5 - Bipolar and Depressive Disorders

Question 1

Which disorder is attributed to be the leading cause of disability worldwide?

Answer 1

Depression

Question 2

Compare the prevalence rates of unipolar and bipolar disorder across genders?

Answer 2

Unipolar more prevalent in females (2:1 ratio); equal prevalence for bipolar

Question 3

There are no race or SES distinctions for mood disorders. What is the typical onset age for more than half of individuals?

Answer 3

Before age of 25

Question 4

How is bipolar disorder defined in diagnosis?

Answer 4

According to most recent episode (manic, depressed or hypomanic)

Question 5

List the manic symptoms for bipolar 1 disorder

Answer 5

Euphoria; grandiosity; pressured speech; impulsivity; excessive libido; recklessness; social intrusiveness; diminished need for sleep

Question 6

What specifiers can be used in describing bipolar 1?

Answer 6

Manic, hypermanic, depressed or unspecified; severity: mild, moderate or severe; with psychotic features; partial or full remission

Question 7

What are some additional features of bipolar 1 disorder?

Answer 7

Anxious distress; mixed features; melancholic features; atypical features; catatonia; peripartum onset (in relation to pregnancy or childbirth); seasonal pattern; rapid cycling; psychosis

Question 8

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?

Answer 8

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

Question 9

Describe criteria C and D of a manic episode

Answer 9

C. Marked impairment in functioning, or need hospitalisation, or psychotic features; D. Not due to effects of substances or another medical condition

Question 10

Hypomanic episode meets most of the criteria for manic episode but isn’t as severe. What are the main features?

Answer 10

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

Question 11

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?

Answer 11

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

Question 12

At least one of which 2 symptoms must be present to be diagnosed with major depressive disorder?

Answer 12

Depressed mood or loss of interest/pleasure (anhedonia)

Question 13

How is bipolar II distinct from bipolar I?

Answer 13

One or more major depressive episodes are accompanied by at least one hypomanic episode, but never had a manic episode

Question 14

Describe cyclothymic disorder

Answer 14

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)

Question 15

What kind of medical disorders and drug use are common differential diagnoses for bipolar?

Answer 15

Medical: Epilepsy; Huntington’s chorea; multiple sclerosis; traumatic brain injury; HIV/AIDS; Drugs: amphetamines; cocaine; hallucinogens; opiates

Question 16

What are some other psychiatric disorders of special consideration for manic symptoms?

Answer 16

Schizophrenia; borderline, narcissistic and histrionic personality disorders

Question 17

Which symptom does bipolar often start with?

Answer 17

Depression

Question 18

Most people experience both depression and mania, with only a minority experiencing manic episodes alone. With more chronic cases, what often decreases?

Answer 18

The amount of time between episodes

Question 19

Compare prognosis for bipolar with depressive disorders, and describe the indicators of a good prognosis

Answer 19

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

Question 20

Which kind of disorder shows higher divorce rates and suicidal behaviour?

Answer 20

Bipolar (over unipolar)

Question 21

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?

Answer 21

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)

Question 22

Although major depressive disorder may be present for 2 yrs when diagnosed with persistent depressive disorder, what disorders are excluded?

Answer 22

Never had manic episode, hypomanic or cyclothymic disorders

Question 23

Describe the suicide risk for mood disorders?

Answer 23

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)

Question 24

List common differential (secondary) diagnoses for major depressive disorder

Answer 24

Neurological problems (PD; dementing illness; epilepsy; stroke; tumours, etc); pharmacological agents (illicit/prescription drugs); other psychiatric disorders (e.g. bipolar)

Question 25

What does depression frequently coexist with?

Answer 25

Eating disorders; personality disorders; schizophrenia; alcohol/drug abuse; anxiety disorders (major probability)

Question 26

Both anxiety and depression share underlying dimensions of negative affect. What distinguishes the two?

Answer 26

Anxiety: anxious arousal; Depression: low positive affect

Question 27

5-10% of people with an initial diagnosis of major depression have a manic episode how long after their first episode of depression?

Answer 27

6-10 years

Question 28

What can withdrawal of antidepressants before 3 months lead to?

Answer 28

Relapse

Question 29

MDD is fundamentally a cyclic disorder. What can increase the risk of recurrence?

Answer 29

History of more than 1 previous depressive episode; co--existence with dysthymia, alcohol/drug abuse, or anxiety symptoms

Question 30

How does the Life Events Perspective explain the aetiology of depression, and what's a problem with this view?

Answer 30

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

Question 31

How does the Life Events Perspective explain the aetiology of bipolar?

Answer 31

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

Question 32

How does the Psychodynamic view explain the aetiology of depression?

Answer 32

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

Question 33

According to Lewinsohn (1975), depression occurs as a result of a reduction in response-contingent positive reinforcement. When may this reduction occur?

Answer 33

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)

Question 34

According to the Reduced Positive Reinforcement view, in which 3 ways may insufficient reinforcement occur?

Answer 34

Environment produces a loss of reinforcement; lack of requisite skills; unable to enjoy or receive satisfaction from reinforcement

Question 35

How do cognitive theories propose the cause of depression?

Answer 35

Event occurs > belief > consequence; it's not what happens to us, but how we perceive it

Question 36

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?

Answer 36

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

Question 37

Describe Beck's Negative triad model

Answer 37

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

Question 38

What does the Interpersonal Theory focus on in depression and bipolar?

Answer 38

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

Question 39

What does the pedigree model propose about the genetic contribution of mood disorders?

Answer 39

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

Question 40

According to the classical twin design, does bipolar or depression have a higher heritability estimate?

Answer 40

Bipolar (80%; depression closer to schizophrenia 52%)); higher in MZ twins for both; There are also polygenic influences (not 1 specific gene)

Question 41

What does the Catecholamine hypothesis propose about neurochemical abnormalities?

Answer 41

Excess (especially noradrenaline) causes mania and too little cause depression (Lithium has been shown to reduce noradrenaline activity at key neural sites)

Question 42

What does the Indolamine hypotheses propose about neurochemical abnormalities?

Answer 42

Deficiency in serotonin also related to depression; some antidepressants increase serotonin levels

Question 43

What are some limitations with the neurochemical perspective?

Answer 43

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

Question 44

What are the four categories of antidepressants, and other than the many side effects, what else may they provoke?

Answer 44

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

Question 45

Although electro-convulsive therapy (ECT) as primary treatment has declined because of the dangers, when is it still used?

Answer 45

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

Question 46

What is lithium used to treat, and how effective is it?

Answer 46

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

Question 47

What are some of the side effects of lithium

Answer 47

Weight gain; transient nausea; trembling; weakness; impaired coordination; memory problems; drinking and passing lots of water; serum levels need to be monitored

Question 48

Describe the role of psychological treatment in relation to bipolar disorder

Answer 48

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

Question 49

Which 3 approaches in combination seem to have the most efficacy in treating depression?

Answer 49

CBT, interpersonal relationship therapy (IPR -focuses on social skills and relationships), and medication

Question 50

In the treatment of depression collaborative research program, which treatments had the greatest efficacy on a long term basis?

Answer 50

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

Question 51

What symptoms is seasonal affective disorder characterised by?

Answer 51

Somatic symptoms, such as overeating; carbohydrate craving; weight gain; fatigue; sleeping more than usual

Question 52

In what way does the evolutionary perspective claim that the symptoms of depression may serve a useful purpose?

Answer 52

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

Question 53

Some evidence suggests that depression is more likely to occur when severe life events are associated with what kind of feelings?

Answer 53

Humiliation; entrapment; and defeat

Question 54

Describe the phenomenon Stress Generation

Answer 54

When depressed people create difficult circumstances that increase the level of stress in their lives (especially in the context of interpersonal relationships)

Question 55

What are the hypotheses concerning Ruminative response styles and Distracting styles?

Answer 55

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

Question 56

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?

Answer 56

S allele of the 5-HTT gene

Question 57

Which important pathway in the endocrine system may be closely related to the aetiology of mood disorders?

Answer 57

Hypothalamic-pituitary-adrenal (HPA) axis

Question 58

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?

Answer 58

Approx. half show a failure of suppression in response to DST (overproduction of cortisol may lead to changes in brain structure and function)

Question 59

Depressed patients with decreased activity in the dlPFC may show what kinds of deficits?

Answer 59

Planning that’s guided by the anticipation of emotion, leading to motivational problems, such as an inability to work towards a pleasurable goal

Question 60

Overactivity in the orbital PFC and vmPFC may be associated with what kinds of deficits?

Answer 60

In the ability to inhibit inappropriate behaviours and assign emotional meaning to perceptions, leading to a prolonged experience of negative emotion

Question 61

When laboratory animals are exposed to uncontrollable stress from which they can’t escape, what kind of behaviour do they exhibit?

Answer 61

Symptoms similar to those seen in depressed humans

Question 62

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?

Answer 62

Foods such as cheese, beer and red wine

Question 63

Rather than descriptive factors, what are classification systems for suicide based on?

Answer 63

Causal theories

Question 64

What are the four different types of suicide identified by Durkheim, which are distinguished by social circumstances?

Answer 64

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)

Question 65

What’s the most commonly reported mechanism for eliciting self-injurious behaviour?

Answer 65

A maladaptive way of regulating intense emotional states (anxiety, anger, frustration or sadness)

Question 66

What did Dirkheim believe to be the reason for increased suicide rates during the 19th century?

Answer 66

An erosion of the influence of traditional sources of social integration and regulation, such as the church and family

Question 67

What special recommendations are considered particularly important in psychological interventions when clients have expressed a serious intent to harm themselves?

Answer 67

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)