Bipolar and Related Disorders and Depressive Disorders

Introduction
This unit explores the diagnoses of depression and bipolar disorder. There are several theories about the causes of bipolar and depressive disorders and the most effective approaches used to treat them. Biological, psychological, and social perspectives of depression and bipolar disorder are presented in the Abnormal Psychology text. Additional articles included in the unit discuss the importance of considering the social, cultural, and systemic influences on people experiencing bipolar and depressive disorders.
Bipolar and Related Disorders
The chapter “Bipolar and Related Disorders” from Section II of the DSM-5 includes bipolar I, bipolar II, and cyclothymic disorder. Bipolar disorders are characterized by unusual shifts in mood, energy, and behaviors. The highs of mania and lows of depression are very different from typical good and low moods. The symptoms of bipolar disorder can last for days, weeks, or months and cause impairment in daily functioning. Page 187 of the Abnormal Psychology text offers specific examples of symptoms of mania.
Depressive Disorders
A common feature of depressive disorders is “the presence of sad, empty, or irritable mood, accompanied by somatic and cognitive changes that significantly affect the individual’s capacity to function” (American Psychiatric Association, 2013). The chapter “Depressive Disorders” from Section II of the DSM-5 includes disruptive mood dysregulation disorder, major depressive disorder (MDD), persistent depressive disorder (dysthymia), and premenstrual dysphoric disorder. Depressive disorders vary in the number of symptoms, severity level, and duration. They frequently co-occur with other disorders, including anxiety disorders, substance-related disorders, and eating disorders. The clinical presentation of depressive symptoms varies according to culture, gender, and age. For example, a child may present with severe temper outbursts and irritable rather than depressed mood as typically experienced by adults. In this case, a diagnosis of disruptive mood dysre gulation may be considered.

Bipolar and depressive disorders are associated with a high risk of suicide attempts and completions. It is important to include a suicide risk assessment as part of the initial evaluation process and throughout treatment. Beginning on page 204, the Abnormal Psychology text offers an in-depth discussion about the assessment and treatment of clients who are feeling suicidal.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
Nolen-Hoeksema, S. (2014). Abnormal psychology (6th ed.). New York, NY: McGraw-Hill

Objectives
To successfully complete this learning unit, you will be expected to:
1. Discuss processes used to assess and diagnose bipolar and related disorders and depressive disorders.
2. Examine the purpose of V and Z codes in understanding a client’s symptoms of depression.
3. Discuss social and cultural factors important to the diagnosis and treatment of bipolar and related disorders and depressive disorders.
4. Explore personal experiences and attitudes that impact the diagnosis and treatment of bipolar and related disorders and depressive disorders.
5. Evaluate approaches used for the treatment of bipolar and related disorders and depressive disorders.

Learning Activities
Unit 4 Study 1
Studies Readings
Use your Abnormal Psychology text to read Chapter 7, “Mood Disorders and Suicide,” pages 174–215.
For this unit, you will read a minimum of two articles to incorporate into your discussions; one is required and you may choose the second from the list below.
Use the library to read the following required article:
• Beach and Whisman’s 2012 article, “Affective Disorders,” from the Journal of Marital and Family Therapy, volume 38, issue 1, pages 201–219.
Use the library to choose one of the following articles to read:
• Jönsson, Skärsäter, Wijk, and Danielson’s 2011 article, “Experience of Living With a Family Member With Bipolar Disorder,” from International Journal of Mental Health Nursing, volume 20, issue 1, pages 29–37.
• Warren’s 2007 article, “Cultural Aspects of Bipolar Disorder: Interpersonal Meaning for Clients & Psychiatric Nurses,” from Journal of Psychosocial Nursing and Mental Health Services, volume 45, issue 7, pages 32–37.
• Waite and Killian’s 2008 article, “Health Beliefs About Depression Among African American Women,” from Perspectives in Psychiatric Care, volume 44, issue 3, pages 185–195.
• Locke, Newcomb, Duclos, and Goodyear’s 2007 article, “Psychosocial Predictors and Correlates of Dysphoria in Adolescent and Young Adult Latinas,” from Journal of Community Psychology, volume 35, issue 2, pages 135–149.
These articles provide additional clinical and cultural information within the context of the unit discussions.
DSM-5 Review
Review the main diagnoses in the chapter “Bipolar and Related Disorders,” pages 123–141, and the main diagnoses in the chapter “Depressive Disorders,” pages 155–175, from Section II.
Optional – Readings
Refer to Optional Readings for Principles of Psychopathology for a list of additional articles about the mental disorders and current issues regarding assessment, diagnosis, and treatment you are studying in this unit.

Unit 4 – Bipolar and Related Disorders and Depressive Disorders
Baucom, B., Eldridge, K., Jones, J., Sevier, M., Clements, M., Markman, H., Christensen, A. (2007). Relative contributions of relationship distress and depression to communication patterns in couples. Journal of Social & Clinical Psychology, 26(6), 689–707.
Brown, R. T., Antonuccio, D. O., Dupaul, G. J., Fristad, M. A., King, C. A., Leslie, L. K., . . . Vitiello, B. (2008). Bipolar disorder. In Childhood mental health disorders: Evidence base and contextual factors for psychosocial, psychopharmacological, and combined interventions (pp. 87–96). Washington, DC: American Psychological Association.
Nobile, M., Cataldo, G. M., Marino, C., & Molteni, M. (2003). Diagnosis and treatment of dysthymia in children and adolescents. CNS Drugs, 17(13), 927–946.
Ramsley, S. E. (2007). Unipolar or bipolar depression? Improving diagnostic confidence with the adult patient. Journal of the American Academy of Nurse Practitioners, 19(4), 172–178.
Ryder, A. G., Yang, J., Zhu, X., Yao, S., Yi, J., Heine, S. J., & Bagby, R. M. (2008). The cultural shaping of depression: Somatic symptoms in China, psychological symptoms in North America? Journal of Abnormal Psychology, 117(2), 300–313.
Books
Blauner, S. R. (2002). How I stayed alive when my brain was trying to kill me: One person’s guide to suicide prevention. New York: Harper Collins. (Suicide.)
Jamison, K. R. (1997). An unquiet mind: A memoir of moods and madness. New York, NY: Vintage. (Bipolar disorder.)
Styron, W. (2007). Darkness visible: A memoir of madness. New York, NY: Random House-Modern Library. (Depression.)

Discussion 1: 1 page needed with minimum of 250 words and 2 references.
Depression Diagnosis
Read the following vignette:
Christina is a 25-year-old Mexican American woman who has been working as an elementary school teacher since she graduated from college three years ago. Although she does well at her job, she has been feeling low ever since she left college. When she took this teaching position, she had to relocate to a city over four hours away from her family and the house she grew up in. Even though she has made some new friends, Christina still feels disconnected and lonely. She is also concerned about her mother, who has been diagnosed with a serious health condition.
For the past month, Christina has felt much worse. She reports feeling very sad and tired most of the time and is having difficulty concentrating at work. She says that she does not have enough energy to accomplish the things she would like to do. She admits to overeating and drinking every evening to “unwind” after school, and is concerned she is sleeping too much on the weekends. She also has very low self-esteem, despite being well-liked at her school and receiving good performance evaluations.
Christina describes her life as “heading nowhere” and says that lately she has felt extremely hopeless. She wonders if she will ever feel as happy as she did when she was in college. She does not have a history of ever feeling worse than this, and is in good health.
Based on the information presented, address the following questions in your discussion post:
1. What depressive disorder diagnosis would you consider giving to Christina? Describe the process you used for making this decision.
2. Knowing that substance use disorders can mimic and co-exist with other disorders, and that depressive disorders frequently co-occur with other disorders, including anxiety disorders, substance-related disorders, and eating disorders, what other information would you gather, or what other assessment instruments might you use, to help you make an accurate diagnosis for Christina? (Remember to refer back to the assessment information you read in Chapter 3 of the Abnormal Psychology text.)
3. What V and Z codes would you consider for Christina? How would including these systemic considerations help you in understanding Christina’s presenting symptoms and thinking about your treatment approach?
4. What social, cultural, and systemic factors would be important for you to consider when assessing and diagnosing Christina? How is the separation from her mother, family, and home impacting her? What multigenerational issues might be affecting Christina at this time?
Support your ideas with references to the course texts, articles from this learning unit, articles from the Optional Readings for Principles of Psychopathology list, or articles from peer-reviewed journals that you locate in the library.

Discussion 2: 1 page needed with minimum of 250 words and 2 references.
Bipolar Disorder Diagnosis
For this discussion:
1. Review the main diagnoses in the chapter “Bipolar and Related Disorders” from Section II of the DSM-5.
o What contextual/systemic factors need to be considered when diagnosing individuals with symptoms of depression, mania, hypomania, and bipolar disorders?
2. Review the material about the treatment of bipolar disorders in the Abnormal Psychology text.
o What are two treatment approaches you would consider using with a client diagnosed with a bipolar disorder?
o What are some advantages and limitations of these approaches?
3. Consider the broader contexts and systems in which a person with bipolar symptoms is embedded. Who else might the therapist consider including in the treatment of a client diagnosed with a bipolar disorder to aid in the client’s support and recovery?
Support your ideas with references to the course texts, articles from this learning unit, articles from the Optional Readings list, or articles from peer-reviewed journals that you located in the library.

 

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