Chapter 8 Flashcards
What are mood disorders?
-> Serious psychological conditions involving significant mood disturbances
->Marked by extreme sadness (depression) or elation/irritability (mania)
->Disabling → Interfere with daily functioning
->Often comorbid with other psychological problems (e.g., anxiety, panic attacks, substance abuse, personality disorders)
What are the main symptoms/disturbances of depression?
- Mood disturbances:
->Great sadness, feelings of worthlessness & guilt
- Cognitive disturbances:
->Self-criticism, self-blame, indecisiveness
->Slowed thinking
->Thoughts of death/suicide
- Physiological & behavioral disturbances:
->Changes in sleep & appetite (increase or decrease)
->Anhedonia: Loss of interest/pleasure in usual activities
What is mania?
->A period of abnormally elevated or irritable mood lasting at least one week or requiring hospitalization
->Extreme pleasure in every activity
->Must have at least 3 of the following:
(a) Inflated self-esteem
(b) Decreased need for sleep
(c) Talkativeness (racing speech, no connection between ideas)
(d) Flight of ideas (racing thoughts)
(e) Distractibility
(f) Increased goal-directed activity
What is a hypomanic episode?
->Mild version of mania
->Does NOT cause major impairment in social or everyday life functioning
->”Hypo” = Below
What are the two main categories of mood disorders?
- Depressive Disorders → Marked by low mood only
—>Major Depressive Disorder (MDD) (formerly unipolar disorder)
—>Disruptive Mood Dysregulation Disorder
—>Persistent Depressive Disorder (Dysthymia)
—>Premenstrual Dysphoric Disorder (PMDD)
- Bipolar & Related Disorders → Characterized by highs and lows in mood
—>Bipolar I Disorder → Can be diagnosed with only a manic episode, even if depression has not yet occurred
—>Bipolar II Disorder → Involves hypomanic & depressive episodes
—>Cyclothymic Disorder → Chronic, less severe mood swings
What is Major Depressive Disorder (MDD)?
->Severe depression with no manic episodes
->Impairs interest/ability to engage in enjoyable activities
->two different types of episodes
What are the types of MDD episodes?
- Recurrent:
->Two or more major depressive episodes
->Separated by at least 2 months of euthymia (normal mood)
- Single episode:
->One major depressive episode
->Less likely to have a family history
What is the average age of onset for MDD?
->Mid to late 20s
->Decreasing over time
How common is MDD?
->One of the leading causes of disability worldwide
->Most common psychiatric disorder globally
What are the diagnostic criteria for MDD?
->Must have 5+ symptoms for at least 2 weeks
->One of the symptoms must be:
1. Depressed mood most of the day, nearly every day
2. Loss of interest or pleasure in usual activities
Other symptoms:
3. Loss of energy, extreme fatigue
4. Feelings of worthlessness, negative self-appraisal
5. Sleep disturbances (insomnia or hypersomnia)
6. Difficulty concentrating
7. Changes in activity level
8. Thoughts of death or suicide
9. Changes in appetite & weight
How long do depressive episodes last?
-> Variable: 2 weeks – several years
->First episode duration (untreated): 2–9 months
->Median duration of recurrent episodes: 4–5 months
->Median lifetime number of episodes: 4–7
What is Persistent Depressive Disorder (Dysthymia)?
-> Chronic depression lasting at least 2 years (1 year in kids/teens)
—>never without symptoms for more then 2 months
->Same symptoms as MDD but are fewer & less intense than MDD but longer-lasting
->More severe than MDD as chronic → More resistant to treatment
->May last 20-30 years
What is Double Depression?
-> Persistent depressive disorder + episodes of MDD
What are Specifiers for Depressive Disorders?
->Specifiers, or symptoms, that may or may not accompany a depressive disorder
->Clinicians use eight specifiers:
- With psychotic features:
—> Mood-congruent: Delusions/hallucinations in line with depression (e.g., hearing voices saying you’re worthless)
—>Mood-incongruent: Psychotic symptoms unrelated to depression (e.g., believing you are a god)
->fulfil criteria of MDD and have hallucinations etc.
-> Generally, do not respond to the usual drug therapies
-> Combined with drugs to treat psychotic disorders such as schizophrenia
- With anxious distress:
—>Restlessness, worry, fear of losing control
- With mixed features:
—>MDD with some manic symptoms (e.g., racing thoughts, excess energy)
EX. people experiencing an episode with mixed features may feel very sad, empty, or hopeless while at the same time feeling extremely energized
- With melancholic features:
—>Extreme lethargy, depression worse in the morning
- With atypical features
—>eat a lot, sleep a lot
- With catatonic features:
—>Motor disturbances (immobility or excessive movement, mimicking others)
- With peripartum onset:
—>Postpartum depression (during pregnancy or after childbirth)
- With seasonal pattern:
—>Depression occurs during specific seasons for at least 2 years
—>SAD (Seasonal Affective Disorder):
——>Depression: Fall/Winter
——>Bipolar: Depression in Winter, Mania in Summer
What is Premenstrual Dysphoric Disorder (PMDD)?
->Physical symptoms, severe mood swings, and anxiety
->Decreased interest in usual activities; difficulty in concertation; lack of energy; hypersomnia or insomnia; Interferes with work, relationships, daily activities
->Different from PMS due to symptom severity and impact
What is Disruptive Mood Dysregulation Disorder (DMDD)? Describe the debate between supporters and critics?
->Common in children (extreme temper tantrums)
->Chronic irritability, anger, aggression, hyperarousal
->Tantrums grossly out of proportion to the situation
->Different from ADHD
Supporters: Created to prevent overdiagnosis of childhood bipolar disorder
Critics: Disagree with labeling temper tantrums as mental illness
What is Bipolar I Disorder?
->Major depressive episodes alternate with full manic episodes
->Can be diagnosed after just one manic episode
What are the diagnostic criteria for a manic episode?
-> Requires presence of elevated or irritable mood + increased activity and at least 3 additional symptoms (4 if mood is only irritable) for at least 1 week:
- Increased goal-directed activity or psychomotor agitation
- Unusual talkativeness; rapid speech
- Flight of ideas (racing thoughts)
- Decreased need for sleep
- Inflated self-esteem
- Distractibility
- Excessive involvement in pleasurable activities (risk-taking behavior)
-> Implication for drug compliance:
—>Patients don’t believe anything is wrong, so they resist taking medication
What is the Rapid-Cycling Specifier in Bipolar Disorder?
->Moving quickly in and out of depressive and manic episodes (doesn’t seem to be permanent)
->At least 4 manic or depressive episodes per year
->20-50% experience rapid cycling (more common in women)
->Types:
1. Rapid switching: No euthymic period in between
2. Ultra-rapid cycle: Episodes last days to weeks
3. Ultra-ultra-rapid cycle: Episodes last less than 24 hours
What is Bipolar II Disorder?
->Need depressive episodes + hypomanic episodes
->Hypomanic episodes are less severe than manic episodes and do not impair daily life
Onset & Duration of Bipolar Disorders
->Bipolar I: 15-18 years
->Bipolar II: 19-22 years (10-13% progress to Bipolar I)
->Develops suddenly (compared to depressive disorders)
->Rare after age 40
->High risk of suicide
->Less common than major depression
What is Cyclothymic Disorder?
->Chronic fluctuations between hypomanic symptoms and depression
->Episodes are not intense or long enough to qualify as full hypomanic or depressive episodes
->Must persist for at least 2 years
->Age of onset: 12-14 years
How common are mood disorders in Canada?
->2.9 million Canadians reported a mood disorder (CCHS, 2019)
->Stable prevalence over time in Canada
How common is Major Depressive Disorder (MDD) worldwide?
->16% lifetime prevalence
->6% prevalence in the preceding year
What are some Gender Differences in Mood Disorders?
Depression: 2x more common in women than men
->Possible explanations:
Women report more symptoms
-> Rumination tendency (overthinking negative emotions)
->Self-objectification theory (viewing oneself as an object → lower self-esteem → sad mood)
Bipolar Disorders: Equally distributed across genders
Mood Disorders in Children & Adolescents
->Similar to adults but age-specific manifestations
->Difficult to differentiate bipolar disorder from ADHD & conduct disorder
->Childhood: Equal prevalence among boys & girls
->Adolescence: Higher rates of depression in girls
Mood Disorders in Older Adults
->Depression presents with:
—>Distractibility
—>Memory loss complaints
->Often comorbid with:
—>Anxiety disorders (GAD, panic disorder)
->Affects men and women equally in later life
Mood Disorders Across Cultures
->More prevalent in individualistic cultures (possibly due to less social support)
->Symptom presentation:
—>Individualistic cultures: More psychological symptoms
—>Collectivist cultures: More somatic symptoms
->Canadian prevalence: Moderate (8%)
->Indigenous communities:
—>4x higher prevalence of mood disorders
—>Chronic stressors from historical marginalization & oppression
Mood Disorders & Creativity
->Manic episodes linked to creativity
->Genetic basis for mood disorders in artists, poets, writers
->High association with bipolar disorder & suicide
Are mood disorders genetic?
->2-3x more likely in relatives of probands (individual being studied in genetic or medical context, serves as reference point for examine prevalence of condition for their relatives)
->Twin studies are heritable (Meta-analysis, 2000) - identical twins more likely to develop mood disorder if one twin is affected (37%)
->Sex differences in genetic vulnerability for depression - 36- 44% for women; 18-24% for men (genic factors play more so in W then M)
->Genetic contribution to bipolar disorders seems to be higher (most inherited gentic condition)
->Bipolar disorder has stronger genetic links
What role does the 5-HTTLPR gene play in depression?
->5-HTTLPR gene = Serotonin transporter gene
->People with 1 or 2 copies of the short variant → Higher depression & suicidality
—>Triggered by stressful life events
Do anxiety and depression share genetic factors?
Yes, they have overlapping genetic contributions
Is biological vulnerability specific to one disorder?
No, it is a general predisposition to both anxiety and depression
What are the three key neurotransmitters involved in mood disorders?
Dopamine (DA), Norepinephrine (NE), Serotonin (SE)
According to early theories, how do neurotransmitter levels affect mood?
↓ NE & DA = Depression
↑ NE & DA = Mania
What enzyme is elevated in untreated depression, and what does it do?
MAO-A, which metabolizes SE, NE, and DA
What role does serotonin play in mood regulation?
It regulates emotional reactions and influences NE and DA systems
What is the “Permissive Hypothesis” regarding serotonin?
Low serotonin → Dysregulation in other neurotransmitters → Mood irregularities
How do tricyclic antidepressants work?
They prevent the reuptake of NE, SE, and DA (but levels normalize in a few days)
How do MAO inhibitors work?
They prevent monoamine oxidase from deactivating SE, NE, and DA, increasing their levels
How do SSRIs (Selective Serotonin Reuptake Inhibitors) work?
They block serotonin reuptake, increasing serotonin levels in the synapse
How do SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors) work?
They block the reuptake of SE and NE
(no clear evidence it works better then SSRI’s but has fewer side effects then tricyclic drugs)
Why is the current view of neurotransmitters different from early theories?
Balance between neurotransmitters is more important than absolute levels
How does cortisol affect mood disorders?
Excess cortisol (e.g., from hypothyroidism) can lead to depression
When are elevated cortisol levels commonly found in depressed individuals?
After stressful events
What is a common symptom of mood disorders related to sleep?
Sleep disturbances
How does REM sleep differ in people with depression?
->REM starts sooner after falling asleep
-> More intense REM activity
-> Slow-wave sleep occurs later
What is the bidirectional relationship between sleep and mood?
Negative moods disrupt sleep, and disrupted sleep leads to negative moods
What sleep issues are common in people with bipolar disorder?
Severe insomnia, hypersomnia, decreased REM latency
How can sleep deprivation affect people with bipolar disorder?
It may reduce depression, possibly due to astrocytes regulating brain chemicals for sleepiness
What brain activity differences are seen in depressed individuals?
-> Greater right-sided anterior activation
-> Less left-sided activation
What does neuroimaging show in people with depression?
->Hyperactive amygdala → Increased depression
->Hypoactive prefrontal regions → Diminished cognitive appraisals
What happens to the hippocampus in recurrent or long-duration untreated depression?
Decreased hippocampal volume and neurocognitive impairment
What percentage of depression cases are caused by psychological experiences?
60-80%
How does interpretation of stressful events impact depression?
Negative interpretations increase vulnerability
What is the Gene–Environment Correlation Model?
People with a genetic predisposition to depression may also be more likely to experience stressful events
What is the relationship between stress and bipolar disorder?
Strong relationship between stressful life events and bipolar episodes
Who developed the learned helplessness theory of depression?
Martin Seligman
What is learned helplessness?
Feeling unable to control life’s stresses, leading to depression
What is the depressive paradox?
conflict experienced by people who feel helpless,
People feel helpless but still blame themselves, leading to guilt and low self-esteem
What are the three aspects of depressive attributional style? (why things happen)
- Internal: Attributing negative events to personal failings
EX. person fails a test and thinks “I didn’t study hard enough”
- Stable: even after a particular negative event passes, the attribution that “additional bad things will always be my fault” remains
→always think the reason for their success or failure will always be the same
EX. student fails math test and thinks “I’m just not good at math” so believe their math skills can’t change
- Global: Assuming failures extend to all areas of life
EX. student fails test thinks “I failed this test so I will fail in all my classes”
What is hopelessness?
The belief that desirable outcomes will not happen and nothing can change the situation
What are two additional risk factors (diatheses) for depression?
-> Low self-esteem
-> Belief that negative life events will have severe consequences
What happens when people develop negative interpretations of life events?
They form negative schemas, seeing the world pessimistically
What is the Negative Cognitive Triad?
-> Negative schema + Cognitive biases = NCT
Negative thoughts about:
✔ The self
✔ The world
✔ The future
->Repeated activation → negative schemas organized into a depressive mode
What are cognitive biases identified by Beck?
- Arbitrary inferences: Drawing conclusions without evidence
EX. someone believes others are thinking negatively about them - Overgeneralization: Making broad conclusions from one event
EX. student receives a low grade on 1 exam they might think “I always fail at everything” even though they’ve performed well in other subjects - Dichotomous thinking: Seeing situations as black and white
EX. someone might think “if I don’t get a perfect score on this test I have completely failed”, ignoring the possibility that doing well or improving is also an achievement - Selective thinking: Focusing only on negative aspects
EX. someone is preparing for a job interview they might fixate on one potential question they struggle to answer in a practice session - Catastrophizing: Assuming the worst possible outcome
EX. someone misses a deadline at work they might think “oh I am going to get fired and I’ll never find another job” which overlooks how it could be addressed with a simple explanation - Personalizing: Believing they are responsible for things outside their control
EX. if a friend is upset and doesn’t respond to a text a person might think “oh it’s my fault that they are upset and I must have done something wrong”
How do sparse social networks impact depression?
They provide little support, making negative life events harder to cope
How do depressed individuals affect social interactions?
They elicit negative reactions from others and have low social skills
What do depressed individuals constantly seek from others?
✔ Reassurance
How does marital dissatisfaction relate to depression?
Disruptions in marriage can lead to depression
What marital factors increase emotional distress?
High conflict and low support
How does bipolar disorder affect marriage?
Bipolar individuals are less likely to marry and more likely to divorce
How much higher is the rate of depression for people who live alone?
✔ 80% higher
How does social support affect depression?
✔ Lack of social support predicts the onset of depression
✔ Social support helps people recover from depressive episodes and postpartum depression
What are tricyclic antidepressants, and which neurotransmitters do they affect?
-> first generation antidepressant
->They primarily target norepinephrine (NE) but also affect serotonin (SE) and dopamine (DA).
->2 to 8 weeks to work
—>Many patients may feel worse during this period → commitment issues
What are two major risks of tricyclic antidepressants?
✔ Cardiac side effects
✔ Lethal in excessive doses
What are MAOIs (Monoamine Oxidase Inhibitors) in terms of depression, and how do they compare to tricyclics?
->first gen antidepressant
->They are as effective as tricyclics but have fewer side effects.
Why are MAOIs used less often?
✔ They can cause severe hypertension when combined with foods containing tryptamine (e.g., cheese, red wine).
–>MAOIs break down tryptamine but is inhibited = accumulation in body which can trigger release of NE which constricts blood vessel and increase heart rate = hypertension
✔ They interact with common medications, such as cold medicines.
What is the primary function of SSRIs (Selective Serotonin Reuptake Inhibitors)?
-> 2nd gen antidepressant
->They inhibit the reuptake of serotonin (SE), increasing its levels in the brain.
Why are SSRIs the first choice for treating depression?
They are effective and have fewer side effects compared to older antidepressants.
What were initial concerns about SSRIs?
✔ Possible link to suicide preoccupations, paranoid reactions, and violence.
What do recent findings say about the risk of suicide with SSRIs like Fluoxetine?
✔ There is no greater risk than with other antidepressants.
What are major side effects of SSRIs?
✔ Physical agitation
✔ Sexual dysfunction
What are SNRIs (Serotonin and Norepinephrine Reuptake Inhibitors)?
-> third gen antidepressant
-> They block the reuptake of both serotonin (SE) and norepinephrine (NE).
->no significant diff when compared to SSRIs
What natural herb is sometimes used to treat depression?
✔ St. John’s Wort (Hypericum)
How does St. John’s Wort affect neurotransmitters? How does it compare to antidepressants?
->It increases levels of serotonin (SE), dopamine (DA), and norepinephrine (NE) in the brain.
->No difference in effectiveness for mild depression, but it may be effective for severe depression.
What is Lithium Carbonate, and how does it help with bipolar disorder?
✔ A common salt that acts as a mood-stabilizing drug.
✔ It is effective in preventing and treating manic episodes in 50% of patients.
What is a major risk of lithium treatment?
✔ Toxicity if not dosed carefully.
What are the relapse rates for patients on lithium?
High relapse rates, but lower frequency and severity of episodes.
What drugs are used for bipolar disorder if lithium is ineffective?
Antipsychotics and anticonvulsants (usually Valproate) with antimanic properties.
How does Valproate compare to lithium in preventing suicide?
✔ It is less effective in preventing suicide compared to lithium.
Who developed Electro convulsion therapy in the early 20th century?
✔ Italian physicians Cerletti and Bini.
When is ECT typically used?
✔ For individuals who do not respond to other treatments.
How is ECT administered?
->Under anesthesia with a muscle relaxant, delivering an electric shock (70-130 volts) for less than a second.
->Do this once daily for a total of 6-10 treatments.
Why is ECT sometimes preferred over medication?
✔ It works faster than medication.
What are common side effects of ECT?
✔ Short-term memory loss and confusion.
What follows ECT treatment?
✔ Medication and/or psychological therapy for long-term management.
What is Transcranial Magnetic Stimulation (TMS) used for?
✔ It is effective in treating depression
->less effective then ECT for severe depression
How does TMS work?
✔ A magnetic coil is placed over the head to deliver localized electromagnetic pulses.
What is Deep Brain Stimulation (DBS)?
->A surgical procedure where electrodes are implanted in the brain to deliver electrical impulses.
->helps with epilepsy and depression
->drawback is it’s expensive
What condition is light therapy primarily used for?
✔ Seasonal Affective Disorder (SAD), also known as winter depression.
How does light therapy work?
✔ Exposure to bright, white light, typically within the first hour of waking up, for 20-30 minutes.
What improves the effectiveness of light therapy?
✔ Combining it with Cognitive Behavioral Therapy (CBT).
For severe cases of SAD, which treatment is more effective?
CBT may be more effective.
What is the goal of cognitive therapy for depression?
To help clients examine and replace negative thoughts with realistic ones.
How does cognitive therapy correct deep-seated negative thinking?
By identifying and challenging cognitive errors.
What is the purpose of homework assignments in cognitive therapy?
✔ Encouraging realistic thinking by monitoring and logging thought processes.
What is a behavioral experiment in cognitive therapy?
✔ A client predicts a negative outcome, then tests their belief by observing the actual outcome.
Who developed interpersonal psychology?
Weissman & Klerman.
What is the primary focus of IPT?
✔ Resolving problems in existing relationships to improve mood.
->15-20 sessions, once per week
What interpersonal issues does IPT address?
✔ Interpersonal disputes, acquiring new relationships, and improving social skills.
What are the three stages of resolving interpersonal disputes in IPT?
- Negotiation stage: Both partners discuss their feelings and frustrations and discuss how the one partners depression affects their relationship, sharing their perspectives
- Impasse stage: Despite recognizing the issues the couple feels stuck, may exhibit low level of resentment by avoiding discussions about their feelings, engaging in passive aggressive behaviors, neither takes initiative to solve
- Resolution stage: After reflection and possibly external support, one partner suggests a temporary separation.
How does combined treatment compare to separate drug or psychosocial therapies for depression?
It is generally just as effective as separate treatments but is especially effective in severe depression.
What is often included in combined treatment for severe depression?
✔ A combination of drug and psychosocial treatments.
What is commonly used for maintenance treatment to prevent relapse in depression?
CBT
What is Mindfulness-Based Cognitive Therapy (MBCT)?
A treatment designed to help individuals develop metacognitive awareness and distance themselves from their feelings.
What is the main focus of MBCT?
Helping recovered depressed patients disengage from negative thinking.
->does this thru Mindfulness meditation—awareness of thoughts and feelings.
What is a significant challenge in treating bipolar disorder?
✔ Treatment compliance.
What is one effective method for managing bipolar disorder?
✔ Psychoeducation, which helps reduce mood swings and promote stability.
What does Interpersonal and Social Rhythm Therapy (IPSRT) focus on?
Regulating circadian rhythms, including eating, sleeping, and daily schedules, while coping with interpersonal stressors.
What is the effect of family-focused treatment for bipolar disorder?
✔ It reduces family tension, leading to a decrease in relapse rates.
How is CBT used in bipolar disorder?
✔ CBT is effective for patients with rapid cycling.
What are the different forms of suicidal behavior?
- Completed suicide
- suicidal attempts (the person survives)
- suicidal ideation (thinking seriously about suicide)
-> Passive (wishes to be death without specific plan) or Active (detailed thoughts about how to carry it out) - suicide gestures (parasuicides)
->Self-injury in which there is no intent to die
What is the global suicide rate in 2019?
9.0 per 100,000 people (World Health Organization, 2021).
How do men and women differ in suicidal behavior?
Women attempt suicide more frequently, but men are more likely to die by suicide
->men often choose more lethal means like gun, jumping off cliff etc and women choose less lethal means like OD or self harm = more survival
Where are suicide rates highest in Canada?
✔ In the Territories.
->Lowest rates in Ontario and British Columbia
What are some risk factors for suicide?
->Shneidman used psychological autopsy to identify risk factor
->Involves reconstructing and examining the psychological profile of someone who has died by suicide to look for clues
- Existing Psychological Disorders
-> 90% have psychological disorders
-> 60% suicides associated with mood disorders
-> Hopelessness, alcohol use, sensation seeking, Borderline personality disorder - family history
->A suicidal family member (trait such impulsivity or observational learning?) increases chance of another member attempting or completing suicide - neurobiology
->- Low levels of serotonin may be linked to suicide
(Vulnerability to act impulsively = suicide?) - stressful life events
What is Durkheim’s Sociological Theory of Suicide?
Durkheim classified suicides based on social and cultural conditions into four types:
- altruistic
-> formalized suicides – sacrificing one’s life to benefit othersEX. preserve tradition or honor of the family, kill urself so family isn’t shamed or experience financial burden etc.- as in an ancient Japanese custom Hara-kiri - egoistic
-> the loss of social supports as an important provocation for suicideEX. an elderly person who lives alone and feels lonely might be at higher risk - anomic
-> the result of marked disruptions (breakdown of social norms or times of great change)EX. someone who loses their job during an economic crisis might feel lost and hopeless - fatalistic
-> result from a loss of control over our own destinyEX. person in a very strict environment like prisoner facing harsh conditions feels they have no way out
What are the positives and negatives to Durkheim’s Sociological Theory of Suicide?
P:
->Shows how important community and social support are in preventing suicide
N:
-> His ideas struggle to explain why people in the same society respond differently to the same situations
EX. not everyone who loses all their money choose to take their own life
What is Baumeister’s Escape Theory of Suicide?
It suggests that people may become suicidal to escape emotional suffering and self-awareness, especially when faced with unrealistic expectations.
How can media affect suicide rates?
Media coverage of suicides, especially romanticizing or detailing methods, can lead to clusters of suicides, particularly among teenagers.
What are some methods of suicide prevention?
Assessing suicide ideation, targeting high-risk individuals, and emphasizing protective factors.
What is the purpose of no-suicide contracts in treatment?
They are used to assess risk and, if necessary, ensure immediate hospitalization for high-risk individuals.
How are suicide prevention efforts implemented in Canada?
Through crisis centers, 24-hour phone services, and school-based curriculum programs.
