Chapter 5 Flashcards
Bipolar I vs Bipolar II
- Bipolar I: At least one episode or mania (NOT hypomania)
- Bipolar II:
- At least one major depressive episode
- At least one episode of hypomania
- No episodes of mania
Psychological Treatment of Depression
- Interpersonal psychotherapy (IPT)
- Cognitive therapy (CT)
- Mindfulness-based cognitive therapy (MBCT)
- Behavioral activation (BA) therapy
- Behavioral couples therapy
Psychological Treatment of Depression (5 total)
Interpersonal psychotherapy (IPT) Cognitive therapy (CT) Mindfulness-based cognitive therapy (MBCT) Behavioral activation (BA) therapy Behavioral couples therapy
Mindfulness-based cognitive therapy (MBCT)
*Use of strategies, including meditation, to detach from depression-related thoughts and prevent relapse
A Psychological Treatment of Depression
Behavioral couples therapy
A Psychological Treatment of Depression
Enhance communication and relationship satisfaction
(improve positive feedback)
Psychological Treatment of Bipolar Disorder
- Psychoeducational approaches
- Cognitive Therapy (CT)
- Family-focused treatment (FFT)
Family-focused treatment (FFT)
Educate family about disorder, enhance family communication, improve problem solving
A Psychological Treatment of Bipolar Disorder
Third Wave CBT
Dialectical Behavioral Therapy (DBT)
Acceptance and Commitment Therapy (ACT)
Biological Treatment of Mood Disorders
Electroconvulsive therapy (ECT)
Transcranial Magnetic Stimulation for Depression (rTMS)
Light Treatment – S.A.D.
Electroconvulsive therapy (ECT)
- Incredibly effective – has come a long way since the early 1900s
- Reserved for treatment non-responders
- Induce brain seizure and momentary unconsciousness
- Side effects: Short-term confusion and memory loss
- Unclear how ECT works
- a biological treatment for mood disorders
Lithium
Up to 80% receive at least some relief
Potentially serious side effect
*Lithium toxicity (Can overdose and die from it)
- medication for treating mood disorders
(a mood stabilizer)
Causation vs Correlation?
- Correlation – two variables are related to each other in some way
- Causation – one variable, at different levels, causes another variable to change
Unipolar Depressive Disorders
- Major depressive disorder
- Persistent depressive disorder
- Premenstrual dysphoric disorder
- Disruptive mood dysregulation disorder
Bipolar Disorders
- Bipolar I disorder
- Bipolar II disorder
- Cyclothymia
- Severity and duration of mania defining feature of each
- Most people will also experience an episode of depression
- Depressive episode required for Bipolar II, but not Bipolar I
Major depressive disorder (DSM - 5) major features
-how long are symptoms present
Five or more depressive symptoms, including sad mood or loss of pleasure, for 2 weeks
- Sad mood OR loss of interest and pleasure
- PLUS four other symptoms:
- Sleeping too much or too little
- Psychomotor retardation or agitation
- Poor appetite and weight loss, or increased appetite and weight gain
- Loss of energy
- Feelings of worthlessness or excessive guilt
- Difficulty concentrating, thinking, or making decisions
- Recurrent thoughts of death or suicide
- Symptoms are present:
- Nearly every day
- Most of the day
- For at least 2 weeks
*Symptoms are distinct and more severe than a normative response to significant loss
Persistent depressive disorder
DSM-5 Criteria
(PDD)
- Low mood and at least two other symptoms of depression at least half of the time for 2 years
- Depressed mood for at least 2 years (1 year for children/adolescent)
- PLUS 2 other symptoms:
- Poor appetite or overeating
- Sleeping too much or too little
- Low energy
- Poor self-esteem
- Trouble concentrating or making decisions
- Feelings of hopelessness
- Symptoms do not clear for more than 2 months at a time
- Bipolar disorders are not present (is mania and hypomania)
- Symptoms do not clear for more than 2 months at a time
- Bipolar disorders are not present (is mania and hypomania)
Premenstrual dysphoric disorder
Mood symptoms in the week before menses
Disruptive mood dysregulation disorder
Severe recurrent temper outbursts and persistent negative mood for at least 1 year beginning before age 10
Bipolar I disorder
At least one lifetime manic episode
Bipolar II disorder
At least one lifetime hypomanic episode and one major depressive episode
Cyclothymia
At least one lifetime hypomanic episode and one major depressive episode
Epidemiology and Consequences of Depression
- Depression is common
- Prevalence varies across cultures
- Symptoms vary across cultures
- Age of onset
- Co-morbidity
How common is Depression?
- **Depression is common
- Lifetime prevalence:
- 16.2% MDD
- 5% Depression more than 2 years
- Twice as common in women as in men
- Three times as common among people in poverty
Depression: Prevalence across cultures
*Prevalence varies across cultures
-MDD: 6.5% in China, 21% in France
(Cultural factors play an important role in depression rates)
(there are big differences in countries)
Epidemiology and Consequences of Depression: Co-morbidity
Co-morbidity
- 5-30% with MDD experience PDD
- 60% of those with MDD will also meet criteria for anxiety disorder at some point
Epidemiology and Consequences of Depression: Symptoms across cultures
- Symptoms vary across cultures
- Focus on somatic symptoms (e.g., pain, fatigue)
- –Ethnic minorities in the US
- –People from Latin America and some Asian countries
Epidemiology and Consequences of Depression: Age of onset
- Early 20s (This is the time for most people)
* Decreased over past 50 years
Generation change for MDD
With Each Generation, The Median Age Of Onset For MDD Gets Younger
T or F : Depressive episode required for Bipolar I, but not Bipolar II
FALSE
Depressive episode required for Bipolar II, but not Bipolar I
Mania
State of intense elation, irritability, or activation
-Severity and duration of mania defining feature of each: Bipolar I, Bipolar II, Cyclothymia
Hypomania
(hypo = “under”)
Symptoms of mania but less intense
Does not involve significant impairment
Might think will think getting a noble peace prize = hypomania but people with regular mania they they are Jesus
DSM-5 Criteria for Manic and Hypomanic Episodes
- Distinctly elevated or irritable mood
- Abnormally increased activity and energy
- PLUS 3 other symptoms (four if mood is irritable):
- Increased goal-directed activity or psychomotor agitation
- Talkativeness or rapid speech
- Flight of ideas or racing thoughts
- Decreased need for sleep
- Increased self-esteem or grandiosity
- Distractibility
- Excessive involvement in activities that are likely to have undesirable consequences (e.g., reckless spending/sexual behavior/driving)
*Symptoms are present most of the day, nearly every day
*For a manic episode
vs For a hypomanic episode
-manic : Symptoms last at least 1 week, require hospitalization, or include psychosis
Symptoms cause significant distress or functional impairment
-hypomanic: Symptoms last at least 4 days
(a little bit lower criteria than manic)
Clear changes in functioning that are observable to others, but impairment is not marked
No psychotic symptoms are present
For a manic episode
vs For a hypomanic episode
(DSM-5 Criteria for Manic and Hypomanic Episodes)
- For a manic episode:
- Symptoms last at least 1 week, require hospitalization, or include psychosis
- Symptoms cause significant distress or functional impairment
- For a hypomanic episode:
- Symptoms last at least 4 days
- Clear changes in functioning that are observable to others, but impairment is not marked
- No psychotic symptoms are present
Cyclothymic disorder (Cyclothymia): DSM-5 Criteria for Bipolar Disorders
- Milder, chronic form of bipolar disorder
- Symptoms lasts at least 2 years in adults (1 year in children/adolescents)
- Numerous periods with hypomanic and depressive symptoms
*Does not meet criteria for hypomania or major depressive episode
*Symptoms do not clear for more than 2 months at a time
*Symptoms cause significant distress or impairment
(“needs to be clinically significant” = requires treatments)
Epidemiology and Consequences of Bipolar Disorder
-gender differences
*Prevalence rates lower than MDD
*Average age of onset in 20s
*No gender differences in rates of bipolar disorders
(Women experience more depressive episodes)
*Severe mental illness
Epidemiology and Consequences of Bipolar Disorder: Prevalence rates
*Prevalence rates lower than MDD
- 1% in U S; 0.6% worldwide for Bipolar I
- 0.4% – 2% for Bipolar II
- 4% for Cyclothymia
Epidemiology and Consequences of Bipolar Disorder: mental illness
*15% unemployed full-time in past year
*Suicide rates high
(A little bit higher compared to depression)
*One in four report suicide attempt : More than half report suicidal ideation in past 12 months
Factors contributing to the onset of mood disorders
Genetic factors Neurotransmitters Brain function Neuroendocrine System Social factors Psychological factors
Etiology of Mood Disorders: Genetic Factors
*Heritability estimates
37% MDD vs 93% Bipolar Disorder (VERY HIGH )
- Unlikely one gene explains these illnesses : More likely Gene x Environment Interaction
- How a gene might increase risk in presence of environmental risk factor
- Serotonin transporter gene (5-HTT) polymorphism
- Short allele combination of the 5-HTT gene and childhood maltreatment or adulthood stressful life events increases risk of MDD
How much does heritability play a role for MDD vs Bipolar Disorder
(Etiology of Mood Disorders: Genetic Factors)
*Heritability estimates
37% MDD vs 93% Bipolar Disorder (VERY HIGH )
gene to predict depression and stress
Stressful life events interact with serotonin transporter gene to predict depression
Short / short allele = more depression
long/long allele= lower depression
(above 1 stressful life events)
Etiology of Mood Disorders: Neurotransmitters (NTs)
*Norepinephrine, dopamine, and serotonin 37% MDD
(Big one for treatments are serotonin and norepinephrine)
*Original models focused on absolute levels of NTs
*New models focus on sensitivity of postsynaptic receptors
-Stress may lead to changes in sensitivity of serotonin receptors
-Dopamine plays a major role in the reward system
-Dopamine dysfunction may be connected to specific symptoms (e.g., changes in energy and motivation)
-Dopamine receptors may be overly sensitive in BD but lack sensitivity in MDD
Etiology of Mood Disorders: Brain Function
*Oversensitivity to emotional stimuli (elevated amygdala)
(Amygdala is main thing want to talk about in regards to emotion)
*Interference with emotion regulation (elevated anterior cingulate, diminished prefrontal cortex and hippocampus)
*Motivation to pursue rewards (striatum)
*Disruptions in the connectivity of these regions
Genetic Contribution
MD vs DB
MD: moderate
BD: High
Neurotransmitter (serotonin, dopamine) dysfunction
MD vs DB
MD: mixed evidence
DB: mixed evidence
Changes in activation of regions in the brain in response to emotion stimuli
MD vs DB
MD: Present
DB: Present
Activation of regions in the brain in response to emotion stimuli
MD vs DB
MD: Diminished
DB: Elevated
Cortisol awakening Response
MD vs DB
MD: elevated
DB: elevated among those with depression
when celebrities commit suicide, others commit suicide, we can see:
when celebrities commit suicide, others commit suicide, we can see correlation but we canNOT see causation, cannot create an experiment
-a mistake in the book:
the relationship between phone freeze and text messaging wont work is …
correlation
how long does one have to have five or more depressive symptoms (including sad mood or loss of pleasure) in order to be classified as depressive disorder
2 weeks
DSM-5 Criteria for Major Depressive Disorder : Symptoms are present for ….
- Symptoms are present:
- Nearly every day
- Most of the day
- For at least 2 weeks
Major Depressive Disorder (MDD)
-types / classifications (i think)
- Episodic: Symptoms tend to dissipate over time
- Recurrent
- Once depression occurs, future episodes likely
- Among people with a first depressive episode : 15% report persistent depressive symptoms and Half report at least one additional episode
-Among people with a first depressive episode : _% report persistent depressive symptoms and _ report at least one additional episode
-Among people with a first depressive episode : 15% report persistent depressive symptoms and Half report at least one additional episode
DSM-5 Criteria for Manic and Hypomanic Episodes: symptoms
- Distinctly elevated or irritable mood
- Abnormally increased activity and energy
- PLUS 3 other symptoms (four if mood is irritable):
Epidemiology and Consequences of Bipolar Disorder: gender
*No gender differences in rates of bipolar disorders
Women experience more depressive episodes