Exam 2 Flashcards
(96 cards)
1
Q
How can you assess mood disorders?
A
- Unstructured clinical interviews
- Semi-structured diagnostic interviews (e.g., Structured -
Clinical Interview for DSM) - Clinician rating scales (e.g., Hamilton Rating Scale for Depression)
- Self-report questionnaires (e.g., Beck Depression Inventory)
- track severity
- All of these methods are useful to get information
2
Q
How do you assess mood disorders in children?
A
Child self-report, parent-report, teacher-report
Only modest correlations (~ .30)
- children are not good reporters of their symptoms
- adolescents may not want to reveal some of the problems they are dealing with
3
Q
What does incidence refer to?
A
The onset of new cases
4
Q
What does prevalence refer to?
A
Someone having the disorder at all, first time or not
5
Q
What are some important case studies of epidemiology?
A
Epidemiological Catchment Area Study (ECA); National Comorbidity Study (NCS) and NCS-replication; World Mental Health Surveys
6
Q
What is the prevalence for Bipolar 1 and Bipolar 1 and 2?
A
~1-2% bipolar 1
~2-4% bipolar 1 and 2
7
Q
What is the prevalence for MDD
A
~15%
8
Q
What is the prevalence of PDD?
A
~5%
9
Q
Are the prevalences of disorders in the US and over or under estimate?
A
- Some people think that it is high and most people don’t have clinical symptoms or that maybe depression is too high
- Some people think that it is too low because people might not report accurately, or don’t report periods of low moods, maybe some people don’t get treatment, or don’t think about it
- Some rates are higher, especially for MDD, a common disorder that affects a lot of people
- We should think about how we currently define disorders
10
Q
True or False: MDD is higher in higher income countries.
A
TRUE.
Can be some cultural differences in the expression of depression
11
Q
True or False: Women are more likely to seek treatment for depression.
A
True
- Also report more symptoms
12
Q
Can restrictions and restraints contribute to depression?
A
YES
13
Q
How do women tend to cope when sad?
A
They ruminate
14
Q
How do men tend to cope when sad?
A
They are likely to distract themselves
15
Q
How can adolescence/puberty be a cause for depression?
A
-hormones;
-physical changes;
-changes in peer and family relationships;
-romantic relationships
-Pubertal timing
16
Q
How are rates of depression affected by age and sex in the national comorbidity study?
A
- First national comorbidity study. Rates of depression increase in adolescence, when sex differences also emerge and persist throughout adulthood. Similar findings in all epidemiological studies.
- We see that at the beginning the rates of depression are similar for men and women
- Sex differences begin to emerge during adolescence around puberty
- A lot of things are changing around the time of puberty
Females who go through puberty higher than their peers may be more susceptible to depression
IF you go through puberty earlier you may hang out with older kids and may do things you aren’t prepared for like intimate relationships
17
Q
What are the birth cohort effects for depression?
A
- Real increase (e.g.., due to sociocultural and environmental changes) vs forgetting, differences in awareness and labelling
- Rates of depression increase after the cohort of WWII
- Different periods where generations have increased depression
17
Q
Is depression an impairment condition?
A
Yes and it can vary in severity
18
Q
Where did depression rank in 2017 in the WHO Global Burden of Disease study?
A
In 2017, depression ranked 3rd for females and 5th for males worldwide in years lived with disability (WHO Global Burden of Disease study)
- Depression ranks remarkable high, top 5 for all mental disorders, ranks higher than many severe physical disorders
- Can be because of how people process their emotions and what they think of depression
19
Q
What physical diseases is depression associated with?
A
cardiovascular, type 2 diabetes, autoimmune diseases
- Depression causes a lot of stress and can lead to some of those diseases, but also having those diseases can lead to a lot of stress that causes depression
- Shared risk factors such an environmental factors
- Genes that are involved in depression can also be similar genes for physical diseases
20
Q
Why do you have to pay attention to course and complications of treatment?
A
Prognosis, treatment planning, evaluating treatment, theory and clues for etiology
- Important to evaluate the effects of treatment
- Gives you expectations when trying new treatment
Some patients do get better without treatment - Useful for theory about etiology of a disorder
- Depression and BPD are often episodic
- Not particularly evidence based these terminology
21
Q
What does response mean in terms of course and complications?
A
Response - > 50% reduction in symptoms
if they’re symptoms reduce then you can say they responded to treatments, might use self – reports to rate their symptoms
22
Q
What does remission mean in terms of course and complications?
A
Remission – does not meet dx criteria for > 3 wks
Can be partial or full
you have a response can no longer meet criteria for the disorder for at least 3 weeks,
- can be full – no more symptoms,
- partial – you can no longer meet the criteria but you still have some lingering symptoms,
- partial remission is one of the best predictors for relapse or recurrence, target for treatment should be full remission
23
Q
What does recovery mean in terms of course and complications?
A
does not meet dx criteria for > 4 mos
Recovery is more prolonged, for at least four months, remission means that symptoms have gone away enough that you don’t meet criteria anymore
We really don’t know how long underlying episodes last
24
What does relapse mean in terms of course and complications?
meets dx criteria again after remission but before recovery
the underlying episode has come back, so meeting criteria again before 4 months, reemergence of the same episode
25
What does recurrence mean in terms of course and complications?
– “new episode”; meets dx criteria again after recovery
you recovered and have meet criteria for an episode again for a new episode
26
When is the onset for BPD?
Onset for BPD is almost always in adolescence or young adulthood
27
True or False: Onset of BPD can be mania or depression.
True.
Half the time it is a depression episode, and bc of this you can’t diagnose BPD since there is no record of mania yet
28
How long is the recovery time for manic episodes?
For manic episodes the time to recover is 2-3 months and almost everyone recovers for a manic episode
29
What is a predictor of a longer time to recovery for bipolar disorder?
Mixed states
- manic episodes with depressive symptoms at the same time
30
Is mania usually recurrent?
Yes
7-9 lifetime episodes, on average
31
What is a predictor of recurrence in bipolar disorder?
partial (not full) recovery, more prior episodes
- If you have an episode, recover but have some symptoms you’re more likely to have more episodes, and if you had episodes in the past you’re more likely to have more episodes
32
When is the onset for depression?
Any age, but commonly adolescence and young adulthood
33
What is the time of recovery for a depressive episode?
5-6 mos;
- 15-20% chance of chronicity (2 yrs)
34
What are some predictors of longer episodes for depression?
length of current episode, childhood maltreatment, comorbidity
- If you’re depressed and also have anxiety disorder the episode is more likely to last longer
35
What is the chance of recurrence for depression?
50%
36
What are predictors of recurrence in MDD?
partial recovery, dysthymia, # prior episodes, comorbidity
- Important that people are symptom free
- People with mild depression are more likely to have MDE, the more episodes you had in the past the more likely you are to have more
37
How does PDD differ from non chronic MDD?
> early adversity, comorbidity, and family history of depression (esp PDD)
38
When is the onset of PDD?
Onset is often prior to age 21 (sometimes as far back as can be remembered) but can be in later adulthood
39
What are the rates of suicide for men and women?
Men 3x more likely to complete; women 2-3x more likely to attempt
Sex differences in lethality of means
40
What are some risk factors for suicide?
- Older males; whites; not married; sexual minorities; groups undergoing social disruption
-
Previous suicide attempts (33%)
- 90% of suicides have a psychiatric disorder: depression (2-6% suicide rate; somewhat higher in bipolar disorder); schizophrenia; anorexia; substance disorders
- Hopelessness
- Impulsivity
- Social isolation; interpersonal loss
- Physical illness; financial loss; legal problems
- History of early adversity/maltreatment
- Family history of suicide (genes appear to play a role)
- Some evidence for contagion via peers and media
41
Is suicide a rare phenomenon in the general population?
- Yes
42
What are some protective factors for suicide?
responsible for children; religiosity
- Having the thought of what happens to my children might stop someone from committing suicide
43
When is the risk highest for suicide?
Risk is highest in the period after recovery from depression or hospital discharge
- Risk for suicide continues even after someone recovers from depression, not clear how long the time is
- When people are very depressed they don’t have a lot of energy to follow through with committing suicide but when they recover they may have more energy to go through with it
- You shouldn’t stop worrying about someone even if they are feeling better
44
Do people who are thinking of suicide communicate intent?
Yes in the majority of cases
- They communicate some form of intentions or clues, may give away possessions
45
Are we able to predict suicide?
challenges of predicting rare events (low base rates) and predicting transient states
- Really bad at predicting if someone will commit suicide, even among people with a lot of risk factors because it is very rare
- Over predicts suicide
- We may be better if someone will EVER commit suicide, but that’s not what we want to know
46
What is Thomas Joiner's Interpersonal Theory of Suicide?
- Acquired capability (habituation to pain, death through prior exposure)
- Thwarted belongingness (i.e., social isolation or exclusion)
- Perceived burdensomeness
Says that suicide requires 3 different elements and all need to be present
- You acquire it over time, you get used to the pain or death maybe from past attempts or something else in your
environment. Anything that makes it seem less extreme,
- Thwarted belongingness- you want to belong and have a community but you don’t for whatever reason, a sense of alienation
- Feeling like you’re a burden to other people, you’re not contributing value
47
What was believed before the late 1970s about depression in children?
it was believed that children were not capable of experiencing depressive disorders.
48
What happened in the late 1970s pertaining to children with depression?
investigators started interviewing school-age children about depression and found that they met full diagnostic criteria for MDD
49
Is there a continuity for child depression and adult depression?
Mixed findings.
- Children who are depressed do have family members that have higher rates of depression but also have higher rates of others issues such as substance abuse – it does run in families but all kinds of things runs in this family – could be a response to all the other difficulties
- Homotypic continuity – mixed. Some studies show that children who have depression are more likely to have depression when they are older, but other studies show that they are more likely to develop a bunch of other things such as anxiety, eating disorders- can be a response to adversity
- Antidepressant treatment seems to be weaker for children than adults
50
Can preschoolers meet the criteria for depression?
Preschoolers can also meet the criteria for depression, but the depression almost never lasts for 2 weeks
51
What is the prevalence of depression in adolescents?
For adolescence this is the period where people have the first episode of depression
It becomes fairly prevalent
52
Is there a continuity between adolescent depression and adult MDD?
Depressed adolescents have family history of depression, recurrency of depression and they tend to respond to antidepressant treatment better than children but not as good as adults
53
What is important to know about the relationship between antidepressants and suicide?
- Medication that treat depression might increase suicidal thoughts or ideations in children, adolescents, and young adulthood
- Black box warning warning about suicidality risk on antidepressants for younger people
- Antidepressants are not very effective in children – risk are higher and the benefits are low
54
What is pediatric bipolar disorder?
Bipolar disorder for children
- Historically believed to be extraordinarily rare before adolescence
55
When was Pediatric Bipolar Disorder recognized?
It was recognized in the mid-late 1990s
56
What is the clinical presentation for pediatric bipolar disorder?
Clinical presentation – irritable, not elated, mood; no distinct episodes - “ultraradian cycling”
- The irritability can be very severe
- For kids there are no distinct episodes, may be irritable all the time, or may have short and frequent episodes
57
What is pediatric bipolar disorder comorbid with?
- Comorbid with other behavioral disorders such as ADHD
- There is some overlap with ADHD with mania – distractibility, hyper activity
- Opposition defiance disorder is also very common with these children
Do these kids really have BPD?
58
Is there a continuity between pediatric bipolar disorder with adult bipolar disorder?
Relatives could have BPD
59
Why was pediatric bipolar disorder a major public health problem?
maybe those kids didn’t have BPD and were being over diagnosed
60
Why was Disruptive Mood Dysregulation Disorder introduced to the DSM-5?
solution to epidemic of pediatric bipolar disorder so they would be less likely to give them medications typically used to BPD
61
What is DMDD characterized by?
- Severe temper outbursts (verbal or behavioral), on average, three or more times per week
- Outbursts and tantrums have been ongoing for at least 12 months
- Chronically irritable or angry mood most of the day, nearly every day
- Typically diagnosed between the ages of 6 and 10.
62
When is DMDD typically diagnosed by?
The ages of 6 and 10
63
Is DMDD valid?
- Don't really care if its valid mostly introduced for public health purposes
- Might have a very severe form of ADHD and something else
- No effective treatments for DMDD
- This diagnosis doesn’t solve the problem, they are still very irritable kids but it does take away the label of being bipola
64
Is DMDD distinct from oppositional defiant disorder and ADHD?
Yes?
There are some overlap
- If you meet the criteria for DMDD you can’t also have oppositional defiance disorder
65
What is the vascular depression hypothesis?
a subgroup of elderly whose depression is due to cerebrovascular disease
66
What is the onset of vascular depression?
65 years or later
67
What are the characteristics of vascular depression?
- Late onset (> 65 yrs)
- White matter hyperintensities on MRI
- History of hypertension
- No family history of depression
- Cognitive deficits on neuropsychological testing
- Lethargy, loss of initiative, apathy
- Poor response to antidepressant medication
- Increased risk of dementia
Probably a secondary effect of neurological damage due to cardiovascular disease
68
What studies are under the behavior genetics of mood disorders?
Family studies
Is familial aggregation due to genetic influences?
Twin studies
Adoption studies
69
What is the main question in family studies?
do mood disorders run in families?
70
What is the bottom-up design in family studies?
probands -> relatives
Bottom-up: group of children and you study their siblings or their parents. You start with probands and study their relatives
71
What is the top-down design in family studies?
parents -> offspring
72
What are two kinds of interview to get information in family studies?
Direct interview vs family history interview
Direct interview :you can go to the doctors office and they will ask if there are diseases in the family – you might not know everything of your family history
Family history interview: You can interview everyone in the family – usually first degree relatives, more accurate picture, you have a more accurate picture if something is genetic
73
Are rates of bipolar disorder and MDD elevated in relatives of probands with bipolar disorder?
Yes.
Rates of both bipolar disorder and MDD are elevated in relatives of probands with bipolar disorder
74
Are rates of MDD and bipolar disorder elevated in relatives of probands with MDD?
No.
Rates of MDD, but not bipolar disorder, are elevated in relatives of probands with MDD
75
What is associated with higher rates of MDD in relatives?
Early-onset and recurrence are associated with higher rates of MDD in relatives
76
What percent of proband who have bipolar 1 have relative with bipolar 1?
3%
77
What percent of proband who have bipolar 1 have relative with bipolar 2?
3%
78
What percent of proband who have bipolar 1 have relative with MDD?
10%
79
What percent of proband who have MDD have relative with bipolar 1?
1%
80
What percent of proband who have MDD have relative with bipolar 2?
1.5%
81
What percent of proband who have MDD have relative with MDD?
14%
82
What percent of proband who have no Dx have relative with MDD?
6%
83
What is the design for twin studies?
- Identical (monozygotic) twins reared apart
- Monozygotic vs dyzygotic twins
- Fraternal twins are dizygotic – no more genetically related than other biological siblings, about 50% of their genes
- Identical twins are 100% genetically identical
84
How can you see if genes are playing a part of mood disorders based on twin studies?
IF genes are playing a role in a disorder than if one has a disorder the other should have a disorder, should show greater resemblance of that disorder
Best way of separating genes is separating the twins
You want to separate genes from the environment
Twins are raised in the same family at the same time – assumption that the environment is stable – often violated
85
What is hertiability?
measure of how much variations can be accounted for by genetics
- So if the environment is the same it has to be due to genetics and vice versa
- Heritability depends on how much variation there is in genes and the environment
- Intelligence is highly heritable
- Heritability is not an absolute number, can change based on variation of genes and environment
86
If an Mz twin has bipolar disorder what is the percentage of the other twin getting it too?
40%
87
How heritable is bipolar disorder based on Maudsley Hospital Twin Study?
96%
- Higher than MDD
88
How heritable is MDD based on Maudsley Hospital Twin Study?
52%
89
What is the design for adoption studies?
- Biological/adoptive parent as proband
(With adoption studies we start with the biological parents giving up their child for adoption – see if the children have the same disorder as their biological parents and then their adoptive parents)
- Adoptee as proband
- Cross-fostering
90
Why is cross-fostering hard?
if you have a history of a psychological disorder it’s much harder to adopt a child
91
What is the summary of the Minnesota Adoption Study?
If the mother has a history of depression the adoptive children are more likely to have depression
Shows that environment is important
92
How is the swedish population registry seperated
Intact, adoptive, not-lived-with father, and stepfather
93
What is the swedish population registry study used for?
Used national health care registries to determine which individuals had been treated for MDD
94
What are the parent-child correlations between genes + rearing, genes alone and rearing alone?
genes + rearing r = .17; genes only r = .08; rearing-only r = .08
- You need genes and the environment for a greater risk of depression, doesn’t go beyond doubling the risk
- For BPD the genetic effects are higher and the environment effects are lower
95
