Mood Mood Disorders Disorders

Aims Aims

By the end of the session you will be able to do the By the end of the session you will be able to do the following:following:

Recognize symptoms that contribute to the diagnosis of Recognize symptoms that contribute to the diagnosis of unipolar and bipolar depression. unipolar and bipolar depression.

Compare and contrast contemporary perspectives in Compare and contrast contemporary perspectives in their explanations of unipolar and bipolar depression.their explanations of unipolar and bipolar depression.

Describe and compare different treatment approaches Describe and compare different treatment approaches used to treat unipolar and bipolar depression.used to treat unipolar and bipolar depression.

Critically be aware of the shortcomings of assessment, Critically be aware of the shortcomings of assessment, diagnosis and treatment and their implications socially, diagnosis and treatment and their implications socially, ethically and legally. ethically and legally.

Depression typesDepression types

Depression TypesDepression Types

Unipolar Depression Unipolar Depression Bipolar Depression Bipolar Depression

Unipolar Depression Unipolar Depression

Major depressive episodeMajor depressive episode1. Presence of at least five of the following symptoms 1. Presence of at least five of the following symptoms

during the same two week period: during the same two week period: depression mood for most of the day, nearly everyday, depression mood for most of the day, nearly everyday, markedly diminished interest or pleasure in almost all activities, most of the day, markedly diminished interest or pleasure in almost all activities, most of the day,

nearly every day, nearly every day, insomnia or hypersomina nearly everyday, psychomotor agitation or retardation insomnia or hypersomina nearly everyday, psychomotor agitation or retardation

nearly everyday,nearly everyday, fatigue or loss of energy nearly everyday,fatigue or loss of energy nearly everyday, feelings of worthlessness or excessive guilt nearly everyday, reduced ability to feelings of worthlessness or excessive guilt nearly everyday, reduced ability to

think or concentrate, or indecisiveness, nearly everyday, think or concentrate, or indecisiveness, nearly everyday, recurrent thoughts of death or suicide, a suicide attempt, or a specific plan for recurrent thoughts of death or suicide, a suicide attempt, or a specific plan for

committing suicide.committing suicide. Significant distress or impairment.Significant distress or impairment. Major Depressive DisorderMajor Depressive Disorder1. The presence of a major depressive episode1. The presence of a major depressive episode2. No history of a manic or hypomanic episode. 2. No history of a manic or hypomanic episode.

DSM-IV-TRDSM-IV-TR

Epidemiology Epidemiology 7% adults suffer from severe unipolar depression, 5% 7% adults suffer from severe unipolar depression, 5%

mild form, in any given year (Kessler et al, 2005). mild form, in any given year (Kessler et al, 2005). 17% will experience an episode of severe unipolar 17% will experience an episode of severe unipolar

depression at some point in their life (Kessler et al 2005).depression at some point in their life (Kessler et al 2005). Women are twice as likely to experience severe Women are twice as likely to experience severe

episodes (26% women compared to 12% of men episodes (26% women compared to 12% of men experience have an episode as some point in their life) experience have an episode as some point in their life) (Weissman et al, 1991). (Weissman et al, 1991).

Half people with unipolar depression recover within six Half people with unipolar depression recover within six weeks and 90% recover within a year, some without weeks and 90% recover within a year, some without treatment (Kessler, 2002). treatment (Kessler, 2002).

Most of them will have at least one other episode of Most of them will have at least one other episode of depression later in their lives (Boland & Keller, 2002). depression later in their lives (Boland & Keller, 2002).

Symptoms Symptoms Emotional Emotional MotivationalMotivational Behavioural Behavioural CognitiveCognitive PhysicalPhysical

Sad.Sad. Lack of drive, Lack of drive, spontaneity, spontaneity, initiative. initiative.

Less active, Less active, productive. productive.

Negative view of Negative view of themselves. themselves.

Headache, Headache, indigestion, indigestion, dizzy spells, dizzy spells, pain. pain.

Anger, anxiety, Anger, anxiety, agitation.agitation.

Force to go to Force to go to work, talk to work, talk to friends. friends.

Move slowly Move slowly Inadequate, Inadequate, undesirable, undesirable, inferior, evil inferior, evil

Depression Depression misdiagnosed misdiagnosed as other as other medical medical problems. problems.

Miserable, Miserable, empty, empty, humiliated. humiliated.

Uninterested in Uninterested in lifelife

Speak slowly Speak slowly Expect the worst, Expect the worst, hopelessness, hopelessness, helplessness. helplessness.

Disturbances in Disturbances in sleep, appetite, sleep, appetite,

Little pressure Little pressure out of anything.out of anything.

Wish to kill Wish to kill themselves themselves

Confused, Confused, distracted, not distracted, not solve simple solve simple problems. problems.

1. Biological Model 1. Biological Model

Evidence from geneticEvidence from genetic

and biochemical studiesand biochemical studies

suggests thatsuggests that

Unipolar depression hasUnipolar depression has

biological causes. biological causes.

1a. Genetic Factors 1a. Genetic Factors Family pedigree studies:Family pedigree studies:

Person with unipolar Person with unipolar depression will have 20% of depression will have 20% of relatives with depression, relatives with depression, compared with 10% relatives compared with 10% relatives (non-depressed).(non-depressed).

Twin Studies:Twin Studies: (Study 200 twins) identical (Study 200 twins) identical

twins 46% higher, fraternal twins 46% higher, fraternal twins 20% (McGuffin et al twins 20% (McGuffin et al 1996).1996).

Molecular Biology:Molecular Biology: Abnormality of 5-HTT gene Abnormality of 5-HTT gene (which transports serotonin in (which transports serotonin in the brain). (Hecimovic & the brain). (Hecimovic & Gilliam, 2006). Gilliam, 2006).

1b. Biochemical Factors1b. Biochemical Factors Low activity of norepinephrine and serotonin Low activity of norepinephrine and serotonin

(neurotransmitters).(neurotransmitters). Medication for high blood pressure (lowered activity of the 2 Medication for high blood pressure (lowered activity of the 2

neurotransmitters). (Ayd, 1956).neurotransmitters). (Ayd, 1956). Antidepressant drugs found by accident (increase activity). Antidepressant drugs found by accident (increase activity). More complicated, not as simple as one NT alone causes More complicated, not as simple as one NT alone causes

depression (Thase et al 2002). depression (Thase et al 2002). Adrenal glands. Adrenal glands. Abnormal levels of cortisol (stress Abnormal levels of cortisol (stress

hormone) (Neumesiter et al 2005). hormone) (Neumesiter et al 2005). Melatonin “Dracula hormone” released in the dark (SAD Melatonin “Dracula hormone” released in the dark (SAD

produced more melatonin during winter) Neto & Aranjo, produced more melatonin during winter) Neto & Aranjo, 2004). 2004).

Within neurons. Within neurons. Chemicals that carry messages which lead Chemicals that carry messages which lead to deficiencies of proteins & other chemicals which impair to deficiencies of proteins & other chemicals which impair the health of neurons (Julien, 2005). the health of neurons (Julien, 2005).

1c.Biological Treatments ECT 1c.Biological Treatments ECT Electroconvulsive therapy Electroconvulsive therapy

discovered by Ugo Cerletti discovered by Ugo Cerletti Electric current 65 to 140 volts Electric current 65 to 140 volts

sent through the brain causing sent through the brain causing a brain seizure that lasts from a brain seizure that lasts from 25 seconds to a few minutes. 25 seconds to a few minutes.

6 to 12 treatments, spaced 6 to 12 treatments, spaced over 2 to 4 week patients feel over 2 to 4 week patients feel less depressed (Andreasen & less depressed (Andreasen & Black, 2006). Black, 2006).

Memory regained after a few Memory regained after a few months but some will have months but some will have permanent amnesia (Fink, permanent amnesia (Fink, 2001).2001).

Declined since the 1950’s Declined since the 1950’s because of effective anti-because of effective anti-depressant drugs. depressant drugs.

1c. Biological Treatments Anti-1c. Biological Treatments Anti-depressant drugs depressant drugs

Sub-types Sub-types

MAO INHIBITORSSlow down

Monoamine OxidaseMAO break down norepinephrine

MAO INHIBITORSSlow down

Monoamine OxidaseMAO break down norepinephrine

TRICYCLICSThree-ring

molecule structure60-65% helped

significantly (Khun, 1958)

Block reuptake process, increasing

neurotransmitter activity.

TRICYCLICSThree-ring

molecule structure60-65% helped

significantly (Khun, 1958)

Block reuptake process, increasing

neurotransmitter activity.

SECOND-GENERATION

ANTI-DEPRESSANTS

Selective serotonin reuptake

Increase serotonin uptake specifically. * Most in demand

SECOND-GENERATION

ANTI-DEPRESSANTS

Selective serotonin reuptake

Increase serotonin uptake specifically. * Most in demand

2. Psychological Models of Unipolar 2. Psychological Models of Unipolar depression depression

PsychodynamicPsychodynamic BehaviouralBehavioural Cognitive***********Cognitive***********

2a. Psychodynamic Explanations 2a. Psychodynamic Explanations

Freud (1917) & Abraham (1916, 1911)Freud (1917) & Abraham (1916, 1911) Emphasis on dependence and loss. Emphasis on dependence and loss. Grief and depression commonalitiesGrief and depression commonalities Sadness, anger for the loved ones towards themselves.Sadness, anger for the loved ones towards themselves. In the face of loss the following groups are more likely to become clinically In the face of loss the following groups are more likely to become clinically

depressed:depressed: Parents who failed to meet their needs during the oral stageParents who failed to meet their needs during the oral stage Parents gratified needs excessivelyParents gratified needs excessively Devote their life to others, greater sense of loss.Devote their life to others, greater sense of loss.

Become depressed without lossBecome depressed without loss Symbolic or imagined loss- equate other events to the loss of a loved one Symbolic or imagined loss- equate other events to the loss of a loved one

Object relations theorist: peoples relationships leave them feeling unsafe and Object relations theorist: peoples relationships leave them feeling unsafe and insecure (Allen et al., 2004)insecure (Allen et al., 2004)

Support early life experiences and depression Support early life experiences and depression Depressed scale administered to 1,250 medical patients, patients whose fathers died Depressed scale administered to 1,250 medical patients, patients whose fathers died

during their childhood scored higher on depression (Barnes & Prosen, 1985)during their childhood scored higher on depression (Barnes & Prosen, 1985) Parental bonding instrument: chid rearing style as affectionless control- low care and Parental bonding instrument: chid rearing style as affectionless control- low care and

high protection (Shah & Waller, 2000)high protection (Shah & Waller, 2000)

Psychodynamic TreatmentsPsychodynamic Treatments

Associate freely during therapy- suggest Associate freely during therapy- suggest interpretations of the individual's interpretations of the individual's associations, dreams and displays of associations, dreams and displays of resistance and transference, help review resistance and transference, help review past events and feelings (Busch et al., past events and feelings (Busch et al., 2004)2004) ““early recall of loss may have spiralled into early recall of loss may have spiralled into

current depression”current depression” Long term- only occasionally helpful. Long term- only occasionally helpful.

2b. Behavioural Explanations2b. Behavioural Explanations Depression results from significant changes in the numbers of rewards and Depression results from significant changes in the numbers of rewards and

punishments people receive in their lives. punishments people receive in their lives. Lewinsohn: positive rewards dwindle, leading to fewer constructive behaviors. Lewinsohn: positive rewards dwindle, leading to fewer constructive behaviors. Depressed individuals experience fewer Depressed individuals experience fewer social rewards social rewards than nondepressed- than nondepressed-

environment and dark and flat mood promote this reduction (Joiner, 2002).environment and dark and flat mood promote this reduction (Joiner, 2002). TreatmentsTreatments Variety of strategies to increase positive behaviors (Lewinsohn et al., 1990).Variety of strategies to increase positive behaviors (Lewinsohn et al., 1990). Tasks pleasurable: set up weekly diary to incorporate these. Tasks pleasurable: set up weekly diary to incorporate these. Ignore client’s depressive behaviors whilst rewarding constructive statements Ignore client’s depressive behaviors whilst rewarding constructive statements

and behavior (i.e., going to work) and behavior (i.e., going to work) Teach effective social skills (Segrin, 2000)Teach effective social skills (Segrin, 2000) Combination need to be applied for effectiveness: track record of pleasurable Combination need to be applied for effectiveness: track record of pleasurable

compared to diary of pleasant activities: effectiveness the same (Jacobson et compared to diary of pleasant activities: effectiveness the same (Jacobson et al., 1996). al., 1996).

2c. Cognitive Explanations 2c. Cognitive Explanations

Two explanations Two explanations

Learned Helplessness

Learned Helplessness

Negative Thinking Negative Thinking

Learned HelplessnessLearned Helplessness Feelings of helplessness are at the centre Feelings of helplessness are at the centre

of depression Seligman (1975). of depression Seligman (1975). Learned Helplessness Theory of Learned Helplessness Theory of

Depression Seligman 1960’s. Depression Seligman 1960’s. (1). No longer have control over the (1). No longer have control over the

reinforcements in their lifereinforcements in their life (2). They themselves are responsible for (2). They themselves are responsible for

this helpless state. this helpless state.

Humans exposed to uncontrollable negative events, they later score higher Humans exposed to uncontrollable negative events, they later score higher than other subjects on a depressive mood survey (Miller & Seligman, 1975).than other subjects on a depressive mood survey (Miller & Seligman, 1975).

Attribution-helplessness theory (Mezulis et al 2004; Abramson et al 2002). Attribution-helplessness theory (Mezulis et al 2004; Abramson et al 2002). Attribute lack of control to internal, global and stable causes “I am useless Attribute lack of control to internal, global and stable causes “I am useless

and everything and I always will be”- more likely to have depression.and everything and I always will be”- more likely to have depression. Depressed people filled out the Attribution Style Questionnaire both before Depressed people filled out the Attribution Style Questionnaire both before

and after therapy. and after therapy. Before therapy: internal/global/stable pattern of attribution.Before therapy: internal/global/stable pattern of attribution. End of therapy (& 1 year later): depression improved and attribution style End of therapy (& 1 year later): depression improved and attribution style

less likely to be internal, global and stable (Seligman et al 1988). less likely to be internal, global and stable (Seligman et al 1988). AnalysisAnalysis Relies on animal studies (Henn & Vollmayr, 2005)Relies on animal studies (Henn & Vollmayr, 2005) Can animals make attributions, even implicitly? Can animals make attributions, even implicitly?

Negative Thinking Negative Thinking Beck (2002, 1967)Beck (2002, 1967) Maladaptive attitudes, cognitive Maladaptive attitudes, cognitive

triad, errors in thinking, automatic triad, errors in thinking, automatic thoughts combine to produce a thoughts combine to produce a clinical disorder.clinical disorder.

Children- “my general worth is tied Children- “my general worth is tied to the tasks I perform” to the tasks I perform” maladaptivemaladaptive

Attitudes: Attitudes: own experiences, family own experiences, family relationships, judgements from relationships, judgements from other people, inaccurateother people, inaccurate

Cognitive Triad: repeatedly interpretCognitive Triad: repeatedly interpret 1. their experience1. their experience 2. themselves2. themselves 3. their future in negative ways3. their future in negative ways

Errors in thinking: Errors in thinking: Arbitrary inferences: negative conclusions based on limited evidence. Arbitrary inferences: negative conclusions based on limited evidence. Minimize positive experiences and magnify negative experiences. Minimize positive experiences and magnify negative experiences. Automatic thoughtsAutomatic thoughts They are inadequate and situation is hopeless. They are inadequate and situation is hopeless. ““Everyone hates me” “I'm worthless” Everyone hates me” “I'm worthless” SupportSupport Depressed people hold maladaptive attitudes, the more held the more Depressed people hold maladaptive attitudes, the more held the more

depressed they are (Evans et al., 2005).depressed they are (Evans et al., 2005). Cognitive triad- depressed recall more negative events than positive ones, select Cognitive triad- depressed recall more negative events than positive ones, select

pessimistic statements, rate their behaviour in labs as poor (Ridout et al., 2003).pessimistic statements, rate their behaviour in labs as poor (Ridout et al., 2003). Errors in logic: female subjects asked to read and interpret paragraphs about Errors in logic: female subjects asked to read and interpret paragraphs about

women in difficult situations. Depressed subjects made more errors in logic women in difficult situations. Depressed subjects made more errors in logic (arbitrary inferences), in their interpretation than non-depressed women (arbitrary inferences), in their interpretation than non-depressed women (Hammen & Krantz, 1976). (Hammen & Krantz, 1976).

Treatment: Cognitive Treatment: Cognitive TherapyTherapy

Designed to recognise and change their maladaptive Designed to recognise and change their maladaptive behaviours.behaviours.

Beck (1985, 1967) similar to Ellis’s Rational Emotive Beck (1985, 1967) similar to Ellis’s Rational Emotive TherapyTherapy

Phase 1: Increase activities and elevate moodPhase 1: Increase activities and elevate mood Phase 2: Challenging automatic thoughtsPhase 2: Challenging automatic thoughts Phase 3: Identifying negative thinking and biasesPhase 3: Identifying negative thinking and biases Phase 4: Changing primary attitudes Phase 4: Changing primary attitudes 50-60% show a near total elimination of symptoms 50-60% show a near total elimination of symptoms

(Petrocelli, 2002). (Petrocelli, 2002).

Stress Link Stress Link

Link between Link between stress stress andanddepressiondepression (Costantino et al 2006)(Costantino et al 2006)

Depressed people are more likelyDepressed people are more likely

to have experienced stressfulto have experienced stressful

events one month before the onsetevents one month before the onset

of their disorder of their disorder (Monoe &(Monoe &

Hadjiyannakis, 2002). Hadjiyannakis, 2002).

Sociocultural Model Sociocultural Model Everyone at risk (WHO, 2004); vary culture to culture (Draguns, 2006).Everyone at risk (WHO, 2004); vary culture to culture (Draguns, 2006). Gender: higher in women- special pressures and complex roles. Gender: higher in women- special pressures and complex roles. Rise with poverty, minorities, family size and number of health problems (Comer, 2007)Rise with poverty, minorities, family size and number of health problems (Comer, 2007) Social Support: influences depression (Kendler et al., 2005)Social Support: influences depression (Kendler et al., 2005) Separated or divorced x3 more depression (Weissman et al., 1991).Separated or divorced x3 more depression (Weissman et al., 1991). Live in isolation without intimacy seem to become more depressed during times of stress (Kendler Live in isolation without intimacy seem to become more depressed during times of stress (Kendler

et al., 2005)et al., 2005) TreatmentsTreatments Interpersonal Psychotherapy and couple therapyInterpersonal Psychotherapy and couple therapy Klerman & Weissman IPTKlerman & Weissman IPT 4 interpersonal problem areas: interpersonal loss (explore grief and relationship with the lost 4 interpersonal problem areas: interpersonal loss (explore grief and relationship with the lost

person & explore feelings of anger-develop new ways of remembering the lost person), person & explore feelings of anger-develop new ways of remembering the lost person), interpersonal role dispute (ways of resolving them), interpersonal role transition (develop social interpersonal role dispute (ways of resolving them), interpersonal role transition (develop social support and skills the new role requires) interpersonal deficits (extreme shyness, social support and skills the new role requires) interpersonal deficits (extreme shyness, social awkwardness- teach them social skills and assertiveness) (Weissman & Markowitz, 2002). awkwardness- teach them social skills and assertiveness) (Weissman & Markowitz, 2002).

Success rate similar to that of Cognitive Therapy. Success rate similar to that of Cognitive Therapy. Couple Therapy: depressed person in a dysfunctional relationship, recovery slower for those in a Couple Therapy: depressed person in a dysfunctional relationship, recovery slower for those in a

non-supportive relationship. If there is conflict this approach is beneficial and effective as the non-supportive relationship. If there is conflict this approach is beneficial and effective as the above therapies (Snyder & Castellani, 2006).above therapies (Snyder & Castellani, 2006).

Bipolar DepressionBipolar Depression

DSM-IV-TRDSM-IV-TRManic EpisodeManic Episode

A period of abnormally and persistently elevated, expansive or irritable mood, lasting at least A period of abnormally and persistently elevated, expansive or irritable mood, lasting at least one week.one week.

Persistence of at least three of the following:Persistence of at least three of the following: Inflated self-esteem or grandiosity, decreased need for sleep, more talkativeness than usual or pressure to Inflated self-esteem or grandiosity, decreased need for sleep, more talkativeness than usual or pressure to

keep talking, flight of ideas or the experience of thoughts are racing, distractibility, increase in activity or keep talking, flight of ideas or the experience of thoughts are racing, distractibility, increase in activity or psychomotor agitation, excessive involvement in pleasurable activities that have a high potential for painful psychomotor agitation, excessive involvement in pleasurable activities that have a high potential for painful consequences.consequences.

Significant distress or impairmentSignificant distress or impairment

Bipolar i Disorder (full manic and depressive episodes)Bipolar i Disorder (full manic and depressive episodes) The presence of a manic, hypomanic or major depressive episodeThe presence of a manic, hypomanic or major depressive episode If currently in a hypomanic or major depressive episode, history of a manic episode.If currently in a hypomanic or major depressive episode, history of a manic episode.

Bipolar ii Disorder (mildly manic- over a course of time)Bipolar ii Disorder (mildly manic- over a course of time) The presence of a hypomanic or major depressive episodeThe presence of a hypomanic or major depressive episode If currently in a major depressive episode, history of a hypomanic episode. If currently in a If currently in a major depressive episode, history of a hypomanic episode. If currently in a

hypomanic episode, history of a major depressive episode. No history of a manic episode.hypomanic episode, history of a major depressive episode. No history of a manic episode.

Significant distress or impairmentSignificant distress or impairment. . (APA,2000) (APA,2000)

Causes: BiologicalCauses: Biological

Neurotransmitters: Neurotransmitters: Norepinephrine activity higher with mania than of depressed control Norepinephrine activity higher with mania than of depressed control

subjects (Post et al., 1980)subjects (Post et al., 1980) Resprine drug (reduce norepinephrine), mania subsided (Telner et al., Resprine drug (reduce norepinephrine), mania subsided (Telner et al.,

1986)1986) Ion activity: improper transport of these ions may cause neurons to Ion activity: improper transport of these ions may cause neurons to

fire too easily, resulting in depression (El-Mallakh, 2004)- abnormal fire too easily, resulting in depression (El-Mallakh, 2004)- abnormal functioning in the proteins that transport ions across a neurons functioning in the proteins that transport ions across a neurons membrane (Monkul et al.,2005)membrane (Monkul et al.,2005)

Brain structure: Brain structure: Brain imaging studies: abnormal brain structures (Lambert & Kinsley, Brain imaging studies: abnormal brain structures (Lambert & Kinsley,

2005)2005) Basal ganglia and cerebellum is smaller- not clear of the role these Basal ganglia and cerebellum is smaller- not clear of the role these

play in bipolar depression yet (Monkul et al., 2005)play in bipolar depression yet (Monkul et al., 2005)

Genetic FactorsGenetic Factors Inherit a biological predisposition to develop bipolar disorders.Inherit a biological predisposition to develop bipolar disorders. Identical twins of person with bipolar depression have 40% Identical twins of person with bipolar depression have 40%

likelihood of developing BD, fraternal twins, siblings have 5-10% likelihood of developing BD, fraternal twins, siblings have 5-10% compared to 1-2% general population (Swann, 2008). compared to 1-2% general population (Swann, 2008).

Molecular biology: Molecular biology: Genes on chromosomes 1,4,6,10,11,12,13,15,18,21,22 (Hayden et Genes on chromosomes 1,4,6,10,11,12,13,15,18,21,22 (Hayden et

al., 2008)al., 2008) Genetic abnormalities combine to create BD (Payne et al., 2005)Genetic abnormalities combine to create BD (Payne et al., 2005)

TreatmentsTreatments Psychotherapist- no successPsychotherapist- no success Anti-depressant drugs- limited effectivenessAnti-depressant drugs- limited effectiveness Lithium Therapy (Cade, 1949)Lithium Therapy (Cade, 1949) Doses: too little- no effect; too much: intoxication-slurred speech, dizziness, kidney Doses: too little- no effect; too much: intoxication-slurred speech, dizziness, kidney

failure, death.failure, death. Effective in treating manic episodes (Grof, 2005)Effective in treating manic episodes (Grof, 2005) 60% patients improve and experience fewer new episodes as long as they carry on 60% patients improve and experience fewer new episodes as long as they carry on

taking lithium (Carney & Goodwin, 2005)taking lithium (Carney & Goodwin, 2005) Relapse risk 28x greater when stop taking antibipolar drugs (Suppes et al., 1991).Relapse risk 28x greater when stop taking antibipolar drugs (Suppes et al., 1991). Helps overcome depressive episodes to a lesser degree than manic episodes (El-Helps overcome depressive episodes to a lesser degree than manic episodes (El-

Mallakh, 2006)Mallakh, 2006) Changes synaptic activity Changes synaptic activity Adjunctive PsychotherapyAdjunctive Psychotherapy Lithium therapy alone is not effective, 30% may not respond to this therapy or relapse Lithium therapy alone is not effective, 30% may not respond to this therapy or relapse

(Julien, 2005)(Julien, 2005) Use individual, group, family therapy as an adjunct to lithium treatment (Colom & Vieta, Use individual, group, family therapy as an adjunct to lithium treatment (Colom & Vieta,

2006) helps to hold a job and social functioning. 2006) helps to hold a job and social functioning.

On a lighter note: creativity and On a lighter note: creativity and abnormality: The price of abnormality: The price of

creativity creativity

Useful in the arts (Ludwig, 1995)Useful in the arts (Ludwig, 1995) Ancient Greeks: divine madness-inspired creative artsAncient Greeks: divine madness-inspired creative arts Today- expectation that creative geniuses to be Today- expectation that creative geniuses to be

psychologically disturbed. psychologically disturbed. Artists and writers more likely to suffer from mood Artists and writers more likely to suffer from mood

disorders (Lauronen et al., 2004)disorders (Lauronen et al., 2004) Sources of inspiration?Sources of inspiration? Work results in becoming disturbed? Work results in becoming disturbed? Predisposition, early life experiences? Predisposition, early life experiences? Majority are stable and medication for those who need it Majority are stable and medication for those who need it

enhances their creativity. enhances their creativity.

Frezied Masterpiece: MessiahFrezied Masterpiece: Messiah(wrote it in less than a month during a manic episode)(wrote it in less than a month during a manic episode)

Today: preventative measures in a hectic Today: preventative measures in a hectic and pressurised worldand pressurised world

Laughter being the best medicineLaughter being the best medicine

Symptoms of Symptoms of ManiaMania

Dramatic and inappropriate rises in mood.Dramatic and inappropriate rises in mood. Active and powerful emotions in search of an Active and powerful emotions in search of an

outlet. outlet. Irritable and angry- others get in the way. Irritable and angry- others get in the way. Want constant excitement, involvement & Want constant excitement, involvement &

companionshipcompanionship Do not know that they are overwhelming, Do not know that they are overwhelming,

domineering & excessive.domineering & excessive. Talk and walk fast- there is not enough timeTalk and walk fast- there is not enough time Flamboyant- clothes, moneyFlamboyant- clothes, money Poor judgement, cannot see pitfalls because Poor judgement, cannot see pitfalls because

of being too quick, do not listen to others.of being too quick, do not listen to others. Inflated opinion of themselvesInflated opinion of themselves Self-esteem- approaches grandiosity. Self-esteem- approaches grandiosity. Difficulty to be in touch with realityDifficulty to be in touch with reality Energetic- little sleep, feel and act wide Energetic- little sleep, feel and act wide

awake (Gupta et al., 2004)awake (Gupta et al., 2004)

Seminar Reading

Is Electroconvulsive Therapy Ethical? YES: Max Fink from Electroshock:

Restoring the Mind (Oxford University Press, 1999)

No: Leonard R. Frank from “Shock Treatment IV: Resistance in the 1990’s,” in Robert F. Morgan, ed., Electroshock: The Case Against (Morgan Foundation, 1999).

Reading

Nevid, J.S., Rathus, S.A., & Greene, B. (2008). Abnormal Psychology In A Changing World. (7th ed.). Pearson Prentice Hall: London. Chapter 8, pp. 246-289.

Oxman, T., Hegel, M., Hull, J., & Dietrich, A. (2008, December). Problem-solving treatment and coping styles in primary care for minor depression. Journal of Consulting and Clinical Psychology, 76(6), 933-943. Retrieved January 23, 2009, doi:10.1037/a0012617

Cohen, L., Gunthert, K., Butler, A., Parrish, B., Wenze, S., & Beck, J. (2008, December). Negative affective spill over from daily events predicts early response to cognitive therapy for depression. Journal of Consulting and Clinical Psychology, 76(6), 955-965. Retrieved January 23, 2009, doi:10.1037/a0014131

Constantino, M., Manber, R., DeGeorge, J., McBride, C., Ravitz, P., Zuroff, D., et al. (2008, December). Interpersonal styles of chronically depressed outpatients: Profiles and therapeutic change. Psychotherapy: Theory, Research, Practice, Training, 45(4), 491-506. Retrieved January 23, 2009, doi:10.1037/a0014335

Tackett, J., Quilty, L., Sellbom, M., Rector, N., & Bagby, R. (2008, November). Additional evidence for a quantitative hierarchical model of mood and anxiety disorders for DSM-V: The context of personality structure. Journal of Abnormal Psychology, 117(4), 812-825. Retrieved January 23, 2009, doi:10.1037/a0013795

Lau, J., & Eley, T. (2008, November). Attribution style as a risk marker of genetic effects for adolescent depressive symptoms. Journal of Abnormal Psychology, 117(4), 849-859. Retrieved January 23, 2009, doi:10.1037/a0013943

Gross, H., Shaw, D., Moilanen, K., Dishion, T., & Wilson, M. (2008, October). Reciprocal models of child behaviour and depressive symptoms in mothers and fathers in a sample of children at risk for early conduct problems. Journal of Family Psychology, 22(5), 742-751. Retrieved January 23, 2009, doi:10.1037/a0013514

One Hour Video

Chapter Eight Mood Disorders Depression is one of the most common psychological problems. In this program, psychologists and biologists look at the causes and treatment of both depression and bipolar disorder and show the progress that has been made in helping people return to productive and satisfying lives.

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