1. Bi-polar depression Explanations of Mania

2. 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 bi- polar!!!

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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.