Chapter 5: Mood Disorders Flashcards
What are mood disorders?
disorders such as depressive disorders or mania, in which there are disabling disturbances in emotion
What are the two broad types of mood disorders recognized by the DSM-5?
- unipolar disorders
2. bipolar disorders
What are unipolar depressive disorders?
disorders that involve only depressive symptoms
What are bipolar disorders?
disorders that involve depressive and manic symptoms
What are the major features of Major depressive disorder?
five or more depressive symptoms, including sad mood or loss of pleasure, for 2 weeks
What are the major features of Persistent depressive disroder?
Low mood and at least two other symptoms of depression at least half of the time for 2 years
What are the features of Premenstrual dysphoric disorder?
mood symptoms in the week before menses; very little is known about it
What are the features of Disruptive mood dysregulation disorder?
severe recurrent temper outbursts and persistent negative mood for at least 1 year beginning before age 10 (in children and adolescents)
What are the features of bipolar I disorder?
at least one lifetime manic episode
What are the features of bipolar II disorder?
at least one lifetime hypomanic episode and one major depressive episode
What are the features of cyclothymia?
recurrent mood changes from high to low for at least 2 years, without hypomanic or depressive episodes
What is psychomotor retardation?
a symptom commonly observed in major depressive disorder in which the person moves his or her limbs and body slowly
What is psychomotor agitation?
sometimes observed in MDD, a symptom characterized by pacing, restlessness, and inability to sit still
What must the symptoms of MDD include, according to the DSM-5?
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)
What is an episodic disorder?
a condition, such as MDD, whose symptoms dissipate but that tends to recur
What percentage of people who recovered from a first episode of MDD experienced at least one more episode across the 10 year follow up?
40-50%
What percentage of people reported experiencing depressive episodes that persisted for more than 2 years?
5%
What are some reasons that women are twice as likely to experience depression than men?
- 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
When does the gender difference in depression emerge?
adolescence
What is seasonal affective disorder (SAD)?
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
What is the relationship between fish consumption and depression?
countries w/ more fish consumption (e.g., Japan and Iceland) have much lower rates of MDD and bipolar disorder
What is the relationship between income disparity and depression?
higher rates of depression among poorer individuals
What are some things that can contribute to seasonal affective disorder?
- a slower metabolism in the winter
- changes in melatonin release
What is a common treatment for seasonal affective disorder?
light therapy
Where is seasonal affective disorder most common?
regions far from the equator
Which physical health disease is depression closely tied to?
cardiovascular disease - depression related to onset and more severe course of CVD
What are the three forms of bipolar disorders recognized by DSM-5?
- bipolar I disorder
- bipolar II disorder
- cyclothymic disorder
What is the defining feature of each type of bipolar disorder?
manic symptoms
Is an episode of depression required for diagnosis of bipolar I?
no
Is an episode of depression required for a diagnosis of bipolar II?
yes
What is mania?
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
What is a flight of ideas?
a symptom of mania that involves a rapid shift in conversation from one subject to another with only superficial associative connections
What is hypomania?
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
What is bipolar 1 disorder?
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
What is bipolar II disorder?
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)
What is cyclothymic disorder?
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
What do studies of etiology focus on?
why specific disorders unfold
What is the serotonin transporter gene?
a particular gene critical to the gene-environment interactions that apparently contributes to the development of depression
What are the three neurotransmitters most intensively studied in mood disorders?
norepinephrine, dopamine, and serotonin
How do tricyclic antidepressant drugs work at the neuron level?
they block the reuptake process so that more neurotransmitter reaches the receptor
Which neurotransmitter do the most common forms of antidepressant medications combat?
serotonin
Which neurotransmitter plays a major role in the sensitivity of the reward system in the brain?
dopamine
What is the reward system?
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
Have scanning studies consistently identified differences in the function of serotonin or dopamine pathways among people with MDD as compared to controls?
no
What is the anterior cingulate?
anterior portion of the cingulate gyrus (stretching about the corpus callosum)
How do depression and mania affect activity levels in the prefrontal cortex?
diminished levels in both depression and mania
How do depression and mania affect activity levels in the hippocampus?
diminished levels in both depression and mania
What is the striatum?
a neural region involved in motor action and responses to reward
How do depression and mania affect activity levels in the anterior cingulate?
elevated activity levels in both depression and mania
How do depression and mania affect activity levels in the striatum?
elevated activity levels in mania, diminished activity levels in depression
What is the dorsolateral prefrontal cortex?
a region of the prefrontal cortex involved in working memory, motor planning, organization, and regulation, which is implicated in many psychopathologies
What is the nucleus accumbens?
a central component of the reward system in the brain that plays a key role in the motivation to pursue rewards
What is the main stress hormone?
cortisol
What triggers the release of cortisol?
the HPA axis
What is Cushing syndrome?
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
What is cortisol awakening response (CAR)?
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
How can high levels of cortisol affect the hippocampus?
high cortisol levels can damage hippocampus (smaller than normal hippocampus volume)
What are cytokines?
proteins that are released as part of an immune response
What are pro-inflammatory cytokines?
cytokines that play a vital role in wound healing and fighting off infection by triggering inflammation
What is sickness behavior?
a syndrome which includes many of the symptoms seen in depression and is supposedly caused by pro-inflammatory cytokines
Which two pro-inflammatory cytokines have been shown to cause sickness behaivior?
IL-1Beta and TNF-alpha
What is interferon?
a drug used for severe medical conditions such as cancer that increases pro-inflammatory cytokine levels and can cause MDD
What can cause an increase in levels of pro-inflammatory cytokines?
major life stresses (particularly interpersonal life stressors), harsh social feedback
What are diatheses?
preexisting vulnerabilities to certain disorders
What are some reasons why some people, but not others, become depressed after stressful life events?
- 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
What is expressed emotion (EE)?
hostility, criticism, and emotional over involvement directed from other people toward the patient, usually within a family
What is neuroticism?
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
What does the DSM-5 specifier (subtype) “with anxious distress” indicate?
is used when depressive episodes are accompanied by at least two anxiety symptoms
What does the presence of anxiety among people who are seeking treatment for depression indicate?
a poor response to antidepressant treatment
What is a negative traid?
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
What are information-processing biases?
Beck’s theory: tendencies to perceive events in a negative manner (ex: ppl w/ depression attending to even the smallest negative feedback about themselves)
What is the Dysfunctional Attitudes Scale (DAS)?
self-report scale used in studies of Beck’s theory to test whether people would consider themselves worthwhile or lovable
What are the three cognitive theories used to describe causes of depression?
- Beck’s theory
- hopelessness theory
- rumination theory
What is the hopelessness theory?
states that the most important trigger of depression is hopelessness
What are attributions?
the explanations a person forms about why a stressor has occurred
What are the two key dimensions of attributions?
- stable (permanent) versus unstable (temporary) causes
2. global (relevant to many life domains) versus specific (limited to one area) causes
What is attributional style?
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
What is rumination?
tendency to repetitively dwell on sad experiences and thoughts
Which gender has a tendency to ruminate more?
women
What are two factors that have been found to predict increases in manic symptoms over time?
- reward sensitivity
2. sleep deprivation
What are some life events that predict increases in manic symptoms among people with bipolar I disorder?
life events that involve attaining goals (such as acceptance to grad school or getting married)
Who proposed rumination theory?
Susan Nolen-Hoeksema
Which types of life events increase risk of a depressive episode?
death of a close other, loss of friendship, breakup, loss of job
What is interpersonal psychotherapy (IPT)?
builds on the idea that depression is closely tied to interpersonal problems (works well!!)
What is cognitive therapy (CT)?
therapy aimed at altering maladaptive thought patterns
What is mindfulness-based cognitive therapy (MBCT)?
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
What is the “decentered” perspective in MBCT?
teaches people to view their thoughts merely as “mental events” rather than core aspects of the self or as accurate reflections of reality
What is Behavioral Activation Therapy?
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
What is behavioral couples therapy?
clinical approach to depression in which a couple works to improve communication and satisfaction; more likely to relieve relationship distress than individual cognitive therapy
What are psychoeducational approaches?
esp w/ bipolar disorder and schizophrenia, interventions that help people learn about symptoms, expected time course, triggers for symptoms, and treatment strategies
What are the two main biological treatments for mood disorders?
electroconvulsive therapy and drugs
What is electroconvulsive therapy used for today?
to treat MDD that has not responded to medication
What does electroconvulsive therapy entail?
deliberately inducing a momentary seizure by passing a 70-130 volt current through the patient’s brain
Why is a unilateral ECT used today over a bilateral ECT?
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
What is a common side effect of ECT?
memory loss (sometimes for up to 6 months after treatment)
What are the four major categories of antidepressant drugs?
- monoamine oxidase inhibitors (MAO inhibitors)
- tricyclic antidepressants
- selectie serotonin reuptake inhibitors (SSRIs)
- serotonin norepinephrine reuptake inhibitors (SNRIs)
What are monoamine oxidase inhibitors (MAO inhibitors)?
a group of antidepressant drugs that prevent the enzyme monoamine oxidase from deactivating catecholamines and indolamines
What are tricyclic antidepressants/
a group of antidepressants with molecular structures characterized by three fused rings; they interfere w/ the reuptake of norepinephrine and serotonin
What are selective serotonin reuptake inhibitors (SSRIs)?
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
What are serotonin-norepinephrine reuptake inhibitors (SNRIs)?
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
How long should antidepressant medications be continued for after a depressive episode ends?
at least 6 months (lowers risk of recurrence)
What are some concerns regarding antidepressants?
- not much more helpful than placebo for treating mild depression (helpful for severe MDD)
- published studies overestimate how well people respond to antidepressants
What is the STAR-D trial?
examined alternative antidepressant medications for patients who were unresponsive to one
Why do many people stop taking antidepressant medication within the first month?
because of side effects such as dizziness, headaches, erectile dysfunction, gastrointestinal complaints
Which antidepressants are the least used?
MAO inhibitors because of their potentially life-threatening side effects if combined with certain foods or beverages
Which antidepressants are the most commonly prescribed?
SSRIs and SNRIs
What is a major drawback to SSRIs and SNRIs?
they have been associated with suicidality during the early phases of treatment or after increases in dosage among those younger than age 25
What is transcranial magnetic stimulation (rTMS)?
a noninvasive technique in which pulsing magnets are used to intensify or diminish brain activity in a given region
What are mood-stabilizing medications?
medications that reduce manic symptoms
What is lithium?
a drug useful in treating both mania and depression in bipolar disorder; a mood-stabilizer
What are the two classes of medications other than lithium that have been approved by the FDA for the treatment of mania?
- anticonvulsant (antiseizure) medications
2. antipsychotic medications
What is an example of an anticonvulsant medication?
divalproex sodium (Depakote)
What is an example of an antipsychotic medication?
olanzapine (Zyprexa)
What are two potential issues associated with adding an antidepressant medication to a mood-stabilizing medication such as lithium?
- not clear whether antidepressants help reduce depression among people who are already taking a mood stabilizer
- 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
What is an advantage of antidepressants over psychotherapy?
antidepressants work more quickly than psychotherapy
What is an advantage of psychotherapy over antidepressants?
psychotherapy may help people learn skills that they can use after treatment is finished to protect against recurrent depressive episodes
What are two advantages of cognitive therapy over medication found in a study comparing the two?
- it was less expensive
2. it helped protect against relapse after treatment was finished
How does cognitive therapy compare to antidepressant medication in the treatment of severe MDD?
it is just as effective
What is the most powerful treatment for MDD especially with psychotic features?
ECT (electroconvulsive therapy)
What is suicidal ideation?
thoughts about intentionally taking one’s own life
What is a suicide attempt?
behavior intended to kill oneself
What is suicide?
death from deliberate self-injury
What is a nonsuicidal self-injury (NSSI)?
behaviors intended to cause immediate injury to oneself without intent to cause death
When is NSSI most common?
during adolescence, and most who try NSSI do so less than 10 times
What are three domains important to consider in whether people engage in NSSI repeatedly?
social factors, emotionality, and self-critical beliefs
What is the most common means of suicide in the United States?
guns (account for 50% of all suicides) - suicide rates higher in regions w/ more guns
Are men or women more likely to kill themselves?
- 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
Which group in the United States are suicides highest for?
white males over age 50
What are some risk factors for suicide?
- psychological factors - psychological disorders
- neurobiological factors - heritability
- social factors - suicide rates shown to increase during economic recessions
What are two issues that suicidality is closely tied to?
- a perceived sense of burden to others
2. a lack of belongingness
What is means restriction?
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)
