Mood Disorders Flashcards
Motivational features
Loss of interest in hobbies, sex
Lack of initiative
Social withdrawal
Behavioural features
Slowness of speech and behaviour
Decreased energy
Fatigue - stay in bed
Physical features
Sleep disturbance (insomnia, hypersomnia) Headaches Dizzy spells Indigestion Constipation General pain
Cognitive features
Negative view of the self, the world and the future (pessimism) Poor concentration Inability to make decisions Worthlessness Shame and guilt
DSM list of depressive disorders
Major Depressive Persistent Premenstrual Dysphoric Substance/Medication Induced SAD
DSM - Major Depressive Disorder criteria
Five + symptoms
2-week period
(1) depressed mood (can be irritable in children)
(2) loss of interest or pleasure
DSM - MDD Symptoms
- Weight loss or gain.
- Insomnia or Hypersomnia nearly every day.
- Psychomotor agitation or retardation (observable by others)
- Fatigue or loss of energy.
- Worthlessness or guilt
- Poor concentration or indecisiveness.
- Suicidal ideation or attempt.
Mania criteria
1 week +
Three (or more) symptoms (four if mood is irritable)
Noticeable change from usual behaviour
DSM Mania symptoms
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
Hypomania
Less extreme
No social or occupational impairment
Doesn’t require hospitalisation
Psychosis = mania
Diagnosis process
- GP, Psychiatrist or Psychologist
- Current circumstances, symptoms, individual & family history
- Mental State Examination – current mood and thought content
- Beck Depression Inventory (Beck et al, 1961; 1996)
- Medical examination – to rule out other causes
UK Prevalence
1 in 5 adults - anxiety or depression
Women > Men
50-54 highest incidence of mild symptoms
27% divorced, 20% single, 16% married - report symptoms.
Worldwide Prevalence
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
Risk factors/Causes
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
Suicide and self harm statistics
90% of suicides diagnosable psychiatric disorder.
Over 50% of suicides are depressed.
“Hopelessness” key feeling.
850,000 deaths per year.
Genetic factors
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
Neurochemical factors
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
Brain abnormalities
Pre-frontal cortex – low, goal maintenance
Anterior cingulate cortex – low, emotional regulation
Hippocampus – low, context of affective reactions
Amygdala – increased, attention to salient stimuli
Psychodynamic theory
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
Problems with Psychodynamic theory
Fit more than one theory
Not all children of poor parents develop depression
Difficult to test psychoanalysis
Behaviour and Reinforcement
- Removal of reinforcement for positive behaviours.
- Extinction of behaviour – “behavioural vacuum”.
- Withdrawal leads to no development of new behaviours.
e. g. no reward for social interaction > social withdrawal
Interpersonal theories
Negative view of self > reassurance seeking > annoy family and friends > vicious circle .
Problems – retrospective, depression must come first.
Beck’s cognitive theory of depression
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.
Negative triad (Beck)
Negative view of self, future, the world.
Things happen due to these (cognitive bias).
No point in trying.
Emotional features
Sadness
Close to tears
Loss of sense of humour
Anxiety
Evidence for Beck
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.
Lack of positive rather than negative bias?
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.
Problems with Beck
Unclear whether negative cognitive biases cause depression or are a consequence of the disorder.
Which comes first?
Learned Helplessness
Seligman (1974)
Dogs given unavoidable electric shocks then trained to avoid them. History of shocks = couldn’t learn avoidance behaviour.
Humans - shocks = trauma, abuse.
Problems with Learned Helplessness
Experience of negative events may improve later performance
Depression includes self-blame
Passivity may be context specific
Attribution Theories
(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.
Hopelessness Theory
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.
Research into Hopelessness Theory
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)
Problems with Hopelessness Theory
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?
Biological treatments
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.
Drug side effects and problems
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.
ECT
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.
Psychodynamic therapy
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.
Social skills training
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.
Behavioural activation therapy
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.
Beck Cognitive Therapy
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).
Mindfulness Cognitive Therapy
Recognise negative feelings and thought processes.
View them as just thoughts.
Alters relationship between thoughts and resultant behaviour.
e.g. Acceptance & Commitment Therapy (ACT)
Research areas
Biological – genes, brain scanning.
Psychological – treatment comparisons.
Cognitive tasks – Stroop, perception and performance.
Depression and creativity
Rumination gives way to productivity.
Heightened perception, flight of ideas.
Bipolar and depression strongly linked.
