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Bipolar and Depressive Disorders Flashcards

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1
Q

Difference(s) in characteristics of manic vs hypomanic disorder

A

timeframe of symptom presentation & severity measured by marked impairment and need for hospitalization
* mania = at least 1 week; need for hospitalization
* hypomania = at least 4 consecutive days; no marked impairment & no need for hospitalization

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2
Q

Duration of symptoms necessary for MDD diagnosis

A

2 weeks

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3
Q

Difference(s) in symptom presentation for bipolar I vs. bipolar II disoder vs. cyclothymic disorder

A

presence of manic vs hypomanic episode AND presence of depressive episode
* bipolar I: at least 1 manic episode; hypomanic or depressive episode NOT required
* bipolar II: at least 1 hypomanic AND 1 depressive episode; manic episode NOT required
* cyclothymic: hypomanic symptoms that DO NOT meet criteria for hypomanic AND depressive symptoms that DO NOT meet criteria for MDD; duration: 2 years for adults and 1 year for children & adolescents

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4
Q

Name etiology linked to Bipolar Disorder

x3

A
  1. heredity
  2. neurotransmitter & brain abnormalities
  3. circadian rhythm irregularities
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5
Q

What is the concordance rates of Bipolar Disorder for monozygotic & dizygotic twins, respectively?

A

1) .67 - 1.0
2) 2.0

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6
Q

What neurotransmitters have been linked to Bipolar Disorder?

A
  • norephinephrine
  • serotonin
  • dopamine
  • glutamate
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7
Q

Structural & functional abnormalities link these brain areas to Bipolar Disoder

A
  • prefrontal cortex
  • amygdala
  • hippocampus
  • basal ganglia
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8
Q

What circadian rhythm irregularities are linked to Bipolar Disorder?

A
  • sleep-wake cycle
  • secretion of hormones
  • appetite
  • core body temp
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9
Q

In differentiating between ADHD and Bipolar Disorder in children and adolescents, these symptoms are important to consider.

A

mania symptoms
* elation
* grandiosity
* flight of ideas/racing thoughts
* decreased need for sleep
* hypersexuality

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10
Q

In differentiating between ADHD and Bipolar Disorder in adults, these symptoms are important to consider.

A

mania symptoms
* euphoric, elevated, irritable mood
* increased self-esteem or grandiosity
* distractibility caused by racing thought
* decreased need for sleep without physical discomfort

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11
Q

Studies on sexuality suggest that adult ADHD is not associated with increased sexual activity, but instead associated with what?

A
  • higher rates of sexual disorders
  • greater involvement in risky sexual behaviors
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12
Q

First-line treatment for Bipolar Disorder

A
  1. evidence-based psychosocial interventions
    * psychoed, interpersonal & social rhythm therapy, CBT, & family-focused therapy
  2. pharmacotherapy
    * Lithium - onset. between 15 & 19 years old
    * anticonvulsants (e.g., carbamazepine, valproic acid) - mixed moods, rapid cycling, onset between 10 & 15 years old
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13
Q

Characteristics of “with atypical features” specifier for Bipolar Disorder

A
  • mood reactivity
  • at least 2 of the following: significant weight gain or increase in appetite, hypersomnia, leaden paralysis, interpersonal rejection sensitivity
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14
Q

Duration criterion for Persistent Depressive Disorder

children/adolescents vs. adults

A

Adults: 2 years
Children/Adolescents: 1 year

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15
Q

duration & frequency criterion for Disruptive Mood Dysregulation Disorder

A
  • 12 months
  • at least 3x/week
  • most of the day, nearly every day
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16
Q

onset/duration criterion for MDD specifier with peripartum onset

A

onset of symptoms during pregnancy or the 4 weeks after delivery

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17
Q

% of women who experience “baby blues” (e.g., sadness, irritability, anxiety) after birth; of the women who meet criteria for MDD, % who experience symptoms prior to delivery

A
  • 80%
  • 50%
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18
Q

First-line treatment for MDD with peripartum onset

A
  • CBT & interpersonal therapy
  • Antidepressants (sertraline)
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19
Q

Neurotransmitter & hormone and levels (lower or higher) linked to Seasonal Affective Disorder. First-line treatment?

describe treatment effect

A
  • lower serotonin
  • higher melatonin
  • phototherapy - exposure to bright light (suppresses production of melatonin)
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20
Q

Gender differences associated with rates of depression in chidhood vs adolescence vs adulthood

include statistics on rates in adolescence & adulthood

A
  • Childhood: similar in males and females
  • Adolescence: increase in females; same in males
  • Adulthood: higher in females
    **rates for female adolescents & adults: 1.5 to 3x higher than males
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21
Q

Name 3 etiologies of MDD

A
  1. heredity
  2. neurotransmitter, hormone, & brain abnormalities
  3. cognitive & behavioral factors
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22
Q

Concordance rates for unipolar depression in twin studies & gender differences

monozygotic & dizygotic

A
  • monozygotic: .30 to .50
  • dizygotic: .20 to .30
  • rates higher for female twins
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23
Q

Describe neurotransmitter abnormalities of MDD

include whether levels are higher or lower

A
  • low serotonin
  • low dopamine
  • low norepinephrine
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24
Q

Abnormalities in what brain areas have been linked to MDD

A
  • hypothalamic-pituitary-adrenal (HPA) axis
  • prefrontal cortex
  • cingulate cortex
  • hippocampus
  • caudate nucleus
  • putamen
  • amygdala
  • thalamus
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25
MDD has been linked to early life exposure to chronic stress, causing (hypoactivity or hyperactivity) of the HPA axis AND hypersecretion of what hormone?
* hyperactivity * cortisol
26
MDD has been linked to abnormally (high or low) activity in what subcortical stucture(s) of the prefrontal cortext? ## Footnote 2 areas
* high activity in the ventromedial PFC * low activity in the dorsolateral PFC
27
Lewinsohn's *social reinforcement theory* assumes depression is the result of what? And typically results in what?
* low rate of response-contingent reinforcement for social behaviors & lack of reinforcement in evnironment and/or poor social skills * social isolation, low self-esteem, pessimism ## Footnote outcomes reduce likelihood of any future positive reinforcement
28
Seligman's *learned helplessness model* links depression to what? | 2 versions - describe both
1. (original) linked to repeated exposure to uncontrollable negative life events 2. (reformulated; *"hoplessness theory"*) stresses link to negative cognitive style - i.e., attributing negative life events to talbe, internal, & global factors * cause is sense of hopelessness, which results in exposure to negative life events & negativev cog style
29
Beck's *cognitive theory* attributeds depression to what?
a negative cognitive triad that consists of negative thoughts about: 1. oneself, 2. the world, and 3. the future
30
Describe the age-related risk factors linked to depression
* younger adults: risk linked to genetics, stressful life events, & limitations in problem-solving * older adults: risk linked to chronic medical illness - strongest risk factor especially when illness decreases physucal functioning & causes social isoltation
31
Describe experience & expression of depression in consideration of **age-related factors & cultural background**
1. Age * older adults: less likely than younger adults to refer to affective symptoms; more likely to refer to somatic symptoms, cognitive changes, & loss of interest 2. Cultural Backgroun * Latino, Mediterranean, Middle Eastern, Asian, & other non-Western culturs: will report larger number of somatic symptoms (than Western cultures) * ppl from Western cultures: report higher number of psychological symptoms
32
differences between Chinese and Euro-Canadian patients' report of symptoms of depressoin?
* Chinese patients more likely to report somatic symptoms (e.g., appetite & sleep disturbances, headaches, heart palpitations) * Euro-Canadian patients more likely to emphasize psychological symptoms (e.g., depressed mood, loneliness, hopelessness)
33
Most common comorbid disorder with MDD? Followed by, in order, what disorders?
1. substance use disorder, especially alcohol use) 2. an anxiety disorder 3. personality disorder
34
What sleep **abnormalities** are linked to depression?
* prolonged sleep latency (longer time to fall asleep) * reduced REM latency (shortened time from sleep onset to REM sleep) * reduced slow-wave sleep (stages 3 and 4) * increased REM density (more rapid eye movements per unit of time)
35
What **physical health issues** are linke to depression? Type of relationship between physical & mental health issues (directional).
* coronary heart disease * stroke * diabetes * Parkinson's **bidirectional**
36
Research has found depression to be independently predictive of an increased risk for what physical health issues?
* myocardial infarction (heart attack) | manifestation of coronary heart disease
37
2 most common psychiatric conditions to develop after heart attack?
* depression (more common than) anxiety
38
Research outcomes associated with **treatment** for depression | psychotherapy vs. pharmacotherpy vs. combined
* varired outcomes * meta-analysis: combined treatment more effective * no sig difference in remission & response rates between psychotherapy alone vs. pharmacotherapy alone
39
APA's guidelines for *treatment* of depression with **children**
* insufficient evidence to recommend specific psychosocial or pharmacological treatment
40
APA's guidelines for *treatment* of depression with a**dolescents**
* CBT * Interpersonal Therapy for adolescents (IPT-A) * fluoxetine **insufficient evidence to recommend either treatment over the other
41
APA's guidelines for *treatment* of depression with **adults**
*offer patient psychotherapy or antidepressant as initial treatment* * psychotherapy: CBT, mindfulness-based cognitive therapy (MBCT), interpersonal therapy (IPT), behavioral therapy, psychodynamic therapy, and supportive therapy
42
APA's guidelines for treatment of **chronic or treatment-resistant depression** for adults
* combo of CBT and IPT with antidepressant
43
APA's guidelines for *treatment* of depression with **older adults**
* group CBT * combo of IPT & second-gen antidepressant **insufficient evidence for self-guided bibliotherapy or life review therapy for older adults
44
Advantages/Disadvantages of **St. John's wort** as treatment for depression
1. Advantages * as effective as SSRI for mild to moderate depression * lower dropout rates * fewer side effects 2. Disadvantages * not effective for severe depression * interacts with SSRIs - serotonin syndrome * interacts with alprazolam, bupropion, & statin/immunosuppressive druges - reduces effectiveness
45
Evidence of **ketamine** as an effective treatment for what type(s) of depression
treatment-resistant depression & suicidal ideation
46
Describe therapeutic effects in brain of ketamine for depression | neurotransmitter(s)
* fast-acting * increases glutamate
47
due to potential for severe side effects of *ketamine therapy* for depression, meds **required to be administered** how?
self-administered under supervision of healthcare provider in healthcare setting
48
Research on electroconvulsive therapy (ECT) for severe depression has shown what outcomes?
* high rates of success * higher response rate (clinically meaningful reduction in symptoms) * higher remission rate (absense of symptoms) * faster time to remission
49
When is ECT typically used? | clinical justifications for using ECT
1. when other treatments have been ineffective 2. when severity of symptoms requires a quick treatment response - high risk for suicide
50
response and remission rates: 1. psychotherapy 2. pharmacotherapy 3. ECT
* psychotherapy: 30% and 60% * pharmacotherapy: 25% and 45% * ECT: 80% and 70%
51
duration of remission rates: 1. psychotherapy 2. pharmacotherapy 3. ECT
1. psychotherapy: IPT or CBT - 6 to 10 weeks 2. pharmacotherapy: antidepressants - 4 to 12 weejs 3. ECT: 1 to 3 weeks
52
Disadvantages of ECT
causes both anterograde & retrograde amnesia * anterograde amnesia - resolves within weeks * retrograde amnesia - resolves within weeks to several months **more likely to affect recently acquired memories AND older memories more likely to return first** *may experience persistent gaps in memory for pre-ECT events*
53
ECT side effects: when is retrograde amnesia is more severe | electrode placement; timeframe; number of sessions
* bilateral placement of electrodes * higher number of treatment sessions * less time between sessions
54
What is repetitive transcranial magnetic stimulation (rTMS)? Treatment for what type of depression?
* noninvasive technique * uses a magnetic field * stimulates left dorsolateral PFC * treatment-resistant depression
55
disadvantage(s) of rTMS for depression | compared to ECT
lower response and remission rates than ECT
56
advantage(s) of rTMS for depression? | compared to ECT
does not requrie sedation or memory loss
57
outcomes from research comparing teletherapy vs. face-to-face therapy for depression | more, less, or same effectiveness
simiar outcomes for symptom severity, quality of life, client satisfaction, and therapeutic alliance
58
suicide rates in U.S. from 2000 to 2020 | prevalence, gender-, age-, and race-related differences
1. increased between 2000 and 2018; decreased slightly between 2018 and 2020 2. gender: 3-4x higher for males 3. age: highest rates of suicide for 75+ years old 4. race: highest rates among American Indians/Alaska Natives, followed in order by: * Whites * Hispanics * Blacks * Asian/Pacific Islanders
59
2020 suicide rates in consideration of both age and gender
males: 75+ years old females: 45 to 64 years old
60
2020 suicide rates in consideration of race and age
* American Indians/Alaska Natives, Hispanics, & Blacks: 25 to 34 years old * whites: 45 to 54 years old * Asian/Pacific Islanders: 85+ years old

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