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Psyc 241 - Midterm 2 > Chapter 8 - Mood Disorders & Suicide > Flashcards

Chapter 8 - Mood Disorders & Suicide Flashcards

1
Q

Exaltation and melancholia

A

Exaltation - mania - excess of warmth and dampness in brain
Melancholia - depression - excess of black bile

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2
Q

Roman times

A

came to recognize role of emotions in depression - Cicero said perturbations of the mind might proceed from a neglect of reason

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3
Q

4th century

A

christian church - supernatural explanations came back

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4
Q

Emil Kraeplin

A

began modern age of theories - coined term manic depression

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5
Q

Early 20th century - Freud and Abraham

A

Drew a parallel between depression and grief - individuals most likely to become depressed after a loss had needs that were either not met or excessively met during oral stage

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6
Q

Mood disorders and suicide diagnostic issues

A

what distinguishes normal mood fluctuations from clinical mood disorders are their duration and severity
• DSM-5-TR categories are arbitrary - those with 4/5 symptoms still suffer considerably
• Depression by its nature is a continuous phenomenon
• Unipolar and bipolar disorders

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7
Q

Depression

A

over 250 million people are living with depression
• Continuum from mild and transient sadness to severe, persisting, debilitating feelings

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8
Q

Major depressive disorder

A

Criteria - 5 or more of, for 2 weeks, represent a change from functioning, depressed mood or loss of interest or pleasure must be present
- depressed mood, marked diminished pleasure, significant weight loss or weight gain, insomnia or hypersonmnia nearly every day, psychomotor agitation, fatigue or loss of energy, feelings of worthlessness, diminished ability to concentrate, recurrent thoughts of death
- symptoms must cause significant distress

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9
Q

MDD prevalence and course

A

11.2% in Canada
• Average first onset early to mid twenties
• 50% comorbid with anxiety disorders
• indigenous heritage - twice the rate of depression, suicide rates are higher

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10
Q

Persistent depressive disorder

A

depressed mood most of day, more days than not, at least 2 years, 3/6 additional symptoms
• 1.3%
• Many also have MDD episodes superimposed on chronic low mood
• Higher impairment, younger age of onset, higher comorbidity, stronger family history… than episodic depression

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11
Q

Mania and hypomania

A

distinct period of elevated, expansive, or irritable mood that lasts at least one week and has at least 3 associated symptoms

Hypomania - similar number of symptoms but only for 4 days

• Increased energy, decreased need for sleep, racing thoughts, pressured speech, problems with attention and concentration, impaired judgment

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12
Q

Mixed state

A

manic/hypomanic and depressive symptoms at the same time, 3 symptoms of opposite episode state

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13
Q

Diagnostic criteria for manic episode

A

three or more, 4 if mood is only irritable
- inflated self esteem, decreased need for sleep, more talkative, flight of ideas, distractibility, increase in goal directed activity, excessive involvement in actives with painful consequences
- marked impairment in social or occupational functioning
- not attributed to physiological effects of a substance

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14
Q

Bipolar 1

A

one or more manic episodes with or without one or more major depressive episodes
• Hypomanic episodes 2 weeks-4 months, depressive 6-9 months - suicide 10-15%
• 0.9%
• 20 yrs

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15
Q

Bipolar 2

A

one or more hypomanic episodes with one or more major depressive episodes
• Hypomanic episodes 2 weeks-4 months, depressive 6-9 months - suicide 10-15%
• 0.6%
• 20 yrs

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16
Q

Kids and bipolar

A

bipolar can onset in childhood and current estimates place the prevalence at 0.5% - tend to have rapid or mixed cycling

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17
Q

Cyclothymia

A

chronic but less severe bipolar
• At least 2 years of alternating hypomanic and depressive episodes that do not meet full criteria for major depression
• 0.4-1%

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18
Q

Rapid cycling specifier

A

• presence of four or more manic and or major depressive episodes in a 12 month period
• Episodes must be separated for at least 2 months by full or partial remission or by a switch to opposite mood state
• Rapid cycling can be induced or made worse by anti depressants
• Ultra rapid - cycling every few days, ultradian - daily cycling

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19
Q

Mood disorder with seasonal pattern

A

seasonal affective disorder - can occur in both unipolar MDD and bipolar disorder
• Recurrent depressive episodes that are tied to changing seasons
• 11% with MDD haven SAD
• General Canadian population - 2-3%, 1.3-3% in Europe, 0.9% Asia
• Patients with SAD have phase delayed circadian rhythms
• Lower vitamin D levels in winter months - vitamin d associated with serotonin activity

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20
Q

Mood disorders with peri or postpartum onset

A

as many as 70% of women experience mood swings and depression after birth
• Some is chronic and meets criteria for major depressive or manic episodes. 0.1% of new mothers experience psychotic symptoms that include command hallucinations to kill the infant - 5% suicide and 4% infanticide rate
• 17.7% global prevalence - 3% Singapore, 38% chile, 14% Canada
• Risk factors - history of depressive episodes, stressful live events, poor marital relationship
• Some women are very sensitive to rapid changes in reproductive hormones - play a role in regulating brain systems associated with arousal, cognition, emotion, motivation

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21
Q

Premenstrual dysphoric disorder

A

marked lability, anger, depression, anxiety, loss of interest in activities, concentration trouble, low energy, changes in appetite, sleep, loss of control
• Must be present for most menstrual cycles in the past year
• Hormonal mechanisms
• SSRIs treat it
• 1.8%

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22
Q

Five factor model of personality

A

CANOE - conscientiousness, agreeableness, neuroticism, openness to experience, extroversion
• Depression most associated with high neuroticism, low extroversion, and low conscientiousness
• Bipolar associated with high extroversion and openness to experience

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23
Q

Behavioural inhibition/activation system

A

BIS = punishment system, regulates avoidance behaviours, high on BIS means fear of novelty and uncertainty, higher depression scores —— BAS = reward system, regulates approach behaviours - high on BAS - more impulsive and difficulty regulating emotions - bipolar

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24
Q

Cognitive theories of mood disorders

A

a persons emotional response to a situation is determined by the manner in which that situation is appraised or evaluated
People with and prone to depression more likely to evaluate situations negatively through cognitive distortions
Diathesis stress model - negative schemas are inactive in the mind and serve as silent vulnerability factors that aren’t expressed until activated by a stressor

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25
Q

Cognitive distortions

A

all or nothing thinking, overgeneralization, magnification, jumping to conclusions
• schemas - contain core beliefs, guide how we interpret information, depresseds schemas have a rigid negative quality

Depressogenic schemas are rigid, tightly organized, and those with this schema who don’t have depression are more likely to develop it

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26
Q

Interpersonal models - stress generation hypothesis

A

individuals with depression have been found to generate stressful life events in the interpersonal domain including fights, arguments, interpersonal rejection

27
Q

Interpersonal model of depression

A

problems in interpersonal relationships of individuals with depression may stem from certain behaviours they display in their interactions - excessive reassurance seeking - negative feedback seeking

28
Q

Life stress perspective

A

for a minority of people, stressful live events can trigger a downward spiral into major depression
• Individuals with depression are nearly 3x more likely to have experienced a stressful life event prior to onset - 75% suffered an extreme loss 3-6 months before onset
• Bipolar - loss events predicts increase in depressive symptoms, rewarding life events predict reward and goal attainment

29
Q

Social support effects of stress

A

Social support, meaningful cultural or religious affiliation, positive personality disposition - buffers effects of life stress - those with trauma with a strong social support were no more likely to develop depression than those without a history of trauma

30
Q

Childhood stressful life events

A

victims of abuse are 2-5x more likely to develop a mood disorder in young adulthood
• The depression is more severe persistent, comorbid
• Early maltreatment internalized by child in form of negative cognitive schemas
• Child abuse associated with death of cells in hippocampus and amygdala - brain areas involved in regulation of mood and emotional memory

31
Q

Genetic factors

A

depression - 2-5x more likely in first degree relatives
• Bipolar - 7-15x more likely in first degree relatives
• Adoption study - 32% bipolar rates in biological parents, 12% in adoptive parents
• Higher concordance in unipolar major depression in MZ twins 40-59% vs DZ 20-30%
• Heritability estimate for MDD is 0.36 - genetics account for 36% of the pie
• 0.75 for bipolar

32
Q

Genome wide association studies

A

102 genetic variants in those with depression, 6 pathways being examined in Etiology of bipolar - genetics may work by influencing individuals stress to the environment

33
Q

Neurotransmitters factors

A

low norepinephrine - both bipolar disorders and severe unipolar depression
• Individuals with depression have fewer 5-HT receptors
• Dopamine transmission depends on level of 5-HT
• NE, DA, 5-HT play a role in mania - abnormal DA may trigger hyperactivity and psychosis seen in extreme mania, abnormal NE may trigger euphoria and grandiosity

34
Q

Stress and the HPA axis

A

stress modulated through HPA
• Encounter stressful event - brain released corticosteroid releasing hormone CRH - release of adrenocorticotropic hormone ACTH - release of cortisol from adrenal gland
• Chronic stressors result in sustained release of cortisol and a breakdown of the negative feedback inhibition of the HPA axis - prolonged periods of this kill brain cells and damage hippocampus
• Activation of HPA - release of pro inflammatory cytokines, associated with sickness behaviour like anhedonia and withdrawal

35
Q

Neuroimaging factors

A

bipolar and unipolar depression associated with decreased blood flow and reduced glucose metabolism in the frontal regions of the cerebral cortex - reversal in this with a shift from depression to mania
• Depression associated with differences in the functional connections between limbic structures involved the processing of emotions and emotional memory - amygdala and hippocampus - and cortical structures involved in higher order decision making, impulse control, judgement and motivation
• Key feature of depression may be the inability to disengage from negative information - they cannot shut off their brains when faced with negative information - continue to ruminate about this information

36
Q

Cognitive behavioural therapy

A

Based on cognitive theory that your emotional reactions to s situations are determined by ones thoughts about the situations
• Help clients make their own insights into their thought processes
• Equally as effective as other psychotherapies and anti depressant medication, contributors to lower relapse rates

37
Q

Methods in CBT

A

Thought records - identify negative thinking patterns, evaluate accuracy of thoughts with evidence, come up with alternative thoughts
• Behavioural experiments - encourage people to treat thoughts as scientific hypotheses that can be tested in an experiment
• Activity scheduling - make a list of activities and gradually schedule them
• Behavioural activation therapy - focuses on behavioural aspects of CBT

38
Q

Mindfulness based cognitive therapy

A

Mindfulness based cognitive therapy - promotes a non evaluative awareness of the here and now, detach from ruminative thinking, decentered, detached perspective to depression related thoughts and feelings

39
Q

Interpersonal psychotherapy

A

presumes that depression occurs in an interpersonal context and that addressing current problems that clients with depression face in the interpersonal realm is the key to relieving symptoms
• Client and therapist identity source of interpersonal dysfunction - interpersonal disputes, role transitions, grief, interpersonal deficit
• Therapist intervenes

40
Q

Family focused therapy - bipolar

A

• education for the patient and their family members about the disorder and its effects on patients functioning

41
Q

Interpersonal and social rhythm therapy - bipolar

A

disruptions in daily routines and conflicts in interpersonal relationships can cause relapses of bipolar episodes
• Patients taught to regulate routines and cope more effectively with stressful events

42
Q

Cognitive therapy for bipolar disorder

A

taught strategies to address regularizing their sleep and daily routines, how to regulate monitor their mood to identity triggers for manic episode relapses, and the importance of medication compliance

43
Q

Tricyclics

A

For MDD

block the reputable from the synapse of NE and or 5-HT - more of them available in synapse to bind to post synaptic receptors
• Side effects - dry mouth, blurry vision, constipation, urinary hesitation, dizziness when standing, sedation,weight gain

44
Q

Monoamine oxidase inhibitors

A

For MDD

inhibits monoamine oxidase which breaks down dopamine, norepinephrine, and serotonin in presynaptic cell
• Many side effects, must avoid foods with amines, avoid over the counter cold medicine with pseudoephedrine, and other drugs that work on serotonin

45
Q

Selective serotonin reuptake inhibitors

A

For MDD

first line treatment for unipolar depression
• Blocks reuptake of serotonin into presynaptic cell - more serotonin available to bind to post synaptic receptors
• Side effects - nausea, insomnia, sedation, sexual dysfunction

46
Q

Other classes of anti depressants

A

serotonin norepinephrine reuptake inhibitors
• Medications that increase dopamine transmission
• Drugs that have actions on other neurotransmitters - GABA

47
Q

Facts about depression medications

A

50-70% of patients who finish an anti depressant trial are expected to respond
• Anti depressants have a high relapse risk - if someone stops taking medications, symptoms could come back and persist even if they start taking medication again

48
Q

Lithium

A

For bipolar
works on multiple brain systems
- reduces transmission of excitatory neurotransmitters
- increases transmission of inhibitory neurotransmitters’ - increases levels of proteins in the brain that inhibit cell death
- preserve or increase brain volumes in critical areas needed for emotion regulation and memory
• dose required is only slightly less than a toxic dose

49
Q

Anticonvulsants

A

For bipolar

40% of patients don’t respond to lithium or can’t tolerate the side effects
• Anticonvulsants are prescribed alone or along with lithium or with an antipsychotic drug to control mania
• increase synthesis and release of GABA which is inhibitory, or decreases glutamate

50
Q

Antipsychotics

A

For bipolar

short term during acute mania or severe depressive episodes
• Can have a mood stabilizing effect
• Reduce serotonin and dopamine

51
Q

Antidepressants for bipolar

A

used to treat depressive phase of bipolar disorder
• Associated with a risk of triggering mania

52
Q

Phototherapy

A

For seasonal affective disorder
exposure to high intensity light - mimics natural sunlight
• May precipitate manic episodes in bipolar SAD
• CBT-SAD

53
Q

Electroconvulsive therapy

A

electrical current applied to patients brain through electrode pads - induces a 25 second seizure
• First line treatment for treatment resistant depression or severe life threatening symptoms where immediate response is necessary

54
Q

Transcranial magnetic stimulation

A

electric current creates magnetic pulse that travels through skull and causes small electrical currents in the brain

55
Q

Integrative treatments for unipolar depression

A

Exercise
• more effective that no treatment, similarly effective to psychotherapy or antidepressant medication

Yoga
• significantly more effective than treatment as usual

56
Q

Suicide definitions

A

suicidal ideation - thoughts of death and plans for suicide
• Suicidal gestures - behaviours that look like a suicide attempt but are not life threatening - often do not have an intent to die, but want to alert others to their suffering
• Suicide attempt - unsuccessful attempt, but clear attempt to die

57
Q

Epidemiology and risk factors for suicide

A

men - aged 19-24 and over 70 are at greatest risk
• Women more likely to attempt - choose less lethal methods
• LGBTQ

58
Q

The role of mental disorder in suicide

A

number 1 cause of suicide is untreated mental disorder
• Depression present in at least half of all suicides
• Those suffering from depression are 25x more likely to attempt suicide
• Alcohol and substance abuse is next in victims of suicide

59
Q

Social contextual factors of suicide

A

Durkheim - suicide caused by sense of anomie, or the feeling that one is rootless and lacks a sense of belonging
• Powerful in explaining differences in suicide rates across and within societies, but does not explain root causes of suicide

60
Q

Biological factors for suicide

A

concordance rates in MZ twins is 5-10x higher than in DZ
• Suicidal behaviour likely determined by many genes - high genetic correlation between suicide and mood disorders
• Low levels of serotonin

61
Q

Psychological factors for suicide

A

interpersonal model of suicide - high levels of perceived burdensomeness and thwarted belongingness along with feelings of hopelessness for the future lead to suicidal ideation
• Motivational volitional model of suicide - cognitions of defeat, humiliation, entrapment in response to stressful life events will result in motivation for suicidal ideation when motivational moderators - feelings of thwarted belongingness and perceived burdensomeness are high

62
Q

Prevention in suicide

A

restrict access to suicide means
• General public education campaigns, specific education strategies
• Secondary/tertiary - training primary care physicians to recognize, screen and respond to suicidal ideation and behaviour, telephone lines, prevention centres,

63
Q

Treatment for suicide

A

Those with clear plan, access to means, intent - should be hospitalized
• Just treating depression with standard anti depressants or CBT is not enough to reduce suicidal ideation and attempts
• Specific form of CBT - identify and modify thoughts, images and core beliefs that were activated prior to previous suicide attempts
• Ketamine - may be useful in emergencies - drop in suicidal ideation relative to placebo and effects lasted up to a week

Psyc 241 - Midterm 2 (4 decks)

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