This document provides information on abnormal affect, specifically depression and mania. It discusses the types of depression and mania, characteristics and diagnostic criteria. Biological explanations for depression include genetic and neurochemical factors. Cognitive explanations include Beck's cognitive theory involving negative thoughts and schemas. Learned helplessness theory and attributional style are also covered. Treatments discussed include biological approaches like drugs that impact neurotransmitters and electroconvulsive therapy, as well as cognitive and behavioral therapies.

1. ABNORMAL AFFECT

2. Abnormal affect
 Types, characteristics, examples of and sex
differences
Types: depression (unipolar) and mania (bipolar); causes
and treatments for manic depression; sex differences
in depression
• explanations of depression
Biological: genetic and neurochemical; cognitive: Beck’s
cognitive theory; learned helplessness/attributional
style (Seligman, 1979)
• treatments for depression
Biological: chemical/drugs (MAO, SSRIs); electro-
convulsive therapy. Cognitive restructuring (Beck,
1979); rational emotive therapy (Ellis, 1962)

3. Some facts
 By the year 2020, the World Health
Organization (WHO) estimates that
depression will be the number two cause
of "lost years of healthy life" worldwide
 Depression considered the common cold
of mental illness in America

4. Types
 Depression (unipolar)
 Mania (bipolar)

5. Depression
 Emotional state marked by
 great sadness
 feelings of worthlessness and guilt
 withdrawal from others
 loss of sleep , appetite , sexual desire
and interest and pleasure in usual
activities.

6.  Often associated with other psych.
disorders ( eg. panic attacks, substance
abuse, sexual dysfunction and personality
disorders)
 Paying attention can be exhausting
 Conversations are a chore
 Some prefer to sit alone while others are
agitated and cannot sit still.
 Pace, wring their hands, continually sigh
and moan or complain.

7.  Can not find solutions when confronted with
problems.
 May neglect personal hygiene and
appearance and complain about numerous
somatic symptoms (with no physical basis)
 Depression although recurrent tends to
dissipate with time.
 Untreated depression may stretch on for 5
mnths or longer with a risk of suicide.
 Chronic depression- earlier level of
functioning

8. DSM IV –TR Criteria for Depression
 Sad depressed mood, most of the day, nearly evdy for
2 weeks or loss of interest in pleasure in usual
activities, plus 4 of the following:
1. Difficulties in sleeping - insomnia, sleeping too
much, early morning awakenings etc.
2. Shift in activity level- lethargic or agitated
3. Poor appetite and weight loss or increased appetite
and weight gain.
4. Loss of energy, great fatigue
5. Negative self-concept, self-reproach and self blame;
feelings of worthlessness and guilt
6. Complaints or evidence of difficulty in concentrating
– slowed thinking, indecisiveness
7. Recurrent thoughts of death or suicide.

9. Sex differences in depression
 Significant research shows that women
are diagnosed with depression twice as
much as men .
 In 7/8 studies of treated cases (ppl
undergoing therapy) in the US females
outnumbered males 2:1.
 In 10 studies outside the US 9 showed
more females than males as depressed.
 Why?

10. Mania
 Emotional state/ mood of unfounded
elation or irritability accompanied by :
 Hyperactivity
 Talkativeness
 Flight of ideas
 Distractibility
 Impractical and grandiose plans
(refer to pg 269 of text for eg)

11. Mania
 Some people who experience episodes of
depression at times suddenly become manic.
 Pure cases of mania are rare
 Manic episodes vary from days to months
 Comes on suddenly
 Subject is loud and has incessant stream of
remarks (jokes, puns, rhymes) may shift
from topic to topic, be annoyingly sociable .
Imprudent sexual behavior
 Any attempt to curb these excesses can lead
anger or rage.

12. DSM –IV-TR Criteria for a Manic
Episode
 Elevated or irritable mood for at least one week plus
3 of the following (4 if the mood is irritable):
1. Increase in activity level at work socially or sexually
2. Unsual talkativeness; rapid speech
3. Flights of ideas or subjective impression that
thoughts are racing
4. Less than usual amount of sleep needed
5. Inflated self-esteem; belief that one has special
powers, talents and abilities.
6. Distractibility; attention easily diverted.
7. Excessive involvement in pleasurable activities that
are likely to have undesirable consequences (eg.
Reckless spending)

13. Some facts about Bipolar Disorder
 Between .6 and 1.1 % of the US population
will have bipolar in their lifetime (as
opposed to 1/20 being depressed)
 Occurs equally in both sexes (unlike unipolar
depression)
 First episode is usually manic not depressive
 Tends to recur and each episode lasts from
several days to several months
 No regular cycling (3 months manic followed
by 3 months depressive)

14. Famous people with bipolar

15. Causes of bipolar
BIPOLAR DISORDER UNDERSTOOD BEST WITHIN
THE BIOLOGICAL MODEL.
 Some theorists believe that bipolar disorder
results from self-correcting biological processes
that are ungoverned. States of depression or
euphoria are kept from spiralling out of bounds
by switching from one state to another.
 Other theorists mention 3 separate systems in
the brain (controlled by neurotransmitters)that
may become unbalanced and cause different
groups of symptoms:

16. Causes of bipolar
1. Lack of enjoyment /interest  excessive
pleasure seeking activity due to brain’s
disinhibition-inhibition process.
2. High sensitivity to pain/negative events 
low sensitivity due to a separate
disinhibition-inhibition process of the
brain.
3. Retarded motor activity  hyperactivity
due to an unregulated movement
processing system .

17. Causes of bipolar disorder
 Individuals are genetically vulnerable to
bipolar disorder
 Family , twin and adoption method to see
if genetic factors are responsible.
Relatives of bipolar patients have 5 times
the normal 1 % risk of developing the
disorder (Rice et al. 1987)
Identical twins have 5 times the
concordance for bipolar than do fraternal
twins.

18. Treatment of bipolar
 Lithium carbonate is the most effective
treatment for bipolar disorder.
 Considered miracle drug for bipolar
disorder
 However quite toxic on overdose
 New treatments use anticonvulsant
(drugs used to control seizures) drugs:
Carbomezapine, valproate, Iamotrigine and
gabapentin .

19. Biological Explanations of
Depression – Genetic
Family , twin and adoption method to see if genetic
factors are responsible.
 Research indicates that genetic factors less
responsible for depression than bipolar disorder.
 However twin studies of depression report higher
concordances in monozygotic than dizygotic
twins with some suggestion that genetics may
play a stronger role in women than in men
(Bierut et al 1999; McGuffin at al 1996 etc)
 Small scale adoption studies have also shown that
depression has a modest genetic component.

20. Biological Explanation of
Depression – Biochemical
Changes in brain and body chemistry certainly
accompany depression.
Evidence:
1. depression in women after giving birth to a
child, at menopause and just before
menstruation.
2. Symptoms similar across cultures, sexes,
ages
3. Drug therapies focusing on
neurotransmitters are effective in
treatment

21.  BUT….
 They measured the metabolic breakdown
products of these transmitters normally
found in blood or urine- results have
been inconsistent
 Medications increase neurotransmitters
immediately but any relief from them
takes 2 to 3 weeks.

22. Biological Expln of Depression-
Biochemical
 This initial evidence led to the hpothesis
that chemical abnormalities in
monoamines (a class of
neurotransmitters) cause depression
 Manoamines: norepinephrine, dopamine ,
seratonin.
 Early on researchers thought that
decreased levels of norepinephrine and
dopamine cause depression

23.  Hence the norepinephrine and dopamine
hypotheses have been abandoned.
 “Downregulation theory”: monoamine
levels are not low but postsynaptic
monoamine receptors are inadequate.
 Thus the growth of receptors or
increasing the sensitivity of exisitng
receptors might be why antidepressants
take time.

24.  Theory of “kindling” : a process by which
certain neurons, by firing repeatedly make
themselves more sensitive to subsequent
stimulation – each episode of depression
makes subsequent ones increasingly likely
because the relevant neurochemical systems
become easily “dysregulated”.
 None of these theories have been adequate
in proving depression but have helped in
treating it.

25.  2 important lessons from the mass of
theories looked at:
1. Neurochemical deficits observed only
when person is depressed .
2. Drugs produce other changes as well .
Hence although monoamine levels
correlate with depression and relief
from depression, they do not cause
either one.

26. Cognitive Explanation of
Depression
 According to Beck depression is caused by
2 mechanisms:
1. Cognitive triad
2. Errors in logic
AARON T. BECK

27. Beck’s Cognitive Theory
1. The cognitive triad consists of negative
thoughts about :
Ongoing
The self experiences
Future

28. Negative thoughts about…
Ongoing
Self Future
experiences
• Defective- • Interpretation • Negative things
never attain that whatever that happen
happiness happens to now will
• Worthless- him/her is bad. continue in the
unpleasant • Drawn to the future…
experiences most negative • Future view is
attributed to possible one of
this interpretation helplessness.
• Inadequate- • Small obstacles
Such thoughts  impassable
lead to low self barriers.
esteem

29. Errors in Logic
 Beck believed that systematic “errors in
logic” are the second mechanism of
depression.
 A person makes five different logical
errors in thinking :

30. Logical errors
Arbitrary inference: drawing a conclusion when there is no
evidence to support it
Selective abstraction: consistently focusing on one insignificant
detail while ignoring the more important features of a situation
Overgeneralization:drawing global conclusions about worth ,
ability or performance on the basis of a single fact.
Magnification and Minimization : magnifying small bad events and
minimizing large good events.
Personalization: incorrectly taking responsibility for bad events in
the world

31. Evaluation of Beck’s theory
 Research confirms that depressed patients
in contrast to non depressed individuals,
think in the negative ways enumerated by
Beck.
 However, we can cannot determine if the
negative thoughts cause depression or that
depression causes the negative thoughts
(chicken or egg??) this relationship can
perhaps work both ways…
 Beck’s theory is testable and has led to
much research on the treatment of
depression.

32. Learned Helplessness
Martin Seligman

34. Learned helplessness
 Unpleasant traumas/ experiences lead to
individual’s passivity and helplessness.
Unpleasant
traumas/experiences
Sense of helplessness
Depression

35. Attribution and Learned
Helplessness
 Problem with the learned helplessness
theory
Eg I am responsible for
my depression . How
am I helpless then???

36. Attribution and learned
helplessness
 Seligman and colleagues came up with a
revised version of the learned
helplessness theory which involves
ATTRIBUTION
 ATTRIBUTION- the explanation one has
for his/her behavior
 Given a situation in which a person
experiences failure, he/she will attribute
the failure to some cause.

37. Attribution and learned
helplessness
 People become depressed when they
attribute negative life events to
personal, stable and global causes.

38. Attributions
Global Specific Stable Unstable Internal External
when the
individual
believes
that the individual when the assigns
cause of believes individual causality
negative that the thinks to factors
cause of a individual that the
events is believes within the
consistent negative cause is person. Assigns
event is the cause specific to causality
across to be
different unique to one point to
a consistent in time situational
contexts across
particular or
situation time external
factors

39. Evaluation of Learned
Helplessness/Attribution Expl.
 Which type of depression is being modeled?
 Accumulating evidence indicates that
selecting subjects solely on the basis of
elevated BDO scores, does not yield a group
who can serve as a good analogue for
clinical depression.
 Even if we allow that attributions are
relevant and powerful determinants of
behavior, findings that support the learned
helplessness theory have been conducted in
the lab.

40. Treatment of Depression
Treatment either biological or
psychological can treat 80 to 90 % of
severe depressions.
Recurrence remains substantial with all
forms of treatments.

41. Biological treatments of
depression
 Drug treatment
 ECT

42. 3 classes of drugs to treat depression:
Tricyclic Monoamine oxidase
Serotonin reuptake
antidepressants inhibitors (MAO
inhibitors (SSRI’s)
(TCA’s) inhibitors)
• Block the reuptake • Prevent the • Eg Zoloft, Paxil and
of norepinephrine breakdown of Prozac prescribed
(NE) leading to more norepinephrine widely for less
NE. • More NE – less severe depression.
• B/w 60 to 75% depressed • Selectively inhibit
patients show • Prescribed less often the reuptake of
clinical improvement than TCA’s or SSRI’s serotonin.
. because inhibition of • 60 to 70 % patients
• Also reduces MAO enzyme can with severe
recurrence have lethal side depression relieved.
• Reduction of “5-HT effects. Low risk of
receptors” which • When combined with overdose.
participate in the shellfish, bp • Altough popular,
reuptake of reducing drugs, red efficacy about the
serotonin might wine, aged cheese same as that of MAO
actually be how the and narcotics , can inhibitors and TCA’s.
TCA’s work (Taylor et be fatal. • Still some concern
al. 1995) • Should be used as that Prozac may lead
the last option from to suicide.
3.

43.  ATYPICAL Depressants are now also used
to treat depression (eg . Wellbutin).
 They affect the availability of both
serotonin and norepinephrine.
 Wellbutin, the most widely used drug
affects dopamine levels .
 Although Wellbutin has its own side
effects, it is free of sexual side effects

44. Evaluation of biological treatments
 Large part of the effect of antidepressant
drugs, is the placebo effect (30-40%).
 Once the drug is stopped, recurrence and
relapse rates are also high.
 However, in profound psychotic
depression psychotherapy is useless and
only drugs or ECT will work.
 Palliative vs curative drugs
 Every single drug for mental illness is
palliative rather than curative.

45.  They suppress the symptoms but these
symptoms have the same risk of returning
once the drug is stopped, as if the drug
had never been taken in the first place!
 Patients who respond well to
antidepressants, might take them
indefinitely to prevent recurrence.

46. Electroconvulsive shock treatment-ECT
Strong evidence exists that
ECT is highly effective when
given to patients with severe
depression.
 80% of patients with major
depression respond to ECT.
Recurrence of depression is
substantial with about 60% of
those being treated with ECT
becoming depressed again the
next year (Sackheim et al ,
1993)
Exactly how ECT works, is
unknown.

47. Cognitive therapy
 Attempts to counter negative thoughts
and errors in logic.
 The therapist actively guides the patient
into reorganizing his thinking and actions
not about the past but the present.
 The cognitive therapist talks a lot and is
directive. She/he argues with the
patient. She persuades; she cajoles; she
leads.

48. Cognitive restructuring (Beck
1979)
 One of the most important tools used in
CBT is cognitive restructuring
 aims to change maladaptive cognitions
and replace them with more adaptive
ways of information processing.
 However, maladaptive thinking patterns
are sometimes so strong and automatic
that they tend to persist and bias the
process of acquiring new adaptive ones.

49.  According to Beck et al. (1979) cognitive restructuring
involves:
(1) identifying maladaptive cognitions
(2) modifying maladaptive cognitions and
(3) assimilating adaptive cognitions.
 This approach does not involve distorting reality in a
positive direction or attempting to believe the
unbelievable.
 Rather, it uses reason and evidence to replace
distorted thought patterns with more accurate,
believable, and functional ones.

50. Ellis’s Rational Emotive Therapy
(1962)

51. Ellis’s Rational Emotive Therapy
 Some people hold assumptions that are
largely irrational about themselves and
their world.
 “Basic irrational assumptions”
 Some common irrational assumptions:

52.  The idea that one should be thoroughly
competent at everything
 The idea that is it catastrophic when things
are not the way you want them to be
 The idea that people have no control over
their happiness
 The idea that you need someone stronger than
yourself to be dependent on
 The idea that your past history greatly
influences your present life
 The idea that there is a perfect solution to
human problems, and it’s a disaster if you
don’t find it.
 REBT employs highly emotive, techniques to
help patients vigorously and forcefully change
this irrational thinking.

53. Ellis’s Rational Emotive Therapy
 A major aid in cognitive therapy is what
Albert Ellis called the ABC Technique of
Irrational Beliefs.
A
• Activating event or objective situation .
Eg Sana scores low in a Math test
B
• Beliefs - the negative thoughts that
occurred . Eg: Sana believes she must have
good grades or she is worthless
c
• Consequence- the negative feelings and
dysfunctional behavior that ensues . Eg:
Sana feels depressed

54. Ellis’s Rational Emotive Therapy
 Ellis believes that it is not (A) the activating
event that causes (C), but rather the irrational
belief system (B) that helps cause the
consequences (C).
 * Reframing* - After irrational beliefs have been
identified, the therapist will often work with
the client in challenging the negative thoughts
on the basis of evidence from the client's
experience by reframing it, meaning to re-
interpret it in a more realistic light. This helps
the client to develop more rational beliefs and
healthy coping strategies.

55. Depression
Cognitive Drugs ECT
Therapy
Improvement 60-75% 60-75% 80% markedly
markedly markedly improved
treatments
improved improved
relapse Moderate High relapse High relapse
relapse
Side effects None Moderate Rather severe
Cost inexpensive inexpensive inexpensive
Time scale A month weeks days
overall V good V good V good