Mood (affective) disorders: depressive disorder (unipolar) and bipolar disorder Flashcards
What are mood disorders?
- Mood disorders refer to a group of disorders including bipolar and depressive disorder.
- Mood disorders are characterised by episodes of particular types of mood over time. Mood episodes can include depressive, manic, mixed and hypomanic episodes.
- Mood episodes aren’t diagnosable in their own right but are the main component of most mood disorders.
What’s depressive disorder?
- Depressive disorder is characterized by depressive mood(feeling sad, irritable, angry) or loss of pleasure.
- Other symptoms accompany it that affect an individuals ability to function such as difficulty concentrating, excessive feelings of worthlessness/guilt, recurrent thoughts of death, changes to eating/sleep patterns.
- A diagnosis of depressive disorder can only be made if the individual has never experienced a manic, mixed or hypomanic episode as that is indicative of bipolar disorder.
- Single episode depressive disorder is characterised by the presence of one depressive episode without a history of previous episodes. Reccurent depressive episode when there are at least two depressive episodes separated by several months or more w/o significant mood disturbance.
- A depressive episode is a period of at least 2 weeks which involves depressed mood and lack of interest in usual activities for most of the day nearly daily.
Bipolar disorders
Type 1 and Type 2 bpd are the 2 types of bipolar disorder and are episodic mood disorders. They’re distinct from each other due to the types of mood experienced.
1. Type 1: defined by the occurence of at least one manic or mixed episode.
* A manic episode lasts for at least a week and is characterised by extreme mood-usually feeling euphoria but also irritable and involves high levels of activity and/or feelings of increased energy. Individuals will usually show rapid speech, impulsivity, reckless behaviour, extremely high self-esteem and rapid changes between mood states.
* A mixed episode is a period of 2 weeks in which there’s a mixture or rapid alternating between manic and depressive states.
Bipolar disorders(2)
Type 2: defined by the occurence of one or more hypomanic episodes and at least one depressive episode.
* A hypomanic episode is a less extreme version of a manic episode , which involves several days of persistent elevated mood or increased irritability, along with increased activity/increased energy levels. Behaviours shown milder versions of that in manic episodes: increased talkativeness, self-esteem and impulsivity.
* It’s different from individuals usual behaviour but won’t cause marked impairment to functioning.
Measures: Beck Depression Inventory
- Psychometric test-widely used tool for detecting depressive disorder
- 21-item self-report measure
- Assesses attitudes and symptoms of depressive disorder.
- Each item in the inventory consists of at least 4 statements and the person must choose one statement that best fits how they’ve been feeling during a recent period of time(may be past week/2 weeks depending on version of test)
- e.g I get as much satisfaction out of things as I used to orI don’t enjoy things the way I used to
- Other items relate to the known symptoms of depressive disorder e.g feelings of guilt & worthlessness
- Total score of test is used to determine the severity of the disorder.
- 10- min.for mild depression, 19-29- moderate depression, 30+- severe depression
Biochemical explanation
Two neurotransmitters associated with depressive disorder: Dopamine and Serotonin
* Dopamine carries signals in parts of the brain responsible for feelings of motivation & pleasure so if reduced, feelings of motivation and pleasure would be affected.
* Core symptoms of depressive disorder are low mood, lack of interest in usual activities and lack of motivation.
* Research shows that low levels of dopamine are often found in those suffering from depressive disorder. Furthermore, anti-depressants reduce symptoms of depressive disorder by increasing dopamine levels, which supports the theory that low dopamine levels were the cause of depressive symptoms
* Serotonin is a neurotransmitter that regulates sleep, appetite, mood and anxiety. When serotonin levels are normal, mood and anxiety levels are balanced but when they reduce this can lead to low mood, anxiety and disruption to sleeping and eating patterns which are all symptoms of depressive disorder.
* Common antidepressants are SSRI’s which work by increasing serotonin levels.
Genetic explanation
- First-degree relatives such as parents and siblings share 50% of their DNA.
- Mental disorders are thought to have a genetic basis just like physical illnesses which means they can be transmitted from one generation to the next.
- Current evidence for bipolar and depressive disorder suggests that there is at least some genetic explanation for why some individuals are more at risk of developing such disorders
Oruc et al.
Aim- To investigate whether the genes encoding for certain serotonin receptors and serotonin transporters could be involved in susceptibility to BPD.
Sample- 42 unrelated patients with BPD type 1, from two Croatian hospitals, 25F 17M, age range: 31-70yrs, 16 had a first-degree relative diagnosed with a major affective disorder such as BPD (info collected from ppts. and family members with diagnosis confirmed through records),ctrl group-40 ppts with no personal or family psychiatric history.
Design: Matched pairs as ppts in the ctrl froup matched the patient sample in terms of age and sex.
Procedure: DNA testing was carried out with ppts. to test for polymorphisms(variations) in the genes responsible for a particular serotonin receptor and serotonin transporter. These genes were chosen because alterations in them can lead to disturbances in specific biochemical pathways with known links to depressive disorders. The results of the DNA analysis were compared between ppts. to look for significant factors.
* * Results:
* No significant associations in the sample-ppts. with BPD were not significantly more likely to have polymorphisms of the genes under investigation than the ctrl group.
* Also means that those with a family history of mood disorder were no more likely to have polymorphisms in these genes than other ppts.
* Serotonin is understood to be sexually dimorphic (there are differences between men and women) so when participants were analysed separately by gender, results showed that polymorphisms for both genes were more common in women with BPD than in the ctrl group. This suggests that polymorphisms in these genes could be responsible for an increased risk of devoloping BPD in women only.
Beck’s cognitive theory of depression
- Beck believed that negative views held by someone with depression form a reality for that person, even if they seem far-fetched to others
- The reason for a person’s low mood and physiological symptoms is an underlying process of incorrect info processing
- Cognitive distortion- when a person tends to see things in a negative way. Develops as a result of negative experiences during childhood leading to negative schemas. This leads to their negative schema activating and they expect things to turn out badly
- Beck’s cognitive triad:
- Individual’s view of themself, they think they’re worthless and incapable.
- Individual views the world as presenting them with impossible obstacles to happiness and well being
- Negative view of the future, anticipating failure/rejection when considering undertaking a new task
Learned helplessness & attribution style(Seligman)
- State that occurs as a result of a person having to endure an unpleasant situation when they percieve the unpleasantness to be inescapable.
- The individual learns that they’re unable to control the situation and prevent suffering, so they eventually stop trying to resist it.
- Seligman believed that learned helplessness could explain depressive disorder. His view was that depression was a direct result of a real/percieved lack of control over the outcome of your situation
- Learned helplessness is the basis of attributional style. Life experiences teach us to develop trust/distrust in our environments so we develop particular patterns of thinking towards the world and ourselves.
Seligman et al.
Aim- How well attributional style could predict depressive symptoms
Sample: 39 patients with depressive disorder, 12 bpd patients participated during a depressive episode, same outpatient clinic, mixed genders, mean age=36yrs. compared with ctrl group of 10 ppts.
Procedure: At the start of the study, ppts completed a short form of the BDI to assess severity of symptoms. They then completed and Attributional Style Questionnaire consisting of 12 hypothetical good and bad events. Ppts. had to make causal attributions for each one and then rate each cause on a seven-point scale for internality, stability and globality.
Results:
* Both the unipolar and bipolar ppts. were found to have more pessimistic, negative attributional styles than the non-patient crl group.
* The more severe the depression score on the BDI, the worse the pessimism on the Attributional Style Questionnaire.
* For those with unipolar depressive disorder undergoing cognitive therapy, an improvement in attributional style correlated with an improvement in BDI scores
Biological Treatment
- Tricyclics(1950s)- Increase the levels of serotonin and norepinephrine in the brain by stopping them from being reabsorbed. Increase in levels of this neurotransmitters reduces symptoms of depressive disorder. Effective when compared to other anti-depressants but tend to have more side-effects(drowsiness, nausea, vomiting, weight gain, blurred vision) than more modern alternatives like SSRI’s
- MAOI’s (Monoamine oxidase inhibitors)- Inhibit the work of enzyme monoamine oxidase which is responsible for breaking down & removing the neurotransmitters, norepinephrine, serotonin, dopamine and prevent them from being broken down and allow them to remain at higher levels in the brain. Side-effects include headaches, drowsiness, nausea, diarrea and consitpation. Can cause issues with withdrawal. may interact with other medications which may lead to negative side-effects e.g high blood pressure/headaches.
- SSRI’s act on the neurontransmitter serotonin to stop it being reabsorbed and broken down once it has crossed a synapse in the brain. This means thats serotonin levels in the brain increase which reduces symptoms of the depressive disorder. They are the most commonly prescribed antidepressant drug in most countries. Have fewer and less severe side effects than MAOI’s and Tricyclics.
Psychological Treatment(Beck’s cognitive restructuring)
- A talking therapy based on one-to-one interaction between the patient with depressive disorder and their therapist
- Involves techniques such as questioning, to identify illogical thinking and talking through ways of changing the patient’s way of thinking.
- Begins with explaining the theory of depressive disorder** -explaining the triad is important as it enables the patient to understand that their way of thinking about themselves and the world contributes to their depressive disorder.-**Train the patient to observe and record their thoughts which is critical to help them identify irrational beliefs.
- These beliefs/thoughts can be discussed and challenged in therapy to explore with the patient whether they are really an accurate reflection of reality.
- ‘Reality testing’ helps patients identify their negative distortions in thinking. The therapist can take them through ‘Reattributing’ in which they discuss whether the problems faced are internal/external.
- Patients can reframe their thinking about an upsetting situation and realize they aren’t responsible for it
- Therapy finishes when patient can employ cognitive restrucuring for themselves and see a reduction in depressive symptoms.
- Wiles et al. showed that it can reduce symptoms of depression in ppl who fail to respond to anti-depressants. A group of **469 **individuals with depressive disorder were randomly allocated either continued usual care(anti-depressants) or care with CBT. Those who recived the therapy were three times more likely to respond to treatment and experience a reduction in symptoms.
Ellis’s rational emotive behaviour therapy(REBT)
- Based on stoicism principle which is a philosophy in which an individual isn’t directly affected by external things but by their own perception of external things.
- therapist helps individuals understanding ABC model( Activating event-Beliefs abt event-Consequences)
- ‘B’ is most important element as we all face adversity and our beliefs abt those experiences impact emotional well-being and thus behaviour
- Goal is to help individuals create and maintain constructive and rational patterns of thinking abt their lives
- Disputing- the therapist forcefully questions the irrational beliefs using a variety of different methods to reformulate dysfunctional beliefs.
- Therapist enables the individual to recognise that whatever setbacks they experience, they can choose how to think and feel about it.
- Individuals must begin to see that the consequences(C) that they experience are only partly a result of the activating event(A). They then must accept that holding onto negative and self-defeating beliefs (B) is a destructive tendency but one can be changed by challenging the beliefs and replacing them with healthier thoughts
- Ellis argues that the tendency to hold onto irrational beliefs is ingrained over time and so REBT has a great focus on the present
