disorders 2 Etiology and ...


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  1. 1. MOOD DISORDERS Etiology Treatment Barlow, D.H. & Durand, V.M. (2001) Abnormal Psychology (2 nd Ed.). Belmont: Wadsworth. Chapter 7 pp. 200-218.
  2. 2. Overview of Etiological factors <ul><li>Social </li></ul><ul><li>Support system </li></ul><ul><li>Woman & mood disorders </li></ul><ul><li>Psychological </li></ul><ul><li>Stressful life events </li></ul><ul><li>Behavioural factors </li></ul><ul><ul><ul><li>Cognitive factors </li></ul></ul></ul><ul><ul><ul><li>Psychodynamic </li></ul></ul></ul><ul><li>Biological </li></ul><ul><li>Neurotransmitters </li></ul><ul><li>Endocrine system </li></ul><ul><li>Family and genetics </li></ul><ul><li>Sleep </li></ul><ul><li>dysfunction </li></ul><ul><li>Woman & mood disorders </li></ul>Mood Disorder
  3. 3. Biological: Neurotransmitters <ul><li>Low levels of serotonin associated with depression. </li></ul><ul><li>Dopamine levels: </li></ul><ul><li>High > Mania </li></ul><ul><li>Low > Depression </li></ul><ul><li>Norepinphrine </li></ul>
  4. 4. Biological: Endocrine system <ul><li>Depression has been associated with dysfunction of the endocrine system, specifically: </li></ul><ul><ul><li>Elevated levels of the stress hormone Cortisol </li></ul></ul><ul><ul><li>Malfunctioning of the thyroid gland </li></ul></ul><ul><ul><li>Dysregulation of the release of growth hormones </li></ul></ul>
  5. 5. Biological: Genetics
  6. 6. Bio: Sleep & Circadian rhythms <ul><li>The following findings suggest a link between sleep and mood disorders: </li></ul><ul><ul><li>Increased duration & intensity of REM during sleep in people suffering from depression </li></ul></ul><ul><ul><li>Sleep deprivation leads to temporary improvement in mood </li></ul></ul><ul><ul><li>Seasonal Affective Disorder suggests the involvement of circadian rhythms </li></ul></ul><ul><ul><li>Extended bouts of insomnia have been linked to manic episodes in Bipolar I disorder </li></ul></ul>
  7. 7. Psychological: Stressful events <ul><li>Stressful events strongly linked to onset of mood disorders. </li></ul><ul><li>Context and meaning of the event more important than the exact nature of event </li></ul><ul><li>In Bipolar disorders stressful events linked with initial episodes but not later episodes </li></ul><ul><li>But 50-80% of individuals do NOT develop mood disorders after stressful events? </li></ul>
  8. 8. Psychological: Behavioural <ul><li>Learned Helplessness: </li></ul><ul><ul><li>Seligman’s experiments with rats and dogs </li></ul></ul><ul><ul><li>Learned helplessness in humans linked with attributions of a lack of control after experiences of being in an impotent position </li></ul></ul><ul><li>Environment which lacks positive reinforcement > reduction in activities and withdrawal </li></ul><ul><li>Positive reinforcement for the depressed role. </li></ul>
  9. 9. Psychological: Cognitive <ul><li>Links between cognition and emotion </li></ul><ul><li>Depression linked to a tendency to interpret everyday events negatively. </li></ul><ul><li>Beck’s cognitive triad: negative cognitions about self, world & future. </li></ul><ul><li>Errors in processing information e.g.: </li></ul><ul><ul><li>Arbitrary inference </li></ul></ul><ul><ul><li>Overgeneralisation etc. </li></ul></ul><ul><li>Early childhood experiences > negative schema > automatic ways of thinking > depression </li></ul>
  10. 10. Psychological: Psychodynamic <ul><li>Depression rooted in an early defect in the attachment relationship with the caregiver. Often the loss or threatened loss of a parent. </li></ul><ul><li>Adult relationships unconsciously constructed in a way that reflects this loss e.g. Loss of early attachment > dependence or avoidance in current relationships. </li></ul><ul><li>Any present event involving loss reactivates the primal loss and the person regresses to the childhood trauma > depression </li></ul>
  11. 11. Social factors: Social support <ul><li>High levels of social support are linked to a decreased occurrence of mood disorders and also an increase in the speed of recovery </li></ul><ul><li>Brown & Harris 1978: </li></ul><ul><ul><li>Two groups of woman who had experienced a serious life stress </li></ul></ul><ul><ul><li>Those who had a close friend > 10% became depressed </li></ul></ul><ul><ul><li>Those who did not have a supportive relationship > 37% became depressed </li></ul></ul>
  12. 12. Social factors: Woman <ul><li>Twice as many woman suffer from unipolar mood disorders. Why?: </li></ul><ul><ul><li>Socialisation: Help seeking behaviour? Expression of distress? </li></ul></ul><ul><ul><li>Patriarchy: less control > learned helplessness </li></ul></ul><ul><ul><li>Biological factors: </li></ul></ul><ul><ul><ul><li>Hormonal </li></ul></ul></ul><ul><ul><ul><li>Post partum (post childbirth) risk </li></ul></ul></ul>
  13. 13. Overview of Etiological factors <ul><li>Social </li></ul><ul><li>Support system </li></ul><ul><li>Woman & mood disorders </li></ul><ul><li>Psychological </li></ul><ul><li>Stressful life events </li></ul><ul><li>Behavioural factors </li></ul><ul><ul><ul><li>Cognitive factors </li></ul></ul></ul><ul><ul><ul><li>Psychodynamic </li></ul></ul></ul><ul><li>Biological </li></ul><ul><li>Neurotransmitters </li></ul><ul><li>Endocrine system </li></ul><ul><li>Family and genetics </li></ul><ul><li>Sleep </li></ul><ul><li>dysfunction </li></ul>Mood Disorder
  14. 14. Social Factors Psycho- logical Factors Biological Factors Integrative model of Etiology Protective factors Stressor Mood Disorder Vulnerability
  15. 15. Threshold for mood disorder Threshold model
  16. 16. Treatment: Medication <ul><li>Used to treat and also prevent relapse. </li></ul><ul><li>Antidepressants: </li></ul><ul><ul><li>Effective in alleviating depression in 50-65% of cases </li></ul></ul><ul><ul><li>3 categories: </li></ul></ul><ul><ul><ul><li>Tricyclics: Effective but can overdose </li></ul></ul></ul><ul><ul><ul><li>Monoamine oxidase inhibitors (MAO’s) </li></ul></ul></ul><ul><ul><ul><li>Selective Serotonin reuptake inhibitors (SSRI’s): cannot overdose eg. Prozac </li></ul></ul></ul><ul><li>Mood stabalisers: </li></ul><ul><ul><li>Lithium </li></ul></ul><ul><ul><li>Anticonvulsants </li></ul></ul>
  17. 17. How do antidepressants work? <ul><li>Increase the amount of specific neurotransmitters in the nerve synapses. </li></ul>
  18. 18. Treatment: Cognitive therapy <ul><li>Short-term therapy </li></ul><ul><li>Aim : to change the habitual errors in thinking which will lead to mood change </li></ul><ul><li>Method : </li></ul><ul><ul><li>Clients are taught to examine there thought processes and link these to emotions. </li></ul></ul><ul><ul><li>Together the therapist and client uncover and change faulty thinking patterns and underlying schemas. </li></ul></ul>
  19. 19. Treatment: Psychodynamic therapy <ul><li>Assumption : Client’s early defective relationship experiences will be re-enacted in therapeutic relationship. </li></ul><ul><li>Aim : To make the client aware of the common patterns between their current and early relationships, so that they can change these patterns and increase their capacity to make full contact with others. </li></ul><ul><li>Method : Interpretations, reflecting on the current therapeutic relationship. </li></ul>
  20. 20. Treatment: Which is best? <ul><li>Less severe symptoms > psychological treatment. Try to avoid side effects of medication. </li></ul><ul><li>Vegetative symptoms and severe symptoms > medication important </li></ul><ul><li>Medication: quicker symptom alleviation than psychotherapy </li></ul><ul><li>Psychotherapy more effective then medication for prevention of relapse. </li></ul><ul><li>Combined treatment most effective for relapse prevention. </li></ul>