Chapter 7

Question 1

Depression Mood Symptoms

Answer 1

• Sadness, emptiness and worthlessness, apathy, hopelessness, low self-esteem.
• Little enthusiasm for things they once enjoyed.
• Feeling irritable, anxious or worried

Question 2

Hypomania/Mania Mood Symptoms

Answer 2

• Elevated mood, extreme confidence, grandiosity, irritability, hostility, emotional lability
• May appear to be in unusually high spirits and full of energy and enthusiasm
• Uncharacteristically irritable, have a low tolerance for frustration, and overreact with anger or hostility in response to environmental stimuli (noises, a child crying) or the people around them.

Question 3

Depression Cognitive Symptoms

Answer 3

• Pessimism, guilt, difficulty concentrating, negative thinking, suicidal thoughts.
• Self critical beliefs
• Rumination: Continually thinking about certain topics or repeatedly reviewing distressing events (Can intensify feelings of depression)
• Distractibility: Interferes with our ability to concentrate, remember things, or make decisions.

Question 4

Hypomania/Mania Cognitive Symptoms

Answer 4

-Disorientation, racing thoughts, decreased focus and attention, creativity, poor judgment
-Energized, goal oriented behaviors
-Excited and talk more than usual, engage in one-sided conversations, and demonstrate little concern about giving others an oppor-tunity to speak
-Difficulty focusing their attention, show poor judgment, and fail to recognize the inappropriateness of their behavior
(Those experiencing mania are much more likely to appear disoriented and exhibit cognitive difficulties; pressured speech and flight of ideas)

Question 5

Depression Behavioral Symptoms

Answer 5

• Social withdrawal, crying, low energy, fatigue, lowered productivity, agitation, poor hygiene, reduced motivation
• Slow or quiet speaking
• Restlessness: Find it difficult to sit still or pace
• Cry for no particular reason or in reaction to sadness, frustration, or anger
• Appear to not care about their grooming or personal cleanliness because daily activities such as getting out of bed, bathing, dressing, or preparing for work or class may feel overwhelming

Question 6

Hypomania/Mania Behavioral Symptoms

Answer 6

• Overactivity, rapid or incoherent speech, impulsivity, risk-taking behaviors; Uninhibited and act impulsively, engaging in uncharacteristic behaviors (reckless driving, excessive drinking, illegal drug use etc.)
• Difficulty delaying gratification, impulsive actions, irritable if loved ones interfere with or encourage them to reconsider their plans (can lead to unsafe sexual practices, illegal activity, behaviors that are highly uncharacteristic for the individual)
• Energetic and productive and display an expansive mood of extreme confidence and self- importance, taking on a variety of complex or creative tasks.
• Agitated and react angrily with little provocation
• Motor movement is often rapid and speech may be incoherent. Wild excitement, ranting, raving (thus the stereotype of a raving “maniac”), constant movement, and agitation characterize severe mania.
• Psychotic symptoms including paranoia, hallucinations, and delusions (false beliefs).

Question 7

Depression Psychological Symptoms

Answer 7

-Appetite and weight changes, sleep disturbance, aches and pain, loss of sex drive

Question 8

Hypomania/Mania Psychological Symptoms

Answer 8

• High levels of physiological arousal, result in intense activity, extreme restlessness, or a need to be constantly “on the go.”
• Decreased sleep, increased sex drive

Question 9

Brief depressive or hypomanic symptoms also occur in people who do not have a mood disorder. Diagnosis is even more complicated because… (What are the difficulties related to assessing mood symptoms?)

Answer 9

depression occurs in both depressive and bipolar disorders and because the symptoms of these disorders may vary considerably from person to person

Question 10

2) Both depressive and hypomanic/manic symptoms include…(What are the difficulties related to assessing mood symptoms?)

Answer 10

Irritability; this further confounds diagnosis, especially when someone’s symptoms during hypomania/mania are predominantly irritable or agitated.

Question 11

3) People often fail to report hypomanic symptoms because… (What are the difficulties related to assessing mood symptoms?)

Answer 11

They do not cause significant problems or impair functioning. (when evaluating someone who is depressed, most clinicians are careful to have the client complete a behavioral checklist regarding any hypomanic or manic symptoms)

Question 12

4) People experiencing a depressive or hypomanic/manic episode sometimes exhibit symptoms from the… (What are the difficulties related to assessing mood symptoms?)

Answer 12

Opposite pole so the clinician specifies that the mood episode has mixed features. Clinicians also ask about the frequency and duration of the mood episodes and about any seasonal changes in mood. They are also interested in whether the symptoms have been mild, moderate, or severe.

Question 13

5) Consider other factors that can cause mood changes, such as… (What are the difficulties related to assessing mood symptoms?)

Answer 13

Medical conditions or the use or abuse of alcohol, illegal drugs, or prescription medications. Careful symptom evaluation prior to diagnosis is important because interventions for depressive and bipolar disorders differ. Therapists also monitor symptoms throughout treatment; a diagnosis may change from a depressive disorder to bipolar disorder if hypomanic or manic symptoms develop.

Question 14

What the symptoms of PMDD?

Answer 14

Severe depression, mood swings, anxiety, tension, or irritability occurring before the onset of menses; Improvement of symptoms within a few days of menstruation and minimal or no symptoms following menstruation; (PMDD produces much greater distress than premenstrual syndrome and interferes with social, interpersonal, academic, or occupational functioning)

Question 15

How many symptoms of PMDD are required for diagnosis?

Answer 15

A PMDD diagnosis requires the presence of five premenstrual symptoms; at least one of the symptoms must involve significantly depressed mood, mood swings, anger, anxiety, tension, irritability, or increased interpersonal conflict. Other symptoms considered in making a diagnosis include difficulty concentrating; social withdrawal; lack of energy; food cravings or overeating; insomnia or excessive sleepiness; feeling overwhelmed; or physical symptoms such as bloating, weight gain, or breast tenderness

Question 16

What percent of people don’t respond to treatment for depression

Answer 16

Approximately 15 percent of those treated for depression fail to show any significant reduction in symptoms

Question 17

Why do approximately 15 percent of those treated for depression fail to show any significant reduction in symptoms?

Answer 17

Some researchers believe that many of these cases represent undiagnosed bipolar disorder (In an 8-year follow-up of individuals diagnosed with MDD, approximately 10 percent eventually received a bipolar diagnosis, including 25 percent of those who did not improve after taking antidepressant medications). People who are misdiagnosed often experience greater impairment, presumably because they initially received ineffective treatment due to the inaccurate diagnosis

Question 18

What are the relationships between cortisol, stress, and depression?

Answer 18

Exposure to stress during early development affects cortisol levels and can increase susceptibility to depression in later life, especially among those who have genetic vulnerability; Many individuals with depression have early life traumas or stressors such as child abuse, neglect, or loss of a parent; An overactive stress response system and excessive cortisol production may cause depressive symptoms by depleting certain neurotransmitters, particularly serotonin

Question 19

What are attributions?

Answer 19

How we explain events that occur in our lives; Can have powerful effects on our mood

Question 20

What types of attributions are seen in depression?

Answer 20

Depression is more likely to occur if we display thinking patterns associated with learned helplessness, a belief that we have little influence over what happens to us (People who have developed an attributional style of learned helplessness often make erroneous assumptions about their experiences)

Question 21

Know that the two factors of sexual orientation that influence depression are…

Answer 21

1) Struggling to keep the orientation hidden

2) Negative reactions to coming out

Question 22

Vagus nerve stimulation and transcranial magnetic stimulation are used to treat…

Answer 22

Sometimes used to treat severe or treatment- resistant depression, especially when life-threatening symptoms such as refusal to eat or intense suicidal intent are present

Question 23

Vagus Nerve Stimulation

Answer 23

For people with chronic, recurrent depression that has not responded to at least four prior treatment attempts. This technique uses an implanted pacemaker-like device that delivers a frequent, 30-second electronic impulse that travels from the vagus nerve to the brain; this eventually produces changes in metabolic activity within the brain, including increased dopamine availability, and subsequent reduction in depressive symptoms. Regularly implemented vagus nerve stimulation has produced profound and sustained improvement in some individuals with treatment-resistant depression

Question 24

Treatment-Resistant Depression

Answer 24

Repetitive transcranial magnetic stimulation. This procedure, which uses an electromagnetic field to stimulate the brain, has proven effective for acute depressive episodes and for maintaining remission of depressive symptoms; (high-intensity stimulation appears to produce the most significant results)

Question 25

How do depressive and bipolar disorders compare in terms of prevalence?

Answer 25

Bipolar disorders are far less prevalent than depressive disorders. It is important to recall, however, that bipolar disorder may be underdiagnosed. It is estimated that more than 10 percent of those diagnosed with a depressive disorder will eventually be diagnosed with a bipolar disorder; No marked gender differences in the prevalence of bipolar I, Depressive and mixed features, bipolar II, and rapid cycling occur more frequently in women

Question 26

Which neurotransmitter is implied in bipolar disorders but not depression?

Answer 26

Multiple brain imaging studies have documented elevated glutamate neurotransmission (a neurotransmitter with stimulatory functions) in the brains of individuals with bipolar disorder

Question 27

Comparing the neuroanatomy of schizophrenia and bipolar disorder reveals similar…

Answer 27

Gray matter abnormalities in several brain regions; however, neuroimaging has also documented structural irregularities that are unique to each disorder. In the case of bipolar disorder, brain regions affected tend to be less extensive and primarily involve areas related to emotional processing; There is substantial overlap in affected brain regions when comparing individuals with schizophrenia and people with bipolar disorder who experience psychosis during mood episodes

Question 28

Bipolar disorder and schizophrenia also involve similar cognitive deficits, including…

Answer 28

Confused thought processes and poor insight (failure to recognize symptoms of one’s own mental illness). In schizophrenia, these difficulties are common throughout the course of the disorder. In bipolar disorder, this lack of insight and failure to recognize the inappropriateness of behavior occurs dur- ing hypomanic/manic episodes; insight is usually adequate during depressive episodes; Neurocognitive deficits that affect psychosocial com- petence and daily functioning are also present in both disorders, although the deficits are usually more severe and more pervasive in schizophrenia and in individuals with bipolar disorder who have experienced a psychotic episode; Significant impairment in vocational functioning due to cognitive deficits involving attention, processing speed, and memory occur in both disorders