Chapter 8 Flashcards
DSM-5 criteria - Major Depressive Disorder
A. Five (or more) of the following symptoms have been present during
the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure (anhedonia).
- Depressed mood most of the day as indicated by either subjective
(e.g., feels sad, empty, hopeless) or observation made by others
(e.g. appears tearful). - Markedly dimished interest or pleasure in all, or almost all, activities
- Significant weight loss when not dieting or weight gain, or decrease
or increase in appetite - Insomnia or hypersomnia
- Psychomotor agitation or retardation
* Speech
* Facial expression
* Eye movements
* Speed and degree of movements
* Posture
* Self-touching - Fatigue or loss of energy
- Feelings of worthlessness or excessive or inappropriate guilt
- Diminished ability to think or concentrate, or indecisiveness
- Recurrent thoughts of death (not just fear of dying), recurrent
suicidal ideation without a specific plan, or a suicide attempt or a
specific plan for committing suicide
B. The symptoms cause clinically significant distress or impariment in
social, occupational, or other important areas of functioning
Persistent Depressive Disorder
Dysthymia
Chronic low mood, lasting for at least
two years
* Poor response to standard
depression treatment (compared to
episodic major depressive disorder)
* Impairment is also higher with
persistent depressive disorder.
Mood disorder with Peri- or
Postpartum Onset
Risk factors:
- Sensitivity to hormonal
fluctuations
- Family history of depression
- Previous episode of MDD
- Low social support
- The imbalance of hormones is
the trigger & the other factors
are making the person more
vulnerable.
Mania
Distinct period of elevated, expansive, or irritable mood that lasts at least one week and is accompanied by at least three assosciated symptoms
In mania, the selective attention function deteriorates and
the filter/prioritizer allows inappropriate and irrelevant stimuli to gain attention and focus
Increasing distractibility in mania leads to disorganization of thought and behavior
Hypomania
less severe mania - similar number of symptoms - only present for 4 days (increased energy, decreased need for sleep, racing thoughts, pressured speech, problems with attention and impaired judgement)
DSM-5 DIAGNOSTIC CRITERIA FOR MANIC EPISODE
A. distinct period of abnormally and persistently elevated,
expansive, or irritable mood and abnormally and persistently
increased goal-directed activity or energy, lasting at least 1 week
and present most of the day, nearly every day (or any duration if
hospitalization is necessary).
B. During the period of mood disturbance and increased energy or activity, three (or more)
of the following symptoms (four if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior:
1. Inflated self-esteem or grandiosity.
2. More talkative than usual or pressure to keep talking.
3. Decreased need for sleep (e.g., feels rested after only three hours of sleep)
4. Flight of ideas or subjective experience that thoughts are racing
5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed.
6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e., purposeless non-goal-directed activity).
7. Excessive involvement in activities that have a high potential for painful consequences
(e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).
C. The mood disturbance is sufficiently severe to cause marked
impairment in social or occupational functioning or to necessitate
hospitalization to prevent harm to self or others, or there are psychotic
features.
D. The episode is not attributable to the physiological effects of a
substance (e.g., a drug, medication) or to another mental condition
Bipolar 1
history of one or more manic episodes - depressive episode is not necessary
Bipolar 2
One or more hypomanic episodes, with one or more depressive episodes
Hypomanic vs manic
hypomanic: last for 4 consecutive days and present most of the day, nearly every day
Manic: at least 1 week and present most of the day, nearly every day OR any duration if hospitalization is
necessary)
hypomanic: unequivocal change in functioning that is uncharacteristic of the individual when not
symptomatic
Manic: mood disturbances is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features)
Cyclothymia
A chronic but less severe
form of bipolar disorder
A history of at least 2 years
of alternating episodes of
depression that do not meet
criteria for major depression
Rapid Cycling Specifier
presence of four or more manic
and/or major depressive
episodes in a 12-month period
High disability, low response to
treatment
Etiology of mood disorders
Heritable:
- personality
- cognitive - temperament is innate - effected by expenses
Stressful life events
- do not impact everyone the same
- diathesis stress model
pre existing vulnerability
- family
- relationships
- personality
Neurotransmitteres : Biological Causal factors
Key studied neurotransmitters: norepinephrine(NE), serotonin (5-HT),
dopamine (DA)
Low NE: bipolar disorder + severe unipolar depression
DA neurotransmission partly depends on the level of 5-HT
- DA linked to regulation of reward processing (experience of pleasure) and motor behavior (psychomotor retardation)
HPA (hypothalamic-pituitary-adrenal) Axis
Cortisol release during stress stimulates receptors in the
hippocampus. The hippocampus inhibit the HPA axis by negative
feedback.
Chronic stressors result in sustained release of cortisol and a
breakdown of the negative feedback inhibition of the HPA axis.
Prolonged periods of cortisol hypersecretion have been found to
kill brain cells and cause permanent damage to the hippocampus.
Supporting studies:
- The HPA axis is more reactive in females (2x depression)
- Depressed and traumatized adults have a smaller hippocampal
volume.
- Child abuse is associated with death of cells in the hippocampus
and amygdala (regulation of mood and emotional memory)
- Amygdala & cingulate cortex: Engage in negative information
(rumination) – difficulty to disengage
Psychological Causal Factors: Stress and Coping
- the way people cope with stressful life events can affect their emotional functioning
Treatment: Encourage to participate in pleasurable activities
low rate of response-contingent positive reinforcement
* Problem: Engaging in actions that are not rewarded
* No feelings of pleasure or sense of accomplishment
* A lack of positive reinforcement extinguishes adaptive behaviors
* Maladaptative coping: avoiding or withdrawing from potentially pleasant activities.
