Mood Disorders

Question 1

Anxiety Disorders

Wittchen et al., 2011

Answer 1

14% of people across Europe are estimated to have anxiety disorders - the most common of all mental illnesses

Question 2

Gender differences in anxiety disorders

Answer 2

Anxiety disorders occur more commonly in females than males

Question 3

Narrow, Rae, Robbins, and Regier, 2002

Answer 3

– In 70% cases anxiety disorders care considered clinically significant e.g., they interfere significantly with life functions causing the person to seek medical or psychological treatment

Question 4

Biological factors in Anxiety disorders - twin study

Answer 4

Identical MZ twins have a concordance rate of 21.5% compared to 13.5% in DZ twins (Andrews et al., 1990)

Question 5

Barlow, 2002

Answer 5

Genetic vulnerability may be down to the ANS overreacting to a perceived threat creating high levels of physical arousal

Question 6

Smoller, 2016

Answer 6

Two genes modulating homeostasis may play a role

Question 7

Mineka et al., 1998

Answer 7

– Hereditary factors may cause over reactivity of NT systems (such as GABA – which is also known to be involved in PD) involved in emotional responses

Question 8

Support from Bremner, 2000

Answer 8

– Low levels of GABA may cause people to have highly reactive nervous systems that quickly produce anxiety responses to stressors

Question 9

Goddard et al., 2001

Answer 9

– People with a history of panic attacks have 22% lower concentration of GABA in the occipital cortex than age matched controls without PD

Question 10

Craske, 2003 - sex-linked condition

Answer 10

Sex differences in anxiety emerge as early as 7. Suggests a sex linked biological predisposition for anxiety disorders however social conditions that give women less power and personal control may also contribute

Question 11

Psychological factors - Freud

Answer 11

neurotic activity occurs when unacceptable impulses threaten to overwhelm the ego’s defenses and explode into the consciousness

Question 12

Evidence from Little Hans study

Answer 12

In phobic disorders neurotic anxiety is displaced onto an external stimulus e.g., little Hans’ fear of horses

Question 13

Psychoanalysts

Answer 13

Psychoanalysts believe that obsessions and compulsions are ways of handling anxiety e.g., in OCD when there is a compulsion of hand washing is a way of dealing with one’s ‘dirty’ sexual impulses

Question 14

Why does general anxiety disorder (GAD) and Personality disorder (PD) occur according to psychanalysts?

Answer 14

GAD and PD are thought to occur when one’s defenses are not strong enough to control or contain neurotic anxiety

Question 15

Cognitive factors in Anxiety disorder

Answer 15

Role of maladaptive thought patters and beliefs in anxiety disorders

People with anxiety catastrophise about demands and magnify them into threats

They anticipate that the worst will happen and feel powerless to cope effectively (Clark, 1988)

Intrusive thoughts about the previous traumatic event are a central feature of PTSD and the presence of such thoughts after the trauma predicts later development of PTSD (Falsetti et al., 2005)

PD results from catastrophic misinterpretation (Clark, 1986, 1988)

Anxiety responses lead to increased anxiety responses

The person becomes hypervigilant where their sensitivity to physical changes is increased

Person uses avoidance to avoid the sensations

However, some people report that they do not engage in catastrophic misrepresentation

Treated with CBT which can included exposure therapy, desensitization, and flooding with the goal of retraining the person to see their physical sensations as being relatively normal

Question 16

How does classical conditioning contribute to the development of anxiety disorder?

Answer 16

Some fears are acquired as a result of traumatic experiences that produce as classically conditioned fear response (Rachman, 1998)

However, some people with anxiety have never had a traumatic experience with the phobic object or situation they now fear (Bruce and Sanderson, 1998)

Question 17

How does operant conditioning contribute to anxiety disorder?

Answer 17

Behaviours that are successful in reducing anxiety such as compulsions or phobic avoidance responses become stronger through negative reinforcement

This prolongs the problem as it prevents the learned anxiety response from being extinguished

Question 18

How does observational learning contribute to anxiety disorder?

Answer 18

May be mediated by cognitive and biological factors whether someone develops a phobia from observing or hearing about a traumatic event

Once anxiety is learned it may be triggered by cues from internal (thoughts or images; Pitman et al., 2000) or external cues

Phobic reactions tend to result from external cues and panic reactions tend to result from internal ones (Clark, 1986)

Question 19

Socio-cultural factors in anxiety disorder

Answer 19

Culture bound disorders e.g., social phobia in Japan called Taijin Kyofushu (Begum and McKenna, 2010) in which people are pathologically fearful of offending others by emitting offensive odours, blushing, staring inappropriately or having a blemish or improper facial expression

This has been attributed to the Japanese value of extreme interpersonal sensitivity and to cultural prohibitions against expressing negative emotions or causing discomfort in others (Kleinknecht et al., 1997)

Eating disorders such as anorexia nervosa is found almost exclusively in developing countries which being thin has become a cultural obsession (Becker et al., 1999)

Question 20

Phobic disorders

What are they?
Where are they most common?
When do they arise?

Answer 20

Strong and irrational fears of certain objects or situations.

Most common in the West: agoraphobia, social phobias, specific phobias e.g., of dogs, snakes, water, injections

Animal phobias are most common among women and fear of heights are most common among men (Curtis et al., 1998)

Many arise during childhood, adolescence, and early adulthood

Once they develop, they rarely go away on their own and may get worse over time (Beck, Emery and Greenberg, 2005)

Question 21

Generalised anxiety disorder (GAD)

Answer 21

Chronic ongoing state of anxiety that is not attached to specific situations or objects

May last for months with signs almost continually present

Interfere significantly with daily functioning

Difficulty concentrating, making decisions, and remembering commitments

Tends to occur in childhood and adolescence (Wittchen et al., 1994

Question 22

Panic Disorder

Answer 22

Panic attacks appear suddenly in the absence of any identifiable stimulus (Clark and Beck, 2010)

60% of people with daytime panic attacks also experience panic attacks during sleep

7.9 million Europeans are predicted to suffer from PD

CBT is regarded as long term and effective treatment but medical treatments such as anti-depressants have also been shown to be effective

Can lead to people developing agoraphobia as they fear they will have a panic attack in public

Danger that these will be seen as two separate things when they are very interlinked (Pompoli et al., 2018)

Some have been known to remain housebound for years at a time (Davey, 2008)

Question 23

OCD

Answer 23

Usually consists of obsessions (repetitive and unwelcome thoughts, images or impulses that invade consciousness and are difficult to dismiss or control) and compulsions (repetitive behavioural responses such as rituals or repetitive checking of light switches or door locks that are difficult to resist)

These can occur separately

Compulsions are often responses that function to reduce the anxiety associated with the intrusive thoughts (Clark and O’Connor, 2005)

Compulsions are strengthened through negative reinforcement because they allow the person to avoid anxiety

Where the thoughts (obsessions) combine with actions (compulsions) there is a situation of Thought Action Fusion (TAF). The thought is equated with the action e.g., ‘if I don’t do this, I will get ill’

1.1 % of the population (Torres et al., 2006) but DeSilva estimates it at 3%

Significant co morbidity with depressive episodes, panic disorders and phobias

OCD was significantly higher in people with other neuroses – 10% (Torres et al., 2006)

Question 24

PTSD

What are the 4 major symptoms? (Falsetti et al., 2009)

Answer 24

Severe anxiety disorder that can occur in people who have been exposed to a traumatic life event
Four major symptoms (Falsetti et al., 2009)

Severe symptoms of anxiety, arousal and distress that were not present before the trauma

Relives trauma recurrently in flashbacks, dreams or fantasies

Becomes numb to the world and avoids stimuli that serves as a reminder to trauma

Intense survivor guilt in instances where others were killed, and individual was spared

Question 25

Where is PTSD prevalent?

Answer 25

Soldiers – 12-month PTSD rate of 27.8% following combat exposure (Prigerson et al., 2002)

Terror attacks
PTSD rates for residents in Manhatten post 9/11 were 7.5% and 20% for those who lived closest to the World Trade Centre

Civilian war victims – PTSD rate of 60.5% in Kosovan refugees (Peterson and Ubelhor, 2002)

Prevalence of PTSD increased as years went by

Reported to have experienced 15 war related crimes

War, rape and torture elicit more severe PTSD reactions than natural disasters (Corales, 2005)

Women exhibit twice the rate of PTSD following exposure to traumatic events (Kimerling et al., 2003)

Rumination keeps the person in a particular emotional state (Ehlers and Clark, 2000). They suggest that this is a cognitive avoidance strategy that stops the person from forming more complex problems by repeatedly appraising the traumatic event negatively

PTSD may increase vulnerability to the later development of other disorders

Women who experience PTSD had double the risk of developing a depressive disorder and three times the risk of developing alcohol related problems (Breslau et al., 1997)

Importance of prompt post trauma intervention

Observing a violent crime can elicit PTSD

Question 26

Somatoform disorders

Answer 26

Somatic symptom disorders involve physical complaints that do not have a physiological explanation. They include hypochondriasis, pain disorders and conversion disorders

Familiar similarities in somatic symptom disorders may have a biological basis or they may be the result of environmental shaping through attention and sympathy

Such disorders tend to occur with greater frequency in cultures that discourage open expression of negative emotions

Question 27

Dissociative disorders

Answer 27

Dissociative disorders involve losses of memory and personal identity. The major dissociative disorders are psychogenic amnesia, psychogenic fugue, and dissociative identity disorder (DID)

The trauma-dissociation theory holds that DID emerges when children dissociate to defend themselves from severe trauma or sexual abuse. This model has been challenged by other theorists who believe that multiple personalities result from role immersion that therapist expectations

Question 28

Mood disorders

Answer 28

Mood disorders include several depressive disorders and bipolar disorders in which intermittent periods of mania (intense mood) and behaviour activation occur

The symptoms of negative emotions and thoughts, loss of motivation and behavioural slowness are reversed in mania

Question 29

Genetic factors of depression

Answer 29

One prominent biochemical theory links depression to underactivity of neurotransmitters (norepinephrine, dopamine, and serotonin) that activate brain areas involved in please and positive motivation. Drugs that relieve depression increase the activity of these transmitters. Bipolar disorder seems to have an even stronger genetic component than does unipolar depression

Question 30

What is the Psychoanalytic theory of depression?

Answer 30

Psychoanalytic theorists view depression as a long-term consequence of traumatic losses and rejections early in life that create a personality vulnerability pattern

Question 31

What is the cognitive theory of mood disorders?

Answer 31

Cognitive theorists emphasise the role of negative beliefs about the self, the world, and the future (the depressive cognitive triad) and describe a depressive attributional pattern in which negative outcomes are attributed to personal causes and successes to situational causes

Question 32

What are the four symptoms of depression?

Answer 32

emotional, cognitive, motivational, and somatic

Question 33

Behavioural model of depression

Answer 33

Lewinsohn et al., (1985) behavioural model of depression states that depression is triggered by loss, by a punishing event or a drastic decrease in positive reinforcement a person receives in their environment.

As the depression begins to take hold the person stops engaging in in hobbies and socialising, a tendency for depressed people to make others feels anxious, depressed and hostile (Joiner and Coyne, 1999) leads to a reduction in social support leading to a deeper depression.

To break this cycle depressed people, need to initially force themselves to engage in behaviours that are likely to produce some degree of pleasure and eventually positive reinforcement produced by this process of behavioural activation will begin to counteract the depressive affect and lead to reduced feelings of hopelessness and increased feelings of personal control over the environment (Martel et al., 2004)

The behavioral approach focuses on the vicious cycle in which depression induced inactivity and aversive behaviors reduce reinforcement from the environment and thereby increase depression still further

Question 34

Seligman’s theory of learned helplessness

Answer 34

Selgiman’s theory of learned helplessness suggests that attributing negative outcomes to personal, stable, and global causes fosters depression

Question 35

What are the two main motives for suicide?

Answer 35

Manipulation and a desire to escape distress are the two major motives for suicide. The risk increases if the person is depressed and has a lethal plan and a history of parasuicide

Question 36

SZ

Answer 36

– SZ is a psychotic disorder featuring disordered thinking and language, poor contact with reality, flat, blunted, or inappropriate emotion, and disordered behaviour

The cognitive portion of the disorder can involve delusions (false beliefs) or hallucinations (false perceptions)

Question 37

Cognitive theory of SZ

Answer 37

Cognitive theorists focus on the thought disorder that is central to SZ. One idea is that people with SZ have a defect in their attentional filters so that they are overwhelmed by internal and external stimuli and become disorganised. Deficiencies may also exist in the executive functions needed to organise behaviour

Question 38

Psychoanalytic theories of SZ

Answer 38

Psychoanalytic theorists regard SZ as a profound regression to a primitive stage of psychosocial development in response to unbearable stress, particularly within the family

Stressful life events do often precede a SZ episode, but researchers have not been successful in identifying a family pattern related to the onset of SZ. Expressed emotion is a family variable related to relapse among formerly hospitalised SZ patients

Question 39

Genetic theory of SZ

Answer 39

There is strong evidence for a genetic predisposition to SZ that makes some people particularly vulnerable to stressful life events

The dopamine hypothesis states that SZ involves over activity of the dopamine system resulting in too much stimulation

Question 40

Sociocultural theory of SZ and the ‘Social Causation Hypothesis’

Answer 40

Sociocultural accounts of the higher incidence of SZ at lower SES include the social causation hypothesis which attributes SZ to the higher levels of life stress that poor people experience and the competing social drift hypothesis which attributes the relation to the downward drift into poverty as the disorder progresses. SZ does not appear to differ in prevalence across cultures.

Question 41

When words fail: providing effective psychological treatment for depression in aphasia

Key points:

Answer 41

2/3 of people with aphasia suffer from clinical depression (Cruice et al., 2010)

Less than 1% of the aphasic population receives direct treatment for psychological distress (Townsend et al., 2010)

Mental health professionals report they have received little education on the nature of aphasia and no training in how to communicate with people suffering from aphasia (King, 2013)

Communication methods employed by SLTs could assist mental health professionals in addressing the needs of people with aphasia

Life Participation for Adults with Aphasia (LPAA; Kagan et al., 2001) has proven highly successful in providing access to community for persons with aphasia

Consideration of the behavioural sources of depression in aphasia, recognition of common aims of the life participation interventions employed by SLTs and behavioural activation interventions for depression could contribute to development and delivery of effective, socially engaging psychological treatments for persons with aphasia and depression