Summary of chapter 3, 5, 6, 7 & 8 for the course Clinical Psychology (1st year) at UvA. These summaries are for all the chapters for interim 1, excluding: CH1 & 2 (more general).
Book: Abnormal Psychology. The Science and Treatment of Psychological Disorders - Kring, A.
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Clinical Psychology Interim 2 (ALL chapters, UvA psy year 1)
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Universiteit van Amsterdam (UvA)
Psychologie
Clinical Psychology
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Clinical Psychology
CH5: Mood Disorders
Clinical descriptions and epidemiology of mood disorders
DSM-5: 2 types mood disorders: 1) only depressive symptoms (unipolar); 2) involve manic
symptoms (bipolar).
Depressive disorders
- MDD and PDD both about twice as common among women>men.
why? – twice as many girls exposed to sexual abuse. – women more likely to be exposed to
stressors (poverty, caretaker responsibilities). – traditional social roles among girls may
intensify self-critical attitudes about appearance. – focus interpersonal relationships,
interpersonal stressors: more felt. – more rumination.
- also more common in people with lower SES.
profound sadness and/or inability to experience pleasure
different from normal by the intensity and duration
- culture / country dependent. (seasonal affective disorder-light therapy- for example more in
countries farther away from equator)
- about 60% MDD: also has anxiety disorder in life.
1) Major Depressive Disorder:
- sad mood and loss of pleasure in usual activities
- at least 5 symptoms (must have one of the above^):
- Sleeping too much/too little
- Psychomotor retardation(slow) or agitation(can’t sit still)
- Weight loss or change in appetite
- Loss of energy
- Feelings of worthlessness or excessive guilt
- Difficulty concentrating, thinking, or making decisions
- Recurrent thoughts of death / suicide
- symptoms are present nearly every day, most of the day, for at least 2 weeks.
Symptoms are distinct and more severe than a normative response to significant loss.
Facts MDD: episodic disorder, present for period of time but clear as well.
2/3rd of people who had MDD are going to experience another episode later on.
one of the most common psychological disorders.
2) Persistent Depressive Disorder (dysthymia in DSM-IV):
- Depressed mood for most of the day more than half of the time for 2 years (1 year in
children/adolescents)
- At least 2 of following:
- Poor appetite/overeating
- Sleeping too much/too little
- Low energy
- Poor self-esteem
- Trouble concentrating or making decisions
- Feelings of hopelessness
- The symptoms do not clear for more than 2 months at a time
- Bipolar disorders not present
,Facts PDD: central feature; chronicity.
3) Premenstrual dysphoric disorder
4) Disruptive mood dysregulation disorder
- Start is in childhood
Bipolar disorders(3):
Mania: state of intense elation, irritability, or activation accompanied by other symptoms (in
diagnostic criteria). During this state: act and think in ways highly unusual compared to
typical self. Might be difficult to interrupt/shift topic rapidly: flight of ideas.
Hypomania: under-less extreme than- mania. Hypomania does not involve significant
impairment while mania does. Involves change in functioning, but does not cause serious
problems.
5) Bipolar I disorder:
- single episode of mania some point in life.
- tends to reoccur, 4+ episodes during lifetime
6) Bipolar II disorder:
- must have experienced at least one major depressive episode + at least one episode
of hypomania. (no lifetime episode of mania)
7) Cyclothymia:
- symptoms must be present for at least 2 years among adults.
- person has frequent but mild symptoms of depression, alternating with mild
symptoms of mania. Although not full blown, typically notices by people with the
disorder and their relatives.
Subtypes of depressive disorders and bipolar disorders
- rapid cycling & seasonal specifier: refer to pattern of episodes over time
Etiology of mood disorders
(causes)
Genetic factors:
MDD: H=37%. Bipolar Disorder: H=93%. Serotonine and dopamine(reward system) receptor
dysfunction is present in both disorders. Cortisol dysregulation also. Changes in activation of
emotion-relevant regions in the brain also present. Activation of stratium in response to
reward: low in MDD, high in BPD.
Brain function: regions involved in emotion
Brain structure Function Level in depression Level in mania
Amygdala Salience + emotional Elevated Elevated
importance stimuli
Anterior cingulate Emotion Elevated Elevated
regulation
Dorsolateral prefrontal Emotion Diminished Diminished
cortex regulation
Hippocampus Emotion Diminished Diminished
regulation
Striatum Reward system Diminished Elevated
,The neuroendocrine system: cortisol dysregulation
HPA axis (hypothalamix-pituitary-adrenocotrical axis) may be overly active during episodes
of MDD. Amygdala overreactive sends sygnals to HPA axis cortisol release (stress
hormone)
- Cushing’s syndrome: oversecretion of cortisol frequently experience depressive
symptoms.
Social factors in depression: childhood adversity, life events, and interpersonal difficulties
- childhood adversity, such as early parental death, physical abuse, or sexual abuse –
increased risk developing depression.
- stressful life events often precede depressive episode (especially interpersonal loss +
humiliation)
- personal vulnerability to stress
- lack of social support
- expressed emotion (EE) of family members: critical/hostile comments toward or emotional
overinvolvement with person with depression. Relapse higher if high EE.
Psychological factors in depression
- neuroticism: tendency to experience frequent and intense negative affect. = predictor
depression onset. Also associated with anxiety.
- Cognitive theories:
- pessimistic and self-critical thoughts are seen as major causes of depression.
1) Beck’s theory: depression associated with a negative triad:
= neg views self, their world, future
neg schemas through experiences in childhood
- activated negative schemas are believed to cause cognitive biases(or
tendencies, to process information in certain negative ways) make
conclusions consistent with underlying schema, maintains the schema.
- testing Beck’s theory: Dysfunctional attitudes scale (DAS)
2) Hopelessness Theory: most important trigger of depression is hopelessness, defined
by the belief that desirable outcomes will not occur and there is nothing a person can
do to change this. Emphasis on 2 dimensions of attributions:
1. Stable versus unstable causes (permanent vs temporary)
2. Global versus specific causes (many life domains vs one domain)
3) Rumination theory: rumination: tendency to repetitively dwell on sad experiences
and thoughts, chew on material again and again. Women tend to ruminate more.
(sociocultural norms about emotion + emotion expression)
Social and psychological factors in bipolar disorder
- Depression in bipolar disorder:
Neg life events, neuroticism, neg. cogn styles, expressed emotion, lack social support
- Predictors of mania:
1) Reward sensitivity
disturbance in reward system brain. Life event with goal that’s attained -> trigger
cogn. changes in confidence, excessive goal pursuit help trigger mania
2) Sleep deprivation
, can trigger manic symptoms, protecting sleep can therefore reduce symptoms BD.
- cytokines can have an influence on MDD as well. (focus on page 155)
Treatment of Mood disorders
Psychological treatment of depression:
1) interpersonal psychotherapy:
core: examine major interpersonal problems (role transitions, conflicts, bereavement)
- typically brief
2) cognitive therapy:
core: altering maladaptive thought patterns.
- mindfulness-based CT
- decentered perspective: view thoughts merely as ‘mental events’ rather than as core
aspects of the self or as accurate reflections of reality.
3) behavioral activation (BA) therapy:
- goal: increase participation in positively reinforcing activities so as to disrupt the
spiral of depression, withdrawal, and avoidance.
4) behavioral couples therapy:
- improve couple communication and relationship satisfaction.
Psychological treatment of bipolar disorder:
- supplement tot medication.
- psychoeducational approaches: help people learn about the symptoms of the disorder, the
expected time course of symptoms, the triggers and treatment strategies. (> more medication
use)
CT & FFT (Family-focused therapy)
Biological treatment of mood disorders:
1) Electroconvulsive therapy for depression (ECT):
- MDD that has not responded to medication.
- deliberately inducing a momentary seizure by passing 70-130 volt current through
patient’s brain. (several treatments, 6-12)
2) medication for depressive disorders:
- antidepressant medications: 3 major categories:
MAOIs(monoamine oxidase inhibitors), Tricyclic antidepressants, SSRIs
(selective serotonin reuptake inhibitors)
- but: placebos are as effective for relieving mild/moderate symptoms of MDD &
PDD.
3) Transcranial Magnetic stimulation (TMS)
- increase activity dorsolateral prefrontal cortex
Comparing treatments for MDD
antidepressants: immediate relief. Psychotherapy may take longer, but may help learn skills
usable after treatment is finished to protect against recurrent episodes. (other pro: cheaper
than medication)
Medications for bipolar disorder
mood-stabilizing medications. Lithium: >80% experience benefit. But: have to check and be
careful because too much Lithium can be toxic.
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