Mood Disorders

Question 1

Motivational features

Answer 1

Loss of interest in hobbies, sex
Lack of initiative
Social withdrawal

Question 2

Behavioural features

Answer 2

Slowness of speech and behaviour
Decreased energy
Fatigue - stay in bed

Question 3

Physical features

Answer 3

Sleep disturbance (insomnia, hypersomnia)
Headaches
Dizzy spells
Indigestion
Constipation
General pain

Question 4

Cognitive features

Answer 4

Negative view of the self, the world and the future (pessimism)
Poor concentration
Inability to make decisions
Worthlessness
Shame and guilt

Question 5

DSM list of depressive disorders

Answer 5

Major Depressive
Persistent
Premenstrual Dysphoric
Substance/Medication Induced
SAD

Question 6

DSM - Major Depressive Disorder criteria

Answer 6

Five + symptoms
2-week period
(1) depressed mood (can be irritable in children)
(2) loss of interest or pleasure

Question 7

DSM - MDD Symptoms

Answer 7

1. Weight loss or gain.
2. Insomnia or Hypersomnia nearly every day.
3. Psychomotor agitation or retardation (observable by others)
4. Fatigue or loss of energy.
5. Worthlessness or guilt
6. Poor concentration or indecisiveness.
7. Suicidal ideation or attempt.

Question 8

Mania criteria

Answer 8

1 week +
Three (or more) symptoms (four if mood is irritable)
Noticeable change from usual behaviour

Question 9

DSM Mania symptoms

Answer 9

Abnormally and persistently elevated or irritable mood

1) Inflated self-esteem or grandiosity
2) Decreased need for sleep
3) More talkative than usual
4) Flight of ideas or racing thoughts
5) Distractibility
6) Increase goal-directed activity or psychomotor agitation
7) Excessive risk taking behaviour

Question 10

Hypomania

Answer 10

Less extreme
No social or occupational impairment
Doesn’t require hospitalisation
Psychosis = mania

Question 11

Diagnosis process

Answer 11

1. GP, Psychiatrist or Psychologist
2. Current circumstances, symptoms, individual & family history
3. Mental State Examination – current mood and thought content
4. Beck Depression Inventory (Beck et al, 1961; 1996)
5. Medical examination – to rule out other causes

Question 12

UK Prevalence

Answer 12

1 in 5 adults - anxiety or depression
Women > Men
50-54 highest incidence of mild symptoms
27% divorced, 20% single, 16% married - report symptoms.

Question 13

Worldwide Prevalence

Answer 13

WHO: 350 million people worldwide
1 in 20 report episode past year

BIOMED Central: 121 million people affected worldwide

Kessler et al (2005): males 3-5%, females 8-10% - N. America

Question 14

Risk factors/Causes

Answer 14

Stressful events
Illness (e.g. longstanding, head injuries or thyroid/gland problems)
Personality (low self-esteem, self-critical)
Family history (genetics)
Giving birth (hormonal changes)
Loneliness
Alcohol and Drugs

Question 15

Suicide and self harm statistics

Answer 15

90% of suicides diagnosable psychiatric disorder.
Over 50% of suicides are depressed.
“Hopelessness” key feeling.
850,000 deaths per year.

Question 16

Genetic factors

Answer 16

Kendler et al. (1993): 5 - 10% 1st degree relatives of sufferers report related symptoms.

McGuffin et al. (1996): 46% MZ , 20% DZ.

No specific gene definitively identified

Question 17

Neurochemical factors

Answer 17

50s High blood pressure meds, decrease serotonin levels.

50s Tricyclic drugs and MAO’s - increase S & N.

Low S & N inhibits neuron communication and brain activity.

Tricyclics inhibit the reuptake of these neurotransmitters, leaving more in the synapse for communication and brain activity.

Serotonin - MDD Norepinephrine - Bipolar

Question 18

Brain abnormalities

Answer 18

Pre-frontal cortex – low, goal maintenance
Anterior cingulate cortex – low, emotional regulation
Hippocampus – low, context of affective reactions
Amygdala – increased, attention to salient stimuli

Question 19

Psychodynamic theory

Answer 19

Depression a response to loss of loved one.

Introjection; integrating identity of person onto themselves.
Regression to oral stage; dependent on others for support.
Symbolic loss; losses equivalent to the loss of a loved one
Poor Parenting; lack of warmth but controlling

Question 20

Problems with Psychodynamic theory

Answer 20

Fit more than one theory
Not all children of poor parents develop depression
Difficult to test psychoanalysis

Question 21

Behaviour and Reinforcement

Answer 21

1. Removal of reinforcement for positive behaviours.
2. Extinction of behaviour – “behavioural vacuum”.
3. Withdrawal leads to no development of new behaviours.
   e. g. no reward for social interaction > social withdrawal

Question 22

Interpersonal theories

Answer 22

Negative view of self > reassurance seeking > annoy family and friends > vicious circle .

Problems – retrospective, depression must come first.

Question 23

Beck’s cognitive theory of depression

Answer 23

Negative schema - belief that affects view of self and world.
Leads to cognitive bias
Effects selection, categorisation and evaluation.
Stable and originates in childhood, concerning loss.
Event in later life reactivates schema.

Question 24

Negative triad (Beck)

Answer 24

Negative view of self, future, the world.

Things happen due to these (cognitive bias).

No point in trying.

Question 25

Emotional features

Answer 25

Sadness Close to tears Loss of sense of humour Anxiety

Question 26

Evidence for Beck

Answer 26

``` Attentional bias to negative stimuli Stroop Task (Gotlib & Cane, 1987) – slower at naming the colours of negative words. ``` Dichotic listening procedure (Ingram et al, 1994) – show difficulty ignoring negative words. Interpretational bias – depression associated with critical self-judgement.

Question 27

Lack of positive rather than negative bias?

Answer 27

Could explain pessimistic thinking. Alloy & Abramson (1979) – sufferers more accurate in evaluating situational control. Lewinsohn et al (1980) – sufferers more accurate in evaluating social impressions on others.

Question 28

Problems with Beck

Answer 28

Unclear whether negative cognitive biases cause depression or are a consequence of the disorder. Which comes first?

Question 29

Learned Helplessness

Answer 29

Seligman (1974) Dogs given unavoidable electric shocks then trained to avoid them. History of shocks = couldn’t learn avoidance behaviour. Humans - shocks = trauma, abuse.

Question 30

Problems with Learned Helplessness

Answer 30

Experience of negative events may improve later performance Depression includes self-blame Passivity may be context specific

Question 31

Attribution Theories

Answer 31

(Abramson, Seligman & Teasdale, 1978) Attributions = explanations people give for behaviour/event. Depression occurs when negative life events are attributed to stable, global and internal factors.

Question 32

Hopelessness Theory

Answer 32

Abramson et al. (1989) Account for interaction between attributional style and other factors. Diathesis-Stress: Attribution style = diathesis Negative event = stress. Hopelessness – expectation that nothing good will happen and the individual is powerless to change it.

Question 33

Research into Hopelessness Theory

Answer 33

A combination of low self-esteem, negative attributional style and negative life events shown to predict depression. Negative attributional style linked to indecisiveness and lethargy, less so to loss of interest and weight loss (Joiner 2001) Predictor of suicidal tendencies and self-harm (Conner et al, 2001)

Question 34

Problems with Hopelessness Theory

Answer 34

Non-clinical research and correlational research. Cannot account for all symptoms. Negative attributional style disappears so may not be enduring individual feature – what comes first?

Question 35

Biological treatments

Answer 35

Tricyclic (imipramine) – increase S & N. MAOIs (rasagiline) – increase S & N. SSRIs (Prozac) – prevent serotonin reuptake. Tricyclic/MAOIs - 50-65% improvement. SSRI’s - more recent, mixed results.

Question 36

Drug side effects and problems

Answer 36

Tricyclic – anxiety, fatigue, dry mouth, high BP, sex dysfunction MAOIs – high BP, dizziness, headaches & nausea SSRIs – anxiety, fatigue, gastric disorders, headaches, dizziness. Little > no effect, dependent on level of depression, relapse common, SSRIs cause suicide? First line treatment – rapid and help people seek other help. Drugs + therapy most effective.

Question 37

ECT

Answer 37

1930’s 70-130 volts, half a second. Developed to induce brain seizures. Severe depression/treatment resistant. Memory loss > 7 months. Confusion, nausea, headache, emotional shallowness. 4 week benefits. Violent procedure.

Question 38

Psychodynamic therapy

Answer 38

Help individual gain insight into conflict from loss & introjection. Long-term causes by exploring past conflicts & relationships. Examines defensive patterns. Free association and dream interpretation. Outcomes inconclusive - difficult to study scientifically and methods often differ.

Question 39

Social skills training

Answer 39

Depression is maintained by inappropriate communication. Trains individual in assertion, conversation, dating & interviews. Modelling, rehearsal, role-playing in a therapeutic setting or in RL. Feedback, positive reinforcement are key.

Question 40

Behavioural activation therapy

Answer 40

Emphasises loss of source of reward. Increase access to positive events/rewards and decrease experience of negative ones. Self-monitoring of pleasant/unpleasant experiences. Identify behavioural goals.

Question 41

Beck Cognitive Therapy

Answer 41

Correct negative thinking bias. Identify negative beliefs & thoughts. Challenge thoughts as dysfunctional/irrational. Replace beliefs with adaptive/rational ones. Monitor negative automatic thoughts and re-interpret difficulties more constructively (not global/stable).

Question 42

Mindfulness Cognitive Therapy

Answer 42

Recognise negative feelings and thought processes. View them as just thoughts. Alters relationship between thoughts and resultant behaviour. e.g. Acceptance & Commitment Therapy (ACT)

Question 43

Research areas

Answer 43

Biological – genes, brain scanning. Psychological – treatment comparisons. Cognitive tasks – Stroop, perception and performance.

Question 44

Depression and creativity

Answer 44

Rumination gives way to productivity. Heightened perception, flight of ideas. Bipolar and depression strongly linked.