6a.+BPSF+Mood+Disorder

=Unit 4.=

Dot Point 6a.
• //application of a biopsychosocial framework to understanding ONE of the following types of mental disorder and its management://

**Mood disorder: major depression ** ** Option 1. - Mood disorder: major depression ** ** Main Characteristics of Mood Disorders – Example: Major Depression ** Mood disorders are mental disorders characterised by extreme disturbances in emotional state that affect: ** Symptoms / Criteria for Diagnosis ** Major Depression is a serious medical illness characterised by : These symptoms need to have persisted for no apparent reason over a period of at least two weeks. ** – Biological contributing factors ** : ** Role of genes in contributing to the risk of developing major depression ** ** Roles of the neurotransmitters serotonin and noradrenaline in major depression **
 * Thinking
 * Physical Symptoms
 * Social Relationships
 * Behaviour
 * Excessive or persistent negative affect (dejected mood)
 * Diminished interest or pleasure in most activities
 * Lack of motivation to do daily tasks (regardless or how simple they are)
 * Difficulty concentrating
 * Memory disturbances
 * Poor or inability to make decisions
 * Faulty self blame attributions
 * Prolonged feelings of despair and irrational hopelessness
 * Decreased energy
 * Lethargy and feeling tired all the time
 * Sleep disturbances (insomnia, early-morning waking, oversleeping)
 * Eating disturbances (loss of appetite or overeating)
 * Excessive Crying.
 * Genetic research indicates that it is highly likely that, when coupled with factors such as lifestyle and traumatic events, a person’s genes can predispose them to depression.
 * Studies have shown that 20-50% of children and adolescents with depression have a family history of the disorder
 * Children of depressed parents are more than 3 times as likely as children with non-depressed parents to experience a depressive disorder.
 * Twin studies have shown that when one identical twin suffers from depression, the other twin has a 50% or higher chance of also suffering it. With fraternal twins the likelihood of another twin suffering from depression or a mood disorder is about 20%
 * Research shows that the decreased levels of the neurotransmitters serotonin and noradrenaline trigger depression.
 * Both chemicals are involved in the areas of the brain involved in emotional behaviour.
 * Evidence for their involvement in depression comes from studies into the action of antidepressant drugs (which increase their activity) and the drug Reserpine, which causes depression by decreasing noradrenaline and serotonin levels.

** The Function of Antidepressant Medication in Management of Mood Disorders ** ** – Psychological Contributing Factors: ** ** Learned helplessness ** ** Aaron Beck ** described learned helplessness as the product of a negative cognitive triad. ** Stress ** ** The Use of Psychotherapies in management of Mood Disorders including: ** ** Cognitive Behavioural Therapy: ** uses specific strategies that are designed to change patterns of thinking, behaviours and beliefs that are related to depression. ** Psychodynamic Psychotherapy: ** focuses on unconscious causes of depression. According to Freud, depressives turn their aggressive drive and anger that they feel towards other people or situations inwards and are, therefore punishing themselves. Techniques used by psychotherapists in their treatment include: ** – Socio-cultural Contributing Factors: ** ** Abuse, poverty, social isolation and social stressors as risk factors; ** ** Support factors including family and social networks and recovery groups ** **__ Family and social networks __** **__ Recovery Groups __**
 * The purpose of antidepressant medication is to treat the chemical imbalance of neurotransmitters in the brain, thus:
 * Relieving depressed feelings
 * Elevating arousal and mood
 * Reducing anxiety
 * Restoring normal sleep patterns and appetite
 * Drugs that alleviate mania reduce noradrenaline, whereas drugs that relieve depression increase noradrenaline or serotonin by blocking either their reuptake or inhibiting the enzyme responsible for their chemical breakdown.
 * Doctors often treat depression by prescribing selective serotonin reuptake inhibitors (SSRI’s), such as Prozac.
 * These drugs raise the level of serotonin in the brain by preventing it from being re-absorbed into cells that released it.
 * Monoamine oxidase inhibitors (MAOIs) and tricyclics may also be used to increase the level of the neurotransmitters noradrenaline and serotonin in the brain.
 * ** Martin Seligman ** proposed that depression results learned helplessness, or a tendency to give passively in the face of unavoidable stressors.
 * People who have a pessimistic explanatory style are likely to experience depression when they perceive a lack of control and believe that nothing they do will improve their situation.
 * The basis of Seligman’s cognitive therapy is help patients overcome depression by learning new explanatory styles.
 * Learned helplessness creates negative schemata and cognitive biases that make the depressed person view:
 * Causes as internal (self-blame, not situational factors)
 * Situations as stable (believing the problem is relatively permanent and showing extreme pessimism about the future
 * Failure is global (not specific to one situation ie over-generalising from a specific problem to their whole lives).
 * Depression not only occurs after major stressful life events (e.g. personal tragedies, disasters) but is also reliably linked with continual levels of stress and ‘hassles’.
 * Studies have indicated that the constant activation of stress hormones such as cortisol can result in chronic depression.
 * Patients are trained to recognise the connections between their thoughts, feelings and behaviour:
 * To monitor their negative thoughts
 * To challenge their negative thoughts with evidence to reverse clients’ catastrophising beliefs
 * To substitute a more constructive, realistic style for their usual irrational interpretations and to focus on new behaviours outside of treatments.
 * 1) __ Free Association: __ Client says whatever comes to mind without any interference by the psychotherapist. Therapist identifies themes that are most involved in the development of the problem (gambling) behaviour
 * 2) __ Dream Interpretation: __ Analysis of dreams to determine underlying ‘causes’ of the addiction
 * 3) Identification of __Defence Mechanisms__: Psychotherapist identifies the defence mechanisms (psychoanalytic version of coping mechanisms) an addict relies on and helps them explore not only how they are related to the problem (gambling) behaviour but how and why they originated in the first place.
 * 4) __ Transference __ : The client responds to the therapist (Unconsciously) as if they are a significant person in their life (often a parent) and shifts, or ‘transfers’, unresolved conflicts and childhood fantasies to their therapist. This allows the client to relive unresolved conflicts that have been repressed since childhood in the context of being an adult in a supporting environment (with the therapist).
 * 5) __ Omnipotence: __ refers to the feeling of being ‘all powerful’ and is a direct defence against feeling of inadequacy and helplessness. Gambling addicts role play this fantasy to help develop solutions to their problems.
 * Poverty, meaningless work, constant criticism and abuse, unemployment, racism and sexism undermine people’s sense of competence, personal control and self-esteem.
 * These socio-cultural factors increase the risk of depression and suicide.
 * They are triggers of depression for people who are already predisposed to suffer from it.
 * Depressed people tend to be more socially isolated than other people.
 * The relationship between the lack of social support and depression is two-way
 * People with poor social skills may be more likely to develop depression
 * Once depressed, these people tend to be an unpleasant companion, causing social rejection that further reduces social support.
 * Awareness than one’s social relationships are deficient further contributes to the depression.
 * Integration into social networks and supports and the presence of close relationships can both be protective against adverse life events and developing major depression, hasten recovery and reduce rates of relapse.
 * The ‘recovery model’ for mental illness emphasises that recovery is not just the reduction or absence of symptoms but the attainment individual goals such as independence, work, study, close relationships and social connection.
 * To achieve these objectives, people need to feel ‘empowered’ to direct, control and be responsible for their recovery.
 * Self-help and support groups share experiences, provide a forum to connect with others with similar problems and discuss solutions.
 * Recovery groups for many people can be the most important and positive approach to treatment but only in conjunction with the treatment recommended by a doctor or psychologist.

** – The Interaction between Biological, Psychological and Socio-cultural Factors which contribute to an understanding of mood disorders and its management **
 * Interaction between biological, psychological and socio-cultural factors in major depression means that most successful treatments use an eclectic approach.
 * Successful treatment combines a biological treatment with a psychological therapy and a supportive strategy to reduce social isolation, financial and other social disadvantage.