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Flashcards in L2 - Mood Disorders Deck (33):
1

What are the two types of mood disorders?

Unipolar - one polar mood. i.e. depression

Bipolar - 2 polar moods fluctuating between periods of depression and mania. --> Bipolar I, Bipolar II or Cyclothymia

2

How do we differentiate between normal and abnormal depression?

*INTENSITY of mood change.
- If mood change pervade all aspects of the person & impairs social and occupational function
- Can they function despite being sad - sleep, appetite, pleasure, socialising, fulfilling role obligations.

*ABSENCE OF PRECIPITANTS
- mood may develop with no real reason, or be grossly out of proportion to a reason

*QUALITY
- the mood change is different from normal level of sadness. palpable

*ASSOCIATED FEATURES
- The mood change might be accompanied by a cluster of signs and symptoms - somatic (sleep disturbance, appetite) + cog (Self esteem).

3

List the DSM5 Depressive disorders

Disruptive Mood Dysregulation Disorder
Major Depressive Disorder
Persistent Depressive Disorder (Dysthymia)
Substance/Medication-induced Depressive Disorder
Depressive disorder due to another medical condition
Other specificed Depressive Disorder
Unspecified Depressive Disorder

4

What is disruptive mood dysregulation disorder/

This disorder is new, and was added to the DSM to reduce the diagnosis of bipolar in children.

- Restricted to under 18's
- Severe recurrent outbursts of anger, out of proportion for situation and doesn't line up with development level
- general mood is irritable/angry


other facts:
some argue this is pathologising normal behaviour/development


5

What is MDD?

Major Depressive Disorder

5 or more of these in 2 week period, representing a change form previous functioning:
- depressed mood most of the day
-diminished pleasure
-insomnia/hypersomnia
-fatigue
-psychomotor agitation/retardation
-diminished ability to think/concentrate
-recurrent thoughts of death/suicidal ideation
-feelings of worthlessness/guilt

most common comorbidity - anxiety

6

What is Persistent depressive disorder?

Persistent Depressive Disorder

Depressed mood for most of the day for more days than not - 2 years. 2 or more of the following:
- poor appetite /under/overeating
-low self esteem
-low energy/fatigue
-feeling hopeless
-poor concentration


It is CHRONIC. not as intense as MDD but impact on functioning as much or more.


7

What are the protective factors of of depression?

Exercise
normal body weight
car ownership --> socioeconomic status? independence?
genetic factors
Physically attractive/tall
Old age
positive social support -STRONGEST P FACTOR

8

What is the course of PDD in relation to MDD?

MDD can precede Persistent Depressive Disorder.
MDD episodes can occur during Persistent Depressive Disorder.
Persistent Depressive Disorder often precedes MDD and can serve as a risk factor for MDD.

9

What are the causes of depression?

*Genetics
- risk increases by 5-25% wen first-degree relative has unipolar depression
- 40-70% heritability

*Neurobiology
- Neurotransmitters - serotonin, dopamine, NA.
- Stress hormones cortisol, ACTH.

*Personality factors
- Neuroticism = more emotionally reactive to events
- Introversion
- Negative self esteem
- Interpersonal sensitivity (react more strongly to interpersonal events)

*Stressful Events
- LOSS, abuse, natural disaster
- 80% of depressed cases were preceded by major life event.
- Stress generation

10

Vulnerability to depression model?

Broad model that states that all of us have a level of vulnerability to depression.


Says that our vulnerability is made up of genetic and early loss vulnerability

recent stress leads to depressed mood

and maintaining factors are depressed physical state, relationships, action and thinking.

11

Describe the 3 main components of Beck's Cognitive Model (1976).

3 Main levels of cognitive components to the maintenance and aetiology of depression.

DEPRESSOGENIC SCHEMAS
- core beliefs
- enduring assumptions that are formed from early life experiences and over time
- may not be evident to the individual, activated by stressors

SYSTEMATIC LOGICAL ERRORS
- info processing biases that sustain -ve thoughts
- conclusions that are reached through:
overgeneralisation, magnification and minimisation, arbitrary inference, personalisation.

NEGATIVE AUTOMATIC THOUGHTS (NATs)
- automatic, unprompted, immediate, unchallenged.
- Negative Triad: -ve thoughts about self, world and future.

12

What is an example of Beck's Cognitive Model (1976)?

Early experience - unfavourable comparisons with sister

Formation of dysfunctional assumptions (DEPRESSOGENIC SCHEMA) - i am inferior, and my worth depends on what others think of me

Critical incident - marriage breaks down

Assumptoms are activated

NATs - it's my fault. i'll be alone forever.

Symptoms of depression occur

13

How does CBT work?

it targets NATs and underlying assumptoms.

also incorporates basic problem solving, assertiveness training and activity scheduling

14

What are treatments other than CBT for depression

medication
ECT
TMS
St johns wort
omega-3-fatty acids

15

what is Premenstrual Dysphoric Disorder (PDD)?

legitimises women's suffering.
must monitor for 2 months. not done retrospectively.

a. In majority of menstrual cycles, at least 5 symptoms must be present in the week before onset of menses, and improve within a few days after the onset.

b. 1 or more of the following
- marked affectivity lability
- marked irritability/anger/conflict
- marked depressed mood
- marked anxiety/tension

c. one or more of:
- decreased interest in activities
- difficulty concentrating
-lethargy
- change in appetite
- hyper/insomnia
- overwhelmed
- physical symps - breast tenderness/joint pain/muscle pain

16

Epidemiology of PDD?

- 1-8% of women
- 30-80% heritable
- history of trauma may increase risk
- prevalence of non-fatal suicidal behaviours increased in PDD populations


treatment - SSRIs, hormones, CBT.

17

What is post-natal depression?

Major episode of MDD occuring post natally.
Doesn't have it's own category, it's under MDD.

- Feelings of anxiety and depression towards child
-fantasies of killing child

18

What are the risk factors of post-natal depression?

- past history of depression/anxiety
- a stressful pregnancy
- depression during pregnancy
- family history of MI
- severe baby blues
- difficulty breast feeding
- lack of financial, practical, emotional support
- unrealistic expectations of motherhood

19

What is mania?

Abnormally and persistently elevated, expansive or irritable mood.

Engages in risky behaviour - sexual, financial interactions.

Other features (leading to poor judgement)
- inflated self-esteem
- decreased need for sleep
- pressured speech
- racing thoughts
- distractibility
- increase in goal directed activites
- psychomotor agitation

20

Criteria for a manic episode

Distinct period of abnormally + persistently elevated, expansive or irritable mood, lasting at least 1 week (or less if hospitalised).

3 or more:
- impaired regard for consequences
- excessively goal oriented
- flight of ideas
- distractibility
- inflated self esteem
- decreased need for sleep

impairs social/occupational func

independent of subs abuse

21

What is a hypomanic Episode?

This is less severe and does not require hospitalisation.
Could be a precede MDD
Doesnt impact functioning as much as mania.

need 3 symptoms. here are some:
- inflated self esteem
- decreased need for sleep
- distractability
- flight of ideas


22

What are the 3 Bipolar Disorders?

Bipolar 1 Disorder - one or more MANIC episodes, usually accompanied by major depressive episodes

Bipolar 2 Disorder - one or more depresive episodes accompanied by at least one HYPOMANIC episode.

Cyclothymic Disorder - at least 2 years of numerous periods of hypomanic and depressive symptoms, that do not meet threshold for manic or depressive episodes.

23

What is the average age of onset for BP1

Around 18 years

24

What is the average age of onset for BP2

Around 20 years

25

What is the course of bipolar?

majority describe multiple episodes with good or partial inter-episode recovery.

very few have just 1 manic episode, or chronic deteriorating illness.

26

What can mania be a side effect from?

Cocaine
amphetamins, ectasy
anti-depressants
CNS disorder
L-dopa

27

Course of illness for BP1

- distinct manic and depressive phases, and mixed phases
- clear cut resoration of functioning between episodes (although some are rapid cyclers)
- if not treated, length of normal periods between episodes decreases, length of each episode increases, depressed phases are more likely, and suicidality is a major risk


15% competed suicide

28

Comorbidities with BP1?

Anxiety is most common
behaviour disorders
substance abuse disorders

29

Possible aetiologies of BP?

Genetics
- risk of Bp is x4 greater with parents that have BP
- risk to children of BP parents developing a non-BP disorder is x2.7 times greater

Neurotransmitter dysregulation
-dysreg of dopamine and serotonin systems interact with deficits in other NT systems such as GABA, and substance P to produce symptoms
- involves diff brain reigions

Psychological Models
- Manic - defence model
- goal dysregulation
- schedule disruption

30

What is the manic-defence model of BP?

Psychodynamic model

- Manic is an unconscious defence against loss and painful feelings about the self.

Limited empirical support. -ve events don't seem to predict mania.

31

What is the goal dysregulation model of BP?

Mania may result from excessive goal engagement or reward sensitivity and increased sensitivity of dopaminergic reward pathways.

32

What is the Schedule Dysruption model of BP?

Social rhythm disturbance may contribute to triggering manic episodes.

Circadian Rhythm
--> Interpersonal and social rhythm therapy
--> Light therapy

BIOPSYCHOSOCIAL MODEL!!!!!

It postulates that stressful events, disruptions in circadian rhythms and personal relationships, and conflicts arising out of difficulty in social adjustment often lead to relapses.

33

Treatment for BP?

- SSRIs
- lithium



- cog therapy
- circadian rhythm regulation