Chapter 7: Mood Disorders -Textbook extras Flashcards
Ahedonia??
-inability to experience pleasure
What symptoms are central to a major depressive episode?
- physical symptoms
L> somatic/vegetative symptoms
In terms a manic episode what is the term flight of ideas referring to?
- rapid speech, incoherent because the individual is attempting to express many exciting ideas all at once
What is a dysphoric episode?
- when someone experiences manic symptoms but still feels somewhat depressed or anxious at the same time.
Major depressive disorder, single episode?
- absence of manic or hypomanic episodes before or during the episode
Major depressive disorder, recurrent?
- stats as well
- two or more major depressive episodes occurred and were separated by at least two months during which the individual was not depressed
85% experience another episode
After the death of someone the frequency of severe depression that follows is a high as __%. They however do/do not consider this a disorder ?
- 62%
- do not unless the symptoms are very severe like psychotic features or suicide ideation or the less alarming symptoms last longer than 2 months.
Natural grief normally lasts how long?
- several months up to a year, sometimes longer
After experiencing a year of grief what is the __% of those that do not recover due to absence of treatment and it turning into a disorder?
- 10-20% it becomes a disorder
When normal grief progresses to a disorder what is it called?
- pathological grief reaction or impacted grief reaction
L> intrusive memories and distressingly strong yearnings for the loved one, and avoiding people or places that are reminders of the loved one.
Bipolar II Disorder?
- major depressive episodes alternate with hypomanic episodes rather than full ones
Bipolar I Disorder?
- major depressive episodes alternate with full manic episodes
During manic episodes what do patients often do?
- they deny anything is wrong with them
Cyclothymic disorder??
- chronic alteration of mood elevation and depression that does not reach the severity of manic or major depressive episodes. They tend to exp one mood state for long periods of time (years) without very few periods of neutral/euthymic mood. (must lasts for two years)
Bipolar I and Bipolar II ages of onset?
onset proceeds what?
- stats of those that progress to BiD I
- is it common for someone to develop BiD after age 40?
- 18
- 22
- onset usually follows minor oscillations in mood or mild cyclothymic mood swings
- 13% with BiD II move on to BiD I
- rare
Suicide rates with BiD are?
12-48%
Postpartum onset specifier? applies to ?
characterized by?
stats for re-experiencing it?
- increases risk ?
- both Major depressive episodes and manic episodes
- severe manic or depressive episodes that first occur during the postpartum period ( four weeks) after child birth….two to three days after delivery..
- 50%
- infants with difficult temperaments, low socioeconomic status and high levels of life stress
What are the 3 specifiers for describing depression or mania?
- Longitudinal course specifiers
- Rapid Cycling specifiers
- seasonal pattern specifiers
- Longitudinal course specifiers? (4)
- history of mania or depression before?
- did they recover between episodes?
- did they have dysthymia before the episode - double depression
- cyclothymic disorder before?
- Rapid cycling specifier?
- stats who experience this
- who does this apply to
- suicide rates?
- do they being with a mania episode first just as people with BiD do in general?
- describe the cycles over time
- only to BiD II and I
- exp at least four manic or depressive episodes within a year is considered to have a rapid cycling pattern, does not respond well to treatments, higher chances of suicide
- 20% with BiD have this
- people with this begin with a depressive episode first rather than mania
- cycles without breaks, increasing in frequency
- Seasonal pattern specifier?
-includes?
-accompanies?
L> Disorder is called?
*explain it both for MDDR and BiD
- both BiD and recurrent major depressive disorder
- accompanies episodes that occur during certain seasons ex: winter depression
- Seasonal Affective disorder
L> Depression begins in fall, ends in spring
L> BiD: begins depression in winter and manic during the summer
What is weird with seasonal affective disorder and the depression experienced?
- Winter depression: excessive sleep instead of decreased sleep, increased appetite rather than decreased and weight gain rather than loss.
Biological explanation for SAD?
- Melatonin
- Circadian rhythms
- location?
- production of melatonin
L> increased production may trigger depression in vulnerable people
L> circadian rhythms are also thought to have some relationship with mood and are delayed in the winter - worse in extreme northern and southern latitudes because of the lack of sunlight
What mood disorder is very common in young children?
- dysthymia
Children below the age of __ seem to present with more ___ and __ swings rather than manic states and are often mistaken to as being __.
- 9
- irritability
- mood
- hyperactive
Children especially boys tend to become ___ and even ___ during depressive episodes.For this reason they are often misdiagnosed with ____ or even___. Often ____ and depression co-occur.
- aggressive, destructive
- conduct disorder or hyperactivity
- conduct disorder
Late onset depressions are associated with what symptoms?
- sleeping difficulties
- hypochondriasis
- complication of diagnosis because of other medical conditions in the elderly
What two disorders frequently accompany depression in elderly ? When depression accompanies one of these the depression is characterized as ?
- GAD and PD
- more severe depression
The gender imbalance with depression disappears after the age of?
65
Almost all depressed patients are anxious but ?
not all anxious patients are depressed
What are the core symptoms of depression that set it apart from anxiety?
- anhedonia
- cognitive content?
- slowing of ?
- anhedonia: inability to experience pleasure
- slowing of both motor and cognitive functions until they are extremely laboured and effortful
- cognitive content: (what is thought about) is usually really negative in depressed people vs anxious.
What are symptoms of negative effect in regards to depression and anxiety/panic?
- symptoms that are not specific to either of the disorders and help define each respectively
Major Depression usually follows ___ and may be a consequence of it.
anxiety
With depression there is also comorbidity with what personality disorder?
borderline personality disorder
self harm behaviour as well
Equifinality ?? Mood disorders?
- same end product (mood disorder) BUT multiple causes
Family studies suggest what about unipolar and bipolar disorders?
-mood disorders run in families
L> the proband (first degree relatives) with a mood disorder and their relatives have a high chance of acquiring it…. 2 to 3 times more so than the gen
Adoption studies and mood disorders?
- data is mixed
Twin studies and mood disorders?
- best evidence
- 66.7% twins (identical) 18.9% fraternal twins if one twin has bipolar
- 45.6% (identical) and 20.2 (fraternal) for if the first twin has unipolar
What plays a greater role in mood disorders, genetics or the environment for men and women?
- environment plays a larger role in causing depression in men than women.
Permissive hypothesis?
- when serotonin lvld are low, other NT are permitted to range more widely, become dysregulated, and contribute to mood irregularities including depression.
Dopamine agonist L-dopa seems to do what in bipolar patients?
- produce hypomania
HPA axis and depression?
- cortisol lvls are elevated in depressed patients ,
Dexamethasone suppression test (DST)?
- used to suppress cortisol levels in normal individuals but when given to depressed individuals , less suppression occurred and what did happen did not last long (mostly only for severe depression cases)
what other type of hormones are involved with Mood disorders?
- neurohormones
Depressed people fall into REM sleep ____ than normal individuals. They also experience REM at a ___ intensity. They have ____ slow wave sleep which the deepest most restful part.
- faster
- greater
- diminished
Depriving depressed patients of sleep causes what? (particularly in their second half part of the night)
- temporary improvement in their condition
People with bipolar disorder and their children have a _____ sensitivity to light. They show ___ suppression of melatonin when they are exposed to light at night. Also extended bouts of insomnia do what?
- increased
- greater
- trigger manic episodes
Light therapy for SAD may have a ___ effect on BiD?
similar
Psychological what is looked for in a person life for activating a predisposition to mood disorders?
- stressful/traumatic event that occurred. The context of the event and the meaning it has for the individual is examined
One must follow people with mood disorders prospectively to avoid what issue when gaining info on the patients life?
- mood disorders distort memory
Reciprocal gene-environment model?
- genetic predisposition increases the probability we will experience stressful life events
Etiology of BiD? (2)
stats of those that do not develop depression or any other psych disorder?
- stressful events trigger early mania and depression, they develop lives of their own with progression
- some manic episodes seem to be related to lost of sleep
- 50 - 80%
Learned Helplessness theory of depression?- depression follows marked hopelessness with coping over difficult life events:
- Internal
- stable
- global
- individual attributes negative events to personal failings
- additional negative things will ALWAYS be my fault - even after the bad event passes
- negative attributes are extended across a wide variety of issues.
Aaron T Beck suggested that depression may result from a tendency to do what?
interpret everyday things in a negative way
Arbitrary inference (Beck)
- emphasizes the negative rather than positive aspects of a situation
Overgeneralization? (Beck)
- overgeneralizing from one small problem/negative event
ex: teacher says a critical remark to you…now you think you will fail the class
Depressive Cognitive triad? (Beck)
- making cognitive errors in thinking negatively about themselves, their immediate world and their future.
Only ___ gain a high risk of developing a mood disorder for the first time immediately following a marital split.
men
Ian Gotlib suggests what two things are important in generating depression?
- high conflict and low supper in marital relations
Depression causes men to do what to their relationship? Women?
- men: withdraw from the relationship
- women: the relationship problems cause depression
About __% of those with major depressive disorder and dysthymia disorder are women.
70%
A socially supported network of friends and family aids in recovery from ___ but not ___ episodes.
-depressive, mania
Risks for women and depression?
- value they place on intimate relationships, they ruminate more than men about their situation and blame themselves (men ignore feelings and go catharsis)
- the experience more discrimination, poverty and sexual harassment
- single mothers and work
Integrative Theory of Depression?
- stressful life event trigger onset of depression in most cases especially the initial episode
-activate stress hormones
L> effect NT ( Sert, NorE and the CRF system)
L> also it causes the activation of certain genes producing long term structural changes in the brain
> long term stress can cause atrophy of neurones in the hippocampus
What are the three kinds of antidepressants?
- tricyclic antidepressants, monoamine oxidase (MAO) inhibitors, and selective serotonin reuptake inhibitors (SSRI)
Tricyclic antidepressants? ex: Torfanil and Elavil - how do they work? L> what NT particularly do the effect - duration to work? -side effects? (6) Why must they be prescribed with caution?
block reuptake of NT allowing them to pool in the synapse
- Norepinephrine and Sert mostly
- desensitize or down regulation of transmission.
- 2-8 weeks to work
- Side effects: blurred vision, dry mouth, constipation, difficulty urinating and weight gain (~6kg) and drowsiness
- can be lethal in excessive doses
Monoamine oxidase Inhibitors?
- block?
- work?
- consuming tyramine causes?
- only prescribed when?
- block the enzyme responsible for breaking down NT like norepinephrine and serf
- pool in synapse
- consuming foods and beverages containing tyramine (cheese, beer, redline etc) can lead to hypertensive episodes and sometimes death
- only prescribed if tricyclics are not working!
Selective serotonin reuptake inhibitors ?
- block the presynaptic reuptake of serotonin
- prozac ex
Side effects of prozac?
- physical agitation, sexual dysfunction, low desire, 50-70% patients, insomnia and gastrointestinal upset.
Venalfaxine is a tricyclic antidepressant but HOW is it DIFFERENT?
- reduces some associated side effects as well as the risk of damage to the cardiovascular system
Nefazodone is related to SSRI but seems to?
- improve sleep
St. Johns Wort?
- mostly just for those exp mild depression
- lethargy occurs when in combination with other antidepressants
There have been sudden death reports in children under 14 for those taking what drugs?
- tricyclic antidepressants
- during exercise mostly
Drug treatment should go how long after the disappearance of the episode?
6-12 months
Lithium carbonate?
-issues?
pros?
ex?
- mood stabilizer
- high dosage can cause poisoning and low thyroid functioning which can intensify the lack of energy associated with depression and weight gain is common.
- it is effective in preventing and treating mania
- ex: valporate
- mostly used for BiD
Tricyclic antidepressants can induce what?
- manic episodes in those with no history
Electroconvulsive Therapy
- once every other day for 6-10 treatments
- 50% of those not responding to medication benefit front his
- induce massive functional and structural changes in the brain, increasing lvld of serotonin, blocks stress hormone, and promotes neurogenesis in the hippocampus
After ECT what treatment follows up?
- drug treatment or psychological treatment is necessary but relapse is still high
Transcarnial Magnetic stimulation (TMS)?
- magnetic coil around the patients head to generate precise electromagnetic pulse.
Vagus nerve stimulation?
- pacemaker like device in the neck that generates pulses influencing NT production in the brain stem and limbic system
Deep Brain stimulation for severely depressed ?
- electrodes implanted in the limbic system, connected to a pacemaker like device
Phototherapy?
treatment for SAD
- exposed to two hours of very bright light after waking up
- mood shift in three days
- remission of winter depression in 1-2 weeks
- side effects:headaches> eye strain> feeling wired
- morning light is superior to evening light
Cognitive Therapy?
- recognize error in thought processes while depressed
- taught these cause depression
- correcting cognitive errors and substituting less depressing and more realistic thoughts and appraisals = treatment
Between Cog Therapy patients do what?
Hypothesis testing along with it?
- monitor their thought processes
- client makes a hypothesis about whats going to happen (usually negative) and then most often discover it was incorrect.
Interpersonal Therapy?
(2)
and the issues tackled (4)
- focuses on resolving problems in existing relationships and learning to form important new ones
- lasts 15 to 20 sessions , once a week
1. role disputs
2. loss of relationship
3. acquiring new relationships
4. correcting deficits in social skills
After identifying the dispute in IT they then identify what dispute stage they are in:
- negotiation stage
- impasse stage
- resolution stage
- aware of dispute trying to talk it out
- low level resentment no attempts to resolve it
- taking some action such as separation or divorce
Psychosocial and medication treatments are____ effective in treating mood disorders
equally
What are maintenance treatments?
- prevent relapse
Cognitive behavioural therapy reduces relapse by more than 50 % vs those treated with meds is an example of what?
maintenance treatment
Mindfulness-based cognitive therapy?
- teach recovered depressed patients to disengage from the kinds of neg thinking that can precipitate a relapse.
- more self aware
Psychosocial therapy?
Family therapy
- less than half of the reoccurrence of those with just med treatment
- family tension is associated with relapse in BiD
Males are ___ more likely to commit suicide than females.
4 times
Male suicide methods?
Female?
- violent: guns, hanging
- drug overdose
Suicidal attempts?
- the person survives
Suicidal ideation?
- seriously thinking about suicide
Females attempt suicide ___times more than men
3
Formalized suicides?aka Altruistic
- costume
- socially accepted
- consequence of action
Egoistic suicide?
- loss of social supports
Anomic suicides?
- marked disruptions like sudden loss of job
Fatalistic suicides?
- loss of control over our own destiny
Durkheim believed what about suicide?
- and depression to some extent indicated unconscious hostility directed inward to the self rather than outward to the person/situation…psychologically punishing others who may have rejected them etc
Psychological autopsy?
- extensive interviews with family, friends of individual that would have insight on the persons thinning prior to suicide
Risk of suicide in families increases when what occurs?
another member commits it
Low lvls of What NT are associated with suicide?
- serotonin
L> and with violent attempts - low lvls of serotonin are related to impulsive behaviour and instability, overreaction as well
More than __% of this who commit suicide have psychological disorders
90
