Mood Affective Disorders - Depression

Question 1

What are the two types of mood affective disorders

Answer 1

1)Bipolar disorder
2)Depressive disorder

Question 2

Both Bipolar disorder and Depressive disorder are characterized by episodes of particular types of moods

what episodes are these?

Answer 2

1)Depressive episode
2)Manic episode
3)Mixed episode
4)Hypomanic episode

Question 3

What is the ICD-11 criteria for a depressive episode

Answer 3

1) Concurrent (simultaneous) presence of at least 5 characteristic symptoms , occurring for most of the day , nearly everyday for at least two weeks.

-At least one symptom must be from the affective cluster symptoms.

The characteristic symptoms are:
a)Affective cluster symptoms
b)Cognitive behavioural clusters
c)Neurovegetative cluster symptoms

2)The symptoms are not better accounted for by bereavement (grief/sadness).

3) The symptoms are not a manifestation of another medical condition e.g a brain tumor and are not due to the effect of a substance or medication on the CNS
e.g anti anxiety drugs (Benzodiazepines)

4)The mood disturbances results in significant impairments in personal , family , social , educational , occupational , or other important areas of functioning.

Question 4

What are the affective cluster symptoms

Answer 4

1) Depressed mood (melancholy /sadness)

2)Significant diminishes interest in activities e.g a reduction in sexual desire

Question 5

What are the Cognitive behavioural clusters as part of the characteristic symptoms for depression

Answer 5

1)Reduced ability to concentrate and sustain attention on tasks.

2)Beliefs of low self worth or excessive and inappropriate guilt.

3)Hopelessness about the future

4)Recurring thoughts of death or suicidal ideation/evidence of attempted suicide.

Question 6

What are the neurovegetative cluster symptoms as part of the characteristic symptoms for depression

Answer 6

1)Significantly disrupted sleep e.g delayed sleep onset , increases frequency of waking in the night/early morning awakening. Sometimes the individual has excessive sleep.

2)Significant change in appetite , (diminished or increased leading to significant weight change (gain or loss)

3)Psychomotor retardation
Slowed down or decreased movement and psychomotor agitation (restlessness)

4) reduced energy, fatigue and marked tiredness

Question 7

What is the ICD-11 criteria for a manic episode;

Answer 7

1)Both of the following features occur concurrently and persist for most of the day nearly everyday. During a period of at least 1 week.

2) an extreme mood state characterized by euphoria, irritability or expansiveness. Individuals commonly exhibit rapid changes among different mood states (mood lability)

3) increased activity or a subjective experience of increased energy

Additional symptoms:
-increased talkativeness or pressured speech
- flight of ideas or experience of rapid (racing thoughts)
-increased self esteem or grandiosity
- Decreased need for sleep
- distractibility
-Impulsive reckless behavior

4) The symptoms are not a manifestation of another medical condition e.g Brain tumor
And are not due to the effect of a substance or medication on the CNS e.g anxiety drugs

5) The mood disturbances result in significant impairments in personal , family , social , educational or other important areas of functioning

Question 8

What is the ICD-11 criteria for a mixed episode

Answer 8

1)Several prominent manic and several prominent depressive symptoms consistent with those observed in manic episode and depressive episode must be present.
They can occur simultaneously or alternate very rapidly from day to day or within the same day.

2) the symptoms are not a manifestation of a medical condition and are not due to the effects of substance misuse or medication.

3) the mood disturbances result in significant impairments in the core areas of functioning e.g family , academics, personal etc

Question 9

What is the ICD-11 criteria for a hypomanic episode

Answer 9

-Both of the following symptoms must occur concurrently and persist for most of the day , nearly everyday for at least several days
a) persistent elevation of mood or increased irritability
b) increased activity or a subjective experience of increased energy

In addition several of the following symptoms must be present;
-> increased talkativeness
-> increased self esteem
-> decreased need for sleep
-> distractibility
-> impulsive reckless behavior

-2) the symptoms are not a manifestation of another medical condition and are not due to the effects of substance misuse or medication

3) The mood disturbance is not sufficiently severe to cause marked impairments in the core areas of functioning, personal , family etc

4) the clinical representation does not meet the diagnostic requirement for a mixed episode

Question 10

What is the ICD-11 criteria for unipolar depression/depressive disorder

Answer 10

-A diagnosis of depressive disorder can only be made if a person has never experienced a manic , mixed or hypomanic episode

-Depressive disorder is characterised by the symptoms of the depressive episode excluding the symptoms of mania.
These symptoms must occur most of the day , nearly everyday for at least two weeks.

-The symptoms are not better accounted for by bereavement

-the symptoms are not a manifestation of another medical condition and are not due to the effects of substance misuse or medication

-The mood disturbances results in significant impairments in personal , family , social , educational , occupational , or other important areas of functioning.

Question 11

Bipolar disorder type 1 is characterised by ……

Answer 11

the occurrence of at least 1 manic or mixed episode

Question 12

The diagnostic criteria for bipolar type 1 is similar to the criteria of what episodes?

Answer 12

Manic and mixed episodes

Question 13

What psychometric can be used by healthcare professionals to identify depressive symptoms in patients

Answer 13

-BDI , Beck depression inventory

Question 14

What is the criteria for bipolar type 2

Answer 14

-You must have experienced one or more hypomanic episodes and at least 2 depressive episodes

Question 15

What is the BDI

Answer 15

• 21 item questionnaire that measures attitude and symptoms related to depressive disorder.

-Each question is based on the known symptoms of depression e.g melancholy
-A four point rating scale is anchored on each item from 0-3
-The minimum score you can get is 0 mad the maximum 63.
-Each item consists of four statements describing a known symptom in increased severity from 0-3.
-

Question 16

Give an example of an item in BDI

Answer 16

Sadness

0. I do not feel sad.
1. I feel sad much of the time.
2. I am sad all the time.
3. I am so sad or unhappy that I can’t stand it.

Pessimism

0. I am not discouraged about my future.
1. I feel more discouraged about my future than I used to.
2. I do not expect things to work out for me.
3. I feel my future is hopeless and will only get worse.

Question 17

How is a total score of the BDI calculated

Answer 17

-It is calculated by adding up the scores in the 21 categories
-The higher the score in the BDI the more severe the depressive disorder.

Question 18

What do the BDI scores represent

Answer 18

1-10= normal ups and downs
11-16=mild mood disturbance
31-40 = severe depression
40 + = exreme depression

Question 19

Give 3 strengths of the BDI

Answer 19

1)Useful application to everyday life ;
-The psychometric is administered to patients to access entry symptoms . It could also be administered at termination of therapy to access progress with therapy. Also clinicians could use it to access the long term effectiveness of intervention

2)High objectivity ;
-Bdi generates quantitative data in the form of scores rated on a 4 point rating scale. Such data is objective as the researcher cannot contaminate it with bias such as opinions , religion , training , stereotypes

3) High validity ;
Research has shown that BDI has concurrent validity with other validated tools such as MMPI-I for adolosent depression.

Question 20

what are weaknesses of the BDI

Answer 20

A weakness of the BDI is that it relies on self-reported data this is a weakness as the data may be affected by social desirability
bias - that is, information may be withheld or the person may exaggerate their symptoms if
they believe this will lead to better services or support. These factors reduce the validity of
the test, limiting its usefulness as a measure of depression.

Question 21

what are the psychological explanations of depressive disorder

Answer 21

1)The cognitive theory - Aaron T Beck
2)Learned helplessness and attributional style - Seligman

Question 22

Explain the cognitive theory Aaron t beck

Answer 22

-According to cognitive psychologists our problems stem from the way we think about our everyday experiences especially the bad events

-Aaron T Beck argues that a depressive trait stems from negative self schemas (belief system) developed in childhood. A negative self schema is formed when a person is exposed to difficult early childhood experiences e.g abuse , neglect , deprivation.
This could lead to cognitive distortions e.g arbitrary inference (taking things out of context) , over generalisations (focusing on one negative thing at the expense of several positives , and catastrophizing (underestimating ability to cope).

-A cognitive distortion is a bias in thinking caused by a distortion of reality. when we are faced with events in adult life a persons negative schema is activated and we expect things to turn out badly , we evaluate our experiences with pessimism we have a pessimistic view of the world , the self and the future called triad.

-The self is viewed as worthless , the world is viewed as full of obstacles to happiness , they anticipate failure and rejection in their future undertakings

-The cognitive triad can be used to explain this = Negative views about oneself -> Negative views about the world -> Negative views about the future

Question 23

When is a negative self schema formed/what causes it

Answer 23

-Formed when a person is exposed to difficult early childhood experiences such as abuse , neglect , deprivation

Question 24

What is a cognitive distortion

Answer 24

-A cognitive distortion is a bias in thinking caused by a distortion pf reality.
Our early childhood experiences especially the negative early childhood experiences have a negative impact in our adult personality therefore negative self schemas are implicated in the development of a depressive trait

Question 25

How is a person's negative self schema activated

Answer 25

- when we are faced with events in adult life a persons negative schema is activated and we expect things to turn out badly. we evaluate our experiences with pessimism we have a pessimistic view of the world , the self and the future called triad.

Question 26

What is a cognitive distortion

Answer 26

a bias in thinking caused by a negative self schema

Question 27

What is catastrophizing

Answer 27

Expecting the worst-case scenario or blowing things out of proportion. For instance, someone may think, "If I make a mistake at work, I’ll lose my job and my life will fall apart."

Question 28

what is over generalisations

Answer 28

: Drawing broad conclusions from a single negative event. For example, "I failed this test, so I’ll never succeed in life. (focusing on one negative thing at the expense of several positives)

Question 29

What is a negative triad

Answer 29

-When we are faced with events in adult life a persons negative schema is activated and we expect things to turn out badly. We evaluate our experiences with pessimism. We have a pessimistic view of the world , the self and the future called a negative triad

Question 30

Explain learned helplessness and attributional style by Seligman as a psychological explanation for mood disorders

Answer 30

-This is when an individual has been in an unpleasant situation/experience for so long and they have to endure suffering because they feel trapped in that unpleasant situation. - When an individual perceives a lack of control over their suffering they relent into a state of helplessness, they stop trying to resist suffering , they learn to become helpless. -This leads to them developing a negative attributional style, this is the way we explain causes of events in our life. there are two types of attributional style; 1)Internal , Stable and global style. 2)External , Unstable , Specific profile style internal =When there is a negative event the individual blames themselves Stable = they believe this event is never going away/its permanent Global = they see negative events as affecting many aspects of their life

Question 31

Evaluate the cognitive theory by Aaron t beck

Answer 31

Determinism vs free will Reductionist Useful application

Question 32

Evaluate learned helplessness and attributional style

Answer 32

One strength of attributional style as an explanation of depression is that it is supported by research evidence. For example, Seligman et al. (1988) found that severity of depressive symptoms decreased following a course of cognitive therapy which targeted pessimistic attributional style. This suggests that pessimism may have been a cause of the symptoms as when this thinking style was replaced with a more optimistic outlook, mood and other symptoms improved. One weakness of depressive attributional style is that it may not be a cause of depression, it may be an effect. Although Seligman et al.'s study shows that changing from pessimism to optimism is followed by a reduction in depressive symptoms, the findings are correlational, and it is therefore impossible to say that therapy caused symptoms to decrease in severity Determinism vs free will Reductionism vs holism Useful application

Question 33

what is learned helplessness

Answer 33

- Learned helplessness is when one has to endure suffering because they feel trapped in an inescapable unpleasant situation. - when an individual perceives a lack of control over their suffering , they relent into a state of helplessness the victim stops trying to resist suffering because they learn that they are unable to overcome the outcome of their situation/their suffering.

Question 34

What is attributional style

Answer 34

- - Attributional style refers to the way we explain causes of events in our life. -when suffering is perceived to be inescapable the victim develops negative attributional style. Attributional styles are also known as explanatory styles

Question 35

What are the two types of attributional style

Answer 35

1. internal , stable and global profile/style 2. External , unstable and specific profile/style

Question 36

Explain internal , stable and global style

Answer 36

1. this is a maladaptive (life threatening)attributional style. It’s a risk factor to depression. -> Internality is when the individual explains bad events internally . They are self critical. (You are responsible for the bad events) -> stability is when the individual thinks that the bad event will not go away. (The bad event is stable) -> Globality is when the individual thinks that when one area of functioning is impaired then they are globally impaired ( impaired as a whole).

Question 37

Explain external , unstable and specific style

Question 38

What is the aim in the study by Seligman -attributional style and predicting depression

Answer 38

-To investigate how well attributional style could predict depressive symptoms.

Question 39

Describe the sample in the study by Seligman

Answer 39

-39 patients with depressive disorder (unipolar) -12 patients with bipolar episode , which all participated during a depressive disorder -They all came from the same outpatient clinic -They had a mean age of 36 years -Mix if both genders -They were compared with a non-clinical control group of 10 participants

Question 40

Describe the procedure in the study by Seligaman

Answer 40

The participants began by completing a short form of the BDI to assess the severity symptoms.They then completed an attributional Style Questionnaire consisting of 12 hypothetical good and bad events. They had to make causal attributions for each one(they needed to say who/what they thought was responsible for the event) and then rate each cause on a 7 point scale for internaility, stability and globality.

Question 41

Describe the results in the study by Seligman

Answer 41

-Both unipolar and Bipolar ss were found to have more pessimistic, negative attributional styles than the non patient group. -The more severe the depression score on the BDI, the worse the pessimism on the Attributional Style Questionnaire. -For those with unipolar depressive disorder undergoing cognitive therapy an improvement in attributional style correlated with an improvement in BDI scores.

Question 42

What is the conclusion in the study by Seligman

Answer 42

The way we make attributions is an important mechanism underlying the experience of unipolar depressive disorder People with both unipolar and bipolar disorder share a cognitive attributional style which favours internal, global and stable attributions of negative events in comparison with people without depression,

Question 43

Evaluate the study by seligman

Answer 43

BDI and ASQ: Standardised measures used e.g. using the BDI and ASQ, which are both valid. 1)Validity Seligman used standardised questionnaires to assess participants.The ASQ and BDI are considered to be valid and reliable measurement tools 2)Correlational A positive correlation between BDI and ASQ does not indicate a causal relationship , it was correlational meaning it is impossible to determine cause and effect in this research. 3) One strength was the use of a matched control group. This allowed the researchers to monitor the extent to which pessimism changes over time. This is important as it helps to provide evidence that pessimism is a stable trait as opposed to a reaction to one's current circumstances (state-pessimism). Evidence to support pessimism as a relatively fixed trait helps to support the cognitive explanation of depression - that depressed mood is a result of pessimism as opposed to a cause. 5)Generalisability A weakness is the gender imbalance in the sample. There were 31 females but only 20 males. This means the findings should be generalised with caution as the relationship between pessimism and unipolar depression may differ in males in comparison with females.

Question 45

what are the biological explanations for depression

Answer 45

-biochemical -genetic

Question 46

What is the biochemical explanation for depression

Answer 46

-Focuses on the neurotransmitters dopamine , serotonin and norepinephrine -Dopamine processes motivation , pleasure and satisfaction. It is therefore logical to conclude that low levels of brain dopamine impair these functions , this leads to sadness , lethargy , anhedonia etc. -There is evidence for the involvement of dopamine in depressive disorder from antidepressants. -Serotonin regulates sleep , appetite , anxiety and sexual drive. Low serotonin levels impair these functions this leads to disturbed sleep , disturbed appetite etc. which are known symptoms of depressive disorder. -Evidence from the involvement of serotonin comes from antidepressants. Most antidepressants e.g SSRIs are serotonin agonists.

Question 47

What is the genetic explanation for mood disorders

Answer 47

Twin studies In an enormous twin study 42,000 pp, Kendler et al. (2006) found a concordance rate of 44 per cent for female (MZ) twins compared with only 16 per cent for female (DZ) twins, and rates of 31 per cent for male MZ twins and 11 per cent for male DZ twins. This suggests that depression has a genetic component but that the condition is more heritable in females. Bipolar disorder appears to be more heritable than unipolar depression, returning rates of 62 per cent concordance in MZ twins compared with just 8 per cent for DZ twins (Bertelsen et al., 1977). Candidate genes Given the huge amount of evidence highlighting the role of serotonin in the development of mood disorders, genetic research has focused on genes that code for postsynaptic serotonin receptors (e.g. 5-HT2c) and presynaptic transporter molecules . The 5-HTT gene, for example, has a polymorphism that results in two different alleles, identified by their length, short and long. Individuals who inherit two short alleles have an increased risk of depression following a stressful life event than those who inherit either two long alleles or a combination of both.

Question 48

Evaluate the biochemical and genetic explanation for mood disorders

Answer 48

Nature vs nurture Reductionism vs holism -The biochemical explanation is reductionist as it argues that the development of depressive disorder is simply because of low levels of serotonin and depression. This is a weakness as it disregards the other plausible explanations of mood disorders e.g negative self schema's. However the genetic explanation is holistic as it looks at both the roles of stressful life events and genes in the development of depression. It argues that individuals who inherit short alleles have an increase risk of depression following a stressful event. This is a strength as it identifies the complexity of mood disorders. Determinism vs free will the biochemical explanation supports the deterministic side which argues that individuals are products of functions beyond our control. It argues that we are products of brain neurotransmitters, ie. that low levels of serotonin and dopamine cause depression. Similarly the genetic explanation is also deterministic as it argues that individuals are functions of genes inherited from their parents. The explanation identifies that depression is a result of genes that we inherit. However if it was to support the free will side of the debate it would identify individuals personal strengths and personality types that would determine whether they would be susceptible to depression or not. For example a pessimistic view of the world. Useful implications Nurture vs nature

Question 49

What is the biological treatment for depression

Answer 49

Antidepressants

Question 50

What are the three types of antidepressants

Answer 50

1)Tricyclics 2) SSRI’s 3)MAOI’s

Question 51

Describe SSRI's

Answer 51

-It stands for selective serotonin reuptake inhibitors -It is the most popular of all antidepressants and it has fewer side effects -Examples of SSRIs ; Citalopram , Dapoxetine

Question 52

How do SSRI's work?

Answer 52

-They are selective as they only target the serotonergic pathways i.e the pathways that modulate sleep , anxiety , sex drive etc -They work by preventing the reuptake and breaking down of synaptic serotonin hence increasing brain serotonin. -

Question 53

What are the side effects of SSRI's

Answer 53

-Feeling agitated -Indigestion -Loss of appetite = weight loss -Blurred vision -Dizziness

Question 54

Describe Tricyclics

Answer 54

-They are the most potent type of antidepressants as they target both serotonin and norepinephrine pathways Examples of tricyclics ; Doxepin , imipramine

Question 55

How do tricyclics work

Answer 55

They work by preventing the reuptake of serotonin and norepinephrine within the presynaptic terminals. -When this happens the level of serotonin and norepinephrine increase in the synaptic gap

Question 56

What are the side effects of tricyclics

Answer 56

-They have numerous side effects and are not recommended as first line treatment -The unpleasant side effects may cause non adherence to tricyclics lowering the validity of the treatment side effects; -Drowsiness -Blurred vision -Weight gain -Vomiting / nausea

Question 57

Describe MAOIs

Answer 57

It stands for monoamine oxidase inhibitors -

Question 58

How do MAOIs work

Answer 58

-They work by inhibiting the activity of the MAO enzyme The MAO enzyme is known to break down and remove the neurotransmitters dopamine , norepinephrine , and serotonin -MAOIs inhibit the activity of the MAO enzyme from breaking down the catecholamines , hence increasing the level of brain Catecholamines

Question 59

What are the side effects of MAOIs

Answer 59

-They tend to have less severe side effects ; -Involuntary muscle jerks -Low blood pressure -Weight gain -Muscle cramps

Question 60

What are the psychological treatments of depressive disorder

Answer 60

-Cognitive restructuring (Aaron T Beck) -Rational emotive behaviour Therapy (REBT)

Question 61

What is cognitive restructuring

Answer 61

-Cognitive restructuring is premised on the idea that our problems stem from the way we think about our experiences especially bad events.

Question 62

How is cognitive restructuring done

Answer 62

step 1 ; Explain the cognitive theory of depressive disorder to the patient Step 2 ; Train patients to observe and catch automatic dysfunction thoughts using a thought diary Step 3 ; Reality testing Step 4 ; Therapy/treatment

Question 63

Explain the first step of cognitive restructuring 1) Explain the cognitive theory of depressive disorder to the patient

Answer 63

-This involves letting patients understand the origin of their pessimism. For example negative self schemas caused by difficult early childhood experiences i.e abuse , neglect leading to cognitive distortions and pessimism

Question 64

Explain the second step of cognitive restructuring 2) Train patients to observe and catch automatic dysfunctional thoughts using thought diary

Answer 64

- This is done outside therapy sessions to increase ecological validity - Using thought diary the patient understands the link between thoughts, emotions and behavior and how they are intertwined. - In the diary the patient records: -> the situation they were in, -> the thoughts they had -> the emotions they experienced. Eg. Having a Job interview (situation) and thinking 'I am going to mess up' (thought), I feel anxious (emotion)

Question 65

Explain the third step of cognitive restructuring 3) Reality testing

Answer 65

-Put the thoughts on trial. The therapist works with the patient to gather evidence for and against their thoughts. Only factual evidence should be considered.

Question 66

Explain the fourth step of cognitive restructuring 4) Therapy/treatment

Answer 66

- Techniques such as reattribution and re-framing (discovering irrational thinking and replacing them with more rational thoughts) are used to help patients to overcome dysfunctional thinking.

Question 67

What is Rational Emotive Behaviour Therapy (REBT) - Ellis

Answer 67

-It is based on the philosophy of stoicism which partially states that , all human behaviours and emotions are the result of what people think or believe about their experience -The problem is how we construct our experiences , especially the bad events

Question 68

What is the ABC mode in REBT

Answer 68

Ellis used the ABC mode to explain the relationship between the bad event , the belief system and the consequence on emotion and behaviour. A - Stands for activating event , e.g a friend passed me in the street without acknowledging me , he is ignoring me , he doesn't like me B- Beliefs about A , (rigid and irrational evaluations) e.g i am unacceptable as a friend so i must be worthless as a person C- stands for consequence emotional and behavioral e.g depression = emotional and social withdrawal = behavioural A triggers B the B causes C

Question 69

According to Ellis what makes us more at risk of depression

Answer 69

When we hold irrational demands about one self e.g " i must do well" , "i must not fail" (having an absolute attitude) and irrational demands about others e.g "people must treat me right" " My circumstances must be the way i want them to be" we are more at risk of depression

Question 70

The goal of REBT is to help patients do what?

Answer 70

is to help patients 1) Uncover their irrational thoughts and core beliefs e.g irrational inferences and evaluations i.e self-drowning , catastrophizing 2)To move patients from irrational self defeating core beliefs and thoughts to more rational thinking using CBT techniques such as rational analysis. (pointing out irrationality in the patients story line), re framing (involves training patients to evaluate their experiences more positively), devils advocate (aka: reverse role playing) (the therapist acts out the irrational thinking of the patient while the patient defends themselves with a more rational thinking). Behavior techniques could also be used such as exposure session, and paradoxical behavior.