AB: Mood Disorders Flashcards
(121 cards)
1
Q
Differ mood from emotions
A
Emotions are a shorter duration, emotions are usually pointed towards an object, mood usually bias cognition while emotion often bias cognition and (immediate) action.
2
Q
Contrast two theories of mood
A
Feeling theory: moods are just “raw” feelings (objectless)
Dispositional theory: Mood generates cognitions and mood-congruent appraisals
sad mood: perceiving situation as uncontrollable,
angry mood: perceiving situation as threatening
3
Q
When are they consider a disorder?
A
When they cause clinically significant distress or dysfunction in social, occupational or other important areas of functioning and it isn’t caused by an external substance.
4
Q
Give the different “poles” of mood in order
A
Mania Hypomania Normal elation Neutral mood Normal sadness Mild- moderate depression Major depressive disorder
5
Q
What is the difference between unipolar and bipolar
A
Unipolar is when you only experience the extremes of one pole, bipolar is when you fluctuate between the two
6
Q
List GAD, Bipolar, Dysthmia, MDD, Social phobia, Agoraphobia, Panic, Specific disorder in order of prevalence (reasonably well)
A
Major depression Social Phobia Specific Phobia Generalised anxiety disorder Panic Dysthymia Bipolar Agoraphobia
7
Q
Does depression have:
1) High recovery rate, high relapse rate
2) High recovery rate, low relapse rate
3) Low recovery rate, High relapse rate
4) Low recovery rate, Low relapse rate
A
High recovery, High relapse
8
Q
Why may there be a high recovery rate
A
Depression is seen as cyclic
9
Q
What are the DSM requirements of depression?
2 affect, 4 physical, 3 cognitive
A
5 or more symptoms nearly every day, most of the day, at least 2 weeks: (Affect)
1. Sad mood OR
2. Loss of interest or pleasure (anhedonia)
PLUS 3 or 4 of the following:
(Physical)
3. Poor appetite and weight loss, or increased appetite and weight gain
4. Loss of energy
5. Psychomotor retardation or agitation
6. Sleeping too much or too little
(Cognitive)
7. Feelings of worthlessness or excessive guilt
8. Difficulty concentrating, thinking, or making decisions
9. Recurrent thoughts of death or suicide
10
Q
What is required for Persistent depressive disorder and give another name for it
A
Dysthymia:
Depressed mood for at least 2 years (>1/2 of days)
(Combines DSM-IV Dysthymia & MDD, chronic subtype)
PLUS 2 other symptoms:
• • • • •
Feelings of hopelessness
Sleeping too much or too little
Poor appetite or overeating
Trouble concentrating or making decisions Poor self-esteem
11
Q
What problems do biological theories of treatment for depression focus on and give a rating of the evidence behind it
A
Problems: Serotonin, dopamine
Intervention: EG SSRI, ECT
Evidence: +++
12
Q
What problems do Psychodynamic theories of treatment for depression focus on and give a rating of the evidence behind it
A
Problems: Grief over loss
Intervention: Acceptance and mourning
Evidence: +/-
13
Q
What problems do Behaviourism/ Learning theories of treatment for depression focus on and give a rating of the evidence behind it
A
Problems: E.g anhedonia
Intervention: E.g behavioural Activation, activity scheduling
Evidence: ++
14
Q
What problems do cognitive theories of treatment for depression focus on and give a rating of the evidence behind it
A
Problems:Negative triad, hopelessness, rumination
Intervention: CT, MBCT, IPT
Evidence: +++
15
Q
What problems does Cognitive Behavioural Therapy treatment for depression focus on and give a rating of the evidence behind it
A
Problems:Various
Intervention: Various
Evidence: +++
16
Q
What is the regular cyclic thought process according to CBT?
A
Situation.
Automatic negative thought
Negative feeling
Behaviour (nothing), which loops back to negative feeling
17
Q
How does CBT work on this?
A
By identifying these thought habits, challenging them and being aware of them and changing behaviour (reward encouraging behaviour)
18
Q
List the process of stepped care
A
- Psychoeducation (tell them about the illness)
- Meta-analyses: most psychotherapies equally effective
- Anti-depressants:
- Only sever depression, then just as effective as psychotherapy
- Overprescription - Intensification or Electroconvulsive therapy
19
Q
How does the neurobiological model explain suicide? (3)
A
- Heritibility of 48% for suicide attempts
- Low levels of serotonin
- Overly reactive HPA system
20
Q
How does the psychological model explain suicide? (3)
A
- Problem solving deficit
- Hopelessness
- Life satisfaction
21
Q
How does the Social model explain suicide? (3)
A
- Economic recessions
- Media reports of suicide
- Social isolation and lack of social belonging
22
Q
What are the Affect symptoms of (Hypo)mania (Criterion A DSM)?
A
- A distinct period of abnormally and persistently elevated or irritable mood:
- at least 1 week or hospitalisation -> mania
- at least 4 days -> hypomania
23
Q
What are the Cognitive symptoms of (Hypo)mania (Criterion B DSM)?
A
During this period, at least 3 (4 if only irritable):
Inflated self-esteem or grandiosity
Decreased need for sleep (e.g. feels rested after three hours of sleep)
More talkative than usual or pressure to keep talking
Flight of ideas or subjective experience that thoughts are racing
24
Q
What are the Physical symptoms of (Hypo)mania (Criterion B DSM)?
A
Distractibility
Physical
Increase in goal-directed activity or psychomotor agitation
Excessive involvement in pleasurable, risky activities
25
What is required for Bipolar 2 but not bipolar 1 and vice versa
Major depressive episode needed in bipolar 2, mania rather than hypomania in bipolar 1, if they've experienced one mania episode in their life it's bipolar 1.
26
What is the percentage heritability of bipolar? Also what biological neurotransmitters is it concerned with?
92% heritability, serotonin/ dopamine
27
What psychological trait is characteristic of those with bipolar disorder?
Reward sensitivity
28
What else may cause BPD?
Major life event- Sleep deprivation
29
What medications may be taken for bipolar disorder and what are their effects?
Lithuum- (mood stabilising) if intolerable
Anticonvulsant (anti seizure) or
Antipsychotic
Mania is hard to treat
30
What kind of therapy is usually used for bipolar and how does this help?
Cognitive therapy
- Depression
- Problem-solving Recognizing symptoms
31
What is Premenstrual dysphoric disorder?
Mood symptoms in the week before before menses
32
What is disruptive mood dysregulation disorder?
Severe recurrent temper outbursts and persistent neg- ative mood for at least 1 year beginning before age 10
33
What is Cyclothymia
Recurrent mood changes from high to low for at least 2 years, without hypomanic or depressive episodes
34
what physical symptoms are common in depression?
fatigue and low energy as well as physical aches and pains. Although peo- ple with depression typically feel exhausted, they may find it hard to fall asleep and may wake up frequently. Sexual interest disappears
35
What is meant by psychomotor retardation and what would be an opposite symptom also typical of depression?
Thoughts and movements may slow but others cannot sit still—they pace, fidget, and wring their hands (psychomotor agitation).
36
Why is MDD an episodic disorder?
because symptoms tend to be present for a period of time and then clear before reoccurring.
37
Describe some environmental factors which may impact depression rates (3-5)
People in worse socioeconomic situations experience it more, distance from the equator (winter depression or seasonal affective disorder are higher farther from the equator), there is a robust negative correlation with fish consumption and levels of depression. Income disparity, family cohesion and mental health stigma also play a role.
38
What biological and social factors may explain the gender difference in depression?
Gonadal hormones. More frequent sexual abuse, more exposed to chronic stressors such as poverty and caretaker responsibilities, the cost of caring, social roles and body image, emotion based coping is encouraged in women while action based (sport) coping is encouraged in men to shake off the feeling
39
What effect could exposure to childhood and chronic stressors, as well as the effects of female hormones have on a woman biologically
could change the reactivity of the hypothalamic-pituitary-adren
40
How may different life events evoke depression in men and women
Men are more likely than women to become depressed after life events involving financial or occupational stress, whereas women are more likely than men to become depressed after inter- personal life events
41
What biological explanation is there for winter blues?
changes in the levels and timing of melatonin release in the brain. Melatonin is exquisitely sensitive to light and dark cycles and is only released during dark
periods.
42
Give two other possible explanation for seasonal affective disorder
For mammals living in the wild, a slower metabolism in the winter could have been a lifesaver during periods of scarce food, Hibernation in animals typically involves sleeping long hours, along with lowered appetite and energy. People may respond to this self critically.
43
What type pf treatment is specific to winter blue (along with CBT and medication)
30 minutes of bright light each morning as with fluoxetine (Prozac)
44
Name some conditions depression is comorbid with
Anxiety (60%), substance, sexual dysfunction and personality disorder
45
What other health problems does depression increase risk for?
There is particularly strong evidence that depression is related to the onset and more severe course of cardiovascular disease.Depression is related to a more than twofold increase in the risk of death from cardiovascular disease, even after controlling for baseline cardiovascular health (
46
Name the differences in a manic and hypomanic episode
Manic lasts 1 week, (HM: 4 days) include hospitalisation or psychosis and symptoms cause significant distress or functional impairment. In hypomania the changes are observable to others but impairment is not marked.
47
What are the requirements for cyclothymic disorder?
For at least 2 years (or 1 year in children or adolescents):
• Numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic episode
• Numerous periods with depressive symptoms that do not meet criteria for a major depressive episode
The symptoms do not clear for more than 2 months at a time.
Criteriaforamajordepressive,manic,orhypomanicepisode have never been met.
Symptoms cause significant distress or functional impairment.
48
Does depression or bipolar disorder recur more
Bipolar
49
What is often comorbid with bipolar disorder?
Anxiety (2/3) and substance abuse
50
What disorder was found to have the highest rate of suicide? What other health risks are associated with this disorder?
Bipolar disorder, bipolar disorder has been found to relate to dying an average of 8.5 to 9 years earlier than those in the general population, , with esti- mates that the risk of death from cardiovascular disease is twice as high for those with bipolar disorder compared with the general population.
51
True or false- Mania stirs creativity
Apparently false
52
How does the activation of the stratum in response to reward differ between depression and bipolar disorder
Diminished in depression, elevated in bipolar
53
How is the cortisol awakening response in MDD and BD
Elevated in MDD and in those with depression in BP
54
Compare the heritability between depression and bipolar
more careful studies of MZ (identical) and DZ (fraternal) twins yield heritability estimates of .37 for MDD. Heritability estimates are higher when researchers study more severe samples. Bipolar disorder is among the most heritable of disorders. One sample obtained a heritability estimate of .93
55
what disorder overlaps a lot with bipolar disorder in respect to CNVs and SNPs (genes)
Schizophrenia
56
When examining a narrower set of genetic loci what factors has genetic loci involved with MDD also been involved in?
MDD has been tied to genetic loci involved in serotonin and glutamate function
57
When examining a narrower set of genetic loci what factors has genetic loci involved with Bipolar disorder also been involved in?
Bipolar disorder has been related to genetic polymorphisms relevant to serotonin and to multiple pathways that help regulate neurotransmitter function
58
How can genes and environment interact in MDD?
a polymorphism of the serotonin transporter gene does appear to be related to MDD. Caspi and colleagues found that those who had the short-short allele or the short-long allele combinations of the serotonin transporter gene were at risk for depression— but only if they also experienced childhood maltreatment (*Interpersonal* stressful events.)
59
What other risk factors for depression has this gene been linked to? What other gene has similar findings been linked to?
Key brain regions and negative cognitive tendencies, Similar findings have emerged for CRH1, a gene involved in guiding the reactivity of the cortisol system, which appears related to depression only among those with a history of child abuse
60
Name three neurotransmitters studied in relation to depression and in what way do new models focus on the role of neurotransmitters in disorders?
Serotonin, norepinephrine and dopamine. recent models have focused on the idea that mood disorders might involve changes in receptors that respond to the presence of neurotransmitters in the synaptic cleft
61
What effect does trycyclic antidepressant drugs have on norepinephrine or serotonin
block the reuptake process in synaptic transmission so that more neurotransmitter reaches the receptor.
62
What evidence is there to support dopamine is involved in mood disorders?
People with depression are less responsive than other people are to drugs that increase dopamine levels. Among people with bipolar disorder, drugs that increase dopamine levels have been found to trigger manic symptoms
63
What has new research on stress shown?
stress may lead to changes in the sensitivity of serotonin receptor
64
Name five neural regions, involved in emotion and reward processing, that are studied in regards to MDD and BP and determine whether the activity levels are elevated or diminished in both mania and Depression
Elevated in both: Amygdala, Anterior cingulate.
Diminished in regions of prefrontal cortex and hippocampus.
Striatum: Diminished in depression and elevated in mania. These are likely what makes a person vulnerable to depression rather than caused by it
65
What is disturbances in the anterior cingulate and the hippocampus and several regions of the prefrontal cortex related to?
effective emotion regulation.
66
How might these findings fit together?
One theory is that the over-activity in the amygdala during depression is related to oversensitivity to emotionally relevant stimuli. At the same time, systems involved in regulating emotions are compromised (the anterior cingulate, the hippo- campus, and regions of the dorsolateral prefrontal cortex).
67
What is diminished activation of the striatum related to?
responding and mobilizing to rewards
68
What specific region of the striatum has a specific role?
A specific region of the striatum (called the nucleus accumbens) is a central component of the reward system in the brain and plays a key role in motivation to pursue rewards
69
When is cortisol secreted, what effect does this have and how is this related to mood disorder?
there is evidence that the amygdala is overly reactive among people with MDD, and the amygdala sends signals that activate the HPA axis. The HPA axis triggers the release of cortisol, the main stress hormone. Cortisol is secreted at times of stress and increases the activity of the immune system to help the body prepare for threats. Various findings link depression to high cortisol levels.
70
What does CAR stand for, what does it mean and how is it related to depression?
Cortisol has very strong diurnal rhythms, and research suggests that this rhythm may be important to consider in depression. Cortisol levels increase sharply as people wake and then in the 30–40 minutes after waking, a pattern that is called the cortisol awakening response (CAR.) a larger CAR at study baseline was related to higher risk of a major depressive episode over the next two and a half years.
71
How can higher levels of cortisol explain smaller hippo campuses in those with depression?
prolonged high levels of cortisol can cause harm to body systems. For example, long-term excesses of cor- tisol have been linked to damage to the hippocampus—this may help explain findings we noted above of smaller-than-normal hippocampus volume among people who have experi- enced depression for years.
72
What type off stressors are particularly likely to trigger depressive episodes?
Interpersonal loss or humiliation
73
Name two social diatheses for depression
Lack of social support and diatheses
74
What is meant by expressed emotion? (EE) How is this related to depression?
a family member’s critical or hostile comments toward or emotional over-involvement with the person with depression. High EE strongly predicts relapse in depression.
75
What do medical conditions often trigger elevations of that could be linked to the onset of depression?
Cytokines, In the short term, this inflammation is adaptive however prolonged exposure has been linked to depression depending on how well and quickly they recover from the influence of pro-inflammatory cytokines
76
What personality trait is linked to depression?
Neuroticism
77
Name three cognitive theories regarding depression
Beck's theory, hopelessness theory and rumination theory
78
What is the negative triad in Beck's theory
negative views of the self, the world, and the future, which is acquired through negative and stressful experiences.
79
When is this negative schema activated and what effect does it have?
The negative schema is activated whenever the person encounters situations similar to those that originally caused the schema to form. Once activated, negative schemas are believed to cause information-processing biases making them process and focus on negative information more.
80
According to the hopelessness theory what attributional styles are more likely to lead to hopelessness and therefore depression?
Negative life events are due to stable, or permanent (rather than unstable, temporary) and global, or relevant to many life domains (rather than specific, limited to one area)
81
What is meant by rumination theory
Rumination, a tendency to repetitively dwell on sad experiences and
thoughts, or to chew on material again and again, especially brood regretfully about why a sad event happened may increase the risk for depression
82
What two factors have been found to predict mania over time?
Reward sensitivity and sleep deprivation
83
Why is there often failure to diagnose bipolar disorder?
Because patients are more likely to seek treatment during depression than mania, and providers often do not ask about prior mania, it typically takes about 7 years after the first episode for those with bipolar disorder to receive the correct diagnosis
84
Name the four therapies listen under psychological treatment of psychology
Interpersonal psychotherapy, cognitive therapy, behavioural Activation (BA) therapy and Behavioural couples therapy
85
What is the core of interpersonal psychotherapy
to examine major interpersonal problems, such as role transitions, interpersonal conflicts, bereavement, and interpersonal isolation.
86
What does interpersonal therapy typically consist of? What techniques are often utilised?
Typically, the therapist and the patient focus on one or two such issues, with the goal of helping the person identify his or her feelings about these issues, make important deci- sions, and effect changes to resolve problems related to these issues. Techniques include dis- cussing interpersonal problems, exploring negative feelings and encouraging their expression, improving communications, problem solving, and suggesting new and more satisfying modes of behavior.
87
How does cognitive therapy begin?
the client is taught to understand how powerfully our thoughts can influence our moods and to see that the negative self-talk that they engage in day by day contributes to their low mood. To help increase aware- ness of the connection between thoughts and their mood, the client might be asked to com- plete daily monitoring homework that involves recording their negative thoughts throughout the week.
88
When a client states something that suggests worthlessness, how does the therapist combat this?
Helps the client look for evidence that contradicts the statement such as abilities that the person is overlooking or discounting. The therapist then teaches the person to challenge negative beliefs and to learn strategies that promote making realistic and positive assumptions
89
What behavioural technique does Beck include in cognitive therapy?
behavioral activation (BA) in which people are encouraged to engage in pleasant activities that might bolster positive thoughts about one’s self and life
90
In CT and IPT what can prevent relapse
IPT- continued therapy when the person leaves, CT- the strategies the person learns in therapy
91
What adaption of cognitive therapy is focused on preventing relapse after successful treatment? What assumption is this based on?
mindfulness-based cognitive therapy (MBCT.) MBCT is based on the assumption that a person becomes vulnerable to relapse because of repeated associations between sad mood and patterns of self-devaluing, hopeless thinking during major depressive episodes
92
What is involved in MBCT?
recognising when they start to feel sad and to try adopting what can be called a “decentered” perspective—viewing their thoughts merely as “mental events” rather than as core aspects of the self or as accurate reflections of reality
93
What risk factors have been associated with success in MBCT
MBCT has been found to be helpful for people with three or more episodes and a history of childhood trauma
94
What idea in behavioural activation therapy based on?
many of the risk factors for depression interfere with receiving positive rein- forcement
95
What is usually included in psychoeducational approaches?
Psychoeducational approaches typically help people learn about the symptoms of the disorder, the expected time course of symptoms, the biological and psychological triggers for symptoms, and treatment strategies.
96
What is the effect of psychoeducational approaches?
education about bipolar disorder can help people adhere to treatment with medications such as lithium. This is an important goal because as many as half of people being treated for bipolar disorder do not take medication consistently. Most impor- tantly, psychoeducation lowers the risk of relapse
97
Name two therapies used tobuild skills, reduce symptoms, and decrease the risk of relapse for those with bipolar disorder.
Both CT and family-focused therapy (FFT.) FFT aims to educate the family about the illness, enhance family communication, and develop problem-solving skills
98
What is possibly the most controversial treatment for MDD and when is it utilised?
electroconvulsive therapy (ECT) is only used to treat MDD that has not responded to medication.
99
What does ECT entail?
deliberately inducing a momentary seizure by passing a 70- to 130-volt current through the patient’s brain. The patient is given a muscle relaxant before the current is applied so that they sleep through the procedure and the convulsive spasms of muscles are barely perceptible. Typically, patients receive between 6 and 12 treatments, spaced several days apart.
100
How has ECT changed and why?
. Formerly, electrodes were placed on each side of the forehead, a method known as bilateral ECT. Today, unilateral ECT, in which the current passes only through the nondominant (typically the right) cerebral hemisphere, is often used because side effects are less pronounced than with bilateral ECT
101
What are the side effects of ECT
some risks of shortterm confusion and memory loss. It is fairly common for patients to have no memory of the period during which they received ECT and sometimes for the weeks surrounding the procedure.
102
What is the most common treatment for depression?
Medication
103
What are the four categories of antidepressants? Which is the most effective?
monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), and serotonin norepinephrine reuptake inhibitors (SNRIs.) The clinical effectiveness of all classes of anti- depressants is about the same
104
How long should people be medicated and what helps prevent recurrence?
Treatment guidelines recommend continuing antidepressant medications for at least 6 months after a depressive episode ends—and longer if a person has experienced several episodes. o prevent recurrence, medication doses should be as high as those offered during acute treatment.
105
What controversies surround the effectiveness of antidepressants?
antidepressants do not appear to be more efficacious than placebos for relieving mild or moderate symptoms of MDD. Antidepressants do offer a clear advantage compared to placebos in the treatment of severe MDD. Although published studies may overestimate how many people respond well to antidepressant medications due to studies not being published.
106
Why are MAOIs the least used antidepressant?
because of their poten- tially life-threatening side effects if combined with certain foods or beverages.
107
In 2008, the FDA approved a treatment for a subset of those with depression. What is the treatment and what is the subset of people
transcranial magnetic stimulation (rTMS) for patients who have failed to respond to a first antidepressant during the current episode.
108
What is involved in the most typical rTMS approach?
an electromagnetic coil is placed against the scalp, and intermittent pulses of magnetic energy are used to increase activity in the left dorsolateral prefrontal cortex. Typical treatment lasts 30 to 60 minutes, with daily doses delivered for 10 to 30 days.
109
What type of medication is usually prescribed to reduce manic symptoms? Give an example of the first one discovered
mood-stabilizing medication; Lithium, a naturally occurring chemical element, was the first mood stabilizer identified.
110
How long is it recomended to take mood stabilisers?
It is recommended that mood-stabilizing medications be used continually for the person’s entire life however
111
What is the downside to lithium?
Because of pos- sibly serious side effects, lithium must be prescribed and used very carefully. Lithium levels that are too high can be toxic, so patients taking lithium must have regular blood tests.
112
What other two classes of medication other than lithium have been approved by the FDA? Who are these reccomended for?
anticonvulsant (antiseizure) medications such as divalproex sodium (Depakote) and antipsychotic medications such as olanzapine (Zyprexa). These other treat- ments are recommended for people who are unable to tolerate lithium’s side effects.
113
Why does therapy for acute mania often begin with both lithium and an antipsychotic medication?
Because lithium takes effect gradually and antipsychotic medication has an immediate calming effect
114
Discuss mood-stabilising medication and depression
They help relieve depression. However, many people continue to experience depression. For these people, an antidepressant medication is often added.
115
What are the two potential issues associated with adding an antidepressant?
it is not clear whether antidepressants help reduce depression among persons who are already taking a mood stabilizer. Second, among people with bipolar disorder, antidepressants are related to a modest increase in the risk of a manic episode if taken without a mood stabilizer
116
Compare pros and cons of medication and therapy (despite a combination being best)
Antidepressants work more quickly than psychotherapy, thus providing immediate relief. Psychotherapy may help people learn skills that they can use after treatment is finished to protect against recurrent depressive episodes and is less expensive.
117
What is meant by non-suicidal self injury?
Nonsuicidal self-injury involves behaviors that are meant to cause immediate bodily harm but are not intended to cause death
118
What percentage of people worldwide have reported suicidal ideation and what percentage have attempted suicide?
9 percent of people report suicidal ideation at least once in their lives, and 2.5 percent have made at least one suicide attempt.
119
What is the gender differences in suicides?
men are 1.7 times more likely than women to kill themselves, Women are more likely than men are to make suicide attempts that do not result in death, Men usually choose to shoot or hang themselves; women are more likely to use pills
120
Who is at the highest rate for suicide?
white males over age 50
121
Compare age differences in suicide
Rates for children and adolescents have increased dramatically but still well under the rate of adults. Generally it is the 10th biggest cause of death in the US, for adolescents between 10 and 24 it is the second highest killer.
