lesson 6 (ch 5): mood disorders Flashcards
(91 cards)
1
Q
two broad types of mood disorders
A
- involves only depressive symptoms
- involves manic symptoms (bipolar disorders)
2
Q
DSM-5 depressive disorders
A
- major depressive disorder
- persistent depressive disorder
- premenstrual dysphoric disorder
- disruptive mood dysregulation disorder
3
Q
persistent depressive disorder combines
A
combines dysthymia and major depressive disorder- chronic subtype
4
Q
DSM-5 bipolar disorders
A
- bipolar I disorder
- bipolar II disorder
- Cyclothymia
5
Q
cardinal symptoms of depression
A
- profound sadness
- inability to experience pleasure
6
Q
Major Depressive Disorder (MDD) subtypes
A
- Episodic
- Recurrent
- Subclinical depression
7
Q
Episodic (MDD)
A
depressive symptoms tend to dissipate over time
8
Q
recurrent (MDD)
A
- once depression occurs, future episodes likely (Avg 4 episodes)
9
Q
subclinical depression
A
- sadness plus 3 other depression symptoms for atleast 10 days
- significant impairments in functioning even though full diagnostic criteria not met
10
Q
DSM-5 criteria for MDD
A
need atleast five
- sad mood or loss of pleasure (anhedonia) (nearly every day for atleast 2wks)
plus four of these:
- psychomotor retardation or agitation
- weightloss or change in apetite
- loss of energy
- feelings of worthlessness or excessive guilt
- difficulty concentrating/ thinking/making decisions
- recurrent thoughts of death or suicide
11
Q
psychomotor retardation/ agitation
A
Symptom of depression
psychomotor retardation: thoughts and movements slow
psychomotor agitation: can’t sit still
12
Q
Persistent Depressive Disorder symptoms
A
- depressed mood for atleast 2 years (1 year for children/adolescents)
plus 2:
- poor appetite or overeating
-sleeping too much or too little - poor self-esteem
- trouble concentrating/making descisions
- feelings of hoplessness
13
Q
does the DSM-5 distinguish btwn chronic MDD and dysthymia? Why/why not?
A
dysthymia considered subclinical, but lasts a long time
the DSM-5 doesn’t distinguish btwn them chronic MDD and dysthymia b/c:
the chronicity of symptoms is a stronger predictor of negative outcome than number of symptoms
14
Q
Premenstrual Dysphoric Disorder
A
in most menstrual cycles during past year, atleast 5 symptoms during final week before period, improve once starts
- affective lability (mood swings)
- irrability
- depressed mood, hopelessness, self-deprecating thoughts
- anxiety
- diminished interest in usual activities
- difficulty concentrating
- lack of energy
- changes in appetite
- sleeping too much/little
- sense of overwhelm/out of control
- physical symptoms
15
Q
Disruptive Mood Dysregulation Disorder
A
new disorder in DSM-5
primary symptom is temper outbursts/negative mood
- severe recurrent temper outbursts including verbal or behavioral expressions out of proportion w/ provocation
- outbursts are inconsistent w/ developmental level
- 3 times a week
- present atleast 12 months and don’t clear for more than 3 months at a time
- negative mood most days
- outbursts present in atleast 2 settings, severe in atleast 1
- age 6 or older (or equivalent developmental level)
- onset before age 10
- no distinct period lasting more than a day of elevated mood + 3 manic symptoms
- doesn’t occur exclussively during course of MDD and not better accounted for by another disorder
- cannot coexist with oppositional defiant disorder, ADHD, intermittent explosive disorder, or bipolar
16
Q
commonality of depression (epidemiology)
A
lifetime prevalence: 16.2%
2.5 % for dysthymia
2x as common in women as in men
3x as common among ppl in poverty
17
Q
depression symptom variation across cultures
A
lantino: nerves/headaches
asian: weakness, fatigue, poor concentration
closer to the equator + higher fish consumption associated w/ lower rates of MDD (Seasonal affective disorder)
18
Q
comorbidity and depression
A
2/3 (60%) of those w/ MDD will also meet criteria for anxiety disorder at some point
19
Q
3 forms of bipolar disorder
A
- bipolar I
- bipolar II
- Cyclothymia
20
Q
is depression required for a bipolar diagnosis?
A
an episode of depression is NOT required for bipolar I,
it is required for bipolar II
21
Q
mania (+ symptoms)
A
state of intense of elation or irritability
- flight of ideas, shifting rapidly from topic to topic
- louder
- overly sociable to point of intrusiveness
- excessively self-confident
- may stop sleeping, lots of energy
22
Q
hypomania
A
symptom of mania, but less intense
doesn’t involve significant impairment
hypo = under
23
Q
Bipolar I
A
formerly manic-depressive disorder
- includes atleast one episode of mania in the course of their life
24
Q
Bipolar II
A
milder form of bipolar
- atleast one major depressive episode
- and atleast one episode of hypomania
25
cyclothymic disorder/ cyclothymia
- milder, chronic form of bipolar disorder
- lasts 2 years in adults, 1 year in children
- numerous periods with hypomanic and depressive symptoms
26
DSM-5 Criteria for Manic and Hypomanic episodes
- distinctly elevated/irritable mood for most of the day nearly every day
- abnormally increased activity and energy
atleast 3 (4 if irritable):
- goal-directed activity/ psychomotor agitation
- talkativeness/ rapid speech
- flight of ideas/ thoughts racing
- decreased need for sleep
-increased self-esteem; belief of special powers/ abilities
- distractibility
- reckless behavior
27
DSM-5 Criteria for just Manic episodes
- symptoms last 1 week or require hospitalization
- cause significant distress or functional impairment
28
DSM-5 Criteria for just Hypomanic episodes
- symptoms last at least 4 days
- clear changes in functioning that are observable to others, but impairment not marked
- no psychotic symptoms
29
epidemiology of bipolar(prevalence)
- Bipolar I: 1% US, 0.6% worldwide
- Bipolar II: 0.4%-2%
- 4% for cyclothymia
30
average onset of bipolar disorder, gender
average onset in 20's
no gender differences, but women have more depressive episodes
31
hospitalization, consequences of bipolar
severe mental illness
1/3 unemployed 1 year after hospitalization
suicide rates high
32
what factors contribute to the onset of mood disorders
- neurobiological factors
(genetic, neurotransmitter, brain-imaging, and neuroendocrine)
- psychosocial factors
33
heritability of MDD and Bipolar I
37% for MDD
- (DRD4.2 gene influences dopamine function may be related)
93% for Bipolar I
specific genes not yet identified, research in progress, need replication
34
serotonin transporter gene
related to MDD-
the gene has a polymorphism, so if someone has a particular combination of alleles (short-short or short-long), they're at risk of depression-
but ONLY if they also experienced childhood maltreatment/ life stress (gene x environment interaction)
35
3 neurotransmitters that have been looked at extensively in psychopathology
- norepinephrine
- dopamine
- serotonin
36
how do neurotransmitters play a role in psychopathology (og model)
- og model: looked at the absolute levels of neurotransmitters in people
- low levels all 3 for MDD
- mania high of nor and do, low serotonin
cant be right b/c medication alters levels immediately, but relief takes 2-3 weeks
37
new model- how do neurotransmitters play a role in psychopathology
focuses on sensitivity of postsynaptic receptors
- dopamine overly sensitive in BD
- dopamine receptors not sensitive enough in MDD
38
brain imaging types (2)
- structural studies
- functional activation studies
39
structural studies
(brain imaging)
focus on # of or connection among cells
40
functional activation studies
(brain imaging)
focus on activity levels
41
5 brain structures most studied in depression
-amygdala
-anterior cingulate
- (regions of the) prefrontal cortex
- hippocampus
- striatum
Mandala, interior, collegiate hippo, strachatella
42
amygdala, striatum and depression
(?)
amygdala engaged when ppl perceive emotionally salient stimuli
functional brain activation studies show elevated amygdala activity on those w/ MDD
striatum: diminished activity of striatum during emotional stimuli, especially to reward stimuli
43
depression and anterior cingulate, hippocampus, and prefrontal cortex
(?)
MDD associated w greater activation of anterior cingulate
and diminished activation of hippocampus and parts of the prefrontal cortex
when viewing negative stimuli
44
bipolar I and brain structures
elevated activity of amygdala and anterior cingulate during emotional regulation tasks, diminished activity of hippocampus and dorsolateral prefrontal cortex
high activation of striatum in functional MRI studies
45
HPA-Axis and depression
- HPA axis (hypothalamic-pituitary-adrenocortal) may be overly active during MDD
- consistent with the idea that stress reactivity is important part of depression
- amygdala overly reactive in ppl w MDD, and amygdala sends signals that activate HPA axis
- HPA axis triggers release of cortisol (stress hormone)
- cortisol linked to depression
46
cushings syndrome
causes over-secretion of cortisol
-symptoms include those of depression
Cortisol cushion
47
cortisol and depression findings
-cushings syndrome
- injecting cortisol in animals produces depressive symptoms
- dexamethasone suppression test:
lack of cortisol suppression in ppl w history of depression
48
cortisol awakening response (CAR)
cortisol levels increase sharply as people wake and in the 30-40 mins after waking
larger CAR at baseline related to higher risk for depression
also related to bipolar (but more the depression part)
49
Social Factors for depression
- life events: many (around 50%) report stressful life event in year prior to depression (prospective research)
- may be lack of social support
- interpersonal difficulties: high levels of expressed emotion by family members predicts relapse, so does marital conflict
- behavior of depressed ppl leads to rejection by others:
- excessive reassurance seeking
- few positive facial expressions
- negative self disclosures
- slow speech and long silences
50
cytokines and sickness behavior
(?)
Pro-inflammatory cytokines cause inflammation when sick to fight off infection
if inflammation is prolonged, can cause sickness behavior, which has many depression like symptoms
social stressors can provoke increase in pro-inflammatory cytokines
51
Expressed emotion (EE)
a family member's critical or hostile comments or emotional over-involvement w/ person w/ depression
52
Psychological factors in depression- cognitive theories
- beck's theory
- hopelessness theory
- rumination theory
53
Beck's theory
(psychosocial factors in depression)
- negative triad: negative view of self, world, future
- negative schema: underlying tendency to see world negatively
- cognitive biases (or Information-processing biases) : caused by negative schema- tendency to process info in negative ways
54
Hopelessness theory
(psychosocial factors in depression)
- most important trigger of depression is hopelessness
- desirable outcomes won't occur
- person has no ability to change situation
- attributional style
- stable and global attributions can cause hopelessness
55
attributional style (+ types)
(part of hopelessness theory)
explanations a person forms about why a stressor occurred
people with depression have stable and global attributional style
- stable (vs unstable): permanent vs temporary
- global (vs specific): relevant to many life domains or limited to one area
56
rumination theory
- a specific way of thinking: tendency to repetitively dwell on sad thoughts
- most detrimental is to brood over cause of events
- susan nolen-hoeksema
57
neuroticism
personality trait that involes tendency to experience frequent and intense negative affect
several longitudinal studies suggest that neuroticism predicts onset of depression, and anxiety
58
depression in bipolar disorder
- triggers of depression in bipolar similar to triggers of MDD
- early adversity, negative life events, neuroticism, negative cognitive styles, family criticism, and lack of social support predict depressive symptoms in bipolar disorder
59
two factors that predict increases in manic symptoms
- reward sensitivity
- sleep deprivation
60
reward sensitivity
(predictor of manic symptoms)
model that suggests mania reflects a disturbance in reward system of brain
bipolar people describe themselves as highly reward-sensitive
life events involving success may trigger excessive goal pursuit which may trigger manic symptoms
61
sleep deprivation
(predictor of manic symptoms)
ppl w bipolar disorder show problems in sleep and circadian rythym even in well periods
sleep deprivation can trigger manic episodes
62
psychological treatment for mood disorders (depression)
- interpersonal psychotherapy (IPT)
- Cognitive therapy
- Mindfulness-based cognitive therapy (MBCT)
Neumonic: sad icp
63
interpersonal psychotherapy (IPT)
- short term psychodynamic therapy
- focuses on current relationships
- depression tied to current relationships
64
Cognitive therapy
-monitor and identify automatic thoughts
- replace neg thoughts w neutral/ pos thoughts
-from aaron beck
- behavioral activation (BA)- engage in pleasant activities to bolster positive thoughts
65
Mindfulness-based cognitive therapy (MBCT)
- strategies including meditation to prevent depression relapse
66
behavior activation (BA)
- increase participation in positively reinforcing activities to disrupt spiral of depression, withdrawal, avoidance
part of beck's cognitive therapy
67
behavioral couples therapy
depression often tied to relationship problems
work with both members of couple to improve communication and relationship satisfaction
68
Psychological treatment of bipolar disorder
- psychoeducational approaches: provides info about symptoms, course, triggers, and treatments
- family-focused treatment (FFT):
- educate family about disorder, enhance family communication, improve problem solving
Neumonic: North Pole school, family
69
Biological treatment of mood disorders (2 main + 1)
- electroconvulsive therapy (ECT)
- drugs
- transcranizal magnetic stimulation
70
electroconvulsive therapy (ECT)
- reserved for ppl who don't respond to medication
- induce brain seizure
- now unilateral ECT, less side effects than bilateral
- side effects: memory loss
- more effective than medication
71
Medications for depressive disorders- 4 categories
- Monoamine oxidase inhibitors (MAO inhibitors)
- Tricyclic antidepressents
- selective serotonin reuptake inhibitors (SSRIs)
- serotonin norepinephrine reuptake inhibitors (SNRIs)
72
studies on medication for depression
- published studies may overestimate the effectiveness of medication
- STAR-D: attempted to evaluate effectiveness of antidepressants
33% achieved relief with citalopram SSRI
30% with other antidepressant
73
psychotherapy vs medication for MDD
- combining psychotherapy and antidepressant medications increase odds of recovery over either alone by 10-20%
- medication is quicker but therapy has longer effects
- ct as effective as medication for severe depression, more effective at preventing relapse
74
transcranial magnetic stimulation (rTMS)
- electromagnetic coil against scalp, intermittent pulses of magnetic energy
75
medications for Bipolar Disorder
- Lithium
newer mood stabilizers-
- anticonvulsants: depakote
- antipsychotics: zyprexa
both have serious side effects
76
lithium
mood stabilizer drug used for bipolar disorder
- up to 80% receive at least some relief
- potentially serious side effects, including lithium toxicity
77
suicide ideation
thoughts of killing oneself
78
suicide attempt
behavior intended to kill oneself
79
suicide
death from deliberate self-injury
80
non-suicidal self-injury
behaviors intended to injure oneself without intent to kill oneself
81
suicide rates
US: 1 per 10,000 in a year, higher where guns are
world wide: 9% report suicidal ideation at least once in life, 2.5% have made at least one attempt
rates for adolescents and children in US increasing dramatically
suicide rate increases in old age- white men over 50 have highest rates
- being divorced or widowed elevates suicide risk 4 or 5x
82
men vs women suicide
- men 4 times as likely to kill selves
- women more likely to make suicide attempts that don't result in death
- women use pills, men hang or shoot
83
myths about suicide
- people who discuss suicide won't commit suicide
- suicide is committed without warning
- suicidal people want to die
- ppl who attempt suicide by low lethal means aren't serious about killing themselves
84
models of suicide/ risk factors
- psychological disorders
- neurobiological models
- social factors
- psychological models
85
risk factors/ models of suicide- psychological disorders
more than half of suicide attempts are depressed
90% suffer from a psychological disorder
most ppl w psychological disorders don't die from suicide
86
risk factors/ models of suicide- neurobiological factors (heritability, neurotransmitters, neuroendocrine)
- heritability of 48% suicide attempts
- low levels of serotonin
- neurotransmitter and cortisol dysregulation
- overly reactive HPA system
87
risk factors/ models of suicide- social factors
- economic recessions
- media reports of suicide
- social isolation and lack of social belonging
88
risk factors/ models of suicide- psychological factors
- problem-solving deficit
- hopelessness: the expectation life will be no better in the future
- lack of life satisfaction
89
preventing suicide
- talk about suicide openly and matter-of-factly
- most people are ambivalent about their suicidal intentions
- treat the associated mental disorder (therapy and/or medication)
- treat suicidality directly (CBT)
- suicide prevention centers
90
means restriction
approach to preventing suicide involving making highly lethal methods lees available
91
Problem-solving deficit
Psychological factor: suicide
Having difficulty creating new/different ways to solve problems
