Flashcards in Mood Disorders (Exam 2) Deck (122):
What are the symptoms of Bipolar I Disorder?
What are the symptoms during a manic episode?
-decreased need for sleep
-flight of ideas
What is grandiosity?
inflated self-esteem (feels like they can do anything)
What does a decreased need for sleep look like?
-feel rested after 3 hours of sleep
-looks like cocaine intoxication
What does pressured speech look like?
What does flight of ideas produce?
delusions (thoughts that are held but no basis of reality)
What are the key differentials that need to be ruled out to be diagnosed with BD?
-drug intoxication (psychostimulants)
-paranoid schizophrenia (also have delusions)
What are the prevalence rates for Bipolar Disorder?
-0.4-1.2%, average is 1% (rare)
-men and women equally likely to develop BD
-first episode seen in early 20s
What is the prevalence rate for suicides due to Bipolar Disorder?
20% of people with BD die by suicide
How are genetics and heritability studies conducted for Bipolar Disorder?
twin study research
What are monozygotic?
1 egg = identical twins
What are dizygotic?
2 egg = fraternal twins
What are the concordance rates for monozygotic?
What are the concordance rates for dizygotic?
What are the criticisms of twin studies and genetic models?
-genetic predispositions do not imply destiny (genetic link does not determine disorder)
-these rates vary wildly (uncontrolled adoptions)
What is the criteria for Bipolar Disorder II?
observe hypomanic episode (not as extreme as BD I)
What is the drug treatment for BD?
What is the efficacy of lithium?
effectively decreases mood fluctuation (60% improvement)
What is the toxicity affect of lithium on the body?
will eventually cause serious kidney damage (can die)
-monitor blood levels of drug in system
What are the compliance issues with lithium?
-people miss their "highs" (life is "boring" w/o them)
-difficult/toxic side effects
What are the other medications for BD?
What are the symptoms for cyclothymic disorder?
-mood fluctuations between bipolar disorder and normal experience
-presence hypomanic episode
-some depression symptoms but not full depth of disorder
What is the duration for cyclothymic disorder?
must have mood cycles for at least 2 years (chronic)
Are medications useful for treating cyclothymic disorder?
medications are not as useful for this disorder (not a clear medical treatment)
What is the issue with having a manic episode and the diagnosing of Major Depressive Disorder (MDD)?
can never have had a manic episode to be diagnosed
How is Major Depressive Disorder diagnosed?
-one or more Major Depressive Episode (MDE) for at least 2 weeks
-5/9 criteria must be met
-symptoms present everyday (sad or depressed mood, or anhedonia)
What is the criteria for MDD?
-psychomotor agitation or retardation
What is anhedonia?
loss of pleasure in things that used to give pleasure
What is psychomotor agitation or retardation?
-restless or agitated (psychomotor agitation)
-psychomotor retardation (may move very slowly)
What is the lifetime prevalence rates for adults for depression?
What is the ratio of females to males for depression in adults?
Is depression common in adolescents and elderly?
If untreated, how many will improve from depression?
90% (vast majority will improve within 5 years)
If untreated, how many will relapse with depression?
75-90% will have 2nd episode if left untreated (much more likely to relapse)
What is the gender concordance rates for MDD in monozygotic twins?
What is the gender concordance rates for MDD in dizygotic twins?
What are the specifiers for depression?
-note whether single episode or recurrent
-note whether mild, moderate, or severe (based on number of criterion symptoms met)
-if severe, note with our without psychotic features
What are the several "types" of depression?
-MDD with Postpartum Onset
What is the PPD prevalence?
-10-15% typically cited
What is endogenous depression?
inside the body (biological level)
What is exogenous depression?
outside the body (environmental factors)
What are some environmental factors that can cause depression?
-effectiveness of psychotherapy
-married women more vulnerable to depression than single women
-single men most likely to be depressed than married men
Which neurotransmitters can contribute to the causes of depression at a biological level?
What is the monoamine hypothesis for the cause of depression at a biological level?
may be related to a functional deficit of neurotransmitters
What is the process of synaptic transmission?
-electrical and chemical process
-signal sent to cell body
-ion gating -> firing of electrical impulse down axon
-axon terminal endings -> chemical transmission
What happens during a chemical transmission?
causes release of neurotransmitters
What is a synaptic cleft?
when the cells are not in direct contact with each other
What can neurotransmitters do when they are in the synapse?
can engage the next neuron or post-synaptic receptor
What does norepinephrine and serotonin get broken down by?
monoamine oxidase (MAO) (enzyme)
What happens during a reuptake?
can be taken back up into the original neuron's terminal button
What is the concept of functional deficit?
may be too little neurotransmitters
What can cause a functional deficit?
-not enough NE or 5-HT being produced
-too much MAO
-receptors are blocked or damaged
-maybe not enough receptors
How do drug therapies work for MDD (MAOIs)?
-prevent breakdown of neurotransmitters
-causes a functional increase in NE and 5-HT
What are the side effects of MAOIs?
-rough side effects
-strong interactions with SSRIs and over the counter cold meds
-react to foods with tyramine
What is the red wine and cheese effect?
-when MAOIs react to foods with tyramine in them
-caused patients to have stroke due to dramatic rise in blood pressure
What are the warnings for MAOIs?
notably hazardous interactions with foods containing tyramine
What does tricyclic do for the treatment of MDD?
cause block of reuptake of NE and 5-HT
Are tricyclics easy to overdose with?
Are tricyclics antidepressants?
What are the side effects of overdosing on tricyclics?
-long and irreversible
What does SSRIs stand for?
selective serotonin reuptake inhibitors
What is the function of SSRIs for treating MDD?
function by blocking serotonin reuptake
What are the clinical efficacy trials for SSRIs for treating MDD at the end of 16 weeks?
57% response rate
Do SSRIs have a strong placebo effect?
What are the side effects of tricyclics?
-fuzzy headed feeling
What are the side effects for SSRIs?
-not as lethal
-don't have the same side effects as other tricyclics (still have side effects)
What are the newer drugs that are being used to treat MDD?
What do atypical antidepressants do?
newer drugs going after either specific receptors or additional neurotransmitter sites of action
Do all the atypical antidepressants have side effects?
What are the clinical efficacy trials for SSRIs for treating MDD after 16 weeks?
57% response rate
How much does placebo account for SSRI outcomes?
Why is placebo accounting for SSRI outcomes?
some patients will report effect in 1 day
What happened when studies compared antidepressants with active placebos?
-placebos with side effects
-reduces difference between drug and placebo
How are the findings of comparing antidepressants with active placebos described now?
described as expectancy effects
What is the link between children on SSRIs and suicide completion?
no scientific link between suicide completion and children on SSRIs
How are SSRIs and suicidality prevented?
-FDA requires a caution on all antidepressants
-requires close observation of all patients on these drugs for emergence of SI
What should you watch for SSRIs and suicidality?
What are the empirically supported psychotherapies for treating MDD?
-cognitive therapy (CT)
-cognitive behavioral therapy (CBT)
-interpersonal psychotherapy (IPT)
What are the efficacy for the empirically supported psychotherapies for treating MDD?
all have equal efficacy for MDD (mild to moderate types)
What is the efficacy response rate for the empirically supported psychotherapies for treating MDD?
55-65% response rate
What is the clinical efficacy trails for medication vs psychotherapy after 16 weeks?
CT (psychotherapy) = 57% response rate
SSRIs (meds) = 57% response rate
What are the relapse rates following cessation of medication vs psychotherapy after 16 weeks?
CT = 25%
meds = 40%
Placebo = 81%
What are the relapse rates following a one year follow up post-treatment after 16 weeks for meds vs CBT?
CBT = 31% relapse rates
Discontinuation of meds = 76%
if stayed on meds = 47% relapse
Do CBT have a lower relapse rate?
yes, reduces risk of relapse by 60%
Who is electroconvulsive therapy used for?
tends to be used for people who are severely depressed
What are the equivocal results for ECT as to effectiveness?
for each study saying ECT is effective another says it is not
How does ECT work?
causes/induces tonic clonic or grand mal seizures activity in the brain
What is the regimen for ECT?
typically the regimen is 3-5/week for several months
What are the side effects for ECT?
What is retrograde amnesia?
-worst side effect is memory loss for events prior to treatment
-can be short or long term
What are the two psychological theories for depression?
What is Lewinsohn's behavioral view of depression?
depressed people do not have enough reinforcement (not enough social reinforcement or opportunities for reinforcement)
When is behavioral therapy needed?
may not have social skills needed to get reinforcement (may push others away when depressed, interpersonal styles)
What is the key to behavioral therapy?
getting people interacting with others
What is behavioral activation designed to do ?
increase activity level of client (ex: exercise, social interaction, practice learned skills)
What is involved with the cognitive theory of depression?
What is learned helplessness?
hypothesized that if people are in non-escapable situation they learn they are helpless
Who came up with learned helplessness?
What cognitive aspect did Seligman add to the cognitive theory of depression?
What are attributions?
casual explanations for why something happened
What are the three dimensions of attributions for the Attribution Theory?
-internal (personal) vs external (universal)
-stable (long term) vs unstable (short term)
-global (trans-situtational) vs specific (situational)
Which three dimensions of the Attribution Theory are associated with depression?
internal, stable, global attributions are more likely to be associated with depression
What did Aaron Beck come with for cognitive therapy?
negative cognitive triad
What is the negative cognitive triad?
depressed clients have negative view of themselves, the environment, the future
What are thinking styles characterized by in cognitive therapy?
What are logical errors for thinking styles characterized in cognitive therapy called?
What are examples of cognitive distortions?
What are overgeneralizations?
sweeping to conclusions based on one event
What is all-or-none thinking?
no middle ground, black and white only
What are arbitrary inferences?
draw conclusions when there is no evidence for it or very little evidence for it
What is the goal for cognitive therapy for depression?
-change how we think
-feelings and actions will follow from improved thinking patterns
What is Persistent Depressive Disorder (formerly dysthymic disorder) and duration?
some characteristics of depression present for at least 2 years w/o ever having prolonged time with normal mood
What are the symptoms for Persistent Depressive Disorder and the diagnostic criteria?
2 + symptoms must be met
-feelings of hopelessness
-insomnia or hypersomnia
poor concentration/difficulty making decisions
What is the treatment for persistent depressive disorder?
-treatment implications aren't clear
-not responsive to meds
-not consistently responsive to short term psychotherapy
What is the relationship of persistent depressive disorder to MDD?
some characteristics of depression are present
Is premenstrual dysphoric disorder (PMDD) in the DSM-5 as an official disorder?
What is the duration for PMDD?
over the course of a year
What are the symptoms for PMDD?
5+ symptoms must be met
What is the treatment for PMDD?
FDA approved the use of fluoxetine (Sarafem) for the treatment of PMDD
What is the controversy of PMDD?
-want to provide assistance for suffering
-whether or not we should psychopathologize a natural process
-divisive against women
What are the changes to the DSM-5 for depressive disorders?
disruptive mood dysregulation disorder