Transcript Bi-polar depression

Bi-polar depression
Explanations of Mania
IMPORTANT NOTICE
• Someone diagnosed with bi-polar
depression will experience states of
depression and mania:
• This means the explanations you have
studied regarding depression are also
relevant in the depressed phases of bipolar!!!
BIOLOGICAL EXPLANATIONS
• Genetic Factors
• Believed we inherit a biological disposition to
developing BP
• Concordance rates of MZ twins = 40%; DZ= 5-10%
compared to 1% prevalence in general population
(Craddock & Jones, ’99)
• Berstelsen et al. (1977) 80% for MZ twins and 16%
for DZ
• Molecular biology techniques – linked BP to genes
on chromosome 1, 4, 6, 10, 11, 12, 13, 15, 18, 21
and 22 (Baron, 2002)
• Wide-ranging findings may mean that the logic
behind gene studies is flawed or that a number of
genetic abnormalities combine to = BP
• Biochemical Explanations
• Post et al (1980, 1978) found that
norepinephrine activity of bi-polar sufferers
was higher than that of depressives or
controls
• Telner et al (1986) patients with BP given
reserpine (bp drug known to reduce
norepinephrine activity) – manic symptoms
subsided
• Kety’s Permissive amine theory
• states that depression may result from the
indirect affect of serotonin. Once serotonin
levels are low, then the other monoamines
(noradrenalin, dopamine, serotonin) are no
longer properly regulated. The resulting
fluctuations in the levels results in the
different symptoms:
• Low 5-HT + low norepinephrine = depression
• Low 5-HT + high norepinephrine = mania
PSYCHOLOGICAL EXPLANATIONS
• Mania as a defence against depression
• BP is a result of the alternating dominance of personality by
the
• Superego-floods individual with exaggerated feelings of guilt
and wrong-doing (depressive phase) and the
• Ego- attempts to defend itself by rebounding and asserting
supremacy, accounting for elation and self-confidence that
are part of the manic phase.
• In response to the excessive display of ego, the superego
dominates = depression etc..
• See case study
• AO2
• Rarely accepted
• Interest now turned to psychological factors which might
affect the course of BP – mostly involve stress and coping
STRESSFUL LIFE EVENTS
• Have been found to trigger both UP and BP
episodes. (E.g. death, loss of job etc)
• Not a primary cause of BP, stressors may
affect the timing of episodes
• Some sufferers may generate high levels of
stress in their lives, due to disruptive
behaviour, thereby potentially contributing to
frequent relapses
FAMILY RELATIONSHIPS
• Difficulties in family r’ships may be both a
trigger and a consequence of BP episodes
• Miklowitz et al (1988) – relapse in young
patients with BP could be significantly
predicted by the level of –ve family attitudes
(e.g. expressed emotion)
• -ve relations with others are also associated
with poorer adjustment overall.