Chapter 8 - Mood Disorders Flashcards
Most common cause of depression
Interpersonal relationships
List types of Unipolar depression
1) Major depression
2) Dysthymic disorder - less severe but more chronic
Cost of depression in Canada
$14.4 billion or 1% of GNP
- due to treatment and lost productivity
Diagnostic criteria for Major Depressive Episode
1) 5 or more symptoms lasting 2+ weeks. Most of the day nearly every day.
a) mood symptoms (1 must)
- depressed mood
- anhedonia
b) Physcial symptoms
- weight loss (common) or gain
- insomnia (common) or hypersomnia
- psychomotor agitation or retardation
- fatigue, loss of energy
c) Cognitive symptoms
- worthlessness or guilt
- indecisiveness
- death or suicidal ideation
2) clinically significant distress or impairment in functioning
3) Depression as a syndrome ***
Define anhedonia
Loss of interest or pleasure in activities
Features of major depressive disorder
1) presence of episode
2) no manic or hypomanic episodes
3) Subtype: single episode or recurrent
4) Specifiers
Name specifiers of major depressive disorder
1) Mild, moderate, severe w/out psychotic features, severe w/ psychotic features (delusions)
2) Atypical - oversleep, overeat, weight gain, anxiety
3) w Catatonic features
4) w Melancholic features (severe, biologically-based. Anhedonia, insomnia, psychomotor agitation, sig weight loss)
5) w Postpartum onset
6) w seasonal pattern. bipolar mania in summer
Bio reason for MDD w postpartum onset
- w/in 4 weeks
- progesterone levels drop post birth
- progesterone had an antianxiety effect on brain prev
Stats on depression?
- 1.5million Canada, 400k in Ontario any year
- 6% women, 3% men given time
- Lifetime: 12% women, 6% men
- increased dramatically in last century
Why does prof think depression increased so dramatically?
- loss of social connections
Course
- 1st episodes adolescence or early child
- precipitated by severe stressor
- episodes 6mos - 1yr (resolve w no intervention)
- after one, will have 5 or 6
Variable course of depression
- full versus partial remission between episodes
Rate of recurrence of depression
1 episode: 50% risk of second
2 episodes: 70% risk of third
3+ : 90% risk of more
Associated features of depression
- risk suicide (15% of multiple episodes commit suicide)
- Comorbidity:
- anxiety disorders 50% - eg panic, OCD
- eating, substance abuse, BPD, sexual dysfunctions
Criteria Features of Dysthymic disorder
- less severe, but more chronic/long lasting
1) depressed mood most of the day, more days than not for 2+ years
2) 2 of: appetite, sleep, energy, low self-esteem, concentration, hopless
3) tends to be chronic, life-long
What’s Double Depression
- Dysthymia + major depressive episodes
What’s hypomania
less severe form of mania
Bipolar subtypes
- Bipolar I disorder - mania + typically major depression episodes
- Bipolar II disorder - hypomania AND major depression episodes
- Cyclothymia - hypomania & dysthymia
Features of a manic episode
1) elevated, expanisive/talkative, irritable mood, 1+ week
2) 3 or more:
- inflated self-esteem, grandiosity
- less sleep needed
- pressure of speech/words tumbling
- racing thoughts
- distractability
- psychomotor agitation
- high risk pleasurable activities
3) Functional impairment
Features of Bipolar I disorder
- just one episode to qualify
- almost never have just mania, often depression episode too
- men = women
- Lifetime: 1%
- onset avg: 20yrs, but can begin in childhood
- recurrent, chronic
- risk of suicide, unemployment, marital, financial
- rapid cycling: less than 10-20% of cases (chgs occur at least 4 times per year)
Features of Bipolar II disorder
- not full mania, only hypomania
- must include depressive episodes
- no history of manic episodes
- men = women
- less common than BP1 .5% lifetime
Features of cyclothymic disorder
- continuous periods of hypomanic and depression, but not meet criteria of major depression
- lasts 2+ years
- clinically significant distress, imairment
- chronic, lifelong
- women = men
- risk for developing BP1 or 2 disorder
- lifetime: <1%
New name for dysthymia
Persistent depressive disorder
DSM - 5 diagnoses
Bipolar & Related disorders
- BP1
- BP2
- Cyclothymic
Depressive Disorders
- MDD
- Persistent depressive disorder (dysthymia)
- Disruptive mood dysregulation disorder
- premenstrual dysphoric disorder
Etiology of mood disorders
see word doc for diagram
1) biological vulnerability
2) psych vuln
3) stressful life event
4) the following
- stress hormones effect neurotransmitters
- negative attributions, hopelessness, dysfunctional attitudes, negative schema
- interpersonal relationship probs, lack support
5) Mood disorder
Genetics of mood disorders
- 75% variance in BPolar disorder is genetic
- 35% variance in depression is genetic
Neurotransmitters involved in Mood disorders
Serotonin: arousal, mood, anxiety, aggression, eating, sleeping, dreaming, pain, sexual beh, memory
- Depression: low levels, due to few receptors in brain
- Mania: abnormal levels -> disinhibition, mood swings
Norepinephrine: arousal, energy, activity, appetite
- Depression: low levels in severe depressions
- Mania: abnormally high/low levels -> euphoria, grandiosity
- early meds focused on this transmitter
Dopamine: pleasure, reward, mood, attention, activity
- Depression: low -> anhedonia, psychomotor retardation
- Mania: abnromal -> hyperactivity, psychosis
- affected by mood-altering drugs (cocaine, meth)
Describe Serotonergic system
- Limbic system, cortex (hypothalamus, hippocampus, amygdala, straitum, thalamus), cerebellum
Deficits in brain activity in mood disorders
- reduced activity in prefrontal cortex (esp left), anterior cingulate cortex, basal ganglia
- reduced PFC: executive functions, working memory, set shifting, planning
Where lesions in brain associated w depression
- left anterior frontal brain lesions
Effect of cortisol on mood
- cortosiol is stress hormone
- elevated in depression
- HPA axis (hypothalamic-pituitary-adrenal)
Biological treatments
- antidepressant meds (ADMs)
- Lithium - bipolar
- anti-convulsants, anti-psychotics - bipolar
- ECT - depression, last resort
What are MAOIs
MAOIs - monoamine oxidaze inhibitors
- affect norepinephrine (inhibit enzymes in synapse)
- also inhibits enzymes in gut, cant’ digest foods (proteins in red wine, chocolate, cheese) leads to high blood pressure
- names: Nardil, Parnate, Marplan
What are Tricyclics
- inhibit reuptake of norephinephrine
- Elavil, Tofranil
What are SSRIs
- selective serotonin reuptake inhibitors
- inhibit serotonin reuptake
- first drug of choice
- side effects: sleep, reduced appetite, sex performance, blurred vision, constipation, weight gain
- Prozac, Paxil, Zoloft, Celexa
History of anti-depressant meds
1) MAOIs
2) Tricyclics
3) SSRIs
Most common psychotic feature co-occuring w depression
Psychotic features
Beck’s cognitive model of depression
depressive self-schema -> faulty info processing -> self/world/future
- I’m bad -> bad is universal -> I won’t get better
Beck’s cognitive triad of depression
Self, world, future
Cognitive distortions & errors
1) all or nothing thinking - if you’re not first, you’re last
2) Overgeneralization: one bad thing -> day complete disaster
3) Jumping to conclusions: you ignore me -> u hate me (mind reading)
4) “Should” statements
5) Emotional reasoning: I feel worthless, so I must be worthless
Three components of CBT for depression
1) Behavioural
- restore & enhance functioning
- counteract withdrawal tendencies
- increase interest & pleasure
2) Cognitive
- id cog distortions
- monitor neg thoughts
- examine evidence
- chg core beliefs
3) Relapse prevention
Describe Interpersonal factors in depression
1) Attachment theory
- secure, avoidance, anxious/ambivalent
2) Marriage and interpersonal relationships
3) Social support
- lack of social support is related to depression (lack of options, more time to ruminate)
- conflicts w close others, family
Describe Interpersonal Therapy approach to treating depression
- assumes: depression is in relationships w others
1) grief, relationship loss
2) interpersonal role disputes (id source, learn to express)
3) Role transitions (life changes)
4) Interpersonal skill deficits - v effective 60-80%
- not cause, but IPT helps
Meds vs CT in depression
- no sig diff between meds and CT in short term
- long term: big advantage of CT
- more upfront costs doing CT upfront, but long term payoff
History of mood disorders
- Hippocrates: melancholia -> bloodletting
- Kraepalin: manic-depression
- Freud: depression/grief similar, imagined loss
Mixed features
- 3+ symptoms of other disorder (depression vs mania) at the same time
Serotonin transporter gene (HTT)
- Long “l” allele -> more activity of gene, higher function of brain.
- ”s” allele related to neg cog style & personality
HPA Axis process
hypothalamus->pituitary->adrenal gland
- produces cortisol
- fight or flight, increased allertness, but time limited
- too much for too long kills brain cells, damages hippocampus
- smaller hippocampal volume
How were anti-depressants figured out
trying to treat tuberculosis
Other treatments
- TMS: increased nerve stimulation, increase blood flow, glucose metabolism
- VNS: Vagus nerve stimulation
- Deep brain stimulation
Suicide rates
- men 3x likely to complete
- women 3x likely to attempt
Parasuicide is aka
suicidal gestures
Durkheim view of suicide
Anomie - feeling of rootless or lack of belonging
- loss social/cultural identity, disenfranchisement
Define Psychache
- feeling of unendurable psych pain/frustration
