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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
Persistent depressive disorder criteria
1. Depressed mood 2. 2+ symptoms (appetite changes, sleep changes, hopelessness) 3. Symptoms 2+ years (adults) or 1+ years (children)
26
Disruptive mood dysregulation disorder criteria
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
27
Major depressive disorder specifiers
1. Peripartum onset 2. With seasonal pattern
28
Major depressive disorder - peripartum onset specifier
Onset during pregnancy or within 4 weeks after birth
29
Peripartum depression prevalence
1. 80% = "baby blues" 2. 9% = episode between conception and birth 3. 7% = episode between birth and 12 months
30
Peripartum depression treatment
1. CBT 2. IPT 3. Antidepressants (sertraline) 4. Inconsistent support (mostly due to methodology) for exercise
31
Considerations for prescribing antidepressants for peripartum depression
1. Potential negative effects on fetus or breastfeeding infant 2. Impact of untreated depression on mother and child
32
Peripartum depression and exercise (meta-analysis)
1. Exercise alone non-significant benefit 2. Exercise combined with intervention better than each intervention standalone
33
Major depressive disorder - with seasonal pattern specifier
1. Symptoms = hypersomnia, overeating, weight gain, carb cravings 2. Low serotonin and high melatonin 3. Treatment = phototherapy
34
Depression prevalence (gender)
1. Rates similar for male and female children 2. 1.5x to 3x higher rates for females than males during adolescence and adulthood
35
Depression etiology
1. Heredity 2. Neurotransmitter, hormone, and brain abnormalities 3. Cognitive and behavioral factors
36
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)
37
Neurotransmitter abnormalities linked to depression
1. Low serotonin 2. Low dopamine 3. Low norepinephrine
38
Hormone abnormalities linked to depression
1. Hypothalamic-pituitary-adrenal (HPA) axis 2. High secretion of cortisol
39
Brain abnormalities linked to depression
1. Prefrontal cortex (hyper vmPFC, hypo dlPFC) 2. Cingulate cortex 3. Hippocampus 4. Caudate nucleus 5. Putamen 6. Amygdala 7. Thalamus
40
Cognitive and behavioral factors linked to depression
1. Lewinsohn's social reinforcement theory 2. Seligman's learned helplessness model 3. Beck's cognitive theory
41
Depression and Lewinsohn's social reinforcement theory
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
Depression and Seligman's learned helplessness model (revised to be "hopelessness theory")
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
Depression and Beck's cognitive theory
Negative thoughts about: 1. Self 2. World 3. Future
44
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)
45
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
46
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)
47
Depression comorbidity
1. Substance use disorder (especially alcohol)* 2. Anxiety disorder 3. Personality disorder 4. Sleep abnormalities 5. Medical conditions
48
Sleep abnormalities linked to depression
1. Prolonged sleep latency 2. Reduced REM latency 3. Reduced slow-wave sleep 4. Increased REM density
49
Medical conditions linked to depression
1. Heart disease 2. Stroke 3. Diabetes 4. Parkinson's Some relationships are bidirectional (depression* and anxiety are common after a heart attack)
50
Depression treatment (overall)
Combination of psychotherapy and medication
51
Depression psychotherapy v. medication (meta-analysis)
1. Combined more effective than either as a standalone 2. No significant difference in therapy v. medication as standalones
52
APA's guide to depression treatment (children)
Not enough evidence for specific suggestions
53
APA's guide to depression treatment (adolescents)
1. Therapy = CBT or IPT-A 2. Medication = Fluoxetine 3. No evidence for one over the other
54
APA's guide to depression treatment (adults)
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
APA's guide to depression treatment (older adults)
1. Group CBT* 2. IPT combined with second-generation antidepressant* 3. Not enough evidence for self-guided bibliotherapy or life review therapy
56
Alternative treatments for depression
1. St. John's wort 2. Ketamine 3. Electroconvulsive therapy (ECT) 4. Repetitive transcranial magnetic stimulation (rTMS) 5. Telehealth
57
Depression and St. John's wort
1. Similar to SSRIs 2. Not for severe depression 3. Interactions (serotonin syndrome, reduces effects of medications, etc.)
58
Depression and ketamine
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
Depression and ECT
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
Depression and rTMS
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
Depression and telehealth
Similar to face-to-face: 1. Symptom severity 2. Quality of life 3. Client satisfaction 4. Therapeutic alliance
62
Suicide rates in the US from 2000-2020
1. Increased 2000-2018 2. Decreased slightly 2018-2020
63
Suicide rates in 2020 (age)
Highest for 75+ yo
64
Suicide rates in 2020 (race)
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
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

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