Mood disorder
Emotions are temporary, moods are long term
Mood disorder → period of time with an emotion dominant their thoughts for at least 2 weeks
Depressive episode: low mood, suicidal thoughts, lack motivation, fatigue
Manic: euphoria and self confidence, super active, impulsive, reckless, behavior exaggerated, hallucination
Episode: a time period where a mood is in dominance
Polar: mood at the extreme end of a spectrum
ICD-11 judge by the duration and intensity of the moods
Mood ranges from normal to depressive episode
A person with at least 2 depressive episodes → recurrent depressive disorder
The 2 moods switches back and forth, once or twice a year
Bipolar (type 1)
Has depressive and manic state
Bipolar (type 2)
Has hypomanic instead of manic (less active, better than manic)
Type 2 are better in daily activity
Experiences depressive symptoms but never reach the threshold for diagnosis depressive episode
Less severe than bipolar, experience multiple hypomania + depressive episode over last 2 years, but symptoms are not as bad as bipolar
How to collect data?
21 items , likert, (0-3)
Only use for 13+ years old
10 being cut off score, below that is normal, higher is mild depression
What does it measure?
Statements (self-dislike, pessimistic) and how they feel the past 2 weeks
5-10 mins to complete (short test)
Good test-retest reliability —> Use to assess the efficacy (effectiveness) of treatment given
Reliable across ethnic group
Correlated with other depression test (Hamilton Depression Scale)
Good at detect bipolar disorder (Type 1) + recurrent depressive disorder (cause most bipolar start with depression)
Not good at detect disorders like bipolar (type 2) and dysthymic
Self-report. Patient may lie
Lack qualitative data
Assumes depression is within the person
Need info about situation that sustain depression
Lack of monoamines ( group of neurotransmitter, dopamine, noradrenaline, serotonin)
Noradrenaline: neurotransmitter in amygdala for emotion
Low noradrenaline level cause depression
(Drugs for high blood pressure lowers noradrenaline but caused depression)
Serotonin control mood and noradrenaline
Low serotonin = low noradrenaline = depression
High serotonin = high noradrenaline = manic episodes
What affects serotonin level?
Serotonin made by tryptophan (amino acid, found in meat), change in diet with tryptophan affect serotonin level
Affected by cortisol (stress hormone)
Lack nurture: a child that got adopted by depressed parent can develop depression as well, even tho no genes are shared
Culture differences: Chinese women genes (LHPP) associated with depression, while European is not
High concordance rate for female MZ twins (44%) compared to 16% of female DZ twins
Candidate genes: Female bipolar have more allele 1 of 5-HTT and allele S of 5-HT2c (only for heterozygotic)
Whether 5-HT2c & 5-HTT genes (associated with serotonin transmission) are more common in bipolar disorder
Correlation study
Analyze blood sample of bipolar (type 1) and healthy people, testing for polymorphism in 5-HTT and 5-HT2c (see if specific DNA have variant or not)
5-HT2c, code for serotonin receptor
5-HTT, code for serotonin transporter
42 Croatian ppt (bipolar type 1) + 40 control ppt (matched for sex and age). From 2 Croatia Psychiatric institution, opportunity sampling
All info collected from medical records
No significant difference in genes in bipolar and normal. However, female bipolar more likely to have gene polymorphism:
Allele 1 of 5-HTT
More allele S of 5-HTR2c. Only in heterozygotic females (who carry 2 genes from mother and father)
==> No genes are linked to bipolar, however, female serotonin polymorphism lead to risk of bipolar
Validity:
All ppt diagnosed, with medical record about family history
Have control group to compare
Scientific measure
Reliability. This study is the replication of another study which also found no effect of 5-HTT + 5-HTR2c
Useful:
Study 2 genes => increase understanding
Help make drugs, personalized drug matching ppt genome is effective. (Pharmacogenomics)
Small sample size. Only 3 males who has SS genotype of 5-HT2c
Too reductionist: didn’t look at epigenetic factor (whether a gene is expressed or silent), should look at interaction between gene and environmental risk factor
Depression caused by negative thoughts + wrong core belief
Think negatively about themselves, the world, the future
Patient filter out info, only accepting negative info matching their belief and ignore positive info
Depressive attributional style for negative event cause depression (how bad patient see the world)
Blame themselves for random things (like blaming themselves when ask family to eat out and then it rains afterwards)
Proven as reducing pessimism in therapy reduce depression
Learned helplessness: Patient believe they are helpless in unpleasant situation, make no attempt to make their life better
(e.g: experiment with dogs in electric cage with or without roof)
Supported by evidence. Therapy reduce depressive attributional style can reduce depression.
Might not be a cause, but an effect. Findings in therapy are correlational, therapy can’t improve depression 100%
Free will: Some people with difficult lives can still be happy, CBT and meditation proved this.
Mini study: Seligman
39 unipolar and 12 patients bipolar disorder, (together with 10 healthy as a control group)
All completed short form of BDI and the Attributional Style Questionnaire (ASQ) before their cognitive therapy, after their cognitive therapy and a year after therapy finished.
The ASQ asks patients to make causal attributions for 12 hypothetical events (both good and bad). They then rate each cause on a 7-point scale for internality, stability and globality.
The results were that a pessimistic explanatory style (scoring highly for internal, stable and global) for negative (bad) events correlated significantly with severity of depression at all three time points,
Therapy reduce depression for unipolar, but not bipolar
Same procedure for all ppt, reliable
Assess symptoms before and after treatment and even 1 year follow up. Measure changes
Not effective control group: only do questionnaire, did not have therapy (cause no symptoms)
Stop serotonin transporter (SERT) + noradrenaline transporter (NET) from being reabsorbed into presynaptic cell membranes
More SERT + NET around to bind with receptors
To increase serotonin and noradrenaline level
SSRI stop reuptake of serotonin by binding with SERT and stop serotonin from being transported
Increase serotonin to bind with 5HT receptors on postsynaptic cell
Monoamine oxidase breaks down neurotransmitter
MAOIs stop the breakdown → increase serotonin level
MAOI subtype A - breaks down serotonin + noradrenaline oxidase (better at treating depression)
MAOI subtype B - breaks down dopamine oxidase. More dopamine, happy for longer
Only use MAOI is other drugs don’t work, cause have harmful side effects
MAOI built up tyramine → more risk of stroke
People on MAOI must avoid food rich in tyramine
Uses of antidepressant
Target different symptoms, personalized treatment
Small symptoms improvement
Side effect, SSRI (vomiting, constipation). Discourage patient to take med
The HDRS scale only requires 2 points improvement to be considered good (not enough)
Individual vs situational: Ignore situational factors (too reductionist). Instead, we should teach victims to remove toxic situations out of their life to avoid depression. (need to be more holistic)
People place too high expectation on themselves, and often felt disappointed
People must approve what I do
I must get other people to treat me well
I must get what I want and deny what I don’t want
Convince patient to see these as goals rather than a must have will reduce symptoms
Depression is caused by 3 negative beliefs
Myself is bad
The world is bad
The future is bad
These belief affect how we interpret situations in the real
Cognitive restructuring: identifying and change negative thoughts
Psychoeducation: teacher victim about feelings + behaviour and how to control them
Write down thoughts + emotions to be discussed in next therapy
Socrative questioning: therapist ask patient question to guide them into thinking positively
Goal is steer people away from negative beliefs, make them more objective, not completely remove pessimism cause it’s impossible.
5-20 weekly session
Risk of relapse is lower with drug + therapy treatment
Cognitive theory breaks the link between negative thoughts and depression
Not work well with old adults
Johnco (2015), showed 60-86 age have poor cognitive flexibility + ability to restructure thoughts
Success of therapy depend on patient motivation to attend all sessions
A- activating events
B- beliefs
C- consequences
Therefore, focus on interpretation of event rather than avoiding bad event
The model explains link between how we think, feel and act
Musturbation: when people allow “3 musts” to control thoughts, feelings and action. They believe they must do something
Disputing
Technique in REBT to reduce musturbation
Therapist dispute (debate) with client on why their “musts” beliefs are not realistic. Until they stop believing
Goal is to accept the bad situations in life
Effective
Iftene (2015), compared 3 groups of REBT, SSRI and REBT + sertaline drugs. All groups showed improvement. Therefore REBT is an alternative to drugs
Only works if ppt commit 100% to therapy
Lyons & Woods (1991), analyse 70 longitudinal studies. Attrition (ppt dropouts) affect generalisation
REBT is less effective to ppt who dropped out
Ethical issues: REBT suggest “musts” should be accepted and the world is not fair. But this disencourage people to solve injustice
Free will: Therapist believe we can change how we think. So even though depression is affected by genes, we can still solve it with right thinking.
Holistic: Holistic approach is multilayered treatments that recognize multifactor of depression. This reduce symptoms the most and reduce relapse.
Emotions are temporary, moods are long term
Mood disorder → period of time with an emotion dominant their thoughts for at least 2 weeks
Depressive episode: low mood, suicidal thoughts, lack motivation, fatigue
Manic: euphoria and self confidence, super active, impulsive, reckless, behavior exaggerated, hallucination
Episode: a time period where a mood is in dominance
Polar: mood at the extreme end of a spectrum
ICD-11 judge by the duration and intensity of the moods
Mood ranges from normal to depressive episode
A person with at least 2 depressive episodes → recurrent depressive disorder
The 2 moods switches back and forth, once or twice a year
Bipolar (type 1)
Has depressive and manic state
Bipolar (type 2)
Has hypomanic instead of manic (less active, better than manic)
Type 2 are better in daily activity
Experiences depressive symptoms but never reach the threshold for diagnosis depressive episode
Less severe than bipolar, experience multiple hypomania + depressive episode over last 2 years, but symptoms are not as bad as bipolar
How to collect data?
21 items , likert, (0-3)
Only use for 13+ years old
10 being cut off score, below that is normal, higher is mild depression
What does it measure?
Statements (self-dislike, pessimistic) and how they feel the past 2 weeks
5-10 mins to complete (short test)
Good test-retest reliability —> Use to assess the efficacy (effectiveness) of treatment given
Reliable across ethnic group
Correlated with other depression test (Hamilton Depression Scale)
Good at detect bipolar disorder (Type 1) + recurrent depressive disorder (cause most bipolar start with depression)
Not good at detect disorders like bipolar (type 2) and dysthymic
Self-report. Patient may lie
Lack qualitative data
Assumes depression is within the person
Need info about situation that sustain depression
Lack of monoamines ( group of neurotransmitter, dopamine, noradrenaline, serotonin)
Noradrenaline: neurotransmitter in amygdala for emotion
Low noradrenaline level cause depression
(Drugs for high blood pressure lowers noradrenaline but caused depression)
Serotonin control mood and noradrenaline
Low serotonin = low noradrenaline = depression
High serotonin = high noradrenaline = manic episodes
What affects serotonin level?
Serotonin made by tryptophan (amino acid, found in meat), change in diet with tryptophan affect serotonin level
Affected by cortisol (stress hormone)
Lack nurture: a child that got adopted by depressed parent can develop depression as well, even tho no genes are shared
Culture differences: Chinese women genes (LHPP) associated with depression, while European is not
High concordance rate for female MZ twins (44%) compared to 16% of female DZ twins
Candidate genes: Female bipolar have more allele 1 of 5-HTT and allele S of 5-HT2c (only for heterozygotic)
Whether 5-HT2c & 5-HTT genes (associated with serotonin transmission) are more common in bipolar disorder
Correlation study
Analyze blood sample of bipolar (type 1) and healthy people, testing for polymorphism in 5-HTT and 5-HT2c (see if specific DNA have variant or not)
5-HT2c, code for serotonin receptor
5-HTT, code for serotonin transporter
42 Croatian ppt (bipolar type 1) + 40 control ppt (matched for sex and age). From 2 Croatia Psychiatric institution, opportunity sampling
All info collected from medical records
No significant difference in genes in bipolar and normal. However, female bipolar more likely to have gene polymorphism:
Allele 1 of 5-HTT
More allele S of 5-HTR2c. Only in heterozygotic females (who carry 2 genes from mother and father)
==> No genes are linked to bipolar, however, female serotonin polymorphism lead to risk of bipolar
Validity:
All ppt diagnosed, with medical record about family history
Have control group to compare
Scientific measure
Reliability. This study is the replication of another study which also found no effect of 5-HTT + 5-HTR2c
Useful:
Study 2 genes => increase understanding
Help make drugs, personalized drug matching ppt genome is effective. (Pharmacogenomics)
Small sample size. Only 3 males who has SS genotype of 5-HT2c
Too reductionist: didn’t look at epigenetic factor (whether a gene is expressed or silent), should look at interaction between gene and environmental risk factor
Depression caused by negative thoughts + wrong core belief
Think negatively about themselves, the world, the future
Patient filter out info, only accepting negative info matching their belief and ignore positive info
Depressive attributional style for negative event cause depression (how bad patient see the world)
Blame themselves for random things (like blaming themselves when ask family to eat out and then it rains afterwards)
Proven as reducing pessimism in therapy reduce depression
Learned helplessness: Patient believe they are helpless in unpleasant situation, make no attempt to make their life better
(e.g: experiment with dogs in electric cage with or without roof)
Supported by evidence. Therapy reduce depressive attributional style can reduce depression.
Might not be a cause, but an effect. Findings in therapy are correlational, therapy can’t improve depression 100%
Free will: Some people with difficult lives can still be happy, CBT and meditation proved this.
Mini study: Seligman
39 unipolar and 12 patients bipolar disorder, (together with 10 healthy as a control group)
All completed short form of BDI and the Attributional Style Questionnaire (ASQ) before their cognitive therapy, after their cognitive therapy and a year after therapy finished.
The ASQ asks patients to make causal attributions for 12 hypothetical events (both good and bad). They then rate each cause on a 7-point scale for internality, stability and globality.
The results were that a pessimistic explanatory style (scoring highly for internal, stable and global) for negative (bad) events correlated significantly with severity of depression at all three time points,
Therapy reduce depression for unipolar, but not bipolar
Same procedure for all ppt, reliable
Assess symptoms before and after treatment and even 1 year follow up. Measure changes
Not effective control group: only do questionnaire, did not have therapy (cause no symptoms)
Stop serotonin transporter (SERT) + noradrenaline transporter (NET) from being reabsorbed into presynaptic cell membranes
More SERT + NET around to bind with receptors
To increase serotonin and noradrenaline level
SSRI stop reuptake of serotonin by binding with SERT and stop serotonin from being transported
Increase serotonin to bind with 5HT receptors on postsynaptic cell
Monoamine oxidase breaks down neurotransmitter
MAOIs stop the breakdown → increase serotonin level
MAOI subtype A - breaks down serotonin + noradrenaline oxidase (better at treating depression)
MAOI subtype B - breaks down dopamine oxidase. More dopamine, happy for longer
Only use MAOI is other drugs don’t work, cause have harmful side effects
MAOI built up tyramine → more risk of stroke
People on MAOI must avoid food rich in tyramine
Uses of antidepressant
Target different symptoms, personalized treatment
Small symptoms improvement
Side effect, SSRI (vomiting, constipation). Discourage patient to take med
The HDRS scale only requires 2 points improvement to be considered good (not enough)
Individual vs situational: Ignore situational factors (too reductionist). Instead, we should teach victims to remove toxic situations out of their life to avoid depression. (need to be more holistic)
People place too high expectation on themselves, and often felt disappointed
People must approve what I do
I must get other people to treat me well
I must get what I want and deny what I don’t want
Convince patient to see these as goals rather than a must have will reduce symptoms
Depression is caused by 3 negative beliefs
Myself is bad
The world is bad
The future is bad
These belief affect how we interpret situations in the real
Cognitive restructuring: identifying and change negative thoughts
Psychoeducation: teacher victim about feelings + behaviour and how to control them
Write down thoughts + emotions to be discussed in next therapy
Socrative questioning: therapist ask patient question to guide them into thinking positively
Goal is steer people away from negative beliefs, make them more objective, not completely remove pessimism cause it’s impossible.
5-20 weekly session
Risk of relapse is lower with drug + therapy treatment
Cognitive theory breaks the link between negative thoughts and depression
Not work well with old adults
Johnco (2015), showed 60-86 age have poor cognitive flexibility + ability to restructure thoughts
Success of therapy depend on patient motivation to attend all sessions
A- activating events
B- beliefs
C- consequences
Therefore, focus on interpretation of event rather than avoiding bad event
The model explains link between how we think, feel and act
Musturbation: when people allow “3 musts” to control thoughts, feelings and action. They believe they must do something
Disputing
Technique in REBT to reduce musturbation
Therapist dispute (debate) with client on why their “musts” beliefs are not realistic. Until they stop believing
Goal is to accept the bad situations in life
Effective
Iftene (2015), compared 3 groups of REBT, SSRI and REBT + sertaline drugs. All groups showed improvement. Therefore REBT is an alternative to drugs
Only works if ppt commit 100% to therapy
Lyons & Woods (1991), analyse 70 longitudinal studies. Attrition (ppt dropouts) affect generalisation
REBT is less effective to ppt who dropped out
Ethical issues: REBT suggest “musts” should be accepted and the world is not fair. But this disencourage people to solve injustice
Free will: Therapist believe we can change how we think. So even though depression is affected by genes, we can still solve it with right thinking.
Holistic: Holistic approach is multilayered treatments that recognize multifactor of depression. This reduce symptoms the most and reduce relapse.
