Psych 202 1st Edition Lecture 24 Psychopathology-Bipolar DisordersoCyclothymia-2 year duration of numerous alternating periods of hypomanic symptoms (shy ofmania) and depressive symptoms (shy of major depressive episodes)oBipolar 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"oBipolar I disorder-Involves the presence of mania at some point-Can currently be manic or if was manic in pastoBipolar II disorder-Recurrent major depressive episodes with hypomanic episodes-Different from cyclothymia: cyc - criteria for recurrent major depressive episodenever occurredoClip: video example of woman with psychomotor retardation-Diagnosis: major depressive episodeHas history of maniaTherefore: bipolar I disorder* because she was manic in pastoClip: "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 episodeFocus on whether his grandiosity is genuinely delusional/psychoticDiagnosis: bipolar I disorder, because he is manic nowCompare 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. 110oExplanations 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.-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 eventsassociated with the onset of psychopathological symptoms in adulthood)-Image on right (from book)oEtiology/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 disorderoHow 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?oWhat about the "stress" side of the equation?oResearch on "stress" or "stressors" as causes:-Major life events and increased hassles precede depressionOne study showed 24% of persons with 3 of more MLE's in past month became depressed compared to 1% of persons with no MLE'sCompare: 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 eventsE.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 stylesThus 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:Genetic and non-genetic factors as predisposing factorsStress 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 predispositionsoBrain chemistry, cognition, and mood: what causes what?-They are all interrelated-Three theoriesPsychoanalytic 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'scontrol-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 thinkingBehavioral 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 behaviorCognitive 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
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