WEEK 6 Mood Disorders

Question 1

Is sadness an adaptive emotion? Why or why not?

Answer 1

Yes it is. It pops up after a loss or setback often, allowing us to reflect, change priorities or accept the current situation, and recover.
Has bhvr indicators for social support.

Question 2

What is the difference between sadness and depression?

Answer 2

Sadness= acute emotion; transient.
Depression= mood; long lasting

Question 3

What are DSM Mood disorders?

Answer 3

They are disorders where individuals have gross deviations in mood, either depressed or elevated.

Question 4

Outline the criteria for a major depressive episode (there is A, B and C):

Answer 4

A. Extremely depressed mood and/or loss of pleasure most of the day, nearly every day, for at least 2 weeks, and FOUR + OF THESE RELATED SYMPTOMS:

1. Change in weight/appetite
   2.Sleep disturbance
2. Restlessness or feeling slowed down
3. Fatigue
4. Feelings of worthlessness or guilt
5. Indecisiveness, difficulty concentrating
   7.Suicidal ideation

B. Symptoms cause clinically significant distress or impairment

C. Symptoms not due to physiological effects of a substance or a general medical condition (e.g. hypothyroidism)

Question 5

Outline the criteria for a manic episode:

Answer 5

A. Elevated, expansive or irritable mood AND abnormally and persistently increased goal directed activity or energy.
- Must last at least 1 week, present most of day, nearly every day (less if hospitalisation is necessary).

B. Plus 3+ more related symptoms (4 if the mood is only irritable)
1. Inflated self esteem or grandiosity
2. Decreased need for sleep
3. More talkative or pressure to keep talking
4. Racing thoughts
5. Distractibility
6. Excessive involvement in risky, pleasurable activities

C. Marked impairment in functioning OR necessitates hospitalisation to prevent harm OR there are psychotic features

D. Episode not attributable to physiological effects of substances or general medical condition

Question 6

Outline the criteria for hypomanic episode:

Answer 6

-3+ related symptoms (if elevated or expansive mood), 4+ related symptoms (if irritable mood) which are milder than for a manic episode.
-Lasts at least 4 days
-Assoc w/ less impairment than a manic episode
-Not better explained by medication, drug or medical condition

Question 7

What is a unipolar mood disorder?

Answer 7

A mood disorder where only one extreme mood is experienced (i..e depression or only mania)

Question 8

Outline the criteria for Major Depressive Disorder

Answer 8

A. At least one major depressive episode
B. The occurrence of major depressive episode is not better explained by a psychotic disorder
C.THERE HAS NEVER BEEN A MANIC OR HYPOMANIC EPISODE

Question 9

What are the “episode” specifiers of major depressive disorder

Answer 9

Single episode (first time) or recurrent episode (not their first time)

Question 10

What are the “severity” specifiers of MDD

Answer 10

mild, moderate, severe
OR
psychotic
OR
partial remission or full remission

mild, moderate, severe if currently happening (based on no of sxs and impairment level)
full remission is a thing because depression is often recurrent

Question 11

What are the type of depression specifiers?

Answer 11

With…
- Anxious distress
-Mixed features
-Melancholic features
-Atypical features
-Mood congruent features
-Mood incongruent features
-Peripartum onset
-Catatonia
-Seasonal pattern

Question 12

What is the “with anxious distress” specifier of MDD?

Answer 12

MDD + anxiety symptoms (e.g. tension, fear of the worst, difficulty concentrating)

Question 13

What is the “with mixed features” specifier of MDD?

Answer 13

Criteria for MDD is met, but there are also SOME criteria for mania or a hypomanic episode.
These must be BELOW meeting criteria for hypomania.

Question 14

What disorder is mixed-feature-type MDD likely a prodromal stage for?

Answer 14

Bipolar disorder

Question 15

What is it like for someone with the “with melancholic features” specifier of MDD

Answer 15

Symptoms like lethargic, despair, waking up feeling sad, hopeless, lack of appetite, cannot move, slow, excessive guilt

Question 16

What is “with atypical features” type specifier of MDD

Answer 16

This means MDD presents with symptoms we tend to not think of as associated with depression.
Symptoms of: weight gain, rejection sensitivity, mood reactivity (e.g. still exp pleasure when something good happens to them)

Question 17

What is “mood congruent psychotic features” type specifier of MDD

Answer 17

Hallucinations characteristic of depression (e.g. guilt and worthlessness.

Question 18

What is “mood incongruent psychotic features” type specifier of MDD

Answer 18

Hallucinations that have nothing to do with depression

Question 19

What is “with perimartum onset” type specifier of MDD

Answer 19

Onset during pregnancy or within four weeks of giving birth

Question 20

What is “with seasonal pattern” type specifier of MDD

Answer 20

ONLY with recurrent depression
-assoc with changes in LIGHT and drastic CHANGES IN WEATHER.

Question 21

Can you have MDD and PDD at the same time in diagnosis?

Answer 21

Yes

Question 22

What are the differences in criteria between MDD and PDD

Answer 22

PDD DOES NOT have anhedonia, agitation OR retardation (moving slowly or pacing everywhere), excessive guilt, OR looking at suicide as criteria.

and also replaces weight loss/gain w poor appetite/overeating to focus more on the behaviour

Question 23

Is suicidal ideation a part of the criterion for PDD?

Answer 23

No

Question 24

Is suicide more common in PDD or MDD

Answer 24

PDD

Question 25

What are the criteria for PDD

Answer 25

A. Depressed mood (irritable for kids) for most of the day, more days than not for at least 2 years (1 year for kids) B. Two or more of... 1. Poor appetite or overeating 2. Insomnia or hypersomnia 3. Fatigue or loss of energy 4. Low self esteem 5. Poor concentration or indecisiveness 6. Feelings of hopelessness C. <2 months without symptoms D. MAY HAVE MDD at same time E. No manic or hypomanic episode ever F. Not better explained by a psychotic disorder G.Symptoms not attributable to physiological effects of substance or another medical condition H. Symptoms cause clinically significant distress or impairment.

Question 26

Anna has come into your office. You have determined that she had symptoms for PDD for three years. Around the time of her birthday last year she had so much fun that she felt better for three months. Can you diagnose Anna with PDD?

Answer 26

No. She went more than 2 months without symptoms

Question 27

What two disorders did the DSM-5 combine to create PDD?

Answer 27

Dysthymia and chronic MDD

Question 28

What is the difference between specifiers of PDD and MDD?

Answer 28

Most specifiers are the same, BUT... -PDD has no seasonal specifier (as one is depressed throughout all seasons of the 2+ yrs) -PDD has an "age of onset" specifier: early onset = onset before age 21, late onset= onset after 21

Question 29

Does early or late onset specifier of PDD have better outcomes?

Answer 29

Late onset has better prognosis.

Question 30

Describe the prevalence for MDD

Answer 30

About 9% lifetime, and 4% year

Question 31

Describe the prevalence of PDD

Answer 31

About 6% lifetime and 3% year

Question 32

True or false: in clinical settings, chronic depression is more common

Answer 32

True

Question 33

What is the gender ratio of depression?

Answer 33

Women to men: 2:1. More common in women.

Question 34

When is the onset of depression likely?

Answer 34

In adolescence. Unlikely in prepubertal children

Question 35

Is there much global variance in depression?

Answer 35

Yes. Seems to be dramatic variation across the globe

Question 36

Out of major depressive episode, PDD, Bipolar and ANY mood disorder, which has most severe impact?

Answer 36

PDD. Greatest number of days out of a role per month.

Question 37

What interpersonal factors are involved in the development and maintenance of depression?

Answer 37

Childhood adversity, negative life events (which are severe and common), a lack of social support

Question 38

How do depressed people contribute to stressful life events and circumstances happening?

Answer 38

More likely to marry people w interpersonal problems, more likely to have marital disharmony, can make home environment more stressful, can have lack of skills to resolve conflicts in relationships

Question 39

Outline psychological factors that contribute to depression

Answer 39

- Neuroticism, learned helplessness, hopelessness, Beck's cognitive triad, Rumination

Question 40

What is Beck's Cognitive Triad

Answer 40

This is a triad of interconnected thought patterns thought to contribute to the susceptibility toward depression. Involves: 1. Negative thoughts about themselves 2. Negative thoughts about the world 3. Negative thoughts about the future.

Question 41

What is learned helplessness?

Answer 41

This is where one may have initially been in inescapable negative circumstances, and stop trying to escape them. Then, when a situation arises where they can exert change, they don't even try because they think they have no control over it.

Question 42

Outline the behavioural activation theory of depression:

Answer 42

Some sort of event (setback) catalyses things... 1. Loss of **reinforcement** for healthy behaviour (and hence negative and positive reinforcement for depressed behaviour) 2. Depressed **mood** increases (occurs for at least two weeks) 3. Less **behavioural activation** (doing things that make us feel worthwhile), and an increase in avoidance and depressed behaviour) 4. Long-term increase in **depressive symptoms.**

Question 43

What is behavioural activation? | (behavioural activation theory)

Answer 43

-This is engaging in behaviour that is meaningful and makes us feel worthwhile. --It is positive reinforcement for healthy behaviours. - Often involves mastery and pleasure

Question 44

Provide an example of a positively reinforcing (R+) and negatively reinforcing (R-) behaviour that could contribute to depression in behavioural activation theory:

Answer 44

E.g. R+ : watching TV R-: avoiding work by staying in bed

Question 45

What is interpersonal therapy to treat depression?

Answer 45

Focuses on improving interpersonal skills: (e.g. problem solving in situations like conflict, self-expression of feelings, learning to get social support)

Question 46

What is cognitive therapy to treat depression?

Answer 46

* targets Beck's cognitive triad * looks for evidence for and against **misattributions and maladaptive beliefs** (e.g. about hope for the future) * Challenging their thoughts to get a more realistic perception * Includes some behavioural components (e.g. connecting with social support)

Question 47

What are third wave therapies for depression and outline the main ones

Answer 47

These are therapies which were developed after interpersonal and cognitive therapy. e.g. mindfulness-based cognitive therapy, acceptance and commitment therapy, and behavioural activation therapy.

Question 48

What is acceptance and commitment therapy for depression

Answer 48

-Focus on being present in the moment -Acknowledging thoughts but not having to interact with them -Can reconnect with life and focus on the current moment.

Question 49

Outline the process of behavioural activation theory in treating depression.

Answer 49

behav

Question 50

which treatment method is best (out of interpersonal psychotherapy, cognitive therapy, third-wave therapies and behavioural activation therapy)

Answer 50

they are all equally as good but a meta-analysis found that cognitive therapy actually works through behavioural activation so because behavioural activation is easier and less sessions, the recommendation is to start with behavioural activation, and if that doesnt work switch to cognitive therapy or another option

Question 51

what medication is used for depression

Answer 51

antidepressants - selective serotonin reuptake inhibitors - tricylic antidepressants - monoamine oxidase inhibitors (MAOI's) - mixed reuptake inhibitors (seroronin/norepinephrine SNRIs)

Question 52

which medications are preferred?

Answer 52

1. SSRIs are the first choice because of their risk benefit ratio (Side effects of SSRIs tend to be things like nausea, sleep problems, diarreha and headaches). 2. If they don’t work, then might go onto other options like SNRIs 3. MAOIs and trcyclic are rarely administered in AUS --> since side effects can be quite dangerous --> tricyclics even lethal, so since suicide is quite common with depression, we dont wanna give ppl too much access. And MAOs when combined with certain foods or drinks can also be quite lethal.

Question 53

what is the effectiveness of medication for depression

Answer 53

all medications are approximately equally effective 50% of patients benefit 25% of patients achieve normal functioning

Question 54

what treatment is used when patients are resistant to medication and what are the side effects of these

Answer 54

1. electroconvulsive therapy (ECT) - results in temporary seizures - short term memory less (which is usally restored) - some patients suffer long term memory loss 2. transcranial magnetic stimulation - use magnets to generate a precise localised electromagnetic pulse to increase brain actvitity - may be combined w medication - Appears to be less effective then ECT but the side effects are much less severe - occasional headaches