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UNIPOLAR AND BIPOLAR DISORDER - Coggle Diagram
UNIPOLAR AND BIPOLAR DISORDER
DIAGNOSTIC CRITERIA
- mood disorders generally include bipolar, manic, hyper-manic, mixed and unipolar/depressive disorder,
BIPOLAR
there are
two
types of bipolar disorders: type 1 and type 2.
Both are
episodic mood disorders
but are different from each other in relation to the types of mood experienced.
TYPE 1:
will have at least one manic and one mixed episode.
Manic episodes will last for a week.
Manic episodes will consist of feeling euphoric but also feeling highly irritable.
Individuals will often show fast speaking, tendency to be impulsive, reckless behavior and extremely high self esteem.
They will also portray rapid changed in mood states.
Mixed episodes will also consist of depressive AND manic episodes and they last for two weeks.
Symptoms will be that they last interest in usual activities, there will be changes in their sleep and appetite.
Other symptoms may include, feeling worthless, guilt, hopeless, having difficulty concentrating and suicidal thoughts.
TYPE 2:
Occurrence of one or more hypomanic episodes and at least one depressive episode.
Hypomanic episodes are a less extreme version of manic episodes.
Hypomanic episodes consist of elevated moods, increased irritability, increased talkativeness, self esteem and impulsivity.
it is important to note that while behaviors will be significantly different from the individuals usual mood/behavior, it will not significantly affect their daily functioning and activities.
UNIPOLAR (depressive disorder)
characterized by a depressive mood or
feeling a loss of pleasure
.
symptoms affect an individuals ability to function on a daily basis,.
important to note
that the diagnosis can only be mad if the individual has NOT experienced manic, mixed or hyper manic disorders.
what is a depressive episode?
a period of at least two weeks during which time there is almost daily depressed mood or decrease in interest in activities.
symptoms include:
difficulty concentrating.
feeling guilt and worthlessness .
thoughts of death
changes to eating and sleeping patterns.
Recurring depressive episode:
when there are atleast two depressive episodes seperated by several months.
Single depressive episode:
Only one episode without a prior history of other depressive episodes.
MEASURE - BDI
BDI- BECK'S DEPRESSION INVENTORY:
It is a
psychometric test
with 21 items assessing symptoms and attitudes of depressive disorders.
it is a widely used tool for
diagnosing/detecting mood disorders.
Each item in the self report will have 4 statements and individuals must choose one statement that best describes how they are feeling during a recent period of time.
The total score across the test will
determine the severity of the disorder.
Ten
will be the minimal diagnosis;
nineteen to twenty nine
will be moderate;
thirty and above
will be severe.
The current version has been
updated twice
, and the current version is the
BDI II (2)
Research methods:
Quantitative measure
, which means objectivity is achieved = good!
High levels of
reliability and validity
.
It however
cannot capture in-detail information
and is only a tool used for diagnosing, not for understanding the experience.
it is a
self report
so individuals may make
exaggerate
.
Issues and debates:
cultural difference
- BDI was created in WESTERN cultures and by WESTERN researchers and tested on WESTERN participants. Therefore, it decreases the validity of measures as it may not be the same across different cultures.
EXPLANATIONS
BIOLOGICAL
GENETIC:
First degree relatives share 50% of their DNA.
This explanation suggests that just like physical illnesses some mental disorders are thought to have a genetic basis meaning they can be transmitted from one generation to the next.
There is current evidence somewhere out there that supports that genetic theory.
BIOCHEMICAL:
Brain chemistry is complex. We cannot conclude that there is one single neurotransmitter that is responsible for these mood disorders. However, two of the main neurotransmitters that can be associated with this are
dopamine
and
serotonin
.
Dopamine
Responsible for
feeling pleasure and motivation.
People diagnosed with depressive disorder, have
low levels of dopamine secretion.
Anti-depressants
reduce symptoms of depressive disorder by increasing dopamine levels.
Anti-depressants support the theory that low dopamine levels were the
cause of depressive disorders.
Serotonin
Regulates sleep and appetite as well as mood and anxiety.
When serotonin levels reduce, it results in low mood and anxiety, and low levels of serotonin disturb the sleeping pattern.
the most common anti-depressants that increase serotonin levels are
SSRI
.
PSYCHOLOGICAL
BECKS COGNITIVE THEORY:
Suggests that negative views held by an individual with depression forms a reality for that person, regardless of how it is perceived by others. The individual goes through incorrect information processing and this causes their low mood and physiological symptoms.
What is cognitive distortion?
Another term for the irrational thinking.
This is when a person tends to view things in a negative light as a result of negative childhood experiences, leading to negative schemas/units of knowledge about the world. - When a person is facing these experiences or events, their negative schema is activated, hence their thinking becomes a negative expectation/they expect things to go badly.
This is where
becks cognitive triad
comes in.
Negative views about oneself (i am worthless)
Negative views about the world (Everybody hates me because i am worthless)
Negative views about the future (I'll never be good at anything because everyone hates me)
LEARNED HELPLESSNESS AND ATTRIBUTIONAL THEORY:
Occurs when a person's state of mind is experiencing something negative and they feel like
they lack control
and feel like
the situation is inescapable
.
This was discovered by a researched named
Seligman
and his colleagues.
This
attributional
theory suggests that
we develop a pattern of thinking towards the world based on our interaction with the stimuli.
For example, they may view things that are going to happen in the future negative, which is a negative attributional style.
Important to note: People who have learned helplessness will consistently that are going to happen in the future as INTERNAL, STABLE AND GLOBAL.
STABLE-
The individual feels it will consistently be like this.
GLOBAL-
The individual believes that more things are likely to go wrong now.
INTERNAL
- The individual feels it is their own fault.
EXAMPLE STUDY: SELIGMAN ET AL (1998)
- investigated how well attributional style could predict depressive symptoms
39 Patients with unipolar
12 patients with bipolar disorder during their depressive episodes.
They all came from the same outpatient clinic and had a average age of 36 years.
These participants were compared to a non-clinical control group of 10 participants.
At the start of the study, all participants completed a short form of the BDI to measure the intensity of symptoms.
Then they completed an Attributional style questionnaire which consisted of 12 hypotheses of good and bad situations.
In this questionnaire, they had to make causal attributions- meaning, they had to state who or what they thought was responsible for the event.
They had to rate each cause on a seven-point scale for internal, global and stable.
Results and findings:
Both bipolar and unipolar patients were found to have
more negative attributional styles
than the non-patient control group.
This means the bipolar and unipolar patients tended to blame themselves for the events that happened
(internality)
, tended to view negative situations as permanent
(stable)
, and tended to believe that this negative event would affect all other areas of their life
(global)
.
The more severe the depression score on the BDI, the higher the levels of pessimism on the ASQ.
For those with unipolar depressive disorder, while undergoing cognitive therapy, there was a improvement in ASQ scores, and when there was an improvement in this attributional style, there was an improvement in BDI scores. They correlated.
In conclusion, our attributional style is an important mechanism for underlying the experience of depressive disorder.
Research methods:
- Used
standardized questionnaires
like ASQ and BDI which are
valid and reliable.
. -In this research, they showed a correlation between attribution and BDI, this means it is impossible to determine a cause and effect in this research. (not good). - Rather than, as suggested by seligman, attributional style prediciting symptoms, it could be that an improvement in symptoms predicts a change in attributional style. - There also could be a third external factor that influences both ASQ and BDI score (such as effective treatment)
Issues and debates:
-Biological explanation reflect the influence of nature in the nature v nurture debate.
This is because particular genes and biochemicals play a role in the development of these illnesses. So, biology is seen as a primary cause, highlighting the nature part of the nature v nurture discussion.
One example of this is the key study, oruc et al. This study investigates the biological factors of causes of bipolar in female population. However, this study completely ignores the nurture side of the debate, which suggests environmental factors that could contribute to learned helplessness.
Although these explanations are often pitted against each other, we can look at explanations of how they interact.
Somone could inherit a genetic predisposition to a mood disorder, but this could get triggered because of environmental influences.
KEY STUDY: ORUC ET AL 1997
AIMS:
to investigate whether
certain serotonin receptors and transporters
could be
involved
in the
susceptibility/influencing of bipolar
.
DESIGN:
42 unrelated patients
from
Croatian
hospitals.
25 females, 17 males
.
between ages
30-70
.
16
of these participants had
first degree relatives with a mood disorder
such as bipolar disorder.
The design of the study was
matched pair
as there was a
control group of 40 participants
.
DNA testing
was carried out in all participants to test for
polymorphism*
.
They were tested for polymorphism in the genes that are in the serotonin receptors and transporters. This was conducted because any alteration in the serotonin receptors and transports could cause
a disturbance in the biochemical pathways.
*polymorphism:
variation in the genes
MAIN THEORIES AND EXPLANATIONS:
A theory suggests that bipolar disorder has the highest chance of being inherited, as there's an 80% chance of genetic factors influencing bipolar. However, since it is very difficult to find specific genes that are responsible for bipolar, one way to investigate this is to look at the neurotransmitters involved (dop, ser and non-adr).
Researchers suggest that since low serotonin levels are linked to the origins of bipolar, it makes sense to further investigate the genetic factors responsible for serotonin levels. This theory particular links back to the study we are looking at now.
RESULTS, FINDINGS AND CONCLUSIONS:
They found that there was
no significant difference
between the sample and control in who was more likely to have polymorphism of genes. Meaning, those with a family history of disorders were
not more likely
to have polymorphism.
Instead, the study is concluding that serotonin as a neurotransmitter is rather
sexually dimorphic.*
Because of this finding, participants were now assessed separately by gender.
These results showed that polymorphism was more common in women with bipolar than the control group. This analysis suggested that polymorphism in these genes could be responsible for an increased risk of developing bipolar for females only.
*sexually dimorphic:
A difference between males and females across any species that doesn't limit to reproductive organs.
CONTEXT:
Bipolar disorder is a very complex disorder. It is a combination of biological and psychological factors. Psychological generally includes more of
situational and environmental
factors. Biological generally includes
genetic and biochemical
factors. Biological factors discuss the three main neurotransmitters involved which are
dopamine, serotonin and non-adrenaline
. Researchers are emphasizing that it is very difficult to find specific genetic combinations for this disorder
EVALUATION:
Small sample size= less generalizability.
Because it is a genetic study, a
larger sample
is required, as well as more female participants.
There was
less control of extraneous variables
because the researcher pointed out that some participants in the control group were still young enough so they could be susceptible to bipolar yet not have it develop yet.
They collected DNA samples that were
analyzed in a lab setting
with
proper equipment
=
increases validity
and
removes researcher bias
.
Application to everyday life:
understanding that there may genetic influences in the onset of bipolar means that family members of someone diagnosed with the disorder could be screened easily/DNA can be tested easily.
Determinism v free will:
The study suggests that individuals with a family history of bipolar are at a greater risk of developing the disorder themselves. Because they are focusing on genetic factors, it is primarily deterministic.
TREATMENT AND MANAGEMENT
BIOLOGICAL:
there are several biochemical treatments for depressive disorder. As a group, they are commonly known as
anti-depressant
drugs. They all work in different ways yet have slight similarities in the effect that have on the particular neurotransmitter. The side effects of these drugs also vary.
MAOIs:
MONOAMINE OXIDASE INHIBITORS
.
Monoamine oxidase is an
enzyme
that breaks down and removes the neurotransmitter norepinephrine, serotonin and dopamine.
The MAOI drug
inhibits
or prevents this enzyme from working.
Thus, MAOIs keep these levels higher and prevent depressive symptoms by doing so.
There has been evidence from the 1950s that the MAOI drug is effective.
SIDE EFFECTS:
Withdrawal, nausea, headaches, insomnia, diarrhea.
MAOI can also interact or collide with other medications and this can cause even more negative side effects like high blood pressure. This is why the MAOI drug is only given once other treatments and medications have been unsuccessful.
SSRISs:
SELECTIVE SEROTONIN REUPTAKE INHIBITORS.
A more recently developed anti depressant group.
SSRIs
stop the serotonin
from being
reabsorbed and broken down
once it has crossed a synapse in the brain. This keeps the
serotonin levels in the brain increased
,
reducing symptoms of depressive disorder
.
SSRIs are commonly prescribed in most countries and has fewer side effects than the MAOI or tryicyclics however some indivuals may respond better to particular drugs.
TRICYCLICS:
Introduced in the 1950s, still used today but only as a last resort.
Work by
increasing levels of serotonin
and
norepinephrine
in the brain by
stopping
them from
reabsorbing
.
An increase in these neurotransmitter levels reduces depressive symptoms.
Tricyclics are effective when compared to other modern alternatives such as SSRIs.
SIDE EFFECTS:
drowsiness, nausea/vomiting, weight gain and blurred vision.
OVERALL SIDE EFFECTS:
Having fewer side effects is important as it provides a stable quality of life and because increased side effects can lead to patients stopping their intake of the drug, hence increasing their symptoms.
OVERALL EFFECTIVENESS:
Evidence proves that the tricyclics, MAOIs and SSRIs are far more effect than using a placebo (giving the patients fake pills and convincing them its reals o they will get better with using this ideology that they are taking the right medication for it.). However, research also shows that this effectiveness and reduction of symptoms is seen more commonly in individuals with more intense disorder rather than those with mild diagnoses.
PSYCHOLOGICAL
ELLIS'S RATIONAL EMOTIVE BEHAVIOUR THERAPY (REBT):
A therapy based on the principles of stoicism.
What is stoicism?
a philosophy when an individual is not directly affected by external factors, rather their own perception of external factors.
ALBERT ELLIS (1962) claimed for his theory to be the core perspective on how depressive disorder should be recognized and treated.
He attributed a person's depression to their internal constructions like their perceptions and attitudes towards things that happen to them in their lives.
The ABC model of psychological change
BELIEFS ABOUT THE EVENT
BELIEFS about the event that was activated and their immediate emotional and behavioural problems.
example: "i'll never get anywhere" or "im just not good enough"
CONSEQUENCES
Emotional and behavioural RESPONSES resulting from the beliefs.
example: feeling sad, tearful, or angry. Social withdrawal. Discouraged to move on to other oppurtunites.
ACTIVATING THE EVENT
The actual event
example: unsuccessful at a job interview
In REBT, patients are made to understand the
ABC mode
l of psychological change (as shown above). The
most important element of this model is 'B'
, which is beliefs about this event. This is because while all of us do experience setbacks and negative events, Ellis believed that our reaction and beliefs we set about this event is what shapes our thinking., and therefore has an impact on our emotional well being and behaviour.
Ellis believed that people who consistently develop negative beliefs after any sort of inconvenience or event are at more of a risk to develop a depressive disorder.
The goal of REBT is to help patients
maintain a reconstructive and rational thinking pattern
in relation to their life. This means identifying and changing thoughts that lead to guilt, self-doubt, or any sort of negative thinking and behaviour. This is acheived through following a
disputing
technique. Therapists intensely question the patients irrational beliefs through a variety of methods in order to reframe their dysfunctional beliefs.
The therapist allows the patient to identify whatever setbacks and inconveniencing events they might have, also allowing them to choose how they think and feel about it. Through the therapy, individuals must begin to see that the
C
onsequences that they experience are ONLY PARTLY result of the
A
ctivating event. Then they must accept that maintaining these negative and self-defeating
B
eliefs is a
destructive tendency
. However, they must also be made to understand that this tendency can be changed by challenging the beliefs and replacing them with healthier thoughts.
IMPORTANT TO NOTE:
Ellis argues that the tendency to mantain irrational and negative beliefs is ingrained into peoples head over time and that is why REBT focuses on the present, not fully exploring the past experiences of the patient- something more often done with a psychoanalysis.
LYONS AND WOODS (1991):
conducted a
meta-analysis
of 70 REBT outcome studies.
What is a meta analysis?
a meta analysis is data collected from a range of studies that investigate the same thing or very similar thing and then analyzed to understand the trends.
Lyon and woods examined a total of 236 comparisons of REBT to baseline, control groups or other psychotherapies.
-They
found
that individuals receiving
REBT demonstrated significant improvement
over baseline measures and control groups.
Recent research portrays that REBT is just as effective as anti-depressants in relieving symptoms of a depressive disorder.
BECKS COGNITIVE RESTRUCTURING:
Aims to "gain entry into the patients cognitive organisation". It is essentially a
taking therapy
. It involves having a one-on-one interaction between the patient with depressive disorder and their therapist. There are techniques used such as questioning, identifying illogical thinking, and talking through ways of changing the patients way of thinking.
This process begins with explaining the theory of depressive disorder to the patient (becks cognitive triad, refer schemas), which is important as it allows the patient to understand that their way of thinking is what fuels their depressive disorder. Furthermore, the patient is trained to observe and record all their thoughts, helping them navigate their way through their irrational and inaccurate beliefs or statements.
Once the patient can recognize their cognitions, the therapist helps understand the connection and how their thoughts, affect and behaviour influence each other. The patient is trained to "catch" automatic (uncontrolled), dysfunctional thoughts and record them. This is practiced outside therapy sessions to help them identify these thoughts in their everyday life situations. They will later be able to discuss these thoughts and challenge them in the therapy sessions and therefore explore whether they are an accurate reflection of reality.
The purpose of reality testing is for patients to be become self sufficient in recognizing their own "negative distortions" in thinking for themselves. The therapist can then use techniques such as "reattributing"/ redirecting the cause and discuss with the patient whether the causes of problems or failures is internal (their own fault) or external (something else on the outsides fault). This is important because many with depressive disorder have the tendency to blame themselves for whatever might go wrong. By reattributing, the patients thinking pattern slowly reframes and they will start realizing in other negative or upsetting situations that the fault is not theirs. This reframing of thinking and redirecting of blame will result in a reduction in their depressive symptoms and this is what is called
COGNITIVE RESTRUCTURING
. Ideally, therapy comes to an end when patients are able to use this cognitive restructuring independently and see a reduction their depressive symptoms.
Cognitive therapy is now a well established away to manage depressive disorder, especially in cases where medication is unsuitable. WILES ET AL (2013) shows that cognitive therapy can reduce symptoms depression in people who fail to respond to anti-depressants by randomly allocating 469 individuals with depressive disorder to either continuing anti depressants or CBT. The results showed that those who received therapy were three items more likely to respond to treatment, and experience a reduction in symptoms.
In short, cognitive therapy proved more effective than anti-depressant medication.
ISSUES AND DEBATES
INDIVIDUAL V SITUATIONAL:
All the forms of treatment outlined in this section focus on the individuals requirements. For example, the focus is on how the individual has neurotransmitters that require correction through anti-depressant drugs or correction of irrational thinking patterns individual to each patient. There is very little consideration given to treating the situational factors that might contribute to the depressive disorders, such as trying to increase social interaction.
BIOLOGICAL V PSYCHOLOGICAL:
RESEARCH METHODS:
All primary studies conducted investigating the effectiveness of the anti-depressants are well controlled and those regarding cognitive therapy and REBT such as Wiles et al (2013) and Lyon and woods (1991) include the use of control groups. This increases the validity of the study and allows researchers to be confident in identifying the cause and effect.