Chapter 7: Mood Disorders and Suicide Flashcards
How do mood disorders differ from feeling depressed from time to time?
Mood disorders involve much more severe alterations in mood for much longer periods of time. In such cases the disturbances of mood are intense and persistent enough to lead to serious problems in relationships and work performance.
What are the two key moods involved in mood disorders?
Depression and Mania.
Out of the two key moods, how can depression best be described?
Involves feelings of extraordinary sadness and dejection
Out of the two key moods, how can mania best be described?
Involves intense and unrealistic feelings of excitement and euphoria.
What is it called when individuals have symptoms of mania and depression (the person experiences rapidly alternating moods such as sadness, euphoria, and irritability, all within the same episode of illness) during the same time period?
Mixed-episode cases.
Name the types of mood disorders.
Unipolar depressive disorders and bipolar and related disorders.
What is a unipolar depressive disorder?
Person experiences only depressive episodes
What is a bipolar and related disorder?
Person experiences both depressive and manic episodes
What episode is the most common form of mood disturbance?
A depressive episode, in which a person is markedly
depressed or loses interest in formerly pleasurable activities (or both) for at least 2 weeks, as well as other symptoms such as changes in sleep or appetite, or feelings of worthlessness (as opposed to a manic episode)
What is a manic episode?
Person shows a markedly elevated, euphoric, or expansive mood, often interrupted by occasional outbursts of intense irritability or even violence—particularly when others refuse to go along with the manic person’s wishes and schemes.
Moods must persist for at least a week for this diagnosis to be made.
Three or more additional symptoms must occur in the same time period, ranging from behavioral symptoms (such as a notable increase in goal-directed activity), to mental symptoms where self-esteem becomes grossly inflated and mental activity may speed up (such as a “flight of ideas” or “racing thoughts”), to physical symptoms (such as a decreased need for sleep or psychomotor agitation).
What is a hypomanic episode?
Person experiences abnormally elevated, expansive, or irritable mood for at least 4 days.
The person must have at least three other symptoms similar to those involved in mania but to a lesser degree (inflated self-esteem, decreased need for sleep, flights of ideas, pressured speech, etc.).
Although the symptoms listed are the same for manic and hypomanic episodes, there is much less impairment in social and occupational functioning in hypomania, and hospitalization is not required.
Prevalence of mood disorders?
Major mood disorders occur with alarming frequency—at least 15 to 20 times more frequently than schizophrenia
Of the two types of serious mood disorders, what is the most common?
Of the two types of serious mood disorders, major depressive disorder (MDD), in which only major depressive episodes occur (also known as unipolar major depression), is the most common, and its occurrence has apparently increased in recent decades
Is unipolar major depression higher for women or men?
Women
Beside Major Depressive Disorder (MDD), what is the other type of major mood disorder?
Bipolar disorder.
Is bipolar disorder more or less common than major depressive disorder?
Less.
What is the lifetime risk of developing (classic) bipolar?
Less than 1%.
Is there a difference in the lifetime risk of developing (classic) bipolar between the sexes?
No.
T or F: Rates of unipolar depression are inversely related to socioeconomic status (SES); that is, higher rates occur in lower socioeconomic groups?
True. Epidemiologic research indicates that rates of
unipolar depression are inversely related to socioeconomic status (SES); that is, higher rates occur in lower socioeconomic groups.
Why might rates of unipolar depression be inversely related to socioeconomic status (SES); that is, higher rates occur in lower socioeconomic groups?
Low SES leads to adversity and life stress
What has new research discovered about bipolar and SES?
That it is not related.
T or F: To be diagnosed with MDD, you cannot have manic, hypomanic, or mixed episodes.
True.
T or F: Anxiety is often comorbid with all types of depression.
True. Few if any depressions—including milder ones—occur in the absence of significant anxiety.
What also happens when a diagnosis of MDD is made?
When a diagnosis of MDD is made, it is usually also specified whether this is a first, and therefore single (initial), episode or a recurrent episode (preceded by one or more previous episodes).
How long do depressive episodes last if left untreated?
6 to 9 months
If symptoms of MDD do not remit over 2 years, what is diagnosed?
If the symptoms of MDD do not remit for over 2 years, in which case persistent depressive disorder is diagnosed
What percentage of people get diagnosed with persistent depressive disorder after symptoms do not remit?
10 to 20 percent
How long do symptoms have to be gone to be considered “remitted” from most depressive episodes?
At least two months.
The return of symptoms (depressive episodes) can be one of two types. What are the two types?
Relapse and recurrence.
What is relapse? (referring to depressive episodes).
Relapse refers to the return of symptoms within a fairly short period of time, a situation that probably reflects the fact that the underlying episode of depression has not yet run its course
What is recurrence? (referring to depressive episodes).
The onset of a new episode of depression
Regarding recurrence (for depressive episodes), what percentage of people does this occur?
Occurs in approximately 40 to 50 percent of people who experience a depressive episode
The probability of recurrence increases with the number of prior episodes and also when the per-son has comorbid disorders.
When is the onset of unipolar depressive disorders most likely to occur?
The onset of unipolar depressive disorders most often occurs during late adolescence up to middle adult-hood, but such reactions may begin at any time from early childhood to old age.
What percentage of adolescents experience major depressive disorder at some point?
15-20%
When do sex differences in rates of depression first emerge?
In adolescence
T or F: Major depression that occurs in adolescence is very likely to recur in adulthood.
True.
What are specifiers (in the DSM-5)?
Symptoms or features that are important to note when making a diagnosis because these patterns have implications for understanding more about the course of the disorder and its most effective treatment.
What are the five specifiers outlined in the DSM-5 for MDD?
MDD with melancholic features/psychotic features/atypical features/catatonic features/seasonal pattern.
What is MDD with melancholic features?
This designation is applied when, in addition to meeting the criteria for a major depressive episode, a patient either has lost interest or pleasure in almost all activities or does not react to usually pleasurable stimuli or desired events.
What is MDD with psychotic features?
Psychotic symptoms, characterized by loss of contact with reality and delusions (false beliefs) or hallucinations (false sensory perceptions), may sometimes accompany other symptoms of major depression (severe major depressive episode with psychotic features).
Ordinarily, any delusions or hallucinations present are mood congruent—that is, they seem in some sense appropriate to serious depression because the con-tent is negative in tone, such as themes of personal inadequacy, guilt, deserved punishment, death, or disease.
Individuals who are psychotically depressed are likely to have longer episodes, more cognitive impairment, and a poorer long-term prognosis than those suffering from depression without psychotic features
What is MDD with atypical features?
Mood reactivity—brightens to positive events; two of the four following symptoms: weight gain or increase in appetite, hypersomnia, leaden paralysis (arms and legs feel as heavy as lead), being acutely sensitive to interpersonal rejection.
What is MDD with catatonic features?
A range of psychomotor symptoms from motoric immobility to extensive psychomotor activity, as well as mutism and rigidity
What is MDD with seasonal pattern?
Used when individuals who experience recurrent depressive episodes show a seasonal pattern, recurrent major depressive episode with a seasonal pattern, also commonly known as seasonal affective disorder.
At least two or more episodes in past 2 years that have occurred at the same time (usually fall or winter), and full remission at the same time (usually spring). No other nonseasonal episodes in the same 2-year period.
What type of MDD-specifier combination is more heritable than most other forms of depression and is often associated with a history of childhood trauma?
Major depressive episode with melancholic features
How do you treat MDD with psychotic features?
With psychotic medication or antidepressants.
Which sex is more likely to have MDD with atypical features?
A disproportionate number of individuals who have atypical features are females, who have an earlier-than-average age of onset and who are more likely to show suicidal thoughts
What disorder is MDD with atypical features linked to?
Atypical depression is linked to a mild form of bipolar disorder that is associated with hypomanic rather than manic episodes
Why is MDD with atypical features important?
There are indications that individuals with atypical features may preferentially respond to a different class of antidepressants—the monoamine oxidase inhibitors—than do most other individuals with depression.
What is Catatonia considered to be a sub-type of?
Catatonia is known more as a sub-type of schizophrenia, but it is actually more frequently associated with certain forms of depression and mania than with schizophrenia
What do prevalence rates suggest about winter seasonal affective disorders?
That winter seasonal affective disorder is more common in people living at higher latitudes (northern climates) and in younger people.
What is persistent depressive disorder?
A disorder characterized by persistently depressed mood most of the day, for more days than not, for at least 2 years (1 year for children and adolescents).
In addition, individuals must have at least two of six additional symptoms when depressed.
Periods of normal mood may occur briefly, but they usually last for only a few days to a few weeks (and for a maximum of 2 months). This is the biggest distinguisher between MDD and PDD.
T or F: Because of its chronic course people with persistent depressive disorder show poorer outcomes and as much impairment as those with MDD
True.
When PDD and MDD co-occur, what is this condition called?
Double depression
In the DSM-5, what is double depression classified under?
In the DSM, double depression is classified as a form of persistent depressive disorder.
T or F: Persistent depressive disorder is quite common.
True. Persistent depressive disorder is quite common, with a lifetime prevalence estimated at between 2.5 and 6 percent
What is the average duration of PDD?
The average duration of persistent depressive disorder is 4 to 5 years, but it can last for 20 years or more
When does PDD often begin?
Persistent depressive disorder often begins during adolescence, and over 50 percent of those who present for treatment have an onset before age 21.
T or F: Depressions are nearly always precipitated by stressful life events.
True. These dramatic events often can push a person into a depressive episode, and psychologists have struggled with how to appropriately diagnose (or not) a person’s response to them.
Bowlby’s (1980) classic observations revealed that there are usually four phases of normal response to the loss of a spouse or close family member. What are they?
(1) numbing and disbelief
(2) yearning and searching for the dead person
(3) disorganization and despair that sets in when the person accepts the loss as permanent
(4) some reorganization as the person gradually begins to rebuild his or her life.
T or F: All loss is followed by depression.
False.
What do recent studies show on those experiencing loss of a spouse, life partner, or parent?
Recent studies of those experiencing the loss of a spouse, life partner, or parent reveal that about 50 percent exhibit genuine resilience in the face of loss, with minimal, very short-lived symptoms of depression or bereavement.
These resilient individuals are not emotionally maladjusted or unattached to their spouses
T or F: Recent research has found that postpartum depression is more common that postpartum blues.
False. In the past it was believed that postpartum major depression in mothers was relatively common, but more recent evidence suggests that only “postpartum blues” are very common.
What are postpartum blues?
Symptoms of postpartum blues typically include changeable mood, crying easily, sadness, and irritability, often liberally intermixed with happy feelings
What percentage of women do postpartum blues occur in?
As many as 50 to 70 percent of women within 10 days of the birth of their child and usually subside on their own
T or F: There is a greater likelihood of developing major depression after the postpartum blues—especially if they are severe.
True.
T or F: Postpartum blues or depression may be especially likely to occur if the new mother has lack of social support or has difficulty in adjusting to her new identity and responsibilities
True.
T or F: Postpartum blues or depression may be especially likely to occur if the woman has a personal or family history of depression that leads to heightened sensitivity to the stress of childbirth
True.
T or F: Family studies have shown that the prevalence of mood disorders is approximately two to three times higher among blood relatives of persons with clinically diagnosed unipolar depression than it is in the population at large.
True.
T or F: Twin studies suggest that there is a moderate genetic contribution to MDD.
True.
Although attempts to identify specific genes that are responsible for genetic influences on mood disorders have been unsuccessful thus far, what is one specific gene that may be implicated?
The serotonin-transporter gene.
What does the serotonin-transporter gene do?
It is involved in the transmission and reuptake of serotonin, which is one of the key neurotransmitters involved in depression.
Regarding the serotonin-transporter gene, what are the two different kinds of versions or alleles that are involved?
The short allele (s) and the long allele (l).
Regarding the short allele (s) and the long allele (l), what compositions usually show in humans?
People either have two short alleles (s/s), two long alleles (l/l), or one of each (s/l).
What does previous work with animals suggest about the alleles involved in the serotonin-transporter gene?
Although previous work with animals has suggested that having ss alleles might predispose a person to depression (in comparison to someone having l/l alleles), human work on this issue has provided mixed results.
T or F: The monoamine theory of depression - that depression was at least sometimes due to an absolute or relative depletion of one or both of the monoamine neurotransmitters (serotonin and norepinephrine) at important receptor sites in the brain - is still influential to this day.
False. It was one influential - in the 1980s, it was clear that no such straightforward mechanism could possibly be responsible for causing depression.
It has not be replaced with an alternative explanation.
Why does dopamine dysfunction have a significant role in some forms of depression, including depression with atypical features and bipolar depression?
Because dopamine is prominently involved in the experience of pleasure and reward - which would impact the prominence of anhedonia (the inability to experience pleasure).
The human stress response is associated with elevated activity of the…
Hypothalamic-pituitary-adrenal (HPA) axis (which is partly controlled by norepinephrine and serotonin.
The perception of stress or threat can lead to norepinephrine activity in the hypothalamus, causing the release of corticotrophin-releasing hormone (CRH) from the hypothalamus, which in turn, triggers the release of adrenocorticotrophic hormone (ACTH) from the pituitary.
The ACTH then typically travels through the blood to the adrenal cortex of the adrenal glands, where cortisol is released.
T or F: Patients having depression with elevated cortisol also tend to show memory impairments and problems with abstract thinking and complex problem solving.
True.