Chapter 7: Mood Disorders Flashcards
1
Q
Mood disorder
A
characterized by gross deviations in mood.
2
Q
Most common psychological disorders
A
mood disroders
3
Q
Major depressive episode
A
severe depression including cognitive symptoms and disturbed physical functions.
- feeling of worthlessness
- altered sleep patterns
- changing appetite and weight
- notable loss of energy
4
Q
mania
A
abnormally exaggerated elation, joy, or euphoira.
5
Q
mania is associated with flight of ideas, which is:
A
when the speech may become so incoherent becasue the individual is attempting to express so many ideas at once.
6
Q
hypomanic episode
A
not as severe as a manic episode. It is less impairing, but the person is still very hyperactive.
7
Q
a decreased need for sleep is associated with the __ portion of a mood disorder
A
a manic portion of a mood disorder.
8
Q
unipolar mood disorder
A
mood remains at one pole of depression-mania continuum
9
Q
bipolar mood disorder
A
mood travels between depression-elation poles.
10
Q
mixed features
A
when symptoms from both poles are expressed at once.
an individual can experience manic symptoms but feel somewhat depressed or anxious at the same time or be depressed with a few symptoms of mania. This episode is characterized as having “mixed features
11
Q
diagnostic criteria for major depressive disorder
A
5 or MORE symtoms that have been present during the SAME 2 week period:
- depressed mood nearly every day
- anhedonia
- weightloss or weight gain
- insomnia or hypersomnia
- psychomotor agitation or retardation
- fatigue or energy loss
- feelings of worthlessness
- diminished ability to conentrate
- recurrent thoughts of death.
12
Q
average duration of a major depressive episode if untreated
A
around 9 months
13
Q
in a major depressive disorder, there is an absense of ___
A
mania
14
Q
recurrent major depression
A
two or more major depressive episodes occurred and were separated by at least two months. Usually have a family history of depression.
15
Q
persistent depressive disordr
A
a depressed mood that isn’t as “intense” as a major depressive disorder, but it continues for at least two years, during which the pt cannot be symptom free for more than two months at a time, even though he or she may not experience all of the symtoms of a major depressive episode.
- in PDD, depression is relatively unchanged over long periods.
16
Q
what is double depression
A
individuals who suffer from both major depression episodes and PDD with fewer symptoms.
17
Q
how long must a person exhibit mania for in order to be diagnosed with mania
A
one week, if they are hospitalized afterwards.
18
Q
what is a specifier
A
a symptom that may or may not accomany a depressive disorder ,but can shed light on the a better classification/type of subtype of disorder.
19
Q
8 specifiers for depressive disorders.
A
1.With psychotic features
•Hallucinations, delusions
2.With anxious distress
•Mild to severe
- With mixed features
- With melancholic features (severe “type” of depression based on more severe somatic symptoms present)
5.With atypical features
•E.g., oversleeping and overeating
- With catatonic features
- With peripartumonset (“peri” means “surrounding”)
- With seasonal pattern•Seasonal affective disorder (SAD)
20
Q
What are psychotic feature specifiers
A
when bouts of depression or mania are accompanied by psychotic symptoms like hallucinations.
21
Q
psychotic specifiers tend to be mood ___
A
congruent. Ex/ hallucinations and delusions that accompany depression are often pessimistic, whereas delusions of grandeur are mood congruent with manic episodes.
22
Q
psychotic specifiers of a depressive/manic episode may suggest that ___ may develop
A
schizophrenia.
23
Q
anxious to distressed specifier
A
when anxious symptoms are present in someone experiencing a mood disorder. For all depressive and bipolar disorders, the presence of anxiety indicates a more severe condition, making suicidal thoughts and suicide more likely.
24
Q
mixed features specifier
A
predominantly depressive episodes that have at least three symptoms of mania.
25
melancholic features specifier
specifier applies only if the FULL CRITERIA for a major depressive episode has been met. Recall, that a major episode of depression requires 5 symptoms within the 2 week time frame. If all 9 symptoms are being met, this is a severe form of major depressive disorder and is considered MDD with melancholic features.
26
catatonic features specifier
seen primarily in major depressive disorder (very rarely in manic episodes) in which the person does not move at all. THey stay in a rigid formation in which they are placed.
27
atypical features specifier
while most people with depression sleep less and lose their appetite, people with atypical features constantly over sleep and over eat. They have the ability to react positively to some things, contrary to other depression specifiers.
28
atypical features are seen more in what gender
women
29
specifier that is highly correlated to diabetes
atypical specifier for depression. because of the unusual over eating seen in these pts.
30
peripartum specifier for depression
depression or depressed mood that is associated with new mothers after giving birth
31
peripartum specific depression and the baby blues
baby blues are seen up to 80% of women for the first few days of giving birth, but peripartum depression affects upwards up 10% for a very long time, months after giving birth. can even manifest in psychotic symptoms.
32
criteria for seasonal affective disorder
the person must experience depression during the winter months for at least 2 years with no indication of depression during the other periods of the year.
33
mean age of onset for major depressive disorder
25 years. 29 years for patients in treatment.
34
trend for the age diagnosis for the mean onset of major depressive disorder
the average age of onset is DECREASING, occurring more and more in adolescence; particularly in females.
35
persistent depressive disorder may last ___-___ years.
20-30 years, median duration of 5 years in adults.
36
T/F Children with persistent mild depression are more likely to experience major depression when they are older
true. they have a 76% chance.
37
acute grief most of us would feel following the death of a loved one eventually evolves into what is called ___ ___
integrated grief.
38
what is integrated grief
in which the finality of death and its consequences are acknowledged, and the individual adjusts to the loss.
39
complicated grief
usually, grief becomes integrated after a year. If it lasts longer and is a cause for concern, teh grief may be considered complicated. complicated grief is in the DSM5
40
integrated grief often reoccurs during:
anniversaries, day of death etc. This is all normal. INfact, psychologists are concerned when integrated grief is not displayed during appropriate times.
41
predictor of pathological grief of a loved one
how dependent someone was on them
42
PMDD vs PMS
PMS is just unpleasant, but PMDD involves severe and incapacitating emotional reactions during premenstrual time.
43
Bipolar I disorder
FULL MANIC EPISODES which MAY be preceded of followed by either hypomanic episode or major depressive episode.
44
Bipolar II disorder
HYPOMANIC (not as severe as full manic) episodes that alternate with MAJOR DEPRESSIVE DISORDER.
45
a specifier that goes with BP
Rapid cycling specifier: some people move quickly in and out of depressive or manic episodes. Someone who experiences 4 manic-depressive cycles in a year may be classified as rapid cycling.
46
how long must someone be afflicted by both a hypomanic and a major depressive episode in order to be classified as bipolar II?
they must reach criteria for a hypomanic episode and major depressive episode at least once, and each episode must last at least 4 days. There has to be no psychotic features.
47
related to rapid cycling, what is rapid mood switching?
usually, there is a bit of a "break" between manic and depressive episodes in which the person appears "normal". In rapid mood switching, there is no break. The pt goes from immediately manic to immediately depressive. Ultra rapid cycling lasts for days to week, and ultra-ultra rapid cycling changes moods in less than 24 hours.
48
which type of BP disorder has the youngest onset
Bipolar I: 18 years
| Bipolar II: 22 years. Some progress to bipolar 1 (full manic episodes)
49
Typically, people with bipolar disorder die __ to ___ years earlier than general population
8-9 years earlier.
50
T/F: it is rare for someone to develop bipolar disorder after the age of 40
true. But once it does appear, its chronic.
51
studies show that women are ___ times more likely to have mood disorders as men
2 times more likely
52
in canada, the rates of mood disorders tend to be ___
decreasing
53
which gender is more impacted by bipolar disorder
men and women have an equal liklihood to be diagnosed with BPD.
54
Why is MDD missed in older adults?
because older adults often have physical and mental disorders like dementia.
Major depressive episodes seen in 18%–20% nursing home residents; complicated by medical illness in this population
Milder symptoms of depression increasing among older adults though; related to increasing illness and decreased social support
55
example of depression in older adults can contribute to physical disease in seniors
being depressed doubles the risk of death in older adults who have suffered a heart attack or stroke.
56
country with highest and lowest rates of depression
USA for highest
Japan for lowest
Canada is in the middle
57
First nations: mood disorders is ___ times as high on some reserves as in the general population
FOUR TIMES
58
creativity is often associated with ___episodes
manic.
59
relationship between mania and creativity
moderate symptoms of mania produce the most creativity. Secrere symptoms tend to just be incapacitating.
60
genetics between mania and creativity
genetics may be associated with BPD and the same genes may also carry the spark of creativity.
61
explain the family influence behind mood disorders
people with mood disorders are 2-3 time more likely to have FIRST DEGREE relatives with mood disorders than controls.
62
twin studies findings behind mood disorders
twin studies show that mood disorders are heritable. an identitcal twin is 2-3times more likely to present with a mood disorder if their twin has a disorder.
63
relationship between twins and unipolar or bipolar disorder
there is a very low chance of having an identical twin with a unipolar disorder while the other has a bipolar disorder. usually, both presnt with the same disorder.
64
genetic contributions to depression fall in the range of 40% for ___, but seem to be significantly less for __.
genetic contributions to depression fall in the range of 40% for women, but seem to be significantly less for men.
65
joint heritability for anxiety and depression.
biological vulnerability for mood disorders may not be specific to that disorder but may reflect a more general predisposition to anxiety or mood disorders, or more likely to a basic temperament underlying all emotional disorders, such as neuroticism.
66
Neurotransmitter system associated with a biological dimension of mood disorder.
low levels of 5HT results in mood swings. 5HT is usually repsonsible for regulating emotions. Lowered DA also causes depression.
67
endocrine system associated with a biological dimension of mood disorder.
diseases leading to excessive secretion of CORTISOL lead to depression. NT activity in the hypothalamus regulates the HPA axis, which produces endocrinological affects.
68
permissive hypothesis of the neurotransmitter system
when 5HT levels are low, other neurotransmitters are permitted to range more widely, become dysregulated, and contribute to mood irregularities.
69
sleep problems associated with a biological dimension of mood disorder.
1) REM starts earlier
2) REM is more intense
3) little if any slow wave sleep.
4) disturbed sleep patterns overall-- insomnia is a risk factor for both the onset and persistence of depression.
70
How would you alter the sleep cycle of a depressed person to improve their condition?
studies have shown that depriving depressed patients of sleep in the second half of the night causes temporary improvement of their condition.
71
relationship between sleep profiles and mood disorder recovery
abnormal sleep proviles and disturbances in REM sleep predict a POORER response to psychological treatment.
72
studying the ___ cortex, __ ___, ___ and ___ ___ cortex all indicate ____ activity, indicating the reason behind increased inhibition and deficits in pursuing desired goals characteristic of depression.
studying the PF cortex, HIPPOCAMPUS, AMYGDALA and ANTERIOR CINGULATE CORTEX cortex all indicate DECREASED activity, indicating the reason behind increased inhibition and deficits in pursuing desired goals characteristic of depression.
73
Psychological dimensions of mood disordrs: in 60-80% of cases, depression is caused by:
psychological events, including stressful life events like single parenting, financial stress etc. There could also be a predisposed psychological vulnerability which doesn't help at all.
- stressors are assessed by MEANING, not just weather the event was good or bad.
74
for epople with recurrent depression, the clear occurrence of a severe life stress before or early in the latest episode predicts a :
much poorer response to treatment and a longer time before remission.
75
gene-environment correlation model:
our genetic endowment might actually increae the porbability that we will experience stressful life events (thus causing depression)
76
3 psychological dimensions of mood disorders
1) negative/stressful life event
2) learned helplessness: : people become depressed when they feel they have no control over life’s stress. They feel a SENSE OF HOPELESSNESS
3) negative cognitive styles/
77
in learned helplessness, depressive attributional sytle is ___, ___ and __
internal ( individual believes that all negative outcomes are because of them )
```
stable (occurs all the time)
and global ( occurs across all situations)
```
78
studies show that attributing negative events to ___ ___ ___ ___ results in hopelessness
our own character flaws.
79
aaron beck's belief about depression
believed that depression occurs because of a tendency to interpret everyday events in a negative way.
80
2 main cognitive errors that may be attributed to depression (aaron beck)
1) arbitrary inference: depressed individual emphasizes the negative of a situation vs the positive
2) overgeneralization: one bad remark is attributed to everything in your life.
81
the two cognitive errors are applied to 3 things to form the depressive cognitive triad:
depressive cognitive triad: making cognitive errors about 1) themselves
2) the immediate world
3) the future.
82
2 negative schemas associatd with depression
1) self-blame schema (person feels responsible for everything)
2) negative self evaluation schema (belief they can never do anything correctly)
83
cognitive errors and schemas associated with derpression are ___
autonomatic: not necessarily concious. The individual might not even be awar they are thinking negatively or illogically.
84
the greater the ____ of positive traits that an individual believe he lacks, the high the person's level of depression
the greater the IMPORTANCE of positive traits that an individual believe he lacks, the high the person's level of depression
EX/ if someone believes its super important to be nice, but they do not think they are a nice person, they may be more depressed since being nice is super important to them.
85
3 prominent social and cultural dimensions toward mood disorders
1) marital relations. Marital dissatisfaction results in depression. Its a cycle because depression are leads to deterioration in marital relations.
2) mood disorders in women. 70% of ppl diagnosed with major depressive and PDD are women. Many of them feel perceptions of uncontrollabilitiy (learned helpnessness), which may be due to the cultural impact of gender roles. they are also more likely to experience harsh life events (single parents, abuse histories)
3) social support
- people who live alone are 80% at higher risk for developing depression
- plays a role in post partum depression. The amount of support the women gets from her spouse is correlated with how severe the PPD is
86
relationship between bipolar disorder and marriag
people with BPD tend to not marry, and if they do, there is a higher rate of divorce.
87
which gender is more at risk for developing a mood disroder after a divorce?
men. ONLY MEN face a heightened risk of developing a mood disorder for the first time immediately following a marital split.
88
how does conflict within a marriage seem to have different effects on men and women
depression seems to CAUSE men to withdraw and disrupt the relationship, whereas women tend to get depressed because of problems in the relationship
89
how does work stress affect men and women differently?
psychological work stress predict depression in men, but physical work stress predict depression in women.
90
(these 5 things) contribute to depression, anxiety, and mania, which can lead to a mood disorder
1) biological vulnerability
2) psychological vulnerability
3) stressful life event
4) hormone imbalance
5) social causes.
91
3 basic types of antidepressant medications used to treat depressive disorders
1) tricyclic antidepressants (typically downregulates NE)
2) MAOs
3) SSRIS.
Lithium sometimes, but it is toxic.
92
why must pregnant women be weary of taking antidepressants
SSRIs are associated with lower APGAR scores in the babies when they are born.
93
one advantage and one disadvantage of lithium
1) toxic at high doses
| 2) good for treating manic episodes.
94
preferred drugs for bipolar disorder
lithium. Often used along side other mood stabilizers like SSRIS
95
for depressed inpatients with psychotic features, what treatment might they benefit from?
ECT
96
cons of ECT
short term memory loss
| possible bone breakage when they are convulsing.
97
neurophysiological benefits to ECT
1) increases 5HT
2) blocks cortisol
3) promotes neurogenesis in the hippocampus.
98
neurophysiological treatments for depression
1) ECT
2) TMS (not as effective as ECT, probs same effectiveness as drugs)
3) vagus nerve stimulation to influence NT transmission in the brain stem
4) deep brain stimulation in deverely depressed pts
99
cognitive therapy
involves correcting cognitive errors and cultivating more realistic thoughts rather than perpetually negative thoughts
- tries to restructures underlying schemas.
100
socratic approach
makes it clear that therapist and clients are working as a team to uncover the faulty thinking patterns and the underlying schemas.
101
behavioural experiment
therapy where pts are asked to predict what behaviour they think their friends wil exhibit (especially if they think their friends don't like them), and then seeing what they actually do
102
interpersonal psychotherapy
focuses on resolving problems in existing relationships and learning to form important new interpersonal relationships.
working out issues such as marital conflict, adjusting to relationship loss, death of a loved one, acquiring new relationships etc.
103
first goal of IPT
to identify an interpersonal dispute. If this disput seems to be associated with the onset of depressive symptoms and to result in a continuing series of arguments and disagreements without resolution, it would become the focus for IPT
104
3 stages of a dispute that is being assessed by IPT
1) negotiation stage; attempts to dissolve the dispute
2) impasse stage; lowlevel resentment, no attempts to resolve it
3) resolution stage; action is being taken, such as separation or divorce
105
T/F: in severe depression, combos of drugs and psychosocial treatments are effective.
true.
IN SEVERE DEPRESSION, COMBOS OF DRUGS AND PSYCHOSOCIAL TREATMENTS ARE EFFECTIVE.
but in not-severe depression, there wasn't much difference.
combining treatments might take advantage of the drugs' rapid action and the psychosocial protection against reoccurence and relapse.
106
Mindfulness: (good at preventing relapse)
“Paying attention in a particular way; on purpose, in the present moment, non judgmentally.”
- Often included as component (with varying emphasis) in many CBT approaches
- Mindfulness-based cognitive therapy (MBCT)
- Acceptance and commitment therapy (ACT)
- Dialectical behaviour therapy (DBT)
- mindfulness behaviour therapy
107
problems with treating bipolar disorder with drugs
compliance. during the manic stage, people with BP don't wanna take their meds.
108
Interpersonal and Social rhythym Therapy
a treatment for bipolar disorder in which therapists try to regulate their pts eating and sleep cycles in addition to daily schedules.
109
4 key areas of dialectical behavioural therapy
1) mindfullness
2) distress tolerance
3) emotion regulation
4) interpersonal effectiveness.
