Chapter 5 - Mood Disorders Flashcards
(98 cards)
1
Q
Mood disorders
A
Mood disorders: involve disabling disturbances in emotion, from the sadness of depression to the elation and irritability of mania. Often associated with other psychological problems
2
Q
Moods
A
Emotional climate
Pervasive/sustained
Influence our perceptions
3
Q
Moods in mood disorders are…
A
More severe and last longer
Maladaptive
4
Q
Unipolar mood disorders
A
One extreme to the pole (from normal to either euphoric or desperate)
Ex: major depression, dysthymia
Mania only does not exist: always bipolar
5
Q
Bipolar mood disorders
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Both extremes of the pole (from desperate to euphoric, and normal)
6
Q
Symptoms for diagnosis of MDD
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5+ symptoms for at least 2 weeks
- Sad/depressed mood all day everyday mandatory
- Loss of interest/pleasure mandatory
- Sleep problems
- Shift in activity level
- Changes in apetite/weight
- Loss of energy/fatigue
- Worthless/guilt
- Concentration issue
- Death/suicide thoughts
7
Q
Cultural variation in depression
A
Less prevalent in non-western societies (ex: China), bc it’s less appropriate to display emotions
Westerners will emphazise psychological symptoms (psychologizers)
8
Q
Is MDD episodic?
A
Yes
9
Q
What is a chronic MD episode
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MD episode that lasts for 2+ years (usually when left untreated)
10
Q
Melancholic features of MDD
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- Pervasive anhedonia
- Don’t feel better when good thing happen
- Apetite/weight loss
- Depression worse in AM
- Early morning awakening
- Psychomotor agitation/retardation
- Inappropriate/excessive guilt
11
Q
Atypical features of MDD
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- Mood reactivity to positive events
- Weight gain / increased apetite
- Hypersomnia
- Physically burdened/paralysis
- Sensitivity to rejection (real or not)
- Still functional
12
Q
Psychosis
A
The person experiences delusions, false beliefs, hallucinations (one or all of those)
Does NOT mean schizo
13
Q
Psychotic features of MDD
A
- Delusions (false beliefs)
- Hallucinations (false sensory perceptions)
- Mood congruent
- likely to suffer from melancholia
- Poor prognosis
14
Q
Catatonic features of MDD
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- Motoric immobility or purposeless
- Physical rigidity
- Echolalia (repeating words)
- Posturing (bizzare postures)
15
Q
Seasonal Affective Disorder (symptoms and diagnosis)
A
MDD with a seasonal pattern (minimum 2 MDE in the past 2yrs, occuring at the same time of the year + no non-seasonal episodes in past 2yrs + more seasonal than non-seasonal episodes in lifetime)
16
Q
SAD in Inuit vs Iceland
A
Highly prevalent in Inuit (18% lifetime)
Not a lot in Iceland (2%) - due to genetic adaptations, diet high in fish, or else
17
Q
Treatment for SAD
A
Phototherapy - even more effective when combined with CBT
18
Q
Post Partum Depression vs PostPartum Blues
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PPD: MDD onset within 4 weeks of giving birth, impact on child relationship
PPB: not meet criteria for MDD, 50-70% of new mothers
19
Q
Prenatal and Peripartum depression
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Prenatal: before pregnancy
Peripartum: during
20
Q
Dysthymic Disorder symptoms and diagnosis
A
NOT meet criteria for MDD, but: Depressed mood for most of the day, most days, for at least 2yrs AND 2+ of those: -Apetite disturbance -Sleep disturbance -Low energy -Low self-esteem -Less concentration -Hopelessness Never without symptoms for + than 2 months in first 2yrs, no MDE during that time, impaired functioning, unrelated to medical conditions
21
Q
Other name for dysthymic disorder
A
Persistent Depressive Disorder
22
Q
Double Depression
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MDE on top of dysthymia, AFTER the 1st 2 yrs (before, its MDD)
23
Q
Discrepancy between men and women for MD diagnosis (women have 10-25% prev., men is 5-12%)
A
Consistently found across the globe
In adolescence; girls are + likely than boys to have risk factors for depression - interacts with challenges of adolescence
Females: more likely to engage in ruminative coping such as brooding (moody contemplation of depressive symptoms) and co-rumination (brooding with friends), males more distracting activities
Women are more likely to use techniques such as
Silencing the self - keeping upsets and concerns to oneself
Objectification theory - being objectified/scrutinized has a greater influence on boys’ self esteem than girls
Creating stress for themselves - boys do it less
24
Q
Risk of recurrence of depression after 3 episodes
A
1st episode - 50-60% will have another
2nd episode - 70%
3rd episode - 90%
After each episode, the time before recurrence shortens, some ppl end up with chronic depression
Residual symptoms between episodes is possible
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Comorbidity of Depression
72% overall
59% with anxiety disorders
30% impulse control disorder
24% substance abuse
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Sociodemographic correlates of depression
Women, age 18-59, homemakers, unemployed/disability, never married or no longer are, low income/poverty
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Psychoanalytic theory of depression - oral stage and link with grief
Freud: said that the potential for depression starts in the oral stage - needs can be overly or insufficiently gratified, causing people to become dependent on them and fixated on this stage
Link with grief; when experiencing grief (either bc of death or distanciation with time),
Introjection phase: the mourner identifies with the person.
We unconsciously harbour negative feelings towards those that we love, therefore we develops guilt and hatred towards ourselves
Period of mourning work: person tries to recall memories with that person to separate themselves from the person and loosen the bonds imposed by introjection - can develop into a period of self-blame and self-abuse - the anger towards the lost one continues to be directed inwards
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Diathesis-stress model in depression
MDE often follow stressful life events, but not everyone becomes depressed
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Congruency hypothesis in depression
Person who has a congruent personality (diathesis at risk for depression) but is non depressed, goes through a tough even (stress), they will become depressed
The kind of stress needs to fit with their personality (a perfectionist person failing an exam, or a dependent person being rejected)
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Cognitive diathesis for depression
latent dysfunctional cognitive patterns (ex: self-schemas - how they perceive themselves)
Does NOT explain HOW those schemas are created, nor WHY
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Beck's negative triad hypothesis for depression
Triad: negative views of self, world, future
Negative schemas develop in childhood
Leads to information processing biases (memory and attentional)
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Beck mentioned 2 personality styles associated w depression
Sociotropy: dependent on others, concerned with pleasing others, avoiding disapproval, avoiding separation
Autonomy: self-critical goal striving, desire for solitude, freedom from control
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Blatt proposed 2 personality styles associated with depression
Introjective: excessive levels of self-criticism
Depressive Experiences Questionnaire assesses dependency and self-criticism - strong association with depression
Anaclitic: excessive dependency to others
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Other cognitive biases of depressed individuals, according to Beck
- Arbitrary inference: conclusion drawn in the absence of sufficient evidence or of any evidence at all
- Selective abstraction: conclusion drawn on the basis of only 1 of many elements in a situation
- Overgeneralization: an overall sweeping conclusion drawn on the basis of a single, perhaps trivial, event
- Magnification and Minimization: exaggerations in evaluating performance
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Difference between selective attention bias and inhibitory dysfunction
Att. bias: focusing on negative stim, selecting it
Inh. dys.: unable to detach oneself from negative material, but not necessarily scanning for negative stuff
Both contribute to depression
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Response Styles Theory
The way a person responds to a negative mood impacts the severity/duration of depression
Rumination: churning at negative emotions/thoughts, keeps depression alive (WHY am I like this? When will it stop? Why can't i get out of this?)
Distraction: focusing on something else, stops depression
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Hopelessness theory for depression
Based on learned helplessness theory: an individual's passivity and sense of being unable to act and control his or her own life is acquired through unpleasant experiences and traumas that the individual tried unsuccessfully to control
Learned helplessness + depressogenic attributional style (to internal, stable and global causes) = hopelessness, depression
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Depressive paradox
Feeling helpless yet blaming oneself
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Depressive predictive certainty
the perceived probability of the future occurrence of negative events become certain, leads to the development of hopelessness depression
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Interpersonal theory of depression
Reduced social support and lesser reliance on it: feature of depressed individuals
More likely to be rejected by their peers
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Heritability of depression
40% concordance in MZ twins
37% variance in risk due to heritability
Promoter of the serotonin transporter gene 5-HTT is a potential gene cause, but MDD is polygenic
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Depression in the brain
Hyperactivity of amygdala + lower activity of PFC = MDD
| Depression also associated with decreased hippocampal volume
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Monoamine hypothesis for depression
Low levels of norepinephrine, dopamine, serotonin thought to cause depression
Not supported, hard to study
Also, higher levels of MAO-A (Monoamine oxidase A) which metabolizes monoamines is associated with MDD
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Serotonin Receptor Sensitivity
Lowered sensitivity of s. receptors thought to increase risk for depression
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Clues for theories of depression based on drug effectiveness
-Tricyclic drugs: prevent reuptake of norepinephrine, serotonin and/or domapine
-MAO inhibitors keep the enzyme from deactivating neurotransmitters, therefore increasing serotonine, norepinephrine and dopamine
-SSRIs inhibit serotonin reuptake
Suggest that depression and mania are related to those neurotransmitters
46
Problems with old antidepressants - finding the right one
More side effects
Pharmacological assessments can be done on the medications that the person is taking and recommendations can be established based on the results
sometimes people need to try different drugs to find the one that works for them - can take a long time before finding the right one
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Medication for treating depression + clinical considerations
MAOIs
Tricyclic antidepressants
SSRIs
Considerations
Delay in effect of medications
Relapse and recurrence
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Risk with antidepresants and depressed people
Don't start working before a few weeks - SUPER important to consider when dealing with major depressive people (often have suicidal ideas) - the person may get a bit more energy before seeing an effect on their mood; therefore if before they had the suicidal ideation but were too tired/depressed to actually do it, it may give them the energy to do it while keeping them in the depressive state that brought the ideas
49
Electroconvulsive therapy (for depression, but also bipolar)
producing a convulsion by passing electrical current through the brain
Works faster than antidepressants/psychotherapy
Bilateral ECT: through both hemispheres
Unilateral ECT: only 1, through the non-dominant hemisphere (right) - creates less memory problems
Client is given an anesthetic and a muscle relaxant
Convulsions are barely noticeable and last a few minutes
Extremely effective, but we don't know why - still drastic, so only for severe depression
Criticism: does not work in all cases, might lead to memory problems, is inhumane
50
Deep Brain Stimulation and Repetitive Transcranial Magnetic Simulation (depression and bipolar)
Deep Brain Simulation and Repetitive Transcranial Magnetic Simulation
DBS: planting electrodes in the brain to deliver low-level electrical impulses
Goal: a brain region is overactive in treatment-resistant depression, therefore disrupting its activity can be useful
Shown to be effective, in various conditions (OCD, substance abuse, brain injury, Alzheimer's, anorexia)
VERY costly
rTMS: brain stimulation using magnetic pulses
As effective as ECT
+ effective than placebo
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Psychodynamic therapies for depression
Goal is to achieve insight into the repressed conflict
Little evidence
Other type: focuses on intrapersonal relationships - more evidence (ITP)
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Mindfulness-Based Cognitive Therapy for depression
| Overgenerality effect
Extension of stress-reduction mindfulness program
Develops metacognitive awareness (ability to step back from thoughts/feelings)
Why does it work? - reduce rumination, increases acceptance of unwanted experiences
Overgenerality effect: remembering broad memories rather than precise ones, strong in depressive people
Reduced by MBCT
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Can therapies influence biological factors?
YES: It's been shown that therapy can have an effect on the balance of neurotransmitters WITHOUT medication
Sometimes people just don't want therapy and only meds - sometimes it's much cheaper to only take the meds and not get therapy
54
Cognitive-Behavioural Therapy for depression
Cognitions can be assessed/changed
Will lead to changes in behaviour
And inversely too; changes in behaviour (forcing oneself to get out of bed) may produce changes in cognition (realization that they actually accomplished something good) - BUT behavioural change itself is not expected to cure depression, change in cognition is
Found that it's less effective in more severe forms of depression, and when its comorbid with PD
55
Why is CBT studied a lot?
It's been studied a lot - it's cheap to study because typically there is a 12-week program, and it's very structured
It's then much easier to do research because the time is limited clearly (compared to other types of therapy that can take more time)
56
Examples of cognitive errors: overgeneralization, selective abstraction, all-or-none thinking
overgeneralization: drawing negative conclusions about one's self-worth based on minimal data
selective abstraction: focusing on isolated negative details of an event, ignoring more positive info
all-or-none thinking: everything is good or bad
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4 steps in CBT
1. Recognize/record automatic thoughts
2. Logically analyze automatic thoughts (evidence supporting the thoughts, evidence against it, best coping method)
3. Generate alternative, rational thoughts
4. Practice alternative thoughts
58
How effective are psychotherapy vs pharmacotherapy treatments for depression in the short term?
Around 50% each
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Manic episode, signs/symptoms, diagnosis
```
Elevated, expansive or irritable mood
3 of the following:
-Inflated self-esteem/grandiosity
-Decreased need for sleep
-Pressured speech
-Racing thoughts
-Distractibility
-Increase in goal-directed activities or psychomotor agitation
-Excessive risky/pleasureable activities
```
60
Manic episode diagnosis
Symptoms of mania last for at least 1 week
| Severe enough to cause impairment or hospitalization
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Hypomanic episode - signs and diagnosis
Same signs/symptoms as mania
| Slightly upper than normal functioning, but lower than manic episode
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Hypomanic episode duration/diagnosis
Symptoms last for at least 4 days
Change in functioning
Change in mood observable by others
Symptoms not severe enought to cause significant impairment or hospitalization
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Mixed episode
Meets criteria for MDE and Mania multiple times in a day for at least 1 week
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Difference between mixed episode and rapid cycling
IN their episode, they experience a mixed episode
| Rapid cycling are episodes by themselves
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Bipolar 1 disorder diagnosis
1+ manic or mixed episode
Symptoms are not better accounted for by a psychotic disorder
History of MDE not required
As soon as a manic episode is detected, someone will be diagnosed with bipolar even though they never had a depressive episode, since its rare that manic will be alone
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Facts about bipolar 1
Preceded by minor mood swings
90% of recurrence of episodes
high impairment event after 1 episode
19% complete suicide
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Bipolar 2 disorder diagnosis
1+ MDE
1+ hypomanic episode
No history of manic or mixed episode
Symptoms are not better accounted for by a psychotic disorder
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Difference between bipolar 1 and 2
Diff between 1 and 2 - whether or not the person becomes fully manic (bipolar 1) or only hypomanic (bipolar 2)
BOTH will experience the MDE
As soon as they experience a manic episode, it's bipolar 1 even if they get hypomanic episodes after
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Facts about bipolar 1 and 2 (prev. sex ratio, link with MDE, etc)
3% lifetime prevalence
1:1 Male-female ratio
Manic episodes immediately precedes or follows MDE in 2/3 cases
(the other 1/3 has a break in between the 2 episodes) - NOT necessarily rapid cycling if it's less than 4 episodes per year
70
Rapid cycling
4+ episodes in a given year
+ frequent in women
Poorer prognosis
NOT the same as mixed episode - rapid cycling is about experiencing (for ex) a MDE followed by a manic episode, many times in the same year (mixed; in one episode they will experience both up and down, in rapid cycling each episode will be either up or down)
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Cyclothymic disorder
Like bipolar 2 but less intense
Numerous periods of hypomanic and depressive symptoms
Duration of at least 2yrs
No manic, mixed or depressive episodes in 1st 2 yrs
Never symptom-free for + than 2 months
Distress, but not impairment
Paired symptoms during depression and hypomania: feeling worthless during depression and inflated self-esteem during hypomania, for ex
May be a precursor to other disorders (ex: young adult have cyclothymia first, and develop bipolar later- 1/3)
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Behavioural activation system dysregulation theory for bipolar
based on the finding that mania is associated with extreme goal striving
The root of mania/bipolar is a hyperresponsiveness to reward cues that can be traced back to high behavioural activation system (BAS) activation
High BAS individual seek more rewarding stimuli, linked with mania
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Heritability of Bipolar
60% in MZ twins, 12% in DZ, 7-9% in 1st degree relatives, 80% of variance accounted for by heritability (VERY high heritability, makes sense since mania is more physiological)
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Role of HPA axis in depression and bipolar
HPA axis thought to be overactive in depression
High levels of cortisone found in ppl with depression - contributes to enlargement of adrenal glands
Dexamethasone - usually suppresses cortisol - does not work in depressed patients, bc the levels are too high
Roles of left/right hemisphere
Right dysfunction: indifference/flat affect
Left: overt symptoms of agitation/sadness
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Medication for mania and depression
Acute mania:
- lithium (70% resp. rate)
- anticonvulsants (50-60% resp rate)
- Antipsychotics, faster onset
Acute Depression:
- Lithium, effect not as robust
- Antidepressants, BUT can lift the mood into mania - mood switching risk
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Lithium inconvenients
50% relapse if discontinue use
| high side effects
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Medication inconvenients for bipolar
High rates of relapse
| Poor medication adherence (people want to keep their high)
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Role of adjunct psychotherapy with medication for bipolar
Improved adherence
fewer episodes, lower relapse
decrease in residual symptoms
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Areas of focus for adjunct psychotherapy for bipolar
```
Medication adherence
Early detection/intervention
Stress/life management (home high in expressed emotion)
Treat comorbid problems
Treat depression
```
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Suicide ideation
thoughts/intentions of killing oneself
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Suicide attempts
self-injury behaviours intended to cause death but that do not lead to death
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Suicide gesture
self-injury in which there is no intent to die, intent is to give the appearance of an attempt in order to communicate with others
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Suicide
behaviours intended to cause death and death usually occurs
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Facts about suicide (prev, population)
0.01% prevalence, but 8th leading cause of death in the US
higher for teens
hard to predict
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Suicide attempters profile
Women, under 25, no psych complaints, impulsive, public attempt, less lethal means
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Suicide completers profile
Men, over 40, DSM disorder, previous intent, private attempt, very lethal means
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Risk factors for suicide
Age 15-24
Gender (3x + females attempt, 4X + males complete)
Divorced, separated, widowed
Plan
Prior attempts - BEST predictor
Lethality of methods (women 10% firearms, men 50%)
Psychiatric history, substance use
Lack of control in maladaptive family
Limited problem-solving ability
Personality: hopelessness and self-criticism
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Possible causal factors for suicide
Genetic
Reduced serotonergic activity
Culture/religion
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Suicidal ambivalence
People who do not really wish to die: still want to communicate a message
People who threaten will usually do it
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Durkheim's Sociological Theory for suicide
3 kinds of suicide:
Egoistic suicide: committed by people who have few ties to family, society, community. Feel alienated from others
Altruistic suicide: response to societal demands, feel part of a group and sacrifice themselves for what they think is the good of society
Anomic suicide: triggered by a sudden change in a person's relationship to society (ex: a successful executive that suffers severe financial reverses)
Individual temperament is thought to interact with these types, so not everyone who loses their money will kill themselves
91
Risk factor model for suicide (4 risk factors)
Risk Factor model: 4 categories of relevant factors
1. Predisposing factors (enduring factors that make a person vulnerable to suicidal behaviour)
2. Precipitating factors (acute factors that create a crisis ex; end of a relationship)
3. Contributing factors (increase exposure to predisposing/precipitating factors, ex;physical illness)
4. Protective factors (decrease the risk of suicidal behaviour, ex; personal resilience)
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Baumeister's escape theory for suicide
Theory that some suicides arise from a strong desire to escape from aversive self-awareness (painful awareness of shortcomings and failures that the person attributes to themselves)
High expectations = crucial role
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Perfectionism social disconnection model (PSDM) for suicide
Trait perfectionism and self-criticism = implicated in suicidal tendencies
Socially prescribed perfectionism = also a risk
Creates a sense of alienation and isolation that amplifies the hopelessness and self-loathing
Amplified when the person has been bullied; creates a pressure to appear perfect all the time
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Joiner's interpersonal theory of suicide
2 factors: need to belong and perceived burdensomeness
Model highlights that the desire and capability to commit suicide are separate
Capability: heightened ability to tolerate physical pain (can be built up with history of self-ha
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Shneidman's approach for suicide
Suicide: an effort to find a solution to a problem that is causing intense psychological suffering (psychache); not necessarily a mental illness
Mental illnesses are relevant only if they contribute to psychache
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Suicide among Canadian Aboriginal People
Excessively high rates of suicide and substance abuse, also sexual abuse and domestic violence
Innus: 13x + likely to commit suicide than other ppl in Canada
Factors: loss of cultural identity, physical and sexual abuse by colonizers
Important factors; degree to which cultural identity has been maintained over time in the community
97
SPAG (Aboriginal people)
SPAG: Suicide Prevention Advisory Group
1. Increase knowledge of what works in suicide prevention
2. Develop + effective and integrated health care services
3. Supporting community-driven approaches
4. Creating strategies for building youth identity, resilience and culture
98
Physical factors for suicide
Chronic Traumatic Encephalopathy (CTE): degenerative neurological disease involving atrophy of brain areas
Risk is partially inherited
Low levels of serotonin
