A-Level (CIE) Psychology- Mood Disorders

Diagnostic Criteria (ICD-11)

1) Mood disorders are characterised by the duration and intensity of the mood.

2)Depressive episodes:-extreme moods of depression lasting at least two weeks.

-changes in appetite and sleep, recurrent thoughts of suicide, feelings of worthlessness, hopelessness, and guilt.

3) Manic episodes:

-an extreme mood state lasting at least 1 week.

-euphoria, behave in an overly enthusiastic manner, highly active, rapid speech, easily distracted, impulsive, and reckless.

4) Bipolar disorder:

-personal alternate between depressive and manic episodes

Beck Depression Inventory (BDI)

1) 21 item inventory measuring the severity of a person's symptoms.

2) 14-19: mild, 20-28: moderate, 29-63: severe.

3) should think of last 2 weeks when answering.

4) e.g. Sadness:

0. I do not feel sad

1. I feel sad much of the time.

2. I am sad all the time.

3. I am so sad or unhappy that I can't stand it.

Evaluation of the BDI

1) Strong test-retest reliability: positively correlated with scores on another measure (the Hamilton Psychometric Rating Scale for Depression) so reliable and valid.

2)Quick to administer but still provides precise data.

3) Self-reported data used so subjective as its based on the patients answers, so there can be social desirability which reduces the validity.

4) Individual vs. situational explanations:

-the quantitative data approach assumes depression resides with the person rather than a qualitative approach which can explain the context in which the person is experiencing their symptoms.

Evaluation of the diagnostic criteria

1) High levels of agreement between independent raters were found for diagnosis of bipolar disorder (84%) and recurrent depressive disorder (74%)

2)Clinicians less likely to agree when diagnosing bipolar type 2 (62%) than type 1 (74%).

3)Cultural differences:

cultural differences are taken into account in ICD-11 as clinicians know that in LMICs, people have more somatic (bodily) symptoms (aches/pains).

Biochemical

1) Monoamine hypothesis:

-Noradrenaline deficiency may cause depression

-Serotonin controls noradrenaline levels so an imbalance of serotonin can cause noradrenaline to drop (leading to depressive episodes) or become too high (leading to manic episodes.

2) Serotonin imbalances:

-serotonin rising and falling.

-problems with serotonin being absorbed back into presynaptic cell can reduce the levels of serotonin for binding on postsynaptic cell.

-serotonin falls because too much monoamine oxidase (breaks down serotonin)

Evaluation of biochemical explanation

1) Research supported: Moreno et al., 1999 experimentally reduced serotonin production and found an increase in depressive symptoms; control group used increases validity.

2) Determinism vs. free will: monoamine hypothesis is deterministic as it suggests everyone responds in the same way to neurochemical alterations; individual differences and our personal vulnerability can't be predicted with this explanation.

Genetic Explanation

1) Twin studies:

-Kendler et al., 2006 found concordance rates for 44% for female MZ twins and 16% female DZ twins. 31% for male MZ twins and 11% for male DZ (depression more heritable in females.)

-Bertlesen et al., 1977 found concordance rates for bipolar of 63% in MZ and 8% in DZ twins.

2) Candidate genes

-5HT2c gene codes for postsynaptic serotonin receptors

-5HTT gene codes for presynaptic transporter molecules; those who inherit two short alleles (w/ stressful life event) are more prone to depression than two long or one short allele (Caspi et al., 2003)

Evaluating genetic explanations

1) Nature vs. nurture:

-environmental factors between MZ and DZ twins may differ which may explain the difference in concordance rates.

-adoption studies support genetic explanations as 31% of biological parents of adopted children with bipolar had also been diagnosed with mood disorder compared to 12% of adoptive parents.

2) Cultural differences:

-a study of Chinese women showed a link between two genes and depression but these findings did not replicate in European women, showing that there may be cultural differences in depression.

Oruč et al. (1997)

1) Aim: investigate whether polymorphism of two genes linked with serotonin transmission where more common in people with bipolar.

2) Correlational study- assessed via interviews and hospital case notes.

3) Sample: Croatian; opportunity sampling; 25 F & 17 M; 16 participants had at least one first-degree relatives with a diagnosis.

4) Blood samples taken to see which alleles they were carrying of the 5-HTR2c (Cys, C and Ser, S) and the 5-HTT (1 and 2)

5) no significant difference in the polymorphism on both genes.

6) sex differences in allele frequency; S allele and allele 1 was more common in females with bipolar.

Evaluation of Oruč et al. (1997)

1) all participants were assessed by experienced psychiatrists using the SADS Lifetime Version.

2) The study strengthens reliability of other studies such as Guiterrez et al., 1996 and Kelsoe et al., 1996 as Oruc found similar findings.

3) Small sample size so no variety of people with different versions of the alleles; less generalisability.

4) Reductions vs. holism:

-study is a reductionist as they examine single genes not epigenetic factors which can affect if a gene is expressed or silenced to give a more holistic approach.

Beck's cognitive theory of depression

1) Depressive symptoms caused by negative thoughts linked to dysfunctional core beliefs.

2) Negative cognitive triad: negative beliefs about the self, the world, and the future.

3) these belief develop during experiences in childhood.

Learned attributional style (Seligman)

1) Animal research:

-dogs were classically conditioned to link a NS (lights) with an electric shock.

-they were placed in an enclosure with a low barrier in which if they jump the barrier, they'd escape the shock which was from the floor.

-dogs made no attempt to escape as they developed a negative expectation that anything they did to control the shocks would be hopeless.

2) In humans

-the way we attribute our circumstances can be a cause of depressive symptoms.

Seligman et al. (1988)

1) Aim: to investigate if there's a positive correlation between depressive attributional style and severity of depressive symptoms

2) 51 patients; 39 unipolar, 12 bipolar; matched control group

3)completed BDI & Attributional Style Questionnaire

(make attributions about 12 positive & negative events)

4) completed 6 months of weekly CBT sessions

5) data from interviews using SADS

6) found a positive correlation.

7) pessimism scores lower in control

8) higher pessimism, greater improvement in symptoms.

Evaluation of Seligman et al. (1988)

1) Matched control group allowed them to show pessimism changes over time.

2) Triangulation: usage of questionnaires & interviews increases validity.

3) Gender imbalance (31 F, 20 M); hard to generalise as findings may differ in males compared to females.

4) 26/39 participants actually completed the assessment; reduces generalisability as the people who dropped out may have had more severe symptoms, so findings could've differed.

Evaluation of psychological explanations

1) Research supported: Seligman et al., 1988 suggests that pessimism may be a cause of the symptoms.

2) Correlational study shows attributional style may not be a cause of depression.

3) Determinism vs. free will: with free will, we always have the power to override the negative thinking biases; successful CBTs prove this.

Biological Treatments

1) Tricyclics

-blocks serotonin transporter molecules (SERT) & noradrenaline transporter molecules (NET) so they can't be reabsorbed and remain in the synapse.

2) MAOIs

-monoamine oxidase inhibitors inhibits the enzyme monoamine oxidase, so there's increased levels of these neurotransmitters.

-only used if other drugs don't work as it can have harmful interactions with other drugs and food.

3) SSRIs

-selective serotonin reuptake inhibitor

-increases level of serotonin by binding to SERT so that it can't be reabsorbed, inhibiting the reuptake process.

Evaluation of biological treatments

1) Research evidence supported: Cipriani et al., 2018 found 21 drugs investigated in a meta-analysis were more effective than placebos.

2) Improvement of symptoms are small; effective drugs have bad compliance rates.

3) Individual vs. situational explanations: focusing solely on biological treatments for depression overlooks situational factors that causes stress. Supporting individuals to address unjust situations may enable recovery without medication, emphasizing the importance of understanding people's lives before suggesting medicine.

4) Applications to everyday life: unpleasant side effects and relapse are consequences of drug treatments.

Beck's cognitive restructuring

1) process of challenging and identifying negative thoughts.

2) goal is to help people rely less on dysfunctional beliefs but more on evidence when making attributions.

3) produces objective, balanced views of the self, the world, and the future.

Evaluation of cognitive restructuring

Risk of relapse after drug treatment is lower when combined with therapy. Fava et al., 1998 found 75% who received this therapy with anti-depressants were symptom-free 24 months follow-up compared to 25% of those who took drugs w/o therapy.

Rational emotive behaviour therapy (REBT)

1) ABC model

-Activating events, Beliefs, Consequences

2) Musturbation

-therapists help identify if any of the three basic musts are affecting their feelings:

a. People must approve of everything I do.

b. Other people must treat me well.

c. I must get what I want and not what I do not want.

-some people allow these musts

to control their thoughts, feelings, behaviour and their ability to enjoy life.

3) Disputing

-reduces musturbation

-therapists ask for evidence as to why everything must be as their beliefs demand, making the person gradually realise their beliefs are irrational and will develop new ways of thinking about their lives.

Evaluation of REBT

1) An effective alternate to drug treatments; Iftene et al., 2015 found that REBT group and drug treatment group showed reduced depressive symptoms.

2) Flawed supporting studies: Lyons & Woods, 1991 did a meta analysis of 70 studies of REBT and found that attrition (participant dropout) affected the findings, reducing generalisability.

3) Determinism vs. free will:

-cognitive therapists believe we have the power of free will to override negative thinking processes and challenge core beliefs.

4) Reductionism vs. holism:

-taking a more holistic approach by combining REBT and anti-depressants help treat depression because of greatest reduction in symptoms.