mood disorders

BIPOLAR AND RELATED DISORDERS 

DEFINITION

Affective disorders are defined by the DSM-IV as mental disorders characterized by disturbances of mood that are intense and persistent to be clearly maladaptive.

TYPES

Depression is the main symptom of a number of disorders including:
– unipolar ( major) depression
– bipolar (mania) depression

SYMPTOMS

Unipolar Depression –  symptoms must be present consistently every day, not be related to another disorder, not be caused by substance abuse, not be caused by grief, should involve a negative change from the initial level of functioning.
– physical: change in appetite, sleeping problems such as insomnia/hypersomnia or pattern disturbance, excessive sleeping as a trial to escape from reality, fatigue
– cognitive: problematic decision making, slow and tangled thinking, pessimistic spirit, impaired memory and concentration, suicide plot
– social: social withdrawal due to not gaining pleasure from social interactions, feeling of not contributing
– emotional: sadness, unhappiness, distress, loss of pleasure, pessimism, low mood
– behavioral: disrupted self-care, takes more time to complete everyday activities, reduced sex drive

Bipolar Depression – in the depressed phase, symptoms are very similar to unipolar depression. In bipolar disorder, there are also alternating periods of mania – wild and unrealistic activity, a flight of ideas, elevated mood; during the manic phase, the individual may lose touch with reality, therefore, this illness may be characterized as psychosis.
– cognitive: disturbed thought processes, delusional ideas, reckless decisions
– emotional: feel fantastic, no social inhibition, confidence, deny anything is wrong
– behavioral: talk fast, reckless actions with bad consequences
– physical: little amount of sleep, increased energy level, super active

DIAGNOSIS

In order for an individual to be diagnosed with depression, they must show consistent low mood for minimum 2 weeks as well at least 5 of the following: weight loss/gain, energy loss/ tiredness, insomnia/hypersomnia, interest loss in previously enjoyed activities, unreasonable feeling of guilt, impaired thinking/concentration, suicidal plot.

For bipolar depression disorder to be diagnosed, symptoms of both depression and mania states has to be experienced.

MEASURING

Depression is measured using psychometric tests. such a test is the BDI – Beck’s Depression Inventory, a multiple-choice self-report used to assess the symptoms and severity of depression. It contains 21 items – consisting of 4 statement choices from which the individuals have to choose 1 that they feel fits best for them. The items address issues such as sadness, disappointment, sleeping and other characteristics that could show signs of depression. Each statement has a score ranging from 0 to 3, these are totaled and the final score is used to determine the severity of the disorder (10 – mild, 10 to 29 – moderate, 30 or above – severe).
The BDI has been updated twice; it is considered fairly accurate because studies showed it has high levels of reliability and validity. The test is objective due to quantitative measurements so there is no chance for assessor bias. An issue with the test is that, because it is a self-report, the individuals taking it can either underestimate or exaggerate the answers, which makes the representation of their state less accurate.
Application to everyday life: the BDI is used in clinical settings as a tool that helps in the diagnosis and treatment of depression and identifying individuals who may be at risk. the test has been adapted to be suitable for children under 13

EXPLANATIONS

Biological

The biological explanation has to aspects – genetic and  biochemical.
Genetic:
The closer a person is to a sufferer, the more genes they share, the more likely the person is to develop a mood disorder. Mood disorder run in families and the incidence in first-degree relatives is higher. Genetic evidence is strongest for the most severe forms of the disorder.
Biochemical:
Lack or excess of certain chemicals affects the functioning of the brain, influencing the emotion regulation. Imbalance in neurotransmitters serotonin and norepinephrine can cause depression – depressed individuals have low activity of serotonin and norepinephrine neurons. Individuals with mania show a reverse pattern.

Oruc et al (1977)
The DNA testing was carried in order to test polymorphism ( a gene variation ) in serotonin receptor and serotonin transporter genes.
42 participants ( 25 females, 17 males), between 32 and 70 years of age, diagnosed with bipolar disorder, from two psychiatric hospitals in Croatia; 16 of them had at least one relative diagnosed with a major affective disorder
They were matched in pairs by gender and age with a control group – 40 participants with  no personal or family history of mental health disorders.
Results: serotonin has been understood to be sexually dysmorphic – differences are cause by either inheriting male or female pattern of genetic material.
Evaluation: a small sample has been used, for accurate and reliable results in a genetic experiment, a large sample is required; it is valid because the DNA sample has been collected and analyzed in the lab – no researcher bias.

Issues and debates: the study shows that there is a possible genetic cause of bipolar depression in females; it is a complementary explanation for the occurrence of unipolar depression. The biological approach is reductionist because it doesn’t take into account other causes of depression. It is also deterministic because it states that nothing can be done to prevent it as the DNA cannot be changed.

Cognitive

The cognitive model states that depression is the result of consistent negative bias in thinking processes; cognitive abnormality results in behavioural symptoms.
Beck (1979) said that depression is based on self-defeating negative beliefs; he outlined three main models: cognitive triad, silent assumption schemas and faulty thinking.

Cognitive triad- three forms of negative thinking :
– negative views on self
– negative views on future
– negative views on the world
When these combine with normal thinking processes, it leads to impairment in perception, memory and problem solving; the person is constantly overwhelmed with negative thoughts
Silent assumption schemas – pessimistic beliefs and expectations acquired as a result of a traumatic event. A stressful life event is required to activate a negative schema. Following that, a number of illogical thoughts and cognitive bias will take other the person’s thinking and reflect on other similar events in the future
Faulty thinking – logical error in information processing, such are:
– arbitrary inference : drawing a negative conclusion without supporting data
– personalisation : a person believes it is their fault when a negative event happens
– selective thinking : focusing only on the bad parts of s situation
– black and white thinking : extremities, either very good or very bad, no in-between

Behavioural

This explanation outlines depression as a result of a person’s interaction with the environment and negative learning by either classical or operant conditioning
Learner Helplessness:
Association between certain stimuli and negative emotional state is learned and remembered. When a person learns that their actions and reactions make no difference to the aversive environment, they will not try to escape or solve the problem even if possible.
Attribution (a cognitive process in which people bind cause of behaviours to events) can be  faulty or biased. previous life events cause specific behaviour
There are three dimension for causal attributions:
– internal/external: internal traits and characteristics vs environmental forces
– stable/unstable: ocasional or consistent forces dentermine future outcomes
– global/specific: outcome affects one task or everything
Seligman et al (1988)
The study was carried out to investigate how well the attributional style would predict depressive symptoms. The sample were 39 participants with unipolar depression and 12 with bipolar, from the same clinic,  mixed genders, mean age of 36. control group were 10 individuals with no mood disorder.
Participants completed an attributional style questionnaire which consisted of 12 hypothetical positive and negative events, participants had to predict the casual attributing and rate each scenario on a 7 point scale based on internality, stability, and globality.
Results: participants with unipolar and bipolar depression showed more pessimistic and negative attributional  styles compared to the control group. the higher the score on the BDI the more pessimistically intense choices on the attributional style questionnaire.
Evaluation – the questionnaires assessing the participants were standardised which make the  experiment more reliable. It is however impossible to rule out the cause and the effect.
Issues and debates – learned helplessness and learned attributional style are the outcome of an individual’s encounter with the environment. The cognitive model assumes that a person’s impaired thinking triggers depression as a result of overwhelming experiences

TREATMENTS

Medical

Antidepressants – drugs that reduce symptoms of depression.
such include MAOIs (monoamine oxidase inhibitors) and SSRIs (selective serotonin reuptake inhibitor.
MAOIs work by blocking the MAO enzyme that breaks down monoamines at the synapse, therefore, monoamines remain in the synapse for a continued amount of time and act on the postsynaptic neurone
SSRIs work by preventing the re-uptake of serotonin by the presynaptic neurone, leaving it to have a more intense effect on the postsynaptic neurone. It is used rather for treating bipolar than unipolar depression.
Evaluation – antidepressants are fairly effective and have previously shown to mild the symptoms rapidly in the majority of studies. They are easy to get and administer as well as cheaper counselling engagement. Drug therapies do involve side effects and are not effective long term, patients have a high likelihood to replace if the course is discontinued. They only treat superficially – the symptoms might be milder but cannot cure the cause of the problem.
Issues and debates – the nature side is taken by medical therapy since biological factors are focused on when reducing symptoms. The individual explanation is highly relative due to the belief that a person’s own levels of neurotransmitters are disturbed and require correction.

ECT
Electro-convulsive therapy works by triggering a seizure in the patient with the help fo an electric current. It appears to be successful for cases of severe depression. It may be harmful so it is only used when patients are not responding well to other forms of treatment.
Direck et al (2012)
The experiment conducted to test the effectiveness of ECT – it implicated 1000 participants with either unipolar or bipolar depression.
Results: 50% of cases had positive outcomes
Evaluation – it is especially necessary to prevent suicide however, it can result in short term memory deficit. It is not a permanent remedy and has a high relapse rate. It is not purely ethical since it can damage the patient’s health both physically and mentally

Cognitive restructuring
Treatment introduced by Beck in 1979. Involves the patients investigating their negative distortions snd reframing their thinking about upsetting situations, changing major attitudes and beliefs.
Wiles et al (2013) conducted a study to investigate the effectiveness of cognitive restructuring – 469 participants diagnosed with depression were incidentally devised to either usual care or care with cognitive restructuring.
Results: participants undergoing treatment with CR were 3 times more likely to respond to treatment and show minimised symptoms.
Evaluation – it takes into account a wide range of beliefs by which it avoids reductionism. to might not be successful in individuals with low intelligence. it is not expensive.

REBT
Rational emotive behaviour therapy aims to help individuals create and mention constructive, rational patterns of thinking about their lives. it works by explaining the patient the ABC model: a certain event > triggers beliefs about it > causes consequences.
This therapy was introduced by Ellis, who believed that depression is caused by people’s perceptions and attitudes regarding past events.
Lyon and Woods (1991) – a meta analysis of 70 different studies on REBT was conducted
analysis compared 263 cases of patients with REBT treatment to control groups or other psychotherapies.
Results: REBT patients showed advantageous improvement compared to others.
Evaluation – findings of the study support the effectiveness or REBT. More confrontational and less sensitive than other treatments, may distress the patient.
Issues and debates – takes the nurture side as it is based on the premise that how individuals think and behave is learned through their experience in the world.