Psychology

Understanding Psychological Disorders And Well Being

Course: Ba Program
Name: Tanvi Taneja
Roll no.: BAP/20/341
Semester: III (3rd semester)
Year: II (2nd year)
Submitted to: Dr. Poonam Vats
Psychological Causal Factors
●Some psychological Causal factors such as life events are mediated by the cascade of the
underlying biological changes that they initiate. One way in which these stressors may act is
by impacting Biochemical and hormonal balances and Biological rhythms.

Stressful Life Events As Causal Factors

•Severely stressful life events often serve as a precipitating factor for unipolar depression.
•Following are some of the episodic events involved in precipitating depression:
A. loss of a loved one
B. Serious threat to an important relationship
C. Threat to one's occupation
D. Severe economic loss
E. Serious health problems
•Separations through death and divorce are strongly associated with depression.
•Losses that involve an element of humiliation can be especially potent.
• An important distinction has been made between stressful events that are independent of
the person's personality or behavior, such as loss of a job or a loved one, or loss of property
because of natural disasters and dependent life events, that are caused by a person's
behavior and personality.
•Dependent life events play a major role In causing depression.
•People with depression have a distinctively negative view of themselves and the world
around them, which may be caused by the cognitive symptoms of their disorder.
•Pessimistic outlook leads them to evaluate events as Stressful.
•Several reviews of recent studies have shown that sophisticated measurement of life stress
that severely stressful episodic events play a causal role in about twenty to fifty percent of
the cases.
•People with depression who have experienced a stressful event show more severe
depressive symptoms than the people who haven't had experienced a stressful event.
•About 70 percent of the people with the first onset of depression have had a recent major
stressful event whereas only forty percent of the people with recurrent episodes have had a
recent major stressful event.

Mildly stressful events and Chronjc Stress

•Minor stressful events are not associated with clinically significant depression.
•Minor events may play a role in the onset of recurrent episodes rather than in initial
episodes.
•Chronic stress has been associated with the increased risk of the onset, maintenance and
recurrence of major depression.
Vulnerability and invulnerability factors in response to stressors
•Individual differences exist in how people respond to chronic stress and stressful events.
•Women at genetic risk for depression may experience more stressful life events and are
more sensitive to them.
•Women with genetic risks were three times more likely than those without a genetic risk to
respond to severely stressful events with depression.
People with lower genetic risk are more invulnerable to the effects of major depression.
Different types of Vulnerabilities for unipolar depression
Neuroticism is the primary personality variable that serves as a Vulnerability factor for
depression.
High levels of this trait may cause negative moods, including sadness, anxiety, guilt and
hostility.
Neuroticism predicts the occurrence of more stressful life events which lead to depression.
Some researchers attribute sex differences in depression to sex differences in nueroticism.
People low on positive affectivity feel unenthusiastic, dull, flat and bored. This makes them
prone to depression.
Negative patterns of thinking make people more prone to depression according to cognitive
diathesis model. People who attribute negative events to be internal, stable and global, are
more prone to depression than the people who attribute the same events as external,
unstable and specific.
Early Adversity As a Diasthesis
Following are the adversities in the early environment that could create a short term and long
term vulnerability to depression:
1. Family turmoil
2. Parental psychopathology
3. Physical or sexual abuse
4. Intrusive and harsh parenting
5. Coercive parenting
(i)Increases individuals' life sensitivity to stressful events during adulthood.
(ii) Following are the biological and psychological effects that could be caused by long term
effects of early environmental adversities:
A. Alterations in the regulation of the hypothalamic-pituitary stress response system.
B. Lower self esteem
C. Insecure attachment relationships
D. Difficulty relating to peers
E. Pessimistic attributions
F. Being resilient
These stress inoculation effects seem to be mediated by strengthening socioemotional and
neuroendocrine resistance to subsequent stressors.
Following are the five major theories explaining the causes of unipolar depression:
A) Psychodynamic Theory
Frued and Karl hypothesized that when a loved one dies the mourner regresses to the oral
stage of development (when the infant cannot differentiate oneself from self) and introjects
or incorporates the lost person, feeling all the same feelings toward the self as toward the
lost person, these feelings were thought to include anger and hostility because as believed
by Frued, we unconsciously hold negative feelings like anger towards the person who have
power over us. Depression was hypothesized to be anger turned inwards, occurring as a
response to imagined or symbolic losses.
B) Behavioural theories
People become depressed when the responses no longer generate positive reinforcement or
when their rate of negative reinforcements increase.
Primary symptoms of depression like pessimism and low levels of energy cause the person
with depression to experience low rates of reinforcements.
C) Beck's cognitive theory
Beck hypothesized that the cognitive symptoms of depression often preceded and caused
the affective or mood symptoms of depression.
Diathesis stress theory
Negative conditions are central
(i)Depressogenic schemas
Underlying dysfunctional beliefs which are rigid, extreme and counterproductive.
(ii)dysfunctional beliefs
Activated by some form of stress.
These beliefs and schemas are developed during childhood or adolescence as a function of
one's negative experiences with her or his family, parents, or significant other, they are
thought to serve as the underlying diathesis of vulnerability.
Pattern of negative thoughts
Thoughts that often occur below the surface of awareness and involve unpleasant,
Pessimistic, predictions.
●Negative cognitive triad
a. Negative thoughts about the self
b. Negative thoughts about one's experiences and surroundings
c. Negative thoughts about one's future
Negative cognitive triad tends to be maintained by variety of cognitive biases or errors, which
involves negative self relevant information:
1. Dichotomous or all in none reasoning, which involves a tendency to think In
extremes.
2. Selective abstraction
A Tendency to focus on one negative detail of a situation, and ignoring other
elements of the situation.
3. Arbitrary inference
Jumping To conclusion based on little or no evidence.
Stressors are necessary to activate depressogenic schemas or dysfunctional beliefs that lie
dormant between episodes. Simply inducing a depressed mood, by playing a sad song, or
an emotional song could activate latent depressogenic schemas in an individual who was
previously depressed.

BIPOLAR DISORDERS
Following are the types of Bipolar disorders:
1) Cyclothymic disorder
a. Less serious version of full blown Bipolar disorder
b. Symptoms must persist for at least two years
c. Psychotic features like delusions and hallucinations aren't present
d. Dejected mood and loss of interest in pleasurable or common activities
e. Low energy, feelings of inadequacy
f. Social withdrawal
g. Brooding attitude
Hypomanic phase of cyclothymia
•Symptoms: Opposite of dysthymia

2) Bipolar I Disorder
Following are the six separate criteria for Bipolar I Disorder:
I. Single manic episode
II. Most recent episode hypomanic
III. Most recent episode manic
IV. Most recent episode mixed
 V. Most recent episode depressed
VI. Most recent episode unspecified

3) Bipolar II disorder
Recurrent major depressive episodes with hypomanic episodes
A) Presence or history of one or major depressive episodes
B) Presence or history of at least one hypomanic episode
C) There has never been a manic or a mixed episode
D) The mood symptoms in criteria A and B are not superimposed for by schizophrenia,
Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder not otherwise
specified.
E) These symptoms cause clinical distress or impairment in social, occupational and
other important areas of functioning.

Manic episode
1. Elevated mood
2. Euphoria
3. Expansive moods
4. Occasional outbursts of extreme irritation or violence
4) Hypomanic episode
Milder versions of the same symptoms last at least four days, lesser impairment is
caused, hospitalization isn't required.
Bipolar disorder occurs equally in males and females and usually starts in adolescence and
young adulthood. Bipolar 2 disorder has an average onset of approximately five years more
than Bipolar 1 disorder.
People with Bipolar depressive episodes tend to show more liability, more psychotic
features, more psychomotor retardation, and more substance abuse.
Causal Factors In Bipolar Disorders
Biological Causal Factors
These factors include genetic, neurological, neurochemical, hormonal, neurophysiological,
neuroanatomical, and Biological rhythm influences.
GENETIC INFLUENCES
A. 8 to 10 % of first degree relatives of a person with a bipolar 1 illness can be expected
to have a bipolar disorder
B. Average concordance rate was about sixty percent of monozygotic twins and about
12 percent for dizygotic twins.
C. 67 percent of monozygotic twins with bipolar disorder had a co twin who shared the
diagnosis of depression.
D. 70 percent of genetic liability for Mania is distinct from the genetic liability for
depression.
Efforts to locate the chromosomal sites of the impacted gene or genes in this genetic
transmission of bipolar disorder suggests that it is polygenic.
NEUROCHEMICAL FACTORS
Bipolar disorder was hypothesized to be caused by the excess of norepinephrine and
serotonin, however, serotonin activities appear to be low in both depressive and manic
phases.
Dopaminergic activities in several brain areas may be related to manic symptoms of
hyperactivity, grandiosity, and euphoria.

ABNORMALITIES OF HORMONAL REGULATORY SYSTEMS

Bipolar depressed patients show evidence of abnormalities on the Dexamethasone
suppression test.
During a manic episode, the rate of DST has generally been found to be much lower.
Abnormalities of the hypothalamic-pituitary-thyroid axis because abnormalities in the thyroid
functioning is generally accompanied by changes in mood.
Thyroid hormone can precipitate manic episodes in patients with bipolar.

NEUROPSYCHOLOGICAL AND NEUROANATOMICAL DIFFERENCES

●Blood flow to the left prefrontal cortex Is reduced during depression, during mania it is
increased in certain other parts of the prefrontal cortex. There are shifting patterns of brain
activity during mania and during depressed and normal moods.

●Deficits in the activity in the prefrontal cortex in Bipolar disorder seem to be related to
neuropsychological deficits that people with Bipolar disorder have with problem solving,
planning, working memory, shifting of att
ention sets, and sustained attention on cognitive tasks.

●Certain subcortical structures including the basal ganglia and amygdala, are enlarged in
Bipolar disorder. Increased activation in Bipolar patients in subcortical brain regions involved
in the emotional processing, such as the thalamus and amygdala.
 Treatments and outcomes
There was a rapid increase in the treatment of depression from 1987 to 1997 and there has
been a modest increase since 1998. Between 1998 and 2007 there has been a rapid decline
in the use of psychotherapy, although the use of antidepressant medication remained
relatively stable.
About 40 percent of individuals with mood disorders receive minimally adequate treatment,
with the other sixty percent receiving no treatment or inadequate care.
Pharmacotherapy
Antidepressant, mood stabilizing and antipsychotic drugs all are used in the treatment of
unipolar and bipolar disorder.

I) Tricyclic antidepressant
Increase neurotransmission of the monoamines. Fifty percent of patients show clinically
significant improvement. Following are the unpleasant side effects of these medicines
Dry mouth, constipation, sexual dysfunction and weight gain.

II) Selective serotonin reuptake inhibitor

[Link] tend to have fewer side effects
[Link] tolerated
[Link] toxic In large doses
Following are the negative side effects of SSRI:
i) decreased interest in sexual activity
ii) problems with orgasm
iii) insomnia
iv) increased physical agitation
v) gastrointestinal distress

III)Atypical Antidepressant
°Has activating effects
°particularly good for depression with significant weight gain, loss of energy and
overstepping.
°venlafaxine
I. Severe to SSRI in terms of chronic depression
Course of treatment with antidepressant drugs
a) Fifty percent of those who do not respond to the first drug respond respond the
second one
b) Natural course of an antidepressant drug is typically 6 to 9 months
c) 25 percent of patients continuing to receive medication during the maintenance
phase of treatment showed recurrence of major depression even while on drugs.
d) Patients showing only a few residual symptoms have the probability to relapse.
Lithium and other mood stabilizing drugs
>Lithium therapy has now become widely used as a treatment for mood disorders.
>mood stabilizer exerts effects on either side, antimanic and antidepressant effects.
>The risk of precipitating manic episodes or rapid cycling, although the risk of this happening
is reduced if the person takes lithium.
Lithium is effective in prevention of rapid cycling between manic and depressive episodes.
One third of patients who took lithium remained free from an episode for five years.
Following are the side effects of lithium therapy:
1. Lethargy
2. Cognitive slowing
3. Weight gain
4. Decreased motor coordination
5. Kidney malfunction
6. Sometimes kidney damage

Anticonvulsants
Such as carbamazepine, divalproex, and Valproate
A. Effective in patients who do not respond to lithium
B. Effective for those who develop unacceptable side effects from it
C. It may be given in a combination with lithium

Alternative biological treatments

1. Electroconvulsive therapy
A. Often used with severely depressed patients
B. Used for those who may present an immediate and serious suicidal risk.
C. Used incase of psychotic and melancholic features
D. Used for patients unable to take antidepressants.
E. Used incase patient is resistant to medication
F. Majority of patients can be better by two to four weeks
G. Treatment Induces seizures which are delivered under general anesthesia and with
muscle relaxants.
H. Side effects:
1. Amnesia
2. Slowed response time

Transcranial magnetic stimulation(TMS)

A. Non invasive technique
B. Allows focal stimulation of the brain of the patients are awake
C. Brief but pulsating magnetic fields induce electrical activity in certain parts of cortex
D. It is a painless procedure
E. Thousands of stimulation are delivered in each treatment session
F. Treatment usually occurs for five days
G. It continues for two to six weeks
H. A promising approach for the treatment of unipolar depression in patients who are
moderately resistant to other treatments

Deep Brain Stimulation

A. Effective for individuals unresponsive to other treatment approaches
B. Involves implanting an electrode in the brain
C. Then stimulating that area with an electric current
D. It has a potential for treatment of unrelenting depression

Bright Light Therapy

A. Alternative non pharmacological biological method
B. Originally used for the treatment of seasonal affective disorder
 C. Now has proved to be effective in the treatment of non seasonal depression as well

Psychotherapy
1. Several forms of psychotherapy have proved effective in the treatment of unipolar
depression
2. Significantly decreased the likelihood of relapse within a two year follow up period
Cognitive behavioural therapy
1. Originally developed by Beck and colleagues
2. It is a brief form of treatment
3. It usually requires 10 to 20 sessions
4. Focuses on here and now issues
5. Consists of highly structuralized, systematic attempts to teach people, a systematic
evaluation of their dysfunctional beliefs
6. Patients of unipolar depression are taught to identify and correct their biases and
distortions in information processing and challenge their depressogenic assumptions
and beliefs
7. Relies on an empirical approach
8. Hypothesis could be tested through the use of behavioural experiments
9. Effective if performed by a trained and specialized therapist
10. Especially advantageous in prevention of relapse
>58 percent either responded to cognitive therapy or medications
>Only twenty five percent of the patients treated with cognitive therapy had a relapse
>Another variant of cognitive therapy is mindfulness based cognitive therapy
A. It focuses on changing the way in which people relate to their thoughts, feelings and
sensations
B. Involves training in mindfulness meditation techniques
C. Developing patient's awareness towards unwanted thoughts, beliefs, sensations
D. They could accept themselves as what they are and who they are
E. Simply thoughts occurring at the moment rather a reflection of reality

Behavioural Activation Treatment

● Intensive focus on getting the patients more active and engaged with their
environment
● Following are the techniques included
A. Scheduling daily activities
B. Rating pleasure and mastery
C. Engaging in pleasurable activities
D. Exploring alternative behaviors to reach goals
E. Role playing to address specific deficits
● Easier to train therapists and administer behavioural activation treatment
● Cognitive therapy was slightly superior in terms of follow up

Interpersonal Therapy
1. Seems to be as effective as medications and cognitive behavioral treatment
2. Focuses on current relationship issues
3. Help the person understand and change maladaptive interaction patterns
4. Useful in long term follow up for individuals with severe recurrent unipolar depression
 5. IPT and medication is associated with lower recurrence rates as compared to
medication and treatment alone
6. It has been adapted for treatment of Bipolar disorder by stabilizing dialog social
rhythms that if they become destabilized, may play a role in precipitating bipolar
episodes
7. This new treatment is called Interpersonal and social rhythm therapy.
● Patients Are taught to recognize the effects of interpersonal events on social and
circadian rhythms and to regularize these rhythms

Family and Marital Therapy

Behavior by a spouse that can be interpreted by a former patient as criticism seems

especially likely to produce depression relapse. For example, for bipolar disorder, some
types of family interventions directed at reducing the level of expressed emotion or hostility,
and at increasing the information available to the family about how to cope with the disorder,
have been found to be very useful in preventing relapse in these situations (e.g., Miklowitz,
2009; Miklowitz & Craighead, 2007). For married people who have unipolar depression and
marital discord, marital therapy (focusing on the marital discord rather than on the depressed
spouse alone) is as effective as cognitive therapy in reducing unipolar depression in the
depressed spouse. Marital therapy has
the further advantage of producing greater increases in marital satisfaction than cognitive
therapy.