Bipolar mood disorder has been traditionally researched, explored, and explained from a modernistic, psychiatric perspective. The purpose of this study is to explicate an alternative description for bipolar mood disorder, from a postmodern perspective. The widely accepted psychiatric knowledge focuses on the signs and symptoms of the disorder, pharmacological treatments, and manualised psychotherapies. This thesis shifts the focus from an intrapsychic, deficit perspective towards one which is inclusive of surrounding discourses and patterned relationships. The social constructionist research approach is followed, utilising vignette and thematic analyses for textual deconstruction and reconstruction. In addition to these data analyses, discourses were analysed using the actual text of the co-researchers. This allowed for a thorough explication of the ways in which discourses shape the construct bipolar mood disorder. From these analyses, emergent themes were then distilled and compared to the existing body of literature in the bipolar mood spectrum field of study. Process models were generated to depict the various pertinent aspects of the social construction of bipolar mood disorder. This research has value for the treating professional, allowing for a broader, more inclusive discourse perspective to add to the already established medical model view. Further, this research gives credence to the voice of the person who has been diagnosed with the illness. This research may also contribute to the epistemological debates within modernist and postmodernist paradigms. Key words: Bipolar mood disorder, medical model, pharmacology, mania, depression, psychiatry, psychotherapy, titrating power relations, expert, problem determined systems, belonging, problems of therapy and therapeutic problems, vignette analysis, people as meaning generating beings, context, reflexivity, self-reflection, multiple realities, positivism, social constructionist epistemology, qualitative research, process model. / Psychology / D. Litt. et Phil. (Psychology)

Text in Afrikaans / Binne die tradisionele christelike westerse samelewing waarin ons leef is daar diskoerse en meta-narratiewe wat dikteer wat van ons as huweliksmaats verwag word. Ons is dikwels onbewus van hoe hierdie verwagtinge, rolle en eise wat aan ons gestel word, deur verskillende diskoerse en stories tot stand gekom het. Die spesifieke lewenstorie en omstandlghede van die indiwidu(e) word meestal in die proses geignoreer, byvoorbeeld die saamleef met 'n huweliksmaat wat "gediagnoseer" is as iemand met 'n "bipolêre gemoedsversteuring", bring noodwendig omstandighede mee wat vir die meeste mense onuithoudbaar mag wees. Hierdie studie vertel die storie van 'n persoon wie daarin kon slaag om ten spyte van hierdie "omstandighede", sy storie so te kon herskryf dat hy steeds met hierdie persoon suksesvol binne die huwelik kan saamleef. Die studie fokus op 'n persoon, wie se lewe op grond van die christelike narratief leef, se belewing van die saamleef met 'n persoon met 'n "bipolere gemoedsversteuring". Die algemene doel van die studie was om aan die deelnemer 'n geleentheid te skep om sy belewinge in die saamleef van 'n persoon met 'n "bipolêre gemoedsversteuring" te kon deel. 'n Spesifieke fokus is geplaas om die rol wat christelike spiritualiteit speel in die verwerking en hantering daarvan, te beskryf. Daar is ook aan die persoon geleentheid gegee om op grond van sy belewlnge en verstaan van christenskap, aanbevelings te maak aan die professlone!e gemeenskap, die geloofsgemeenskap en aan huweliksmaats wat met soortgelyke omstandighede meet saamleef. Die navorslng is vanuit 'n postmoderne diskoers-oogpunt aangepak en op 'n kwalitatiewe wyse uitgevoer by wyse van 'n gevallestudle. Die deelnemer se storie is deur middel van sosiale konstruksieteorie en 'n narratiewe terapeutiese benadering, gedekonstrueer. Dit was duidelik vanuit die studie dat die funksie wat mense se spirituele oortuiginge en hul belewing daarvan in hul lewens verrig, in berekening gebring moet word in die terapeutiese proses. Wanneer kliënte belangrike besluite moet neem, moet die invloed van geloofsoortuiginge in die besluitnemingsproses in berekening gebring word. / Philosophy, Practical and Systematic Theology / M. Th. - (Pastoral Theology)

Bipolar disorder is a serious illness affecting approximately 2-4% of the population and is one of the world’s leading causes of disability. In individuals with bipolar disorder, medical comorbidity associated with cardiovascular, respiratory and endocrine disorders is related to increased rates of mortality. Recent updates to multi-system inflammatory related conceptualizations of bipolar disorder focus on the unique power that medical illness and biological processes may play as factors associated with course and outcome in bipolar disorder. The current study examined medical comorbidity and its associations with various demographic and psychological variables in individuals with bipolar disorder, schizophrenia, and major depressive disorder with psychotic features followed for 10 years from their first hospital admission. When compared to an age, gender and race-matched control sample from the population, those with bipolar disorder had significantly higher medical comorbidity across a range of medical diagnoses both at 6 months and 10 years after first hospital admission. Ten years following initial hospitalization, individuals in all three diagnostic groups reported increased rates of diabetes (OR: 2.0 – 3.7), stroke (OR: 4.6 – 7.0) and asthma (OR: 1.9 - 3.1), and individuals with bipolar disorder reported increased rates of cancer (OR = 2.1). A number of psychological and demographic symptoms were examined for their ability to predict the development of medical illness across the assessment interval. Overall rates of medical illness were elevated both early in illness course and 10 years after diagnosis, suggesting that broad sequelae of multi-system inflammation are present early and progress over time.

The aims of the current research program were to examine the social-cognitive and sociological models of stigma in relation to student attitudes towards an individual experiencing a mood disorder. Two experiments (Studies 1 and 2) sought to empirically distinguish between controllability and responsibility, both constructs of the attribution model which is subsidiary to the social-cognitive model of stigma. Despite manipulating controllability, participants were reluctant to attribute controllability of cause to individuals experiencing depression or bipolar disorder. The stability of beliefs about the controllability of cause for condition onset was consistent with research suggesting that the Australian public increasingly conceptualise mental disorders in terms of biochemical and genetic causal factors. These findings, in combination with past research linking biogenetic beliefs to negative attitudes, resulted in a change in focus of investigation in Studies 3, 4, 5 and 6 to explain why, contrary to the prediction of the attribution model, biogenetic explanations of mental disorders are associated with the proliferation of stigma. To measure causal beliefs, the Causal Belief Inventory (CBI) was developed in Study 3 and refined in Study 4. The correlational results examined in Studies 4, 5 and 6 found that genetic and biochemical causal beliefs were associated with a number of positive attitudes towards individuals experiencing a mood disorder and that genetic cause was associated with a reduced implicit bias against major depression. Furthermore, each study pointed to the centrality of judgments of differentness in determining affective responses and direct and proxy measures of behaviour. In contrast, manipulation of genetic and psychosocial cause in Study 5 found that causal condition largely failed to impact upon student attitudes. Mediator analysis did, however, find that beliefs about the stability of the vignette actor's condition fully mediated the relationship between the negative influence of genetic cause on proxy helping behaviour. Manipulation of psychosocial, genetic and biochemical cause with the inclusion of a non-depressed control in Study 6 resulted in more ambiguous findings. The combination of findings from Studies 1 to 6 suggest that focusing on the impact of the controllability of cause of depression onset on student attitudes is unwarranted. Instead researchers and public health educators should be examining models which facilitate the examination of the cognitive factors that mediate these relationships. Two such models, namely the social-cognitive and sociological models of stigma, were found to adequately fit the data. Recommendations for integrating these two models of stigma are discussed.

Positive Clinical Psychology (PCP) argues that positive and negative psychological constructs are jointly important for explaining psychological problems. “Positive” constructs have been explicitly focused on by positive psychology researchers and “negative” constructs have been explicitly focused on by mental health researchers. This thesis examines the relationship between positive and negative constructs in relation to four psychological problems: depressive symptoms (Chapter 2), anxiety-problems (Chapter 3), suicide attempts (SAs) (Chapter 4 and 5), and nonsuicidal self-injury (NSSI) (Chapter 4 and 5). Clarifying how psychological problems are most appropriately conceptualised has implications for definitions, diagnostic criteria, measurement, and clinical interventions. This thesis provides evidence that some constructs form bipolar continua, having a positive pole and a negative pole, whilst other constructs do not. Chapters 2 and 3 demonstrate that well-being and calmness respectively form continua with depressive and anxiety symptoms. In contrast, Chapters 4 and 5 demonstrate that SA and NSSI cognitions do not form a continuum with another construct. Results indicate that positive and negative constructs appear to have different relationships to one-another depending on the construct under investigation. Constructs that are common in the general population – such as depressive symptoms, anxiety symptoms, well-being symptoms, and calmness symptoms – appear to be bipolar, having a positive and a negative pole. Psychological constructs that are rare in the general population and which specifically characterise psychological problems (rather than being an extreme manifestation of a common psychological experience) – such as SA and NSSI cognitions – appear to be unipolar. The replication of scientific findings also features strongly throughout this thesis. Each chapter may therefore have a timely bearing on the emerging “replication crisis” literature.

Indiana University-Purdue University Indianapolis (IUPUI) / Our laboratory has previously identified the clock gene D-box Binding Protein (DBP) as a candidate gene for bipolar disorder and alcoholism using a Convergent Functional Genomics (CFG) approach. In subsequent work, we established mice with a homozygous deletion of DBP as a stress-reactive genetic animal model of bipolar disorder and co-morbid alcoholism. In the present study, we found that the omega-3 fatty acid, DHA, may have mood stabilizing capabilities in stressed DBP knockout mice, and reduces alcohol consumption in these mice as well as in the alcohol preferring (P) rats. Given their potential health benefits and their relative lack of negative side-effects, omega-3 fatty acids may become an important supplement for bipolar patients and co-morbid alcoholics, a potential that warrants continued research.

For more than half a decade, lithium has been successfully used to treat bipolar disorder. Worldwide, it is considered the first-line mood stabilizer. Apart from its proven antimanic and prophylactic effects, considerable evidence also suggests an antisuicidal effect in affective disorders. Lithium is also effectively used to augment antidepressant drugs in the treatment of refractory major depressive episodes and prevent relapses in recurrent unipolar depression. In contrast to many psychiatric drugs, lithium has outlasted various pharmacotherapeutic ‘fashions’, and remains an indispensable element in contemporary psychopharmacology. Nevertheless, data from pharmacogenetic studies of lithium are comparatively sparse, and these studies are generally characterized by small sample sizes and varying definitions of response. Here, we present an international effort to elucidate the genetic underpinnings of lithium response in bipolar disorder. Following an initiative by the International Group for the Study of Lithium-Treated Patients (www.IGSLI.org) and the Unit on the Genetic Basis of Mood and Anxiety Disorders at the National Institute of Mental Health,lithium researchers from around the world have formed the Consortium on Lithium Genetics (www.ConLiGen.org) to establish the largest sample to date for genome-wide studies of lithium response in bipolar disorder, currently comprising more than 1,200 patients characterized for response to lithium treatment. A stringent phenotype definition of response is one of the hallmarks of this collaboration. ConLiGen invites all lithium researchers to join its efforts. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

This study explored the Object Relations of a sample of 45 subjects who were using alcohol and were diagnosed with co-morbid Depressive or Bipolar disorders and/or Personality disorders. All subjects were receiving treatment at a government psychiatric hospital in South Africa. The similarities and differences in the Object Relations of these individuals were identified. A biographical questionnaire, the Alcohol Use Disorder Test (AUDIT), which was used as a screening measure, and the Bells Object Relations and Reality Testing Inventory (BORRTI) were administered to obtain information from a purposive sample. Descriptive and inferential statistics were used to analyse the results of the assessment measures. Analysis of the BORRTI data indicated a high rate of depressive and personality disorders within this sample. Results of the sub-sample (n=29) whose scores were included in the Pearson’s Correlation Coefficient analysis indicate that higher levels of alcohol consumption result in increased levels of hallucinations and delusions. Other correlations were identified between high levels of alcohol consumption and heightened levels of reality distortions and more uncertainty in the perceptions of these individuals. Significant differences in the scores of the male and female participants were identified. With the female participants, the higher the level of alcohol consumption, the lower the individuals scored in terms of pathological levels of egocentricity, uncertain perceptions, insecure attachments, alienation, social incompetence as well as hallucinations and delusions. Alternatively, in the male sample, higher levels of alcohol consumption result in increased hallucinations and delusions, reality distortions, uncertainty in perceptions, alienation, social incompetence and egocentricity. / Psychology / M.A. (Research Psychology)

Text in English / This qualitative psychobiographical study sets out to explore and describe the life of Sir Winston Churchill within the context of his lifelong experience with depression, his ‘Black Dog’. The aim of the research is to present a case for depressive realism with Churchill as the single case study. The reconstruction of Churchill’s life as a psychological narrative is contextualised within the theoretical framework of Alfred Adler’s Theory of Individual Psychology. Data was collated via biographical and life history material. Data was analysed by means of thematic analysis. Data trustworthiness and ethical considerations were adhered to. The findings of this study reveal that Churchill’s depression had positive gains of him striving to contribute to society, potentially demonstrating that depressive realism exists as a side-effect of depression. The significance of which, conceivably substantiates the idea that positive aspects of depression do exist, enabling a potentially more encouraging and constructive outlook for individuals suffering from depression. / Psychology / M.A. (Psychology)

Text in English / This qualitative psychobiographical study sets out to explore and describe the life of Sir Winston Churchill within the context of his lifelong experience with depression, his ‘Black Dog’. The aim of the research is to present a case for depressive realism with Churchill as the single case study. The reconstruction of Churchill’s life as a psychological narrative is contextualised within the theoretical framework of Alfred Adler’s Theory of Individual Psychology. Data was collated via biographical and life history material. Data was analysed by means of thematic analysis. Data trustworthiness and ethical considerations were adhered to. The findings of this study reveal that Churchill’s depression had positive gains of him striving to contribute to society, potentially demonstrating that depressive realism exists as a side-effect of depression. The significance of which, conceivably substantiates the idea that positive aspects of depression do exist, enabling a potentially more encouraging and constructive outlook for individuals suffering from depression. / Psychology / M.A. (Psychology)