Ch. 6 - Mood disorders Flashcards
% worldwide
8%
Mood disorder demographics
- Gender
- Relationship
- Age
gender
women > men
- women internalize depression, men externalize depression
Relationship
single women < single men
married women > married men
single women < single men
married women > married men
- social standards, men are protectors, need wife
- women are homemakers
- married men turn to spouse for support, single women have greater support (feel isolated when married)
Age
women: 20-29 (spikes in teens
Men: 40 - 49 and old age
Infants: separation
rumination disorder
babies regurgitate food and eat again
Major depressive disorder symptoms
(must be recurrent)
- 5 or more symptoms in 2 weeks
1. Mood sx
2. Cognitive sx
3. Motivational sx
4. motor and somatic sx
how many episodes to have recurrent major depressive disorder
2 or more episodes in a 2 month interval (ppl who have had depression are more likely to have recurrent)
MDD Mood Sx
sad, crying, numbness, helplessness, hopeless
MDD Cognitive Sx
low self-esteem, unrealistic guilt, exaggerate seriousness, delusions, memory problems, indecisive, decrease concentration
ex. MDD cognitive sx
worrying that kid will be homeless bc of 1 D on exam > blame themselves
MDD Motivational Sx
anhedonia - loss of interest, social ideation
typical pattern: take long time to fall asleep, wake up early and can’t go back to sleep
MDD Motor and somatic sx
appetite disturbance, sleep disturbance, fatigue, headaches, nausea
2nd to schizophrenia in hospital admits
major depression
What increases probability of recurrence of episodes
number of previous episodes
Beck Depression Inventory (BDI)
quick screening/assessment
Depressive sx in children
somatic problems, irritability, social withdraw, school problems
ex. of somatic in children
stomach aches
ex of school probs in children
low grades, fights
symptoms of MDD in elderly
memory loss, distractibility (mimics dementia)
Types of Major Depression
- Post-Partum
- Seasonal Affective Disorder (SAD)
- Dysthymia
- Mania and Bipolar Disorder
Post-Partum depression
onset w/in 4 weeks after birth
- affects 10-15% mothers
- NOT baby blues
- 28% still affected 1 yr later
- 5% still affected 4 yrs later
Post-Partum risk factors
- previous depression
- poor/no relationship with partner
- weak social support
Post-Partum cause
abnormal prenatal hormones
- mothers may not initially feel anything for child (no connection)
Seasonal Affective Disorder (SAD)
fall/winter
increase in appetite and sleep
cause of SAD
serotonin deficiencies in winter
treatment of SAD
light therapy, antidepressants
Dysthymia
chronic, mild depression for 2-20 yrs
Criteria: need 2 symptoms of major depression in past 2 years
Double depression
dysthymia + major depression
Mania and Bipolar disorder, symptoms
elevated/irritable mood, hyperacctivity, excessive talkativeness, flight of ideas, inflated self-esteem, high distractibility, sleeplessness, involvement in activities w/ painful consequences
ex. of involvement in activities w/ painful consequences
shopping when you have a lack of money
how often must you exhibit mania symptoms to have disorder
must exhibit 3 or more symptoms in 1 week
- must be abnormal for the person
inflated self-esteem
delusionsn (false beliefs) ex. thinking you can fly
sleeplessness
lack of sleep but still active
Manic episode criteria
- 3 or more symptoms for one week and one of the following:
- significant impact in occupation/social function
- need hospitalized to prevent harm
- presence of psychotic features
Hypomanic episode
- 3 or more symptoms for 4 days
- doesnt exhibit the sig. impact, need for hospitalization, or psychotic features
- less severe, not severe enough to become threat to someone else or hospitalization
Types of Manic Disorders
- Mania
- Bipolar I Disorder
- Bipolar II Disorder
- Cyclothymia
Bipolar I Disorder
mania w/ major depression
- can have all
symptoms of major depression
- often begins late adolescence w/ manic episode
- commonly doesn’t exhibit major depression symptoms prior to 1st manic episode
Bipolar II Disorder
- involves episodes of hypomania w/ major depression
- rather than mania, ppl often seek treatment for depressive symptoms
Cyclothymia
- depression and mania are less severe than Bipolar I/II
- usually 2 yr duration
more bipolar info
- rapid cycling: poorer prognosis
- median age of onset: 25
higher among SES groups - Bipolar I: no sex difference
- Bipolar II greater in females
causes of bipolar disorder
- heredity
- neurotransmitters
- role of stress
Bipolar causes: heredity
MZ twins: 40% likely both have disorder
DZ twins: 5-10 % likely
- you are likely to have another family member with a mood disorder (higher genetic component)
Bipolar causes: neurotransmitters
many ppl with bipolar disorder have low serotonin and high norepinephrine (clinical challenge to treat both)
Bipolar causes: stress
can precipitate manic episodes
- children are more likely to develop when parent has frequent episodes
Treatment of Bipolar Disorder
- use mood stabilizers
1. Lithium
2. Anticonvulsants
3. Antipsychotics
All work by changing activity within the receiving neuron
why aren’t antidepressants used to treat bipolar disorder
antidepressants can bring on a manic episode
Lithium
treats mania and depression
- slows dopamine and norepinephrine
- increases serotonin
problems with lithium
weight gain, tremors
Anticonvulsants problems
weight gain, drowsiness
Theories of depression
- cognitive theory
- learned helplessness
- learning model
- biological model
depression: cognitive theory
irrational, illogical beliefs lead to depression
- arbitrary inference
- selective abstraction
- magnification and minimization
arbitrary inference
conclusions from insufficient evidence
ex. friend blows you off without strong explanation, believe they don’t like you anymore
selective abstraction
focus on insignificant detail and ignore the important
ex. get report card and focus on one C+ instead of all other B’s
magnification and minimization
small bad events blow up, minimize larger good events
ex. ignoring an A on an exam
Learned helplessness
- perception that behavior has no effect on our experience
- inescapable (ex. can’t leave relationship/job)
- hopelessness often occurs
Learning model
over-reinforcement of depressed behavior and under-reinforcement of non-depressive behavior
Biological model
neurotransmitter imbalance
- faulty transmission of norepinephrine and serotonin (not enough is getting through)
Treatment for Depression
- antidepressant medication
- ECT
- Talk Therapies
- Psychedelic therapy
antidepressant medication
- tricyclics
- MAO inhibitors
- SSRI’s
Tricyclics
act on reuptake of norepinephrine and serotonin (slow down reuptake process and get more nor and ser through to post synaptic neuron)
side effects of tricyclics
“anticholinergic effects”: dry mouth, blur vission, disrupt sexual function
“cardiotoxic”: high risk of overdose
MAO inhibitors
stop MAO enzyme, used for atypical symptoms
- would have to watch diet and avoid foods that increase blood pressure
MAO
tends to degrade transmitters we want
- need MAO bc it helps control blood pressure
SSRI (selective serotonin reuptake inhibitors
- fewer side effects
SNRI (selective serotonin and norepinephrine reuptake
used for both ser and nor
- stops reuptake of ser and nor
- fewer side effects: sleep probs, headaches, sexual probs
Why did the FDA require warnings on SSRI’s
effects motivation before mood so depressed people who were previously unmotivated to harm themselves may now have the motivation
ECT (electroconvulsive shock treatment)
now a valid treatment for severe depression unresponsive to meds
- given 70-130 volts, 6-12 treatments over 1 month
side effects: temporary memory loss, confusion
Talk Therapies
- interpersonal therapy
- behavioral therapy
- cognitive therapy
interpersonal therapy
short term, focus on problems people have in relationships, boundaries, self-esteem
behavioral therapy
helping people display non-depressed symptoms
- focus on social skills training and assertiveness
Cognitive therapy
teach clients to be own therapist, replace irrational beliefs with rational beliefs
Psychedelic therapy
involves use of MDMA to treat depression, anxiety, and ptsd
- guided therapeutic session using psychedelics (discuss feelings with drug induced sense of openness and warmth
most effective treatment for depression
cognative therapy and antidepressants combined
