244 CHAPTER 6
SUMMING UP
Summary of Depressive
Disorders
A major depressive episode (MDE) is the build-
ing block for a diagnosis of major depressive
disorder (MDD); when a person has an MDE,
he or she is diagnosed with MDD. Symptoms
of an MDE can arise in three areas: affect,
behavior, and cognition.
Depression is becoming increasingly prev-
alent in younger cohorts. Depression and anxi-
ety disorders have a high comorbidity—around
50%. MDD may arise with melancholic fea-
tures, catatonic features, or psychotic features.
Symptoms may also fall into less common pat-
terns, as in atypical depression and chronic
depression.
A diagnosis of dysthymic disorder re-
quires fewer symptoms than does a diagnosis
of MDD; however, the symptoms of dys thymic
disorder must persist for a longer time than do
symptoms of MDD. People who have both
dysthymic disorder and MDD are said to have
double depression.
Neurological factors related to depression
include low activity in the frontal lobes, and
abnormal functioning of dopamine, serotonin,
and norepinephrine. The stress–diathesis
model of depression highlights the role of in-
creased activity of the HPA axis and of excess
cortisol in the blood, but people with atypi-
cal depression have the opposite pattern—
decreased activity in the HPA axis. Genes can
play a role in depression.
Psychological factors that are associated
with depression include a bias toward paying
attention to negative stimuli, dysfunctional
thoughts, rumination, a negative attributional
style and learned helplessness.
Social factors that are associated with de-
pression include stressful life events, social
exclusion, and problems with social interac-
tions or relationships. Culture and gender can
infl uence the specifi c ways that symptoms of
depression are expressed.
Neurological, psychological and social
factors can affect each other through feedback
loops, as outlined by the stress–diathesis
model and Coyne’s interactional theory of
depression.
Biomedical treatments that target neu-
rological factors for depressive disorders are
medications and brain stimulation. Treat-
ments for depression that target psychological
factors include CBT. Treatments that target
social factors include IPT and family systems
therapy.Thinking like a clinician
Suppose that a friend began to sleep through
morning classes, seemed uninterested in go-
ing out and doing things together, and became
quiet and withdrawn. What could you con-
clude or not conclude based on these observa-
tions? If you were concerned that these were
symptoms of depression, what other symp-
toms would you look for? What if your friend’s
symptoms did not appear to meet the criteria
for an MDE—what could you conclude or not
conclude? If your friend was, in fact, suffering
from depression, how might the three types of
factors explain the depressive episode? What
treatments might be appropriate?Summary of Bipolar
Disorders
The four building blocks for diagnosing bipolar
disorders are major depressive episode (MDE),
manic episode, mixed episode, and hypomanic
episode. Symptoms of a manic episode include
grandiosity, pressured speech, fl ight of ideas,
distractibility, poor judgment, decreased need
for sleep, and psychomotor agitation. A mixed
episode is characterized by symptoms of both
an MDE and a manic episode and may include
psychotic features and suicidal thinking. A
hypomanic episode involves mood that is per-
sistently elated, irritable, or euphoric; unlike
other mood episodes, hypomanic episodes do
not impair functioning.
Researchers have characterized two
types of bipolar disorder. Bipolar I disorder—
usually more severe—requires only a manic
or mixed episode; an MDE may occur but is
not necessary for this diagnosis. Bipolar II
disorder requires alternating hypomanic epi-
sodes and MDEs and no history of manic or
mixed episodes. Both disorders may involve
rapid cycling. Cyclothmic disorder is a more
chronic but less intense version of bipolar II
disorder.
Neurological factors that are associated
with bipolar disorders include an enlarged
and more active amygdala. Norepinephrine,
serotonin, and glutamate are also involved.
Bipolar disorders are influenced by genetic
factors, which may infl uence mood disorders
in general.
Psychological factors that are associated
with bipolar disorders include the cognitive
distortions and negative thinking associated
with depression. Moreover, some people with
bipolar I disorder may have residual cognitive
defi cits after a manic episode is over.Social factors that are associated with
bipolar disorders include disruptive life
changes and social and environmental stres-
sors. The different factors create feedback
loops that can lead to a bipolar disorder or
make the patient more likely to relapse.
Mood stabilizers are one treatment that
targets neurological factors; when manic,
patients may receive an antipsychotic medica-
tion or a benzodiazepine.
Treatment that targets psychological
factors—particularly CBT—helps patients
recognize warning signs of mood episodes,
develop better sleeping strategies, and, when
appropriate, stay on medication.
Treatments that target social factors
include interpersonal and social rhythm ther-
apy (IPSRT), which can increase the regularity
of daily events and decrease social stressors;
family therapy and education; and group ther-
apy or a self-help group, which is intended to
decrease shame and isolation.Thinking like a clinician
You get in touch with a friend from high school
who tells you that she recently had a hypo-
manic episode. What are two possible DSM-
IV-TR diagnoses that she might have had (be
specifi c)? What will determine which diagno-
sis is most appropriate? What are a few of the
symptoms that are hallmarks of a hypomanic
episode? What would be the difference in
symptoms if your friend instead experienced
a manic episode? Would her diagnosis change
or stay the same? Explain. How do the three
types of factors (neurological, psychological,
and social) explain why bipolar disorders de-
velop? What would be the most appropriate
ways to treat bipolar disorders?Summary of Suicide
Having thoughts of suicide or making a plan
to carry it out may indicate a risk for suicide;
behavioral changes (such as giving away
possessions) may indicate a more serious
risk. However, not everyone who attempts or
commits suicide displays warning signs. In
addition, certain self-harming behaviors may
be parasuicidal behaviors rather than suicide
attempts. The presence of certain psychologi-
cal disorders, such as MDD, and a history of
previous serious suicide attempts increase an
individual’s risk for suicide.
Neurological factors that are associated
with suicide include structural abnormalities
in the frontal lobes and altered serotonin activ-
ity. In addition, suicide may be associated with