Chapter 5 - Mood Disorders

Question 1

Which of the following is not considered a common symptom of depression?

Select one:

a. Psychomotor retardation or agitation
b. Sleeping too much or too little
c. Feelings of worthlessness or excessive guilt
d. All of the above are common symptoms of depression

Answer 1

d. All of the above are common symptoms of depression

Question 2

Disruptive mood dysregulation disorder involves
Select one:
a. Children.
b. Adolescents.
c. Adults.
d. Children and adolescents.

Answer 2

d. Children and adolescents.

Question 3

Jacqueline has been consistently depressed for the past three years. Based on this information, the best diagnosis for Jacqueline would be

Select one:

a. Persistent depressive disorder.
b. Cyclothymic disorder.
c. Bipolar disorder.
d. Disruptive mood regulation disorder.

Answer 3

a. Persistent depressive disorder.

Question 4

Which of the following factors has NOT been proposed as an explanation for the gender difference in depression?
Select one:
a. Girls are more likely to be exposed to sexual abuse than boys.
b. Women tend to be more creative than men.
c. Women are more likely to be exposed to chronic stressors in adulthood.
d. Social roles promote emotion-focused coping among women.

Answer 4

b. Women tend to be more creative than men.

Question 5

Flight of ideas refers to
Select one:
a. delusional thinking.
b. suicidal thinking.
c. the thinking of a person with dementia.
d. rapid shifts in topics while speaking.

Answer 5

d. rapid shifts in topics while speaking.

Question 6

To be diagnosed with bipolar I disorder, a person

Select one:

a. must be currently experiencing manic symptoms.
b. must have experienced hypomanic symptoms as well as depressive symptoms at some point in their lifetime.
c. must have had at least one episode of mania at some point in their lifetime.
d. must have experienced at least one depressive episode.

Answer 6

c. must have had at least one episode of mania at some point in their lifetime.

Question 7

Which of the following treatments for seasonal affective disorder is now considered a first-line recommendation in the APA Treatment Guidelines for Depression?
Select one:
a. Hypnosis
b. Regular bright light exposure
c. Psychodynamic therapy
d. Traveling to a warmer climate during winter months

Answer 7

b. Regular bright light exposure

Question 8

Pleasure, motivation, and energy decrease in depression and increase in mania. This suggests neurological changes in the
Select one:
a. amygdala.
b. second messengers.
c. HPA axis.
d. reward system.

Answer 8

d. reward system.

Question 9

Stressful life events

Select one:

a. are only related to the first episode of depression.
b. are important in triggering episodes of depression.
c. play little role in the onset of depressive episodes.
d. mediate the relationship between genetics and environment.

Answer 9

b. are important in triggering episodes of depression.

Question 10

The latest findings regarding the efficacy of medication versus psychotherapy in the treatment of depression conclude that
Select one:
a. medication is superior to psychotherapy in the long term.
b. findings are inconsistent, thus more research is needed in this area.
c. psychotherapy works better than medication in the short term.
d. none of the above.

Answer 10

b. findings are inconsistent, thus more research is needed in this area.

Question 11

While many difficulties might get a person thinking about suicide, \_\_\_\_\_\_\_\_\_\_ seems to predict the switch from suicidal thoughts to suicidal actions.
Select one:
a. impulsivity.
b. mania.
c. drug use.
d. helplessness.

Answer 11

a. impulsivity.

Question 12

Non-suicidal self-injury is described in section III of the DSM-5 in order to
Select one:
a. focus more attention on this issue
b. reduce the incidence of this problematic behaviour
c. make clear that it is not diagnosable
d. distinguish it from serious suicidal intent

Answer 12

a. focus more attention on this issue

Question 13

What are the diagnostic criteria for major depressive disorder?

Answer 13

5 depressive symptoms for at least 2 weeks. Must include at least depressed mood or loss of interest and pleasure. Additional symptoms:

• changes in sleep, appetite, concentration or decision making
• feelings of worthlessness
• thoughts of suicide
• psychomotor retardation or agitation

Question 14

What are the diagnostic criteria for persistent depressive disorder?

Answer 14

Depressed mood of most of the day more than half the time for 2 years (1 year for children and adolescents). At least 2 of the following during that time:
- poor appetite or overeating
- sleeping too much or too little
- low energy
- poor self-esteem
- trouble concentrating or making decisions
- feelings of hopelessness
The symptoms do not clear for more than 2 months at a time. Bipolar disorders are not present.

Question 15

What is prevalence of MDD?

Answer 15

16.2% lifetime prevanlence.
MDD and PDD are twice as common among women than men. MDD 3x more likely in impoverished.
Prevalence varies across culture - further away from equator and fish consumption.

Question 16

What are the comorbid diagnosis of MMD?

Answer 16

60% met anxiety disorder. SUD, sexual dysfunctions and personality disorders.

Question 17

What is mania?

Answer 17

State of intense elation, irritability or activation accompanied by other symptoms shown in the diagnostic criteria. May shift rapidly from topic to topic - flight of ideas. Become sociable to the point of intrusiveness, excessively self-confident, stop sleeping but remain incredibly energetic. Significant impairment.
Symptoms last at least 1 week, requiring hospitalisation, or include psychosis.

Hypomania - less extreme than mania. A change in functioning that does not cause significant impairment.
Symptoms last at least 4 days. No psychotic symptoms are present.

Question 18

What is bipolar I disorder?

Answer 18

Single episode of mania during a person’s life. Bipolar episodes tend to reoccur. More than half of people with bipolar I disorder experience 4+ episodes in their life.

Question 19

What is bipolar II disorder?

Answer 19

at least one MDD episode and one hypomania episode (no lifetime episode of mania).

Question 20

What is cyclothymic disorder?

Answer 20

For at least 2 years (1 year in children and adolescents):
- numerous periods with hypomanic symptoms that do not see criteria for a hypomanic episode
- numerous periods with depressive symptoms that do not meet the criteria for a MDD episode.
The symptoms do not clear for more than 2 months at a time. Criteria for a major depressive, manic or hypomanic episode have never been met. Symptoms cause significant distress or functional impairment.

Question 21

What is the prevalence of bipolar disorders?

Answer 21

Bipolar I disorder - 0.6% meet criteria - US (1%).
Bipolar II disorder - 0.4-2%.
Cyclothymic disorder - 4%.

Onset typically before 25years. Bipolar disorders occur equally between men and women but women experience more depressive episodes.

Question 22

What is bipolar comorbid with?

Answer 22

Anxiety disorder and substance use disorder.

Question 23

What is the aetiology of mood disorders?

Answer 23

Genetic factors:
- heritability - 37% for MDD; 93% for bipolar.
Neurotransmitters - issues with serotonin, dopamine and norepinephrine receptors.
Brain function - amygdala and anterior cingulate overactive. Diminished activation of hippocampus and dorsolateral PFC. Bipolar also shows increased activation of striatum.
HPA axis is overly active during MDD. Issues in the regulation of cortisol levels.

Social factors:
- Depression often preceded by negative life event

Psychological factors:

• Neurotocism - personality trait that involves the tendency to experience frequent and intense negative affect.
• Cognitive theories - negative thoughts and beliefs are seen as major causes.
• Beck’s theory - depression is associated with a negative triad views of the self, the world and the future. People acquire negative schemas. Schema is activated whenever a person experiences other similar schemas. Schemas cause cognitive biases - thendence story process info in certain ways.
• Hopelessness theory - most important trigger of depression is hopelessness - belief that desirable outcome will not occur and there is nothing person can do to change this.
• Rumination theory - tendency to repetitively dwell on sad experiences and thoughts.

Bipolar:
Triggers for depression episode same.
Neurotocism, negative cognitive styles, expressed motion and lack of social support are predictors for MDD episodes.
Predictors of mania - reward sensitivity - mania reflects disturbance of the reward system in the brain. Life events around attaining goals predict increase in manic symptoms. Sleep deprivation - relationship between mania and disruptions in sleep and circadian rhythms.

Question 24

What are the psychological treatments for depression?

Answer 24

Relatively brief - 3-4 months of weekly sessions.

• Interpersonal psychotherapy - examines role of major interpersonal problems
• Cogntive theory - Becks aimed at altering maladaptive thought pattterns.
• Behavioural activation - engage in activities that might boost thought of slef
• Behavioural activation therapy - many risk factors for depression interfere with receiving the reinforcement.

Question 25

What are the psychological treatments for bipolar disorder?

Answer 25

Medication is necessary part of treatment but psychological approaches support.

• Psychoeducational approaches - help learn about symptoms, expected time course of symptoms, biological and psychological triggers and treatment strategies. Can improve medication compliance.
• Family focused therapy - aims to educate family about illness, enhance family communication and develop problem solving skills.

Question 26

What are the biological treatments for mood disorders:

Answer 26

Electroconvulsive therapy (ECT) for depression. Only used to treat depression that hasn’t responded to meds. Entails deliberately inducing a momentary seizure by passing a 70-130 volt current through the brain. ECT is more powerful than antidepressants. Decreases in cognitive functioning 6 months after treatment.

Medications for depression:
- MAOI’s - monoamine oxidase inhibitors
- tricyclics
- SSRI’s - selective serotonin reuptake inhibitors
Should continue taking 6 months after episode finishes.

Transcranical Magnetic Stimulation
- electromagnetic coil placed on side of head and intermittent pulses of magnetic energy increase activity in dorsolateral PFC.

Combining psychotherapy and meds increases recovery odds by 10-20%.

Medications for bipolar disorder:

• Mood stabiliser -lithium - decreases symptoms but patients still experience mild manic or depressive symptoms. Lithium can be toxic - regular blood tests.
• ANticonvulsive meds or antipsychotic meds (olanzapine) can be used as well.