3: Mood Disorders Flashcards
How are mood disorders classified?
depressive or maniac episodes
- each have key symptoms associated with both
What are the cirterias to be diagnosed with a mood disorder?
- depressive/ maniac episodes must be severe enough that it is causing significant impairment in their social + occupational function
- episodes should not be explained by other external factors like medication/ other disorders
- for depressive = must not be the result of bereavement
What are the subdivision within depressive disorders?
- major depressive disorder
- dsythymic disorder
- disruptive mood dsyregulation disorder
- premenstrual dysphoric disorder
Describe major depressive disroder
- single or recurrant episodes of depression
- where symptoms last for more than 2 months
Describe dsythymic disorder
- persistent depressive disorder
- similar symptoms to major depression but less severe
- but last much longer like 2 yrs
Describe disruptive mood dsyregulation disorder
- severe recurring temper tantrums
- verbal/ behavioural nature
Describe premenstrual dysphoric disorder
mood swings associated with phases of menstrual cycle
Describe bipolar disorder
- extreme fluctuation in mood
- alt between depression + mania
- og called manic depression
What are the 3 subtypes of bipolar disorder?
Bipolar I D
Bipolar II D
Cylcothymic disorder
What is hypomania?
- symptoms similar to those in mania
- but not sever enough to impair functioning
so = less severe form of mania
What is the difference between bipolar I vs II?
I = depressive/ manic/ hypomaic episodes present
- previous manic/ depressive episode may have been present
- psychosis also may be present
II = major depression/ hypomanic episodes
- history of at least one episode of major depression/ hypomania
Describe Cylcothymic disorder, one of the subtypes of bipolar diorder
- within 2 yrs = cycle of hypomanic episodes at w/ depressive symptoms
- major depression not severe enough = major depression
- no history of major depression/ mania
Who is Nathalie?
- og quiet person + periods of depression
- sudden change in energy + xp grandiose delusions
= diagnosed with bipolar I
What is…
- Rapid cycling
- Ultra-rapid cycling
- Ultradian cycling
The different cycling nature of bipolar disorder:
- 4+ episodes of manic/ hypomanic + depressive symptoms within one year
- Extreme fluctuation over a period of days
- Extreme fluctuation within the same day
What are some symptoms of someone experiencing a manic episode?
- extremely elevated mood
- grandiose ideas
- flight of ideas
- Distractibility
Some patients can have both manic + depressive episodes together. Why is this particularly dangerous?
- increased risk of suicide
- recurring thoughts of death + impulsivity (Swann et al, 2007)
What are the monoamine neurotransmitter?
Dopamine, serotonin + norepinephrine
Which genes have been suggested to have a role in the development of depression?
- Seretonin transporter gene
- stress –> depletion of neurotransmitter - DRD4 - dopamine D4 receptor
How is stress related to development of depression (Karg, Burmeister, Shedden + Sen, 2011)?
depressed patients = higher cortisol lvls than others
- increased prolonged reactivity to stressor may deplete neurotransmitter system, esp serotonin (Leonard, 2010)
What is the circadian rhythm?
describes the cyclical physiological changes than occur within an organism over a repeated time period
eg 24hr sleep-wake cycle
How has the circadian rhythm been suggested to have a role in the development of depression?
dsyfunctional central regulator which controls circadian rhythm found in depression (Germain + Kupfer, 2008)
Which neuroanatomical parts of the brain are suggested to have a role in the development of depression?
- Pre-frontal cortex
- reduced activity
(Davidson + Pizzagalli, Nitschke + Putnam, 2002) - Hippocampus
- reduced size in depressed patients
(Malhi + Lagopoulos, 2008)
What is thought to be the role of the pre-frontal cortex, related to depression?
control fear response from the limbic system esp amygdala
- no control = fear response manifests eg anxiety - symptom of depression
What is thought to be the role of the hippocampus, related to depression?
learning + memory
- memory impairment eg memory recollection mediated by hippocampus (Campbell + MacQueen, 2004)
What are some difficulties with drawing conclusions about neuroanatomical irregularities and depression?
- cannot tell if affect of medication or disorder
2. irregularities as a result of symptom or stable biological markers
What are the different biological factors?
- Genetics
- cortisol
- circadian
- neurotransmitters
What are the different psychological factors?
- Behavioural
- loss of positive social reinforcement
- Lewinsohn - Psychodynamic
- Low self-esteem
- Guilt - Cognitive
- Negative interpretations
- learned helplessness - Environmental
- Stress
- genetic vulnerability for stress
How did Freud explain how depression developed (Psychodynamic)?
Emphasis on: LOW self-esteem
- Loss of a loved one/ figure = negative effect on self-esteem
- This reflected via guilt, self-criticism etc = trigger depression
What did McWilliams (1994) emphasised was important in the development of depression (Psychodynamic)?
emphasis on: GUILT
- even children likely to develop depressive feelings from depressed parents because of the guilt they xp from imagined role
What are the criticisms of the psychodynamic explanation of the development of depression?
- not everyone who loses someone = depression
- Freud making conclusions from a small sample of viennese women (Dozois, 2000)
What does the behaviourist approach emphasise in the development of depression?
LOSS of positive social reinforcement
- Learn you are happy with job/ in a relationship
- Loss of either = loss of the positive reinforcement
What did Lewinsohn emphasised were important in the development of depression (behaviourist approach)?
- Social environment
- can’t find another job = withdrawn from all positive job related reinforcement - behaviour of individual
- shy = unable to make new friends
What are some criticism of the behaviourist explanation of depression?
- lacking empirical evidence
- doesn’t consider the emotional + cognitive factors (Blaney 1977, Eastman, 1976)
What does the cognitive explanation emphasise on being important for the development of depression?
THOUGHT process
Ellis (1993)
- the negative interpretation = problematic = depressive emotional reaction
Learned helplessness = HOPELESSNESS
- belief no control over their physical/ social environment (seligman, 1975) = hopelessness
What are some faulty thinking present in depression?
- Catastrophic thinking
- worst will always happen - Overgeneralising
- negative generalisation made from isolated incidents
What environmental factor has been emphasised to have an intricate relationship with depression?
STRESS
- actue (loss of job) + chronic (relationship difficulties)
What type of stress is more likely to lead to depression?
stress from loss, social rejection/ humiliation more likely = depression VS stress from dangerous situations
How is genetics related to the environmental explanation for the development of depression?
genetic role in the vulnerability to stress:
- evidence of POLYMORPHISM of serotonin transporter mediating relationship between stress + depression (Karg et al, 2011)
What environmental factors offer some protection against depression being triggered by stress?
- familia support
- financial support
- participation in sport
Is there a high genetic component for bipolar disorder?
HIGH concordance rate
MZ = 20/75%
Dz = 0-8%
* also evidence genes responsible for the regulation of circadian rhythms play a role in disorder (Soria et al, 2010)
What are the different explanations for the aetiology of bipolar disorder?
- biological
- high genetics component
- brain abnormalities
What brain abnormalities are observed in people with bipolar disorder?
- enlarged amygdala (Arnone et al, 2009)
- generation of emotional response - decreased cerebellum volume (Baldacara et al, 2011)
- emotional regulation - Fluctuation between dopaminergic + serotonergic systems when in depressed/ manic phase
- increased serotonin lvl in limbic system when in depressed phase (Heinzel + Muller, 2012)
How do the psychodynamic approach explain the mania part of bipolar disorder?
- Freud: symbolic liberation from the depression
2. Melanie Klein: defence mechanism triggered by guilt for the hostile feels they held for their loved ones
What do the behavioural approach say about the mania part of bipolar disorder?
at risk of heightened sensitivity to reward
= get more pleasure from a positive event (Johnson + Jones, 2009)
What do the cognitive + environmental explanations say about the mania part of bipolar?
Cognitive = certain thinking style = increased risk eg acting before thinking, over confidence (Johnson + Jones, 2006) Environment = home which emphasise achievement/ ambition related to manic symptoms (Chen + Johnson, 2012)
Which country has the highest and lowest prevalence of bipolar disorder?
USA = 4.4% VS India = 0.1%
What are biological treatment approaches for major depression?
- Antidepressants
2. Electroconvulsive therapy (ECT)
What are the 3 main classes of antidepressants for major depression?
- Tricyclics
- Selective Serotonin re-uptake inhibitors (SSRI)
- Serotonin + noradrenaline re-uptake inhibitors (SNRI)
How do the antidepressants tricyclics work for the treatment of major depression?
- Amitriptyline
prevent absorption of serotonin + norepinephrine
SA: dry mouth, increased heartbeat + constipation
How do the antidepressants SSRI work for the treatment of major depression?
- Fluoxetine
stop re-uptake of serotonin
SA: nausea, anxiety, indigestion
How do the antidepressants SNR work for the treatment of major depression?
- Venlafaxine
obstruct obstruction of norepinephrine + serotonin
SA: nausea, anxiety, indigestion - not be used for ppl with existing heart problems
How does Electroconvulsive Therapy (ECT) work for the treatment of major depression ?
- producing a seizure by applying electric current to the brain
- used when all other options are not working
ST-SA: headaches, muscle ache
LT-SA: memory problems
What are the psychological treatment for major depression?
- CBT
2. Behavioural Activation Therapy
How does Behavioural Activation Therapy for the treatment of major depression?
- main goal to increase number of enjoyable activities an individual engages in
What are the main biological treatments for bipolar disorder?
- Mood-stabilising drugs
2. Antipsychotic drugs
How do mood-stabilising drugs work for the treatment of bipolar disorder?
- Lithium, Sodium Valproate
- unsure how it works
- works on both parts of bipolar disorder
SA: weight gain, thirstiness, blurred vision
How do antipsychotic drugs work for the treatment of bipolar disorder?
- usd for bipolar 1 = psychosis may be present
- Olanzapine, Risperidone
- alt lvls of neurotransmitters esp serotonin + dopamine
What are psychological treatment for bipolar disorder?
- CBT
- Psychoeducation
- Family Focused Therapy (FFT)
How does psychoeducation for the treatment of bipolar disorder work?
- improve understanding of the disorder for the individual + family
- symtoms, treatments, coping strategies etc
- create a more caring + understanding environment to reduce environmental stressors + likelihood of relapse
How does Family-Focused therapy (FFT) for the treatment of bipolar disorder work?
work on psychoeducation + positive communication
