Splitters and lumpers

These terms summarize the different conceptualizations of the major psychoses throughout the early twentieth century. Splitters favour separation in terms of aetiology by way of categories. Lumpers postulate clustering of characteristics at the root of a predisposition to any of the major psychoses. Wernicke (1906) proceeded conceptually from neurology, describing three functional brain systems involving the association cortex namely, the psychomotor (awareness of own body), the psychosensory...

Dysfunctional attitudes

Beck (1983) proposed that individuals in a manic phase can exhibit an autonomous tendency and individuals in a depressive state can exhibit a tendency towards over-dependence upon others. Within the cognitive model framework, it is also postulated by Lam et al. (1999) that extreme achievement-orientated attitudes in bipolar affective disorder might lead to extreme striving behaviour and irregular daily routine. Lam et al. (in press) carried out a principal component analysis of the...

Depression As A Category And A Dimension

As described in the introduction, a third key concern of a developmental approach has been a focus on the links between normality and pathology. Depression can be conceptualized both as a dimension and as a category (see Chapter 1). Epidemiological studies suggest that juvenile depression is a continuum that is associated with problems at most levels of severity. Even minor forms of depression are associated with social impairment (Pickles et al., 2001). Indeed, it seems that there is no good...

The Cognitive Model

At its most general, the cognitive model of depression suggests that there is a strong connection between people's construal of events, their behaviour, and their emotional state. The model postulates that incoming information from the environment is processed via meaning-making structures that result in particular interpretations for each individual, and that in depression such cognitive structures are negatively oriented in their processing and tone, generating negative emotions and...

Neurotransmitter Systems

A large proportion of candidate-gene studies have focused on key enzymes and proteins involved in dopamine-norepinephrine- and serotonin-based neurotransmitter systems. Among the first candidates to be studied by association analysis was the gene for tyrosine hydroxylase, a rate-limiting enzyme in the metabolism of catecholamines. The apparent success of linkage to chromosome 11p15 in the large Old Order Amish kindreds with multiple cases of bipolar disorder (Egeland et al., 1987) led to...

What is the evidence that there are different levels of cognition and that the presence of the different types of

The cognitive model makes clear that negative cognition exists at different levels or layers. Some of these layers or levels are accessible to the person and can be spontaneously described, but other levels are under less effortful control and cannot be reported by the individual directly, without training. At the most observable level, negative thinking, we have seen that there is good evidence that depressed individuals are likely to have more negative thoughts. Is there also evidence that...

References

Abramson, L.Y., Seligman, M.E.P. & Teasdale, J. (1978). Learned helplessness in humans Critique and reformulation. Journal of Abnormal Psychology, 87, 49-74. Allen, J.J., Iacono, W.G., Depue, R.A. & Arbisi, P. (1993). Regional electroencephalographic asymmetries in bipolar seasonal affective disorder before and after exposure to bright light. Biological Psychiatry, 33, 642-646. Allen, M.G., Cohen, S., Pollin, W., et al. (1974). Affective illness in veteran twins A diagnostic review....

The pharmacological treatment of unipolar disorder

Mood disorders, particularly depression, are among the more psychologically plausible of mental health problems. For this reason, the general public assumes that psychotherapeutic approaches are the naturally effective treatment for these conditions. Even after a targeted public campaign (Defeat Depression, Royal Colleges of General Practitioners and Psychiatrists), this belief persists together with the conviction that antidepressants are addictive (Paykel et al., 1998). In contrast to this...

Behavioural Activation System Dysregulation Model

Another system that has been considered as a possible site of pathology in bipolar disorder is the behavioural activation system (BAS). The concept of the BAS was derived from investigations of the motivational effects of appetitive and aversive stimuli upon the behaviour of animals (Gray, 1982). The BAS governs approach behaviour, such that it is activated by, and seeks to bring the animal into contact with, conditioned and unconditioned positive incentive stimuli (Gray, 1990). Exposure to...

What Adaptations And Under What Circumstances

Adaptations are not always essential for older people to benefit from treatment with cognitive therapy for depression (Steuer & Hammen, 1983 Zeiss & Steffen, 1996). Modification of therapy may be indicated and may be required to take account of issues to do with normal age-related changes, such as the presence of chronic physical illness and slowed cognitive processing (Grant & Casey, 1995). Modifications are intended to enhance treatment outcome within the model of therapy (that is,...

Subsyndromally depressed hospitalized elderly patients

Recognizing that subthreshold symptoms for major depression impeded recovery of hospitalized elderly patients, Mossey et al. (1996) conducted a trial using a modification of IPT called interpersonal counseling (IPC) (Klerman et al., 1987). Nonpsychiatric nurses treated geriatric, medically hospitalized patients with minor depressive symptoms for 10 1-hour sessions flexibly scheduled to accommodate the patient's medical status. Seventy-six hospitalized patients over age 60 who had subsyndromal...

Selfblame and subordination

Self-blame can be part of internal harassment, especially if people focus and ruminate on how (they believe) they may have caused bad things to happen. The origins of self-blame are many for example, it may be guilt or shame based (Gilbert, 1997). People may blame themselves for not being able to live up to others' expectations, or parents may blame themselves for how their children turn out. Cognitive therapists (Beck et al., 1979) often see depression-linked self-blame as a cognitive...

Endocrine Models Of Depression Hypothalamopituitaryadrenal HPA axis

Thyrotrophin Releasing Hormone

The HPA axis mediates the response of the body to stress as such, it has been a natural focus of biological research into a disorder with a close link to stress. A schematic representation of the HPA axis is shown in Figure 2.1. The HPA axis has been extensively studied in depression about 50 of depressed patients show apicture of hypercortisolaemia. However, this varies with the symptomatic picture rates are higher in those with features of DSM-IV melancholic depression, strong somatic...

The pharmacological treatment of bipolar disorder

The primary aim of long-term treatment is the prevention of recurrent episodes (either mania or depression) (see also Chapter 11). According to current guidelines, any patient who has had at least two episodes in 5 years is likely to benefit from prophylactic treatment (American Psychiatric Association, 1994). Despite problems with tolerability, lithium still remains the 'gold standard' against which other treatments are measured. The effectiveness of long-term treatment with lithium to prevent...

Clinical vignette

Amy is a 31-year-old single woman with a 10-year history of bipolar disorder. Recent plasma levels of her current primary mood stabilizer, sodium divalproex, were perplex-ingly low. In IPSRT, the therapist reviewed with Amy the parameters of therapeutic blood levels and then pointed out that the two most recent blood tests fell below the therapeutic range. The therapist reminded Amy about the risk of nonadherence to pharmacotherapy, and gently asked her whether she had any insight into her...

Theoretical Models

Theories of depression are like other theories that span the biopsychological domain in that either they are of the mindless brain variety and focus solely on putative biochemical or brain-circuit mechanisms, or they are of the brainless mind variety and focus solely on fashionable psychological models that might be impossible to implement in the brain. Western culture does, of course, have a long philosophical tradition that has encouraged this mind-brain dualism, so one should not be harder...

Hypothalamopituitarythyroid HPT axis

Clinical disorders of thyroid function are known to cause alteration in mood. Classically, patients with hypothyroidism frequently report features similar to depression and, while usually more closely linked to feelings of anxiety, depressive reactions are also sometimes seen in hyperthyroid patients. In depression, several abnormalities in thyroid function have been described. Figure 2.2 shows the axis, and Table 2.2 lists the abnormalities described. While not entirely consistent, the blunted...

Relating Styles

In the model I am suggesting, social contexts and relating styles (mediated by self-other schema) that make it difficult to elicit or maintain a flow of positive affiliative relationships, or achieve evolutionarily meaningful biosocial goals (McGuire & Troisi, 1998b), as well as disruptions of relationships that recruit perceptions of inferiority and low rank, are likely to be vulnerability factors for depression (Sloman et al., 2003). Brown et al. (1995) found that social losses associated...

Serotonin hypothesis of depression

Classically, several pieces of evidence are cited to support the serotonin theory (see Maes & Meltzer, 1995, for review). First, there is evidence of a reduced availability of the 5-HT precursor tryptophan. Studies suggest reduced plasma levels of tryptophan and also enhanced non-CNS pathways for tryptophan catabolism, such as the kynurenine pathway in the liver. Second, there is evidence of changes in the normal physiology of serotonin metabolism. For example, there is reduced uptake of...

The Application Of Cbt In The Treatment Of Bipolar Disorder

Overall, the cognitive behavioural approach to the treatment of bipolar disorder aims to enhance non-pharmacological coping skills, to enhance elements of self-efficacy and responsibility in the treatment of the condition, to support individuals in recognising and managing psychosocial stressors and the impact of past episodes, to introduce specific strategies to deal with cognitive and behavioural difficulties, and to modify underlying schemata and core assumptions. CBT for bipolar disorder...

Cyclothymia hypomania hyperthymia and personality disorder Axis II

Despite the vagaries of epidemiology and the interpretation of various rates, it is useful to spend a moment reflecting on what constitute the outer edges of bipolar disorder. Kraepelin (1921) and Kretschmer (1936) both described affective states which ranged from the severest to the mildest and which existed on a continuum that included personal predisposition or temperament. Both described cyclothymic people in whom low-grade subdepressive and hypomanic presentations occurred. Some people...

Role of comorbidity with nondepressive psychopathology

Several studies have reported that comorbidity with non-depressive disorders predicts a worse outcome for juvenile depressive disorder (Goodyer et al., 1997a Kovacs et al., 1997 Sandford et al., 1995). For instance, Kovacs et al. (1997) found that comorbid externalizing disorder predicted a much more protracted recovery from dysthymic disorder. Goodyer et al. (1997a) reported that comorbid obsessive-compulsive disorder was associated with persistence of major depression at 36 weeks' follow-up.

Scarring or sensitization

Another potential mechanism of continuity is that individuals are changed in one way or another by their first episode, so that they become more likely to have subsequent ones. This notion, sometimes referred to as scarring or sensitization, has attracted a good deal of attention from investigators of the neurobiological (Post, 1992) and psychological (Rohde et al., 1990) processes that may be involved in the relapsing and remitting course of depression in adults. Post and colleagues (Post,...

Implications for preventive policies

The evidence on the course of early-onset depressive disorders also has implications for preventive policies. For example, it may be that intensive work with at-risk groups, such as the children of depressed parents, will reduce the risk of depression in the children. Unfortunately, so far, data are lacking on the extent to which primary preventive interventions are, in fact, protective, so it may be better to concentrate on the early recognition and intensive treatment of the first episode of...

Depressed adolescents IPTA

Mufson et al. (1993) modified IPT to address developmental issues of adolescence. In adapting IPT to this population, they added a fifth problem area and potential focus the single-parent family. This interpersonal situation appeared frequently in their adolescent treatment population, and actually reflected multiple wider social problems in an economically deprived, high-crime, and drug-filled neighborhood. Other adaptations included family and school contacts. The researchers conducted an...

Conjoint IPT for depressed patients with marital disputes IPTCM

It is well established that marital conflict, separation, and divorce can precipitate or complicate depressive episodes (Rounsaville et al., 1979). Some clinicians have feared that individual psychotherapy for depressed patients in marital disputes can lead to premature rupture of marriages (Gurman & Kniskern, 1978). To test and address these concerns, Kler-man and Weissman developed an IPT manual for conjoint therapy of depressed patients with marital disputes (Klerman & Weissman, 1993)....

Competing to be valued and loved and losing

As we emphasised, human relationships provide an array of valuable resources to individuals in the form of protection, care, support, and opportunities for reproduction (Buss, 1999 Gilbert, 1989). They are also physiologically powerful, including effects on the immune system (Cacioppo et al., 2000). It is worth remembering that viruses (and other pathogens) have played a large role in human evolution the mortality rate was often high in early hominids. The influenza epidemic of 1918, at the end...

Types categories dimensions and discontinuities

Despite the undoubted usefulness of syndromic approaches to mental disorders, from which the above is derived, there is concern with them. This is partly because they tend to see symptom clusters as disorders and distinct categories that can overlap with other disorders, and vary in levels of severity, but are distinct nonetheless (Gilbert, 1992). It is clear, however, that depression is a highly heterogeneous disorder with a variety of proposed subtypes, such as neurotic-psychotic,...

Jonathan Rottenberg and Ian H Gotlib

Major depressive disorder (MDD) is a psychiatric syndrome characterized by impaired functioning in multiple domains, including biology, behavior, emotion, and cognition. Investigators working within each of these domains face an ever-expanding corpus of theory, methodology, and empirical findings. Perhaps in part due to these burgeoning literatures, different groups of researchers have typically focused on only one of these domains of functioning. While understandable, the consequence of this...

Diagnosis And Management Of Depression In Older People

Depression in older people cannot be dismissed as unimportant, not least because suicide in older people is much higher than in younger people (Kinsella & Velkoff, 2001 Pearson & Brown, 2000 WHO, 2001), but also because depression in later life appears to have a negative impact on life expectancy, with an increased risk of death that may not be completely accounted for by physical ill health (Ames & Allen, 1991) or by suicide (Burvill & Hall, 1994). Unfortunately, depression in...

Selfmonitoring And Prodromal Changes

Dealing with manic and hypomanic phases has been described as being the biggest clinical challenge in the treatment of bipolar individuals. Most individuals suffering from bipolar disorder would describe a manic phase as being inescapable. Once their mood starts to rise, the initial positive reinforcement of experiencing new sources of energy and creativity develops. Especially when this happens after long periods of depressed mood, it easily develops into a self-reinforcing pattern that seems...

Subsequent social impairment

There are a number of reasons for thinking that early-onset depression might not only predict further depression, but also could be associated with effects on social and cognitive functioning. Thus, depression in young people is frequently accompanied by social withdrawal and irritability, and so depressed youngsters may find it more difficult to establish and maintain social relationships. In addition, symptoms such as loss of concentration and psychomotor retardation may interfere with the...

Are these cognitive distortions related to environmental stimuli and do these distortions have an impact on emotion and

This question is equally important because the cognitive model specifies that negative thoughts will not occur randomly, but in response to specific events that are misinterpreted by the individual. Moreover, this misinterpretation is said to fuel a cycle of negative emotions, and influence the behaviour of the depressed individual. Phrased in more technical terms, these ideas have been termed selective processing and primacy. The selective-processing hypothesis states that depression is...

The Cognitive Behavioural Model Of Bipolar Disorder

Many authors have argued that there is a marked lack of a coherent psychological model of bipolar disorder (e.g., Jones, 2001 Scott, 2001a). Recent research, however, highlights the role of cognitive and psychosocial factors in the development and course of bipolar disorder, and the first treatment manuals were published in recent years, delineating the application of CBT principles to bipolar disorders (Basco & Rush, 1996 Lam et al., 1999 Newman et al., 2002 Scott, 2001b). A body of...