CH 7 Mood Disorders and Suicide

Question 1

7.1 What are the two key moods involved in mood disorders?

Answer 1

Depression and mania

Question 2

7.1 Unipolar Depressive Disorders

Answer 2

Mood disorders in which a person experiences only depressive episodes

Question 3

7.1 Bipolar disorders

Answer 3

Mood Disorders in which a person experiences BOTH depressive AND manic episodes (or hypomanic and depressive, or mania and no depression)

Question 4

7.1 Depressive Episode

Answer 4

The most common form of mood disturbance, in which a person is markedly depressed or loses interest in formerly pleasurable activities (or both) for at least two weeks (most days, nearly every day)

Other symptoms include:
• changes in sleep/constantly tired - insomnia/hypersomnia
• changes in appetite and weight
• difficulty in concentration and focus
• feelings of worthlessness among others
• suicidal ideation and self harm
• psychomotor agitation

Question 5

7.1 DSM-5 Criteria for a Manic Episode

Answer 5

A person shows a markedly elevated, euphoric, or expansive mood

Often interrupted by occasional outbursts of intense irritability or even violence

Persist for at least a week

3 other symptoms must be present
• 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
• distractability
• increase in goal-directed or psychomotor agitation
• excessive involvement in activities that have high potential for painful consequences

Question 6

7.1 DSM-5 Criteria for Manic Episode

Answer 6

A. Distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day, nearly every day (any duration if hospitalization is necessary)

B. 3 or more of the following are present to a significant degree (noticeable change from usual behavior)
1. Inflated self-esteem/grandiosity
2. Decreased need for sleep
3. More talkative/pressure to keep
talking
4. Flight of ideas or subjective
experience that thoughts are racing
5. Distractibility
6. Increase in goal-directed activity or
psychomotor agitation
7. Excessive involvement in activities
with a high potential for painful
consequences

C. Mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self/others or there are psychotic features

D. Episode is not attributable to the physiological effects of a substance

Question 7

7.1 Describe the prevalence of depression

Answer 7

15-20 times more frequent than schizophrenia

Almost the same rate as all anxiety disorders taken together

Second most prevalent worldwide, following anxiety disorders

Higher in women

Inversely related to SES

Question 8

7.1 Describe the prevalence of bipolar disorders

Answer 8

Less common than unipolar depression

Question 9

7.2 DSM-5 Criteria for Major Depressive Disorder

Answer 9

A. 5 or more of the following
1. Depressed mood most of the day
and nearly every day
2. Markedly diminished
interest/pleasure in most/all
activities most of the day and nearly
every day
3. Significant weight loss NOT by
dieting OR weight gain
4. Insomnia/hypersomnia nearly every
day
5. Psychomotor agitation or
retardation nearly every day
6. Fatigue or loss of energy nearly
every day
7. Feelings of worthlessness/excessive
guilt nearly every day
8. Diminished ability to concentrate,
indecisiveness, nearly every day
9. Recurrent thoughts of death, suicidal
ideation

B. Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

C. Episode is not attributable to the physiological effects of a substance or another condition

D. Occurrence of the major depressive episode is NOT better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other schizo/psychotic disorders

E. There has NEVER been a manic or hypomanic episode

Question 10

7.2 Relapse vs. Recurrence

Answer 10

Relapse - the return of symptoms within a short period, reflects the fact that the episode has not yet run its course

Recurrence - the onset of a new episode

Question 11

7.2 Specifiers

Answer 11

Different patterns of symptoms that sometimes characterize major depressive episodes that may help predict the course and preferred treatments

Question 12

7.2 List specifiers of major depressive episodes

Answer 12

With…

Melancholic features
Psychotic features
Atypical features
Catatonic features
Seasonal pattern

Question 13

7.2 Melancholic features

Answer 13

3 of the following: early morning awakening, depression worse in the morning, marked psychomotor agitation or retardation, loss of appetite or weight, excessive guilt, qualitatively different depressed mood

Question 14

7.2 Psychotic features

Answer 14

Delusions or hallucinations; feelings of guilt and worthlessness common

Question 15

7.2 Atypical features

Answer 15

Mood reactivity–brightens to positive events;

2/4 of the following: weight gain or increased appetite, hypersomnia, leaden paralysis, being acutely sensitive to interpersonal rejection

Question 16

7.2 Catatonic features

Answer 16

A range of psychomotor symptoms from motoric immobility to extensive psychomotor activity, as well as mutism and rigidity

Question 17

7.2 Seasonal pattern

Answer 17

At least 2+ episodes in the past 2 years occurred at the same time, usually fall or winter, and full remission at the same time, usually spring, NO OTHER nonseasonal episodes in the same period

Question 18

7.2 DSM-5 Criteria for Persistent Depressive Disorder

Answer 18

A. Depressed mood most of the day for most days for at least 2 years

B. 2 or more of following:
1. Poor appetite or overeating
2. Insomnia or hypersomnia
3. Low energy or fatigue
4. Low self-esteem
5. Poor concentration or difficulty
making decisions
6. Feelings of hopelessness

C. During 2 year period (1 for children/adolescents), the individual has never been without criteria A and B symptoms for more than 2 months at a time

D. Criteria for MDD may be continuously present for 2 years

E. There has NEVER been a manic/hypomanic episode, and criteria have NEVER been met for cyclothymic disorder

F. Disturbance is not better explained by schizo or psychotic disorders

G. Symptoms are not attributable to substances

H. Symptoms cause clinically significant distress or impairment in functioning

Question 19

7.2 Double Depression

Answer 19

Co-occurence of MDD and PDD

Question 20

7.3 Biological causal factors for unipolar mood disorders (depression)

Answer 20

Moderate genetic contribution to vulnerability to depression

Depression is associated with multiple interacting disturbances in neurochemical, neuroendocrine, and neurophysiological systems

Disruptions in circadian and seasonal rhythms

Question 21

7.3 Psychosocial theories of causes of depression

Answer 21

Beck’s cognitive theory

Reformulated helplessness and hopelessness theories (diathesis-stress models)

Cognitive diathesis

Question 22

7.3 Personality variables like _______ may also serve as diatheses for depression.

Answer 22

neuroticism

Question 23

7.3 Beck’s Cognitive Theory

Answer 23

Early experiences can lead to the formation of dysfunctional assumptions that leave one vulnerable to depression later in life if certain critical incidents activate those assumptions

Once activated, assumptions trigger automatic thoughts that produce depressive symptoms

Question 24

7.3 Helplessness Theory of Depression

Answer 24

Seligman and colleagues

Dogs

Lack of percieved control > unmotivated to respond to future situations

Question 25

7.3 Hopelessness Theory of Depression

Answer 25

Abramson and colleagues

Pessimistic attributional style + negative life events =/= depression UNLESS one is already hopeless

Question 26

7.3 Ruminative Response Styles Theory of Depression

Answer 26

Nolen-Hoeksema

Ruminate > more lengthy periods of depressive symptoms and full-blown episodes of MDD

Women are more likely to ruminate

Question 27

7.4 Cyclothymia

Answer 27

Repeated experience of hypomanic symptoms for a period of AT LEAST 2 years

NO MANIC EPISODES AND NO DEPRESSIVE EPISODES

Question 28

7.4 Bipolar I

Answer 28

Full-blown mania

Episodes of mania and periods of depression, even if periods of depression do not reach the threshold for a major depressive episode

Question 29

7.4 Bipolar II

Answer 29

Periods of hypomania, but below threshold of full-blown mania

Periods of depressed mood that meet criteria for major depression

Question 30

7.5
TRUE OR FALSE
Biological causal factors probably play a more prominent role in unipolar disorders than bipolar disorders.

Answer 30

FALSE, opposite

Question 31

7.5 How do stressful life events relate to bipolar disorder?

Answer 31

They may be involved in precipitating episodes, but it is unlikely that they cause the disorder

Question 32

7.6 How can cultural factors influence the expression of mood disorders?

Answer 32

Factors such as differing rates of stigma, stressors, risk factors for mood disorders, and a different manifestation of symptoms across cultures all have been suggested as possible explanations for the different rate and expression of mood disorders across cultures.

Question 33

7.7 Describe and distinguish between different treatments for mood disorders.

Answer 33

Biologically based treatments such as meds and electroconvulsive therapy are often used for severe major disorders

Psychosocial treatments like cognitive therapy, behavioral activation treatment, and interpersonal therapy are also being used to good effect in many cases of severe AND mild cases

Recurrent depression is best treated by specialized forms of psychotherapy or maintenance on medications for prolonged periods

Question 34

7.8 Describe the prevalence and clinical picture of suicidal behaviors

Answer 34

Suicide is a leading cause of death worldwide

Nearly 10% of adults report that they have seriously considered and nearly 3% have attempted

The rate of suicidal thoughts and behavior increases DRASTICALLY in adolescent and young adult years, mood disorders are especially at risk

Question 35

7.9 Explain efforts currently used to prevent and treat suicide

Answer 35

Suicide prevention programs generally include crisis intervention in the form of suicide hotlines

Efficacy is unclear atm

Question 36

7.1 Describe the BASIC DIFFERENCES between hypomania and mania

Answer 36

Mania has a minimum of 1 week, hypomania has a minimum of 4 days

Hypomania involves the same symptoms, but to a lesser severity

People do NOT suffer in daily functioning and do NOT need to be hospitalized

Question 37

Loss of interest or pleasure

Answer 37

Anhedonia

Question 38

Who is most associated with cognitive therapy?

Answer 38

Aaron Beck