Chapter 8 Flashcards
(134 cards)
What are mood disorders?
-> Serious psychological conditions involving significant mood disturbances
->Marked by extreme sadness (depression) or elation/irritability (mania)
->Disabling → Interfere with daily functioning
->Often comorbid with other psychological problems (e.g., anxiety, panic attacks, substance abuse, personality disorders)
What are the main symptoms/disturbances of depression?
- Mood disturbances:
->Great sadness, feelings of worthlessness & guilt
- Cognitive disturbances:
->Self-criticism, self-blame, indecisiveness
->Slowed thinking
->Thoughts of death/suicide
- Physiological & behavioral disturbances:
->Changes in sleep & appetite (increase or decrease)
->Anhedonia: Loss of interest/pleasure in usual activities
What is mania?
->A period of abnormally elevated or irritable mood lasting at least one week or requiring hospitalization
->Extreme pleasure in every activity
->Must have at least 3 of the following:
(a) Inflated self-esteem
(b) Decreased need for sleep
(c) Talkativeness (racing speech, no connection between ideas)
(d) Flight of ideas (racing thoughts)
(e) Distractibility
(f) Increased goal-directed activity
What is a hypomanic episode?
->Mild version of mania
->Does NOT cause major impairment in social or everyday life functioning
->”Hypo” = Below
What are the two main categories of mood disorders?
- Depressive Disorders → Marked by low mood only
—>Major Depressive Disorder (MDD) (formerly unipolar disorder)
—>Disruptive Mood Dysregulation Disorder
—>Persistent Depressive Disorder (Dysthymia)
—>Premenstrual Dysphoric Disorder (PMDD)
- Bipolar & Related Disorders → Characterized by highs and lows in mood
—>Bipolar I Disorder → Can be diagnosed with only a manic episode, even if depression has not yet occurred
—>Bipolar II Disorder → Involves hypomanic & depressive episodes
—>Cyclothymic Disorder → Chronic, less severe mood swings
What is Major Depressive Disorder (MDD)?
->Severe depression with no manic episodes
->Impairs interest/ability to engage in enjoyable activities
->two different types of episodes
What are the types of MDD episodes?
- Recurrent:
->Two or more major depressive episodes
->Separated by at least 2 months of euthymia (normal mood)
- Single episode:
->One major depressive episode
->Less likely to have a family history
What is the average age of onset for MDD?
->Mid to late 20s
->Decreasing over time
How common is MDD?
->One of the leading causes of disability worldwide
->Most common psychiatric disorder globally
What are the diagnostic criteria for MDD?
->Must have 5+ symptoms for at least 2 weeks
->One of the symptoms must be:
1. Depressed mood most of the day, nearly every day
2. Loss of interest or pleasure in usual activities
Other symptoms:
3. Loss of energy, extreme fatigue
4. Feelings of worthlessness, negative self-appraisal
5. Sleep disturbances (insomnia or hypersomnia)
6. Difficulty concentrating
7. Changes in activity level
8. Thoughts of death or suicide
9. Changes in appetite & weight
How long do depressive episodes last?
-> Variable: 2 weeks – several years
->First episode duration (untreated): 2–9 months
->Median duration of recurrent episodes: 4–5 months
->Median lifetime number of episodes: 4–7
What is Persistent Depressive Disorder (Dysthymia)?
-> Chronic depression lasting at least 2 years (1 year in kids/teens)
—>never without symptoms for more then 2 months
->Same symptoms as MDD but are fewer & less intense than MDD but longer-lasting
->More severe than MDD as chronic → More resistant to treatment
->May last 20-30 years
What is Double Depression?
-> Persistent depressive disorder + episodes of MDD
What are Specifiers for Depressive Disorders?
->Specifiers, or symptoms, that may or may not accompany a depressive disorder
->Clinicians use eight specifiers:
- With psychotic features:
—> Mood-congruent: Delusions/hallucinations in line with depression (e.g., hearing voices saying you’re worthless)
—>Mood-incongruent: Psychotic symptoms unrelated to depression (e.g., believing you are a god)
->fulfil criteria of MDD and have hallucinations etc.
-> Generally, do not respond to the usual drug therapies
-> Combined with drugs to treat psychotic disorders such as schizophrenia
- With anxious distress:
—>Restlessness, worry, fear of losing control
- With mixed features:
—>MDD with some manic symptoms (e.g., racing thoughts, excess energy)
EX. people experiencing an episode with mixed features may feel very sad, empty, or hopeless while at the same time feeling extremely energized
- With melancholic features:
—>Extreme lethargy, depression worse in the morning
- With atypical features
—>eat a lot, sleep a lot
- With catatonic features:
—>Motor disturbances (immobility or excessive movement, mimicking others)
- With peripartum onset:
—>Postpartum depression (during pregnancy or after childbirth)
- With seasonal pattern:
—>Depression occurs during specific seasons for at least 2 years
—>SAD (Seasonal Affective Disorder):
——>Depression: Fall/Winter
——>Bipolar: Depression in Winter, Mania in Summer
What is Premenstrual Dysphoric Disorder (PMDD)?
->Physical symptoms, severe mood swings, and anxiety
->Decreased interest in usual activities; difficulty in concertation; lack of energy; hypersomnia or insomnia; Interferes with work, relationships, daily activities
->Different from PMS due to symptom severity and impact
What is Disruptive Mood Dysregulation Disorder (DMDD)? Describe the debate between supporters and critics?
->Common in children (extreme temper tantrums)
->Chronic irritability, anger, aggression, hyperarousal
->Tantrums grossly out of proportion to the situation
->Different from ADHD
Supporters: Created to prevent overdiagnosis of childhood bipolar disorder
Critics: Disagree with labeling temper tantrums as mental illness
What is Bipolar I Disorder?
->Major depressive episodes alternate with full manic episodes
->Can be diagnosed after just one manic episode
What are the diagnostic criteria for a manic episode?
-> Requires presence of elevated or irritable mood + increased activity and at least 3 additional symptoms (4 if mood is only irritable) for at least 1 week:
- Increased goal-directed activity or psychomotor agitation
- Unusual talkativeness; rapid speech
- Flight of ideas (racing thoughts)
- Decreased need for sleep
- Inflated self-esteem
- Distractibility
- Excessive involvement in pleasurable activities (risk-taking behavior)
-> Implication for drug compliance:
—>Patients don’t believe anything is wrong, so they resist taking medication
What is the Rapid-Cycling Specifier in Bipolar Disorder?
->Moving quickly in and out of depressive and manic episodes (doesn’t seem to be permanent)
->At least 4 manic or depressive episodes per year
->20-50% experience rapid cycling (more common in women)
->Types:
1. Rapid switching: No euthymic period in between
2. Ultra-rapid cycle: Episodes last days to weeks
3. Ultra-ultra-rapid cycle: Episodes last less than 24 hours
What is Bipolar II Disorder?
->Need depressive episodes + hypomanic episodes
->Hypomanic episodes are less severe than manic episodes and do not impair daily life
Onset & Duration of Bipolar Disorders
->Bipolar I: 15-18 years
->Bipolar II: 19-22 years (10-13% progress to Bipolar I)
->Develops suddenly (compared to depressive disorders)
->Rare after age 40
->High risk of suicide
->Less common than major depression
What is Cyclothymic Disorder?
->Chronic fluctuations between hypomanic symptoms and depression
->Episodes are not intense or long enough to qualify as full hypomanic or depressive episodes
->Must persist for at least 2 years
->Age of onset: 12-14 years
How common are mood disorders in Canada?
->2.9 million Canadians reported a mood disorder (CCHS, 2019)
->Stable prevalence over time in Canada
How common is Major Depressive Disorder (MDD) worldwide?
->16% lifetime prevalence
->6% prevalence in the preceding year