Mood Disorders Flashcards
(58 cards)
1
Q
What were depressive disorders grouped with in the DSM-IV?
A
-Depressive disorders and bipolar and related disorders were grouped together
2
Q
What changes were made to the DSM-V?
A
- Depressive disorders and bipolar and related disorders are separate chapters
- Bipolar and related disorders is placed in between chapters on
Schizophrenia spectrum and other psychotic disorders and depressive disorders as a bridge between two diagnostic classes in terms of symptoms, family history, and genetics
3
Q
What are the general characteristics of mood disorders?
A
- Much more serious than typical emotional states that everyone feels
- Involve significant disturbances in emotion, including extreme sadness (depression) or elation /irritability (mania)
- Are disabling (i.e., interfere with daily activities/ functioning)
4
Q
What other serious psychological problems are mood disorders often associated with?
A
- Panic attacks
- Substance abuse
- Sexual dysfunction
- Personality disorders
5
Q
What are the main diagnostic criteria of Major depressive disorder?
A
- Symptoms have to be present during the same 2 week period and represent a change from previous functioning with at least one of the symptoms being depressed mood or loss of interest or pleasure
- Other symptoms include: significant weight loss or weight gain, Insomnia or hypersomia nearly every day, psychomotor agitation, fatigue or loss of energy, feelings of worthlessness or excessive or inappropriate guilt, diminished ability to think or concentrate, recurrent thoughts of death
6
Q
What was the lifetime prevalence rates of MDD in the US?
A
- from 5.2% to 17.1%
7
Q
Is major depressive disorder more common in women or men?
A
- 2x more common in women than in men
- Difference appears in adolescence and is maintained across the
lifespan
8
Q
Why is there a gender difference in MDD?
A
- Men more likely to distract (e.g., watch a hockey game)
- Women are more likely to ruminate (brooding) on their depressive feelings and the causes of their depressive feelings. They are also more likely to co-ruminate with friends.
9
Q
What did persistent depressive disorder used to be in the DSM-IV?
A
This disorder represents a consolidation of DSM-IV defined chronic major depressive disorder and dysthymic disorder
10
Q
What is the main diagnostic criteria for persistent depressive disorder (dysthymia)?
A
- Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years
- During the 2 year period of the disturbance, the individual has never been without the symptoms in criteria A and B for more than 2 months at a time.
- Criteria for MDD may be continuously present for 2 years
11
Q
What is the lifetime prevalence of persistent mood disorder?
A
- lifetime prevalence of PDD is 4.6%, which is lower than lifetime prevalence of MDD
12
Q
What is double depression?
A
People with persistent depressive disorder may also experience episodes of major depressive disorder.
13
Q
What is Bipolar I disorder?
A
- Historically called manic-depressive disorder.
- For a diagnosis of Bipolar I Disorder, the presence of at least 1 manic episode is required.
14
Q
What is Bipolar II disorder?
A
For a diagnosis of a Bipolar II Disorder, at least 1 hypomanic episode, and at least 1 Major Depressive episode is required.
15
Q
What is cyclothymic disorder?
A
- Don’t meet criteria for an actual hypomanic, manic, or depressive episode
- Duration is 2 years, chronic, low levels of these symptoms (have to have been present for 50% of the time)
16
Q
What is the difference between Depressive disorders and Bipolar related disorders
A
key to depressive disorders is that no one has Mania or hypermania, if you have either of these you are automatically in the bipolar disorders. Mania distinguishes between the two types of disorders. You can have bipolar disorder without depression (i.e., just meet criteria for mania)
17
Q
What are the signs and symptoms of mania?
A
- An emotional state or mood of intense but unfounded elation accompanied by irritability, hyperactivity, talkativeness, flight of ideas, distractibility, and impractical, grandiose plans
- Noticed by others due to loud and incessant remarks, sometimes full of puns, jokes, rhyming, etc., difficult to interrupt, shifting from topic to topic, need for activity that can be annoying to others and with poor planning
18
Q
What is a manic episode according to the Bipolar I diagnostic criteria?
A
- a distinct period of abnormally and persistently elevated, expansive or irritable mood and abnormally and persistently increased goal directed activity or energy, lasting at least 1 week and present most of the day, nearly every day
- during the period of mood disturbance and increased energy or activity, three of the following symptoms (four if mood is only irritable) are present and represent a noticeable change from usual behaviour: inflated self esteem or grandiosity, decreased need for sleep, more talkative than usual, flight of ideas or subjective experience that thoughts are racing, distractibility, increase in goal directed acitivty or psychomotor agitation, excessive involvement in activities that have a high potential of painful consequences.
19
Q
What is a hypomanic episode according to the Bipolar I diagnostic criteria?
A
- A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day
- during the period of mood disturbance and increased energy or activity, three of the following symptoms (four if mood is only irritable) are present and represent a noticeable change from usual behaviour: inflated self esteem or grandiosity, decreased need for sleep, more talkative than usual, flight of ideas or subjective experience that thoughts are racing, distractibility, increase in goal directed activity or psychomotor agitation, excessive involvement in activities that have a high potential of painful consequences.
20
Q
What are mixed episodes?
A
- Can occur during a Depressive, Manic, or Hypomanic episode.
- Symptoms occur during the majority of days of the episode.
- The individual experiences rapidly alternating moods (sadness, irritability, euphoria) accompanied by symptoms of mania and depression.
- Criteria are met for both a Manic/Hypomanic Episode and a Major Depressive Episode nearly every day.
21
Q
What is the main diagnostic criteria for Bipolar II disorder?
A
- Criteria have been met for at least one hypomanic episode and at least one major depressive episode
- There has never been a manic episode
22
Q
What is the main diagnostic criteria for Cyclothymic disorder?
A
- for at least 2 years there have been numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic episode and numerous periods with depressive symptoms that do not meet criteria for a MDD.
- During the above 2 year period, the hypomanic and depressive periods have been present for at least half of the time and the individual has not been without symptoms for 2 months at a time
- criteria for a major depressive, manic or hypomanic episode have never been met
23
Q
Which is more common bipolar or MDD?
A
Bipolar and related disorders occur less often than MDD
-lifetime prevalence for Bipolar disorders (I and II) is 4.4 of the population. Cyclothymic is 2.5%
24
Q
What is the average age of onset for bipolar and related disorders?
A
- averagge age of onset is in the 20s
25
What are the gender differences in bipolar disorder?
- Bipolar Disorders occur equally often in men and women, however, the kinds of episodes vary:
- - In women, episodes of depression are more common
- - In men, episodes of mania are more common
26
Do bipolar disorders recur?
- Bipolar Disorders tend to recur
- - More than 50% have a recurrence within 12 months
- - More than 50% of cases have 4+ episodes
27
What is the psychoanalytic theory of depression?
- Analogy to bereavement, according to Freud.
- Depression is seen to be like a mourner who over identifies with (introjects) a lost loved one.
- Anger turned inward (resents feeling abandoned).
- Research: some individuals who show high dependency traits are more prone to depression following loss experiences.
28
What is the negative triad?
- Negative views about the world (everyone is against me because I'm worthless)
- Negative views about oneself (I'm worthless and inadequate)
- Negative views about the future (I'll never be good at anything)
29
What personality factors increase vulnerability to depression?
- Sociotropy – over concern with pleasing others, avoiding disapproval, and avoiding separation
- Autonomy (Self-critical goal striving, Preference for solitude, Freedom from control (independence)
- Perfectionism
- Diathesis-stress
30
What is the learned helplessness theory of depression?
- Uncontrollable aversive events --> Sense of helplessness --> Depression
31
What is the attributional reformulation theory of depression?
- Aversive events --> attribution to global and stable factors --> sense of helplessness; no response available to alter the situation --> Depression
32
what is the learned hopelessness theory of depression?
- Aversive events --> attribution to global and stable factors; or other cognitive factor --> sense of hopelessness; no response available to alter the situation and an expectation that desirable outcomes will not occur --> depression
33
What is the interpersonal theory of depression?
- Sparse social networks that provide little support
- - Decrease an individual’s ability to handle negative life events.
- - Increase vulnerability to depression.
- Depressed people also elicit negative reactions from others and are low in social skills.
- They also constantly seek the reassurance of others
34
Are there psychological theories for the etiology of bipolar disorder?
Largely neglected by scholars and clinicians
35
What is the genetic data for bipolar disorder?
- Concordance rate is as high as 85%
- Adoption studies provide support for a strong heritable component
- May be linked to a dominant gene on the 11th chromosome
- Brain-derived neurotrophic factor (BDNF) gene also
implicated
36
What is the genetic data for MDD?
- Heritability estimate = 35%
- Relatives of unipolar probands are at increased risk for unipolar depression
- Serotonin transporter gene-linked promoter region (5- HTTLPR) is being considered
37
What did early biological theories postulate?
- lower levels of norepinephrine and dopamine lead to depression.
- higher levels of norepinephrine and dopamine lead to mania.
38
What is the serotonin theory?
- Serotonin (which regulates norepinephrine) produces both depression
and mania.
39
What are the clues for theories 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 (SSRI) inhibit the reuptake of
serotonin
40
What do neuroimaging studies show
- decrease in hippocampal volume and neurocognitive impairment
41
How does the neuroendocrine system play a role in depression and bipolar disorder?
- HPA axis may play a role in depression.
-- Limbic area of brain (closely linked to emotion) affects the hypothalamus
which in turn controls endocrine glands (release of hormones).
-- increased levels of cortisol in depressed patients
- Disorders of thyroid function are often seen in bipolar patients.
-- Thyroid hormones can induce mania.
- Right hemisphere dysfunction – sense of indifference or flatness
42
What are the psychological therapies for mood disorders?
- Psychodynamic Therapies
- Cognitive and Behaviour Therapies
- Mindfulness-Based Cognitive Therapy
- Psychological Treatment for Bipolar Disorder
43
What are the biological therapies for mood disorders?
- Electroconvulsive therapy (ECT)
| - Drug therapy
44
Suicide was the _____ leading cause of death in Canada in 2005
9th
45
Suicideis the ___ cause of death (after accidents) in youth ages 15 to 24
2nd
46
What are the gender differences in suicide?
- Women have higher rates of suicide attempts but lower rates of suicide as compared to men, a phenomenon called gender paradox of suicidal behaviour
47
What is suicidal ideation?
Thoughts and intentions of killing oneself
48
What are suicide attempts?
Self-injury behaviours intended to cause death but that do not lead to death
49
What are suicide gestures?
Self-injury in which there is no intent to die
50
What is suicide?
- Behaviours intended to cause death and death occurs
51
What is the risk factor model (psychological theories of suicide)?
- Predisposing (vulnerability) factors (such as psychological disorder, abuse, early loss)
- Precipitating (crisis) factors (such as end of relationship, job loss, rejection)
- Contributing factors (such as physical illness, isolation)
- Protective (decrease risk) factors (such as personal resilience, active coping skills, positive future expectations, social support)
52
What women and men specific risk factors for suicide attempts did the meta analysis presented in class find?
- Women-specific risk factors for suicide attempts: Eating disorders, PTSD, bipolar disorder, being a victim of dating violence, depressive symptoms, interpersonal problems and previous abortion
- Men-specific risk factors for suicide attempts: disruptive behavior/conduct problems, hopelessness, parental separation/divorce, friend’s suicidal behavior, access to means (e.g., firearms, pesticides, toxic gas)
- Men-specific risk factors for suicide death: drug abuse, externalizing disorders, and access to means
53
What is shneidman's approach to understanding suicide?
- Perturbation of mind is a key feature
| - Suicidal individuals are experiencing psychache which is intense anguish
54
What is Baumeister's escape theory and perfectionism?
- Painfully aware of personal shortcomings
- Become suicidal to escape aversive self-awareness
- Perfectionists have such impossibly high self-standards
55
What is perfection and social disconnection theory for understanding suicide?
- Perfectionism is linked to low perceived social support, having no sense of belonging, not being accepted, and failing to meet others’ expectations.
56
What are some additional psychological factors that contribute to suicide?
Suicidal individuals have constricted thinking – makes it hard to see options - need to help them see a wider range of alternatives to solve the problem that provoked the suicidal distress
57
What are the physical factors in suicide?
- Repeated concussion injuries (such as hockey ‘enforcers’) develop chronic traumatic encephalopathy (CTE)
- MZ twins have a much higher concordance for suicidality than DZ twins
- decrease in levels of 5-HIAA may be especially related to impulsive suicide
58
How can we prevent suicide?
- Treating the underlying mental disorder
- Treating Suicidality Directly
- Suicide Prevention Centres
