Bipolar and Depressive Disorders Flashcards
Difference(s) in characteristics of manic vs hypomanic disorder
timeframe of symptom presentation & severity measured by marked impairment and need for hospitalization
* mania = at least 1 week; need for hospitalization
* hypomania = at least 4 consecutive days; no marked impairment & no need for hospitalization
Duration of symptoms necessary for MDD diagnosis
2 weeks
Difference(s) in symptom presentation for bipolar I vs. bipolar II disoder vs. cyclothymic disorder
presence of manic vs hypomanic episode AND presence of depressive episode
* bipolar I: at least 1 manic episode; hypomanic or depressive episode NOT required
* bipolar II: at least 1 hypomanic AND 1 depressive episode; manic episode NOT required
* cyclothymic: hypomanic symptoms that DO NOT meet criteria for hypomanic AND depressive symptoms that DO NOT meet criteria for MDD; duration: 2 years for adults and 1 year for children & adolescents
Name etiology linked to Bipolar Disorder
x3
- heredity
- neurotransmitter & brain abnormalities
- circadian rhythm irregularities
What is the concordance rates of Bipolar Disorder for monozygotic & dizygotic twins, respectively?
1) .67 - 1.0
2) 2.0
What neurotransmitters have been linked to Bipolar Disorder?
- norephinephrine
- serotonin
- dopamine
- glutamate
Structural & functional abnormalities link these brain areas to Bipolar Disoder
- prefrontal cortex
- amygdala
- hippocampus
- basal ganglia
What circadian rhythm irregularities are linked to Bipolar Disorder?
- sleep-wake cycle
- secretion of hormones
- appetite
- core body temp
In differentiating between ADHD and Bipolar Disorder in children and adolescents, these symptoms are important to consider.
mania symptoms
* elation
* grandiosity
* flight of ideas/racing thoughts
* decreased need for sleep
* hypersexuality
In differentiating between ADHD and Bipolar Disorder in adults, these symptoms are important to consider.
mania symptoms
* euphoric, elevated, irritable mood
* increased self-esteem or grandiosity
* distractibility caused by racing thought
* decreased need for sleep without physical discomfort
Studies on sexuality suggest that adult ADHD is not associated with increased sexual activity, but instead associated with what?
- higher rates of sexual disorders
- greater involvement in risky sexual behaviors
First-line treatment for Bipolar Disorder
- evidence-based psychosocial interventions
* psychoed, interpersonal & social rhythm therapy, CBT, & family-focused therapy - pharmacotherapy
* Lithium - onset. between 15 & 19 years old
* anticonvulsants (e.g., carbamazepine, valproic acid) - mixed moods, rapid cycling, onset between 10 & 15 years old
Characteristics of “with atypical features” specifier for Bipolar Disorder
- mood reactivity
- at least 2 of the following: significant weight gain or increase in appetite, hypersomnia, leaden paralysis, interpersonal rejection sensitivity
Duration criterion for Persistent Depressive Disorder
children/adolescents vs. adults
Adults: 2 years
Children/Adolescents: 1 year
duration & frequency criterion for Disruptive Mood Dysregulation Disorder
- 12 months
- at least 3x/week
- most of the day, nearly every day
onset/duration criterion for MDD specifier with peripartum onset
onset of symptoms during pregnancy or the 4 weeks after delivery
% of women who experience “baby blues” (e.g., sadness, irritability, anxiety) after birth; of the women who meet criteria for MDD, % who experience symptoms prior to delivery
- 80%
- 50%
First-line treatment for MDD with peripartum onset
- CBT & interpersonal therapy
- Antidepressants (sertraline)
Neurotransmitter & hormone and levels (lower or higher) linked to Seasonal Affective Disorder. First-line treatment?
describe treatment effect
- lower serotonin
- higher melatonin
- phototherapy - exposure to bright light (suppresses production of melatonin)
Gender differences associated with rates of depression in chidhood vs adolescence vs adulthood
include statistics on rates in adolescence & adulthood
- Childhood: similar in males and females
- Adolescence: increase in females; same in males
- Adulthood: higher in females
**rates for female adolescents & adults: 1.5 to 3x higher than males
Name 3 etiologies of MDD
- heredity
- neurotransmitter, hormone, & brain abnormalities
- cognitive & behavioral factors
Concordance rates for unipolar depression in twin studies & gender differences
monozygotic & dizygotic
- monozygotic: .30 to .50
- dizygotic: .20 to .30
- rates higher for female twins
Describe neurotransmitter abnormalities of MDD
include whether levels are higher or lower
- low serotonin
- low dopamine
- low norepinephrine
Abnormalities in what brain areas have been linked to MDD
- hypothalamic-pituitary-adrenal (HPA) axis
- prefrontal cortex
- cingulate cortex
- hippocampus
- caudate nucleus
- putamen
- amygdala
- thalamus
MDD has been linked to early life exposure to chronic stress, causing (hypoactivity or hyperactivity) of the HPA axis AND hypersecretion of what hormone?
- hyperactivity
- cortisol
MDD has been linked to abnormally (high or low) activity in what subcortical stucture(s) of the prefrontal cortext?
2 areas
- high activity in the ventromedial PFC
- low activity in the dorsolateral PFC
Lewinsohn’s social reinforcement theory assumes depression is the result of what? And typically results in what?
- low rate of response-contingent reinforcement for social behaviors & lack of reinforcement in evnironment and/or poor social skills
- social isolation, low self-esteem, pessimism
outcomes reduce likelihood of any future positive reinforcement
Seligman’s learned helplessness model links depression to what?
2 versions - describe both
- (original) linked to repeated exposure to uncontrollable negative life events
- (reformulated; “hoplessness theory”) stresses link to negative cognitive style - i.e., attributing negative life events to talbe, internal, & global factors
* cause is sense of hopelessness, which results in exposure to negative life events & negativev cog style
Beck’s cognitive theory attributeds depression to what?
a negative cognitive triad that consists of negative thoughts about:
1. oneself,
2. the world, and
3. the future
Describe the age-related risk factors linked to depression
- younger adults: risk linked to genetics, stressful life events, & limitations in problem-solving
- older adults: risk linked to chronic medical illness - strongest risk factor especially when illness decreases physucal functioning & causes social isoltation
Describe experience & expression of depression in consideration of age-related factors & cultural background
- Age
* older adults: less likely than younger adults to refer to affective symptoms; more likely to refer to somatic symptoms, cognitive changes, & loss of interest - Cultural Backgroun
* Latino, Mediterranean, Middle Eastern, Asian, & other non-Western culturs: will report larger number of somatic symptoms (than Western cultures)
* ppl from Western cultures: report higher number of psychological symptoms
differences between Chinese and Euro-Canadian patients’ report of symptoms of depressoin?
- Chinese patients more likely to report somatic symptoms (e.g., appetite & sleep disturbances, headaches, heart palpitations)
- Euro-Canadian patients more likely to emphasize psychological symptoms (e.g., depressed mood, loneliness, hopelessness)
Most common comorbid disorder with MDD? Followed by, in order, what disorders?
- substance use disorder, especially alcohol use)
- an anxiety disorder
- personality disorder
What sleep abnormalities are linked to depression?
- prolonged sleep latency (longer time to fall asleep)
- reduced REM latency (shortened time from sleep onset to REM sleep)
- reduced slow-wave sleep (stages 3 and 4)
- increased REM density (more rapid eye movements per unit of time)
What physical health issues are linke to depression? Type of relationship between physical & mental health issues (directional).
- coronary heart disease
- stroke
- diabetes
- Parkinson’s
bidirectional
Research has found depression to be independently predictive of an increased risk for what physical health issues?
- myocardial infarction (heart attack)
manifestation of coronary heart disease
2 most common psychiatric conditions to develop after heart attack?
- depression (more common than) anxiety
Research outcomes associated with treatment for depression
psychotherapy vs. pharmacotherpy vs. combined
- varired outcomes
- meta-analysis: combined treatment more effective
- no sig difference in remission & response rates between psychotherapy alone vs. pharmacotherapy alone
APA’s guidelines for treatment of depression with children
- insufficient evidence to recommend specific psychosocial or pharmacological treatment
APA’s guidelines for treatment of depression with adolescents
- CBT
- Interpersonal Therapy for adolescents (IPT-A)
- fluoxetine
**insufficient evidence to recommend either treatment over the other
APA’s guidelines for treatment of depression with adults
offer patient psychotherapy or antidepressant as initial treatment
* psychotherapy: CBT, mindfulness-based cognitive therapy (MBCT), interpersonal therapy (IPT), behavioral therapy, psychodynamic therapy, and supportive therapy
APA’s guidelines for treatment of chronic or treatment-resistant depression for adults
- combo of CBT and IPT with antidepressant
APA’s guidelines for treatment of depression with older adults
- group CBT
- combo of IPT & second-gen antidepressant
**insufficient evidence for self-guided bibliotherapy or life review therapy for older adults
Advantages/Disadvantages of St. John’s wort as treatment for depression
- Advantages
* as effective as SSRI for mild to moderate depression
* lower dropout rates
* fewer side effects - Disadvantages
* not effective for severe depression
* interacts with SSRIs - serotonin syndrome
* interacts with alprazolam, bupropion, & statin/immunosuppressive druges - reduces effectiveness
Evidence of ketamine as an effective treatment for what type(s) of depression
treatment-resistant depression & suicidal ideation
Describe therapeutic effects in brain of ketamine for depression
neurotransmitter(s)
- fast-acting
- increases glutamate
due to potential for severe side effects of ketamine therapy for depression, meds required to be administered how?
self-administered under supervision of healthcare provider in healthcare setting
Research on electroconvulsive therapy (ECT) for severe depression has shown what outcomes?
- high rates of success
- higher response rate (clinically meaningful reduction in symptoms)
- higher remission rate (absense of symptoms)
- faster time to remission
When is ECT typically used?
clinical justifications for using ECT
- when other treatments have been ineffective
- when severity of symptoms requires a quick treatment response - high risk for suicide
response and remission rates:
1. psychotherapy
2. pharmacotherapy
3. ECT
- psychotherapy: 30% and 60%
- pharmacotherapy: 25% and 45%
- ECT: 80% and 70%
duration of remission rates:
1. psychotherapy
2. pharmacotherapy
3. ECT
- psychotherapy: IPT or CBT - 6 to 10 weeks
- pharmacotherapy: antidepressants - 4 to 12 weejs
- ECT: 1 to 3 weeks
Disadvantages of ECT
causes both anterograde & retrograde amnesia
* anterograde amnesia - resolves within weeks
* retrograde amnesia - resolves within weeks to several months
more likely to affect recently acquired memories AND older memories more likely to return first
may experience persistent gaps in memory for pre-ECT events
ECT side effects: when is retrograde amnesia is more severe
electrode placement; timeframe; number of sessions
- bilateral placement of electrodes
- higher number of treatment sessions
- less time between sessions
What is repetitive transcranial magnetic stimulation (rTMS)? Treatment for what type of depression?
- noninvasive technique
- uses a magnetic field
- stimulates left dorsolateral PFC
- treatment-resistant depression
disadvantage(s) of rTMS for depression
compared to ECT
lower response and remission rates than ECT
advantage(s) of rTMS for depression?
compared to ECT
does not requrie sedation or memory loss
outcomes from research comparing teletherapy vs. face-to-face therapy for depression
more, less, or same effectiveness
simiar outcomes for symptom severity, quality of life, client satisfaction, and therapeutic alliance
suicide rates in U.S. from 2000 to 2020
prevalence, gender-, age-, and race-related differences
- increased between 2000 and 2018; decreased slightly between 2018 and 2020
- gender: 3-4x higher for males
- age: highest rates of suicide for 75+ years old
- race: highest rates among American Indians/Alaska Natives, followed in order by:
* Whites
* Hispanics
* Blacks
* Asian/Pacific Islanders
2020 suicide rates in consideration of both age and gender
males: 75+ years old
females: 45 to 64 years old
2020 suicide rates in consideration of race and age
- American Indians/Alaska Natives, Hispanics, & Blacks: 25 to 34 years old
- whites: 45 to 54 years old
- Asian/Pacific Islanders: 85+ years old
