Psychological disorders 2

Depressive disorders

Sustained low mood and changes in thinking, behaviour and emotion that can interfere with relationships, study and work

DSM-5 depressive-disorder group

1.        Major depressive disorder (MDD)

2.        Persistent depressive disorder (PDD/dysthymia)

3.        Disruptive mood dysregulation disorder

4.        Premenstrual dysphoric disorder

5.        Substance/medical-condition-related forms

Major depressive disorder

·      At least 5 symptoms within the same 2-week period, including depressed mood OR loss of interest/pleasure

-              Symptoms occur most of the day, nearly every day and cause distress or impairment

·      Symptoms: appetite change, sleep disturbance, fatigue, worthlessness/excessive guilt, poor concentration, recurrent thoughts of suicide

Diathesis–stress model

Inherited vulnerability interacts with stressful life events to increase risk

·      Vulnerability does not mean depression is inevitable

Cognitive-behavioural model (Beck)

Automatic negative thoughts and biased beliefs influence feelings and actions

·      Withdrawal then reduces rewarding experiences, reinforcing low mood

Beck’s negative cognition triad

Negative beliefs about self, world/environment and future

·      Same event, different interpretation → different emotion

Mental filter

Focus on negative info while overlooking positives

Personalisation / self-blame

Take responsibility for failures but discount successes

Mindreading

Assume others dislike or judge you without evidence

Catastrophising

Predict the worst outcome

Black-and-white thinking

View events as total success or failure

Emotional reasoning

Treat feelings as proof

Overgeneralisation

Use one setback to draw a broad negative conclusion

Depressive maintenance cycle

Stressful event → automatic negative belief → low mood → withdrawal / less activity → fewer positive experiences → stronger negative belief and mood

·      Behavioural consequences: reduced motivation, stopping enjoyable activities or exercise, social isolation, difficulties with study/work - these maintain depression

·      Thoughts alone don’t cause depression, biological predisposition and stressful events also matter

Persistent depressive disorder (PDD)

·      Depressed mood for ≥2 years in adults (≥1 year in children/adolescents)

·      Most of the day and on more days than not

·      ≥2 symptoms of appetite, sleep, energy, self-esteem, concentration or hopelessness symptoms

·      Symptom-free intervals do not exceed two months

·      Symptoms are often less intense than MDD but more enduring

-              MDD and PDD can co-occur

Bipolar disorders

Episodes of elevated/irritable mood and increased energy or activity, with depressive episodes also important

·     Strong biological/genetic contribution; episodes and severity vary

Manic episode

·      Abnormally elevated, expansive or irritable mood AND increased activity/energy for ≥1 week

·      Most of the day nearly every day

·      ≥3 associated symptoms (≥4 if mood only irritable), with marked impairment

·      Symptoms: grandiosity, decreased need for sleep, pressured speech, racing thoughts, distractibility, increased goal-directed activity or agitation, risky activities

·      May feel euphoric or productive initially symptoms can have serious consequences

Mania vs hypomania vs bipolar subtypes

Clinical significance and management

·      Diagnosis requires attention to severity, duration, impairment and whether symptoms fit depression or mania

-              Elevated mood alone does not establish bipolar disorder

·      Combining medical treatment (e.g. lithium) with psychological support to manage current episodes and prevent recurrence

Positive symptoms

Presence of unusual experiences/behaviours

Negative symptoms

Reduction or absence of normal functioning

Psychotic symptoms:

• Delusions

• Hallucinations

• Disorganised thinking/speech

• Disorganised or abnormal motor behaviour

• Negative symptoms

Schizophrenia

Delusions

Strongly held false beliefs despite contradictory evidence; may involve confirmation bias.

• Types: persecution, influence and grandeur

• Positive symptom

Hallucinations

Perception without an external stimulus

• Often auditory (critical or commanding voices)

• Positive symptom

Disorganised thinking/speech

Disrupted thought processes reflected in speech

• Loose associations: jumping between unrelated ideas

• Clang associations: linking words by sound rather than meaning

• Paralogic: reasoning appears logical but is seriously flawed

• Speech may be chaotic or nonsensical

• Positive symptom

Disorganised motor behaviour

Inappropriate or unpredictable behaviour, agitation, silliness and difficulty with daily activities

• Positive symptom

Catatonic behaviour

Markedly reduced responsiveness, resistance to instructions, rigid postures or mutism

• May involve unusual or exaggerated motor activity

• Positive symptom

Reduced emotional expression

Limited facial expression, eye contact and gestures

• Negative symptom

Avolition

Reduced motivation/initiation of goal-directed activity

• Negative symptom

Alogia

Reduced speech

• Negative symptom

Anhedonia

Reduced ability to experience pleasure

• Negative symptom

Associated problems with schizophrenia

• Sleep disturbance, depression/anxiety, substance use

• Cognitive difficulties, poor insight and motor deficits

• Elevated suicide risk (5–6% die by suicide; 20–30% attempt)

• Violence may occur but is NOT characteristic of most people with schizophrenia

Course and phases of schizophrenia

• Prodromal: early changes before an active episode

• Active: prominent psychotic symptoms

• Residual/remission: active symptoms reduce, but some difficulties may persist

• Often requires long-term management

-              Symptoms can relapse and remit

Historical subtypes

1.      Paranoid

2.        Disorganised

3.        Catatonic

4.        Undifferentiated

5.        Residual

Vulnerability / diathesis-stress model

• Schizophrenia may develop through interaction between predisposition (vulnerability) and environmental stress

• Different combinations of vulnerability and stress may contribute to onset

Susto

• Latin American cultural concept involving fear/fright, anxiety and physical symptoms (e.g. weakness, weight loss, palpitations)

• Traditionally attributed to frightening events or supernatural influences

• Traditional healing practices may be used

Winigo

• Historically described in some Algonquian cultural contexts

• Fear of transformation into a cannibalistic supernatural being

• Depression, appetite loss, nausea and insomnia

Anorexia Nervosa

• Restriction of food intake, intense fear of weight gain and body-image disturbance

• Historically associated with Western cultural ideals, but occurs across cultures

• Not strictly a culture-bound disorder