Psych 202 1st Edition Lecture 24 Psychopathology Bipolar Disorders o Cyclothymia 2 year duration of numerous alternating periods of hypomanic symptoms shy of mania and depressive symptoms shy of major depressive episodes o Bipolar disorder Present mental state can be principally a manic episode or a hypomanic episode or a major depressive episode Diagnosis is bipolar as long as there has been a past history of mania of hypomania Specifically if currently depressed with a history of manic episodes the diagnosis becomes bipolar disorder depressed o Bipolar I disorder Involves the presence of mania at some point Can currently be manic or if was manic in past o Bipolar II disorder Recurrent major depressive episodes with hypomanic episodes Different from cyclothymia cyc criteria for recurrent major depressive episode never occurred o Clip video example of woman with psychomotor retardation Diagnosis major depressive episode Has history of mania Therefore bipolar I disorder because she was manic in past o Clip I m brilliant This video example hovers near the threshold for diagnosis of bipolar disorder manic with psychotic features In this clip we see him during then after the presence of a manic episode Focus on whether his grandiosity is genuinely delusional psychotic Diagnosis bipolar I disorder because he is manic now Compare his description of the duration of his manias and subsequent depressions and compare with Kay Jamison s report of herself a floridly psychotic mania was followed inevitably by a long and lacerating black suicidal depression it lasted more than a year and a half Pg 110 o Explanations of psychopathology usually rely on the Diathesis Stress model A general framework for explaining the causes etiology of psychopathological conditions These notes represent a detailed interpretation of the professor s lecture GradeBuddy is best used as a supplement to your own notes not as a substitute o o o o Diathesis predisposing factors e g genetics personality trait dispositions developed via the combination of genetics and environmental influence early and prolonged stressors and stress responses resulting in emotionally and behaviorally maladaptive circuits in the brain Stress precipitating factors or triggering factors e g stressful major life events associated with the onset of psychopathological symptoms in adulthood Image on right from book Etiology causation of mood disorders Diathesis stress models predominate Genetic predisposition data are summarized in next slide Unipolar disorder major depressive disorder Conclusion from genetic data Differences in MZ vs DZ concordances demonstrate that genetic predispositions are influential but the lack of 100 concordance in MZ twins is strong evidence for environmental contributions learning stress and coping effects possible viral infection of unknown origin etc Genetic dispositions are much more strongly influential in bipolar than unipolar disorder How do genetic dispositions affect the neurobiology of mood disturbance in unipolar and bipolar patients Unipolar 5 HT and NE deficiencies as genetically regulated Bipolar NE excess Review pages 195 198 in An Unquiet Mind UBO s genetic dimension to UBO s and other structural abnormalities What about the stress side of the equation Research on stress or stressors as causes Major life events and increased hassles precede depression One study showed 24 of persons with 3 of more MLE s in past month became depressed compared to 1 of persons with no MLE s Compare what proportion of refugees in nightline video were said to show profound symptoms of depression And how many trauma events had the average refugee experienced Some persons are more vulnerable though Persons with pessimistic self blaming thought patterns recall our discussion in personality of stress reactivity as a trait are more likely to develop depression in response to stressful life events E g Stanford University students assessed as prone to brooding over negative events showed more sx s of depression 10 days and 7 weeks after 1989 earthquake Or consider the research with Temple PA and UW students Over 2 5 year period 17 of students with pessimistic thinking styles had a first episode of major depression compared to 1 of students with optimistic styles Thus pessimism is a risk factor as would also low self efficacy low hardiness high neuroticism emotional instability Optimism is a protective factor indicating resilience Conclusions from diathesis stress analyses o Genetic and non genetic factors as predisposing factors Stress is influential as a precipitating triggering factor but who experiences stress and thus who is most vulnerable is influenced not only by objective MLE s and objective hassles but also by cognitive and personality predispositions Brain chemistry cognition and mood what causes what They are all interrelated Three theories Psychoanalytic theory Anger turned inwards the punishing role of the harsh superego Superego judging quality of self dysregulation of ego processes Makes moral judgments about others and society Goal insight make the unconscious conscious expand the ego s control How Free association say everything on their mind tell their dreams which are analyzed and relate it to past childhood to discover where their problems came from Analysis of transference patient transfers emotional conflict that belongs to their family parents mainly unconsciously and project it onto analyst Putting childhood issues onto analyst Dream analysis Want to change unconscious thinking Behavioral learning theory An insufficiency of contingencies of positive reinforcement S R model Goal change behavioral responses to increase reinforcement of non depressed behavior Want to change behavior Cognitive and social learning theories The basic idea emotions and moods are caused by cognitive processes perception thinking cognitive appraisal underlying reasoning processes Depression and depressive mood episodes result from irrational thinking irrational beliefs irrational cognitions Seligman s ABC model borrowed form Ellis below And treatment involves the ABCDE model Goal change cognition thinking to alter mood When people don t focus on their beliefs and thinking they don t realize what the problem is within themselves When people challenge their irrational thinking D disputation To dispute the reasonableness of your own conclusions Higher sense of self criticism Reappraise their beliefs and challenge themselves Learn to