Manic Episode
- Abnormal, persistent, elevated, expansive or irritable mood
- Persistently increased goal-directed activity or energy
- Both of these lasting at least one week
- Sufficiently severe to cause marked impairment or require hospitalization
Hypomanic Episode
- All of the same criteria as a manic episode, but shorter duration
- Must last at least 4 days
- Not severe enough to cause hospitalization or marked impairment but observable by others
Bipolar II
Major depression with hypomanic states
Bipolar I
Major depression with full manic states
Cyclothymic Disorder
Symptomology of hypomania and depressed mood without sufficient criteria
Stress and Bipolar
- Stress is shown to be related to the depressive episodes, just as it is in unipolar depression
- Other types of stress, such as those related to striving for success, may precipitate a manic episode
The Swing of Bipolar
- Cycle takes on a life of its own
- Causes exhaustion
- A struggle for those with bipolar disorder is having to give up the energy that comes with mania - the boundless energy, hope, and ability to accomplish so much
Treatments for Bipolar Disorders
- Pharmacotherapy
- Electroconvulsive Therapy
- Transcranial Magnetic Stimulation
- Neurofeedback
For depression specifically: - CBT
- Interpersonal Psychotherapy
Pharmacotherapy for Bipolar Disorders
SSRIs:
- Block reuptake of serotonin
- Fluoxetine (Prozac)
Tricyclic Antidepressants:
- Widely used
- Block reuptake of norepinephrine, other neurotransmitters
Mixed Reuptake Inhibitors and SNRIs:
- Block reuptake of norepinephrine and serotonin
Monoamine Oxidase (MAO) Inhibitors
- Block the enzyme that breaks down norepinephrine
- Must avoid certain foods containing tyramine
Electroconvulsive Therapy (ECT)
- Effective for cases of severe depression, usually as a last resort
- Brief electrical currents, usually unilaterally
- Temporary seizures
- 6-10 outpatient treatments usually required
- Side effects are few, include short-term memory loss
- Uncertain why it works
- Relapse is common
Transcranial Magnetic Stimulation (TMS)
- Noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain
- Improves depression
- Prefrontal cortex
- Mild or minimal side effects
Neurofeedback
- Type of biofeedback that uses real-time display of brain activity - most commonly EEG - to teach self-regulation of brain function
- Your brain learns without you
- Done on a computer, e.g. the child playing the fish game on the computer
Behavioral Activation
- Type of CBT
- Has to do with getting people up and moving
- Monitoring of daily activities often shows people they’re actually doing a lot more than they realize, or it brings to light how little they’re doing but then we can track it
- Assessment of pleasure and mastery - finding out what the client thinks they did well and what they enjoyed
- Interventions to help ameliorate social skills and other skills
Interpersonal Psychotherapy
- Focuses on problematic interpersonal relationships
- Role conflict: when you’re in conflict in terms of what your role is now and what it was before
- Role disputes: the role you play in your family vs the role you play in your in-laws family
- Addresses problematic interpersonal behaviors
Outcome for Psychological Treatment
- Comparable to medications, but meds may work faster
- Possibly better long term outcomes for psychotherapy
- Combined medication and psychotherapy is modestly more effective
- ECT appears to be somewhat more effective than medication
Depressive Disorders
Five or more of the following symptoms present for two weeks and present a change from previous functioning; at least one of the symptoms is either:
- . *Depressed Mood or
- . *Loss of interest or pleasure
- Significant weight loss when not dieting or weight gain
- Insomnia
- Psychomotor agitation or retardation
- Fatigue or loss of energy
- Feelings of worthlessness or guilt
- Diminished ability to think or concentrate
- Recurrent thoughts of death, suicidal ideation, or suicide attempt or plan
*** There has never been a manic episode or a hypomanic episode
Equifinality
The same outcome resulting from possibly different outcomes
Biological Theories on Depression
Familial and Genetic: some evidence to suggest there is a genetic component
Neurotransmitter systems: serotonin, SSRIs and SNRIs
Immune System: stress hypothesis
Stress Hypothesis
Suggests there is something to do with the immune system and inflammation that is related to depression
Self Referent Encoding Task
- Respondent sees a serious of adjectives on the screen
- Has to rate them as “describes me” or “does not describe me”
- Typically a distractor or filler task
- Respondent is asked to recall as many adjectives as possible
- Depressed people rate more negative adjectives as self-descriptive
- Depressed people recall more negative, self-referent words than other words
Deployment of Attention/Dot Probe
- Assesses where the respondent’s visual attention is
- Two stimuli are presented
- Dot is presented in place of one of the stimuli
- Sometimes dot is presented in the place of a positive word, sometimes a negative word, or no dot
- Where (if anywhere) the person perceives the dot tells us if they were focused on a positive or a negative
- Suggests that people without depression actually have some level of PROTECTIVE attention AWAY from negative stimuli
Psychological Distance Scaling Task
- Task designed to measure interstimulus distance between positive and negative adjectives
- Provides a 2-dimensional representation of a person’s self schema
- Looks like a graph with distributed adjectives
Internal Attributions
Negative outcomes are one’s own fault
Stable Attributions
Believing future negative outcomes will be one’s fault
