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Flashcards in Mood Disorders Deck (56):
1

What are moods?

Emotional “climate”
Pervasive and sustained
Influence our perception of the world
Occurs in a person for a length of time
Not as intense as affect

2

How are mood disorders characterized?

On a continuum
Severity
Duration
=> Maladaptive

3

How is major depressive disorder diagnosed based on the DSM-5?

Presence of 5 or more symptoms for at least 2 weeks
Note: Depressed mood or loss of interest and pleasure must be 1 of the 5 symptoms

4

What are the symptoms of depression?

Sad, depressed mood, most of the day, nearly every day
Loss of interest and pleasure in usual activities (ex. sex)
Difficulties in sleeping
Shift in activity level
Changes in appetite and weight
Loss of energy, great fatigue
Feeling worthless/excessive guilt
Difficulty in concentrating
Recurrent thoughts of death or suicide
Somatic symptoms with no apparent physical basis
Negative self-concept, self-reproach and self-blame

5

What are the specifiers for major depressive disorder?

Melancholic features
Atypical features
Psychotic features
Catatonic features
Seasonal pattern (Seasonal Affective Disorder)
With postpartum onset
Mixed episode
Rapid cycling

6

What are the characteristics of melancholic features?

Pervasive anhedonia (no joy)
Don’t feel better even when pleasant or good things happen
Significant appetite and weight loss
Depression worse in the morning
Early morning awakenings
Psychomotor retardation or agitation
Inappropriate or excessive guilt

7

What are the characteristics of atypical features?

Mood reactivity – positive events
Weight gain or increased appetite
Hypersomnia
Physically burdened - paralysis
Sensitivity to interpersonal rejection

8

What are the characteristics of psychotic features?

Delusions (false beliefs)
Hallucinations (false sensory perceptions)
Mood congruent (e.g., internal organs rotten)
More likely to suffer from melancholia
Poor prognosis

9

What are the characteristics of catatonic features?

Motoric immobility or purposeless movement
Physical rigidity
Echolalia (repeat what they hear)
Posturing – sit hunched, away from world, sometimes bizarre statue like poses

10

What are the characteristics of Seasonal Affective Disorder (SAD)?

MDD with seasonal pattern
At least 2 MDEs in past 2 yrs occurring at the same time of the year (mostly winter)
No non-seasonal episode in past 2 years
More seasonal than non-seasonal lifetime episodes

11

What are the characteristics of Postpartum depression?

MDE with postpartum onset
Onset of MDE within 4 wks after childbirth
Impact of maternal depression on children
Different from “postpartum blues”:
mother is emotionally labile, irritable, but does not meet criteria for MDD
occurs in 50-70% of new mothers (not MDD)

12

What are the characteristics of 
Dysthymic Disorder?

Low grade depression
Depressed mood most of the day, more days than not, for at least 2 years. Never without symptoms more than 2 months at a time.
No Major Depressive Episode during the first 2 years
Significant distress or impaired functioning
Not due to substance or general medical condition
Two (or more) of the following:
Appetite disturbance
Sleep disturbance
Low energy or fatigue
Low self-esteem
Diminished concentration
Feelings of hopelessness

13

What is double depression?

When a MDE occurs on top of dysthymia

14

What is the danger with the reoccurence of depression?

Each MDE increases the risk of a subsequent episode. After:
1 episode – 50-60% will have another
2 episodes – 70% will have another
3 episodes – 90% will have another
With each subsequent MDE, the length of time to recurrence is shortened

15

What is the diathesis stress model for depression?

Depressive episodes often follow stressful life events
Not everyone becomes depressed following stressful life events.
Some are possibly biologically predisposed

16

What is the cognitive model for depression?

Cognitive diathesis: latent dysfunctional cognitive patterns (e.g., self-schemas)
Models differ in how the cognitive diathesis is conceptualized
Stress: broadly defined – severe life events, sad mood
Cognitive models of vulnerability to depression.
Beck’s negative triad
Response styles theory
Hopelessness theory

17

What is Beck's theory of depression?

Negative triad: Self, World, Future
Negative schemata develop in childhood
Information-processing, Memory and Attentional biases:
Depression is not associated with greater initial orientation toward negative stimuli
Depression is associated with difficulties in disengaging attention from negative material: Inhibitory dysfunction
Inhibitory dysfunction linked to rumination.

18

What is the response styles theory of depression?

The way a person responds to a negative mood can have an impact on the severity and/or duration of depression symptoms.
Rumination:
Passively focusing one's attention on a negative emotional state, and thinking repetitively about the causes, meanings and consequences of that state.
Depressed individuals tend to ruminate more than non-depressed individuals when in a negative mood.

19

What is the hopelessness theory of depression? (Based on Seligman’s theory of learned helplessness)

An individual's passivity and sense of being unable to act and control his or her own life is acquired though unpleasant experiences and traumas that the individual tried unsuccessfully to control.
Depressogenic attributional style: negative events due to causes that are:
Internal – “It’s all my fault”
Stable – “I’ll always be this way”
Global – “I’m a total loser”
Now thought to explain only “hopelessness depression”
Depressive paradox: Feeling helpless yet blaming oneself
Depressive predictive certainty: Perceived probability of the future occurrence of negative events becomes certain

20

What are the biological theory for depression?

Heritability
Neurobiological dysfunction
Neuroendocrine system
Potential gene candidate: promoter of the serotonin transporter gene (5-HTT)
Lowered sensitivity of serotonine receptors makes some individuals more vulnerable to depression.

21

What is the Monamine theory of depression?

Depression once thought to be caused by low levels of:
Norepinephrine
Dopamine
Serotonin

Not supported by empirical research: more complex.

22

What clues for theories of depression are based on drug effectiveness
?

Tricyclic drugs prevent some of the reuptake of norepinephrine, serotonin, and/or dopamine by the presynaptic neuron after it has fired.
Monoamine oxidase (MAO) inhibitors keep the enzyme monoamine oxidase from deactivating neurotransmitters therefore increase the levels of serotonin, norepinephrine, and/or dopamine in the synapse.
Selective serotonin reuptake inhibitors inhibit the reuptake of serotonin

23

What medications are used to treat depression? What are some considerations clinicians should take into account?

Monoamine Oxidase Inhibitors (MAOIs)
Tricyclic antidepressants
Selective Serotonin Reuptake Inhibitors

Delay in effect of medications
Relapse and recurrence
Both MAOIs and Tricyclics take 7-14 days to relieve depression, but by that time, the NT levels have already returned to their previous state

24

What are other examples of biological therapy for depression?

Electroconvulsive Therapy (ECT)
Transcranial magnetic stimulation (TMS) over left prefrontal regions
High relapse rate

25

What are the psychological therapies for depression?

Psychodynamic Therapies
Cognitive and Behaviour Therapies
Mindfulness-Based Cognitive Therapy

26

What does CBT consist of?

Person’s affect and behavior are largely determined by the way in which they view the world.
Cognitions can be assessed and changed.
Modification of cognitions will lead to changes in affect and behavior
Aimed at altering maladaptive thought patterns
Change opinions of events and self
Behavioural assignments

27

What are some examples of cognitive errors?

Overgeneralization: Arbitrary inference
Depressed persons draw negative conclusions about their self-worth, based on minimal data

Selective abstraction:
Depressed person focuses on isolated negative details of an event and ignores more positive information

All-or-none thinking:
Everything is good or bad

Magnification and Minimization:
Exaggerations in evaluating performance

28

What are the steps of CBT?

Step 1: Recognize and record automatic thoughts
Daily monitoring of thoughts, situations, emotions

Step 2: Logical analysis of automatic thoughts
Is there any evidence that supports the thought?
Is there any evidence that goes against it?
If the negative thought is accurate, what can be done to best cope with it?

Step 3: Generate alternative, rational thoughts
What is another way to think about situation?

Step 4: Practice alternative thoughts

29

What is a manic episode?

An emotional state of intense but unfounded emotions accompanied by elevated, expansive or irritable mood
At least 3 of the following: Hyperactivity
Inflated self-esteem or grandiosity
Decreased need for sleep
Pressured speech (talkativeness)
Racing thoughts (flight of ideas)
Distractibility
Increase in goal-directed activities (impractical grandiose plans)
Psychomotor agitation
Excessive risky or pleasurable activities
Symptoms last for at least 1 week

Severe enough to cause significant impairment in functioning or hospitalization or there are psychotic features.

30

What is a mixed episode?

Meets criteria for MDE and Mania for at least 1 week nearly every day

31

What are the features of Bipolar I?

One or more Manic or Mixed Episode(s)
Symptoms are not better accounted for by a psychotic disorder
History of MDE is NOT required for diagnosis
Requires the presence of elevated or irritable mood and abnormally and persistently increased goal-directed activity +3 additional manic symptoms.

32

What are the features of Bipolar II?

One or more MDE
One or more Hypomanic episode
NO history of Manic or Mixed episode
Symptoms are not better accounted for by a psychotic disorder
Psychotic and melancholic features

33

What are the features of Cyclothymic Disorder?

Numerous periods of hypomanic symptoms and numerous periods of depressive symptoms.
Duration of at least 2 years
No Manic, Mixed or Depressive Episodes in first 2 years
Never symptom-free for more than 2 months
Distress but no severe impairment

34

What are biological theories of Mood disorders?

Heritability - Genetic vulnerability
(Twin, family and adoption studies, linkage analysis)
Bipolar I the most heritable disorder
Gene-environement interaction
Stress Reactivity (HPA axis) - Overactive - elevated levels of cortisol in both types of mood episodes.
Bipolar caused by overly sensitive dopamine receptors
Depression caused by amygdala hyperactivity (hippocampus, prefrontal cortex and anterior cingulate)

35

What are the treatments for Bipolar Disorder?

Medication - high relapse and side effects, low adherence rate. Stopping can be dangerous (dangerous, even fatal, calcium levels need to be monitored). Cuts highs and lows
Acute Mania
Lithium: 70% response rate
Anticonvulsants: 50-60% response rate
Antipsychotics: faster onset
Acute Depression
Lithium: effects not as robust
Antidepressants
Mood switching risk
Maintenance
Lithium: 50% relapse if discontinue

Adjunct Psychotherapy:
Improved medication adherence
Fewer episodes; lower relapse rates
Decrease in residual symptoms

36

What are the Areas of Focus for Adjunct Psychotherapy?

Medication Adherence
Early Detection and Intervention
Stress and Life Management
Treat comorbid problems
Treatment of depression

37

What are the features of suicide attempters?

ATTEMPTERS
Women
Under 25
No psych. complaints
Impulsive
Public attempt
Less lethal means

38

What are the features of suicide completers?

COMPLETERS
Men
Over 40
DSM disorder
Previous intent
Private attempt
Very lethal means

39

What are risk factors for suicide?

Age: 15-24 or 65 and older
Marital status: Divorced, separated, widowed
Plan
Prior attempts – best predictor
Psychiatric history, substance use
Experience of lack of control in maladaptive family
Limited problem-solving ability
Hopelessness, perfectionism and self criticism
Severity of suicide ideation
Unemployment

40

What are some possible causal factors of suicide?

Genetic factors may play a role in risk for suicide
Reduced serotonergic activity appears to be associated with increased risk
Rates of suicide vary across cultures and religions

41

What is Suicidal Ambivalence?

Some people do not really wish to die but instead want to communicate a dramatic message concerning their distress

Research has clearly disproved the tragic belief that those who threaten to take their lives seldom do so

42

What characterizes Hypomania?

Symptoms last for at least 4 days
Change in functioning
Change in mood and functioning is observable by others.
Same symptoms as mania but they are not severe enough to cause significant impairment in functioning or hospitalization and there are NO psychotic features.

43

What is the psychoanalytic theory of mood disorders?

Stuck in the oral stage because of over/under gratification in childhood causing a fixation. The person is excessively dependent on other for maintenance of self-esteem. Analysis of bereavement - loss of a loved one, identify with them, they become an object of hate and guilt that get directed inwards.

44

What does the Dysfunctional Attitudes Scale (DAS) measure?

Attitudes that bias interpretation of events:
1) Dysfunctional beliefs reflective the need for approval
2) Dysfunctional beliefs reflecting the need for achievement and perfection

45

What is the interpersonal theory of depression?

Behavioural aspects - sparse social networks, regard them as providing little support - vulnerability
Elicit negative reactions from others including rejection
Tend to reject their partners and display few positive social behaviours
Self orientation
Low social skills ex. speech patterns and eye contact
Constant reassurance seeking - temporarily satisfied
Seek out negative feedback to validate self-image - inconsistent

46

What are the psychodynamic therapies for mood disorders?

Achieve insight
Encourages outward release of the hostility
Interpersonal therapy (IT): Concentrates of the present-day interactions between the depressed person and the social environment. Good for preventing relapse.

47

What is involved in Mindfulness-based CT? (MBCT)

Prevents relapse
Teaches how to combat stress through mindful meditation
Relaxation techniques designed to increase awareness of changes in the body and mind - cognitive intervention techniques
Meta-cognitive awareness
Reduced over generality effect
Reduces the cognitive tendency to engage in rumination

48

What is the STAR*D approach?

Sequence Treatment Alternative to Relieve Depression
Modifiable treatment process for major depressive disorder in adults in outpatient settings "whatever works"

49

What is the treatment for SAD?

Bright white light phototherapy
More effective if combined with CBT
Counteract negative thoughts
Encourage engagement in everyday pleasurable activities
Social skills training

50

What are Durkheim's sociological theories of suicide?

Egotistic suicide: committed by people who have few ties to family, society or community. These people feel alienated from others and cut off from the social supports that are important to keep them functioning adaptively as social beings.
Altruistic Suicide: is viewed as a response to societal demands. Some people who commit suicide feel very much a part of a group and sacrifice themselves for what they take to be the good of society.
Anomic suicide: May be triggered by a sudden change in a person's relationship to society (lifestyle)
Realistic suicide: Euphanasia
Inadvertent suicide: Suicidal guesture to manipulate someone else but then accidently kill themselves
Spite: Intends to kill themselves to hurt someone else
Bizarre: Comits suicide because of a hallucination or delusion ex. command hallucinations

51

What is Baumeister's escape theory of suicide?

Arises from desire to escape from painful or aversive self-awareness; short-comings, failures.

52

What is Joiner's interpersonal theory of suicide?

Prevention
A thwarted need to belong
Perceived burdensome
Both the will and the ways
Pain tolerance, distress tolerance, sensation seeking

53

What is Shneidman's approach to suicide?

Conscious effort to seek a solution to a problem that is causing intense and intolerable pain - psychache
Proximal predictor mediates distal risk factors

54

What comprises the Reasons for Living Inventory? (RFL)

1) Survival and coping beliefs
2) Responsibility to family
3) Concerns about children
4) Fear of social disapproval
5) Fear of suicide
6) Moral objections

55

How does one prevent suicide using the SUPRE-MISS model?

1) Health and empowered individuals, families and schools
2) Clinical and community preventive services
3) Treatment and support servies
4) Surveillance, research and evaluation

56

How to treat suicidality directly?

1. Reduce the intense psycholigcal pain and suffering
2. Lift the blinders; that is, expand the constricted view by helping the individual see options other than the extremes of continued suffering or nothingness
3. Encourage the person to pull back even a little from the self-destructive act.