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Flashcards in Mood Disorders (Exam 2) Deck (122):
1

What are the symptoms of Bipolar I Disorder?

manic episode

2

What are the symptoms during a manic episode?

-grandiosity
-decreased need for sleep
-pressured speech
-flight of ideas

3

What is grandiosity?

inflated self-esteem (feels like they can do anything)

4

What does a decreased need for sleep look like?

-feel rested after 3 hours of sleep
-looks like cocaine intoxication

5

What does pressured speech look like?

rapid speech

6

What does flight of ideas produce?

delusions (thoughts that are held but no basis of reality)

7

What are the key differentials that need to be ruled out to be diagnosed with BD?

-drug intoxication (psychostimulants)
-paranoid schizophrenia (also have delusions)

8

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

9

What is the prevalence rate for suicides due to Bipolar Disorder?

20% of people with BD die by suicide

10

How are genetics and heritability studies conducted for Bipolar Disorder?

twin study research

11

What are monozygotic?

1 egg = identical twins

12

What are dizygotic?

2 egg = fraternal twins

13

What are the concordance rates for monozygotic?

72-80%

14

What are the concordance rates for dizygotic?

14-20%

15

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)

16

What is the criteria for Bipolar Disorder II?

observe hypomanic episode (not as extreme as BD I)

17

What is the drug treatment for BD?

lithium

18

What is the efficacy of lithium?

effectively decreases mood fluctuation (60% improvement)

19

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

20

What are the compliance issues with lithium?

-people miss their "highs" (life is "boring" w/o them)
-difficult/toxic side effects

21

What are the other medications for BD?

-anticonvulsants
-antipsychotics

22

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

23

What is the duration for cyclothymic disorder?

must have mood cycles for at least 2 years (chronic)

24

Are medications useful for treating cyclothymic disorder?

medications are not as useful for this disorder (not a clear medical treatment)

25

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

26

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)

27

What is the criteria for MDD?

-anhedonia
-psychomotor agitation or retardation

28

What is anhedonia?

loss of pleasure in things that used to give pleasure

29

What is psychomotor agitation or retardation?

-restless or agitated (psychomotor agitation)
-psychomotor retardation (may move very slowly)

30

What is the lifetime prevalence rates for adults for depression?

12-20%

31

What is the ratio of females to males for depression in adults?

2:1 ratio

32

Is depression common in adolescents and elderly?

yes

33

If untreated, how many will improve from depression?

90% (vast majority will improve within 5 years)

34

If untreated, how many will relapse with depression?

75-90% will have 2nd episode if left untreated (much more likely to relapse)

35

What is the gender concordance rates for MDD in monozygotic twins?

36%

36

What is the gender concordance rates for MDD in dizygotic twins?

17%

37

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

38

What are the several "types" of depression?

-MDD with Postpartum Onset
-Endogenous depression
-Exogenous depression

39

What is the PPD prevalence?

-5-25%
-10-15% typically cited

40

What is endogenous depression?

inside the body (biological level)

41

What is exogenous depression?

outside the body (environmental factors)

42

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

43

Which neurotransmitters can contribute to the causes of depression at a biological level?

-serotonin (5-HT)
-Norepinephrine (NE)

44

What is the monoamine hypothesis for the cause of depression at a biological level?

may be related to a functional deficit of neurotransmitters

45

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

46

What happens during a chemical transmission?

causes release of neurotransmitters

47

What is a synaptic cleft?

when the cells are not in direct contact with each other

48

What can neurotransmitters do when they are in the synapse?

can engage the next neuron or post-synaptic receptor

49

What does norepinephrine and serotonin get broken down by?

monoamine oxidase (MAO) (enzyme)

50

What happens during a reuptake?

can be taken back up into the original neuron's terminal button

51

What is the concept of functional deficit?

may be too little neurotransmitters

52

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

53

How do drug therapies work for MDD (MAOIs)?

-prevent breakdown of neurotransmitters
-causes a functional increase in NE and 5-HT

54

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

55

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

56

What are the warnings for MAOIs?

notably hazardous interactions with foods containing tyramine

57

What does tricyclic do for the treatment of MDD?

cause block of reuptake of NE and 5-HT

58

Are tricyclics easy to overdose with?

yes

59

Are tricyclics antidepressants?

yes

60

What are the side effects of overdosing on tricyclics?

-long and irreversible
-painful
-cardiac arrhythmias

61

What does SSRIs stand for?

selective serotonin reuptake inhibitors

62

What is the function of SSRIs for treating MDD?

function by blocking serotonin reuptake

63

What are the clinical efficacy trials for SSRIs for treating MDD at the end of 16 weeks?

57% response rate

64

Do SSRIs have a strong placebo effect?

yes

65

What are the side effects of tricyclics?

-blurred vision
-dry mouth
-fuzzy headed feeling
-sedation

66

What are the side effects for SSRIs?

-not as lethal
-don't have the same side effects as other tricyclics (still have side effects)

67

What are the newer drugs that are being used to treat MDD?

atypical antidepressants

68

What do atypical antidepressants do?

newer drugs going after either specific receptors or additional neurotransmitter sites of action

69

Do all the atypical antidepressants have side effects?

yes

70

What are the clinical efficacy trials for SSRIs for treating MDD after 16 weeks?

57% response rate

71

How much does placebo account for SSRI outcomes?

50-75% outcome

72

Why is placebo accounting for SSRI outcomes?

some patients will report effect in 1 day

73

What happened when studies compared antidepressants with active placebos?

-placebos with side effects
-reduces difference between drug and placebo

74

How are the findings of comparing antidepressants with active placebos described now?

described as expectancy effects

75

What is the link between children on SSRIs and suicide completion?

no scientific link between suicide completion and children on SSRIs

76

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

77

What should you watch for SSRIs and suicidality?

-anxiety
-agitation
-panic
-insomnia
-irritability
etc.

78

What are the empirically supported psychotherapies for treating MDD?

-behavioral therapies
-cognitive therapy (CT)
-cognitive behavioral therapy (CBT)
-interpersonal psychotherapy (IPT)

79

What are the efficacy for the empirically supported psychotherapies for treating MDD?

all have equal efficacy for MDD (mild to moderate types)

80

What is the efficacy response rate for the empirically supported psychotherapies for treating MDD?

55-65% response rate

81

What is the clinical efficacy trails for medication vs psychotherapy after 16 weeks?

CT (psychotherapy) = 57% response rate
SSRIs (meds) = 57% response rate

82

What are the relapse rates following cessation of medication vs psychotherapy after 16 weeks?

CT = 25%
meds = 40%
Placebo = 81%

83

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

84

Do CBT have a lower relapse rate?

yes, reduces risk of relapse by 60%

85

Who is electroconvulsive therapy used for?

tends to be used for people who are severely depressed

86

What are the equivocal results for ECT as to effectiveness?

for each study saying ECT is effective another says it is not

87

How does ECT work?

causes/induces tonic clonic or grand mal seizures activity in the brain

88

What is the regimen for ECT?

typically the regimen is 3-5/week for several months

89

What are the side effects for ECT?

retrograde amnesia

90

What is retrograde amnesia?

-worst side effect is memory loss for events prior to treatment
-can be short or long term

91

What are the two psychological theories for depression?

-behavioral views
-cognitive views

92

What is Lewinsohn's behavioral view of depression?

depressed people do not have enough reinforcement (not enough social reinforcement or opportunities for reinforcement)

93

When is behavioral therapy needed?

may not have social skills needed to get reinforcement (may push others away when depressed, interpersonal styles)

94

What is the key to behavioral therapy?

getting people interacting with others

95

What is behavioral activation designed to do ?

increase activity level of client (ex: exercise, social interaction, practice learned skills)

96

What is involved with the cognitive theory of depression?

learned helplessness

97

What is learned helplessness?

hypothesized that if people are in non-escapable situation they learn they are helpless

98

Who came up with learned helplessness?

Seligman

99

What cognitive aspect did Seligman add to the cognitive theory of depression?

attributions

100

What are attributions?

casual explanations for why something happened

101

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)

102

Which three dimensions of the Attribution Theory are associated with depression?

internal, stable, global attributions are more likely to be associated with depression

103

What did Aaron Beck come with for cognitive therapy?

negative cognitive triad

104

What is the negative cognitive triad?

depressed clients have negative view of themselves, the environment, the future

105

What are thinking styles characterized by in cognitive therapy?

logical errors

106

What are logical errors for thinking styles characterized in cognitive therapy called?

cognitive distortions

107

What are examples of cognitive distortions?

-overgeneralizations
-all-or-none thinking
-arbitrary inferences

108

What are overgeneralizations?

sweeping to conclusions based on one event

109

What is all-or-none thinking?

no middle ground, black and white only

110

What are arbitrary inferences?

draw conclusions when there is no evidence for it or very little evidence for it

111

What is the goal for cognitive therapy for depression?

-change how we think
-feelings and actions will follow from improved thinking patterns

112

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

113

What are the symptoms for Persistent Depressive Disorder and the diagnostic criteria?

2 + symptoms must be met
-low self-esteem
-feelings of hopelessness
-poor appetite/overeating
-insomnia or hypersomnia
-low energy
poor concentration/difficulty making decisions

114

What is the treatment for persistent depressive disorder?

-treatment implications aren't clear
-not responsive to meds
-not consistently responsive to short term psychotherapy

115

What is the relationship of persistent depressive disorder to MDD?

some characteristics of depression are present

116

Is premenstrual dysphoric disorder (PMDD) in the DSM-5 as an official disorder?

yes

117

What is the duration for PMDD?

over the course of a year

118

What are the symptoms for PMDD?

5+ symptoms must be met
-depressed mood
-anger/irritability
-difficulty concentrating
-moodiness
-tender breasts
-bloating
-weight gain
-etc.

119

What is the treatment for PMDD?

FDA approved the use of fluoxetine (Sarafem) for the treatment of PMDD

120

What is the controversy of PMDD?

-want to provide assistance for suffering
-whether or not we should psychopathologize a natural process
-divisive against women

121

What are the changes to the DSM-5 for depressive disorders?

disruptive mood dysregulation disorder

122

What is Disruptive Mood Dysregulation Disorder?

frequent temper outbursts 3 or more times per week over 1 year that is developmentally inappropriate