W3: Depressive & Bipolar Disorders

Question 1

What are the mood disorders in the DSM

Answer 1

Unipolar depressive disorders and bipolar disorders

Question 2

What are the depressive disorders in the DSM

Answer 2

Major depressive disorder

Persistent depressive disorder (dysthymia)

Disruptive mood dysregulation disorder

Premenstrual dysphoric disorder

Question 3

What is major depressive disorder (MDD)? 

Answer 3

Clinically significant sadness with associated cognitive and somatic changes

It’s an episodic disorder with periods of normal mood in between periods of the depressed mood

Question 4

What is the DSM criteria for major depressive disorder

Answer 4

Need to have five or more of the following within the same two week period

Depressed mood most of the day, nearly every day
Markedly diminished interest or pleasure in all or almost all activities most of the day, nearly every day (anhedonia)
Significant weight loss or gain or increase/decrease in appetite
insomnia or hypersomnia nearly every day
Psycho motor agitation or retardation nearly every day
Fatigue or loss of energy nearly every day
Feelings of worthlessness or excessive or inappropriate guilt nearly every day
Diminished ability to think, concentrate, or indecisiveness nearly every day
Recurrent thoughts of death, suicidal ideation, suicide attempt or plan

Causes clinically significant distress, not attributable to substances or other medical conditions or mental disorder

There has never been a manic or hypomanic episode!!!!!!


Question 5

What is the prevalence of MDD

Answer 5

14.4%

Question 6

What is the mean onset of MDD

Answer 6

The main age of onset is 30.5 but this age seems to be decreasing this could be because people are becoming more aware and are willing to seek help earlier

Question 7

Are there any gender differences in MDD

Answer 7

There are higher rights in women but is this a genuine reflection of prevalence or are women socialised to get help

Question 8

Explain relapse in MDD

Answer 8

The risk of relapse is high but it is lowered went successfully completing CBT compared with medication

Question 9

What is suicide ideation

Answer 9

Thoughts about ending your life this is common in depression

Question 10

What is suicide attempt

Answer 10

An attempt was made to end your life but it is not completed

Women attempt suicide more than men

Question 11

What is suicide

Answer 11

Successful death from a suicide attempt

Completed suicides are more likely in men

Question 12

What is nonsuicidal self injury

Answer 12

The aim is to cause harm for not to die there may be a range of reasons for this but the main one seen is a release of pain

Question 13

Differential diagnosis between bipolar and major depressive disorder

Answer 13

When you have someone with a major depressive episode it is important to always assess for a history of mania and or hypo mania - if the patient has had a manic or hypomanic episode it will exclude them from a diagnosis of MDD

Question 14

What does the DSM say about persistent depressive disorder (dysthymia)?

Answer 14

Depressed mood for most of the day, for more days the not, as indicated by subjective account or observation by others, for at least two years

Two or more of the following: 
Poor appetite or over eating
Insomnia or hypersomnia
Low energy or fatigue
Low self-esteem
Poor concentration or difficulty making decisions
Feelings of hopelessness

During the two year period the individual has not been without symptoms for more than two months at a time

There has never been a manic or hypomanic episode

The disturbance is not better explained by schizoaffective disorder, schizophrenia, delusional disorder, other psychotic disorder

Not due to substances or medical conditions and cause clinically significant distress or impairment

Question 15

What is Persistent depressive disorder (dysthymia)?

Answer 15

A mild but long-term form of depression.
Dysthymia is defined as a low mood occurring for at least two years, along with at least two other symptoms of depression.

Question 16

Individuals with MDD and PDD often experience comorbidity disorders such as

Answer 16

Anxiety disorders
Substance use disorders
Personality disorders (borderline & dependent)

Question 17

Explain the specifier of MDD and PDD of anxious distress

Answer 17

2 of the following;
Feeling keyed up or tense
Feeling unusually restless
Difficulty concentrating because of worry
Fear that something awful might happen
Feeling that the individual might lose control of himself or herself

Question 18

Explain the specifier of MDD and PDD of mixed features

Answer 18

3 manic/hypomanic symptoms:
Elevated, expansive mood
Inflated self-esteem or grandiosity
More talkative than usual or pressure to keep talking
Flight of ideas or subjective experience that thoughts are racing
Increase in energy or goal directed energy
Increased or excessive involvement in activities that have a high potential for painful consequences
Decreased need for sleep 

Question 19

Explain the specifier of MDD and PDD of melancholic features

Answer 19

1 of the following when episode is most severe

• loss of pleasure in all, or almost all, activities
• loss of reactivity to usually pleasurable stimuli

3+:
– Depressed mood characterised by profound despondency, despair, and or empty mood
– Depression that is regularly worse in the morning
– Early-morning awakening
– Marked psychomotor agitation or retardation
- Significant anorexia or weight gain
– Excessive or inappropriate guilt

Question 20

Explain the specifier of MDD and PDD of atypical features

Answer 20

Mood reactivity (mood brightens in response to actual or potential positive events)

2 or more:
Significant weight gain or increasing appetite
Hypersomnia
Leaden paralysis (heavy feelings in arms and legs)
A long-standing pattern of interpersonal rejection sensitivity that results in significant social occupational impairment

Criteria is not met with melancholic features or with catatonia

Question 21

Explain the specifier of MDD and PDD of psychotic features

Answer 21

Delusions and hallucinations are present

With mood congruent psychotic features, content is consistent with depressive themes

• inadequacy
• guilt
• disease
• death
• deserved punishment

With mood incongruent psychotic features, content is not consistent with depressive themes

Question 22

Explain the specifier of MDD (only) of Catalonia?

Answer 22

Catatonic features
dominated by 3 or more:
- stupor (no psychomotor activity, not actively relating to the environment)
- catalepsy (passive induction of a posture held against gravity)
- waxy flexibility (slight, even resistance to positioning by the examiner)
- mutism (no, or little verbal message)
- negativism (opposition or no response to instructions or external stimuli)
- posturing (spontaneous and active maintenance of a posture against gravity)
- mannerism (odd, circumstantial caricature of normal actions)
- stereotypy (repetitive, abnormally frequent, non-goal directed movements)
- agitation (not influenced by external stimuli)
- grimacing (pulling unusual faces)
- echolalia (mimicking others speech)
- echopraxia (mimicking others movement)

Question 23

Explain the specifier of MDD and PDD of peripartum onset

Answer 23

Onset of symptoms occurs during pregnancy or in the 4 weeks following delivery

Question 24

Explain the specifier of MDD (only) of seasonal pattern

Answer 24

There has been a regular temporal relationship between the onset of major depressive episodes and a particular time of the year
- usually autumn and winter 
See full remission occur at characteristic times of the year usually spring and summer

This pattern needs to be seen for at least two years and seasonal episodes need to outnumber non-seasonal episodes

Question 25

Are there any criticisms to these PDD and MDD specifiers

Answer 25

Not well validated - seasonal pattern is probably the most well researched and validated

Question 26

What is the paediatric diagnosis of depression

Answer 26

Disruptive mood dysregulation disorder – diagnosed in children from 6 to 18 years

Question 27

What is disruptive mood dysregulation disorder

Answer 27

Characterised by persistent irritability and frequent episodes of extreme out of control behaviour – included to address concerns about over diagnosis of bipolar disorder in kids

Question 28

What does the DSM say about disruptive mood dysregulation disorder

Answer 28

Severe recurrent temper outburst manifested verbally and or behaviourally but are grossly out of proportion in intensity or duration to the situation or provocation The temple outbursts are inconsistent with their developmental level (out this characteristic of a three-year-old would be concerning seen in a 17-year-old) The temper outbursts occur on average three or more times per week  The mood between temper outbursts is persistently irritable or angry most of the day, nearly every day, and is observable by others Present for more than 12 months and throughout this time the individual has not had a period lasting three or more months without symptoms Severe outbursts and irritable or angry mood in between are present in at least two settings for example at home and at school and are severe in at least one of these

Question 29

What are the bipolar disorders in the DSM

Answer 29

Bipolar I Bipolar II Cyclothymic disorder 

Question 30

What are bipolar disorders

Answer 30

The bipolar disorders are characterised by the presence of a manic or hypomanic episode

Question 31

What are manic or hypomanic episodes

Answer 31

There are periods of intense elation and/or irritation

Question 32

What is the difference between bipolar I and bipolar II

Answer 32

The main difference between bipolar 1 and bipolar 2 disorders lies in the severity of the manic episodes caused by each type. A person with bipolar 1 will experience a full manic episode, while a person with bipolar 2 will experience only a hypomanic episode (a period that's less severe than a full manic episode).

Question 33

What is the DSM criteria for manic episode

Answer 33

Period of abnormal and persistent elevated, expansive, irritable mood and increase goal directed activities or energy, lasting at least one week (or any duration of hospitalisation is required) 3+ of following noticeable change from usuals behaviour: -Inflated self-esteem or grandiosity – Decreased need for sleep – More talkative than usual or pressure to keep talking – Flight of ideas or subjective experience that thoughts are racing usually evident in speech -Distractibility – An increase in goal directed behaviour or psychomotor agitation -Excessive involvement in activities that have a high potential for painful consequences Severe enough to cause marked impairment in functioning or to necessitate hospitalisation to prevent harm to self or others – symptoms not due to substance or other medical condition 

Question 34

What is the DSM criteria for bipolar II

Answer 34

This is a more mild version of bipolar I The DSM criteria states that criteria have been met for at least one hypomanic episode and at least one major depressive episode There has never been a manic episode

Question 35

What does the DSM say for a hypomanic episode

Answer 35

abnormally and persistently elevated, expansive or irritable mood and increased goal directed activity or energy lasting at least four consecutive days three of the following are present to a significant degree -Inflated self-esteem or grandiosity -Decreased need for sleep – More talkative than usual or pressure to keep talking – Flight of ideas or subjective experience that thoughts are racing -Distractibility -Increased in goal directed behaviour or psychomotor agitation -Excessive involvement in activities that have a high potential for painful consequences equitable change in functioning that is uncharacteristic of the individual were not symptomatic The disturbance in mood and the change in functioning is observable to others The episode is NOT severe enough to cause marked impairment in social or occupational functioning or two necessitate hospitalisation Not attributable to the Physiological effects of a drug

Question 36

What does the DSM say about cyclothymic disorder

Answer 36

Akin to persistent depressive disorder in the depressive disorders is a chronic disorder For at least two years or one year in children or adolescence, there has been numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic episode in numerous periods with depressive symptoms that do not meet criteria for major depressive episode During this time the hypomanic or depressive episodes have been present for at least half the time and the individual has not been without symptoms for more than two months at a time

Question 37

When is the typical onset of bipolar spectrum disorders

Answer 37

Most people develop symptoms before the age of 25

Question 38

why are suicide rates so high in the bipolar spectrum disorders

Answer 38

They may do things in manic episodes that are then reflected on episodes of depression

Question 39

Why are individuals with bipolar spectrum disorders often reluctant to take medication

Answer 39

They may receive a sense of achievement due to the mania productivity and feel this is a loss if they take medication but they are happy that depressive symptoms ease

Question 40

Explain the specifier rapid cycling

Answer 40

Can be applied to bipolar I or II Presence of at least 4 mood episodes in the previous 12 months that meet criteria for manic, hypomanic or major depressive episode – basically faster turnaround between the episodes

Question 41

Are there any genetic links in depression

Answer 41

Twin studies demonstrate that about 30 to 40% of the variance in depression is accounted for by genetics

Question 42

Is bipolar heritable

Answer 42

Twin studies demonstrate that bipolar is highly heritable up to 90%

Question 43

Explain the role of dopamine in depressive disorders

Answer 43

Dopamine is involved in the reward system of the brain this is involved in pleasure, motivation and energy there is evidence that people with depression have reduced dopamine

Question 44

Explain the role of serotonin in depressive disorders

Answer 44

Serotonin is involved in the regulation of emotional reactions it is hypothesised that people with a vulnerability to depression have serotonin receptors that are less sensitive than others without such a vulnerability

Question 45

Explain dopamine in bipolar

Answer 45

Increasing dopamine levels leads to manic symptoms It is hypothesised that in bipolar disorder dopamine receptors are too sensitive and you can be genetically predisposed to this as well which may point more towards the genetic link of bipolar 

Question 46

Explain brain functioning in depressive disorders

Answer 46

Brain imaging studies show that people with depressive symptoms demonstrate changes in brain functioning Such as elevated amygdala which is for emotional responses as well as elevated anterior cingulate  May also see diminished hippocampus activity for memory and dorsolateral pre-frontal cortex activity for higher order thinking such as decision-making planning and motivation

Question 47

Explain brain functioning in bipolar

Answer 47

Similar to depression but in mania the striatum aka basal ganglia is also implicated

Question 48

Explain endocrine models for depressive disorders

Answer 48

The amygdala regulates the HPA axis and the HPA axis triggers cortisol - there is a link between depression and high levels of cortisol

Question 49

What is the triple vulnerability theory of bipolar and depressive disorders

Answer 49

Biological vulnerability such as genes, psychological vulnerability such as coping skills, and stressful life events such as trauma all combine and lead to …. physiological effects such as the release of stress hormones, cognitive effects such as depression negative thoughts hopelessness etc and mania such as inflated self belief and impulsivity and social effects such as increased difficulty in relationships and reduce support all of these lead to bipolar or depressive disorder

Question 50

What medications are there for depressive disorders

Answer 50

SSRIs - is the most common and stop serotonin from being reabsorbed so that it can be used for longer However it does take 4 to 6 weeks to work and symptoms can return when medication is withdrawn

Question 51

What are the medical treatments for depression

Answer 51

ECT or electroconvulsive therapy It involves inducing a mild seizure by sending an electric current through the brain. The aim is to disrupt the circuitry of the brain and is only used in extreme cases for medication resistant depression – Often short-term confusion and memory loss associated TMS Involves a magnet over the brain that provides a pulse to the dorsolateral pre-frontal cortex it is less invasive than ECT and has emerging evidence in the treatment of depression

Question 52

What medication is there for bipolar disorders

Answer 52

Medication is the first line of treatment for bipolar Mood stabilisers are the most common E.g. Lithium toxic and requires ongoing monitoring of blood levels - not an easy medication to take and may be problems with compliance There will also still be residual symptoms that often persist despite the adequate use of medication

Question 53

What is the cognitive model of depression

Answer 53

Maintained by distorted thinking - automatic thoughts, assumptions and core beliefs This model states if you change distorted thinking you improve mood and reduce depressive behaviours Core beliefs, assumptions and automatic thoughts lead to a reaction whether emotional behavioural and physiological

Question 54

Give an example of the cognitive model of depression

Answer 54

The situation is a friend doesn’t return your call Your core belief is that you’re worthless Your assumption is that if you are not popular then you’re nothing And your automatic thought to your friend not returning your call is that she hates you Your reaction to this may be: Emotional-anxious and sad Behavioural – delete friend off of Facebook Physiological – tense

Question 55

So what is cognitive behavioural treatment for depression

Answer 55

Getting the client to look at evidence for and against the belief - aim is to develop a more adaptive way of thinking (not positive thinking, rational thinking) Behavioural activation is the main behavioural treatment for depression this involves getting the client to gradually engage in more and more activities over time 

Question 56

What is CBT for bipolar disorders

Answer 56

Treatment interventions differ according to the current mood state - depressed: CBT treatment for depression with behavioural activation and thought challenging - manic: usually hospitalisation is required Psychologist = enhance compliance with medications by psycho education and helping them to understand benefits They also may be able to help prevent relapse through circadian rhythm management, sleep, exercise, diet, stress management