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Chapter 8

PSYB32-Chapter 8 Notes

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Konstantine Zakzanis

Chapter 8: Mood Disorder General Characteristics of Mood Disorders • Mood disorders: involve disabling disturbances in emotion, from the sadness of depression to the elation and irritability of mania. Mood disorders are often associated with other psychological problems, such as panic attacks, substance abuse, sexual dysfunction, and personality disorders. Depression: Signs and Symptoms • As illustrated by the case of John Bentley Mays, depression is an emotional state marked by great sadness and feelings of worthlessness and guilt. Additional symptoms include withdrawal from others and loss of sleep, appetite, sexual desire, and interest, and pleasure in usual activities. • Paying attention is exhausting for depressed people. • Depression in children often results in somatic complaints, such as headaches or stomach aches. In older adults, depression is often characterized by distractibility and complaints of memory loss. • Psychologizers: people who emphasize the psychological aspects of depression. Mania: Signs and Symptoms • Mania: is an emotional state or mood on intense but unfound elation accompanied by irritability, hyperactivity, talkativeness, flight of ideas, distractibility, and impractical, grandiose plans. • The individual shifts rapidly from topic to topic. Formal Diagnosis Listing of Mood Disorders • Two major mood disorders listed in DSM-IV-TR: major depression, also referred to as unipolar depression, and bipolar disorder. Diagnosis of Depression • Major depressive disorder (MDD) requires the presence of five of the following symptoms for at least two weeks. Either depressed mood or loss of interest and pleasure must be one of the five symptoms: - Sad, depressed mood - Loss on interest and pleasure in usual activities - Difficulties in sleeping - Shift in activity level, becoming either lethargic or agitated - Poor appetite and weight loss, on increased appetite and weight gain. - Loss of energy - Negative self-concept - Complaints or evidence of difficulty in concentrating such as slowed thinking and indecisiveness. - Recurrent thought of death or suicide. • Ruminative coping: A tendency to focus cognitively (perhaps to the point of obsession) on the causes of depression and associated feelings rather than engaging in forms of distraction. • Brooding: A moody contemplation of depressive symptoms – “what am I doing to deserve this?” – that is more common in females than males. • An interpersonal form of rumination called corumination, in which friends, typically female friends, discuss and brood over each other’s problems as part of their friendship, has been linked with depression in adolescent girls but, on a positive note it is also fosters stronger friendships. • Feminist scholar Dana Jack suggests that females are more likely than males to engage in silencing the self – a passive style of keeping upsets and concerns to oneself in order to maintain important relationships (akin to “suffering in silence”). A definitive longitudinal test of the hypothesis remains to be conduced. Another explanation is objectification theory, based on the premise that the tendency to be viewed as an object, scrutinized and appraised by others, including appraisals of physical appearance, has a greater negative, influence on the self-esteem of girls than boys. • Kindling hypothesis: the notion that once a depression has already been experienced, it takes relatively less stress to induce a recurrence. Diagnosis of Bipolar Disorder • Bipolar I disorder: as involving episodes of mania or mixed episodes that include symptoms of both mania and depression. • A formal diagnosis of a manic episode requires the presence of elevated or irritable mood plus three additional symptoms (four if the mood is irritable) • The symptoms must be sufficiently severe to impair social and occupational functioning: - Increase in activity level at work, socially, or sexually - Unusual talkativeness; rapid speech - Flight of ideas or subjective impression that thought are racing - Less than the usual amount of sleep needed - Inflated self-esteem - Distractibility - Excessive involvement in pleasurable activities that are likely to have undesirable consequences, such as reckless spending. Heterogeneity within the Categories • Bipolar II disorder individuals have episodes of major depression accompanied by hypomania (hypo comes from the Greek for “under”) a change in behaviour and mood that is less extreme than full-blown mania. • The term melancholic refers to a specific pattern of depressive symptoms. People with melancholic features find no pleasure in any activity (anhedonia) and are unable to feel better even temporarily when something good happens. Their depressed mood is worse in the morning. • Seasonal affective disorder (SAD): The “winter depressions” that stem from reduced exposure to daylight. • Reduced light does cause decreases in the activity of serotonin neurons of the hypothalamus, and these neurons regulate some behaviours, such as sleep. • Postpartum depression: The depression experienced by some mothers after giving birth. Chronic Mood Disorders • In cyclothymic disorders: the personal has frequent period of depressed mood and hypomania, which may be mixed with, may alternate with, or may be separated by periods of normal mood lasting as long as two months. • The person with dysthymic disorder, is chronically depressed – more than half the time for at least two years – according to the DSM –IV-TR. Besides feeling blue and losing pleasure in usual activities and pastimes, the person experiences several other signs of depression, such as insomnia or sleeping too much; feelings of inadequacy ineffectiveness, and lack of energy; pessimism; an inability to concentrate and to think clearly; and a desire to avoid the company of others. • Double depression: A comorbid condition that applies to someone characterized by both dysthymia and major depression. Psychological Theories of Mood Disorders Cognitive Theories of Depression Beck’s Theory of Depression • Aaron Beck is responsible for the most important contemporary theory that regards thought processes as causative factors in depression. His central thesis is the depressed individuals feel as they do because their thinking is biased toward negative interpretations. • Negative schemata, together with cognitive biases or distortions, maintain what Beck called the negative triad: negative views of the self, the world, and the future. • Arbitrary inference – a conclusion drawn in the absence of sufficient evidence. • Selective abstraction – conclusion drawn on the basis of only one of many elements in a situation. • Overgeneralization – an overall sweeping conclusion drawn on the basis of a single, perhaps trivial, event. • Magnification and minimization – exaggerations in evaluating performance. • First, depressed individuals, relative to non-depressed individuals, endorse more negative words and fewer positive words as self-descriptive. Secondly, they exhibit a cognitive bias: they have greater recall of adjectives with depressive content, especially if the adjectives were rated as self-descriptive. • Depressed and non-depressed people do not differ in whether their schemas involve positive or negative content; rather, they differ in cognitive processing. Depressed people pay greater attention to negative stimuli and can more readily access negative than positive information. • Differences in cognitive processing are assessed via the Stroop task. Participants are provided with a series of words in different colours and are asked to identify the colour of each word and ignore the actual word itself. The Stroop task assesses the latency or length of time it takes to respond. • People who had a history of depression but were in a neutral mood tended to divert their attention when presented with negative stimuli, once again suggesting the presence of a protective bias. Evaluation: • We must address two key issues when evaluating Beck’s theory. The first is whether depressed people actually think in the negative ways enumerated by Beck. • The second issue represents perhaps the greatest challenge for cognitive theories of depression: whether it could be that the negative beliefs of depressed people do not follow the depression but in fact cause the depressed mood. Helplessness/Hopelessness Theories: • In this section we discuss the evolution of an influential cognitive theory of depression – actually, three theories: the original learned helplessness theory; its subsequent, more cognitive, attributional version; and its transformation into the learned hopelessness theory. Learned Helplessness: • The basic premise of the learned helplessness theory is that an individual’s passivity and sense of being unable to act and control his or her own life is acquired through unpleasant experiences and traumas that the individual tried unsuccessfully to control. • Aaron Beck taking a cognitive perspective, proposed that depression is associated with two personality styles: sociotropy and autonomy. Sociotropic individuals are dependent on others. They are especially concerned with pleasing others, avoiding disapproval, and avoiding separation. Autonomy is an achievement-related constructs that focuses on self-critical goal striving, a desire for solitude and freedom from control. • Congruency hypothesis: The prediction that people are likely to be depressed if they have a personality vulnerability that is matched by congruent life events (e.g. perfectionists who experience a failure to achieve). It is derived from research on personality, stress, and depression. Attribution and Learned Helplessness: • Depressive paradox: A cognitive tendency for depressed individuals to accept personal responsibility for negative outcomes despite feeling a lack of personal control. • The essence of the revised theory is the concept of attribution – the explanation a person has for his or her behaviour. When a person has experienced failure, he or she will try to attribute the failure to some cause. • Abramson, Seligman, and Teasdale formulation to various ways in which a university student might attribute a low score on the mathematics portion of the Graduate Record Examination (GRE). The formulation is based on answers to three questions: 1. Are the reasons for failure believed to be internal (personal) or external (environmentally caused)? 2. Is the problem believed to be stable or unstable? 3. How global or specific is the inability to succeed perceived to be? Hopelessness Theory • Depressogenic inferential style the tendency to perceive negative events as having disastrous consequences. • Depressive predictive certainty: the concept that people become prone to depression when they perceive that an anticipated state of helplessness in certain to occur. It is derived from the hopelessness theory of depression. • The measurement of stress generation involves making the distinction between independent events (i.e. not due to oneself) and dependent events (i.e. stemming from personal choices or actions depend on the self) • Stress generation predicted depression in adolescent girls but not in boys. Biological Theories of Mood Disorders Genetic Vulnerability • Research on genetic factors in bipolar disorder and MDD has used twin, family, and adoption methods. Bipolar disorder is one of the most heritable of disorders. th • Bipolar disorder results from a dominant gene on the 11 chromosome. • Brain-derived neurotropic factor (BDNF) gene appears to predict risk of developing rapid cycling. • People who possess one or two copies of the short variant of the 5-HTTLPR (serotonin transporter) gene, which is involved in modulating serotonin levels, experienced higher levels of depression and suicidality following a recent stressful event. • Non-depressed children homozygous for the 5-HTTLPR short allele demo
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