Chapter 8 - Mood Disorders and Suicide Flashcards
What are two diagnostic issues of mood disorders?
MDs differ in duration and severity
Arbitrary categorical conventions
How long and how many symptoms need to be present for MDD?
At least 5-9 symptoms, 2+ weeks
What is Major Depressive Disorder also known as?
Common cold
What is the average age onset of MDD?
Early to mid 20s
How do MDD rates change in children and adolescents?
Same for both genders in childhood
After age 10, rates increase for girls and level out for boys
What is MDD frequently comorbid with?
Anxiety disorders
What is Persistent Depressive Disorder also known as?
Dysthymia
What contributes to a PDD diagnosis?
Chronic low mood lasting 2+ years
What is “Double Depression”?
People with PDD experience recurrent episodes of MDD as well
What factors are PDD associated with?
Impairment
Younger age onset
Comorbidity
Family history
Low social support
High stress
Dysfunctional personality traits
Less responsive to treatments
What is Seasonal Affective Disorder (SAD)?
Recurrent depressive episodes tied to changing of seasons
What causes mood disorder with seasonal patterns (SAD)?
Melatonin dysregulation
What happens during Premenstrual Dysphoric Disorder?
Marked affective lability, irritability/anger, depressed mood, and/or anxiety
How long do symptoms have to be present to diagnose premenstrual dysphoric disorder?
Most cycles in the past year
What possibly causes premenstrual dysphoric disorder?
Decrease in serotonin
What are the risk factors for peri- and postpartum mood disorder?
Family/self history
Marital problems
Low social support
Stressful life events
How is premenstrual dysphoric disorder treated?
SSRIs and birth control
What is mania?
Distinctive period of elevated, expansive, or irritable mood lasting at least 1 week
How many symptoms diagnose mania?
3 symptoms
What is hypomania?
Less severe form of mania
How many symptoms and for how long to diagnose hypomania?
3 symptoms present for only 4 days
What is a mixed state?
Experience both manic/hypomanic and depressive symptoms @ same time
What are symptoms of mania?
Increased energy
Decreased need for sleep
Racing thoughts
Pressured speech
Problems with attention and concentration
Impaired judgement
What happens as mania progresses?
Symptoms become more severe and experienced as disturbing/frightening
Can lead to psychosis
How do people with mania view symptoms?
As enjoyable
Can lead to treatment resistence
What’s the difference between bipolar I and II?
Bipolar I: history of manic episodes with or without MDE
Bipolar II: history of hypomanic episodes with MDE, more difficult to diagnose
How long do manic and hypomanic episodes typically last?
2 weeks to 4 months
How long do depressive episodes last?
6-9 months
What is the lifetime prevalence of bipolar I and II?
Bipolar I: 0.8%
BIpolar II: 0.5%
Do bipolar rates differ between men and women?
No
What is the average age onset of bipolar disorder?
20 years old
Can occur in childhood (controversial)
What are 3 symptoms of pediatric bipolar disorder?
Increased energy
Irritable mood
Grandiosity
What is cyclothymia?
Chronic but less severe form of bipolar disorder
What factors diagnose cyclothymia?
2+ years alternating hypomanic and depressive episodes
Why are people with cyclothymia at risk for developing full-blown disorder?
Often do not seek treatment
What do antidepressants do to cyclothymia?
May trigger manic episodes
What is rapid cycling specifier?
Form of bipolar disorder with 4+ manic and/or MDE in past year
How long do episodes of rapid cycling specifier need to be separated by?
2 months
What 3 personality traits contribute to mood disorders?
Dependent
Self-critical
Maladaptive parenting styles or childhood trauma
What is Beck’s cognitive theory of depression?
People prone to depression more likely to see situations negatively, hence experience negative mood in response to situations
What are the 4 cognitive distortions?
All-or-nothing
Overgeneralization (black-and-white)
Magnification (catastrophizing)
Jumping to conclusions
What are schemas?
Hypothetical structures in mind containing core beliefs (cognitive triad)
What is the diathesis-stress model?
Negative cognitive schemas inactive until activated by stressful life event
What 3 researches support cognitive theories of MDs?
Negative thinking
Cognitive vulnerability
Likelihood to attend to negative information
What does the interpersonal model state about mood disorders?
Key feature of depression are problems in interpersonal relationships
What is negative feedback seeking?
Tendency to actively seek out criticism and negative feedback from others
What is excessive reassurance seeking?
Tendency to repeatedly seek assurance about one’s worth and lovability
What is the stress generation hypothesis?
Depressed individuals generate stressful life events in interpersonal domains
What is the life stress perspective of depression?
Individuals with depression likely to have experienced stressful life event prior to onset
What does the life stress perspective state about bipolar disorders?
Loss events predict depressive symptoms
Life events (reward/goal) predict manic symptoms
Children and adolescence who are victims of abuse are _______ more likely to develop depression in young adulthood due to _______.
2-5x; internalized negative cognitive schemas
How does childhood abuse affect the brain?
Death of cells in hippocampus and amygdala
Child abuse is associated with dysregulation of _____________.
Stress response system (HPA axis)
How much more likely do first relatives with MDD and bipolar make an individual?
MDD: 2-5x depression
Bipolar: 7-15x any mood disorder
Heritability estimates for MDD and bipolar are…
MDD = 0.36
Bipolar = 0.75
Which hormones are associated with postpartum mood disorder?
Reproductive (progesterone and estradiol)
How do alleles of the serotonin transporter gene (HTT) on chromosome 17 influence mood disorders?
Long allele: higher serotonin functioning
Short allele: heightens reactivity to stress
Which 3 neurotransmitters are associated with mood disorders?
Norepinephrine, serotonin, dopamine
Depressed individuals have fewer ___________ receptors.
Serotonin (5HT)
What are the effects of abnormal neurotransmitters on bipolar disorder?
Dopamine: hyperactivity, psychosis
Norepinephrine: euphoria, grandiosity
Serotonin: disinhibition of behaviours
Depressed individuals show elevated levels of _________ compared to control groups.
Cortisol
Depressed individuals have smaller ____________ due to __________.
Hippocampal volumes; cortisol hypersectretion
Depressed individuals have increased _______________ associated with ________ and _______.
Pro-inflammatory cytokines; anhedonia; withdrawal
3 treatments for unipolar depression are…
CBT, interpersonal therapy (IPT), medication (imipramine)
What are the 3 types of interventions utilized in CBT?
Activity scheduling
Thought records
Behavioural experiments
What are the 4 areas of dysfunction as stated by interpersonal psychotherapy?
Interpersonal disputes
Role transitions
Grief
Interpersonal deficits
What do tricyclics do?
Blocks reuptake of norepinephrine and serotonin
**Increases presence in synapse
What are the side effects of tricyclics?
Dry mouth
Blurry vision
Weight gain
Exacerbate heart rhythm
Lethal in overdose
What do MAOIs do?
Inhibit enzyme that breaks down neurotransmitters
**Increase presence in synapse
What is the potential dangerous side effect of MAOIs?
Inhibiting breakdown of amines means too much can raise blood pressure
What do SSRIs do?
Inhibit reuptake of serotonin
What is a downside of antidepressants?
High risk of relapse
What are the 4 medications for bipolar disorder?
Lithium
Anticonvulsants
Antipsychotics
Antidepressants
What does lithium do?
Stabilize mood
How does lithium work in the body?
Deactivate enzymes related to sleep cycle, metabolism, and activity
Antagonist of excitatory glutamate
Lithium was successfully utilized on…
Manic patients
Why use anticonvulsants?
40% do not respond to or cannot tolerate side effects of lithium
What do anticonvulsants do in the body?
Increase synthesis and release of GABA
Reduce glutamate
How are anticonvulsants prescribed?
Alone, with lithium, with antipsychotics
When are antipsychotics used?
Short-term treatment during acute manic or severe depressive episodes
What do antipsychotics do?
Control psychotic symptoms
Can be used as sedative
What is a risk of antidepressants for bipolar disorder?
Risk of triggering mania
What are 4 considerations for combining psychotherapy and medication?
Severity
Persistence
Preventing relapse
Adolescents
What disorder is phototherapy used for?
SAD
What happens during phototherapy?
Mimic sunlight to increase neurobiological processes (increase serotonin, inhibit melatonin)
What happens in treatment resistant depression?
Failure to achieve remission following 2 trials of antidepressant medication
What 4 functioning impairments are associated with treatment resistant depression?
Social
Educational
Occupational
Health
What happens during electroconvulsive therapy?
Induces seizures
What are the side effects of ECT?
Confusion, memory loss
What does transcranial magnetic stimulation (TMS) do?
Use magnetic fields to alter brain activity
TMS is ________ effective than ECT, but has ________ side effects.
Less; fewer
What does vagus nerve stimulation do?
Increases release of norepinephrine and serotonin
Increases blood flow to brain
What is deep brain stimulation?
Surgically implant wires into brain to deliver electrical currents
What is the age range of most suicides?
40-59 years old
What are the 3 risk factors of suicide?
Gender, age, minority
What are the 3 strongest predictors of suicide attempts?
Bipolar disorder, PTSD, MDD
What does Durkheim state about suicide?
Cause by feeling rootless and lack sense of belonging
Suicide rates differ across/within cultures with changing times
What are the 2 biological factors of suicide?
Concordance
Low serotonin levels
What is suicide contagion?
Publicized suicide serves as trigger
What are the 2 categories in Joiner’s interpersonal model of suicide?
Interaction between two domains, acquired capability
What are the motivational moderators of suicide?
Thwarted belongingness
Perceived burdensomeness
What are the volitional moderators of suicide?
Social/role models
Impulsivity
Overcome fear of death
What is primary prevention for suicide?
Education programs
Restricting access to suicide means
What is secondary/tertiary prevention of suicide?
Prevention centers
Telephone hotlines
What are the 4 treatments for suicide?
Hospitalization
Outpatient treatment
DBT
Ketamine
What is outpatient treatment?
CBT
**If patient not in imminent danger
What is dialectical behaviour therapy?
Target, reduce, and monitor suicide risks
Diary card
Ultimate goal: build life worth living
