Lecture 5 (Mood disorders) Flashcards
(18 cards)
Mood aspects definition
Emotion is a state of arousal for subjective states of feeling
-> affect refers to observable expressions of emotions
->mood is sustained emotion
Depressive disorders epidemiology
-> depression is most common cause of disability
-> most common in 15-24
-> lifetime risk for MDD is 16% -> more prevalent in females
-> lifetime risk of bipolar 1 and 2 is 4%
-> no difference in SES or race for mood disorders
Premenstrual dysphoria
at least 5 symptoms in the week leading to menses
One or more
-> affective lability (saddened moods)
-> irritability
-> anxiety
One or more
-> anhedonia
->concentration
-> fatigue
-> appetite changes
-> hyper/insomnia
-> overwhelmed or out of control feeling
-> physical symptoms -> may cause an effect in thinking symptoms
Persistent depressive disorder
Symptoms for 2+ years without a break of more than 2 months on more days than not
2 or more
-> poor appetite
-> hyper/insomnia
-> fatigue
-> low self esteem
-> concentration
-> hopelessness
can be comorbid with MDD
MDD
presence of at least 1 episode of MDD
Not better explained by any psychotic disorders
Never had manic or hypomanic
five or more over two week period at least one of depressed mood or anhedonia
- depressed mood
- anhedonia
- weight loss/gain
- hyper/insomnia
- agitation or retardation
- fatigue
- worthlessness / excessive guilt
- concentration
- suicidality
MDD specifiers and differentials
Specifiers:
severity/psychotic/remission
with anxious distress
with mixed features
with melancholic features (low reaction to environment)
with atypical features (e.g. hyper/insomnia, appetite chance, weight gain)
with mood congruent psychotic -> intensifies sense of emptiness and desperation associated with depression
with mood incongruent psychotic -> mimic a manic state in bipolar
With catatonia -> can be selective mutism
With postpartum onset
With seasonal pattern (e.g. not seeing light in environment)
Differentials
Medical conditions, pharm, psychiatric
Comorbidity -> high comorbid with anxiety ED, personality disorders, substance use
Depression course and prognosis
50% have episode before 40
untreated episode usually lasts 6-13 months
treated episode usually lasts 3 months
antidepressent withdrawal usually 3 month relapse
5-10% of initial MDD have a manic episode 6-10 years later
MDD is a cyclic disorder -> usually have at least 2 with average of 5-6 episodes in lifetime
Risk of recurrence-> history of a previous episode
Co existing with the common co-morbids
Manic episode criteria vs Hypomanic
A. Distinct periods of abnormally and persistently elevated, expansive or irritable mood and goal directed energy for AT LEAST A WEEK
B. 3 or more
1. Grandiosity
2. Decreased need for sleep
3. increased speech
4. racing thoughts
5. Distractibility
6. Increased goal directed behaviour
7. excessive involvement in pleasurable activities e.g. gambling
C. Marked impairment of functioning or hospitalisation
D. not due to substance
Hypomanic
Meets most criteria for manic episode but not as sever
-> only has to last FOUR days
-> associated with uncharacteristic change in functioning
-> not severe enough to cause a marked impairment on functioning
-> NO psychotic features
Bipolar 1 vs Bipolar 2 and specifiers
Bipolar 1 = at least one manic episode
Most recent episode -> hypomanic, manic, depressed, unspecified
Bipolar 2 = one or more MDD episodes accompanied by at least one hypomanic episode
NEVER had a manic episode
Specifiers
The same for MDD
Bipolar differentials, course, prognosis
Symptoms of grandiosity may be a feature in some psychiatric disorders -> schizophrenia, personality disorders (BPD, narc, histrionic)
Course:
Bipolar often starts with depression
Age of onset usually young -> 18-22
10-20% only experience mania
Prognosis:
50% manage disorder well, others have ongoing disability
Those with pure manic symptoms usually do better than those with depressed or mixed features (doing better than someone going through ups and down)
20-50% effected in work and interpersonal relationships
High divorce rates and alc abuse
Suicide risks
16% with MDD have attempted
30% Bipolar have attempted
60% with co morbid major depressive episode and BPD have attempted
Biological / Neurochemical aetiology
Pedigree -> higher frequency depression among relatives of depression probands that control
50-60% of bipolar have family history
Twin designs support polygenic influence of depression and bipolar
Neurochemical:
Catecholamine hypothesis:
-> excess noradrenaline can cause mania and too little can cause depression
Indolamine hypothesis
-> deficiency in serotonin related to depression
Limitations:
-> a simple biochemical model cannot account for a heterogenous disorder
Life events perspective
Depression
25% increase prevalence during first year of covid
Expressed emotion families can cause increase relapse
But -> mediators (e.g. coping skills) may be more important in understanding effects of life events
Bipolar
Life events usually precede an episode
-> schedule disrupting events (e.g. sleep pattern disruptions)
-> goal attainment events (e.g. trying to make deadline)
Attributional styles and how dysfunctional attitudes interact with life events
Behavioural theory
Depression occurs as a result of a reduction in response-contingent positive reinforcement
-> not engaging in activities that give pleasure
3 ways why insufficient reinforcement may occur
1. Environment produces loss of reinforcement
2. lack of skills
3. unable to enjoy or receive satisfaction from reinforcement
Cognitive theories
ABC model
Learned helplessness model
attributing everything bad as personal, global, stable
learned helplessness
Uncontrollable aversive events -> sense of helplessness -> depression
Attributional reformulation
Aversive events -> negative attribution -> sense of helplessness / expectation that desirable outcomes will not occur -> depression
Cognitive triad / becks model of depression
Cognitive triad
Negative views about the world (e.g. everyone is against me) affecting negative views about the future and oneself
Becks cognitive model of depression
Early experiences -> development of core beliefs -> attitudes and rules for living (then…if) -> precipitating event (activating core poor beliefs)
interacts with the ABC model in how it is then maintained
Interpersonal therapy
People with depression may have social networks that are more sparse and less supportive
-> targets specific social domains, e.g. developing social skills and trying to help integrate person into social networks
Bipolar disorder = low social support associated with longer episodes
Treatment -> pharm and CBT
use of SSRIs, TCAs, MAO-Is, lithium for bipolar
CBT best for relapse prevention
CBT usually includes psychoeducation, mood diaries, activity scheduling
