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Flashcards in Mood DIsorders Final Deck (97):
1

Depression symptoms must be 5/9- Present during same 2 week period

Weight gain or loss Insomnia or hyper-somnia Psychomotor agitation or retardation Fatigue or loss of energy Feelings of worthlessness or excessive or inappropriate guilt Diminished ability to think or concentrate or indecisiveness Recurrent thoughts of death or suicidal ideation or attempt or plan

2

Major Depressive Disorder: Coded

Mild/moderate/severe without psychotic features/severe with psychotic features

3

Persistent Depressive Disorder (Dysthymic Disorder)

Depressed mood, most of the day, more days than not, for at least 2 yrs (Must be Chronic)

4

Persistent Depressive Disorder

Poor appetite or overeating Insomnia or hypersomnia Low energy or fatigue Low self-esteem Poor concentration or difficulty making decisions Feelings of hopelessness (never a manic, mixed or hypomanic episode)

5

Major Depression Prevalence

19%

6

Dysmthic Disorder Prevalence

6 % (DSM IV-TR) 2.5 % (Kessler et al, 2005)

7

Major Depression Likely for

Females 2x males Course and treatment response – little difference Poor 3x risk Unrelated to ethnicity, education

8

Major Depression onset

Any age Ave. 1st episode - 20s

9

Chances of More episodes go up as more occur

Single episode - at least 60% have a 2nd Episode Two episodes – 70% chance of a 3rd Three episodes – 90% chance of 4th Single episode – 5-10% dev. Bipolar I

10

Major Depressive Disorder Length

Ave. 3-5 months Abrupt or gradual onset About 12% becomes chronic

11

Specifiers for Major Depressive Disorder

anxious mood Psychotic features Seasonal Pattern Peripartum onset Pregnancy or post-partum

12

Seasonal Affective Disorder

Late fall/winter Severe enough to meet MDD criteria Often increased appetite & hypersomnia

13

Premenstrual Dysmorphic Disorder Symptoms

Mood swings ….. Irritability, anger, conflicts Depressed mood, hopelessness, self-deprecating thoughts Anxiety……. 1 of above

14

Depression and Culture

Symptoms similar in many culture Sometimes expressed more in somatic terms

15

Depression in Children

< 13 yrs 2% < 13 yrs. f. = m. 13-18 yrs 6-8 % Teens f. higher (as many as 20 % teens may have a depressive episode at some point)

16

Disruptive Mood Regulation Disorder

severe pattern of rage chronic, severe, persistent irritability with frequent temper outbursts After 6 yrs old 1st diagnosis before 10 yr.

17

Psychodynamic View of Depression

Freud – early loss (or imagined loss) Early needs not met Early trauma > hypersensitivity to loss

18

Klerman Interpersonal Approach

Disrupted relationships can lead to depression Depression disrupts relationships

19

Bowlby Attachment theory

Attachment Bonds disrupted ….vulnerability to depression

20

CHECK

Research – Death of parent Also: quality of parenting before loss quality of parenting after loss Other related theories about childhood loss, abuse, family discord, pathology of parent, rejection, intrusion

21

Learning/ Behavioral Theory

Reduction in social reinforcement Learned Helplessness Seligman’s Dogs

22

Beck Cognitive Theory Depression

(Beck) Negative Cognitive Set Negative Triad Self, world (experience), future

23

Cognitive Disturben Patterns of Thinking Depression

overgeneralization selective abstraction arbitrary inferences magnification &amp; minimization

24

Genetics Mood Disorder

Meta-analysis – twin studies Heritability est. 37% higher in inpatient pops. Higher in women than men

25

Tricyclics

increase NE &amp; 5HT available by blocking reuptakeused

26

MAOIs

increase NE &amp; 5HT available by preventing enzyme degradation

27

Riserpine

Other : Reserpine –causing depression, used to treat hyper tension, root of drug growing in india

28

Problem with Trycilics

- Tricyclics/ MAOs 1-2 weeks - Increase in NE and 5HT: quick - Other problems with theory: meds increase NE and 5HT initially, but then stop Revised Theory: - Post synaptic receptor sensitivity - Interactions in Biogenic Amines

29

Death of Parent iN Depression

Death of a parent - Also: quality of parenting before loss/ quality of parenting after loss

30

Fogs Helplesness

1. Escape group: shocked, stopped shock with noses, hopped over barrier 2. Helpless group: shocked, no way of escaping, slower to jump over barrier (depressed) 3. Control group: not shocked, jumped over barrier (helplessness is important in maintaining depression

31

Peck cognitive theory

- Negative cognitive set: how you perceive yourself is a key element in depression - Negative triad: self, world experience, future (Perceive self negatively)

32

Research on Cognitive theory

- correlation between negative cognitive set and depression - casual research: limited

33

Psychological Factors

- Marital dissatisfaction and conflict - Interpersonal problems with family: high EE (emotional overinvovlvement)

34

Social Support

- Important when facing adversity, perceive bond as positive - Intimacy

35

Highest rates Depression in

unemployed, divorced man

36

Lowest Rates Depression

Employed Married Man

37

Marriage and gender

- Married women vs. men: women more likely to be depressed

38

Biogenic Amines in Depression

(dopamine, norepherine, serotonin)

39

Low levels of NE

depression, high levels of mania is unlikely

40

Major Depression Episode risk

- Single episode: at least 60% have second episode - Two episodes: 70% of third - Three episodes: 90% chance of 4th - Single Episode: 5- 10% Bipolar I

41

Average age of Episode Major Depression

- Any age - Average first episode: 20s

42

Dysthymic Disorder

- A risk factor for MDD - Clinical settings: less than 75% will develop MDD within 5 years

43

Depressive Episodes in Depression

- Average: 3 to 5 months - Abrupt or gradual onset - About 12% becomes chronic

44

MDD Specifiers

Anxious mood Psychotic features Seasonal pattern Peripartum onset

45

Seasonal Pattern of Depression- treated light therapy

- Seasonal affective disorder - Late fall/ winter - Severe enough to meet MDD criteria - Often increased appetite and hypersomnia

46

Premenstrual Dysphoric Disorder

- Mood swings - Irritability, anger, conflicts - Depressed mood, hopelessness, self- deprecating thoughts - Anxiety Must have one of the above and total of five symptoms - Symptoms as severe as MDD or GAD

47

Disruptive Mood Disregulation Disorder

- Severe pattern of rage - Chronic, persistent, severe irritability with frequent temper outburst

48

Dysruptive Mood Disregulation Disorder

- After 6 years old - 1st diagnosis before 10 years - more apt to develop depression or anxiety, not bipolar

49

Psychodynamic Theory of Depression

- Freud = early loss/ imagined loss - Early needs not met - Early trauma - Hypersensitivity to loss= early needs not met or an early traumatic event

50

Neurotransmitter theory of Depression

- Biogenic amines (dopamine, norepherine, serotonin)

51

MAOis Depression Theory

2. MAIOs- increase NE and 5HT available by preventing enzyme degradation

52

Hormone imbalance in Depression

- Malfunction of hypothalamus: 4 fs - Hypothalamus: mood, appetite, sex, regulates pituitary gland (- Evidence: irregulates in this process in depression)

53

Cortisol and Depression

high cortisol levels - High in other disorders too

54

Dysregulation in Hypothalamic Pituitary Axis

- Hypothalamic- pituitary axis - Both MDD and PTSD Child maltreatment/ early life stressors - Associated with deregulation of HPA axis

55

Sleep Disturbance in Depression

- Common in depression - Abnormalities in sleep stages - Eg “shortened REM latency”

56

Manic Episode Bipolar Symptoms (3 or more)

- inflated self esteem or grandiosity - decreased need for sleep - more talkative - flight of ideas - distractability - increase in activity or agitation - excessive involvement in pleasurable activities- with high potential for painful consequences marked impairment in functioning or hospitalization necessary to prevent harm

57

Hypomanic Episode same as Mania but

Same symptoms as manic - BUT NOT severe enough to Cause marked impairment in functioning Require hospitalization No psychosis Mood for at least 4 days Episode uncharacteristic Mood change observable by others

58

Bipolar 1

- At least 1 manic episode (over 50% have 4 or more) - Depressive episode (or will have) - Many have hypomanic episodes too - May have mixed episodes

59

Bipolar 2

- At least one depressive episode - At least one hypermanic episode

60

Cyclothymic Disorder

- At least 2 years - Frequent mild depression - Frequent hypomania

61

Bipolar age of onset

- Bipolar I: 18 years - Bipolar II: 19 years - Usually starts 15- 44 years

62

Bipolar Prevalence

- Lifetime bipolar: up to 4% - Lifetime cyclothymic: .4 to 1% • 12 months - Bipolar I= .6% - Bipolar II= 11.8%

63

Gender and Bipolar

- M. = F. - 1st episode is more likely to be depression in females and mania in males - females have more depressive episodes and rapid cycling is more frequent

64

Bipolar I and II comorbidity

- Bipolar I and II - Anxiety Disorders: I 75% II 75% - Substance abuse: I 50% II 37% - ADHD (I), Impulse Control Disorders (I), Eating Disorders (II) - High Suicide Rate (I and II)

65

Bipolar and suicide

- High Suicide Rate (I and II) - 15X general population - 1/3 attempt suicide - 15- 20% complete suicide

66

Bipolar in Children

- Increase in diagnosis - National survey adults: 33% report symptoms before age 15 (note: retrospective) - “catch all category” - over- medication

67

Psychological Theories Bipolar

- Mania as defense against: depression, low self esteem

68

Genetics and Bipolar

more common in bipolar than depression - High heritability - 1st degree relatives - twins

69

Twin studies and Bipolar

- MZ 40%, DZ 5- 10% (Comer) - MZ 70%, DZ 20- 25% (Kring et al) - MZ 72%, DZ 14% (Sue and Sue)

70

People who complete suicide

- 70% severe depression (adolescents= 75%) - 20% chronic alcoholism - 10% schizophrenia - severe depression and alc dependent= especially at risk

71

25% of these commit suicide

- Severe depression - Alcoholism - Schizophrenia

72

Suicide associated with

- Hopelessness - Poor problem solving - Impulsivity - Low “life satisfaction” - Sever stressful event - Depression, anxiety or agitator/ poor impulse control - Lack of social support

73

Tricylics

- Block NE and 5HT reuptake and alters sensitivity of receptors - Imipramine etc. - Helps 50 to 60%

74

MAO inhibitors

- Block MAO (enzyme) from degrading NE - Problem: rise in blood pressure with foods with Tyrolamine (aged cheeses, bannanas) - Helps 50%

75

Second generation antidepressors (inhibitors)

- SSRIS (inhibit 5HT) - Prozac (fluoxetine) - Zoloft - Lexapro - Clexa

76

Newer re-uptake inhibitors

- NRI (NE only): Strattera - SNRI (5HT and NE) - NDRI (NE and DA)

77

Adult improvement from Mood disorders

- 50 to 70% improve (• Children and adolescents Less research, Less effective)

78

ECT

- Electroconvulsive thereapy

79

Brain stimulation

- Transcranial Magnetic Stimulation (TMS): severe depression, implant pulse maker - Vagus Nerve Stimulation: only used if 4 treatments fail - Deep Brain Stimulation - Exercise: moderate intensity, aerobic

80

Interpersonal psychotherapy

four issues must be adressed: interpersonal loss, interpersonal role dispute (parts of each partner), interpersonal role transition(New life event), interpersonal deficits (lacks)- therapist helps with each

81

NIMH study/ NIMH outcomes

- 4 groups: CBT, IPT, Imipramine (tricyclic and support), placebo and support - 16 weeks long Outcomes: No significant difference between treatment groups, All significant better than the placebo, Imipramine faster- but others caught up

82

Treatment stats Depressive

- Meds- 1/3 get better, 2/3 improve - Therapy- 1/3 get better, 2/3 improve - Combined: similar, but better for chronic MDD - Note: some studies produce higher rates

83

Low levels of NE and 5HT

1) Low levels of NE -----depression (High levels of NE ----mania ? ) 2) Low levels of Serotonin ----depression

84

Indole Amines

Serotonin

85

Catecholamines

dopamine, norepinephrine, and epinephrine

86

Low levels NE

mania is often observed in people who have high levels of norepinephrine

87

Personality- Enduring patterns of

experience and behavior

88

Prevalence Personality

Unknown, 9-13% of adults

89

Tricylics name

Impramine

90

MAO name

Monoamine oxidase inhibitors)

91

SSRI name

Prozac, Zoloft, Lexapro)

92

SNRI name

Strattera)

93

Serotonin/Norepinephrine Reuptake Inhibitors

(Effexor)

94

Indole Amines

Serotonin

95

Catechloamines

DA NE

96

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