Mood Disorders – Flashcards

Sufferer experiences deep, depressive periods. 5-7% adults suffer An emotional disorder that may affect other psychological functions. Diagnosis= 5 symptoms present for 2 weeks and NO HISTORY OF MANIA

Emotional: sadness, irritability, feelings of guilt or worthlessness Cognitive: poor concentration, poor memory, suicidal thoughts Physiological: lack of energy, headaches, fidgeting, sleep disturbances Behavioural: withdrawal from social life, loss of interest in sex, poor performance at work Extreme depression - may have delusions (e.g. of guilt) and hallucinations (e.g. auditory telling sufferer to commit suicide)

Sufferer experiences periods of major depression and periods of mania. To be diagnosed, need to have experienced a major depressive episode and a manic episode. Manic episode classified by experiencing manic symptoms for 1 week + distress or impairment of mental function. 1-2% adults suffer, same rates in men and women

Emotional: euphoria/highly elevated mood states, lack of social inhibition, irritability due to not getting own way. Cognitive: belief that others are out to get them, reckless decision making, grandiose plans, delusional ideas Behavioural and Physiological: Lack of sleep, talkative, high energy, increased work, social and sexual activity

-Genetics -Biochemical (neurotransmitters) -Hormones and the endocrine system -Brain abnormalities

Mood disorders (especially bipolar) have a genetic basis. The risk of developing a M.D. doubles if there is a family history of depression. -Twin studies (such as McGuffin) show that MZ twins have higher concordance rates for Bipolar than DZs. (McGuffin: MZ=46%, DZ=20%) -Kendler believed that twin studies show that M.D.s are more common in women than in men, however other studies show no difference. - No single gene has been identified, but Wilhelm suggested that abnormal serotonin transport (SERT) gene could be responsible. Current view= multiple genes are probably involved.

McGuffin: MZs= 46% DZs= 20%

Neurotransmitters serotonin and norepinephrine associated with unipolar and bipolar. Both are found in the limbic system and affect energy levels, sleep pattern and appetite, all of which are symptoms of depression. Low levels of both= depression (evidence: drug called reserpine reduces serotonin and norepinephrine and can also cause depression) Low serotonin, high norepinephrine= mania

1.When stressed, levels of certain hormones increase, for example cortisol. Cortisol helps to respond to stress during the fight-or-flight response. People with depression have high levels of cortisol, even after a stressful event disappears. A common response to stress is depression, so (because of the lasting levels of hormones), depression continues even when stress is gone. 2. It has been proposed that depression in women is linked to menstrual cycle, the post-partum period and the menopause. However, evidence has not really supported claim that this is linked to levels of the hormones oestrogen and progesterone. May be stressful life events that cause depression, such as marital problems or 'difficult' babies.

Brain scans have associated 4 areas of the brain that show abnormalitites with depression: -Prefrontal cortex -Hippocampus -Amygdala -Anterior Cingulated Cortex The amygdala is responsible for mood and the anterior cingulated cortex is responsible for stress responses, which feature in the symptoms of depression...brain abnormalities could cause symptoms.

-Twin studies, MZs not 100%, must be other environmental factors involved. -Twin studies may neglect fact that MZs are more likely to share environment, so depression could be down to e.g. shared poverty. - No single gene identified - Brain abnormalities and hormone levels- cause or effect? -Oversimplification as ignores social factors? -Reductionist as reduces complex disorder to cells and chemicals.

- Based on idea that depressives gain rewards for behaving in -ve ways. - Seligman proposed the learned helplessness theory, which assumes that uncontrollable -ve events in a person's life can lead to depression. -Seligman's dog experiment using classical conditioning supports his learned helplessness theory. -Also supported by Seligman and Miller (when exposed to uncontrollable -ve events, people scored highly on a depressive mood questionnaire) -Lewinsohn proposed a behavioural explanation based on operant conditioning. (Loss=less +ve reinforcement= social withdrawal= less +ve reinforcement...) -This downwards spiral results in depression and is reinforced by sympathy and attention from others.

Uncontrollable -ve events in a person's life can lead to depression... Can't control -ve events= believe you can't control any events in your life= feelings of helplessness= depression. Supported by Seligman's dog experiment- he used classical conditioning to show how learned helplessness occurs in dogs. -Dogs placed in apparatus where they couldn't escape electric shocks. At first they tried to escape but soon gave up and no longer tried to escape shocks. -Then dogs placed in apparatus where it was possible to escape the shcoks, but dogs did not attempt to escape- they were helpless. -Having no control over -ve events leads to learned helplessness. Also supported by Seligman and Miller who found that when people experienced uncontrollable -ve events, they scored highly on a depressive mood questionnaire.

Lewinsohn proposed a behavioural explanation based on operant conditioning... Loss= reduction in amount of +ve reinforcement experienced= withdrawal from social life= further reduction of +ve reinforcement... This downward spiral results in depression and can be reinforced by the sympathy and attention of others. Those with poor social skills are more prone to this.

-Animal research (Seligman's dogs). Can you generalise? - Explanation not purely behaviourist as takes account of cognitive processes- learned helplessness was reformulated as attribution-helplessness to take account of cognitive factors -Ignores biological factors

-People become depressed because they think in -ve ways. 1. Negative schemas (Beck) 2. Beck's cognitive triad 3. Attribution-helplessness 4. Seligman's Questionnaire

- Negative schemas develop in childhood as a result of over-demanding parents and authority figures. - They continue into adult life and provide a cognitive framework for viewing events pessimistically. - 4 traits of -ve schemas: overgeneralisation, magnification, absolutist thinking, selective perception. STUDY: Beck investigated schemas of people with depression using the DAS (dysfunctional attitude scale) on 2 groups (1 depressed, 1 control). The DAS consists of states you agree/disagree with. Depressives scored highly on the DAS indicating that they thought more -vely about life and used -ve schemas.

-Beck proposed the cognitive triad, where depressed people consistently think -vely about their SELF, the WORLD, and the FUTURE. -E.g. Self- 'I'm rubbish', World- 'My life is horrible', Future- 'Nothing good will ever happen to me'

-Adapted from behavioural explanation of learned helplessness. Based on the way people attribute a cause to each event. -Attributions are internal ('Its all my fault'), global ('this is how i am with all events in my life') or stable ('thats the way I always will be'). -These attributions result in lower self esteem and lack of motivation to change...these lead to depression.

It aimed to assess a person's attributional style. There are 12 hypothetical situations for which a cause has to be indicated. Depressed people show an attributional style whereby negative events are caused by themselves, and positive events are caused by others. (There are 4 categories of situation: +ve acheivement, -ve acheivement, +ve interpersonal, -ve interpersonal)

+ Based on sound experimental research. + Explains cause, not just symptoms - Doesn't explain manic phase + Has resulted in therapies for depression (CBT)

1. Freud and Abraham explained depression through loss, grief and dependency. How child responds to loss in childhood sets a precedent for adult behaviour. -Grief often followed by feelings of desertion and rejection. -Child is self-centred and believes these feelings result from something they have done, heightening feelings of desertion -Unable to express anger at others for this loss, child projects their feelings inwards, resulting in self- blame and punishment -This is known as introjection of hostility...results in depression - If child can't overcome feelings of desertion, they will still be unable to cope with loss as an adult and may regress back to the oral stage...outcome of this is depression. 2. Depression results from failure to meet the expectations of parents in the first 5yrs. Overly critical parents= child can't live up to high expectations= causes depression in adulthood as you will grow up to set yourself unacheivable goals. Failure leads to depression. 3. Interpersonal theories are concerned with formation and maintenance of attach. Poor attachment with caregiver in childhood may lead to adult depression because person attempts to seek approval from others to compensate for childhood rejection. 4. Bipolar caused by id, ego and superego attempting to control each other. Depressive phase= superego dominating ego, making person feel guilty and inadequate. Ego tries to take control but overreacts, causing person to enter manic phase. Cycle is repeated.

+ Freud's work led to interpersonal theories which resulted in an effective treatment of depression. + Interpersonal and failure=depression theories supported by Bowlby's work on attachment

- Tricyclic Antidepressants - Monamine Oxidase Inhibitors (MAOIs) - Selective Serotonin Reuptake Inhibitors (SSRIs) e.g. Prozac

Tricyclic Antidepressants: prevent noreadrenalin and serotonin being taken back into the neuron after it has been relased, which increases the activity of these neurotransmitters. MAOIs: stops the breakdown of the monamine oxidase chemical in the neuron, increases the level of the neurotransmitter SSRIs: Allow serotonin to remain active in the synapse for longer

Tricyclic antidepressants: Effective in 60% of people. Can take 6-8 weeks to work. Side effects= dry mouth, constipation, excessive perspiration, blurred vision, sexual dysfunction. Can be fatal if overdose by only 5x prescription. MAOIs: Side effects= Weight gain, liver damage, increased blood pressure, interacts with certain foods (chocolate and red wine) SSRIs: Most recent, e.g. Prozac. Fast acting- effective after 2 weeks. Side effects: Increased risk of suicide, increased feelings of agitation and anxiety

Lithium Returns levels of neurotransmitters (dopamine, serotonin) to normal. More effective for mania than depression. -Dosage is individual and must be carefully monitored - Needs to be taken continually, even in absence of mania. Many Ps stop taking as they feel OK- mania reoccurs. - Side effects: Blurred vision, difficulty concentrating, kidney dysfunction

+All help reduce depression - All have undesirable side effects - Not everyone responds to drugs (only 60% respond to tricyclic) - All take time to work - tricyclic takes 6-8 weeks. But SSRIs take only 2. - Lithium: dosage v. specific and individual. Must be taken continually or mania reoccurs

Treat depression by challenging and removing -ve thoughts and behaviours. 1. Rational- Emotive Therapy (Ellis) 2. Beck's Cognitive therapy

Replaces irrational (self-defeating and -ve) thoughts with rational ones. Therapist makes P aware of -ve and irrational thoughts (e.g. 'I must be perfect at everything') and challenges them through confrontation and argument. Outcome: Irrational belief replaced with rational one e.g. 'I will always try my best'...self-esteem will increase.

Challenges cognitive triad of -ve thoughts: 1. Increases confidence and elevates mood 2. Challenges automatic -ve thoughts 3. Identifies -ve thoughts 4. Changes key attitudes and beliefs Involves the 'patient as scientist' working with therapist to set hypotheses about P's behaviour and thoughts. P keeps diary between sessions to monitor thoughts. Targets are set at each session, which challenge P to change an aspect of their behaviour.

Hollon et al compared cognitive therapy with drug therapy. 2 groups of depressives given drugs or cog therapy and followed for 1 year. Cog relapse rates 40%, Drug relapse rates 45%. So cog therapy is as effective as drug therapy.

- Doesn't cure mania + Highly effective. Recovery rates typically 60-70% + Can be 1 to 1 or group- cost effective + Combo of cognitive and drug therapy most effective treatment + Good at preventing mild depression developing into severe

Psychodynamic therapy and interpersonal psychotherapy

3 times a week for several years Free association and childhood analysis used Requires P to have insight and understanding into condition so not for bipolar sufferers, especially when in manic phase.

Focusses on way P interacts with other people. 4 aspects of interpersonal dysfunction treated: 1. Grief (due to loss of loved one). IPT helps P come to terms with loss and form new relationships. 2. Interpersonal role disputes (e.g. diff expectations in a relationship) IPT helps resolve 3. Role transitions (due to lifestyle changes, e.g. divorce) IPT provides support 4. Interpersonal skill deficits (e.g. shyness, awkwardness) IPT helps social interactions IPT is particularly useful when cause of depression is interpersonal, e.g. divorce or death