Mood Disorders

Question 1

What is mood, in psychiatric terms?

Answer 1

Pervasive and sustained emotion/feeling that affects the way a person behaves and perceives the world.

Question 2

Mood vs affect

Answer 2

• Mood: how a person feels (symptom)
• Affect: external, observable expression (sign)

Question 3

When do mood changes become a mood disorder?

Answer 3

When they go beyond normal fluctuations and begin to impact on day to day life and functioning.

Question 4

What are the different DSM-5 categories of mood disorders?

Answer 4

• Bipolar/related disorders (recall 3 types)
• Schizophrenia spectrum disorders
• Depressive disorders

Question 5

True or false: MDD can fluctuate, but tends to be relatively constant once a patient begins sufffering

Answer 5

• False
• It is typically episodic in nature

Question 6

Describe the first criterion for MDD (the one with five symptoms)

Answer 6

• At least five of the following symptoms need to be newly onset/changed, for at least two weeks, with the inclusion of depressed mood and/or anhedonia:
• Depressed mood most of the time, most days
• Markedly reduced pleasure
• > =5% weight loss gain in a month
• Insomnia/hypersomnia nearly every day
• Psychomotor agitation/retardation (must be observed)
• Fatigue/energhy loss
• Worthlessness/inappropriate guilt
• Poor concentration/decisiveness
• Recurrent suicidal ideation/attempts/plan

Question 7

Other than the first, what are the other four DSM-5 criteria for MDD?

Answer 7

• Impairment on social, occupational, or everyday function
• Not attributable to a substance/medical condition
• Not better explained by schizophrenia, schizoaffective disorder, or other psychological conditions
• Never been a manic or hypomanic episode (why?)

Question 8

What is the criteria for an MDD remission in the DSM-5?

Answer 8

Criteria A-E no longer fully met for two months.

Question 9

Break down the possible aetiologies of depression using the appropriate model

Answer 9

• Biopsychosocial model
• Bio: physical health conditions, substance use, genetic predisposition, HPA dysfunction, gut microbiome)
• Psycho: maladaptive coping mechanisms, low self esteem, neuroticism/perfectionism, rumination
• Social: homelessness, financial stress, food insecurity, isolation, lower levels of education

Question 10

Explain the diathesis stress model of depression

Answer 10

Biological predispositions to depression (diathesis: bio/psycho factors) interplay with environmental stressors (stress: stressful events/social factors) to determine whether someone experiences depression (like delirium threshold).

Question 11

Goals of treatment in MDD

Answer 11

1. Symptom remission, rather than reduction
2. Functional recovery (to pre-morbid levels)

Question 12

Outline biological treatments for depression

Answer 12

• Pharmacotherapy: typically SSRIs and SNRIs (monoamine modulation)
• Electroconvulsive therapy (induction of therapeutic seizures under general anesthetics, usually inpatient)

Question 13

What are the three monoamines

Answer 13

• Serotonin
• Dopamine
• Noradrenaline

Question 14

Indications/adverse effects of ECT

Answer 14

• Indications: severe/treatment resistant depression, acute concerns (e.g. patient is not eating or drinking)
• Adverse effects: headache, confusion, anaesthetic reaction

Question 15

How long do antidepressants typically take to work?

Answer 15

4-6 weeks

Question 16

What are the common goals of all psychotherapeutic aproaches

Answer 16

• Establish therapeutic alliance/safe environment
• Clear boundaries
• Clear goals right from the get go

Question 17

What are some psychotherapeutic modalities

Answer 17

• Psychoanalysis
• Cognitive behavioural therapy
• Interpersonal therapy
• Family/relationship therapy

Question 18

What is Freud’s basic thesis of psychoanalysis

Answer 18

• Freud believed unconscious conflicts caused issues
• He developed psychoanalysis to resolvethese conflicts, impulses, and fantasies

Question 19

What is the basic approach of CBT?

Answer 19

• Identify and change distorted thinking patterns (cognitive) that lead to depressive symptoms
• Use learning principles (through association w/ neutral stimuli [classical] or voluntary behaviour [operant] conditioning) to alter depressogenic behaviourWhat

Question 20

What are Leila Hormozi’s three pillars of CBT?

Answer 20

• Thoughts
• Emotions
• Behaviours

Question 21

List and explain treatment for common depressogenic social factors

Answer 21

• Financial stress -> centrelink
• Work stress -> leave cert + return to work plan
• Relationship issues -> relationship therapy
• Domestic violence -> contact police
• Homelessness -> public housing
• Loneliness -> local social groups