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psyc 300 > chapter 6 : Mood Disorders * > Flashcards

chapter 6 : Mood Disorders * Flashcards

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1
Q

themes

A
  1. Depressive Disorders
  2. MDD (Biological)
  3. MDD (Psychological)
  4. MDD (Psychosocial)
  5. MDD (Treatment)
  6. Bipolar Disorder
  7. Bipolar Disorder Etiology & Treatment
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2
Q

Major Depressive Disorder (MDD)

A

to have this u need :
Sad, depressed mood
Loss of interest/pleasure
Sleep difficulties
Lethargy or agitation(more or less energy)
Appetite problems / weight loss or gain
Loss of sexual desire
Extreme fatigue
Feelings of worthlessness and guilt
Difficulty concentrating
Recurrent thoughts of death or suicide

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3
Q

Prevalence

A

Lifetime: ~11%
1-year: ~4.5%

~ 80% experience 1 episode > more
Average # of episodes: 4

Kindling hypothesis: each episode u have make easier for u to follow another episode

Average duration: 3-5 months

12% of episodes last > 2 years

Gender ratio is 2:1 (women : men) (more in women)

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4
Q

Chronic Depression

A

Persistent Depressive Disorder (PDD)
Chronic (≥ 2 years) low-grade depression
Average duration 4-5 years
Intermittent normal moods

“Double depression”
Frequent periods of MDD with PDD

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5
Q

MDD vs. PDD

A

Major Depression: intense mood where it goes very down

PDD (persistent depression disorder): goes up and down- not to down

Double depression(is a conbination): pdd( it goes up and down), then it gooes MD (it goes very down), then it comes back to pdd (up and down again) - but it donts stay up

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6
Q

Etiology: Bio

A

Genes

  • Heritability estimate ~35%
  • 1st degree relatives 3x higher risk MDD
  • Influence via depressogenic reaction to stress?

5-HTT alleles
* Dysfunction in 5-HT system
* Linked to temperament (neuroticism)
* Hyperresponsive to aversive stimuli and stress
-Vulnerability for depression and anxiety

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7
Q

MDD (NTs)

A
  • Sad, depressed mood (obsessive grief) – 5-HT (decresed)
  • Loss of interest/pleasure – Dopamine (decresed)
  • Sleep difficulties
  • Lethargy or agitation
  • Psychomotor retardation – NE (decreased) - moving slower
  • Appetite problems / weight loss or gain
  • Loss of sexual desire
  • Extreme fatigue
  • Feelings of worthlessness and guilt (obsessive) – 5-HT (decreased)
  • Difficulty concentrating
  • Recurrent thoughts of death or suicide – 5-HT (decresed)
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8
Q

Neurotransmitters

A

decresed 5-HT Levels (seratonin) : regulats DA and NE

Indirect
“Permissive theory”
Regulates other NTs (e.g., NE and DA) when the NTs go crazy because the seratonin is not regulating them properly it causes depression or mania
decresed NE & DA causes depression
increse NE & DA causes mania

Direct
Tryptophan= a 5-HT pre-cursor
Depletion > relapse

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9
Q

5-HT mysteries…

seratonin

A

Returns to homeostasis before symptoms improve

decresed metabolite levels not consistently found (more often with suicidal ideation and behaviour)

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10
Q

Neuroendocrine System

A
  1. Stress
  2. Release of CRH (CRF) from hypothalamus
  3. Release of corticotropin (ACTH) into circulation
  4. Release of cortisol from adrenal cortex into blood
  5. Cortisol inhibits release of ACTH from pituitary at the same time Cortisol inhibits release of CRH from hypothalamus >
  6. Increase in energy release (incresed blood glucose), suppression of inflammatory and immune response
  7. Coping with stress
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11
Q

Cortisol Suppression: Faulty Feedback

A

people with major depression rather their body understanding there is no more stress and so the cortisol levels can be lowered now, depression peoples feedback loopy continious even though it doesnt need it to

have a lot of cortisol

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12
Q

Stress and Relapse

A
  • Stressful event
  • 4-5 episodes it develops its own cycle:
  • Own cycle (no longer requires Stressful event to cause depressive episode)

which causes Excessive cortisol that depletes Dopamine (anhedonia) - lack of caring

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13
Q

Brain Activity

A

decresed Left PFC
* Approach, emotion regulation, turns off amygdala alarm

increse Right PFC
* Avoid, inhibit, Negative Nelly

increse Amygdala
* Fear, fear, fear!

decresed Anterior cingulate cortex (ACC)
* Error-related rewards & losses (selective attn)

decresed Hippocampal volume
Memory & learning, also regulates ACTH

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14
Q

Other Biological Factors

A

Disruptions of following may also play role:

  • Sleep
  • Circadian rhythm
  • Exposure to sunlight
  • Inflammatory response system
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15
Q

Etiology: Psycho

A
  • (Chronic) Stressful life events (stress) > Independent vs. dependent > Vulnerability in response to stress
  • Risk-related vulnerability factors > (diathesis) Personality and cognitive diatheses > Early adversity
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16
Q

Beck’s Cognitive Theory

A

Main idea:
Negative interpretations of situations/events causes Feelings of depression but depression also causes negative interpretetions
(they go both ways)

Evidence
-People with depression:
* Lack of positivity bias
* Greater accessibility of negative content

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17
Q

Beck’s Cognitive Model

A
  1. Early experience
  2. Formation of dysfunctional beliefs(diathesis)
  3. critical incidents(stressor)
  4. belifs activated
  5. negative autometic thoughts
  6. symptoms of depression:
    *behavioural,motivational,affective,cognitive,somatic
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18
Q

Negative Cognitive Triad

A
  • self (i’m unlovable)
  • world (no one loves me)
  • future (no one will ever love me)
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19
Q

Learned Helplessness

Hopelessness Theory

A

Learned Helplessness
Lack of perceived control over life events

Depressive Attributional Style
* Internal attributions
Negative outcomes are one’s own fault
* Stable attributions
Future negative outcomes will be one’s fault
* Global attribution
Negative events disrupt many life activities (increse sense of hopelessness)

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20
Q

Helplessness Theory

Study These Flashcards
A

Original animal model:
1. Uncontrollable event(schock)
2. Sense of helplessness
3. Emerging depression

21
Q

Helplessness Theory

Reformulated learned helplessness

Study These Flashcards
A

in humans:

  1. Uncontrollable event
  2. Attributions (key factor)
  3. Sense of helplessness
  4. Emerging depression
22
Q

Hopelessness theory

Study These Flashcards
A
  1. Uncontrollable event
  2. Attributions or other cognitive factors(biases,pessamic thinking style)
  3. Sense of hopelessness;no response no hope
  4. Emerging depression
23
Q

Hopelessness Theory

Study These Flashcards
A

Explains increse comorbidity between anxiety and depression:

Helplessness increses anxiety

Persistent helplessness + no hope > depression( both helplessness and hopelessness causes depression

24
Q

Helplessness/Hopelessness

Study These Flashcards
A

Helplessness theory
* Pessimistic attributional style = diathesis

Hopelessness theory
Pessimistic attributional style +
one or more negative life events
will not > depression
unless person first experiences state of hopelessness (no loss of hope no depression)

25
Attributions: Failed Math Test
* Global,Stable,Internal: i'm stupid * Global,Unstable internal : i'm exhausted * Global,Stable,External: my professor hates me * Global,Unstable,External: Its an unlucky day everything is going wrong * Specific,stable,Internal: i'm horable in math * specific,unstable,internal: i didnt study enought for this test * Specific,stable external: the math test are unfair * specific,unstable,external: my math test was number 13 | Unstable: not gonna last forever
26
Psychoanalytical Theory
Freud Depression = anger turned inward we are biologically figthing against itself
27
Etiology: Psychosocial
Interpersonal Theories **People who are depressed may act in ways:**  genuinely negative effect on others  alienation from social support network
28
**Interpersonal Theories: Evidence**
* Poor social networks (all eggs in few baskets) - not that helpfull * Few positive social behaviours * Elicit negative reactions from others * Marital discord * Insecurity in relationships (e.g., frequent reassurance-seeking)
29
Gender ratio
women are 2x more likely **Bio** Cortisol higher in women Estrogen : progesterone ratio **Psycho** Rumination **Social** * Interpersonal (cost of caring) * Type of traumatic events * Chronic negative events -Poverty -Sexual harrassment -Lack of affirmation/power in intimate relationships
30
**Rumination**
Focus on distress & possible causes/ consequences unproductive, repetitive, & passive 4x as likely to develop depression
31
Rumination
**Predicts** * Low confidence in own solutions * Failure to act on solutions **Drives others away** **Depressed ruminators more likely to stay depressed** **Focus on emotion** Women – sadness Men – anger Anxiety link?
32
Other Psychological Factors
* Neuroticism * Sensitivity to aversive events
33
Integrative Model
34
Treatment: Bio
**Pharmacotherapy** * SSRIs * SNRIs * Take 3-12 weeks to work **Light therapy** Seasonal depression
35
Treatment Resistance: Bio Options
**ECT** (schock therapy) How: Electric current induces seizure * **Potential benefits: works quickly when it works** * **Risks: confusion, memory loss** **TMS** How: Magnetic stimulation in select parts of brain * **Potential benefits: non-invasive** * **Risks: still relatively new in use**
36
Treatment: Psychosocial
**Psychodynamic** * Importance of early loss * Attachment to mother/parent **Lack of sufficient nurturance/love > low self-esteem** Anger at self = anger at mother
37
Treatment: Psychosocial
* **Interpersonal therapy Relationships:** working on how you relate to other people * **Family and marital therapy**
38
**CBT**
1. **Primary Control **: helps with things you can control (Problem-solving) 2. **Secondary Control** help with things you can't control (Maladaptive cognitions, Attention) 3. **Behavioural activation** help with actions like brushing teeth,going to work ( the disorder increses because you have less stress, have more people around,increse level of activity) most impoertant
39
Manic Episodes
* **Marked increase in activity level** (work, social, sexual) * Unusual talkativeness, rapid speech * Flight of ideas or racing thoughts * Less than the usual amount of sleep needed * Inflated self-esteem & believe have special talents, powers, and abilities * Distractibility, attention easily diverted * Excessive involvement in pleasurable activities that are likely to have undesirable consequences (e.g., reckless spending)
40
**Bipolar I Disorder**
**Manic (or mixed) episodes + Major depressive episodes** * **High suicide risk** * Domestic violence * Divorce * Truancy * Occupational failure * Substance abuse * Episodic antisocial behaviour
41
prevelance
Lifetime prevalence: **0.4–2.2%** ~3 people in this class **No gender difference**(but women are more likely to be in depressive episodes and man are more likely to be in manic **3:1 depressed : manic days** manic episodes are way less frequent then depression Average age of **onset 18-22** **Recurrent** > than 50% of cases have 4+ episodes (very few is one time episode)
42
**Etiology: Bio**
**Genes** * 1º relatives at risk * Unipolar(like depression) more likely in relative then bipolar **Twin studies** MZ twins 85% DZ twins 14% meaning genes play a huge role
43
NTs
NE, DA, 5-HT (all involved in mood states) (Remember from Part 2 of this lecture) - NE & DA + depression + NE & DA - mania But... NTs return to homeostasis after several days of medication treatment but symptoms consists Expected metabolite levels (+ and -) not consistently found
44
Other Biological Factors
**Cortisol levels** **Disturbances in biological rhythms** (e.g., circadian rhythm – even in remission) **Shifting patterns of blood flow to L & R PFC**
45
Etiology: Psychosocial
**Pessimistic attributional style** Personality * **Neuroticism** * **High levels of achievement striving** **Stressful life events** (esp. dependent) **Low social support**
46
**Treatment: Bio**
**Pharmacotherapy** * **Mood stabilizers** (e.g., **Lithium**, anticonvulsants) * **Antipsychotics** Other Bio * **TMS** * **ECT**
47
Lithium
**Relapse rate = 34% with lithium** (vs. 81% with placebo) over 1 year **Not effective over long haul** (36% over 5 years) **Prognosis** (what can increse the affect of lithium) * **Good:** Family history of bipolar illness * **Poor:** Rapid cycling, multiple prior episodes, substance abuse
48
Treatment: Psycho
**CBT** * Cognitive restructuring * Behavioural activation **Mindfulness based cognitive therapy (MBCT)** * Acceptance of thoughts, emotions **Interpersonal and social rhythm therapy** * Interpersonal interactions can influence daily rhythms **Family & marital therapy** * Reduce criticism, hostility (expressed emotion; EE)

psyc 300 (15 decks)

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