chapter 7 Flashcards
mood
A group of persisting feelings associated with evaluative and cognitive states which influence all the future evaluations, feelings, and actions
A psychological state comprised of thoughts, feelings, physiological changes, expressive behaviors, and inclinations to act
Emotions or feelings → mood → temperament/personality traits
mood disorders
Characterized by unusually severe or prolonged disturbances of mood
Depression, bipolar
Range of mood discussed in Mood Disorders
mania
hypomania
normal mood
milk
moderate
severe
mania
unusual elation, energy, and activity
hypomania
a mild state of mania
mild
5 symptoms (minimum for a diagnosis)
moderate
6-7 symptoms
severe
8-9 symptoms
Stress and Depression
Stressful life events, such as:
The loss of a loved one
Interpersonal struggles
Physical illness
Economic hardship
Lack of secure attachment
Increased vulnerability for both major depression and bipolar disorder
- Social support from family and friends may buffer the effects of stress and reduce the risk of depression
psychodynamic theories
Depression
- Anger turned inward
Bipolar
- Balance between ego and superego
humanistic theory
Depression and lack of meaning and authenticity in life
learning theory
Depression results from situational factors, such as reduction in reinforcement
cognitive theory
Beck’s cognitive triad and learned helplessness
Beck’s Triad - Learned Helplessness
Uncontrollable bad events → perceived lack of control → generalized helpless behavior
Factors can be internal, global, or stable
TRIANGLE
- arrows connecting
top
- negative views about the world
bottom right
- negative views about the future
bottom left
- negative views about oneself
genetics
Imbalance in neurotransmitter activity in the brain appear to be involved in depression AND mania
Brain abnormalities may contribute to mood disorders, as reduced volume and lower metabolic activity in the areas of the brain involved in regulating thinking processes, mood, and memory have been observed
The diathesis-stress model is used as an explanatory framework to illustrate how biological or psychological diathesis may interact with stress in the development of depression
major depressive disorder
Most common diagnosable mood disorder - more than one in five US adults
Women are disproportionately affected
Rates are climbing in teens and young adults
Risk factors: age, socioeconomic status, marital status, gender, family history
major depressive disorder criteria
A) Five (or more) of the following symptoms have been present during the same 2 week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure
B) The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
C) The episode is not attributable to the physiological effects of a substance or another medical condition
D) At least one major depressive episode is not better explained by schizoaffective disorder and is not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders
E) There has never been a manic episode or a hypomanic episode
Depressive Episode Symptoms
Depressed mood most of the day, nearly every day, as indicated by either subjective report (feels sad, empty, hopeless) or observation made by others
Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day
Insomnia or hypersomnia nearly every day
Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
Fatigue or loss of energy nearly every day
Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self reproach or guilt about being sick)
Diminished ability to think or concentrate, or indecisiveness, nearly every day
Recurrent thoughts of death; recurrent suicidal ideation without a specific plan; a specific suicide plan; or a suicide attempt
Seasonal affective disorder (SAD)
3-10% of population; women more affected than men
Not a diagnostic category on its own; a specifier or subcategory of MDD
Persistent Depressive Disorder
Applies to cases of chronic depression lasting for at least 2 years
Major form of this disorder, dysthymia, affects about 2.5 percent of the general population
More common in women than men
Persistent Depressive Disorder criteria
A) Depressed mood for most of the day, for more days than not, as indicated by either subjective account for observation by others, for at least 2 years
- Note: in children and adolescents, mood can be irritable and duration must be at least 1 year
B) Presence, while depressed, of two (or more) of the following:
- Poor appetite or overeating
- Insomnia or hypersomnia
- Low energy or fatigue
- Low self esteem
- Poor concentration or difficulty making decisions
- Feelings of hopelessness
C) During the 2 year period (1 year for children or adolescents) of the disturbance, the individual has never been without the symptoms in Criteria A and B for more than 2 months at a time
D) Criteria for a major depressive disorder may be continuously present for 2 years
E) There has never been a manic episode or a hypomanic episode
F) The disturbance is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder
G) The symptoms are not attributable to the psychological effects of a substance
H) The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
Premenstrual Dysphoric Disorder
More severe form of premenstrual syndrome (PMS)
Mood swings, sudden tearfulness or feelings of sadness, depressed mood or feelings of hopelessness, irritability or anger, feelings of anxiety, tension, being on edge, greater sensitivity to cues of rejection, and negative thoughts about oneself
premenstrual syndrome (PMS)
A cluster of physical and mood related symptoms occurring during a woman’s premenstrual period
Premenstrual Dysphoric Disorder criteria
A) In the majority of menstrual cycles, at least five symptoms must be present in the final week before the onset of menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week postmenses
B) One (or more) of the following symptoms must be present:
- Marked affective lability
- Marked irritability or anger or increased interpersonal conflicts
- Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts
- Marked anxiety, tension, and/or feelings of being keyed up or on edge
C) One (or more) of the following symptom must additionally be present, to reach a total of five symptoms when combined with symptoms from Criterion B above
- Decreased interest in usual activities
- Subjective difficulty in concentration
- Lethargy, easy fatigability, or marks lack of energy
- Marked change in appetite; overeating; or specific food cravings
- Hypersomnia or insomnia
- A sense of being overwhelmed or out of control
- Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of “bloating” or weight gain
D) The symptoms cause clinically significant distress or interference with work, school, usual social activities, or relationships with others
E) The disturbance is not merely an exacerbation of the symptoms of another disorder, such as major depressive disorder, panic disorder, persistent depressive disorder, or a personality disorder
F) Criterion A should be confirmed by prospective daily ratings during at least two symptomatic cycles
G) The symptoms are not attributable to the physiological effects of a substance
Depressive Disorder Specifiers (with)
With anxious distress
With mixed features
With melancholic features
With atypical features
With mood congruent or mood incongruent psychotic features
With catatonia
With peripartum onset
With seasonal pattern
specify if (depressive disorder)
Mild
Few, if any, symptoms in excess of those required to make the diagnosis are present, the intensity of the symptom is distressing but manageable, and the symptoms result in minor impairment in social or occupational functioning
Moderate
The number of symptoms, intensity or symptoms, and/or functional impairment are between those specified for “mild” and “severe”
Severe
The number of symptoms is substantially in excess of that required to make the diagnosis, the intensity of the symptoms is seriously distressing and unmanageable, and the symptoms markedly interfere with social and occupational functioning
Bipolar disorder
A psychological disorder characterized by extreme swings of mood changes in energy and activity levels
Elation to depression; continuous cycle
Manic episode → few weeks - a month or two
Shorter and ends more abruptly than major depressive episodes
Two types:
BP1
BP2
Bipolar I
Manic episode requirement for dx
Major depressive episodes, or hypomania, can occur before or after, but not necessary
Applies to people who have at least one full manic episode at some point in their lives
Involves extreme mood swings and between manic episodes and major depression, with intervening periods of normal mood
Possibile to apply to a person who does not have a history of a major depressive episode
Bipolar II
Major depressive episode required for dx
Hypomanic episode required for dx
No episodes meet criteria for manic episodes
Applies to people who have both hypomanic episodes and a history of at least one major depressive episode, but have never had a full blown manic episode
- Hypomanic episodes are less severe
manic episode
Beings abruptly, fathering force within a few days
Periods of unrealistically heightened euphoria, extreme restlessness, and excessive activity characterized by disorganized behavior and impaired judgment
Range of mood discussed in mood disorders
Severe mania
Moderate mania
Hypomania
Normal mood
Mild depression
Moderate depression
Severe depression
Bipolar I Disorder criteria
A) Manic Episode: A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally persistently increased activity or energy, at least 1 week and present most of the day, nearly every day (or any duration of hospitalization is necessary)
B) During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior
C) he mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessaire hospitalization to prevent harm to self or others, or there are psychotic features
D) The episode is not attributable to the physiological effects of a substance or another medical condition
Bipolar Criteria: Manic and Hypomanic symptoms
- Inflated self-esteem or grandiosity
- Decreased need for sleep
- More talkative than usual or pressure to keep talking
- Flight of ideas or subjective experience that thoughts are racing
- Distractibility as reported or observed
- Increase in goal directed activity or psychomotor agitation
- Excessive involvement in activities that high potential for painful consequences
Mania vs. Hypomania
Mania
- At least 1 week (or any duration of hospitalization is necessary)
- 3 or more symptoms
- Sufficiently severe to cause marked impairment in social or occupational functioning or not necessitate hospitalization to prevent harm to self or others, or there are psychotic features
- Only requirement for Bipolar I
Hypomania
- At least 4 consecutive days
- 3 or more symptoms
- Not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization. If there are psychotic features, the episode is, by definition, manic
- Unequivocal change in functioning that is uncharacteristic of individual when not symptomatic
Bipolar II Disorder criteria
A) Hypomanic episode: A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 days and present most of the day, nearly any day, and at least one major depressive episode
B) There has never been a manic episode
C) At least one hypomanic episode and at least one major depressive episode are not better explained by schizoaffective disorder and are not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder
D) The symptoms of depression or the unpredictability caused by frequent alternation between periods of depression and hypomania causes clinically significant distress or impairment in social, occupational, or other important areas functioning
Cyclothymic disorder
A mood disorder characterized by a chronic pattern of less severe mood swings that are found in bipolar disorder
Normal mood: more than a month or two
Elevated and depressed mood: not as severe to warrant a diagnosis of bipolar disorder
Cyclothymic disorder criteria
A) For at least 2 years (at least 1 year in children and adolescents) there have been numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic episode and numerous periods with depressive symptoms that do not meet criteria for a major depressive
B) During the above 2 year period (1 year in children and adolescents), Criterion A symptoms have been present for at least half the time and the individual has not been without the symptoms for more than 2 months at a time
C) Criteria for a major depressive, manic, or hypomanic episode have been met
D) The symptoms in Criterion A are not better explained by schizoaffective disorder and are not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder
E) The symptoms are not attributable to the physiological effects of a substance or another medical condition
F) The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
Psychological Treatment - Psychodynamic
Focus on relational work, support client self awareness and understanding of the influence of the past on present behavior
Goal of achieving self-worth and resolving interpersonal conflicts
Theory → resolve feelings of anger directed outward (then inward) and unconscious conflicts
free association, dream analysis, transference, countertransference, interpretations, introjection
free association
Expression of whatever comes to mind without judgment to unblock defense
dream analysis
Analysis of mind content with less barriers
transference
Displacement of feelings towards another onto the therapist
countertransference
Feelings projected onto of feelings towards the client by the therapist
interpretations
Pairing of connections observed by therapist to support client insight
introjection
Feelings or thoughts of others taken on by the client
Psychological Treatment - Cognitive
Focus on correcting faulty thinking, distorted beliefs and self defeating attitudes
Usually short → 8-10 sessions
Rational emotive behavior therapy, beck’s cognitive therapy, cognitive behavioral therapy
rational emotive behavior therapy (REBT)
Therapists collaboratively dispute irrational beliefs and substitute with better behaviors
beck’s cognitive therapy
Help clients to recognize and change cognitive distortions and test reality
cognitive behavioral therapy (CBT)
Identify and correct maladaptive beliefs and negative thoughts with cognitive restructuring and behavior changes
Biomedical Treatment
Antidepressants
- TCAS, MAOiS, SSRIS, SNRIS, Lithium and Anticonvulsive drugs
electroconvulsive therapy, transcranoal magnetic stimulation (TMC)
Electroconvulsive therapy
Electric shocks cause chemical and cellular changes in the brain that causes changes to the molecules and cells of the brains of people with depression, helping relieve severe depression
Transcranial magnetic stimulation (TMC)
Applies a series of short magnetic pulses to stimulate nerve cells and influence activity in areas of the brain associated with depressive symptoms
suicide
Mood disorders are often linked to suicide
Womeene are more likely to attempt suicide, more men actually succeed, probably because they select more lethal means
The elderly, not the young are more likely to commit suicide
Rate of suicide among the elderly appears to be increasing
People who attempt suicide are often depressed, bu they are genreally in touch with reality
suicidal behaviors
Low self esteem
Inability to perform daily tasks
Previous suicide attempts
Suicide note
Engaging in risky or impulsive behavior
Sudden poor school or job performance e
Giving away important things
Lack of interest in things previously enjoyed
Sudden refraining from activities with family and friends
Sudden unexplained recovery from depression, sudden positive outlook - like the person is fine
suicide - situational
School or career problems
Loss of job/career
Death of a loved one or peer
Suicide of a loved one or peer
Relationship break-up/separation/divorce
Multiple losses
Terminal illness
suicide - emotional
Preoccupation with death
Lack of appetite/overeating
Sleep disturbances
Poor concentration
Isolation
Crying
suicide - psychological
Long term depression
Feeling helpless
Feeling hopeless
Feeling overwhelmed
Feeling sad
suicide - direct vs non direct
DIRECT:
“I am going to kill myself”
INDIRECT:
“You are all going to be sorry, when I am no longer here.”
“My life is not worth living anymore”
Psychodynamic perspective - suicide
suicide results from inward directed anger
sociocultural theorists - suicide
Attribute suicide to alienation and social isolation
learning theories - suicide
People who attempt suicide lack problem solving skills for handling significant stressors
social cognitive - suicide
Focuses on personal expectancies and modeling
biological theory - suicide
Focuses on genetic factors and neurotransmitter imbalances inherited
Bottom line → motivation to escape from unbearable emotional pain
