AB: Mood Disorders Flashcards
Differ mood from emotions
Emotions are a shorter duration, emotions are usually pointed towards an object, mood usually bias cognition while emotion often bias cognition and (immediate) action.
Contrast two theories of mood
Feeling theory: moods are just “raw” feelings (objectless)
Dispositional theory: Mood generates cognitions and mood-congruent appraisals
sad mood: perceiving situation as uncontrollable,
angry mood: perceiving situation as threatening
When are they consider a disorder?
When they cause clinically significant distress or dysfunction in social, occupational or other important areas of functioning and it isn’t caused by an external substance.
Give the different “poles” of mood in order
Mania Hypomania Normal elation Neutral mood Normal sadness Mild- moderate depression Major depressive disorder
What is the difference between unipolar and bipolar
Unipolar is when you only experience the extremes of one pole, bipolar is when you fluctuate between the two
List GAD, Bipolar, Dysthmia, MDD, Social phobia, Agoraphobia, Panic, Specific disorder in order of prevalence (reasonably well)
Major depression Social Phobia Specific Phobia Generalised anxiety disorder Panic Dysthymia Bipolar Agoraphobia
Does depression have:
1) High recovery rate, high relapse rate
2) High recovery rate, low relapse rate
3) Low recovery rate, High relapse rate
4) Low recovery rate, Low relapse rate
High recovery, High relapse
Why may there be a high recovery rate
Depression is seen as cyclic
What are the DSM requirements of depression?
2 affect, 4 physical, 3 cognitive
5 or more symptoms nearly every day, most of the day, at least 2 weeks: (Affect)
1. Sad mood OR
2. Loss of interest or pleasure (anhedonia)
PLUS 3 or 4 of the following:
(Physical)
3. Poor appetite and weight loss, or increased appetite and weight gain
4. Loss of energy
5. Psychomotor retardation or agitation
6. Sleeping too much or too little
(Cognitive)
7. Feelings of worthlessness or excessive guilt
8. Difficulty concentrating, thinking, or making decisions
9. Recurrent thoughts of death or suicide
What is required for Persistent depressive disorder and give another name for it
Dysthymia:
Depressed mood for at least 2 years (>1/2 of days)
(Combines DSM-IV Dysthymia & MDD, chronic subtype)
PLUS 2 other symptoms:
• • • • •
Feelings of hopelessness
Sleeping too much or too little
Poor appetite or overeating
Trouble concentrating or making decisions Poor self-esteem
What problems do biological theories of treatment for depression focus on and give a rating of the evidence behind it
Problems: Serotonin, dopamine
Intervention: EG SSRI, ECT
Evidence: +++
What problems do Psychodynamic theories of treatment for depression focus on and give a rating of the evidence behind it
Problems: Grief over loss
Intervention: Acceptance and mourning
Evidence: +/-
What problems do Behaviourism/ Learning theories of treatment for depression focus on and give a rating of the evidence behind it
Problems: E.g anhedonia
Intervention: E.g behavioural Activation, activity scheduling
Evidence: ++
What problems do cognitive theories of treatment for depression focus on and give a rating of the evidence behind it
Problems:Negative triad, hopelessness, rumination
Intervention: CT, MBCT, IPT
Evidence: +++
What problems does Cognitive Behavioural Therapy treatment for depression focus on and give a rating of the evidence behind it
Problems:Various
Intervention: Various
Evidence: +++
What is the regular cyclic thought process according to CBT?
Situation.
Automatic negative thought
Negative feeling
Behaviour (nothing), which loops back to negative feeling
How does CBT work on this?
By identifying these thought habits, challenging them and being aware of them and changing behaviour (reward encouraging behaviour)
List the process of stepped care
- Psychoeducation (tell them about the illness)
- Meta-analyses: most psychotherapies equally effective
- Anti-depressants:
- Only sever depression, then just as effective as psychotherapy
- Overprescription - Intensification or Electroconvulsive therapy
How does the neurobiological model explain suicide? (3)
- Heritibility of 48% for suicide attempts
- Low levels of serotonin
- Overly reactive HPA system
How does the psychological model explain suicide? (3)
- Problem solving deficit
- Hopelessness
- Life satisfaction
How does the Social model explain suicide? (3)
- Economic recessions
- Media reports of suicide
- Social isolation and lack of social belonging
What are the Affect symptoms of (Hypo)mania (Criterion A DSM)?
- A distinct period of abnormally and persistently elevated or irritable mood:
- at least 1 week or hospitalisation -> mania
- at least 4 days -> hypomania
What are the Cognitive symptoms of (Hypo)mania (Criterion B DSM)?
During this period, at least 3 (4 if only irritable):
Inflated self-esteem or grandiosity
Decreased need for sleep (e.g. feels rested after three hours of sleep)
More talkative than usual or pressure to keep talking
Flight of ideas or subjective experience that thoughts are racing
What are the Physical symptoms of (Hypo)mania (Criterion B DSM)?
Distractibility
Physical
Increase in goal-directed activity or psychomotor agitation
Excessive involvement in pleasurable, risky activities
What is required for Bipolar 2 but not bipolar 1 and vice versa
Major depressive episode needed in bipolar 2, mania rather than hypomania in bipolar 1, if they’ve experienced one mania episode in their life it’s bipolar 1.
What is the percentage heritability of bipolar? Also what biological neurotransmitters is it concerned with?
92% heritability, serotonin/ dopamine
What psychological trait is characteristic of those with bipolar disorder?
Reward sensitivity
What else may cause BPD?
Major life event- Sleep deprivation
What medications may be taken for bipolar disorder and what are their effects?
Lithuum- (mood stabilising) if intolerable
Anticonvulsant (anti seizure) or
Antipsychotic
Mania is hard to treat
What kind of therapy is usually used for bipolar and how does this help?
Cognitive therapy
- Depression
- Problem-solving Recognizing symptoms
What is Premenstrual dysphoric disorder?
Mood symptoms in the week before before menses
What is disruptive mood dysregulation disorder?
Severe recurrent temper outbursts and persistent neg- ative mood for at least 1 year beginning before age 10
What is Cyclothymia
Recurrent mood changes from high to low for at least 2 years, without hypomanic or depressive episodes
what physical symptoms are common in depression?
fatigue and low energy as well as physical aches and pains. Although peo- ple with depression typically feel exhausted, they may find it hard to fall asleep and may wake up frequently. Sexual interest disappears
What is meant by psychomotor retardation and what would be an opposite symptom also typical of depression?
Thoughts and movements may slow but others cannot sit still—they pace, fidget, and wring their hands (psychomotor agitation).
Why is MDD an episodic disorder?
because symptoms tend to be present for a period of time and then clear before reoccurring.
Describe some environmental factors which may impact depression rates (3-5)
People in worse socioeconomic situations experience it more, distance from the equator (winter depression or seasonal affective disorder are higher farther from the equator), there is a robust negative correlation with fish consumption and levels of depression. Income disparity, family cohesion and mental health stigma also play a role.
What biological and social factors may explain the gender difference in depression?
Gonadal hormones. More frequent sexual abuse, more exposed to chronic stressors such as poverty and caretaker responsibilities, the cost of caring, social roles and body image, emotion based coping is encouraged in women while action based (sport) coping is encouraged in men to shake off the feeling
What effect could exposure to childhood and chronic stressors, as well as the effects of female hormones have on a woman biologically
could change the reactivity of the hypothalamic-pituitary-adren
How may different life events evoke depression in men and women
Men are more likely than women to become depressed after life events involving financial or occupational stress, whereas women are more likely than men to become depressed after inter- personal life events
What biological explanation is there for winter blues?
changes in the levels and timing of melatonin release in the brain. Melatonin is exquisitely sensitive to light and dark cycles and is only released during dark
periods.
Give two other possible explanation for seasonal affective disorder
For mammals living in the wild, a slower metabolism in the winter could have been a lifesaver during periods of scarce food, Hibernation in animals typically involves sleeping long hours, along with lowered appetite and energy. People may respond to this self critically.
What type pf treatment is specific to winter blue (along with CBT and medication)
30 minutes of bright light each morning as with fluoxetine (Prozac)
Name some conditions depression is comorbid with
Anxiety (60%), substance, sexual dysfunction and personality disorder
What other health problems does depression increase risk for?
There is particularly strong evidence that depression is related to the onset and more severe course of cardiovascular disease.Depression is related to a more than twofold increase in the risk of death from cardiovascular disease, even after controlling for baseline cardiovascular health (
Name the differences in a manic and hypomanic episode
Manic lasts 1 week, (HM: 4 days) include hospitalisation or psychosis and symptoms cause significant distress or functional impairment. In hypomania the changes are observable to others but impairment is not marked.
What are the requirements for cyclothymic disorder?
For at least 2 years (or 1 year in children or adolescents):
• Numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic episode
• Numerous periods with depressive symptoms that do not meet criteria for a major depressive episode
The symptoms do not clear for more than 2 months at a time.
Criteriaforamajordepressive,manic,orhypomanicepisode have never been met.
Symptoms cause significant distress or functional impairment.
Does depression or bipolar disorder recur more
Bipolar