
Age of onset usually between 13 and 15 years Average episode lasts eight months
Most children eventually recover from initial episode, but the disorder does not go
away
70% recurrence within 5 years
1/3 develop bipolar disorder within 5 years of the depression
Overall outcome is not optimistic
More common in girls
Before puberty it is very similar, but it then gets higher for females
Gender, ethnicity, and culture
No gender differences until puberty; then, females are two to three times more likely
to suffer from depression
Symptom presentation is similar for both sexes, although correlates of depression
differ for the sexes
Physical, psychological, and social changes are related to the emergence of sex
differences in adolescence
Coping styles and depression
Is Distraction a Bad Thing?
Action-oriented coping style versus ruminative coping style
What are the pros and cons of using distraction to cope with depression?
What do you think would happen if you consistently use distraction when
feeling depressed
Running away from the problem
Activity
Write about a time when you felt depressed. What happened?
What were your thoughts, feelings, and how did you behave?
What made you feel better?
Psychological theories of mood disorders
Behavioural Theories
Learned helplessness theory
Cognitive Theories
Aaron Becks Theory
Reformulated learned helplessness theory
Ruminative response styles theory
Psychodynamic Theory
Interpersonal Theories
Learned helplessness
Depression results from a perceived absence of control over the outcome of a
situation
Example: The Stanford prison experiment
Watch the video clip
Cognitive theories
Focus on relationship between negative thinking and mood
Emphasize depressogenic cognitions
Hopelessness theory
Cognitive theories
Becks cognitive model: depressed individuals make negative interpretations about
life events
Biased and negative beliefs are used as interpretive filters for understanding
events
Three areas of cognitive problems
Cognitive biases and distortions
Selective attentional biases
Feelings of worthlessness, negative beliefs, attributions of failure, self-critical and
automatic thoughts
Depressive ruminative style, pessimistic outlook, and negative self-esteem
Negative thinking and faulty conclusions generalized across situations, hopelessness,
and suicidal ideation
Learned helplessness
Depression results from a perceived absence of control over the outcome of a
situation
Example: The Stanford prison experiment
Reformulated learned helplessness
Attributional style and depression: People who attribute negative events to internal,
stable, and, global causes are more likely than other people to experience learned
helplessness deficits following such events and are thus predisposed to depression
Bipolar disorder
Features a striking period of unusually and persistently elevated, expansive, or
irritable mood, alternating with or accompanied by one or more major depressive
episodes
Elation and euphoria can quickly change to anger and hostility if behavior is
impeded
May be experienced simultaneously with depression
Bipolar disorder in young people
Young people with BP display:
Significant impairment in functioning, including previous hospitalization, MDD,
medication treatment, co-occurring disruptive behavior, and anxiety disorders
History of psychotic symptoms and suicidal ideation/ attempts are common
Bipolar disorder symptoms
Symptoms include restlessness, agitation, sleeplessness, pressured speech, flight of
ideas, racing thoughts, sexual disinhibition, surges of energy, expansive grandiose
beliefs
The diagnosis of mania
Mr.jones
Bipolar disorder mania in young people
Youngsters with mania may present with atypical symptoms volatile and erratic
changes in mood, psychomotor agitation, and mental excitation
Classic symptoms for children with mania include pressured speech, racing thoughts,
and flight of ideas
Video clip: raising sadie
A mother describes her experience raising her BP daughter
BREAK
Depression and suicide
Most youngsters with depression think about suicide, and as many as one-third who
think about it, attempt it
Worldwide, the strongest risk factors are having a mood disorder and being a
young female
Ages 13 and 14 are peak periods for a first suicide attempt by those with
depression
Suicide
The suicide of tyler clementi
Watch the video clip
Discussion
Rate of suicide among 15- to 24-year-old youth has increased dramatically in the past
40 years.
How does contemporary culture differ from that of your parents and grandparents
with respect to specific factors contributing to the rise in suicide rates among the
young?
Treatment of depression
Fewer than half of children with depression receive help for their problem
Rates vary by racial/ethnic background
Cognitive-behavioral therapy (CBT)
Has shown the most success in treating children and adolescents with
depression
Aaron beck
Errors in thinking and depression
Activity: cognitive distortions
Think of a situation in which you may engage in this thinking error
Develop a brief skit that illustrates this thinking error to the rest of the class
What could someone else say in this situation that would point out and correct the
thinking error?
1) All-or-Nothing Thinking 2) Overgeneralization 3) Mental Filter 4) Disqualifying the
Positive 5) Jumping to Conclusions 6) Emotional Reasoning 7) Personalization
Treatment of depression
Interpersonal Psychotherapy for Adolescent Depression (IPT-A)
Focuses on improving interpersonal communication and has also been effective
Psychopharmacological treatments
With the exception of SSRIs, which have problematic side effects, medications
have been less effective than CBT and IPT-A
Psychosocial interventions
Behavior therapy
Focuses on increasing pleasurable activities and events, and providing the
youngster with the skills necessary to obtain more reinforcement
Cognitive therapy
Teaches depressed youngsters to identify, challenge, and modify negative
thought processes
Activity
The polar bear: try to pose for yourself this task, not to think of a polar bear, what
happens?
Psychosocial interventions
Cognitive-behavioral therapy (CBT)
Most common form of psychosocial intervention combining behavioral and
cognitive therapies
Interpersonal Psychotherapy for Adolescent Depression (IPT-A)
Focus is on depressive symptoms and social context in which they occur
Medications
Tricyclic antidepressants consistently fail to demonstrate any advantage over placebo
in treating depression in youth
SSRIs (e.g., Prozac, Zoloft, and Celexa) are the most commonly prescribed medications
for treating childhood depression
Up to 60% of depressed youngsters respond to placebo
Prevention
CBT and interpersonal psychotherapy are most effective at lowering the risk for
depression and for preventing recurrences
School-based initiatives may provide a comprehensive program to enhance protective
factors in the environment and to develop young peoples individual resiliency skills
Treatment for bipolar disorder
There is no cure for BP
A multimodal plan includes:
Monitoring symptoms closely
Educating the patient and the family
Matching treatments to individuals
Administering medication, e.g., lithium
Addressing symptoms and related psychosocial impairments with
psychotherapeutic interventions
Week 8: Depressive and Bipolar Disorders
Monday, November 5, 2018
12:54 PM
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This preview shows pages 1-3 of the document.
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Symptoms of depression
Cognitive
Physiological and behavioural
Emotional
Watch the video clip
Dr. Aaron beck on depression
Depressed people significantly differed from the non-depressed
Overview of mood disorders
The spectrum runs from severe depression to extreme mania
DSM-5 divides mood disorders into two general categories:
Depressive disorders: extreme sadness, loss of pleasure/interest
Bipolar disorder: mood swings, state of sadness to high euphoria
Depression
A pervasive unhappy mood disorder
Children who are depressed cannot shake their sadness - interferes with their daily
routines, social relationships, school performance, and overall functioning
History
In the past, it was mistakenly believed that depression did not exist in children in a
form comparable to that in adults
We now know:
Children do experience recurrent depression
Depression in children is not masked, but rather may be overlooked
Anatomy of depression
Depression (symptom): feeling sad or miserable
Depression (syndrome): a group of symptoms that occur together more often than by
chance
Depression (disorder):
Major depressive disorder (MDD)
Dysthymic disorder depressed mood is generally less severe but with longer-
lasting symptoms (a year or more) and significant impairment in functioning
Depression in young people
Almost all young people experience some symptoms of depression
Suicide among teens is a serious concern
90% of youngsters with depression show significant impairment in daily functions
More than sad: teen depression
What is different?
Watch the video clip
Depression and development
Experience and expression of depression change with age
In children under age 7 (as young as 3-5)
Tends to be diffuse and less easily identified – Anaclitic depression (Spitz) –
infants
Preschoolers
School-age children
Preteens - isolate themselves
Major depressive disorders
Diagnosis in children
Same criteria for school-age children and adolescents
Depression is easily overlooked because other behaviors attract more attention
Some features are more common in children and adolescents than in adults
Reacting irritibly to minor events
Prevalence
Between 2% and 8% of children age 4-18 experience MDD
Depression is rare among preschool and school-age children (1-2%)
The sharp increase in adolescence may result from biological maturation at puberty
interacting with developmental changes
Onset, course, and outcome
Onset may be gradual or sudden
Age of onset usually between 13 and 15 years Average episode lasts eight months
Most children eventually recover from initial episode, but the disorder does not go
away
70% recurrence within 5 years
1/3 develop bipolar disorder within 5 years of the depression
Overall outcome is not optimistic
More common in girls
Before puberty it is very similar, but it then gets higher for females
Gender, ethnicity, and culture
No gender differences until puberty; then, females are two to three times more likely
to suffer from depression
Symptom presentation is similar for both sexes, although correlates of depression
differ for the sexes
Physical, psychological, and social changes are related to the emergence of sex
differences in adolescence
Coping styles and depression
Is Distraction a Bad Thing?
Action-oriented coping style versus ruminative coping style
What are the pros and cons of using distraction to cope with depression?
What do you think would happen if you consistently use distraction when
feeling depressed
Running away from the problem
Activity
Write about a time when you felt depressed. What happened?
What were your thoughts, feelings, and how did you behave?
What made you feel better?
Psychological theories of mood disorders
Behavioural Theories
Learned helplessness theory
Cognitive Theories
Aaron Becks Theory
Reformulated learned helplessness theory
Ruminative response styles theory
Psychodynamic Theory
Interpersonal Theories
Learned helplessness
Depression results from a perceived absence of control over the outcome of a
situation
Example: The Stanford prison experiment
Watch the video clip
Cognitive theories
Focus on relationship between negative thinking and mood
Emphasize depressogenic cognitions
Hopelessness theory
Cognitive theories
Becks cognitive model: depressed individuals make negative interpretations about
life events
Biased and negative beliefs are used as interpretive filters for understanding
events
Three areas of cognitive problems
Cognitive biases and distortions
Selective attentional biases
Feelings of worthlessness, negative beliefs, attributions of failure, self-critical and
automatic thoughts
Depressive ruminative style, pessimistic outlook, and negative self-esteem
Negative thinking and faulty conclusions generalized across situations, hopelessness,
and suicidal ideation
Learned helplessness
Depression results from a perceived absence of control over the outcome of a
situation
Example: The Stanford prison experiment
Reformulated learned helplessness
Attributional style and depression: People who attribute negative events to internal,
stable, and, global causes are more likely than other people to experience learned
helplessness deficits following such events and are thus predisposed to depression
Bipolar disorder
Features a striking period of unusually and persistently elevated, expansive, or
irritable mood, alternating with or accompanied by one or more major depressive
episodes
Elation and euphoria can quickly change to anger and hostility if behavior is
impeded
May be experienced simultaneously with depression
Bipolar disorder in young people
Young people with BP display:
Significant impairment in functioning, including previous hospitalization, MDD,
medication treatment, co-occurring disruptive behavior, and anxiety disorders
History of psychotic symptoms and suicidal ideation/ attempts are common
Bipolar disorder symptoms
Symptoms include restlessness, agitation, sleeplessness, pressured speech, flight of
ideas, racing thoughts, sexual disinhibition, surges of energy, expansive grandiose
beliefs
The diagnosis of mania
Mr.jones
Bipolar disorder mania in young people
Youngsters with mania may present with atypical symptoms volatile and erratic
changes in mood, psychomotor agitation, and mental excitation
Classic symptoms for children with mania include pressured speech, racing thoughts,
and flight of ideas
Video clip: raising sadie
A mother describes her experience raising her BP daughter
BREAK
Depression and suicide
Most youngsters with depression think about suicide, and as many as one-third who
think about it, attempt it
Worldwide, the strongest risk factors are having a mood disorder and being a
young female
Ages 13 and 14 are peak periods for a first suicide attempt by those with
depression
Suicide
The suicide of tyler clementi
Watch the video clip
Discussion
Rate of suicide among 15- to 24-year-old youth has increased dramatically in the past
40 years.
How does contemporary culture differ from that of your parents and grandparents
with respect to specific factors contributing to the rise in suicide rates among the
young?
Treatment of depression
Fewer than half of children with depression receive help for their problem
Rates vary by racial/ethnic background
Cognitive-behavioral therapy (CBT)
Has shown the most success in treating children and adolescents with
depression
Aaron beck
Errors in thinking and depression
Activity: cognitive distortions
Think of a situation in which you may engage in this thinking error
Develop a brief skit that illustrates this thinking error to the rest of the class
What could someone else say in this situation that would point out and correct the
thinking error?
1) All-or-Nothing Thinking 2) Overgeneralization 3) Mental Filter 4) Disqualifying the
Positive 5) Jumping to Conclusions 6) Emotional Reasoning 7) Personalization
Treatment of depression
Interpersonal Psychotherapy for Adolescent Depression (IPT-A)
Focuses on improving interpersonal communication and has also been effective
Psychopharmacological treatments
With the exception of SSRIs, which have problematic side effects, medications
have been less effective than CBT and IPT-A
Psychosocial interventions
Behavior therapy
Focuses on increasing pleasurable activities and events, and providing the
youngster with the skills necessary to obtain more reinforcement
Cognitive therapy
Teaches depressed youngsters to identify, challenge, and modify negative
thought processes
Activity
The polar bear: try to pose for yourself this task, not to think of a polar bear, what
happens?
Psychosocial interventions
Cognitive-behavioral therapy (CBT)
Most common form of psychosocial intervention combining behavioral and
cognitive therapies
Interpersonal Psychotherapy for Adolescent Depression (IPT-A)
Focus is on depressive symptoms and social context in which they occur
Medications
Tricyclic antidepressants consistently fail to demonstrate any advantage over placebo
in treating depression in youth
SSRIs (e.g., Prozac, Zoloft, and Celexa) are the most commonly prescribed medications
for treating childhood depression
Up to 60% of depressed youngsters respond to placebo
Prevention
CBT and interpersonal psychotherapy are most effective at lowering the risk for
depression and for preventing recurrences
School-based initiatives may provide a comprehensive program to enhance protective
factors in the environment and to develop young peoples individual resiliency skills
Treatment for bipolar disorder
There is no cure for BP
A multimodal plan includes:
Monitoring symptoms closely
Educating the patient and the family
Matching treatments to individuals
Administering medication, e.g., lithium
Addressing symptoms and related psychosocial impairments with
psychotherapeutic interventions
Week 8: Depressive and Bipolar Disorders
Monday, November 5, 2018 12:54 PM
Unlock document

This preview shows pages 1-3 of the document.
Unlock all 9 pages and 3 million more documents.

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Symptoms of depression
Cognitive
Physiological and behavioural
Emotional
Watch the video clip
Dr. Aaron beck on depression
Depressed people significantly differed from the non-depressed
Overview of mood disorders
The spectrum runs from severe depression to extreme mania
DSM-5 divides mood disorders into two general categories:
Depressive disorders: extreme sadness, loss of pleasure/interest
Bipolar disorder: mood swings, state of sadness to high euphoria
Depression
A pervasive unhappy mood disorder
Children who are depressed cannot shake their sadness - interferes with their daily
routines, social relationships, school performance, and overall functioning
History
In the past, it was mistakenly believed that depression did not exist in children in a
form comparable to that in adults
We now know:
Children do experience recurrent depression
Depression in children is not masked, but rather may be overlooked
Anatomy of depression
Depression (symptom): feeling sad or miserable
Depression (syndrome): a group of symptoms that occur together more often than by
chance
Depression (disorder):
Major depressive disorder (MDD)
Dysthymic disorder depressed mood is generally less severe but with longer-
lasting symptoms (a year or more) and significant impairment in functioning
Depression in young people
Almost all young people experience some symptoms of depression
Suicide among teens is a serious concern
90% of youngsters with depression show significant impairment in daily functions
More than sad: teen depression
What is different?
Watch the video clip
Depression and development
Experience and expression of depression change with age
In children under age 7 (as young as 3-5)
Tends to be diffuse and less easily identified Anaclitic depression (Spitz)
infants
Preschoolers
School-age children
Preteens - isolate themselves
Major depressive disorders
Diagnosis in children
Same criteria for school-age children and adolescents
Depression is easily overlooked because other behaviors attract more attention
Some features are more common in children and adolescents than in adults
Reacting irritibly to minor events
Prevalence
Between 2% and 8% of children age 4-18 experience MDD
Depression is rare among preschool and school-age children (1-2%)
The sharp increase in adolescence may result from biological maturation at puberty
interacting with developmental changes
Onset, course, and outcome
Onset may be gradual or sudden
Age of onset usually between 13 and 15 years Average episode lasts eight months
Most children eventually recover from initial episode, but the disorder does not go
away
70% recurrence within 5 years
1/3 develop bipolar disorder within 5 years of the depression
Overall outcome is not optimistic
More common in girls
Before puberty it is very similar, but it then gets higher for females
Gender, ethnicity, and culture
No gender differences until puberty; then, females are two to three times more likely
to suffer from depression
Symptom presentation is similar for both sexes, although correlates of depression
differ for the sexes
Physical, psychological, and social changes are related to the emergence of sex
differences in adolescence
Coping styles and depression
Is Distraction a Bad Thing?
Action-oriented coping style versus ruminative coping style
What are the pros and cons of using distraction to cope with depression?
What do you think would happen if you consistently use distraction when
feeling depressed
Running away from the problem
Activity
Write about a time when you felt depressed. What happened?
What were your thoughts, feelings, and how did you behave?
What made you feel better?
Psychological theories of mood disorders
Behavioural Theories
Learned helplessness theory
Cognitive Theories
Aaron Becks Theory
Reformulated learned helplessness theory
Ruminative response styles theory
Psychodynamic Theory
Interpersonal Theories
Learned helplessness
Depression results from a perceived absence of control over the outcome of a
situation
Example: The Stanford prison experiment
Watch the video clip
Cognitive theories
Focus on relationship between negative thinking and mood
Emphasize depressogenic cognitions
Hopelessness theory
Cognitive theories
Becks cognitive model: depressed individuals make negative interpretations about
life events
Biased and negative beliefs are used as interpretive filters for understanding
events
Three areas of cognitive problems
Cognitive biases and distortions
Selective attentional biases
Feelings of worthlessness, negative beliefs, attributions of failure, self-critical and
automatic thoughts
Depressive ruminative style, pessimistic outlook, and negative self-esteem
Negative thinking and faulty conclusions generalized across situations, hopelessness,
and suicidal ideation
Learned helplessness
Depression results from a perceived absence of control over the outcome of a
situation
Example: The Stanford prison experiment
Reformulated learned helplessness
Attributional style and depression: People who attribute negative events to internal,
stable, and, global causes are more likely than other people to experience learned
helplessness deficits following such events and are thus predisposed to depression
Bipolar disorder
Features a striking period of unusually and persistently elevated, expansive, or
irritable mood, alternating with or accompanied by one or more major depressive
episodes
Elation and euphoria can quickly change to anger and hostility if behavior is
impeded
May be experienced simultaneously with depression
Bipolar disorder in young people
Young people with BP display:
Significant impairment in functioning, including previous hospitalization, MDD,
medication treatment, co-occurring disruptive behavior, and anxiety disorders
History of psychotic symptoms and suicidal ideation/ attempts are common
Bipolar disorder symptoms
Symptoms include restlessness, agitation, sleeplessness, pressured speech, flight of
ideas, racing thoughts, sexual disinhibition, surges of energy, expansive grandiose
beliefs
The diagnosis of mania
Mr.jones
Bipolar disorder mania in young people
Youngsters with mania may present with atypical symptoms volatile and erratic
changes in mood, psychomotor agitation, and mental excitation
Classic symptoms for children with mania include pressured speech, racing thoughts,
and flight of ideas
Video clip: raising sadie
A mother describes her experience raising her BP daughter
BREAK
Depression and suicide
Most youngsters with depression think about suicide, and as many as one-third who
think about it, attempt it
Worldwide, the strongest risk factors are having a mood disorder and being a
young female
Ages 13 and 14 are peak periods for a first suicide attempt by those with
depression
Suicide
The suicide of tyler clementi
Watch the video clip
Discussion
Rate of suicide among 15- to 24-year-old youth has increased dramatically in the past
40 years.
How does contemporary culture differ from that of your parents and grandparents
with respect to specific factors contributing to the rise in suicide rates among the
young?
Treatment of depression
Fewer than half of children with depression receive help for their problem
Rates vary by racial/ethnic background
Cognitive-behavioral therapy (CBT)
Has shown the most success in treating children and adolescents with
depression
Aaron beck
Errors in thinking and depression
Activity: cognitive distortions
Think of a situation in which you may engage in this thinking error
Develop a brief skit that illustrates this thinking error to the rest of the class
What could someone else say in this situation that would point out and correct the
thinking error?
1) All-or-Nothing Thinking 2) Overgeneralization 3) Mental Filter 4) Disqualifying the
Positive 5) Jumping to Conclusions 6) Emotional Reasoning 7) Personalization
Treatment of depression
Interpersonal Psychotherapy for Adolescent Depression (IPT-A)
Focuses on improving interpersonal communication and has also been effective
Psychopharmacological treatments
With the exception of SSRIs, which have problematic side effects, medications
have been less effective than CBT and IPT-A
Psychosocial interventions
Behavior therapy
Focuses on increasing pleasurable activities and events, and providing the
youngster with the skills necessary to obtain more reinforcement
Cognitive therapy
Teaches depressed youngsters to identify, challenge, and modify negative
thought processes
Activity
The polar bear: try to pose for yourself this task, not to think of a polar bear, what
happens?
Psychosocial interventions
Cognitive-behavioral therapy (CBT)
Most common form of psychosocial intervention combining behavioral and
cognitive therapies
Interpersonal Psychotherapy for Adolescent Depression (IPT-A)
Focus is on depressive symptoms and social context in which they occur
Medications
Tricyclic antidepressants consistently fail to demonstrate any advantage over placebo
in treating depression in youth
SSRIs (e.g., Prozac, Zoloft, and Celexa) are the most commonly prescribed medications
for treating childhood depression
Up to 60% of depressed youngsters respond to placebo
Prevention
CBT and interpersonal psychotherapy are most effective at lowering the risk for
depression and for preventing recurrences
School-based initiatives may provide a comprehensive program to enhance protective
factors in the environment and to develop young peoples individual resiliency skills
Treatment for bipolar disorder
There is no cure for BP
A multimodal plan includes:
Monitoring symptoms closely
Educating the patient and the family
Matching treatments to individuals
Administering medication, e.g., lithium
Addressing symptoms and related psychosocial impairments with
psychotherapeutic interventions
Week 8: Depressive and Bipolar Disorders
Monday, November 5, 2018 12:54 PM
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