Mood disorder

Question 1

Three types of anti-depressants:

Answer 1

Tricyclics
Monoamine oxidase inhibitor (MAOI)
Selective serotonin reuptake inhibitors (SSRI)

Question 2

Explain how MAOIs works

Answer 2

MAOI inhibits the action of monoamine oxidase. This prevents the breakdown and removal norepinephrine, serotonin and dopamine.

Question 3

Explain how tricyclics work

Answer 3

Increase levels of serotonin and norepinephrine in the brain by stopping them from being reabsorbed.

Question 4

Explain how SSRIs work

Answer 4

Act on the neurons to stop serotonin from being reabsorbed by the synapses and broken down, thereby increasing the release of serotonin.

Question 5

Describe the sample of Oruč et al. (1997)

Answer 5

42 patients with bipolar disorder type 1.
From two Croatian hospitals.
25 females and 17 males.
31 to 70 years.
Participants in both groups are matched in terms of age and sex.
40 control participants with no family or psychiatric history.

Question 6

ICD-11 Criteria for depressive disorder

Answer 6

Characterised by a depressive mood or loss of pleasure. This can be accompanied by other symptoms such as difficulty concentrating, excessive feelings of worthlessness, guilt, recurrent thoughts of death & changes to eating or sleeping patterns. These feelings last at least 2 weeks, during which there is almost daily depressed mood or loss of pleasure. The patient must not have experienced any manic, hypomanic or mixed episode before.
Single episode: one episode with no previous history of episodes.
Recurrent: at least 2 previous episodes of depression separated by several months.

Question 7

ICD-11 Criteria for Type 1 Bipolar:

Answer 7

Defined by the occurence of at least one manic or mixed episode. Often also experiencing depressive episodes.

A manic episode is an extreme high mood - such as feeling euphoric, irritable etc… - and increased levels of energy or activity for at least one week.

A mixed episode is a rapid alternating between manic and depressive states on most days of a 2 week period.

Question 8

ICD-11 Criteria for Type 2 Bipolar:

Answer 8

Defined by the occurrence of one or more hypomanic episodes and at least one depressive episode

Hypomanic episodes are a less extreme version of manic episodes, where the patient experiences persistent elevated mood, irritability. This is significantly different to the patient’s usual behaviours but will not cause marked impairment to their functioning.

There is no history of manic or mixed episodes.

Question 9

State 5 types of cognitive distortions

Answer 9

1. Arbitrary inference
2. Selective thinking
3. Overgeneralization
4. Personalization
5. Magnification and minimization

Question 10

Define depressive episode

Answer 10

A period of at least two weeks, during which time there is almost daily depressed mood.

Question 11

State the condition(s) required for the diagnosis of type 1 bipolar disorder

Answer 11

At least one manic OR mixed episode.

Question 12

State the condition(s) required for the diagnosis of type 2 bipolar disorder

Answer 12

At least one hypomanic AND depressive episode.

Question 13

Define a mixed episode

Answer 13

A mixture of manic and depressive states on most days during a two week period.

Question 14

State the biochemical explanation for depressive disorder

Answer 14

Low levels of certain neurotransmitters, such as serotonin and dopamine, have been identified to be associated with depression.

Dopamine carries signals in parts of the brain responsible for pleasure and motivation. Low levels of dopamine can cause a lack of motivation and enjoyment from usual activities, which are core symptoms of depressive disorder. Research has found that patients with depression have lower levels of dopamine. Further evidence shows that anti-depressants which raise dopamine levels can reduce depressive symptoms.

Serotonin is a neurotransmitter that regulates sleep, appetite, mood and anxiety. Low levels of serotonin can lead to low mood, anxiety and disruption in sleep and appetite, which are symptoms of depressive disorder. Evidence is shows that SSRIs, which increase serotonin levels, can reduce symptoms of depression.

Question 15

Explain arbitrary inference

Answer 15

It involves drawing a conclusion without any evidence.

Question 16

Explain selective thinking.

Answer 16

It involves focusing on only one aspect of a situation while ignoring all other relevant aspects.

Question 17

Explain overgeneralization.

Answer 17

It involves drawing conclusions based on a single incident and applying it to unrelated events.

Question 18

Explain personalization.

Answer 18

It involves taking responsibility or blame for events that are unrelated to the person.

Question 19

Explain magnification and minimization.

Answer 19

It involves blowing negative events out of proportion while ignoring positive events.

Question 20

Explain learned helplessness

Answer 20

A state that occurs as a result of a person having to endure an unpleasant situation that they perceive as inescapable. Because they learn that they have no control over the situation to prevent suffering, they eventually stop trying to resist it.

Seligman believed that this state of learned helplessness can explain depression as a direct result of a real or perceived lack of control over the outcome of their situation.

Question 21

Explain attributional style

Answer 21

As we go through life, we have many different experiences which lead to we developing certain thinking patterns towards the world and ourselves. Where someone has persistent difficult life experiences, they learn

Negative atrributional style may arise due to learned helplessness. For example, a person who has had a difficult upbringing or experienced death of a loved one during childhood may perceive a lack of control over negative events in their lives.

When bad events happen, they might blame themselves (internality); they might think things will never get better (stability) and they might think more things will go wrong (globality).

Question 22

Describe the sample of Seligman et al. (1988).

Answer 22

39 patients with depressive disorder
12 patients with bipolar disorder
10 non-clinical participants in control group
Mean age of 36 years

Question 23

Describe Beck’s cognitive theory of depression.

Answer 23

The negative views held by someone with depression become a reality to that person, even if they seem far-fetched to others. This irrational negative way of thinking is known as cognitive distortion.
According to Beck, cognitive distortion develops as a result of negative experiences during childhood which lead to negative schemas for the world.
When faced with experiences throughout their life, this negative schema is activated and they expect things to turn out badly.

Cognitive processes involved in depression can be understood using Beck’s cognitive triad.
Firstly, the person has negative thoughts/beliefs about themselves. Secondly, the person perceives the world as presenting them with insurmountable obstacles to their happiness. Third, the person anticipates failure in future undertakings, leading to them feeling worthless again. And the cycle goes on.

Question 24

Describe the procedure of Seligman et al. (1988).

Answer 24

1. Participants completed BDI to assess severity of symptoms.
2. Participants completed Attributional Style Questionnaire. It consisted of 12 hypothetical good and bad events. Participants needed to say what or who is responsible for the event. Then, they rate each cause on a seven-point scale of internality, stability and globality.

Question 25

Describe the results of Seligman et al. (1988).

Answer 25

The higher the score of BDI, the greater the negativity displayed in the Attributional Style Questionnaire. Bipolar and unipolar participants have more negative attributional styles than the control group. For those unipolar participants undergoing cognitive therapy, an improvement in attributional style correlated with an improvement in BDI scores. This suggests that attributional style is an important factor in our experience with depresive disorder.

Question 26

Describe Beck's cognitive restructuring as a treatment for depression.

Answer 26

It is believed that depression is caused by faulty thinking. A form of talking therapy to identify illogical thinking and enables patient to understand that their way of thinking about themselves and the world contributes to their depression. It helps them to recognise irrational or inaccurate beliefs and statements. It requires active participation from patients as patients need to do their own "homework". First, they have to understand the link between their thoughts, affect and behaviour and how each influence each other. This helps them to notice negative distortions in thinking for themselves. Then, patients are taught "reattributing" where they discuss whether the cause of their failures are internal or external. This helps them to reframe their thinking about an upsetting situation.

Question 27

Briefly explain the strengths and weaknesses of cognitive restructuring as a treatment for depression.

Answer 27

Strengths: 1. Quicker than CBT because it only involves cognitive approach. 2. No side effects such as those caused by medication. Weaknesses: 1. Requires active participation. 2. Costly.

Question 28

Describe rational emotive behavioural therapy (REBT).

Answer 28

Based on ABC model, A is activating event, B is belief and C is consequences. B is the most important element. Albert Ellis argues that we all experience adversity but it is how we think about those experiences that have the greatest impact on our emotional well-being and behavioural outcome. Based on principles of stoicisim which argue that individual is not directly affected by external things. It is believed that a person becomes depressed because of internal constructions. The goal is to help individuals create and maintain constructive, rational patterns of thinking about their lives. This is done through "disputing".

Question 29

Describe the study by Wiles et al. (2013).

Answer 29

469 individuals with depressive disorder were randomly allocated to continued usual care or care with CBT. Showed that CBT can reduce symptoms in people who fail to respond to anti-depressants. Those who received CBT were three times more likely to respond to treatment and experience reduction in symptoms.

Question 30

Describe the study by Lyons and Woods (1991).

Answer 30

Meta analysis of 70 REBT studies that compared REBT to baseline, control groups or other psychotherapies. Found that individuals receiving REBT showed significant improvement over baseline and control groups.

Question 31

Explain the Beck depression inventory (BDI)

Answer 31

A 21 item self-report measure assessing attitudes and symptoms of depressive disorder with a score given for each item. Each item consists of at least 4 statements and the patient is asked to select which statement they feel best fits how they have felt for the past one or two weeks. I get as much satisfaction out of things as I used to (0) I don't enjoy things the way I used to (1) I don't get real satisfaction out of anything anymore (2) I am dissatisfied and bored with everything (3) The scores for each item are added up to give a total BDI score. The minimum score for diagnosis is 10 (mild) with scores over 30 indicating severe depression.

Question 32

Describe the aim of Oruč et al. (1997).

Answer 32

To investigate whether genes coding for serotonin receptors and transporters are linked to bipolar disorder.

Question 33

Describe the procedure of Oruč et al. (1997).

Answer 33

Genetic analysis of DNA polymorphisms in serotonin receptor and transporter.

Question 34

Describe the results of Oruč et al. (1997).

Answer 34

No significant associations in polymorphism were found in the sample. 16 bipolar disorder type 1 patients had at least one first-degree relative suffering from major affective disorders. Polymorphism in these genes are more common in women with bipolar disorder type 1.