5 - Bipolar and Depressive Disorders Flashcards
Which disorder is attributed to be the leading cause of disability worldwide?
Depression
Compare the prevalence rates of unipolar and bipolar disorder across genders?
Unipolar more prevalent in females (2:1 ratio); equal prevalence for bipolar
There are no race or SES distinctions for mood disorders. What is the typical onset age for more than half of individuals?
Before age of 25
How is bipolar disorder defined in diagnosis?
According to most recent episode (manic, depressed or hypomanic)
List the manic symptoms for bipolar 1 disorder
Euphoria; grandiosity; pressured speech; impulsivity; excessive libido; recklessness; social intrusiveness; diminished need for sleep
What specifiers can be used in describing bipolar 1?
Manic, hypermanic, depressed or unspecified; severity: mild, moderate or severe; with psychotic features; partial or full remission
What are some additional features of bipolar 1 disorder?
Anxious distress; mixed features; melancholic features; atypical features; catatonia; peripartum onset (in relation to pregnancy or childbirth); seasonal pattern; rapid cycling; psychosis
In the diagnostic criteria of a manic episode, A is a distinct period of abnormally and persistently elevated, expansive or irritable mood and goal-directed activity or energy for at least 1 week. Criteria B must include 3 or more of which symptoms?
Inflated self esteem/grandiosity; decreased need for sleep; increased speech, talkativeness or pressure of speech; flight of ideas or racing thoughts; distractibility (reported/observed); increased goal-directed activities or psychomotor agitation; excessive involvement in pleasurable activities with high potential for painful consequences
Describe criteria C and D of a manic episode
C. Marked impairment in functioning, or need hospitalisation, or psychotic features; D. Not due to effects of substances or another medical condition
Hypomanic episode meets most of the criteria for manic episode but isn’t as severe. What are the main features?
Lasts for only 4 consecutive days; associated with uncharacteristic change in functioning; observable to others; not severe enough to cause impaired social or occupational functioning, or hospitalisation, and no psychotic features
In a major depressive episode, 5 or more symptoms must be present during the same 2 week period and represent change from previous functioning. What may these symptoms include?
Depressed mood; diminished interest/pleasure; significant weight loss; insomnia/hypersomnia; psychomotor retardation; fatigue; feelings of worthlessness/inappropriate guilt; diminished concentration/indecisiveness; recurrent thoughts of death/suicide
At least one of which 2 symptoms must be present to be diagnosed with major depressive disorder?
Depressed mood or loss of interest/pleasure (anhedonia)
How is bipolar II distinct from bipolar I?
One or more major depressive episodes are accompanied by at least one hypomanic episode, but never had a manic episode
Describe cyclothymic disorder
Mild form of bipolar; at least a 2 yr period (1 for children) of hypomanic and depressive symptoms but don’t reach episodes (or fulfill criteria); not without symptoms for 2 months in the 2 yr period; insidious onset in late teens or early 20s; female to male ratio of 3:2; less than 1% lifetime prevalence; a third develop a major mood disorder (bipolar I)
What kind of medical disorders and drug use are common differential diagnoses for bipolar?
Medical: Epilepsy; Huntington’s chorea; multiple sclerosis; traumatic brain injury; HIV/AIDS; Drugs: amphetamines; cocaine; hallucinogens; opiates
What are some other psychiatric disorders of special consideration for manic symptoms?
Schizophrenia; borderline, narcissistic and histrionic personality disorders
Which symptom does bipolar often start with?
Depression
Most people experience both depression and mania, with only a minority experiencing manic episodes alone. With more chronic cases, what often decreases?
The amount of time between episodes
Compare prognosis for bipolar with depressive disorders, and describe the indicators of a good prognosis
Worse prognosis for bipolar; those with pure manic symptoms do better than those with mixed or depressed symptoms; Good prognosis indicators: short duration of manic episodes; oder onset age; few suicidal thoughts; few co-existing psychiatric/medical problems
Which kind of disorder shows higher divorce rates and suicidal behaviour?
Bipolar (over unipolar)
Persistent depressive disorder is the low grade form of depressive disorders, and must be present for at least 2 yrs (1 in children). The presence of 2 or more of which symptoms must be present while depressed?
Poor appetite/overeating; insomnia/hypersomnia; low energy/fatigue; low self-esteem; poor concentration/indecisiveness; feelings of hopelessness (not without symptoms for a 2 month period)
Although major depressive disorder may be present for 2 yrs when diagnosed with persistent depressive disorder, what disorders are excluded?
Never had manic episode, hypomanic or cyclothymic disorders
Describe the suicide risk for mood disorders?
30 times more risk than general population (15% for uni and bipolar); 2/3 of clinically depressed contemplate suicide; increase in youth and decrease for older people (15-24 age range, mostly men)
List common differential (secondary) diagnoses for major depressive disorder
Neurological problems (PD; dementing illness; epilepsy; stroke; tumours, etc); pharmacological agents (illicit/prescription drugs); other psychiatric disorders (e.g. bipolar)
What does depression frequently coexist with?
Eating disorders; personality disorders; schizophrenia; alcohol/drug abuse; anxiety disorders (major probability)
Both anxiety and depression share underlying dimensions of negative affect. What distinguishes the two?
Anxiety: anxious arousal; Depression: low positive affect
5-10% of people with an initial diagnosis of major depression have a manic episode how long after their first episode of depression?
6-10 years
What can withdrawal of antidepressants before 3 months lead to?
Relapse
MDD is fundamentally a cyclic disorder. What can increase the risk of recurrence?
History of more than 1 previous depressive episode; co–existence with dysthymia, alcohol/drug abuse, or anxiety symptoms
How does the Life Events Perspective explain the aetiology of depression, and what’s a problem with this view?
It highlights events involving loss; EE is linked to relapse; but environmental precipitants are not always identified, and it’s not just the events but how we deal with it that mediates the effects
How does the Life Events Perspective explain the aetiology of bipolar?
Life events precede episodes (e.g. schedule disrupting events/goal attainment events - not able to regulate); attributional styles and dysfunctional attitudes interact with intervening life events; family discord predicts poor short-term outcomes
How does the Psychodynamic view explain the aetiology of depression?
It’s a reaction to the loss of an unconsciously/ambivalently held object (whereas grief/mourning is consciously perceived loss); reflects internalised aggressive impulses; high dependency needs predisposes people to a depressive reaction; but no empirical support that anger is turned inward
According to Lewinsohn (1975), depression occurs as a result of a reduction in response-contingent positive reinforcement. When may this reduction occur?
When the probability that the individual’s behaviour will be followed by reinforcement is low; or the probability that the individual will be reinforced when they don’t emit the behaviour is high (poor correspondence between what they do and what’s reinforced)
According to the Reduced Positive Reinforcement view, in which 3 ways may insufficient reinforcement occur?
Environment produces a loss of reinforcement; lack of requisite skills; unable to enjoy or receive satisfaction from reinforcement
How do cognitive theories propose the cause of depression?
Event occurs > belief > consequence; it’s not what happens to us, but how we perceive it
The Learned Helplessness model by Seligman proposes that attributions we make vary along several dimensions: personal/universal; global/specific; stable/unstable. Depressive symptoms are more likely to occur when we make which attributions about aversive events?
Personal; stable; and global (e.g. “I failed the test because I’m totally hopeless with any sort of test situation”); this leads to a sense of helplessness and an expectation that desirable outcomes will not occur > depression
Describe Beck’s Negative triad model
A person has a negative view of self, world and future > negative schemata or belief (triggered by negative life events > cognitive biases (e.g. arbitrary inference) > depression
What does the Interpersonal Theory focus on in depression and bipolar?
Role of social support in health; suggest people with depression have fewer and less supportive social networks; social skills deficits (problem-solving skills; marital communication); bipolar: low social support associated with longer episodes
What does the pedigree model propose about the genetic contribution of mood disorders?
Higher frequency of mood disorders among relatives of bipolar probands that unipolar depressed; 50-60% of those with bipolar have a family history of the disorder; higher frequency of depression among relatives of depression probands than among relatives of control families
According to the classical twin design, does bipolar or depression have a higher heritability estimate?
Bipolar (80%; depression closer to schizophrenia 52%)); higher in MZ twins for both; There are also polygenic influences (not 1 specific gene)
What does the Catecholamine hypothesis propose about neurochemical abnormalities?
Excess (especially noradrenaline) causes mania and too little cause depression (Lithium has been shown to reduce noradrenaline activity at key neural sites)
What does the Indolamine hypotheses propose about neurochemical abnormalities?
Deficiency in serotonin also related to depression; some antidepressants increase serotonin levels
What are some limitations with the neurochemical perspective?
There are complex inter-relationship between neurotransmitters and other biological systems which preclude a simple deficit model; a simple biochemical deficit/excess model can’t account for a heterogeneous disorder like depression, which involves a dysregulation of many functions
What are the four categories of antidepressants, and other than the many side effects, what else may they provoke?
SSRIs (most frequently used); Tricyclics (TCAs; Monoamine oxidase inhibitors (MAO-Is); other more recently developed drugs; Can provoke an episode of mania in bipolar patients
Although electro-convulsive therapy (ECT) as primary treatment has declined because of the dangers, when is it still used?
When: prominent psychotic/melancholic features; severe depression doesn’t respond to medication; severe life-threatening situations require rapid response (e.g. suicidal); prior clinical response to ECT positive
What is lithium used to treat, and how effective is it?
Manic episodes and cyclothymia (60% respond well); alleviates manic episodes for some and depressive episodes; maintained use between episodes - less likely to relapse; about 57% non-compliance rate
What are some of the side effects of lithium
Weight gain; transient nausea; trembling; weakness; impaired coordination; memory problems; drinking and passing lots of water; serum levels need to be monitored
Describe the role of psychological treatment in relation to bipolar disorder
Lack of controlled blind clinical trials; some studies report negative results; interventions often show efficacy in terms of the psychosocial consequences; but less definite results in terms of medication compliance and relapse; relapse prevention seems to be most effectively gained via medication compliance
Which 3 approaches in combination seem to have the most efficacy in treating depression?
CBT, interpersonal relationship therapy (IPR -focuses on social skills and relationships), and medication
In the treatment of depression collaborative research program, which treatments had the greatest efficacy on a long term basis?
All three treatments were equally effective short-term: medication, CBT and IPR; but at 18 month follow up, none of the groups differed from the placebo group; more than 70% relapse rate
What symptoms is seasonal affective disorder characterised by?
Somatic symptoms, such as overeating; carbohydrate craving; weight gain; fatigue; sleeping more than usual
In what way does the evolutionary perspective claim that the symptoms of depression may serve a useful purpose?
Symptoms (e.g. slowing down; withdrawal, etc) may represent a response system that helps the person disengage from a situation that’s not going well, or help refocus motivations
Some evidence suggests that depression is more likely to occur when severe life events are associated with what kind of feelings?
Humiliation; entrapment; and defeat
Describe the phenomenon Stress Generation
When depressed people create difficult circumstances that increase the level of stress in their lives (especially in the context of interpersonal relationships)
What are the hypotheses concerning Ruminative response styles and Distracting styles?
People who engage in ruminative responses (turning attention inwards) have longer and more severe episodes of depression than people who engage in distracting responses; women are more likely to engage in ruminating and men more likely to employ distracting styles
People who are homozygous for which allele in which gene, are at a particularly high risk for becoming clinically depressed if they experience stressful life events?
S allele of the 5-HTT gene
Which important pathway in the endocrine system may be closely related to the aetiology of mood disorders?
Hypothalamic-pituitary-adrenal (HPA) axis
People who take a test dose of Dexamethasone show a suppression of cortisol secretion, as the hypothalamus is fooled into thinking there’s enough cortisol circulating in the system. How do some people with depression respond to this?
Approx. half show a failure of suppression in response to DST (overproduction of cortisol may lead to changes in brain structure and function)
Depressed patients with decreased activity in the dlPFC may show what kinds of deficits?
Planning that’s guided by the anticipation of emotion, leading to motivational problems, such as an inability to work towards a pleasurable goal
Overactivity in the orbital PFC and vmPFC may be associated with what kinds of deficits?
In the ability to inhibit inappropriate behaviours and assign emotional meaning to perceptions, leading to a prolonged experience of negative emotion
When laboratory animals are exposed to uncontrollable stress from which they can’t escape, what kind of behaviour do they exhibit?
Symptoms similar to those seen in depressed humans
Monoamine Oxidase inhibitors (MAOIs) have been found to be useful in treating depressed patients, and certain anxiety disorders such as agoraphobia and panic attacks, as long as they avoid what?
Foods such as cheese, beer and red wine
Rather than descriptive factors, what are classification systems for suicide based on?
Causal theories
What are the four different types of suicide identified by Durkheim, which are distinguished by social circumstances?
Egoistic (diminished integration – detachment from society); altruistic (excessive integration – sacrifice for the sake of others); Anomic (diminished regulation – adjusting to unexpected loss of social/occupational role); fatalistic (excessive regulation – unbearable life circumstances)
What’s the most commonly reported mechanism for eliciting self-injurious behaviour?
A maladaptive way of regulating intense emotional states (anxiety, anger, frustration or sadness)
What did Dirkheim believe to be the reason for increased suicide rates during the 19th century?
An erosion of the influence of traditional sources of social integration and regulation, such as the church and family
What special recommendations are considered particularly important in psychological interventions when clients have expressed a serious intent to harm themselves?
Reduce lethality (reduce psychological pain and means to commit suicide); negotiate agreements (sign a contract); provide support (involve friends and family); replace tunnel vision with a broader perspective (help them develop more flexible, adaptive patterns)
