Mood disorders - Etiological theories

What is Seligman’s learned helplessness theorY?

Lack of perceived control over life events leads to decreased attempts to improve own situation

Subsequent research → Attributions about stress management are important

Humans learn to be passive/unable to control life by past history

What are types of attributions in learned helplessness?

Internal attributions (vs. external)

• Negative outcomes = one’s own fault

Stable attributions (vs. variable)

• Future negative outcomes will be one’s fault

Global attribution (vs. specific)

• Negative events will disrupt many life activities

What is the Low Response-Contingent Positive reinforcement theory?

Depression comes from loss of positive reinforcement

• Low opportunity for reinforcement

• Individual differences in what is reinforcing

• Person does not carry out behaviours that will be reinforced

Lack of positive reinforcement

→ response extinguished

→ loss of pleasure → dysphoria → other depressive symptoms

What is the behavioural inactivity theory for depression?

Behaviour in epression relates to reinforcement

Avoidance and escape behaviours increased

Positive reinforcement decreased

Vicious cycle of avoidance, relief, strengthened avoidance

Pedesky’s five factor model

Reciprocal interaction of inner experiences (thoughts, feelings, physical rxns, behaviours) surrounded by environment

Beck’s cognitive theory proposes that not ____ but _____ are important.

events; interpretations of events

What are three key concepts in depression, according to Beck?

• Negative schemas

• Faulty info processing/Cognitive errors

• Depressive cognitive triad

What are negative schemas?

Structural organisation of thinking based on early experience that are relatively stable

Mediate between environmental stimuli/events and specific response

Impact attention, organisation, and interpretation of events

What is the depressive cognitive triad?

Think negatively about:

• Oneself

• The world

• The future

What is a diagram for Beck’s cognitive theory of depression?

Early experiences

Cognitive and behavioural processes

Precipitant/Critical incident (external)

Cycle of NATs, bodily symptoms, behaviour, and emotion

What are maintaining processes?

What keeps the depression going when its established

Usually conceptualised as a closed loop identifying cycles of maintanence

Maintaining process example: NATs

Negative mood, depression, hopelessness → ordinary event → bisaed interpretation, interpreting negatively →

Maintaining process: RUmination and self attack

Negative thoughts - What’s wrong now?

Rumination, over-focus on what went wrong

Negative mood, depressed, hopeless

Biased interpretation of events

Maintaining process: unhelpful behaviors

Depressed mood

Unhelpful behaviors (rumination, SH, substance abuse, doomscrolling)

Negative thoughts (what a waste of time)

Vicious flower formulation

Center are core concerns (“I am worthless”)

Surrounded by loops which work by themselves and are reinforced by core concerns

What is the integrative cognitive model? (bipolar)

Trigger event

V

Change in internal state

v^

Appraisal as having one of several personal meanings

v^

Beliefs about self, world, and others

v^

Life experiences

Also ascent and descent behaviors

What is the main feature of the integrative cognitive model? (differentiating it from other unipolar models)

Misinterpretation of inner experiences, appraisal of it having extreme personal meanings

Interpreting elevating, manic symptoms as “This means I’m powerful”

Types of bipolar disorder

Bipolar I

• MDEs, manic (but only manic episode required)

Bipolar II

• MDEs, hypomanic (if any manic, goes to Bipolar I)

Cyclothymic

• Less depressive, hypomanic

What is unipolar mania?

Mania in absence of depressive episodes

Ppl w/ this can go on to develop depressive episodes (and usually do)

What is a specifier unique to bipolar disorders?

Ra[pid cycling - moving quickly in and out of mania, depression

At least four manic or depressive episodes w/in a year

Greater severity

Clinical features for bipolar: symptom rates (incl for children, adolescents)

Most common symptoms in manic episodes in children, adolescents:

• Increased energy

• Distractibility

• Pressure of speech

Irritability, grandosity in 80%

Elation, decreased need for sleep, racing thoughts in 70%

Clinical features for bipolar: suicide, impairment

VERY high risk of suicide

• 12-15x, 4x than depression

• 11% die by suicide

• Higher in younger, recent-onset males, comorbid substance disorders, social isolation, aggression, impulsiveness

High functional impairment

• One-third work full time

• Over 50% unable to work at all

Increased creativity/productivity

• Famous artists, writers, musicians

Lifetime prevalence of bipolar

2-4% gen population

Sex differences of bipolar disorder

Equal distribution BUT

Women more likely to experience rapid cycling and depressive periods

Ethnicity and bipolar disorder

Not much known

But, ethnicities are less likely to receive adequate treatment

• Less likely to be prescribed mood stabilising

• More likely to be prescribed antipsychotics

Course and prognosis of bipolar

Recurrence is norm (37% 1 yr, 60% 2 year, 73% 5 year)

20% have rapid cycling

Persistent, residual symptoms between episodes, usually depressive

Role of life events in bipolar disorder

• 4.5x greater risk

• High expressed emotion in family increased risk

• High affective negativity (family to patient) increased risk

• Social rhythm disruptions

• Goal dysregulation - more extreme response to rewarding stimuli

What causes bipolar?

• Complex interplay of genes, neurobiology, stress, and psychological vulnerabilities

• Heritability estimate 59-87%

• Cyclical dopamine dysregulation (greater dopamine transmission during manic phase)

• Circadian rhythm disruption

Ascent and descent behaviors

Counter productive attempts at control

(Increased and decreased activation)