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                            Affective Disorders Outline


What is a mood disorder?
The etiology of an affective disor...
2


         •   Sadness, a tendency to suicide, feelings of indifference,
             psychomotor agitation.
         • ...
3


   •   Gender differences don’t start until mid-adolescence; estimates same for
       boys and girls.
   •   Not much...
4


   •   But…negative life events do correlate with depression, but are not a
       sufficient cause of depression.

Le...
5


Sociotropic & Autonomous Depression Subtypes
   • Sociotropic individuals
   • Autonomous individuals

Self-regulatory...
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Affective Disorders Outline

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Transcript of "Affective Disorders Outline"

  1. 1. 1 Affective Disorders Outline What is a mood disorder? The etiology of an affective disorder: 1. biological process? What is the evidence? 2. problems with studying biological processes. 3. are biological abnormalities unrelated to the primary disorder? Biological Theories of Affective Disorders Familial & Genetic Influences • Probands 2-3x higher than in normal probands. • Proband with bipolar disorder – relative has unipolar depression, not bipolar. • Adoption studies mixed. • Twin studies: identical – other twin 3x as likely than fraternal twin to have mood disorder. • Sex differences – higher for females. • Environment – higher role in males. • Unipolar & bipolar seem to be inherited separately. Neurological Influences: • Low levels of serotonin in relation to other neurotransmitters, including norepinephrine & dopmine. • Serotonin’s function = to regulate systems involving norepinephrine & dopamine. • Permissive Hypothesis – stipulates that where serotonin levels are low, other NTs are permitted to range more widely, become dysregulated, and contribute to mood problems. • Endorine system involvement, e.g. elevated levels of cortisol. The relationship of dexamethasone suppression test (DST) = less suppression of cortisol. • Sleep disturbance – depressed individuals move into REM sleep more quickly and shows diminished slow wave sleep. • Bipolar individuals show increased sensitivity to light. • Different alpha EEG values reported in 2 hemispheres of brains of depressed individuals. Is depression similar to the common cold? The history of depression • Disruptions of balance among four fluids or humors in the body • Melancholia = imbalance of black bile.
  2. 2. 2 • Sadness, a tendency to suicide, feelings of indifference, psychomotor agitation. • Kant = emotions don’t cause mental illness. • Abraham (1960) & Freud (1917) psychological/emotional factors in onset & maintenance of depression Issues with Diagnosis of Mood disorders • Mood should be separate from melancholia characterized by psychosis or delirium • Kraeplein (1904/1968) Mania separate disorder from schizophrenia or other psychotic disorders. • Other early theorists did not make this distinction. • Current evidence: difference in unipolar versus bipolar disorder. • Other distinctions: endogenous (naturally occurring depression) versus psychogenic or reactive depression. • Personality “trait” versus reactive “state” • Issues of bereavement (Beckham, Leber, & Youll, 1995) • Dysthmia • Cyclothymia, bipolar I, bipolar II • Adjustment disorder with depressed mood • Major depression • Cognitive versus biologically mediated depression • Nonaxious versus anxious depression Definition Issues • Mood state • Classification category • Depression as a symptom • Depression as a syndrome • Categorical conceptualization used by DSM-IV • Issues of continuum Epidemiology of Depression • Prevalence 5 to 44% • Estimates vary depending on sample/measurement/children versus adults • Lifetime prevalence 4.9% • Lifetime rates 17.1% • Estimates in population between 3 to 5.3% • 20% display chronic course • sex differences – 2x more frequently with women versus men • Age: more common in younger versus older adults; highest 25-45. • First onset 30s to 40s. • 50% before age 40. • Rates lower for adults over 65.
  3. 3. 3 • Gender differences don’t start until mid-adolescence; estimates same for boys and girls. • Not much difference with ethnicity when SES controlled. • Symptom constellations within cultures. • Worldwide, depression problematic. Models of Depression • Historically, single causal agents. • Contemporary approaches are multifactorial and integrative. Life Events Model • Problem with self-report checklist methods • Possible problems with memory / validity of self-reports • Is negative life events a consequence or a cause? • Investigator-based assessment procedures, e.g. Shrout et al (1989) individuals with depression are 2.5x more likely than nondepressed individuals to have experienced one or more fateful loss events. • Semistructure interview method (Brown & Harris, 1986) – severe events. • Finlay-Jones & Brown, 1981 – loss events especially when they involve a threat to self-identity & self-worth. • Additive threats, e.g. Vinokur et al (1996). • Brown & Harris (1989) – 3/4ths of recently depressed individuals experienced a preceding negative life event. Also, 1/5 individuals went on to develop depression. • Women 3x more likely to develop depression. • Vulnerability factors = low social support & low self-esteem. • But…women contributory role? Poor interpersonal problem solving? Behavioral & Interpersonal Models • Problematic interactions with others. • Social behaviors of the depressed individual? Lewinsohn’s Behavioral Model of Depression • Lewinsohn (1974) – depression is the result of a low rate of response- contingent positive reinforcement, e.g. initiating a conversation. • Low rate of behavioral responding. • Depressive symptoms reinforced by social environment. • Social skills deficit theory? • The link to negative life events? • Depressed individuals feel they are less socially skilled. • They differ on a variety of social skills. • They speak differently. • They are more self-demeaning.
  4. 4. 4 • But…negative life events do correlate with depression, but are not a sufficient cause of depression. Lewinsohn Revised Model • Depression caused by stressful life events in people with inadequate coping skills. • Cognitive changes. • Behavioral changes. • Person becomes more negative. • Behaves less competently socially. • Vicious Cycle. Coyne’s Interpersonal Model • Stressful life events, especially loss of significant relationships, = depression. • Goal: restore social support, gain acceptance. • Friends & family respond with concern & support = reinforces the depression symptomotology. • But …. Eventually aversive responding. • Depressed people are rejected, but features of the person matters. • Why rejected? Joiner et al (1992); Segrin & Abramson (1994) Beck’s Cognitive Theory of Depression • Activation of depressive self-schema. • This could be relative to a social stressor. Information-Processing Models of Depression • Latent structures that have been activated by life event stressors. • Depressed people think negatively about themselves. • More critical. • High recurrence & runs in families. • Selective encoding of negative information. • These symptoms disappear when they are not depressed. • Cognitive distortions? == re-evaluation of Beck’s theory – not inaccuracy or distorted thought content; negative thought content. Learned Helplessness (Seligman, 1975) • Expectations that they are helpless to control aversive outcomes. • 1978 revision – beliefs about the causes of events – attributional style Abramason et al (1989) • hopelessness theory of depression • Separate subtype?
  5. 5. 5 Sociotropic & Autonomous Depression Subtypes • Sociotropic individuals • Autonomous individuals Self-regulatory approaches to depression • How people regulate their behavior in the absence of external reinforcement. • The role of cognitive processes.

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