Chapter 8 Flashcards
Mood Disorders
Group of disorders involving severe and enduring disturbances in
emotionality ranging from elation to severe depression
Unipolar Mood Disorder
mood remains at one pole of depression–mania continuum
Bipolar Mood Disorder
mood travels between depression–elation poles
Mixed Features
Mix of Symptoms
Major Depressive Disorder
- Mood disorder involving one (single episode) or more (separated
by at least two months without depression , recurrent) major depressive episodes
-Cognitive Symptoms; feelings of worthlessness and indecisiveness
-Disturbed physical functions;altered sleeping patterns, significant changes in appetite and weight, or a very notable loss of energy
-Recurrent
Persistent Depressive Disorder (Dysthymia)
Mood disorder involving persistently depressed
mood, with low self-esteem, withdraw, pessimism, or despair; present for at least two
years, with no absence of symptoms for more than two months
Double Depression
Severe mood disorder typified by major depressive episodes
superimposed over a background of dysthymic disorder
8 Specifiers to Describe Depressive Disorders
- With psychotic features (mood-congruent or mood-incongruent),
- With anxious distress (mild to severe),
- With mixed features,
4.With melancholic features, - With atypical features,
- With catatonic features,
7, With peripartum onset, - With season pattern
Seasonal Affective Disorder (SAD)
Mood disorder involving cycling of episodes corresponding to the seasons of the year, typically with depression occurring during the
winter
Psychotic Features Specifiers
Hallucinations (seeing or hearing things that are not there),
delusions (strongly held but inaccurate beliefs)
Peripartum
Peri, meaning surrounding, period of time just before and after giving birth
Baby Blues
Minor reaction in adjustment to childbirth, last only a few days, mothers may be tearful and have mood swings but this disappears quickly
Onset and Duration of Depressive Disorders
-Mean age of onset is 25 years
Average age may be decreasing; seeing rise in adolescence, especially girls
-Average duration of the first episode is two to nine months if left untreated
-Persistent depressive disorder may last 20–30 years (PDD)
Integrated Grief
Grief that evolves from acute grief into a condition in which the individual accepts the finality of a death and adjusts to the loss
PMDD
Disorder of mood whose symptoms include physical symptoms, severe mood swings, and anxiety that cause incapacitation during most menstrual cycles, starting in the final week before the onset of menses, improving within a few days after the onset of menses, and becoming absent in the week post-menses
Disruptive Mood Dysregulation Disorder
Condition in which a child has chronic negative
moods such as anger and irritability without any accompanying mania
Bipolar II Disorder
Alteration of major depressive episodes with hypomanic episodes (not full manic episodes)
Bipolar I Disorder
Alternation of major depressive episodes with full manic episodes - can be diagnosed based on manic episodes only
Cyclothymic Disorder
Chronic (at least two years) mood disorder characterized by alternating mood elevations and depression levels that are not as severe as manic or major
depressive episodes
Mania
extreme pleasure in every activity
-Hyperactivity, rapid speech
-Flight of ideas
-Person may require hospitalization
Hypomanic Episode
not as severe as a manic episode
-No marked impairment in social or occupational functioning
-“Hypo”: below; thus below level of a manic episode
Bipolar Specifiers
- Mixed features
- Rapid-cycling
Rapid Cycling/Rapid Mood Switching
Experiencing 4 or more manic and depressive episodes within a year - harder to treat and more likely to choose suicide
Ultra Rapid Cycle
Cycle length that only last for days to weeks
Ultra-Ultra Rapid Cycle
Cycle lengths of less than 24 hours
Onset and Duration
Average age of onset:
-Bipolar I disorder: 15–18 years
-Bipolar II disorder: 19–22 years (10%–25% progress to full Bipolar I)
-Suicide can be a consequence (6-7%)
-60% of cyclothymic patients women
-Sufferers are thought to be high-strung, explosive, moody, or hyperactive
Gender Differences in Mood Disorders
-Child and adolescent is more boys (but women are increasing)
-In adulthood it is more women then men
-older adults it is equal
Mood Disorders in Children and Adolescents
-Mood disorders in children similar to mood disorders in adults
-Manifestation is age-specific: facial expression in younger children
-Limited activities in older children increases risk
-Decline in annual prevalence rates
Mood Disorders in Older Adults
-Major depressive episodes seen in
18%–20% nursing home residents
-Depression in older adults strongly associated with race and ethnicity
-Depression can contribute to physical disease in seniors
-Affects men and women in equal numbers
Mood Disorders in the Creative
-Creativity associated with manic episodes
-Genetics may play a role too
-Many poets and writers bipolar and suicidal
Anhedonia
Marked general loss of interest and the ability to experience pleasure from life
Flight of Ideas
Speech very rapid and may become incoherent, because the individual is attempting to express so many exciting ideas at once
Full Remission
Patient recovers fully for at least two months between episodes
Partial Remission
Only partially recover retaining some symptoms
Biological Causes of Mood Disorders
-Familial and Genetic Influences
-Joint Heritability of Anxiety and Depression
-Neurotransmitter Systems
-The endocrine System
-Neurohormones
-Sleep and circadian rythms
-Brain Structure and Function
Familial and Genetic Influences
and Mood Disorders
Two to three times in relatives of probands
Joint Heritability of Anxiety and Depression and causes of mood disorders
Close relationship among depression, anxiety, and panic
Genes also implicated
Neurotransmitter Systems and Mood Disorders
-Low levels of serotonin (hence mood swings)
-Serotonin regulates emotions
-Chronic stress also reduces dopamine levels
-Possibly produces depressive-like behaviour
The Endocrine System and Mood Disorders
-Diseases leading to excessive secretion of cortisol lead to depression
-Neurotransmitter activity in hypothalamus regulates HPA axis
-People’s diet might have a role in depression
Neurohormones
-Hormones that affect the brain and are increasingly the focus of study in psychopathology
- affect the central nervous system
Sleep and Circadian Rhythms and Mood Disorders
-REM starts sooner after falling asleep in depressed people
-Depressed experience more intense REM activity
-Slow wave (deep) sleep occurs later
-Disturbed sleep
Brain Structure and Mood Disorders
Depressed individuals show:
-Greater right-sided anterior activation of brain
-Less left-sided activation
HPA Axis
Begins in hypothalamus, runs through the pituitary gland, which coordinated the
endocrine system
Psychological Causes of Mood Disorders
-Stressful Life events
-Learned helplessness
-Negative cognitive styles
-Cognitive triad
-Cognitive Vulnerability for Depression: An Integration
Stressful Life Events and Mood Disorders
-In 20%–50% of cases, depression is caused by severe events
-Interpretation of stressful events
-Jobs, single parenting, financial stresses
-Gene–environment correlation model
-Vulnerability
-COVID-19 pandemic
Learned Helplessness and Mood Disorders
-People become depressed when they feel they have no control over life’s stresses
-Learned helplessness theory of depression
-Depressive attributional style is:
Internal, stable, global
-Sense of hopelessness experienced; pessimistic lifestyle
Depressive Attributional Style: Internal
Internal; in that the individual attributes negative events to
personal failings
Depressive Attributional Style: Stable
in that even after a particular negative event passes, the
attribution that ‘ additional bad things will always be my fault’ remains
Depressive Attributional Style: Global
in that the attributions extend across a wide variety of issues
Negative Cognitive Styles and Mood Disorders
-depression arises from interpreting everyday events negatively
-Cognitive errors: arbitrary inference and overgeneralization
Cognitive Triad
depression may result from a tendency to think negatively about three areas; 1. The self,
2, the immediate world,
3. And the future
Cognitive Vulnerability for Depression: An Integration and Mood Disorders
Depression always associated with
-Pessimistic explanatory style and negative cognitions
Cognitive vulnerabilities predispose some people to view events in a very negative way
-Puts them at risk for depression
Social and Cultural Causes of Mood Disorders
-Marital Relations
-Mood Disorders in Women
-Social Support
Marital Relations and Mood Disorders
-Marital dissatisfaction: disruptions lead to depression
-High conflict, low support
-Deterioration in marital relationships
-Bipolar individuals less likely to marry, more likely to divorce (if they marry)
Mood Disorders in Women
-70% of people with major depressive and persistent depressive disorders are women
-Perceptions of uncontrollability
-Other factors:
-Societal roles assigned to women, rumination, poverty, single mothers, abuse histories
Social Support and Mood Disorders
-Rate of depression 80% higher for those who live alone
-Lack of social support predicts onset of symptoms of depression
-Social support enables speedy recovery from depressive episodes and postpartum depression
Medications For Depression
-SSRI
-SNRI
-Tricyclics
-MAOI
Problems with Tricyclics
overdose
Monoamine Oxidase Side Effects (MOA)
Consuming food/beverage containing tyramine
such as cheese, red wine, or beer can lead to severe hypertensive episode and occasionally death.
Bipolar Medications (Mood Stabilizers)
-Lithium
-Valproic Acid (Valproate)
Lithium
Lithium carbonate: a common salt
-Effective in preventing and treating manic episodes for 50% of patients
-Mood-stabilizing drug
Valproic acid (valproate)
-Anticonvulsants
-Become more widely used than Lithium
-Less effective on suicide than lithium
Electroconvulsive Therapy (ECT)
biological treatment for severe, chronic depression involving the application of electrical impulses through the brain to produce seizures. The reasons for its effectiveness are unknown
Transcranial Magnetic Stimulations (TMS)
-Method for altering electrical activity in the brain by setting up a strong magnetic field, works by placing magnetic coil over the individuals head to generate precisely localized electromagnetic pulse
- more lowkey than ECT
Psychosocial Treatments for Mood Disorders
-Cognitive Therapy
- Interpersonal Psychotherapy (IPT)
Cognitive Therapy
-Correcting cognitive errors in deep-seated negative thinking
-Realistic thinking encouraged by monitoring and logging thought processes
-Other activities to decrease depression are encouraged
Interpersonal Psychotherapy (IPT)
Therapy that focuses on resolving problems in existing relationships and learning to form important new interpersonal relationships
3 Stages of IPT
- Negotiation stage, 2. Impasse stage, 3. Resolution stage
Combined Treatments
-Combined treatment generally just as effective as separate drug or psychosocial therapies in treatment of depression
-In severe depression, combination of drug and psychosocial treatments effective
-Depends on the individual being treated
Maintenance Treatment
Combination of continued psychosocial treatment or medication designed to prevent relapse following therapy
Mindfulness-based cognitive therapy
teaches depressed patients to disengage from negative thinking (Therapy Prevents Depressive Relapse)
Psychosocial Treatments for Bipolar Disorder
-Interpersonal and social rhythm therapy (IPSRT)
-Family-focused treatment combined with medication
-CBT is effective for bipolar patients with rapid cycling
Suicide Attempts
Efforts to kill oneself
Suicidal Ideation
Serious thoughts about committing suicide
Psychological Autopsy
Post-modern psychological profile of a suicide victim constructed from
interviews with people who know the person before death
Treatment for Suicide
Assess for possible suicide ideation
-Suicide prevention and crisis centres
-Cognitive-behavioural interventions
-Coping-based interventions
-Stress reduction techniques
