bipolar & related disorders

questions

1. What is bipolar disorder?

- Involves abnormality of affect and is also classified as a 'mood disorder’ in DSM‐V.
The disorders are separated into two types, unipolar and bipolar. Emotions are
amplified in either extremely negative or extremely positive directions which can
persist for long periods of time and Impair an individual's ability to function normally,
leading to lower life expectancy.

2. describe the types of affective (mood) disorders.

- the types include depression (unipolar) and mania (bipolar)
- Unipolar depression is one type of affective disorder and it’s central characteristics
- include: Sadness and hopelessness, It ranges from mild to moderate to severe. The
Individual no longer enjoys activities they used to find pleasurable. Mood may not be
noticeable to others, May appear angry, withdrawn or teary. May experience changes
in appetite, Sleep disturbances, experience fatigue and exhaustion and reduced
concentration which
- affects normal functioning, making it difficult to complete daily tasks. Psychomotor
agitation (physical movements such as pacing or handwringing) Could be also be
suicidal
- • Bipolar depression is another type of affective disorder and is also referred to as
'manic' depression. Distinctly different from unipolar depression, it Involves a
marked swing between depressive and manic symptoms. Symptoms of unipolar
depression can last for varying periods of time which Leads to dramatic changes in
mood and behaviour which is more noticeable. Mania symptoms include Long
periods of 'euphoria’, Rage/ irritability, Easily distracted, Sudden interest in new
activities, Speaking quickly, Over‐confidence in one's abilities, Sleeping less and
Engaging in risky behaviours like gambling.

3. Describe the Method used to measure depression.

- Depression is commonly measured using psychometric tests like The Beck's
Depression inventory (BDI). BDI is a 21‐item self report measure that assesses the
attitudes and symptoms of depression, it’s the Most widely used tool for detecting
depression.It has been updated twice. Current version is the BDI‐II, issued in 1996,
retaining the same structure as the original but including 'increase and loss of
appetite' and 'fatigue' as symptoms.
- Each item on the test has at least four statements and one has to choose which one
best fits how they have been feeling during a recent time period. The total score is
used to determine the severity of the disorder:
○ 1‐10 = these ups and downs are considered as normal
○ 11‐16 = mild mood disturbance
○ 17‐20 = borderline clinical depression
○ 21‐30 = moderate depression
○ 31‐40 = severe depression
○ Over 40 = extreme depression
An Example of an item from the BDI:
0 I do not feel sad.
1 I feel sad
2 I am sad all the time and I can't snap out of it.
3 I am so sad and unhappy that I can't stand it.
Items relate to the known symptoms of depression; feelings of guilt and hopelessness, and
physiological symptoms such as weight loss and fatigue

4. Evaluate the Beck’s Depression inventory.

○ BDI is a robust instrument

○ High levels of reliability and validity ‐ fairly accurate & consistent in measuring
depression
○ Quantitative measurement ‐ provides numerical data which is objective
○ Lack qualitative data, so we do not know the reasons why the person feels in that
particular manner
○ Self‐report and so may decrease validity as there may be response bias
 5. What are the possible explanations of bipolar and related disorders?
The possible explanations include:
- biological: - cognitive (Beck, 1979)
genetic and
neurochemical Cognitive theorists believe that
negative views of someone with
There is some evidence depression from a reality for
as to why some them. So, the reason for an
individuals are more at a individual's physiological
risk of developing this symptoms and low mood is due
disorder to an underlying process of
incorrect information
processing, also termedas
'cognitive distortion'.
- learned
helplessness/attributio
nal style (Seligman,
1988)
- Theory developed by
Martin Seligman & his
colleagues in the 1960s
He believed that this
phenomenon might help
explain depression. They
thought that depression
was a direct result of real
or perceived lack of
control over the outcome
of one's situation.
Learned helplessness is
behaviour that occurs as
a result of a person
having to endure an
unpleasant situation,
when they perceive the
unpleasantness to be
inescapable.The
individual learns that they
are unable to control the
situation and prevent
their
suffering, so they
eventually cease to resist
it.
This theory is the basis of
'attributional style' or
'explanatory style' ‐ the
way in which an
individual explains the
causes of his behaviour
and events. Someone
inclined to a negative
attributional style would
consistently view things
as internal, stable or
global. For example, if
something bad happens,
they might think it is their
fault (internal) or that it
will stay forever (stable)
or that more bad things
are going to happen
(global).
evidence : oruc et al evidence: beck evidence: seligman
1997 - Cognitive distortion is an Seligman et al (1988) ‐
- 42 participants automatic process which investigated how attributional
diagnosed with style could predict depressive
develops as a result of
bipolar disorder
early life experiences Symptoms,
and control group
of 40 through developing - Sample: 39 patients with
- Aged between schemas. unipolar depression, 12
17-30, drawn from patient from the same
2 psychiatric - The results of this are outpatient, clinic with
hospitals in the emotional, cognitive bipolar depression took
croatia, (25M and part in this study during a
and behavioural
17F)
symptoms of depressive episode
- Control group had
no previous Depression. - Included a mix of gender
history of illness, and a mean age of 36
matched for sex - Beck introduced a - Control group - (non
and age cognitive triad which clinical) of 10 participants
- 16 of bipolar includes :
group had Completed a short form of the
○ Negative views about
relatives who
oneself ‐ attribution of BDI ‐ assess severity of
suffered with
major affective unpleasant experiences symptoms. They also Completed
disorder Internally an Attributional Style,
- Information ○ Negative views about Questionnaire ‐ 12 hypothetical
collected by the world ‐ perceived good/bad events. for which the
participants and participants had to make causal
the world as presenting
their families,
them with attributions and then rate on a
diagnosis was
confimed by insurmountable seven‐
family members obstacles to happiness point scale for internality, stability
- DNA analysis and well‐being and globality.
carried out - test ○ Negative views about
for polymorphisms the future ‐ anticipating
in serotonin
failure or rejections
receptor and
transporter genes, when
These genes thinking about a task in
were chosen the future
since alteration in
them can lead to
disturbances in
specific
biochemical
pathways with
known links to
depressive
disorders.
- Results showed
no significant
association in the
sample.
 - Serotonin as a Bipolar and Unipolar groups
neurotransmitter were found to have a more
is known to be pessimistic & negative
sexually attributional style Greater the
dimorphic, hence severity score on the BDI, more
when data pessimistic on the ASQ. Unipolar
was analysed by depression patients undergoing
gender, trends for cognitive therapy: improvement
associations with in attributional style correlated
both well with an improvement in BDI
polymorphisms scores Way we make attributions
were more is an important mechanism
observed in underlying the experience of
female depression.
participants.This
suggested that
these
polymorphisms
could be
responsible for an
increased risk of
developing bipolar
disorder in
females.

Essay:
- The possible explanations of Bipolar and depression include:

- biological: genetic and neurochemical (Oruc et al., 1997) There is some genetic
explanation and evidence as to why some individuals are more at risk of developing
this disorder. Oruc et al conducted a study consisting of 42 participants who were
diagnosed with bipolar disorder and a control group of 40 participants. The patients
were between 31 and 70 years old and were drawn from two psychiatric hospitals in
Croatia. (25 F & 17 M) 16 relatives who suffered with a major affective disorder.
Information was collected from participants and their families, diagnosis was
confirmed through medical records. DNA analysis was carried out to test for
polymorphisms in the serotonin receptor ]’ and the serotonin transporter genes. rs
Results showed no significant associations in the sample. Serotonin as a
neurotransmitter is known to be sexually dimorphic, hence when data
was analysed by gender, trends for associations with both polymorphisms were more
observed in female participants.This suggested that these polymorphisms could be
responsible for an increased risk of developing bipolar disorder in females.

- cognitive (Beck, 1979) Cognitive theorists believe that negative views of someone
with depression from a reality for them. So, the reason for an individual's
 physiological symptoms and low mood is due to an underlying process of incorrect
information processing, also termed
as 'cognitive distortion'. Cognitive distortion is an automatic process which develops
as a result of early life experiences through developing schemas. The results of this
are the emotional, cognitive and behavioural symptoms of Depression. Beck
introduced a cognitive triad which includes Negative views about oneself ‐ attribution
of unpleasant experiences internally

- learned helplessness/attributional style (Seligman, 1988) Theory developed by

Martin Seligman & his colleagues in the 1960s He believed that this phenomenon
might help explain depression. They thought that depression was a direct result of
real or perceived lack of control over the outcome of one's situation. Learned
helplessness is behaviour that occurs as a result of a person having to endure an
unpleasant situation, when they perceive the unpleasantness to be inescapable.The
individual learns that they are unable to control the situation and prevent their
suffering, so they eventually cease to resist it. This theory is the basis of 'attributional
style' or 'explanatory style' ‐ the way in which an individual explains the causes of his
behaviour and events. Someone inclined to a negative attributional style would
consistently view things as internal, stable or global. For example, if something bad
happens, they might think it is their fault (internal) or that it will stay forever (stable) or
that more bad things are going to happen (global). Seligman et al (1988) ‐
investigated how attributional style could predict depressive Symptoms, 39 patients
with unipolar depression and 12 patients from the same outpatient
a clinic with bipolar depression took part in the study during a depressive episode.
They included a mix of gender and had a mean age of 36 years. Compared to a
non‐clinical group (control) of 10 participants, Completed a short form of the BDI ‐
assess severity of symptoms. They also Completed an Attributional Style,
Questionnaire ‐ 12 hypothetical good/bad events.
for which the participants had to make causal attributions and then rate on a seven‐
point scale for internality, stability and globality. Bipolar and Unipolar groups were
found to have a more pessimistic & negative attributional style Greater the severity
score on the BDI, more pessimistic on the ASQ. Unipolar depression patients
undergoing cognitive therapy: improvement in attributional style correlated well with
an improvement in BDI scores Way we make attributions is an important mechanism
underlying the experience of depression.

6. Evaluate the explanations of bipolar disorder.

High validity Low researcher Standardised Individual vs

- Oruc et al was bias questionnaires situational
conducted in a - Oruc et al, - Seligman et al, explanation
laboratory & results Standardised - Cognitive (beck
they collected were questionnaires 1979), because
their dna objective like ADQ and they say that
samples with and BDI are valid & depression
 automated quantitativ reliable results from an
equipment e in measurement individuals
nature tools dysfunctional
thinking

Low generalizability Extraneous No causal Nature vs nurture

- Oruc et al, variables: relationship - Cognitive ,
sample size - Oruc et al, - Seligman et al, external
was small and age could The influences lead
generalisability be an relationship to negative
was low, extraneou between BDI schemas
genetic studies s variable and positivity - nurture ,
usually require because was a seligman,
large samples, correlation adverse life
for accurate & events trigger
valid analysis depression,
learned
helplessness
supports
nurture
completely

Individual Nature vs Reductionist Deterministic

explanation nurture – biological, it - Depends on
- Learned - Genes focuswes onb a family
helplessness, support narrow set of genes (biological,
Because it develops nature that may be genes)
as a result of debate, responsible for the
individuals interaction neuroche disorder - Cognitive (beck
with their environment micals are 1979)
involved deterministic,
in cousin because
depressio distortion
n (oruc et occurs
al) automatically

7. Describe the treatment and management of bipolar disorder.

- The possible methods of treatment are:

biological: electro‐convulsive cognitive

chemical/drugs therapy restructuring REBT - rational
(MAO, SSRIs) (Beck, 1979) emotive behaviour
This is another
biological treatment
 Antidepressant which involves Aims to gain entry therapy (Ellis,
drugs ‐ monoamine briefly passing to a person's 1962)
oxidase inhibitors electricity through cognitive
(MAOIs) & selective the brain with the organisation. psychological
serotonin intention of inducing Talking therapy, treatment based on
reuptake inhibitors a seizure.The based on the principles of
(SSRIs). MAOIs patient is given one‐to‐one stoicism. The crux
inhibit the enzyme anaesthetics and interactions. of this therapy is
monoamine oxidase. muscle relaxants. Involves techniques that all individuals
Electrodes are such as questioning have strict,
- This enzyme is fitted to specific and identifying irrational and rigid
responsible for areas of the head illogical thinking to beliefs that result
breaking down and after which a small determine and in unhealthy
removing electric current is change the patient's thinking patterns
norepinephrine, passed through way of thinking. and mental
serotonin and them for no longer disturbances.In
dopamine than one second. A ‘'Reattributing' ‐ REBT the therapist
(neurotransmitters) course of ECT is discussing whether helps individuals to
and allow them to be usually 6‐12 the cause of understand the
at high levels in the sessions, initially problems is internal process known as
brain given twice a week or external the ABC model. (A
and then less and as a result = activating event, B
frequently over time. reframing their = beliefs about
Earlier, it used to be thinking about an the event, C =
applied bilaterally, upsetting situation. consequences;
but now is applied emotional and
unilaterally on the This therapy is a behavioural
non‐dominant well‐establish way responses)
hemisphere to to manage
reduce memory loss. treatments where The goal of the
Significant risks: it drug therapy is therapy is to help
affects the CNS and Unsuitable individuals create
cardiovascular and maintain
system, dangerous constructive,ration
for those al patterns of
with pre‐existing thinking about
medical conditions, their lives. This is
temporary memory achieved through a
loss, lasting process known as
neurological ‘disputing’. The
damage or death. REBT therapist
forcefully questions
irrational beliefs
using a variety of
different methods in
order to
 reformulate
dysfunctional
beliefs. Thus, the
therapist enables
the individual to
recognise that
whatever setbacks
befall them, they
can choose how
they think and feel
about it

Numerous side One theory is that A study by Wiles et The therapy

effects ‐ this affects the al. (2013) shows encourages patients
headaches, post‐synaptic that it can reduce to recognise such
nausea, responses to the symptoms of belies and replace
drowsiness/insomn CNS transmitters. It depression in them with
ia, diarrhoea and is the last resort people who fail to logical, flexible
Constipation. Can treatment form. respond to patterns after a
cause patient antidepressants. period of
issues with - Dierckx et al. 2012 self‐analysis.
withdrawal and may carried out a study 469 individuals with Lyons and Woods
interact with other involving over 1000 depression (1991) conducted a
medications. MAOIs patients with randomly allocated meta‐analysis of 70
only used for unipolar or bipolar to 2 groups: usual REBT outcome
atypical depression. ECT care (on‐going studies. 236
depression, when had similar levels of antidepressants) or comparisons to
other treatments effectiveness care with cognitive REBT to baseline,
have been resulting in around a behavioural therapy. control groups or
unsuccessful. SSRI 50% remission rate. other
was more recently Those who psychotherapies
developed (e.g. Benefits of the received therapy were examined.
Prozac). Acts on the treatment may be were three times
neurotransmitter short‐term in more likely to Result: Individuals
serotonin ‐ stops it contrast to the respond to receiving REBT
from being broken 'maintenance' effect treatment and demonstrated
down and being by on‐going drug experience a significant
reabsorbed once it therapy. reduction in improvement.
has crossed a symptoms.
synapse. Very
commonly
prescribed and has
less severe side
effects. MAOIs &
SSRIs are more
effective for
 treatment rather than
placebo.

Impact of these
drugs is far more
noticeable in
patients with
moderate to severe
symptoms and less
in mild depression
(Fournier t al. 2010).

Essay:

○ biological: chemical/drugs (MAO, SSRIs) Antidepressant drugs ‐ monoamine oxidase

inhibitors (MAOIs) & selective serotonin
reuptake inhibitors (SSRIs). MAOIs inhibit the enzyme monoamine oxidase. This enzyme is
responsible for breaking down and removing norepinephrine,
serotonin and dopamine (neurotransmitters) and allow them to be at high levels in the brain
Numerous side effects ‐ headaches, nausea, drowsiness/insomnia, diarrhoea and
Constipation. Can cause patient issues with withdrawal and may interact with other
medications. MAOIs only used for atypical depression, when other treatments have been
unsuccessful. SSRI was more recently developed (e.g. Prozac). Acts on the
neurotransmitter serotonin ‐ stops it from being broken down and being
reabsorbed once it has crossed a synapse. Very commonly prescribed and has less severe
side effects. MAOIs & SSRIs are more effective for treatment rather than placebo. Impact of
these drugs is far more noticeable in patients with moderate to severe
symptoms and less in mild depression (Fournier t al. 2010).

○ electro‐convulsive therapy This is another biological treatment which involves briefly

passing electricity through the brain with the intention of inducing a seizure.The patient is
given anaesthetics and muscle relaxants. Electrodes are fitted to specific areas of the head
after which a small electric current is passed through them for no longer than one second. A
course of ECT is usually 6‐12 sessions, initially given twice a week and then less
frequently over time. Earlier, it used to be applied bilaterally, but now is applied unilaterally
on the non‐dominant hemisphere to reduce memory loss. Significant risks: it affects the
CNS and cardiovascular system, dangerous for those
with pre‐existing medical conditions, temporary memory loss, lasting neurological
damage or death. One theory is that this affects the post‐synaptic responses to the CNS
transmitters. It is the last resort treatment form. Dierckx et al. 2012 carried out a study
involving over 1000 patients with unipolar or bipolar depression. ECT had similar levels of
effectiveness resulting in around a 50% remission rate. Benefits of the treatment may be
short‐term in contrast to the 'maintenance' effect by on‐going drug therapy.

○ cognitive restructuring (Beck, 1979) Aims to gain entry to a person's cognitive

organisation. Talking therapy, based on one‐to‐one interactions. Involves techniques such
as questioning and identifying illogical thinking to determine and change the patient's way of
thinking. ‘'Reattributing' ‐ discussing whether the cause of problems is internal or external
and as a result reframing their thinking about an upsetting situation. This therapy is a
well‐establish way to manage treatments where drug therapy is
Unsuitable. A study by Wiles et al. (2013) shows that it can reduce symptoms of depression
in people who fail to respond to antidepressants. 469 individuals with depression randomly
allocated to 2 groups: usual care (on‐going antidepressants) or care with cognitive
behavioural therapy. Those who received therapy were three times more likely to respond to
treatment and experience a reduction in symptoms. ○ rational emotive behaviour therapy
(Ellis, 1962)

○ REBT is a psychological treatment based on the principles of stoicism. The crux of this
therapy is that all individuals have strict, irrational and rigid beliefs that result in unhealthy
thinking patterns and mental disturbances.In REBT the therapist helps individuals to
understand the process known as the ABC model. (A = activating event, B = beliefs about
the event, C = consequences; emotional and behavioural responses)The goal of the therapy
is to help individuals create and maintain constructive,rational patterns of thinking about their
lives. This is achieved through a process known as ‘disputing’. The REBT therapist
forcefully questions irrational beliefs using a variety of different methods in order to
reformulate dysfunctional beliefs. Thus, the therapist enables the individual to recognise that
whatever setbacks befall them, they can choose how they think and feel about it. The
therapy encourages patients to recognise such belies and replace them with
logical, flexible patterns after a period of self‐analysis. Lyons and Woods (1991) conducted a
meta‐analysis of 70 REBT outcome studies. 236 comparisons to REBT to baseline, control
groups or other psychotherapies were examined. Result: Individuals receiving REBT
demonstrated significant improvement.

8. Evaluate the treatment and management of bipolar and related disorders.

Studies investigating
effectiveness of
antidepressants - MAOI &
SSRI, used large samples in
a well‐controlled
experimental setting which
is highly reliable
Use of control groups allows Serious ethical
the experimenters to draw considerations around the
valid conclusions about use of antidepressants and
the causal ECT because of
relationships potential physical and
psychological harm.
Similarly, research
considering the use of
cognitive therapy and REBT
such as Wiles et al. (2013),
Lyons and Woods (1991)
and Iftene et al. (2015) also
include the use of control
groups. This allows the
experimenters to draw valid
conclusions about cause
and effect. For example,
Lyons and Woods assessed
results between those
receiving REBT and the
control group who did not
receive the therapy.

Studies in this section Individual vs situational In terms of the nature versus

investigating the
effectiveness of
antidepressants such as
MAOIs and SSRIs consist
of generally well-controlled
experimental research using
large samples which is
highly replicable.
explanations are highly
relevant to this topic. All the
forms of treatment
outlined in this section focus
on the individual's
requirements. For
example, the individual is
considered
to have problematic levels of
neurotransmitters which
require correction through
antidepressant usage, or
irrational thinking which
needs to be challenged.
Little
consideration is given to
changing situational factors
which may contribute to
depression, such as trying
to alleviate social isolation
nurture argument, the
biochemical treatments such
as MAOIs, SSRIs and ECT
consider biological factors
(nature) as most important in
reducing symptoms of
depression. By contrast,
cognitive therapy and REBT
regard dysfunctional patterns
of behaviour and thinking as
learned from our experiences
with the world. For example,
Ellis argued that adverse or
activating events in one’s life
can trigger irrational beliefs,
meaning depression can be
treated only when we consider
how we react to situational
variables.