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124-458: The book chronicles author Linea Johnson's onset of depressive episodes starting in high school, and leading into her first year away from home in college, when she is hospitalized for the first time and diagnosed with bipolar II disorder . The story shares her perspective of being treated with the illness and suicide attempts, and also, the perspective of her mother, Cinda Johnson, a mental health professor at Seattle University . Perfect Chaos

248-577: A "well-being plan" serves several purposes: it informs the patients, protects them from future episodes, teaches them to add value to their life, and works toward building a strong sense of self to fend off depression and reduce the desire to succumb to the seductive hypomanic highs. The plan has to aim high. Otherwise, patients will relapse into depression. A large part of this plan involves the patient being very aware of warning signs and stress triggers so that they take an active role in their recovery and prevention of relapse. Several studies have shown that

372-593: A certain amount of cognitive processing of information has been accomplished. In this view, such affective reactions as liking, disliking, evaluation, or the experience of pleasure or displeasure each result from a different prior cognitive process that makes a variety of content discriminations and identifies features, examines them to find value, and weighs them according to their contributions (Brewin, 1989). Some scholars (e.g. Lerner and Keltner 2000) argue that affect can be both pre- and post-cognitive: initial emotional responses produce thoughts, which produce affect. In

496-421: A chronic relapsing nature. It has been suggested that BP-II patients have a higher degree of relapse than BP-I patients. Generally, within four years of an episode, around 60% of patients will relapse into another episode. Some patients are symptomatic half the time, either with full on episodes or symptoms that fall just below the threshold of an episode. Because of the nature of the illness, long-term therapy

620-569: A class, the first generation antipsychotics are associated with movement disorders , along with anticholinergic side effects compared with second generation antipsychotics. There is evidence to support the use of SSRI and SNRI antidepressants in BP-II, but the use of these treatments is controversial. Potential risks of antidepressant pharmacotherapy in patients with bipolar disorder include increased mood cycling, development of rapid cycling, dysphoria , and switch to hypomania. In addition,

744-434: A colored box, but the participants did not know that they would eventually be asked what color box the word appeared in. Motivation intensity refers to the strength of urge to move toward or away from a particular stimulus. Anger and fear affective states, induced via film clips, resulted in more selective attention on a flanker task compared to controls as indicated by reaction times that were not very different, even when

868-801: A comprehensive history, medication review, and laboratory work are key to diagnosing BP-II and differentiating it from other conditions. The differential diagnosis of BP-II is as follows: unipolar major depression , borderline personality disorder , posttraumatic stress disorder , substance use disorders , and attention deficit hyperactivity disorder . Major differences between BP-I and BP-II have been identified in their clinical features, comorbidity rates and family histories. During depressive episodes, BP-II patients tend to show higher rates of psychomotor agitation , guilt, shame, suicidal ideation , and suicide attempts. BP-II patients have shown higher lifetime comorbidity rates of phobias , anxiety disorders , substance use, and eating disorders . In addition, there

992-476: A decrease in brain excitation due to blockage of low-voltage sodium-gated channels, decrease in glutamate and excitatory amino acids, and potentiation of levels of GABA . There is evidence that lamotrigine decreases the risk of relapse in rapid-cycling BP-II. It is more effective in BP-II than BP-I, suggesting that lamotrigine is more effective for the treatment of depressive rather than manic episodes. Doses ranging from 100 to 200 mg have been reported to have

1116-406: A depressive episode. It is during depressive episodes that BP-II patients often seek help. Symptoms may be syndromal or subsyndromal . Depressive episodes in BP-II can present similarly to those experienced in unipolar depressive disorders . Patients characteristically experience a depressed mood and may describe themselves as feeling sad, gloomy, down in the dumps, or hopeless, for most of

1240-501: A depressive period, or simply to better organize one's life by setting boundaries for one's perceptions and behaviors. There is evidence to suggest that BP-II has a more chronic course of illness than BP-I. This constant and pervasive course of the illness leads to an increased risk in suicide and more hypomanic and major depressive episodes with shorter periods between episodes than BP-I patients experience. The natural course of BP-II, when left untreated, leads to patients spending

1364-554: A direct and persisting impact on psychosocial functioning. An abnormal semantic memory organization can manipulate thoughts and lead to the formation of delusions and possibly affect speech and communication problems, which can lead to interpersonal issues. BP-II patients have also been shown to present worse cognitive functioning than those patients with BP-I, though they demonstrate about the same disability when it comes to occupational functioning, interpersonal relationships, and autonomy . This disruption in cognitive functioning takes

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1488-427: A faster reaction to name the smaller letters within the larger letter. A source-monitoring paradigm can also be used to measure how much contextual information is perceived: for instance, participants are tasked to watch a screen which serially displays words to be memorized for 3 seconds each, and also have to remember whether the word appeared on the left or the right half of the screen. The words were also encased in

1612-433: A flanker attention task to figure out whether cognitive scope is broadened or narrowed. For example, using the letters "H" and "N" participants need to identify as quickly as possible the middle letter of 5 when all the letters are the same (e.g. "HHHHH") and when the middle letter is different from the flanking letters (e.g. "HHNHH"). Broadened cognitive scope would be indicated if reaction times differed greatly from when all

1736-442: A further iteration, some scholars argue that affect is necessary for enabling more rational modes of cognition (e.g. Damasio 1994). A divergence from a narrow reinforcement model of emotion allows other perspectives about how affect influences emotional development. Thus, temperament , cognitive development, socialization patterns, and the idiosyncrasies of one's family or subculture might interact in nonlinear ways. For example,

1860-466: A greater risk of substance use, anxiety disorders, and suicidality. In addition, they are associated with increased treatment resistance compared to non-mixed episodes. Bipolar disorder is often a lifelong condition, and patients should be followed up regularly for relapse prevention. Although BP-II is thought to be less severe than BP-I in regard to symptom intensity, BP-II is associated with higher frequencies of rapid cycling and depressive episodes. In

1984-586: A high potential for painful consequences (engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments.) Hypomania is distinct from mania . During a typical hypomanic episode, patients may present as upbeat, may show signs of poor judgment or display signs of increased energy despite lack of sleep, but do not meet the full criteria for an acute manic episode. Patients may display elevated confidence, but do not express delusional thoughts as in mania. They can experience increase in goal-directed activity and creativity , but do not reach

2108-527: A logical and consistent framework for research. Researchers can predict a person's actions by assuming effort refers to the energy investment. The motivational intensity theory is used to show how changes in goal attractiveness and energy investment correlate. Mood , like emotion, is an affective state. However, an emotion tends to have a clear focus (i.e., its cause is self-evident), while mood tends to be more unfocused and diffuse. Mood, according to Batson, Shaw and Oleson (1992), involves tone and intensity and

2232-440: A major cause of psychosocial disability. There is evidence that shows the mild depressive symptoms, or even sub-syndromal symptoms, are responsible for the non-recovery of social functioning, which furthers the idea that residual depressive symptoms are detrimental for functional recovery in patients being treated for BP-II. It has been suggested that symptom interference in relation to social and interpersonal relationships in BP-II

2356-402: A major depressive episode, the best chance for recovery is to have therapeutic interventions that focus on the residual depressive symptoms and to aim for improvement in psychosocial and cognitive functioning. Even with treatment, a certain amount of responsibility is placed in the patient's hands; they have to be able to assume responsibility for their illness by accepting their diagnosis, taking

2480-513: A multi-agent system—a system that contains multiple agents interacting with each other and/or with their environments over time. The outcomes of individual agents' behaviors are interdependent: Each agent's ability to achieve its goals depends on not only what it does but also what other agents do. Emotions are one of the main sources for the interaction. Emotions of an individual influence the emotions, thoughts and behaviors of others; others' reactions can then influence their future interactions with

2604-501: A narrowed attentional scope. The experimenters further increased the narrowed attentional scope in appetitive stimuli by telling participants they would be allowed to consume the desserts shown in the pictures. The results revealed that their hypothesis was correct, in that the broad attentional scope led to quicker detection of global letters, while narrowed attentional scope led to quicker detection of local letters. Researchers Bradley, Codispoti, Cuthbert and Lang wanted to further examine

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2728-411: A note should be considered on the differences between affect and emotion. Arousal is a basic physiological response to the presentation of stimuli. When this occurs, a non-conscious affective process takes the form of two control mechanisms: one mobilizing and the other immobilizing. Within the human brain, the amygdala regulates an instinctual reaction initiating this arousal process, either freezing

2852-581: A patient with depression with mixed features may have a depressed mood, but has simultaneous symptoms of rapid speech, increased energy, and flight of ideas. Conversely, a patient with hypomania with mixed features will present with the full criteria for a hypomanic episode, but with concurrent symptoms of decreased appetite, loss of interest, and low energy. Episodes with mixed features can last up to several months. They occur more frequently in patients with an earlier onset of bipolar disorder, are associated with higher frequency of episodes, and are associated with

2976-454: A patient's prognosis, long-term therapy is most favorably recommended for controlling symptoms, maintaining remission and preventing relapses. With treatment, patients have been shown to present a decreased risk of suicide (especially when treated with lithium ) and a reduction of frequency and severity of their episodes, which in turn moves them toward a stable life and reduces the time they spend ill. To maintain their state of balance, therapy

3100-518: A person's life can trigger a relapse in patients with BP-II. These include stressful life events, criticism from peers or relatives, and a disrupted circadian rhythm. In addition, the addition of antidepressant medications can trigger a hypomanic episode. Comorbid conditions are extremely common in individuals with BP-II. In fact, individuals are twice as likely to present a comorbid disorder than not. These include anxiety , eating , personality (cluster B) , and substance use disorders . For BP-II,

3224-434: A research article about affect tolerance written by psychiatrist Jerome Sashin, "Affect tolerance can be defined as the ability to respond to a stimulus which would ordinarily be expected to evoke affects by the subjective experiencing of feelings." Essentially it refers to one's ability to react to emotions and feelings. One who is low in affect tolerance would show little to no reaction to emotion and feeling of any kind. This

3348-454: A result of the high suicide risk for this group, reducing the risk and preventing attempts remains a main part of the treatment; a combination of self-monitoring, close supervision by a therapist, and faithful adherence to their medication regimen will help to reduce the risk and prevent the likelihood of suicide. Suicide is a common endpoint for many patients with severe psychiatric illness. The mood disorders (depression and bipolar) are by far

3472-589: A result, an internationally reliable short-form, the I-PANAS-SF, has been developed and validated comprising two 5-item scales with internal reliability, cross-sample and cross-cultural factorial invariance, temporal stability, convergent and criterion-related validities. Mroczek and Kolarz have also developed another set of scales to measure positive and negative affect. Each of the scales has 6 items. The scales have shown evidence of acceptable validity and reliability across cultures. In relation to perception,

3596-754: A sad picture, participants were faster to identify the larger letter in a Navon attention task, suggesting more global or broadened cognitive scope. Sadness is thought to sometimes have low motivational intensity. But, after seeing a disgusting picture, participants were faster to identify the component letters, indicative of a localized and narrower cognitive scope. Disgust has high motivational intensity. Affects which are high in motivational intensity narrow one's cognitive scope, enabling people to focus more on central information, whereas affects which are low in motivational intensity broadened cognitive scope, allowing for faster global interpretation. The changes in cognitive scope associated with different affective states

3720-423: A simultaneously painful and inspiring page-turner". In a 2012 Publishers Weekly review, the reviewer said of Perfect Chaos , "The journey for Linea and her family is a moving and hopeful one, as they better understand how she reacts to the illness, and realize that being bipolar is only a part of someone’s life, not the whole." Patrick J. Kennedy , a former Member of Congress with bipolar disorder, received

3844-556: A specific event), and affectivity (an individual's overall disposition or temperament , which can be characterized as having a generally positive or negative affect). In psychology, the term affect is often used interchangeably with several related terms and concepts, though each term may have slightly different nuances. These terms encompass: emotion, feeling, mood, emotional state, sentiment, affective state, emotional response, affective reactivity, disposition . Researchers and psychologists may employ specific terms based on their focus and

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3968-585: A strong motivation to consume alcohol. The researchers tested the participants by exposing them to alcohol and neutral pictures. After the picture was displayed on a screen, the participants finished a test evaluating attentional focus. The findings proved that exposure to alcohol-related pictures led to a narrowing of attentional focus to individuals who were motivated to use alcohol. However, exposure to neutral pictures did not correlate with alcohol-related motivation to manipulate attentional focus. The Alcohol Myopia Theory (AMT) states that alcohol consumption reduces

4092-501: A structured set of beliefs about general expectations of a future experience of pleasure or pain, or of positive or negative affect in the future. Unlike instant reactions that produce affect or emotion, and that change with expectations of future pleasure or pain, moods, being diffuse and unfocused and thus harder to cope with, can last for days, weeks, months or even years (Schucman, 1975). Moods are hypothetical constructs depicting an individual's emotional state. Researchers typically infer

4216-436: A toll on their ability to function in the workplace, which leads to high rates of work loss in BP-II patient populations. After treatment and while in remission, BP-II patients tend to report a good psychosocial functioning but they still score less than patients without the disorder. These lasting impacts further suggest that a prolonged period of untreated BP-II can lead to permanent adverse effects on functioning. BP-II has

4340-479: A type of non-conscious affect may be separate from the cognitive processing of environmental stimuli. A monohierarchy of perception, affect and cognition considers the roles of arousal , attention tendencies, affective primacy (Zajonc, 1980), evolutionary constraints (Shepard, 1984; 1994), and covert perception (Weiskrantz, 1997) within the sensing and processing of preferences and discriminations. Emotions are complex chains of events triggered by certain stimuli. There

4464-408: Is a construct that is closely related to motivational intensity, they differ in that motivation necessarily implies action while arousal does not. Affect is sometimes used to mean affect display , which is "a facial, vocal, or gestural behavior that serves as an indicator of affect" (APA 2006). In psychology, affect defines the organisms ' interaction with stimuli . It can influence the scope of

4588-526: Is a higher correlation between BP-II patients and family history of psychiatric illness, including major depression and substance-related disorders compared to BP-I. The occurrence rate of psychiatric illness in first degree relatives of BP-II patients was 26.5%, versus 15.4% in BP-I patients. Although BP-II is a prevalent condition associated with morbidity and mortality, there has been an absence of robust clinical trials and systematic reviews that investigate

4712-447: Is a result of an anticipated, experienced, or imagined outcome of an adaptational transaction between organism and environment, therefore cognitive appraisal processes are keys to the development and expression of an emotion (Lazarus, 1982). Affective states vary along three principal dimensions: valence , arousal, and motivational intensity . It is important to note that arousal is different from motivational intensity. While arousal

4836-474: Is closely related to alexithymia . "Alexithymia is a subclinical phenomenon involving a lack of emotional awareness or, more specifically, difficulty in identifying and describing feelings and in distinguishing feelings from the bodily sensations of emotional arousal" At its core, alexithymia is an inability for an individual to recognize what emotions they are feeling—as well as an inability to describe them. According to Dalya Samur < Archived 2022-01-09 at

4960-530: Is directly tied to poor psychosocial functioning, a common side-effect in patients with BP-II. The impact on a patient's psychosocial functioning stems from the depressive symptoms (more common in BP-II than BP-I). An increase in these symptoms' severity seems to correlate with a significant increase in psychosocial disability. Psychosocial disability can present itself in poor semantic memory , which in turn affects other cognitive domains like verbal memory and (as mentioned earlier) executive functioning leading to

5084-400: Is evolutionarily adaptive because high motivational intensity affects elicited by stimuli that require movement and action should be focused on, in a phenomenon known as goal-directed behavior. For example, in early times, seeing a lion (a fearful stimulus) probably elicited a negative but highly motivational affective state (fear) in which the human being was propelled to run away. In this case

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5208-510: Is more chronic and consists of more frequent cycling than the course of BP-I. Finally, BP-II is associated with a greater risk of suicidal thoughts and behaviors than BP-I or unipolar depression . BP-II is no less severe than BP-I, and types I and II present equally severe burdens. BP-II is notoriously difficult to diagnose. Patients usually seek help when they are in a depressed state, or when their hypomanic symptoms manifest themselves in unwanted effects, such as high levels of anxiety , or

5332-423: Is more common than BP-I, while BP-II and major depressive disorder have about the same rate of diagnosis. Of all individuals initially diagnosed with major depressive disorder , between 40% and 50% will later be diagnosed with either BP-I or BP-II. Substance use disorders (which have high co-morbidity with BP-II) and periods of mixed depression may also make it more difficult to accurately identify BP-II. Despite

5456-400: Is narrated by both Linea and Cinda Johnson, as well as a collection of essays and journal entries by the mother and daughter pair. The book started out as Linea Johnson's chronicling her moods as a part of her treatment and recovery, and Cinda's suggestion that they share their story after witnessing inequities in the treatment of the disorder. Perfect Chaos has received positive reviews from

5580-617: Is no way to completely describe an emotion by knowing only some of its components. Verbal reports of feelings are often inaccurate because people may not know exactly what they feel, or they may feel several different emotions at the same time. There are also situations that arise in which individuals attempt to hide their feelings, and there are some who believe that public and private events seldom coincide exactly, and that words for feelings are generally more ambiguous than are words for objects or events. Therefore, non-conscious emotions need to be measured by measures circumventing self-report such as

5704-695: Is often continued indefinitely, as around 50% of the patients who discontinue it relapse quickly and experience either full-blown episodes or sub-syndromal symptoms that bring significant functional impairments. The deficits in functioning associated with BP-II stem mostly from the recurrent depression that BP-II patients experience. Depressive symptoms are much more disabling than hypomanic symptoms and are potentially as, or more disabling than mania symptoms. Functional impairment has been shown to be directly linked with increasing percentages of depressive symptoms, and because sub-syndromal symptoms are more common—and frequent—in BP-II, they have been implicated heavily as

5828-432: Is separate from the reward of food itself. Therefore, earning the reward and anticipating the reward are separate processes and both create an excitatory influence of reward-related cues. Both processes are dissociated at the level of the amygdala, and are functionally integrated within larger neural systems. Cognitive scope can be measured by tasks involving attention, perception, categorization and memory. Some studies use

5952-407: Is strongly associated with atypical depression . A mixed episode is defined by the presence of a hypomanic or depressive episode that is accompanied by symptoms of the opposite polarity. This is commonly referred to as a mood episode with mixed features (e.g. depression with mixed features or hypomania with mixed features), but can also be referred to as mixed episodes or mixed states. For example,

6076-539: Is strongly linked to social activity. Recent research suggests that high functional support is related to higher levels of positive affect. In his work on negative affect arousal and white noise, Seidner found support for the existence of a negative affect arousal mechanism regarding the devaluation of speakers from other ethnic origins. The exact process through which social support is linked to positive affect remains unclear. The process could derive from predictable, regularized social interaction, from leisure activities where

6200-403: Is that the mood episodes cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (from the depressive symptoms or the unpredictability of cycling between periods of depression and hypomania). A hypomanic episode is established if a patient's symptoms last for most of the day each day for at least four days. Furthermore, three or more of

6324-555: Is the Positive and Negative Affect Schedule (PANAS). The PANAS is a lexical measure developed in a North American setting and consisting of 20 single-word items, for instance excited , alert , determined for positive affect, and upset , guilty , and jittery for negative affect. However, some of the PANAS items have been found either to be redundant or to have ambiguous meanings to English speakers from non-North American cultures. As

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6448-463: Is the best option and aims to not only control the symptoms but to maintain sustained remission and prevent relapses from occurring. Even with treatment, patients do not always regain full functioning, especially in the social realm. There is a very clear gap between symptomatic recovery and full functional recovery for both BP-I and BP-II patients. As such, and because those with BP-II spend more time with depressive symptoms that do not quite qualify as

6572-502: Is the only mood stabilizer to demonstrate a decrease in suicide and self-harm in patients with mood disorders. Due to lithium's narrow therapeutic index , lithium levels must be monitored regularly for prevention of lithium toxicity . There is also evidence that the anticonvulsants valproate, lamotrigine, carbamazepine, and topiramate are effective in the reduction of symptoms of hypomanic and depressive episodes of bipolar disorder. Potential mechanisms contributing to these effects include

6696-564: Is the standard of care for treatment of both BP-I and BP-II, additional non-pharmaceutical therapies can also help those with the illness. Benefits include prevention of relapse and improved maintenance medication adherence. These include psychotherapy (e.g. cognitive behavioral therapy , psychodynamic therapy , psychoanalysis , interpersonal therapy , behavioral therapy , cognitive therapy , and family-focused therapy ), social rhythm therapy , art therapy , music therapy , psychoeducation , mindfulness , and light therapy . Meta-analyses in

6820-500: Is the underlying experience of feeling , emotion , attachment , or mood . It encompasses a wide range of emotional states and can be positive (e.g., happiness, joy, excitement) or negative (e.g., sadness, anger, fear, disgust). Affect is a fundamental aspect of human experience and plays a central role in many psychological theories and studies. It can be understood as a combination of three components: emotion, mood (enduring, less intense emotional states that are not necessarily tied to

6944-464: Is usually a manifestation of severe psychiatric distress that is often associated with a diagnosable and treatable form of depression or other mental illness. In a clinical setting, an assessment of suicidal risk must precede any attempt to treat psychiatric illness. The global estimated lifetime prevalence of bipolar disorder among adults range from 1 to 3 percent. The annual incidence is estimated to vary from 0.3 to 1.2 percent worldwide. According to

7068-494: Is very recurrent and results in severe disabilities, interpersonal relationship problems, barriers to academic, financial, and vocational goals, and a loss of social standing in their community, all of which increase the likelihood of suicide. Mixed symptoms and rapid-cycling, both very common in BP-II, are also associated with an increased risk of suicide. The tendency for BP-II to be misdiagnosed and treated ineffectively, or not at all in some cases, leads to an increased risk. As

7192-449: Is worse than symptom interference in other chronic medical illnesses such as cancer. This social impairment can last for years, even after treatment that has resulted in a resolution of mood symptoms. The factors related to this persistent social impairment are residual depressive symptoms, limited illness insight (a very common occurrence in patients with BP-II), and impaired executive functioning. Impaired ability in executive functions

7316-594: The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) . In addition, alternative diagnostic criteria is established in the World Health Organization's International Classification of Diseases-11th Revision (ICD-11)]. The diagnostic criteria are established from self-reported experiences from patients or their family members, the psychiatric assessment , and

7440-649: The ICD-11 , a BP-II patient will have experienced episodic experiences of one or more hypomaniac episodes and one or more major depressive episodes , and no history of a manic episode or mixed episode. These symptoms cannot be explained by other diagnoses such as: The specifiers are the same as the DSM-5 with the exception of catatonic features and if symptoms have occurred with or without psychosis about 6 weeks after childbirth . The signs and symptoms of BP-II may overlap significantly with those of other conditions. Thus,

7564-461: The Navon letters . The Navon task included a neutral affect comparison condition. Typically, neutral states cause broadened attention with a neutral stimulus. They predicted that a broad attentional scope could cause faster detection of global (large) letters, whereas a narrow attentional scope could cause faster detection of local (small) letters. The evidence proved that the appetitive stimuli produced

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7688-851: The Wayback Machine > and colleagues, persons with alexithymia have been shown to have correlations with increased suicide rates, mental discomfort, and deaths. Affect tolerance factors, including anxiety sensitivity, intolerance of uncertainty, and emotional distress tolerance , may be helped by mindfulness . Mindfulness is a mental state achieved by focusing one's awareness on the present moment, while calmly acknowledging and accepting one's feelings, thoughts, and bodily sensations without judgment. The practice of Intention, Attention, & Attitude. Mindfulness has been shown to produce "increased subjective well-being, reduced psychological symptoms and emotional reactivity, and improved behavioral regulation." The affective domain represents one of

7812-425: The glutamatergic system , and hormonal regulation play a role in the pathophysiology of the disease. The cause of Bipolar disorder can be attributed to misfiring neurotransmitters that overstimulate the amygdala, which in turn causes the prefrontal cortex to stop working properly. The bipolar patient becomes overwhelmed with emotional stimulation with no way of understanding it, which can trigger mania and exacerbate

7936-664: The mental status examination . In addition, Screening instruments like the Mood Disorders Questionnaire are helpful tools in determining a patient's status on the bipolar spectrum. In addition, certain features have been shown to increase the chances that depressed patients have a bipolar disorder, including atypical symptoms of depression like hypersomnia and hyperphagia , a family history of bipolar disorder, medication-induced hypomania, recurrent or psychotic depression , antidepressant refractory depression , and early or postpartum depression . According to

8060-431: The DSM-5, a patient diagnosed with BP-II will have experienced at least one hypomanic episode , at least one major depressive episodes , and no manic episode . Furthermore, the occurrence of the mood episodes are not better explained by schizoaffective disorder , schizophrenia , delusional disorder , or other specified or unspecified schizophrenia spectrum and other psychotic disorder. The final criteria that must be met

8184-477: The Implicit Positive and Negative Affect Test (IPANAT; Quirin, Kazén, & Kuhl, 2009). Affective responses, on the other hand, are more basic and may be less problematic in terms of assessment. Brewin has proposed two experiential processes that frame non-cognitive relations between various affective experiences: those that are prewired dispositions (i.e. non-conscious processes), able to "select from

8308-751: The World Mental Health Survey Initiative, the lifetime prevalence of BP-II was found to be 0.4%, with a 12-month prevalence of 0.3%. Other meta-analyses have found lifetime prevalence of BP-II up to 1.57%. In the United States, the estimated lifetime prevalence of BP-II was found to be 1.1%, with a 12-month prevalence of 0.8%. The mean age of onset for BP-II was 20 years. Thus far, there have been no studies that have conclusively demonstrated that an unequal distribution of bipolar disorders across sex and ethnicity exists. Affect (psychology) Affect , in psychology ,

8432-427: The amount of information available in memory, which also narrows attention so only the most proximal items or striking sources are encompassed in attentional scope. This narrowed attention leads intoxicated persons to make more extreme decisions than they would when sober. Researchers provided evidence that substance-related stimuli capture the attention of individuals when they have high and intense motivation to consume

8556-563: The book positively saying the authors, "brilliantly light a path to hope, understanding, and acceptance as they smash through the stigma of brain illness." HuffPost referred to Perfect Chaos as "honest, raw and inspiring." In an academic review, Charmaine Crockett, special projects coordinator at the Center on Disability Studies at the University of Hawaiʻi at Mānoa , examined Perfect Chaos for its criticism on mental healthcare for

8680-495: The case of a relapse, patients may experience new onset sleep disturbance, racing thoughts and/or speech, anxiety, irritability , and increase in emotional intensity. Family and/or friends may notice that patients are arguing more frequently with them, spending more money than usual, are increasing their binging on food, drugs, or alcohol, and may suddenly start taking on many projects at once. These symptoms often occur and are considered early warning signs. Psychosocial factors in

8804-406: The cognitive processes. Initially, researchers had thought that positive affects broadened the cognitive scope, whereas negative affects narrowed it. Thereafter, evidences suggested that affects high in motivational intensity narrow the cognitive scope, whereas affects low in motivational intensity broaden it. The construct of cognitive scope could be valuable in cognitive psychology. According to

8928-415: The color of the box the word was in compared to nondepressed students. Sadness (low motivational intensity) is usually associated with depression, so the more broad focus on contextual information of sadder students supports that affects high in motivational intensity narrow cognitive scope whereas affects low in motivational intensity broaden cognitive scope. The motivational intensity theory states that

9052-641: The context of their work. The modern conception of affect developed in the 19th century with Wilhelm Wundt . The word comes from the German Gefühl , meaning "feeling". A number of experiments have been conducted in the study of social and psychological affective preferences (i.e., what people like or dislike). Specific research has been done on preferences, attitudes , impression formation , and decision-making . This research contrasts findings with recognition memory (old-new judgments), allowing researchers to demonstrate reliable distinctions between

9176-515: The day, nearly every day. In children, this can present with an irritable mood. Most patients report significant fatigue , loss of energy, or tiredness. Patients or their family members may note diminished interest in usual activities such as sex, hobbies, or daily routines. Many patients report a change in appetite along with associated weight change. Sleep disturbances may be present, and can manifest as problems falling or staying asleep, frequent awakenings, excessive sleep, or difficulties getting up in

9300-566: The difficulties, it is important that BP-II individuals be correctly assessed so that they can receive the proper treatment. Antidepressant use, in the absence of mood stabilizers, is correlated with worsening BP-II symptoms. Multiple factors contribute to the development of bipolar spectrum disorders, although there have been very few studies conducted to examine the possible causes of BP-II specifically. While no identifiable single dysfunctions in specific neurotransmitters have been found, preliminary data has shown that calcium signal transmission,

9424-427: The difficulty of a task combined with the importance of success determine the energy invested by an individual. The theory has three main layers. The innermost layer says human behavior is guided by the desire to conserve as much energy as possible. Individuals aim to avoid wasting energy so they invest only the energy that is required to complete the task. The middle layer focuses on the difficulty of tasks combined with

9548-410: The effect of appetitive stimuli on narrowed attention. They also tested whether individual dissimilarities in approach motivation are associated with attentional narrowing. In order to test the hypothesis, the researchers used the same Navon task with appetitive and neutral pictures in addition to having the participants indicate how long since they had last eaten in minutes. To examine neural activation,

9672-732: The effects of depression. Bipolar disorder is characterized by marked swings in mood, activity, and behavior. BP-II is characterized by periods of hypomania, which may occur before, after, or independently of a depressive episode . Hypomania is the signature characteristic of BP-II, defined by an experience of elevated mood. A patient's mood is typically cheerful, enthusiastic, euphoric, or irritable. In addition, they can present with symptoms of inflated self-esteem or grandiosity, decreased need for sleep, talkativeness or pressured speech, flight of ideas or rapid cycling of thoughts, distractibility, increased goal-directed activity, psychomotor agitation, and/or excessive involvement in activities that have

9796-440: The efficacy of pharmacologic treatments for the hypomanic and depressive phases of BP-II. Thus, the current treatment guidelines for the symptoms of BP-II are derived and extrapolated from the treatment guidelines in BP-I, along with limited randomized controlled trials published in the literature. The treatment of BP-II consists of the following: treatment of hypomania, treatment of major depression, and maintenance therapy for

9920-604: The emotional reactions in picture priming. Instead of using an appetitive stimulus they used stimulus sets from the International Affective Picture System (IAPS). The image set includes various unpleasant pictures such as snakes, insects, attack scenes, accidents, illness, and loss. They predicted that an unpleasant picture would stimulate a defensive motivational intensity response, which would produce strong emotional arousal such as skin gland responses and cardiac deceleration. Participants rated

10044-436: The evidence for their efficacy in bipolar depression is mixed. Thus, in most cases, antidepressant monotherapy in patients with BP-II is not recommended. However, antidepressants may provide benefit to some patients when used in addition to mood stabilizers and antipsychotics, as these drugs reduce the risk of manic/hypomanic switching. However, the risk still exists, and should be used with caution. Although medication therapy

10168-452: The existence of moods from a variety of behavioral referents (Blechman, 1990). Habitual negative affect and negative mood is characteristic of high neuroticism. Positive affect and negative affect ( PANAS ) represent independent domains of emotion in the general population, and positive affect is strongly linked to social interaction. Positive and negative daily events show independent relationships to subjective well-being, and positive affect

10292-468: The field have attempted to find reliable differences between BP-I depressive episodes and episodes of major depressive disorder, but the data is inconsistent. However, some clinicians report that patients who came in with a depressive episode, but were later diagnosed as having bipolar disorder often presented with hypersomnia , increased appetite, psychomotor retardation , and a history of antidepressant -induced hypomania. Evidence also suggests that BP-II

10416-403: The flanking letters were different from the middle target letter. Both anger and fear have high motivational intensity because propulsion to act would be high in the face of an angry or fearful stimulus, like a screaming person or coiled snake. Affects which are high in motivational intensity, and thus are narrow in cognitive scope, enable people to focus more on target information. After seeing

10540-463: The focus is on relaxation and positive mood, or from the enjoyment of shared activities. The techniques used to shift a negative mood to a positive one are called mood repair strategies . Affect display is a critical facet of interpersonal communication . Evolutionary psychologists have advanced the hypothesis that hominids have evolved with sophisticated capability of reading affect displays. Emotions are portrayed as dynamic processes that mediate

10664-412: The following symptoms must be present: Inflated sense of self-esteem or grandiose thoughts, feeling well rested despite getting low amounts of sleep (3 hours), talkativeness, racing thoughts, distractibility, and increase in goal-directed activity or psychomotor agitation, or excessive involvement in activities with high risk of painful consequences. Per DSM-5 criteria, a major depressive episode consists of

10788-406: The frequency and severity of depressive episodes. Lithium prevents mood relapse and works especially well in BP-II patients who experience rapid-cycling. Almost all BP-II patients who take lithium have a decrease in the amount of time they spend ill and a decrease in mood episodes. Along with medication, other forms of therapy have been shown to be beneficial for BP-II patients. A treatment called

10912-414: The goal orientation of the athletes were significantly associated with alcohol use but not alcohol-related problems. In terms of psychopathological implications and applications, college students showing depressive symptoms were better at retrieving seemingly "nonrelevant" contextual information from a source monitoring paradigm task. Namely, the students with depressive symptoms were better at identifying

11036-478: The goal would be to avoid getting killed. Moving beyond just negative affective states, researchers wanted to test whether or not negative or positive affective states varied between high and low motivational intensity. To evaluate this theory, Harmon-Jones, Gable and Price created an experiment using appetitive picture priming and the Navon task, which would allow them to measure the attentional scope with detection of

11160-423: The importance of success and how this affects energy conservation. It focuses on energy investment in situations of clear and unclear task difficulty. The last layer looks at predictions for energy invested by a person when they have several possible options to choose at different task difficulties. The person is free to choose among several possible options of task difficulty. The motivational intensity theory offers

11284-479: The individual expressing the original emotion, as well as that individual's future emotions and behaviors. Emotion operates in cycles that can involve multiple people in a process of reciprocal influence. Affect, emotion, or feeling is displayed to others through facial expressions , hand gestures , posture, voice characteristics , and other physical manifestation. These affect displays vary between and within cultures and are displayed in various forms ranging from

11408-784: The individual must never have experienced a full manic episode . Otherwise, one manic episode meets the criteria for bipolar I disorder (BP-I). Hypomania is a sustained state of elevated or irritable mood that is less severe than mania yet may still significantly affect the quality of life and result in permanent consequences including reckless spending, damaged relationships and poor judgment. Unlike mania, hypomania cannot include psychosis . The hypomanic episodes associated with BP-II must last for at least four days. Commonly, depressive episodes are more frequent and more intense than hypomanic episodes. Additionally, when compared to BP-I, type II presents more frequent depressive episodes and shorter intervals of well-being. The course of BP-II

11532-437: The individual or accelerating mobilization. The arousal response is illustrated in studies focused on reward systems that control food-seeking behavior (Balleine, 2005). Researchers have focused on learning processes and modulatory processes that are present while encoding and retrieving goal values. When an organism seeks food, the anticipation of reward based on environmental events becomes another influence on food seeking that

11656-433: The individual's relation to a continually changing social environment. In other words, emotions are considered to be processes of establishing, maintaining, or disrupting the relation between the organism and the environment on matters of significance to the person. Most social and psychological phenomena occur as the result of repeated interactions between multiple individuals over time. These interactions should be seen as

11780-461: The left frontal-central region due to frustration. This statement was proved false because the research showed that dessert pictures increased positive affect even in hungry individuals. The findings revealed that narrowed cognitive scope has the ability to assist us in goal accomplishment. Later on, researchers connected motivational intensity to clinical applications and found that alcohol-related pictures caused narrowed attention for persons who had

11904-454: The letters were the same compared to when the middle letter is different. Other studies use a Navon attention task to measure difference in cognitive scope. A large letter is composed of smaller letters, in most cases smaller "L"'s or "F"'s that make up the shape of the letter "T" or "H" or vice versa. Broadened cognitive scope would be suggested by a faster reaction to name the larger letter, whereas narrowed cognitive scope would be suggested by

12028-400: The literary and disability community, as well as scholars in the mental health community. Glenn Close , whose sister was diagnosed with bipolar disorder in 2004, called said the book's "emotional transparency moved [Close] to [her] core and deepened [her] empathy for all those touched by mental illness". Kirkus Reviews said that the book is "a no-holds-barred 'biography of depression,' ...

12152-422: The literature has shown that psychotherapy plus pharmacotherapy was associated with a lower relapse rate compared with patients treated with pharmacotherapy alone. However, relapse can still occur, despite continued medication and therapy. People with bipolar disorder may develop dissociation to match each mood they experience. For some, this is done intentionally, as a means by which to escape trauma or pain from

12276-422: The majority of their lives with some symptoms, primarily stemming from depression . Their recurrent depression results in personal distress and disability. This disability can present itself in the form of psychosocial impairment, which has been suggested to be worse in BP-II patients than in BP-I patients. Another facet of this illness that is associated with a poorer prognosis is rapid cycling , which denotes

12400-593: The morning. Around half of depressed patients develop changes in psychomotor activity, described as slowness in thinking, speaking, or movement. Conversely, they may also present with agitation, with inability to sit still or wringing their hands. Changes in posture, speech, facial expression, and grooming can be observed. Other signs and symptoms include changes in posture and facial expression, slowed speech, poor hygiene, unkempt appearance, feelings of guilt, shame, or helplessness, diminished ability to concentrate, nihilistic thoughts, and suicidal ideation . Many experts in

12524-430: The most common psychiatric conditions associated with suicide. At least 25% to 50% of patients with bipolar disorder also attempt suicide at least once. Aside from lithium—which is the most demonstrably effective treatment against suicide—little is known about contributions of specific mood-altering treatments to minimizing mortality rates in persons with either major mood disorders or bipolar depression specifically. Suicide

12648-401: The most conservative estimate of lifetime prevalence of alcohol or other substance use disorders is 20%. In patients with comorbid substance use disorder and BP-II, episodes have a longer duration and treatment compliance decreases. Preliminary studies suggest that comorbid substance use is also linked to increased risk of suicidality. BP-II is diagnosed according to the criteria established in

12772-472: The most discrete of facial expressions to the most dramatic and prolific gestures. Observers are sensitive to agents' emotions, and are capable of recognizing the messages these emotions convey. They react to and draw inferences from an agent's emotions. The emotion an agent displays may not be an authentic reflection of their actual state (See also Emotional labor ). Agents' emotions can have effects on four broad sets of factors: Emotion may affect not only

12896-400: The most efficacy, while experimental doses of 400 mg have rendered little response. A large, multicenter trial comparing carbamazepine and lithium over two and a half years found that carbamazepine was superior in terms of preventing future episodes of BP-II, although lithium was superior in individuals with BP-I. There is also some evidence for the use of valproate and topiramate, although

13020-402: The occurrence of four or more major Depressive, Hypomanic, and/or mixed episodes in a 12-month period. Rapid cycling is quite common in those with BP-II, much more so in women than in men (70% vs. 40%), and without treatment leads to added sources of disability and an increased risk of suicide. Women are more prone to rapid cycling between hypomanic episodes and depressive episodes. To improve

13144-532: The person at whom it was directed, but also third parties who observe an agent's emotion. Moreover, emotions can affect larger social entities such as a group or a team. Emotions are a kind of message and therefore can influence the emotions, attributions and ensuing behaviors of others, potentially evoking a feedback process to the original agent. Agents' feelings evoke feelings in others by two suggested distinct mechanisms: People may not only react emotionally, but may also draw inferences about emotive agents such as

13268-551: The pictures based on valence , arousal and dominance on the Self-Assessment Manikin (SAM) rating scale. The findings were consistent with the hypothesis and proved that emotion is organized motivationally by the intensity of activation in appetitive or defensive systems. Prior to research in 2013, Harmon-Jones and Gable performed an experiment to examine whether neural activation related to approach-motivation intensity (left frontal-central activity) would trigger

13392-472: The presence of a depressed mood or loss of interest/pleasure in activities ( anhedonia ). In addition to the former symptoms, five out of the nine following symptoms must occur for more than two weeks (to the extent in which it impairs functioning): weight loss/gain, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue, feelings of worthlessness/inappropriate guilt, decreased concentration, or thoughts of death/suicide. Specifiers: According to

13516-474: The prevention of relapse of hypomania or depression. As BP-II is a chronic condition, the goal of treatment is to achieve remission of symptoms and prevention of self-harm in patients. Treatment modalities of BP-II include medication-based pharmacotherapy, along with various forms of psychotherapy. The most common pharmacologic agents utilized in the treatment of BP-II includes mood stabilizers , antipsychotics , and antidepressants . Mood stabilizers used in

13640-412: The required medication, and seeking help when needed to do well in the future. Treatment often lasts after remission is achieved, and the treatment that worked is continued during the continuation phase (lasting anywhere from 6–12 months) and maintenance can last 1–2 years or, in some cases, indefinitely. One of the treatments of choice is Lithium , which has been shown to be very beneficial in reducing

13764-420: The researchers used electroencephalography and recorded eye movements in order to detect what regions of the brain were being used during approach motivation. The results supported the hypothesis that the left frontal-central brain region is related to approach-motivational processes and narrowed attentional scope. Some psychologists were concerned that the individuals who were hungry had an increase in activity in

13888-675: The results for the use of gabapentin have been disappointing. Antipsychotics are utilized as a second line option for hypomanic episodes, typically indicated patients who do not respond to mood stabilizers. However, quetiapine is the only antipsychotic that has demonstrated efficacy in multiple meta-analyses of Randomized controlled trials for treating acute BP-II depression, and is a first-line option for patients with BP-II depression. Other antipsychotics that are used to treat BP-II include lurasidone , olanzapine , cariprazine , aripiprazole , asenapine , paliperidone , risperidone , ziprasidone , haloperidol , and chlorpromazine . As

14012-567: The risk of suicide is slightly higher in patients who have BP-II than those with BP-I. In results of a summary of several lifetime study experiments, it was found that 32.4% of BP-I patients experienced suicidal ideation or suicide attempts compared to 36% in BP-II patients. Bipolar disorders, in general, are the third leading cause of death in 15- to 24-year-olds. BP-II patients were also found to employ more lethal means and have more complete suicides overall. BP-II patients have several risk factors that increase their risk of suicide. The illness

14136-524: The seeming inability to focus on tasks. Because many of the symptoms of hypomania are often mistaken for high-functioning behavior or simply attributed to personality, patients are typically not aware of their hypomanic symptoms. In addition, many people with BP-II have periods of normal affect . As a result, when patients seek help, they are very often unable to provide their doctor with all the information needed for an accurate assessment; these individuals are often misdiagnosed with unipolar depression. BP-II

14260-537: The severity of aimlessness and disorganization. Speech may be rapid, but interruptible. Patients with hypomania never present with psychotic symptoms and do not reach the severity to require psychiatric hospitalization. For these reasons, hypomania commonly goes unnoticed. Individuals often will only seek treatment during a depressive episode, and their history of hypomania may go undiagnosed. Although hypomania may increase functioning, episodes require treatment as they may indicate increasing instability and can precipitate

14384-674: The substance. Motivational intensity and cue-induced narrowing of attention has a unique role in shaping people's initial decision to consume alcohol. In 2013, psychologists from the University of Missouri investigated the connection between sport achievement orientation and alcohol outcomes. They asked varsity athletes to complete a Sport Orientation Questionnaire which measured their sport-related achievement orientation on three scales—competitiveness, win orientation, and goal orientation. The participants also completed assessments of alcohol use and alcohol-related problems. The results revealed that

14508-443: The temperament of a highly reactive/low self-soothing infant may "disproportionately" affect the process of emotion regulation in the early months of life (Griffiths, 1997). Some other social sciences, such as geography or anthropology , have adopted the concept of affect during the last decade. In French psychoanalysis a major contribution to the field of affect comes from André Green . The focus on affect has largely derived from

14632-513: The three divisions described in modern psychology : the other two being the behavioral , and the cognitive . Classically, these divisions have also been referred to as the "ABC's of psychology", However, in certain views, the cognitive may be considered as a part of the affective, or the affective as a part of the cognitive; it is important to note that "cognitive and affective states … [are] merely analytic categories." "Affect" can mean an instinctual reaction to stimulation that occurs before

14756-484: The total stimulus array those stimuli that are causally relevant, using such criteria as perceptual salience, spatiotemporal cues, and predictive value in relation to data stored in memory" (Brewin, 1989, p. 381), and those that are automatic (i.e. subconscious processes), characterized as "rapid, relatively inflexible and difficult to modify... (requiring) minimal attention to occur and... (capable of being) activated without intention or awareness" (1989 p. 381). But

14880-405: The treatment of hypomanic and depressive episodes of BP-II include lithium , and the anticonvulsant medications valproate , carbamazepine , lamotrigine , and topiramate . There is strong evidence that lithium is effective in treating both the depressive and hypomanic symptoms in BP-II, along with the reduction of hypomanic switch in patients treated with antidepressants. Furthermore, lithium

15004-420: The two. Affect-based judgments and cognitive processes have been examined with noted differences indicated, and some argue affect and cognition are under the control of separate and partially independent systems that can influence each other in a variety of ways ( Zajonc , 1980). Both affect and cognition may constitute independent sources of effects within systems of information processing. Others suggest emotion

15128-526: The typical cognitive processes considered necessary for the formation of a more complex emotion. Robert B. Zajonc asserts this reaction to stimuli is primary for human beings and that it is the dominant reaction for non-human organisms. Zajonc suggests that affective reactions can occur without extensive perceptual and cognitive encoding and be made sooner and with greater confidence than cognitive judgments (Zajonc, 1980). Many theorists (e.g. Lazarus, 1982) consider affect to be post-cognitive: elicited only after

15252-484: The uninsured and underprivileged and stigma around mental illness. Crockett referred to the book as a welcome addition to the community, saying it enriches "the intersection between disability studies, mental health and literature." Bipolar II disorder Bipolar II disorder ( BP-II ) is a mood disorder on the bipolar spectrum , characterized by at least one episode of hypomania and at least one episode of major depression . Diagnosis for BP-II requires that

15376-520: The work of Deleuze and brought emotional and visceral concerns into such conventional discourses as those on geopolitics, urban life and material culture. Affect has also challenged methodologies of the social sciences by emphasizing somatic power over the idea of a removed objectivity and therefore has strong ties with the contemporary non-representational theory . Affect has been found across cultures to comprise both positive and negative dimensions. The most commonly used measure in scholarly research

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