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Never-Ending Road to Licensure > Bipolar and Depressive Disorders > Flashcards

Bipolar and Depressive Disorders Flashcards

1
Q

Manic episode criteria

A
  1. Elevated, expansive, or irritable mood
  2. Abnormal and persistent
  3. Increased energy and activity
  4. Symptoms 7+ days
  5. 3+ symptoms (grandiosity, decreased sleep, flight of ideas)
  6. Impairment, hospitalization, and/or psychosis
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2
Q

Hypomanic episode criteria

A
  1. Elevated, expansive, or irritable mood
  2. Abnormal and persistent
  3. Increased energy and activity
  4. Symptoms 4+ days
  5. 3+ symptoms (grandiosity, decreased sleep, flight of ideas)
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3
Q

Mania v. hypomania

A

Mania = symptoms 7+ days, marked impairment or hospitalization or psychosis

Hypomania = symptoms 4+ days, no impairment or hospitalization or psychosis

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4
Q

Major depressive episode criteria

A
  1. 5+ symptoms
  2. 1 symptom must be depressed mood or loss of interest
  3. Symptoms 2+ weeks
  4. Distress or impairment
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5
Q

Bipolar I Disorder criteria

A
  1. 1+ manic episodes
  2. Can include 1+ major depressive or hypomanic episodes
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6
Q

Bipolar II Disorder criteria

A
  1. 1+ hypomanic episodes
  2. 1+ major depressive episodes
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7
Q

Cyclothymic Disorder criteria

A
  1. Multiple periods of hypomanic symptoms that do not meet criteria for episode
  2. Multiple periods of depressive symptoms that do not meet criteria for episode
  3. Symptoms 2+ years (adults) or 1+ years (children)
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8
Q

Bipolar disorder etiology

A
  1. Heredity
  2. Neurotransmitter and brain abnormalities
  3. Circadian rhythm disruption
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9
Q

Bipolar disorder twin studies

A

Concordance rates:
1. Monozygotic = .67 to 1.0
2. Dizygotic = .20

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10
Q

Neurotransmitters linked to bipolar disorder

A
  1. Norepinephrine
  2. Serotonin
  3. Dopamine
  4. Glutamate
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11
Q

Brain abnormalities linked to bipolar disorder

A
  1. Prefrontal cortex
  2. Amygdala
  3. Hippocampus
  4. Basal ganglia
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12
Q

Circadian rhythm disruptions linked to bipolar disorder

A
  1. Sleep-wake cycle disruptions
  2. Hormone secretion
  3. Appetite
  4. Core body temperature
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13
Q

Bipolar disorder v. ADHD in children

A

Manic-specific symptoms:
1. Elation
2. Grandiosity
3. Flight of ideas
4. Decreased sleep
5. Hypersexuality

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14
Q

Bipolar disorder v. ADHD in adults

A

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

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15
Q

Sexual behavior in bipolar disorder v. ADHD

A

Bipolar disorder = mania linked to more sex

ADHD = not linked to more sex, but linked to more sexual disorders and risky sex

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16
Q

Bipolar disorder treatment (overall)

A

Combination of psychosocial interventions and medications

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17
Q

Bipolar disorder psychosocial interventions

A
  1. Psychoeducation
  2. Interpersonal and social rhythm therapy
  3. CBT
  4. Family-focused therapy
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18
Q

Bipolar disorder medications

A

Classic:
1. Lithium

Atypical:
1. Anticonvulsants (carbamazepine, valproic acid)
2. Second generation antipsychotics

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19
Q

Classic bipolar disorder characteristics

A
  1. Low likelihood of mixed-mood states
  2. Rapid cycling
  3. Long recovery periods between episodes
  4. Onset 10-15 yo
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20
Q

Atypical bipolar disorder characteristics

A
  1. Mixed-mood states
  2. Rapid cycling
  3. Lack of full recovery between episodes
  4. Onset 10-15 yo
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21
Q

Bipolar disorder - atypical features specifier

A
  1. Mood reactivity
  2. 2+ other symptoms (increased appetite/weight, leaden paralysis, interpersonal rejection sensitivity)
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22
Q

Bipolar disorders

A
  1. Bipolar I disorder
  2. Bipolar II disorder
  3. Cyclothymic disorder
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23
Q

Depressive disorders

A
  1. MDD
  2. PDD
  3. DMDD
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24
Q

Major depressive disorder criteria

A
  1. 5+ symptoms
  2. 1 symptom must be depressed mood or loss of interest in activities
  3. Symptoms 2+ weeks
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25
Q

Persistent depressive disorder criteria

A
  1. Depressed mood
  2. 2+ symptoms (appetite changes, sleep changes, hopelessness)
  3. Symptoms 2+ years (adults) or 1+ years (children)
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26
Q

Disruptive mood dysregulation disorder criteria

A
  1. Severe and recurring outbursts
  2. Outbursts out of proportion to events
  3. Outbursts are behavioral and/or verbal
  4. Outbursts 3+ times
    per week
  5. Angry or irritable mood between outbursts
  6. Symptoms 12+ months
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27
Q

Major depressive disorder specifiers

A
  1. Peripartum onset
  2. With seasonal pattern
28
Q

Major depressive disorder - peripartum onset specifier

A

Onset during pregnancy or within 4 weeks after birth

29
Q

Peripartum depression prevalence

A
  1. 80% = “baby blues”
  2. 9% = episode between conception and birth
  3. 7% = episode between birth and 12 months
30
Q

Peripartum depression treatment

A
  1. CBT
  2. IPT
  3. Antidepressants (sertraline)
  4. Inconsistent support (mostly due to methodology) for exercise
31
Q

Considerations for prescribing antidepressants for peripartum depression

A
  1. Potential negative effects on fetus or breastfeeding infant
  2. Impact of untreated depression on mother and child
32
Q

Peripartum depression and exercise (meta-analysis)

A
  1. Exercise alone non-significant benefit
  2. Exercise combined with intervention better than each intervention standalone
33
Q

Major depressive disorder - with seasonal pattern specifier

A
  1. Symptoms = hypersomnia, overeating, weight gain, carb cravings
  2. Low serotonin and high melatonin
  3. Treatment = phototherapy
34
Q

Depression prevalence (gender)

A
  1. Rates similar for male and female children
  2. 1.5x to 3x higher rates for females than males during adolescence and adulthood
35
Q

Depression etiology

A
  1. Heredity
  2. Neurotransmitter, hormone, and brain abnormalities
  3. Cognitive and behavioral factors
36
Q

Depression twin studies

A

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)

37
Q

Neurotransmitter abnormalities linked to depression

A
  1. Low serotonin
  2. Low dopamine
  3. Low norepinephrine
38
Q

Hormone abnormalities linked to depression

A
  1. Hypothalamic-pituitary-adrenal (HPA) axis
  2. High secretion of cortisol
39
Q

Brain abnormalities linked to depression

A
  1. Prefrontal cortex (hyper vmPFC, hypo dlPFC)
  2. Cingulate cortex
  3. Hippocampus
  4. Caudate nucleus
  5. Putamen
  6. Amygdala
  7. Thalamus
40
Q

Cognitive and behavioral factors linked to depression

A
  1. Lewinsohn’s social reinforcement theory
  2. Seligman’s learned helplessness model
  3. Beck’s cognitive theory
41
Q

Depression and Lewinsohn’s social reinforcement theory

A
  1. Low reinforcement for social behaviors (lack of reinforcement in environment, poor social skills)
  2. Results in depressive traits (isolation, low self-esteem, pessimism) that further limits likelihood of reinforcement
42
Q

Depression and Seligman’s learned helplessness model (revised to be “hopelessness theory”)

A
  1. Repeated exposure to uncontrollable negative life events
  2. Results in helplessness
  3. Negative cognitive style that attributes events to stable, internal, global factors
  4. Results in hopelessness
43
Q

Depression and Beck’s cognitive theory

A

Negative thoughts about:
1. Self
2. World
3. Future

44
Q

Depression risk factors (age)

A

Younger adults:
1. Genetics
2. Stressful events
3. Limited cognition

Older adults:
1. Chronic illness (especially with physical and social changes)

45
Q

Depressive symptoms (age)

A

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

46
Q

Depressive symptoms (culture)

A

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)

47
Q

Depression comorbidity

A
  1. Substance use disorder (especially alcohol)*
  2. Anxiety disorder
  3. Personality disorder
  4. Sleep abnormalities
  5. Medical conditions
48
Q

Sleep abnormalities linked to depression

A
  1. Prolonged sleep latency
  2. Reduced REM latency
  3. Reduced slow-wave sleep
  4. Increased REM density
49
Q

Medical conditions linked to depression

A
  1. Heart disease
  2. Stroke
  3. Diabetes
  4. Parkinson’s

Some relationships are bidirectional (depression* and anxiety are common after a heart attack)

50
Q

Depression treatment (overall)

A

Combination of psychotherapy and medication

51
Q

Depression psychotherapy v. medication (meta-analysis)

A
  1. Combined more effective than either as a standalone
  2. No significant difference in therapy v. medication as standalones
52
Q

APA’s guide to depression treatment (children)

A

Not enough evidence for specific suggestions

53
Q

APA’s guide to depression treatment (adolescents)

A
  1. Therapy = CBT or IPT-A
  2. Medication = Fluoxetine
  3. No evidence for one over the other
54
Q

APA’s guide to depression treatment (adults)

A
  1. Therapy = CBT, IPT, MBCT, behavioral, psychodynamic, or supportive therapy
  2. Medication = Second generation antidepressant
  3. CBT or IPT combined with second generation antidepressant*
55
Q

APA’s guide to depression treatment (older adults)

A
  1. Group CBT*
  2. IPT combined with second-generation antidepressant*
  3. Not enough evidence for self-guided bibliotherapy or life review therapy
56
Q

Alternative treatments for depression

A
  1. St. John’s wort
  2. Ketamine
  3. Electroconvulsive therapy (ECT)
  4. Repetitive transcranial magnetic stimulation (rTMS)
  5. Telehealth
57
Q

Depression and St. John’s wort

A
  1. Similar to SSRIs
  2. Not for severe depression
  3. Interactions (serotonin syndrome, reduces effects of medications, etc.)
58
Q

Depression and ketamine

A
  1. Similar to fast-acting treatment for treatment-resistant depression and suicidal ideation
  2. Increases glutamate
  3. Prescribed as nasal spray combined with oral antidepressant
  4. Side effects
59
Q

Depression and ECT

A
  1. Severe depression, high suicide risk, and/or not responsive to other treatments
  2. Higher response and remission rates, faster response rates
  3. Requires sedation
  4. Anterograde (resolves in weeks) and retrograde amnesia (resolves in weeks to months)
60
Q

Depression and rTMS

A
  1. Treatment-resistant depression
  2. Uses magnetic field to stimulate dlPFC
  3. Lower response and remission rates than ECT
  4. No sedation or amnesia
61
Q

Depression and telehealth

A

Similar to face-to-face:
1. Symptom severity
2. Quality of life
3. Client satisfaction
4. Therapeutic alliance

62
Q

Suicide rates in the US from 2000-2020

A
  1. Increased 2000-2018
  2. Decreased slightly 2018-2020
63
Q

Suicide rates in 2020 (age)

A

Highest for 75+ yo

64
Q

Suicide rates in 2020 (race)

A
  1. Native American (highest for 25-34 yo)
  2. White (highest for 45-54 yo)
  3. Hispanic (highest for 25-34 yo)
  4. Black (highest for 25-34 yo)
  5. Asian (highest for 85+ yo)
65
Q

Suicide rates in 2020 (gender)

A

Males:
1. 3-4x higher than females 2000-2020
2. Highest rates for 75+ yo

Females:
1. Highest rates for 45-64 yo

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