Bipolar and Depressive Disorders Flashcards
Manic episode criteria
- Elevated, expansive, or irritable mood
- Abnormal and persistent
- Increased energy and activity
- Symptoms 7+ days
- 3+ symptoms (grandiosity, decreased sleep, flight of ideas)
- Impairment, hospitalization, and/or psychosis
Hypomanic episode criteria
- Elevated, expansive, or irritable mood
- Abnormal and persistent
- Increased energy and activity
- Symptoms 4+ days
- 3+ symptoms (grandiosity, decreased sleep, flight of ideas)
Mania v. hypomania
Mania = symptoms 7+ days, marked impairment or hospitalization or psychosis
Hypomania = symptoms 4+ days, no impairment or hospitalization or psychosis
Major depressive episode criteria
- 5+ symptoms
- 1 symptom must be depressed mood or loss of interest
- Symptoms 2+ weeks
- Distress or impairment
Bipolar I Disorder criteria
- 1+ manic episodes
- Can include 1+ major depressive or hypomanic episodes
Bipolar II Disorder criteria
- 1+ hypomanic episodes
- 1+ major depressive episodes
Cyclothymic Disorder criteria
- Multiple periods of hypomanic symptoms that do not meet criteria for episode
- Multiple periods of depressive symptoms that do not meet criteria for episode
- Symptoms 2+ years (adults) or 1+ years (children)
Bipolar disorder etiology
- Heredity
- Neurotransmitter and brain abnormalities
- Circadian rhythm disruption
Bipolar disorder twin studies
Concordance rates:
1. Monozygotic = .67 to 1.0
2. Dizygotic = .20
Neurotransmitters linked to bipolar disorder
- Norepinephrine
- Serotonin
- Dopamine
- Glutamate
Brain abnormalities linked to bipolar disorder
- Prefrontal cortex
- Amygdala
- Hippocampus
- Basal ganglia
Circadian rhythm disruptions linked to bipolar disorder
- Sleep-wake cycle disruptions
- Hormone secretion
- Appetite
- Core body temperature
Bipolar disorder v. ADHD in children
Manic-specific symptoms:
1. Elation
2. Grandiosity
3. Flight of ideas
4. Decreased sleep
5. Hypersexuality
Bipolar disorder v. ADHD in adults
Manic-specific symptoms:
1. Euphoric mood
2. Higher self-esteem
3. Distracted (flight of ideas)
4. Decreased sleep without discomfort
ADHD-specific symptoms:
1. Dysphoric mood
2. Lower self-esteem
3. Distracted (wandering)
4. Decreased sleep with discomfort
Sexual behavior in bipolar disorder v. ADHD
Bipolar disorder = mania linked to more sex
ADHD = not linked to more sex, but linked to more sexual disorders and risky sex
Bipolar disorder treatment (overall)
Combination of psychosocial interventions and medications
Bipolar disorder psychosocial interventions
- Psychoeducation
- Interpersonal and social rhythm therapy
- CBT
- Family-focused therapy
Bipolar disorder medications
Classic:
1. Lithium
Atypical:
1. Anticonvulsants (carbamazepine, valproic acid)
2. Second generation antipsychotics
Classic bipolar disorder characteristics
- Low likelihood of mixed-mood states
- Rapid cycling
- Long recovery periods between episodes
- Onset 10-15 yo
Atypical bipolar disorder characteristics
- Mixed-mood states
- Rapid cycling
- Lack of full recovery between episodes
- Onset 10-15 yo
Bipolar disorder - atypical features specifier
- Mood reactivity
- 2+ other symptoms (increased appetite/weight, leaden paralysis, interpersonal rejection sensitivity)
Bipolar disorders
- Bipolar I disorder
- Bipolar II disorder
- Cyclothymic disorder
Depressive disorders
- MDD
- PDD
- DMDD
Major depressive disorder criteria
- 5+ symptoms
- 1 symptom must be depressed mood or loss of interest in activities
- Symptoms 2+ weeks
Persistent depressive disorder criteria
- Depressed mood
- 2+ symptoms (appetite changes, sleep changes, hopelessness)
- Symptoms 2+ years (adults) or 1+ years (children)
Disruptive mood dysregulation disorder criteria
- Severe and recurring outbursts
- Outbursts out of proportion to events
- Outbursts are behavioral and/or verbal
- Outbursts 3+ times
per week - Angry or irritable mood between outbursts
- Symptoms 12+ months
Major depressive disorder specifiers
- Peripartum onset
- With seasonal pattern
Major depressive disorder - peripartum onset specifier
Onset during pregnancy or within 4 weeks after birth
Peripartum depression prevalence
- 80% = “baby blues”
- 9% = episode between conception and birth
- 7% = episode between birth and 12 months
Peripartum depression treatment
- CBT
- IPT
- Antidepressants (sertraline)
- Inconsistent support (mostly due to methodology) for exercise
Considerations for prescribing antidepressants for peripartum depression
- Potential negative effects on fetus or breastfeeding infant
- Impact of untreated depression on mother and child
Peripartum depression and exercise (meta-analysis)
- Exercise alone non-significant benefit
- Exercise combined with intervention better than each intervention standalone
Major depressive disorder - with seasonal pattern specifier
- Symptoms = hypersomnia, overeating, weight gain, carb cravings
- Low serotonin and high melatonin
- Treatment = phototherapy
Depression prevalence (gender)
- Rates similar for male and female children
- 1.5x to 3x higher rates for females than males during adolescence and adulthood
Depression etiology
- Heredity
- Neurotransmitter, hormone, and brain abnormalities
- Cognitive and behavioral factors
Depression twin studies
Concordance rates:
1. Monozygotic = .50
2. Dizygotic = .20
Concordance rates based on gender:
1. Females = .50 (mono) and .34 (di)
2. Males = .40 (mono) and .28 (di)
Neurotransmitter abnormalities linked to depression
- Low serotonin
- Low dopamine
- Low norepinephrine
Hormone abnormalities linked to depression
- Hypothalamic-pituitary-adrenal (HPA) axis
- High secretion of cortisol
Brain abnormalities linked to depression
- Prefrontal cortex (hyper vmPFC, hypo dlPFC)
- Cingulate cortex
- Hippocampus
- Caudate nucleus
- Putamen
- Amygdala
- Thalamus
Cognitive and behavioral factors linked to depression
- Lewinsohn’s social reinforcement theory
- Seligman’s learned helplessness model
- Beck’s cognitive theory
Depression and Lewinsohn’s social reinforcement theory
- Low reinforcement for social behaviors (lack of reinforcement in environment, poor social skills)
- Results in depressive traits (isolation, low self-esteem, pessimism) that further limits likelihood of reinforcement
Depression and Seligman’s learned helplessness model (revised to be “hopelessness theory”)
- Repeated exposure to uncontrollable negative life events
- Results in helplessness
- Negative cognitive style that attributes events to stable, internal, global factors
- Results in hopelessness
Depression and Beck’s cognitive theory
Negative thoughts about:
1. Self
2. World
3. Future
Depression risk factors (age)
Younger adults:
1. Genetics
2. Stressful events
3. Limited cognition
Older adults:
1. Chronic illness (especially with physical and social changes)
Depressive symptoms (age)
Older adults less likely to report:
1. Affective symptoms
Older adults more likely to report:
1. Somatic symptoms
2. Cognitive changes
3. Loss of interest
Depressive symptoms (culture)
Non-Western cultures more likely to report:
1. Somatic symptoms (appetite, sleep, headaches, heart palpitations)
Western culture more likely to report:
1. Psychological symptoms (depressed mood, loneliness, hopelessness)
Depression comorbidity
- Substance use disorder (especially alcohol)*
- Anxiety disorder
- Personality disorder
- Sleep abnormalities
- Medical conditions
Sleep abnormalities linked to depression
- Prolonged sleep latency
- Reduced REM latency
- Reduced slow-wave sleep
- Increased REM density
Medical conditions linked to depression
- Heart disease
- Stroke
- Diabetes
- Parkinson’s
Some relationships are bidirectional (depression* and anxiety are common after a heart attack)
Depression treatment (overall)
Combination of psychotherapy and medication
Depression psychotherapy v. medication (meta-analysis)
- Combined more effective than either as a standalone
- No significant difference in therapy v. medication as standalones
APA’s guide to depression treatment (children)
Not enough evidence for specific suggestions
APA’s guide to depression treatment (adolescents)
- Therapy = CBT or IPT-A
- Medication = Fluoxetine
- No evidence for one over the other
APA’s guide to depression treatment (adults)
- Therapy = CBT, IPT, MBCT, behavioral, psychodynamic, or supportive therapy
- Medication = Second generation antidepressant
- CBT or IPT combined with second generation antidepressant*
APA’s guide to depression treatment (older adults)
- Group CBT*
- IPT combined with second-generation antidepressant*
- Not enough evidence for self-guided bibliotherapy or life review therapy
Alternative treatments for depression
- St. John’s wort
- Ketamine
- Electroconvulsive therapy (ECT)
- Repetitive transcranial magnetic stimulation (rTMS)
- Telehealth
Depression and St. John’s wort
- Similar to SSRIs
- Not for severe depression
- Interactions (serotonin syndrome, reduces effects of medications, etc.)
Depression and ketamine
- Similar to fast-acting treatment for treatment-resistant depression and suicidal ideation
- Increases glutamate
- Prescribed as nasal spray combined with oral antidepressant
- Side effects
Depression and ECT
- Severe depression, high suicide risk, and/or not responsive to other treatments
- Higher response and remission rates, faster response rates
- Requires sedation
- Anterograde (resolves in weeks) and retrograde amnesia (resolves in weeks to months)
Depression and rTMS
- Treatment-resistant depression
- Uses magnetic field to stimulate dlPFC
- Lower response and remission rates than ECT
- No sedation or amnesia
Depression and telehealth
Similar to face-to-face:
1. Symptom severity
2. Quality of life
3. Client satisfaction
4. Therapeutic alliance
Suicide rates in the US from 2000-2020
- Increased 2000-2018
- Decreased slightly 2018-2020
Suicide rates in 2020 (age)
Highest for 75+ yo
Suicide rates in 2020 (race)
- Native American (highest for 25-34 yo)
- White (highest for 45-54 yo)
- Hispanic (highest for 25-34 yo)
- Black (highest for 25-34 yo)
- Asian (highest for 85+ yo)
Suicide rates in 2020 (gender)
Males:
1. 3-4x higher than females 2000-2020
2. Highest rates for 75+ yo
Females:
1. Highest rates for 45-64 yo
