Chapter 8: Mood Disorders Flashcards
Define depression.
A low, sad state in which life seems dark and its challenges overwhelming
Define mania.
- Opposite of depression
- State of breathless euphoria and frenzied energy in which people may have an exaggerated belief that the world is theirs for the taking
How is depression a “spectrum disorder”?
Spectrum from feeling blue all the way to psychotic or suicidal depression
What is unipolar depression?
- Depression w/o a history of mania
- Return to nearly normal mood when depression lifts
What are the different categories of symptoms of depression? Examples?
- Emotional = sadness, crying, anhedonia, anger, anxiety
- Cognitive = poor memory & concentration, inability to make decisions, pessimism
- Physical = general pain, headaches, low energy, decreased appetite, sleep, sex drive
What is the DSM-V definition of a major depressive episode?
For at least 2 weeks, at least 5 of the following symptoms must be met. (at least one of the first 2 must be present)
- Depressed mood most of the day
- Anhedonia = diminished interest or pleasure in almost all activities previously enjoyed
- Significant weight loss or weight gain or significant change in appetite
- Insomnia or hypersomnia
- Psychomotor retardation or psychomotor agitation nearly everyday
- Indecisiveness or diminished ability to concentrate
- Fatigue or loss of energy nearly everyday
- Feelings of worthlessness or inappropriate guilt
- Recurrent thoughts of death and/or suicidal ideation
What is the DSM-V definition of major depressive disorder?
- Entails a history of one or more major depressive episodes
- Symptoms severe enough o cause clinically significant distress or impairment
List the specifiers or MDD?
- Single episode vs. recurrent episodes
- Mild, moderate, severe MD episodes
- With psychotic features
- With mixed features
- With anxious distress
- With seasonal pattern
- With peripartum onset
- With atypical features
- With catatonic features
What are the factors that contribute to a single episode vs. recurrent episodes of MDD?
- 75% of those who have one episode will have at least one other
- If only one episode, it was likely in response to a major life stressor
- W/o treatment, an MDD sufferer has on avg 5-6 episodes in a lifetime
- An untreated MD episode lasts 8-10 months
- Recovery after an episode may be complete or mild depression left
- Dangers of repeated untreated episodes for long-term brain dysregulation
Describe the psychotic features of MDD.
- Psychotic symptoms = breaks w/ reality, delusions, hallucinations
- Always associated w/ a severe episode, but severe episodes don’t have to include psychosis
Describe the mixed features of MDD.
- Presence of manic symptoms pointing at possibility of underlying bipolar disorder
- Feeling mostly depressed but combined w/ increased energy level, irritability, restlessness, impulsiveness, high risk of suicide
Describe the anxious distress specifier of MDD.
Anxiety symptoms beyond what would be expected for depressive state
Describe the seasonal pattern of MDD.
- Seasonal Affective Disorder (SAD)
- Low energy, oversleeping, craving carbs
Describe the peripartum onset of MDD.
Onset of symptoms during or after pregnancy
Describe the atypical features of MDD.
- Significant weight gain and increase in appetite
- Hypersomnia
- Long-standing pattern of interpersonal rejection sensitivity
Describe the catatonic features of MDD.
- Motoric immobility or stupor
- Not responding to instructions
- Odd, bizarre postures
- Echoalia or echopraxia (repeating others speech or movements)
- Motionless alternates w/ agitation
Endogenous vs. Exogenic depression
- Endogenous = response to internal factors
- Exogenic = aka reactive; follows clear-cut stressful events
What is the DSM-V definition of persistent depressive disorder?
- Chronic pattern of depression that has lasted for at least 2 years
- Person experiences depressive symptoms that are mild, moderate, or severe
What is premenstrual dysphoric disorder?
Marked change in mood during a woman’s premenstrual period
What is the one year prevalence of MDD?
8%
What is the gender ratio for MDD?
2:1 (female: male)
What is the typical age onset of MDD?
24-29 years old
What is the percentage of people currently receiving treatment for MDD?
50%
What is the one year prevalence of dysthymic disorder?
1.5-5%
What is the gender ratio of dysthymic disorder?
Between 3:2 and 2:1
What is the typical age onset of dysthymic disorder?
10-25 years old
What is the percentage of people currently receiving treatment for dysthymic disorder?
36.8%
What are the different theories as to why women are more prone to depression?
- Artifact theory
- Hormone explanation
- Life stress theory
- Body dissatisfaction explanation
- Lack of control theory
- Rumination theory
Explain the artifact theory of gender and depression.
- Women and men equally prone to depression, but clinicians often fail to detect depression in men
- Women display more emotional symptoms
- Men find it less socially acceptable to admit feeling depressed or to seek treatment
Explain the hormone theory of gender and depression.
- Hormone changes trigger depression in women
- Gender differences in rates of depression span the same years of hormone level changes in women
Explain the life stress theory of gender and depression.
- Women in our society experience more stress than men
- More poverty, menial jobs, less adequate housing, more discrimination
Explain the body dissatisfaction explanation of gender and depression.
- Females in western society are taught to seek a low body weight and slender body shape
- Cultural standards for males much more lenient
Explain the lack of control theory of gender and depression.
- Women feel less control than men over their lives
- Women more prone to develop learned helplessness in lab
- Victimization of any kind can produce a general sense of helplessness and increases symptoms of depression
Explain the rumination theory of gender and depression.
Women more likely than men to ruminate when their moods darken, making them more vulnerable to the onset of depression
What biochemical factors influence the cause of depression?
- Low activity of norepinephrine and serotonin linked to unipolar depression
- Depressed peeps have an overall imbalance in the activity of serotonin, norepinephrine, dopamine, and acetylcholine
- Deficiencies w/in neurons may impair the health of neurons and lead to depression
What is the brain circuit associated w/ depression? What is the role of each in depression?
- Prefrontal cortex = lower activity and blood flow in depressed peeps
- Hippocampus = hippocampal neurogenesis decreases dramatically when peeps are depressed
- Amygdala = blood flow and activity is greater in depressed peeps –> express more negative emotions and memories
- Brodmann Area 25 = “depression switch” more active in depressed peeps
How does the immune system play a role in depression?
- Depressed peeps display lower lymphocyte activity, increased CRP production and body inflammation
- Depressed peeps have higher incidence of migraines, irritable bowel syndrome, chronic fatigue syndrome, rheumatoid arthritis
Explain the psychodynamic view of depression.
- Similarity between clinical depression and grief in peeps who lost a loved one –> crying, loss of appetite, difficulty sleeping, anhedonia, withdrawal
- 2 kinds of peeps likely to become depressed:
- Those whose parents failed to nurture them and meet their needs during oral stage become overly dependent and have low self esteem
- Those whose parents overly gratified needs resist moving on to subsequent stages
- Symbolic/imagined loss = equate other events as a loss of a loved one
Explain the behavioral view of depression.
- Unipolar depression results from significant changes in the # of rewards and punishment peeps receive in their lives
- Decline in rewards leads them to perform fewer constructive behaviors
What are the components of the theory of negative thinking and their roles in depression?
- Maladaptive attitudes = inaccurate, set stage for negative thoughts and reactions
- Cognitive triad = interpreting their experiences, themselves, and their futures in a negative way
- Errors in thinking = negative conclusions based on little evidence, minimizing positive experiences, magnifying negative ones
- Automatic thoughts = steady train of unpleasant thoughts that cause or maintain depression, anxiety, or other psychological dysfunction
Explain learned helplessness and its role in depression.
Perception, based on past experiences, that one has no control over one’s reinforcements and that they themselves are responsible for this helpless state
Explain the family-social perspective of depression.
- Depression tied to unavailability of social support such as that found in a happy marriage
- Peeps who are isolated w/o intimacy more prone to becoming depressed
- Depressed peeps have weaker social skills and communicate poorly
How does culture play a role in depression?
- Depressed peeps in non-Western countries are more likely to be troubled by physical symptoms (fatigue, weakness, weight loss, sleep disturbances)
- Less often marked by cognitive symptoms like self blame, low self esteem, guilt
What is the DSM-V criteria for a manic episode?
-Abnormally high energy level
-Abnormally and persistently elevated, expansive, or irritable mood
-Symptoms last one week OR hospitalization needed
(at least 3 of the following)
-grandiosity or inflated self-esteem
-decreased need for sleep
-increased talkativeness
-racing thoughts
-distractibility
-Psychomotor agitation or increase in goal-directed activity
-Poor judgment (buying sprees, sexual indiscretions, foolish investments)
What is the DSM-V criteria for a hypomanic episode?
Types of symptoms are the same for manic episode EXCEPT:
- less severe
- less impairment in social or occupational functioning
- no psychotic symptoms
- hospitalization not needed
- symptoms need to last at least 4 days
What is the criteria for bipolar I disorder?
- At least one manic episode
- Usually mania alternates w/ major depression, but there doesn’t need to be depression to meet criteria
What is the criteria for bipolar II disorder?
At least one hypomanic episode and one or more major depressive episodes
What is the criteria for cycolothymia?
- For at least 2 years, periods of hypomania symptoms and depressive symptoms
- Depressive symptoms are milder than w/ bipolar II disorder
What are the specifiers of bipolar I and II disorder?
- With psychotic features
- With mixed features
- With anxious distress
- With seasonal pattern
- With peripartum onset
- With rapid cycling
What is rapid cycling?
- More than 4 episodes w/in one year, but usually many more
- Can be precipitated by going off mood stabilizing meds or taking antidepressants only
What percentage of bipolars are rapid cyclers? What percentage of them are women?
- 20%
- 90%
What is the one year prevalence of bipolar I disorder?
1.6%
What is the gender ratio of bipolar I disorder?
1:1
What is the typical age onset of bipolar I disorder?
15-44 years old
What is the percentage of people currently receiving treatment for bipolar I disorder?
33.8%
What is the one year prevalence of bipolar II disorder?
1%
What is the gender ratio of bipolar II disorder?
1:1
What is the typical age onset of bipolar II disorder?
15-44 years old
What is the percentage of people currently receiving treatment for bipolar II disorder?
33.8%
What is the one year prevalence of cycolothymia?
0.4%
What is the gender ratio of cycolothymia?
1:1
What is the typical age onset of cycolothymia?
15-25 years old
What is the avg onset and trend of MDD?
- Avg onset = mid to late 20s
- Trend = earlier and earlier
What is the course of MDD?
- With each episode, more episodes likely
- After 3 episodes, life-long MDD likely
What is the lifetime prevalence of MDD?
10-15%
What is the gender ratio of MDD?
2:1 (female: male)
What is the onset of PDD?
- Onset of chronic low level depression can be early (childhood, teens)
- Onset may be slow, starting w/ milder symptoms
What is the course of PDD?
- Chronic by definition (at least 2 years of duration)
- May develop into severe MDD
What is the lifetime prevalence of PDD?
6-7%
What is the gender ratio of PDD?
2:1 (female: male)
What is the onset of PMDD?
Puberty at the earliest
What is the course of PMDD?
Likely to vary throughout life cycle
What is the lifetime prevalence of PMDD?
3-8%
What is the onset, avg onset and trend of bipolar I disorder?
- Avg = 18 (50% started by adolescence)
- Trend = earlier and earlier
- Mania rarely starts after age 40 unless prior history of depression
- More acute onset than MDD
What course does bipolar I disorder take?
- Worse w/ childhood onset
- Risk of deterioration w/o treatment
- Pattern may change throughout life
- Chronic disorder, but manageable w/ meds
What is the lifetime prevalence of bipolar I disorder?
1.5%
What is the gender ratio of bipolar I disorder?
1:1
When is the avg onset of bipolar II disorder?
22 years old
What course does bipolar II disorder take?
May develop into bipolar I disorder
What is the lifetime prevalence of bipolar II disorder?
1-2%
What is the gender ratio of bipolar II disorder?
1:1
What is the onset of cyclothymic disorder?
- Teens
- Slow onset
What course does cyclothymic disorder take?
50% later meet criteria for bipolar I or bipolar II disorder
What is the lifetime prevalence of cyclothymic disorder?
1-2%
What is the gender ratio of cyclothymic disorder?
1:1
What role does genetics play in mood disorders?
- No single gene responsible for any mood disorders
- Mood disorders are polygenic disorders
What have twin studies shown about MDD?
- Identical twin has MDD –> 46% chance other identical twin has MDD
- Fraternal twin has MDD –> 20% change other fraternal twin has MDD
What have twin studies shown about bipolar I disorder?
Identical twin has bipolar I disorder:
- 40% chance that other identical twin is bipolar I
- 80% chance that other identical twin is bipolar I or has MDD
What do mood disorders have to do w/ creativity?
- Mood disorders are over-represented among creative individuals (poets, writers, artists)
- About 20% of famous poets found to be bipolar
- Many committed suicide
- High productivity and creativity in hypomanic state
