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1 Running Head: Little Miss Sunshine

Little Miss Sunshine PSYCH 2320 Hannah Smith Tarleton State University

2 Little Miss Sunshine For my clinical impression’s movie choice, I have chosen Little Miss Sunshine. In Little Miss Sunshine, each character presents evidence that may build a case that shows some variation of an abnormal psychological disorder, however, Frank Ginsberg, shoes the most evidence to make a case for. The movie had already shown that Frank lost his job and was admitted for attempt of suicide after his boyfriend broke up with him while replacing Frank with, according to Richard, a “life winner”. But those events are just a few big triggers that pushed Frank over the edge to a type of depression. This newly found fear of rejection made Frank become isolated which, finally, triggered Frank into his major depressive episode. Frank goes through major life changes that impacted his life in a negative way. He starts to become extremely isolated from his family. Frank also shows signs of anxiety, but more precise, social anxiety, which often go hand in hand with depression; depression may create some social anxiety, while social anxiety may also lead one to depression (Kanter et al., 2008). There are many categories of depression categorized on the DSM-5, such as major depressive disorder (MDD). Major depressive disorder is a severe mood disorder which an episode occurs every day for at least a two-week period. Table of criteria and Frank’s associated behaviors Five (or more) of the following have been consistent, or shown, nearly every day during a 2week period and have changed from a person’s baseline symptoms (Barlow et al, 2015). Having a depressed mood.

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Frank shows signs of a depressed mood daily

Not showing as much interest in the activities that used to give pleasure. Significant weight loss or gain.

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Frank often lost his appetite, therefore the weight loss occurred.

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When Sharyl tries to ask Frank questions he responds with ‘No.’ Frank usually lacked sleep, therefore,

Insomnia or Hypersomnia. Psychomotor agitation or retardation that are noticed by others. Loss of energy.

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3 Little Miss Sunshine causing him to be fatigued. Feelings of worthlessness or guilt everyday Loss of concentration or indecisiveness Suicidal thoughts, thoughts of death, suicidal attempts.

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Frank tried to cut off his wrists in attempted suicide.

Current Research and Intervention Depression is one of the most common mental disorders but also the most ignored psychiatric disorder as well. This disorder is estimated to affect nearly 14 million adults per year within the United States and has a lifetime prevalence rate of 16%. However, major depressive disorder is seen in 20-26% of women and 8-12% in men that have been to a doctor to get it diagnosed and treated (Lieber, 2017). As technology becomes more precise, we are able to know more about depression and how it can be treated. There are many ways that major depressive disorder develops. Additionally, there is still a stigma around any disorder, especially any form of depression, so many people go untreated. Etiology: Genetics plays a major role within the etiology of major depressive disorder, but not by any means the only way for the disorder to develop. In the case of Frank, his MDD was socioeconomic stressful life events, such as the loss of his job as well as his boyfriend, were the cause for his episodes. However, that is not the case for everyone; this disorder, for many, can be caused by physiological and anatomical factors as well. In some cases, manic episodes of “hyperactivity, euphoria, and an increase of pleasure seeking” will or have been seem in patients with MDD (Belmaker & Agam, 2011). Major depressive disorder can include feelings of sadness, feeling down, empty, etc. The most familiar symptoms are negative thoughts, agitation, irritability, increase of sleep, and in some cases,

4 Little Miss Sunshine suicidal thoughts (Lieber, 2017). Furthermore, patients may describe their symptoms as feelings of heaviness or being “pressed down” (Kanter et al., 2008). Treatment Plans: Before treating the disorder, it is important for doctors to develop a baseline of what the current depressive symptoms are for the patient. This baseline assessment will help to create treatment plans that are beneficial to each patient individually, while also providing the doctors a reference point to progress, or regression, of which the patients started and or ended their symptoms. Antidepressant medications (AMD) are the most common type of medications prescribed to treat patients suffering from MDD. Antidepressants are able to relieve patients from the majority of depressive symptoms or show improvement from the symptoms they are having (DeRubeis et al., 2008). However, if a patient that is currently taking the medications suddenly stops taking it, that person is more likely to relapse if they haven’t been taking it for at least than six months (Mehta et al., 2014). Studies have shown cognitive therapy along with the appropriate dosage of antidepressant medications are the most effective way of treating the disorder at the source (DeRubeis et al., 2008). However, electroconvulsive treatment is sometime used, but is typically not considered as an option in most treatment plans except for extreme cases (Lieber, 2017). Psychotherapy is one of the most common treatments. There are many types of psychological therapy such as interpersonal, psychoanalytic, counseling, relaxation, etc. (Kanter, 2008). Cognitive therapy is also a popular treatment plan. Cognitive therapy replaces “automatic emotional reactivity with more-controll[ed] processing” and by doing so, it dampens the

5 Little Miss Sunshine automatic limbic reactions (DeRubeis et al., 2008). By engaging in cognitive therapy, the patient is increasing their emotion-regulating skills. How Major Depressive Disorder Effects the Brain: Major depressive disorder affects three major parts in the brain: the prefrontal cortex, amygdala, and hippocampus (Belmaker & Agam, 2011). Located toward the very front of the brain is the prefrontal cortex. This is where emotions are regulated, memory formation, and decision-making takes place. (Cirino, 2016). Secondly, the amygdala is responsible for one’s emotional responses. However, patients with MDD, when exposed to higher amounts of cortisol the amygdala is enlarged. Furthermore, this affects one’s sleep and can lead to further complications due to irregular hormone amounts within the body (Cirino, 2016). Near the center of the brain is where the hippocampus will be found; it is in control of one’s memories and regulation of cortisol production, which is released during any type of mental and or physical stress (Barlow et al., 2015). This becomes a problem during a state of depression because too much excess of this hormone, cortisol, creating an imbalance within the body. According to Belmaker & Agam (2011), within an MDD mind, increase of cortisol levels have the ability to slow neuron production which causes the hippocampus, much like the prefrontal cortex, to shrink and lead to memory problems. Patients with MDD do not perform as well in a work setting, whether this be at the workplace or simply doing household chores. Studies have shown that there are correlations to the severity of which one is suffering from depression and one’s job performance (Mehta, 2014). Mehta et al. (2014) also explores studies regarding the prevalence to depressive episodes being related to one having a poor performance at their workplace.

6 Little Miss Sunshine Medications and Therapy: The main medication used to treat major depressive disorder is antidepressant medication (ADM). The reason that ADM is the most common is because the medication successfully blocks reuptakes of different bodily agents, including dopamine, serotonin, and noradrenaline (DeRubeis et al., 2008). However, as much as antidepressants are prescribed, they are not always curative (DeRubeis et al., 2008), and if a patient that is prescribed ADM stops taking the medication, they are more likely at risk for the depression to return. Cognitive therapy also works hand in hand with the prescribed medications. Therapy is a healthy way to be treated for MDD and has evidence that shows that cognitive therapy lowers the risk of relapse and or reoccurrence of depressive symptoms (DeRubeis et al., 2008). DeRubeis et al. (2008) discusses a study that shows patients with MDD performed better, short-term, that received both cognitive therapy and ADM. Furthermore, in the study, it also showed that the participants were less likely to fall back into a relapse of symptoms is continued the medication and therapy.

7 Little Miss Sunshine References Barlow, D. H., Durand, V. M., Hofmann, S. G., (2015). Abnormal Psychology: An Intergrative Approach. Boston, MA: Cengage Learning. Belmaker, R. H., Agam, G. (2011). Mechanisms of Disease: Major Depressive Disorder. The New England Journal of Medicine. Retrieved from https://www.researchgate.net/profile/Robert_Belmaker/publication/5677983_Major_depr essive_disorder_invited_review/links/0deec5358d0b15c987000000/Major-depressivedisorder-invited-review.pdf DeRubeis, R. J., Siegle, G., Hollon, S. D., (2008). Cognitive Therapy vs. Medications for Depression: Treatment outcomes and neural mechanisms. Nature Reviews, Neuroscience 9(10), 788-796. doi: 10.1038/nrn2345 Kanter, J. W., Busch, A. M., Weeks, C. E., Landes, S. J., (2008). The Nature of Clinical Depression: Symptoms, Syndromes, and Behavioral Analysis. The Behavioral Analyst, 31(1), 1-21. doi: 10.1007/bf03392158 Lieber, A, (2017). Major Depression (Unipolar Depression): Major Depressive Disorder Can Often be Treated for Better Quality of Life. Retrieved from https://www.psycom.net/depression.central.major.html Mehta, S., Mittal, P. K., Swami, M. K., (2014). Psychological Functioning in Depressive Patients: A Comparitive Study between Major Depressive Disorder and Bipolar Affective Disorder. Depression Research and Treatment, 2014. doi: https://search-proquestcom.zeus.tarleton.edu/docview/1710725264/fulltextPDF/5F6DEA2911644B87PQ/8? accountid=7078...