Abnormal Psychology (5PS020): Abnormal Psychology (5PS020) Affective Disorders Professor Paul Gilbert


Learning outcomes: Learning outcomes Understand depression as an affective disorder Understand the DSM & ICD classification system for depression Evaluate theories of depression Evaluate interventions associated with major affective disorders


Depression as a Syndrome: Depression as a Syndrome


Classification : Classification DSM-1V: Major Depression: major depressive disorder (single episode or recurrent major melancholic type Bipolar Disorder:mixed; depressed; seasonal pattern; cyclothymia Dysthymia: depressive neurosis Depressive disorder: not otherwise specified


DSM 1V Checklist for Major Depression: DSM 1V Checklist for Major Depression Five or more of the following during the same 2-week period: Depressed mood most of the day, nearly every day Markedly diminished interest or pleasure in almost all activities Significant weight loss (while not dieting) or weight gain Insomnia or hypersonia (nearly every day) Fatigue or loss of energy (nearly every day) Psychomotor agitation or retardation (nearly every day) Feeling of worthlessness or excessive or inappropriate guilt (which may be delusional) Diminished ability to think, concentrate, or make decisions (nearly everyday) Recurrent thoughts of death (recurrent ideation of death without plan or suicidal attempt) (Comer 2004, p242)


DSM 1V Checklist for Dysthymic Disorder: DSM 1V Checklist for Dysthymic Disorder Depressed mood most of the day, for more days than not, for at least two years Presence, while depressed, of at two of the following: Poor appetite or overeating Insomnia or hypersonia Fatigue or low energy Low self-esteem Poor concentration or difficulty making decisions Feeling of hopelessness During the two year-period symptoms NOT absent for more than two months at a time Should be No history of manic or hypomanic episode (Comer 2004, p242)


ICD 10 Classification: ICD 10 Classification Bipolar affective disorder: current episode; manic, hypomania, depressed, or mixed Depressive episode: mild- (a) without somatic symptoms (b) with somatic symptoms Depressive episode: moderate - (a) without somatic symptoms (b) with somatic symptoms Depressive episode: severe - without psychotic symptoms (b) with psychotic symptoms


Newcastle Scale for Endogenous Depression: Newcastle Scale for Endogenous Depression


Research Diagnostic Criteria for Endogenous Depression: Research Diagnostic Criteria for Endogenous Depression


DSM-1V for Melancholia: DSM-1V for Melancholia At least five of the following: Loss of interest or pleasure in all or most activities Lack of reactivity to usually pleasurable stimuli Depression regularly worse in the morning Early morning waking up (at least 2 hours early) Psychomotor retardation or agitation Significant weight loss or anorexia (e.g. more than 5% loss in a month) No significant personality disturbance before first major depressive episode History of one or more depressive episodes followed by complete recovery


Onset, Severity, Duration & Frequency: Onset, Severity, Duration & Frequency


Mood disorders Profile: Mood disorders Profile


Biopsychosocial Interactions In Depression: Biopsychosocial Interactions In Depression EARLY VULNERABILITY Genes Early Abuse Separations/Death Affectionless/Control Poor peer relations CURRENT VULNERABILITY Low Support/No close confidant Conflicts/Bullying Financial Strain unemployment PROVOKING EVENTS Major Life Events Death, Loss, Separation Defeats, Conflicts, Traps STRESS NEGATIVE BELIEFS BEHAVIOUR Cortisol Self Withdrawn- non coping 5-HT, DA, NA World Blocked Escape Immune, Future DEPRESSION SYMPTOMS mood/anhedonia, sleep disturbance, fatigue self /future perceptions, chronicity. RELIEVING FACTORS SOCIAL Improving social circumstances Social Support Fresh starts PSYCHOLOGICAL Increase self–esteem Improve coping behaviours Working through difficulties, past and present BIOLGCIAL Improve the physical side of depression. e.g., anti-depressants, SAD (light), exercise, diet


Theories of male-female variation: Theories of male-female variation


Early biological theory: Early biological theory Brain Reward Area: Important in mood states Monoamine Transmitters: These brain areas use neuro-chemicals known as monoamines Drug Treatment: Drugs that increase or facilitate monoamine transmission have mood elevating properties & those which reduce it increase negative moods Theory: Depression results from problems in chemical transmission in certain parts of the brain


Personality factors in depression: Personality factors in depression Neuroticism Introversion Social dependency & high approval needs Achievement striving Self critical style


Seasonal affective disorder (SAD): Seasonal affective disorder (SAD) Key Symptoms: Hypersomnia, difficulty waking up/feeling awake, seasonal variation of mood, depression beginning autumn-xmas, carbohydrate craving (plus other typical symptoms of depression. May respond well to light therapy Theory: SAD results from changes in light interacting with certain brain areas possibly via the retino-hypothalamic tract


Social & Life Events: Social & Life Events Vulnerability Factors: Low intimacy Low self-esteem 2 or more children at home No outside employment Provoking agents: Loss or threatened losses with long term implications Theory:Ongoing vulnerability and major, aversive life events produce hopelessness and/or unresolved grief, and leads to depression. Life events that have long term consequences are associated with depression rather than those with short term consequences


Overview of Cognitive Theory: Overview of Cognitive Theory Early Experience: Parents not attentive and dismissive of efforts for approval Depressogenic Beliefs: I am not worth bothering with I am a failure and second rate


Overview of Cognitive Theory 2: Overview of Cognitive Theory 2 Depressogenic Behaviours: Poor assertiveness Tends to withdraw from social situations Critical Event: Broken relationship Ruminative Thoughts: It's all my fault I can never make a success of relationship No-one will ever love me


Defeat/Involuntary Subordination, Rank and Depression: Defeat/Involuntary Subordination, Rank and Depression Things that can activate demobilisation Psychological 1. Unobtainable aspirations - leading to sense of failure 2. Tendency to self-blame for negative events 3. Negative social comparisons 4. Labelling self as subordinate, (Shame) 5. Poor assertiveness skills


Slide22: Defeat Mechanism Physiology Safety behaviours Early learning Strategies Phenotypes Life events and Contexts, defeats bullying Focus on negative Self monitor/self-blame Self-criticism Simple Evolutionary Model


Defeat/Involuntary Subordination, Rank and Depression: Defeat/Involuntary Subordination, Rank and Depression Things that can activate demobilisation Social 1. Experiencing high level of put downs 2. Entrapments (obligations/guilt and lack of resources/power) 3. Reduced opportunities for social supportive relationships 4. Life events that defeat long term goals


Defeat/Involuntary Subordination, Rank and Depression: Defeat/Involuntary Subordination, Rank and Depression Things that can activate demobilisation Biological 1. Disruption to rank control regulators (e.g., drugs, head injury, stress). 2. Sensitivity in brain mechanisms controlling ranking behaviour


Summary: Summary Overview of Theories: Biological Theory: Depression results from problems in the chemical transmission in certain areas of the brain. Probable genetic vulnerability for some of the more severe forms of depression. Biology and Stress Theory: Depression arises from the disruption of monoamine transmission brought about by a combination of stress and reduced control.


Summary: Summary Overview of Theories: Social Theory: Ongoing vulnerability and major, aversive life events produce hopelessness and/or unresolved grief, which leads to depression. Life events to be considered in relation to economic opportunities, cultural (gendered) values, and experiences of abuse/oppression/shame. Marital relationships often important in depression (e.g high expressed emotional, Spouse criticism is a major predictor of relapse)


Summary: Summary Overview of Theories: Psychological Theory: Depression arises from, or at least is maintained by, errors in reasoning, such as blaming self for negative events. These errors/distortions lead to a negative view of the self the world and the future. Poor problem solving skills and/or poor social skills. Low level of positively reinforcible behaviour.


Summary: Summary Overview of Theories: Evolution Theory: Activation of a biologically wired-in potential "defeat/involuntary subordination-system" which evolved to inhibit (further) challenging in the context of dominate others or overwhelming odds. Involves, induced loss of energy, confidence, hope for future, reduces aspiration etc. State of demobilisation.


Suicide: Suicide Risk: (1)1 per 100,000 (2) Over 50% of completers preceded by attempts Life Time Risk 3. 10-15% Major depression: 10-40% Bipolar depression: 10% Schizophrenia. 10-20% Alcohol (especially depressed 40-60 year men)


Risk factors: Risk factors Personality disorder (poor impulse control) Use of Alcohol to escape problems Young, male, unemployed, History of deliberate self-harm (30 fold increased risk). Living alone Major life event - loss or exit Illness Family/Marital/Partner disputes Anniversaries Sudden separations (e.g., key worker) Suicide in the family Means


Psychological Risk Factors: Psychological Risk Factors Suicidal Ideation - from thoughts to plans Hopelessness Sense of entrapment - previous wish to run away Poor coping skills Shame and low self-esteem Regret previous attempts not successful Angry and vengeful - sense of injustice Recovering from a severe depression episode especially bipolar. Can’t face it again


Interventions: Interventions Which problem first (what would client like to achieve). 2. Break path to goal(s) down into steps. 3. Consider possible consequences. 4. Advantages and disadvantages of actions: Including reasons for living. 5. Choose first steps (e.g., inviting another to the therapy).


Interventions 2: Interventions 2 6. Carry out homework task 7. Review progress. 8. Anticipate problems and how to cope. 9. Note and attempt to modify various cognitive distortions during the process (e.g., all- or-nothing thinking). 10. Use various cognitive techniques (e.g., role play, writing thoughts down, forward planning) to help develop more life supporting thinking.


Recommended Reading: Recommended Reading Comer, R., J. (2004) Abnormal Psychology (5th edition) Worth Publishers: New York, Chapter 8 Gilbert, P. (1997) Overcoming Depression. A self-help guide using cognitive-behavioural techniques. London: Robinsons.