Mood (Affective) Disorders Notes PDF

6.2 Mood (Affective) Disorders Diagnostic Criteria Mood Disorders: A category of disorders involving severe disturbances in mood. These disorders can involve low mood (depression) or mood swings (bipolar disorder) and significantly impact a person's ability to function in daily life. Depressive Di...

6.2 Mood (Affective) Disorders Diagnostic Criteria Mood Disorders: A category of disorders involving severe disturbances in mood. These disorders can involve low mood (depression) or mood swings (bipolar disorder) and significantly impact a person's ability to function in daily life. Depressive Disorder (Unipolar) Definition: Characterized by persistently low mood, sadness, and a loss of interest in most activities. Symptoms include emotional, cognitive, and physical changes that impair daily functioning.: Intense sadness and low mood. Fatigue or loss of energy. Feelings of worthlessness or excessive guilt. Changes in appetite (weight loss or gain). Difficulty concentrating or indecisiveness. Recurrent thoughts of death or suicide. Duration: most of the day, nearly every day, for at least two weeks. Bipolar Disorder: Definition: A disorder characterized by extreme mood swings that include both depressive episodes and episodes of mania or hypomania (elevated mood). Type 1: Characterized by the occurrence of at least one manic episode, which can alternate with depressive episodes. Type 2: Characterized by at least one episode of severe depression and one hypomanic episode, with less severe manic symptoms.  Manic Episode: A period of at least one week where the individual experiences elevated mood, increased activity or energy, inflated self-esteem, decreased need for sleep, and reckless behavior. Hypomania: Similar to mania but less severe; it does not lead to significant impairment in functioning or require hospitalization. Psychometric Testing: a method of measuring personality traits, emotional states or other experiences by using sets of questions and numerical scales. Beck Depression Inventory (BDI) Description: The BDI is a widely used self-report questionnaire designed to assess the severity of depression in clinical and non-clinical populations. Structure: Consists of 21 multiple-choice items, with each item corresponding to a specific symptom of depression (e.g., sadness, fatigue, changes in sleep). Example items include: "I feel sad." "I feel hopeless about the future." "I have lost interest in things I used to enjoy." Responses range from 0 to 3, where 0 indicates no symptom, and 3 indicates severe symptoms. Scoring: Total score indicates the severity of depression, with higher scores suggesting more severe depressive symptoms. Scores can be categorized as minimal, mild(10), moderate(19-29), or severe depression(30+). Strengths: Robust instrument – high levels of reliability and validity. Fairly consistent and accurate measurements. Quantitative measure means assessment is easy and objectivity is ensured. Limitations: Self-report – which can introduce bias (e.g., individuals may underreport or overreport symptoms). Does not account for cultural or situational factors that may influence depressive symptoms. Explanations for Depression and Bipolar Disorder Biological Explanations Biochemical: Depression: Associated with low levels of key neurotransmitters such as serotonin, dopamine, and noradrenaline. These chemicals are responsible for regulating mood, energy, and reward pathways in the brain. Serotonin: Regulates mood, sleep, and appetite. Deficiencies in serotonin levels can result in feelings of sadness, hopelessness, and fatigue. Dopamine: Involved in reward, pleasure, and motivation. Low levels of dopamine are associated with the lack of motivation and pleasure experienced in depression (anhedonia).  Bipolar Disorder: The disorder may involve dysregulation of both serotonin and dopamine. While depressive episodes may be linked to low serotonin levels, manic episodes might be connected to an overactivity of dopamine pathways. Genetic: First-degree relatives of individuals with bipolar disorder are more likely to develop the disorder than the general population. One gene that has been linked to mood disorders is the 5-HTT gene(serotonin transporter gene). Key Study: Oruc et al. (1997) Context: Researchers sought to identify genetic markers associated with bipolar disorder, specifically focusing on the 5-HTT gene (serotonin transporter). Bipolar disorder involves extreme mood swings between depression and mania, with potential genetic factors playing a crucial role in its development. Aim: Investigated whether specific genetic factors, particularly the 5-HTT gene, are associated with a predisposition to bipolar disorder. Design: A matched pair design was used. Participants in the control group matched the patient sample in terms of age and sex. Participants: 42 individuals (25 women, 17 men) diagnosed with bipolar disorder type I, and their family members, in Croatia. Aged between 31-70. There was a control group of 40 participants. Procedure: Blood samples were taken from the participants, and genetic testing was conducted to look for polymorphism in the 5-HTT gene and other related genetic markers. Findings: There were no significant associations in the sample. Serotonin, as a neurotransmitter, was understood to be sexually dimorphic (there are differences between men and women). There was evidence that female participants were more likely to have genetic markers linked to mood disorders. Conclusion: The study supports the role of genetic factors in the development of bipolar disorder, though gender differences in genetic vulnerability were noted. Strengths: Provides empirical support for the role of genetics in mood disorders. Utilizes modern genetic testing techniques to identify biological factors in bipolar disorder.  Limitations: The sample size (42 participants) was relatively small, limiting the generalizability of the findings. The study only included participants from one country (Croatia), which may limit the applicability of the findings to other populations. Application: Understanding genetic factors can help tailor treatments for individuals with mood disorders, particularly in terms of personalized medicine. Debate: Determinism VS Free Will: Suggests that individuals with family histories of this disorder have greater susceptibility to it, removing free will from the picture. However, in this study, for females, it only suggests a small genetic susceptibility. This means there must be other non- genetic causes. Psychological Explanations Cognitive Explanation: Beck’s Cognitive Theory of Depression: Negative Cognitive Triad: According to Beck (1967), depression is caused by distorted thinking patterns. Depressed individuals tend to hold negative views about: Themselves (e.g., "I am worthless"). The World (e.g., "Everyone hates me"). The Future (e.g., "Things will never get better"). These negative thoughts feed into and reinforce depressive symptoms, creating a vicious cycle of hopelessness. Cognitive Distortions: Depressed individuals are prone to errors in thinking, such as:  Overgeneralization: Taking a single negative event and applying it broadly (e.g., "I failed once, so I will always fail"). Catastrophizing: Expecting the worst-case scenario to occur. Personalization: Blaming oneself for negative events that are not entirely within one’s control. Learned Helplessness/Attributional Style: Learned helplessness describes a state of passive resignation or a belief that one has no control over their circumstances, even when opportunities for control or change exist. This learned helplessness is often a result of experiencing repeated or prolonged adversity, particularly when the individual believes their efforts to change the situation are futile. Attributional Style: Seligman proposed that one's attributional style plays a crucial role in the development of learned helplessness. People who are prone to learned helplessness tend to make three types of attributions: Internal Attributions: They attribute negative events to their own personal characteristics or abilities. For example, if they fail an exam, they might believe it's because they are inherently unintelligent. Global Attributions: They view negative events as pervasive and affecting all aspects of their lives. Failing one exam might lead them to conclude that they are doomed to fail in all areas of life. Stable Attributions: They believe that negative events will persist over time. Failing an exam could lead them to think they will never succeed academically. Attribution: the cognitive process by which individuals explain the causes of behaviour and events. Example Study: Seligman et al.(1988) Aim: Confirm link between attribution style and prediction of depressive symptoms. Methodology: 51 participants with mood disorders (39 unipolar, 12 bipolar). Mean age: 36 years. Completed BDI and ASQ. Compared to non-clininal controls (10 participants). Results: Positive correlation between depressive attributions and symptom severity. Held for both unipolar and bipolar disorders. Non-depressed controls had lower pessimism levels. Reduced pessimism during therapy linked to symptom improvement. Improvements lasted over time. Pessimism levels similar between unipolar and bipolar, but high trait anxiety in bipolar led to higher pessimism. Improvement in attributional style correlated with an improvement in BDI scores.  Conclusion: Depressed individuals share a cognitive attribution style. Includes internal, global, and stable attributions for negative events. Cognitive therapy can alter this style, increasing remission chances at 12 months. Evaluation: Standardised questionnaires meant higher validity and reliable measurement. However, the link between BDI and positivity of attribution was correlational (could not predict cause and effect relationship). Treatment and Management Biological Tricyclics: Introduced in the 1950s, still used today as antidepressants, mainly when other treatments fail. They work by increasing serotonin and norepinephrine in the brain by stopping their reabsorption. Side effects include drowsiness, nausea, vomiting, blurred vision, and weight gain. MAOIs (Monoamine Oxidase Inhibitors): These inhibit the enzyme monoamine oxidase, responsible for breaking down neurotransmitters. They prevent neurotransmitters like serotonin, norepinephrine, and dopamine from being broken down. Side effects include headaches, insomnia, nausea, diarrhea, and constipation. MAOIs can cause withdrawal symptoms and negative interactions with other medications. SSRIs (Selective Serotonin Reuptake Inhibitors): These increase serotonin levels by stopping its reabsorption. They have fewer and less severe side effects compared to tricyclics and MAOIs and are the most commonly prescribed antidepressants today. Clinical Evidence - Studies suggest that tricyclics, MAOIs, and SSRIs are more effective than placebos. The effectiveness of these drugs is more pronounced in individuals with moderate to severe depressive symptoms (Fournier et al., 2010). Psychological Beck’s Cognitive Restructuring: A form of talking therapy that helps patients gain insight into their depressive thoughts and behaviors. It involves questioning irrational thoughts and replacing them with more balanced thinking. The therapy encourages patients to observe and record their thoughts to identify and challenge dysfunctional patterns. The therapist helps the patient reframe their thoughts about distressing situations, reducing the influence of negative automatic thoughts. By practicing cognitive restructuring, patients can recognize and reduce symptoms of depression. Well-established in treating depression. A study by Wiles et al. (2013) found that cognitive therapy reduced symptoms in 469 patients who were resistant to antidepressants. Those who received therapy were three times more likely to respond to treatment.  Ellis's Rational Emotive Behavior Therapy (REBT): Based on the philosophy of stoicism, REBT focuses on changing irrational beliefs. Stoicism suggests that individuals are not directly affected by external events but by their perception of these events. Albert Ellis developed REBT based on the ABC model – activating events (A), beliefs (B), and consequences (C). Depression is caused by irrational beliefs about life events. Ellis emphasized that people can change their attitudes and perceptions, leading to reduced symptoms of depression. REBT involves identifying and challenging irrational beliefs and replacing them with rational thoughts, helping patients reduce depressive symptoms. Goal of therapy – create and maintain constructive, rational patterns of thinking – through a process known as “disputing”. Individuals must begin to see that the consequences they experience are only partly a result of an activating event. Then they must believe that holding onto a negative belief is a destructive tendency (which can be changed by challenging one’s beliefs) Lyons and Woods (1991) conducted a meta analysis of 70 REBT outcome studies – they found out through 236 comparisons that individuals receiving REBT demonstrated significant improvement over baseline measures and control groups. Key Terms: Inhibit: Prevent or stop a process, such as the inhibition of neurotransmitter reabsorption by drugs. Withdrawal: Negative physical or psychological effects after stopping a medication. Stoicism: A philosophy asserting that people are affected not by events but by their perception of those events. Meta analysis: Data from a range of studies into the same subject are combined and analysed to get an overall understanding of the trends.