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PSYCH 130 > Chapter 5: Mood Disorders > Flashcards

Chapter 5: Mood Disorders Flashcards

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1
Q

What are mood disorders?

A

disorders such as depressive disorders or mania, in which there are disabling disturbances in emotion

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2
Q

What are the two broad types of mood disorders recognized by the DSM-5?

A
  1. unipolar disorders

2. bipolar disorders

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3
Q

What are unipolar depressive disorders?

A

disorders that involve only depressive symptoms

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4
Q

What are bipolar disorders?

A

disorders that involve depressive and manic symptoms

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5
Q

What are the major features of Major depressive disorder?

A

five or more depressive symptoms, including sad mood or loss of pleasure, for 2 weeks

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6
Q

What are the major features of Persistent depressive disroder?

A

Low mood and at least two other symptoms of depression at least half of the time for 2 years

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7
Q

What are the features of Premenstrual dysphoric disorder?

A

mood symptoms in the week before menses; very little is known about it

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8
Q

What are the features of Disruptive mood dysregulation disorder?

A

severe recurrent temper outbursts and persistent negative mood for at least 1 year beginning before age 10 (in children and adolescents)

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9
Q

What are the features of bipolar I disorder?

A

at least one lifetime manic episode

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10
Q

What are the features of bipolar II disorder?

A

at least one lifetime hypomanic episode and one major depressive episode

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11
Q

What are the features of cyclothymia?

A

recurrent mood changes from high to low for at least 2 years, without hypomanic or depressive episodes

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12
Q

What is psychomotor retardation?

A

a symptom commonly observed in major depressive disorder in which the person moves his or her limbs and body slowly

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13
Q

What is psychomotor agitation?

A

sometimes observed in MDD, a symptom characterized by pacing, restlessness, and inability to sit still

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14
Q

What must the symptoms of MDD include, according to the DSM-5?

A

MUST include either depressed mood or loss of interest and pleasure AND ADDITIONAL SYMPTOMS (ex: changes in sleep, appetite, concentration, decision making, feelings of worthlessness, suicidality)

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15
Q

What is an episodic disorder?

A

a condition, such as MDD, whose symptoms dissipate but that tends to recur

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16
Q

What percentage of people who recovered from a first episode of MDD experienced at least one more episode across the 10 year follow up?

A

40-50%

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17
Q

What percentage of people reported experiencing depressive episodes that persisted for more than 2 years?

A

5%

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18
Q

What are some reasons that women are twice as likely to experience depression than men?

A
  • hormone fluctuations
  • twice as many girls as boys are exposed to childhood sexual abuse
  • women are more likely to be exposed to chronic stressors (poverty, caretaker responsibilities)
  • “the cost of caring”: women tend to provide more support to others facing stress
  • body image
  • social roles promote emotion focused coping among women
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19
Q

When does the gender difference in depression emerge?

A

adolescence

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20
Q

What is seasonal affective disorder (SAD)?

A

a subtype of mood disorders in which episodes consistently occur at the same time of year; in the most common form, major depressive episodes consistently occur in the winter

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21
Q

What is the relationship between fish consumption and depression?

A

countries w/ more fish consumption (e.g., Japan and Iceland) have much lower rates of MDD and bipolar disorder

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22
Q

What is the relationship between income disparity and depression?

A

higher rates of depression among poorer individuals

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23
Q

What are some things that can contribute to seasonal affective disorder?

A
  • a slower metabolism in the winter

- changes in melatonin release

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24
Q

What is a common treatment for seasonal affective disorder?

A

light therapy

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25
Q

Where is seasonal affective disorder most common?

A

regions far from the equator

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26
Q

Which physical health disease is depression closely tied to?

A

cardiovascular disease - depression related to onset and more severe course of CVD

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27
Q

What are the three forms of bipolar disorders recognized by DSM-5?

A
  1. bipolar I disorder
  2. bipolar II disorder
  3. cyclothymic disorder
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28
Q

What is the defining feature of each type of bipolar disorder?

A

manic symptoms

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29
Q

Is an episode of depression required for diagnosis of bipolar I?

A

no

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30
Q

Is an episode of depression required for a diagnosis of bipolar II?

A

yes

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31
Q

What is mania?

A

intense elation or irritability, accompanied by symptoms such as excessive talkativeness, rapid thoughts, distractibility, grandiose plans, heightened activity, and insensitivity to the negative consequences of actions

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32
Q

What is a flight of ideas?

A

a symptom of mania that involves a rapid shift in conversation from one subject to another with only superficial associative connections

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33
Q

What is hypomania?

A

an extremely happy or irritable mood accompanied by symptoms such as increased energy and decreased need for sleep, but without the significant functional impairment associated with mania

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34
Q

What is bipolar 1 disorder?

A

a diagnosis defined on the basis of at least one lifetime episode of mania; most people with this disorder also experience episodes of major depression

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35
Q

What is bipolar II disorder?

A

a form of bipolar disorder, diagnosed in those who have experienced at least one major depressive disorder and at least one episode of hypomania (and no lifetime episode of mania)

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36
Q

What is cyclothymic disorder?

A

a form of bipolar disorder characterized by swings between elation and depression over at least a 2-year period, but w/ moods not so severe as manic or major depressive episodes

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37
Q

What do studies of etiology focus on?

A

why specific disorders unfold

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38
Q

What is the serotonin transporter gene?

A

a particular gene critical to the gene-environment interactions that apparently contributes to the development of depression

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39
Q

What are the three neurotransmitters most intensively studied in mood disorders?

A

norepinephrine, dopamine, and serotonin

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40
Q

How do tricyclic antidepressant drugs work at the neuron level?

A

they block the reuptake process so that more neurotransmitter reaches the receptor

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41
Q

Which neurotransmitter do the most common forms of antidepressant medications combat?

A

serotonin

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42
Q

Which neurotransmitter plays a major role in the sensitivity of the reward system in the brain?

A

dopamine

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43
Q

What is the reward system?

A

a system of brain structures involved in the motivation to pursue rewards - is believed to be involved in depression, mania, schizophrenia, and substance use disorders

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44
Q

Have scanning studies consistently identified differences in the function of serotonin or dopamine pathways among people with MDD as compared to controls?

A

no

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45
Q

What is the anterior cingulate?

A

anterior portion of the cingulate gyrus (stretching about the corpus callosum)

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46
Q

How do depression and mania affect activity levels in the prefrontal cortex?

A

diminished levels in both depression and mania

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47
Q

How do depression and mania affect activity levels in the hippocampus?

A

diminished levels in both depression and mania

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48
Q

What is the striatum?

A

a neural region involved in motor action and responses to reward

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49
Q

How do depression and mania affect activity levels in the anterior cingulate?

A

elevated activity levels in both depression and mania

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50
Q

How do depression and mania affect activity levels in the striatum?

A

elevated activity levels in mania, diminished activity levels in depression

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51
Q

What is the dorsolateral prefrontal cortex?

A

a region of the prefrontal cortex involved in working memory, motor planning, organization, and regulation, which is implicated in many psychopathologies

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52
Q

What is the nucleus accumbens?

A

a central component of the reward system in the brain that plays a key role in the motivation to pursue rewards

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53
Q

What is the main stress hormone?

A

cortisol

54
Q

What triggers the release of cortisol?

A

the HPA axis

55
Q

What is Cushing syndrome?

A

an endocrine disorder usually affecting young women, produced by over secretion of cortisone and marked by mood swings, irritability, agitation, and physical disfigurement; often experience depressive symptoms

56
Q

What is cortisol awakening response (CAR)?

A

an increase in cortisol levels that occurs in the first 30 minutes after awakening; about a 50% increase occurs on average, though levels vary across individuals; has been related to the onset of anxiety and depressive disorders

57
Q

How can high levels of cortisol affect the hippocampus?

A

high cortisol levels can damage hippocampus (smaller than normal hippocampus volume)

58
Q

What are cytokines?

A

proteins that are released as part of an immune response

59
Q

What are pro-inflammatory cytokines?

A

cytokines that play a vital role in wound healing and fighting off infection by triggering inflammation

60
Q

What is sickness behavior?

A

a syndrome which includes many of the symptoms seen in depression and is supposedly caused by pro-inflammatory cytokines

61
Q

Which two pro-inflammatory cytokines have been shown to cause sickness behaivior?

A

IL-1Beta and TNF-alpha

62
Q

What is interferon?

A

a drug used for severe medical conditions such as cancer that increases pro-inflammatory cytokine levels and can cause MDD

63
Q

What can cause an increase in levels of pro-inflammatory cytokines?

A

major life stresses (particularly interpersonal life stressors), harsh social feedback

64
Q

What are diatheses?

A

preexisting vulnerabilities to certain disorders

65
Q

What are some reasons why some people, but not others, become depressed after stressful life events?

A
  • some people have diatheses that increase risk of mood disorders
  • increased social support reduces risk of developing mood disorder
  • family problems (high expressed emotion)
  • marital discord
66
Q

What is expressed emotion (EE)?

A

hostility, criticism, and emotional over involvement directed from other people toward the patient, usually within a family

67
Q

What is neuroticism?

A

the tendency to react to events with more frequent or greater than average negative affect; a strong predictor of onset of anxiety disorders and depression

68
Q

What does the DSM-5 specifier (subtype) “with anxious distress” indicate?

A

is used when depressive episodes are accompanied by at least two anxiety symptoms

69
Q

What does the presence of anxiety among people who are seeking treatment for depression indicate?

A

a poor response to antidepressant treatment

70
Q

What is a negative traid?

A

in Beck’s theory of depression, a person’s negative views of the self, the world, and the future, in a reciprocal causal relationship with the pessimistic assumptions (schemas) and cognitive biases such as selective abstraction

71
Q

What are information-processing biases?

A

Beck’s theory: tendencies to perceive events in a negative manner (ex: ppl w/ depression attending to even the smallest negative feedback about themselves)

72
Q

What is the Dysfunctional Attitudes Scale (DAS)?

A

self-report scale used in studies of Beck’s theory to test whether people would consider themselves worthwhile or lovable

73
Q

What are the three cognitive theories used to describe causes of depression?

A
  1. Beck’s theory
  2. hopelessness theory
  3. rumination theory
74
Q

What is the hopelessness theory?

A

states that the most important trigger of depression is hopelessness

75
Q

What are attributions?

A

the explanations a person forms about why a stressor has occurred

76
Q

What are the two key dimensions of attributions?

A
  1. stable (permanent) versus unstable (temporary) causes

2. global (relevant to many life domains) versus specific (limited to one area) causes

77
Q

What is attributional style?

A

trait-like tendencies to make a certain type of attribution for life events; people whose attributional style leads them to believe that negative life events are due to stable and global causes are more likely to become hopeless

78
Q

What is rumination?

A

tendency to repetitively dwell on sad experiences and thoughts

79
Q

Which gender has a tendency to ruminate more?

A

women

80
Q

What are two factors that have been found to predict increases in manic symptoms over time?

A
  1. reward sensitivity

2. sleep deprivation

81
Q

What are some life events that predict increases in manic symptoms among people with bipolar I disorder?

A

life events that involve attaining goals (such as acceptance to grad school or getting married)

82
Q

Who proposed rumination theory?

A

Susan Nolen-Hoeksema

83
Q

Which types of life events increase risk of a depressive episode?

A

death of a close other, loss of friendship, breakup, loss of job

84
Q

What is interpersonal psychotherapy (IPT)?

A

builds on the idea that depression is closely tied to interpersonal problems (works well!!)

85
Q

What is cognitive therapy (CT)?

A

therapy aimed at altering maladaptive thought patterns

86
Q

What is mindfulness-based cognitive therapy (MBCT)?

A

recent adaptation of cognitive therapy/restructuring that focuses on relapse prevention after successful treatment for recurrent episodes of major depression; aims to “decenter” the person’s perspective in order to break the cycle between sadness and thinking patterns

87
Q

What is the “decentered” perspective in MBCT?

A

teaches people to view their thoughts merely as “mental events” rather than core aspects of the self or as accurate reflections of reality

88
Q

What is Behavioral Activation Therapy?

A

based on the idea that many of the risk factors for depression interfere with receiving positive reinforcement ; goal is to increase participation in positively reinforcing activities as to disrupt the spiral of depression, withdrawal, and avoidance

89
Q

What is behavioral couples therapy?

A

clinical approach to depression in which a couple works to improve communication and satisfaction; more likely to relieve relationship distress than individual cognitive therapy

90
Q

What are psychoeducational approaches?

A

esp w/ bipolar disorder and schizophrenia, interventions that help people learn about symptoms, expected time course, triggers for symptoms, and treatment strategies

91
Q

What are the two main biological treatments for mood disorders?

A

electroconvulsive therapy and drugs

92
Q

What is electroconvulsive therapy used for today?

A

to treat MDD that has not responded to medication

93
Q

What does electroconvulsive therapy entail?

A

deliberately inducing a momentary seizure by passing a 70-130 volt current through the patient’s brain

94
Q

Why is a unilateral ECT used today over a bilateral ECT?

A

a unilateral ECT passes current only through the nondominant (typically right) portion of the hemisphere because the side effects are less pronounced than with bilateral ECT

95
Q

What is a common side effect of ECT?

A

memory loss (sometimes for up to 6 months after treatment)

96
Q

What are the four major categories of antidepressant drugs?

A
  1. monoamine oxidase inhibitors (MAO inhibitors)
  2. tricyclic antidepressants
  3. selectie serotonin reuptake inhibitors (SSRIs)
  4. serotonin norepinephrine reuptake inhibitors (SNRIs)
97
Q

What are monoamine oxidase inhibitors (MAO inhibitors)?

A

a group of antidepressant drugs that prevent the enzyme monoamine oxidase from deactivating catecholamines and indolamines

98
Q

What are tricyclic antidepressants/

A

a group of antidepressants with molecular structures characterized by three fused rings; they interfere w/ the reuptake of norepinephrine and serotonin

99
Q

What are selective serotonin reuptake inhibitors (SSRIs)?

A

a specific form of serotonin reuptake inhibitors with less effect on dopamine and norepinephrine levels - they inhibit the reuptake of serotonin into the presynaptic neuron, so that serotonin levels in the cleft are sustained for a longer period

100
Q

What are serotonin-norepinephrine reuptake inhibitors (SNRIs)?

A

any of various drugs that inhibit the presynaptic reuptake of serotonin and norepinephrine, such that both neurotransmitters will have more prolonged effects on postsynaptic neurons

101
Q

How long should antidepressant medications be continued for after a depressive episode ends?

A

at least 6 months (lowers risk of recurrence)

102
Q

What are some concerns regarding antidepressants?

A
  • not much more helpful than placebo for treating mild depression (helpful for severe MDD)
  • published studies overestimate how well people respond to antidepressants
103
Q

What is the STAR-D trial?

A

examined alternative antidepressant medications for patients who were unresponsive to one

104
Q

Why do many people stop taking antidepressant medication within the first month?

A

because of side effects such as dizziness, headaches, erectile dysfunction, gastrointestinal complaints

105
Q

Which antidepressants are the least used?

A

MAO inhibitors because of their potentially life-threatening side effects if combined with certain foods or beverages

106
Q

Which antidepressants are the most commonly prescribed?

A

SSRIs and SNRIs

107
Q

What is a major drawback to SSRIs and SNRIs?

A

they have been associated with suicidality during the early phases of treatment or after increases in dosage among those younger than age 25

108
Q

What is transcranial magnetic stimulation (rTMS)?

A

a noninvasive technique in which pulsing magnets are used to intensify or diminish brain activity in a given region

109
Q

What are mood-stabilizing medications?

A

medications that reduce manic symptoms

110
Q

What is lithium?

A

a drug useful in treating both mania and depression in bipolar disorder; a mood-stabilizer

111
Q

What are the two classes of medications other than lithium that have been approved by the FDA for the treatment of mania?

A
  1. anticonvulsant (antiseizure) medications

2. antipsychotic medications

112
Q

What is an example of an anticonvulsant medication?

A

divalproex sodium (Depakote)

113
Q

What is an example of an antipsychotic medication?

A

olanzapine (Zyprexa)

114
Q

What are two potential issues associated with adding an antidepressant medication to a mood-stabilizing medication such as lithium?

A
  1. not clear whether antidepressants help reduce depression among people who are already taking a mood stabilizer
  2. among people w/ bipolar disorder, antidepressants are related to a modest increase in the risk of a manic episode if taken without a mood stabilizer
115
Q

What is an advantage of antidepressants over psychotherapy?

A

antidepressants work more quickly than psychotherapy

116
Q

What is an advantage of psychotherapy over antidepressants?

A

psychotherapy may help people learn skills that they can use after treatment is finished to protect against recurrent depressive episodes

117
Q

What are two advantages of cognitive therapy over medication found in a study comparing the two?

A
  1. it was less expensive

2. it helped protect against relapse after treatment was finished

118
Q

How does cognitive therapy compare to antidepressant medication in the treatment of severe MDD?

A

it is just as effective

119
Q

What is the most powerful treatment for MDD especially with psychotic features?

A

ECT (electroconvulsive therapy)

120
Q

What is suicidal ideation?

A

thoughts about intentionally taking one’s own life

121
Q

What is a suicide attempt?

A

behavior intended to kill oneself

122
Q

What is suicide?

A

death from deliberate self-injury

123
Q

What is a nonsuicidal self-injury (NSSI)?

A

behaviors intended to cause immediate injury to oneself without intent to cause death

124
Q

When is NSSI most common?

A

during adolescence, and most who try NSSI do so less than 10 times

125
Q

What are three domains important to consider in whether people engage in NSSI repeatedly?

A

social factors, emotionality, and self-critical beliefs

126
Q

What is the most common means of suicide in the United States?

A

guns (account for 50% of all suicides) - suicide rates higher in regions w/ more guns

127
Q

Are men or women more likely to kill themselves?

A
  • men (1.7x more likely) BUT women more likely to make suicide attempts that do not result in death
  • women more likely to use pills, men more likely to shoot/hang themselves
128
Q

Which group in the United States are suicides highest for?

A

white males over age 50

129
Q

What are some risk factors for suicide?

A
  1. psychological factors - psychological disorders
  2. neurobiological factors - heritability
  3. social factors - suicide rates shown to increase during economic recessions
130
Q

What are two issues that suicidality is closely tied to?

A
  1. a perceived sense of burden to others

2. a lack of belongingness

131
Q

What is means restriction?

A

an approach to suicide prevention in which access to lethal methods is reduced (ex: keeping guns locked in cabinets, reducing unrestricted sale of poisons, building suicide barriers on bridges)

PSYCH 130 (7 decks)

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