CP: Chapter 5 Mood Disorders Flashcards
mood disorders =
disorders that involve depressive or manic symptoms
major depressive disorder DSM
either (1) depressed mood or (2) loss of interest or pleasure.
- insomnia or hypersomnia
- weight loss or gain
- concentration issues or indecisiveness
- psychomotor agitation (a state of restlessness and anxiety that results in repetitive and unintentional movements) or retardation (slowing down of thought and a reduction of physical movements in an individual).
- fatigue
- feelings of worthlessness
- thoughts of death
at least 5, at least 1 or 2, and for a period of 2 weeks
B. symptoms should cause distress/impairment
C. not due to medication or other disorder
D. not better explained by schizoaffective disorders
E. never a manic/hypomanic episode (excl. die tijdens medicatie of door andere disorder)
The diagnostic code for major depressive disorder is based on whether this is a ….
recurrent?
severity?
psychotic?
remission?
remission =
beter voelen, meestal na een MDD episode.
persistent depressive disorder DSM
A. depressed mood for most of the days, for at least 2 years.
(one year in children and adolescents, + here the mood may be irritability)
B. 2 van de volgende symptomen:
1. Poor appetite or overeating.
2. Insomnia or hypersomnia.
3. Low energy or fatigue.
4. Low self-esteem. (anders dan MDD!)
5. Poor concentration or difficulty making decisions.
6. Feelings of hopelessness.
C. nooit meer dan 2 maanden zonder de symptomen geweest
D. Criteria for a major depressive disorder may be continuously present for 2 years.
E. never manic
F. no schizophrenia/psychosis
G. not due to substances or other disorder
H. symptoms cause distress/impairment
persistent depressive disorder is een combinatie van…
chronic major depressive disorder and dysthymic disorder.
If criteria are met for both major depressive disorder and
persistent depressive disorder, both can be diagnosed.
oke
disruptive mood dysregulation
A. temper outbursts (verbal or physical)
B. temper is inconsistent with developmental level
C. temper; 3 or more times per week
D. mood during temper is irritated or angry, and observed by others
E. criteria a-d meer dan 12 maanden, en gedurende die tijd niet meer dan 3 maanden weg
F. a-d present in at least 2 settings (at school/home/peers) and at least one of them was severe
G. diagnosis: between 6 and 18 years old
H. meestal voor age of 10
I. nooit criteria voor hypo/mania
J. The behaviors do not occur exclusively during an episode of major depressive disorder and are not better explained by another mental disorder (e.g., autism spectrum disorder, posttraumatic stress disorder, separation anxiety disorder, persistent depressive disorder).
K. nooit door substances, medication of andere medical condition
premenstrual dysphoric disorder
A. In the majority of menstrual cycles, at least five symptoms must be present in the final week before the onset of menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week postmenses.
B. at least one:
1. Marked affective lability (e.g., mood swings; feeling suddenly sad or tearful, or increased sensitivity to rejection).
2. Marked irritability or anger or increased interpersonal conflicts.
3. Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts.
4. Marked anxiety, tension, and/or feelings of being keyed up or on edge.
C. One (or more) of the following symptoms must additionally be present, to reach a total of five symptoms when combined with symptoms from B above.
1. Decreased interest in usual activities (e.g., work, school, friends, hobbies).
2. Subjective difficulty in concentration.
3. Lethargy, easy fatigability, or marked lack of energy.
4. Marked change in appetite; overeating; or specific food cravings.
5. Hypersomnia or insomnia.
6. A sense of being overwhelmed or out of control.
7. Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of “bloating,” or weight gain.
D. symptoms cause distress/impairment
E. not other disorders
F. should be confirmed by daily ratings(but: The diagnosis may be made provisionally prior to this confirmation.)
G. not due to substances
mdd men vs women
women 3 : men 1
mdd poor vs rich people
poor people: 3x more likely
minorities vs people who were born in USA
minorities: less MDD than people who were born there
bipolar disorder 1 most important criteria =
mania
bipolar disorder 2 most important criteria
major depressive episode
mania =(A)
A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy
how long should mania last
lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary).
B criterima mania
3 van deze:
- Inflated self-esteem or grandiosity.
- Decreased need for sleep
- talkative
- Flight of ideas
- Distractibility
- Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e., purposeless non-goal-directed activity).
- Excessive involvement in activities that have a high potential for painful consequences
hoeveel manic episodes voor bipolar 1 diagnosis
at least one in lifetime
hypomanic A criteria
A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy
hypomania hoelang moet het duren?
lasting at least 4 consecutive days and present most of the day, nearly every day.
hypomania B criteria
3 van deze:
- Inflated self-esteem or grandiosity.
- Decreased need for sleep
- talkative
- Flight of ideas
- Distractibility
- Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e., purposeless non-goal-directed activity).
- Excessive involvement in activities that have a high potential for painful consequences
differences mania and hypomania
mania = one week
hypomania = 4 dagen
mania = severe, impairs functioning
hypomania = can still function normally =unequivocal change in functioning). but still noticable by others!
wat als iemand psychotic features heeft bij bipolar?
per definition = manic
hypomania in bipolar 1?
Hypomanic episodes are common in bipolar I disorder but are not required for the diagnosis of bipolar I disorder.
bipolar disorder 1 criteria
at least one manic episode, not explained by other disorders
3 reasons why we sometimes misdiagnose bipolar disorder 1 as unipolar depression/MDD
1) the first episode of bipolar disorder is often depressive, 2) depressive symptoms are the most frequent symptoms experienced across the long-term course of bipolar I disorder
3) the problem for which individuals typically seek help is depression.
globaal bipolar 2 criteria
een past or current hypomania episode, een pas or current MDD episode
manic episode in bipolar 2 ?
bestaat niet! manic episode = altijd bipolar 1
cyclothymic disorder
periods with hypomanic symptoms (do not meet criteria for mania) mixed with periods of depressive symptoms (do not meet criteria MDD)
how long should cyclothymic disorder last
at least 2 years (1 year for children and adolescents)
symptoms do not go away for more than 2 months at a time
which is more prevalent: bipolar 1 or mdd?
mdd
hard to estimate the prevalence of bipolar 2, why?
because milder forms are hard to detect with diagnostic interviews
what is observed age of onset of bipolar spectrum disorders
usually before age of 25.
prevalence is increasing amongst children and adolescents!
what are the most severe consequences of bipolar
unemployment, suicide and high risk of other medical conditions
subtypes of depressive and bipolar disorders
anxious distress
mixed features
rapid cycling
peripartum onset
seasonal pattern
mood-congruent psychotic features
mood-incongruent psychotic features
catatonic features
melancholic features
atypical features
suicide risk severity
seasonal pattern
episodes happen regularly at a particular time of the year
rapid cycling
at least four episodes within the past year
mood-congruent psychotic features
delusions/hallucinations that are consistent with the mood state
mood-incongruent psychotic features
delusions or hallucinations with themes that do not match the valence of the depressive or manic episode
eg. believing you have superpowers despite going through a major depressive episode
mixed features
at least 3 manic episodes during a depressive episode, or at least 3 depressive symptoms during a manic episode
catatonic features
extreme immobility or excessive movement
melancholic features
lack of pleasure, no relief, and at least 3 other symptoms of depression
atypical features
symptoms that are unusual for manic/depressive state
with anxious distress
with anxiety
suicide risk severity
suicidal ideation
is bipolar heritable
yes, strongly
is depression heritable
somewhat
which neurotransmitters are affected in mania and depression
serotonin: diminished sensitivity
dopamine: decreased sensitivity bij dep, increased sensitivity bij mania
how does dopamine relate to mania and depression
mania: higher sensitivity
depression: lower sensitivity
which brain structure is related to bipolar disorder
amygdala (assessing how emotionally important a stimulus is), hogere activiteit
subgenual anterior cingulate (voor emotion regulation), lagere activteit
striatum (rewards!!), hogere activiteit (deze is juist lager in depression)
hpa axis in depression
hogere activiteit = minder suppression of cortisol = meer stress = depression
which social factors are risk factors for depression
low social support
high expressed emotion
high need for reassurance (-> rejection -> lead weer tot meer depressie)
poor social skills
neuroticism leidt tot meer..
depression and anxiety
becks theory of depression
acquired negative schemas in childhood -> unconscious set of beliefs -> cognitive biases to process info in negative ways -> overly attentive to negative feedback
hopeless theory
expectation that desirable outcomes will never occur, person has no resources to change this. their attributional style leads them to believe that negative life events are due to stable and global causes, zelf geen invloed op -> hopelessness -> depression
rumination theory
tendency to dwell on sad experiences and thoughts may increase risk of depression
2 predictors of mania
- reward sensitivity: mania reflects disturbances in reward sensitivity. -> live event dat leidt tot success -> confidence -> exscessive goal persuit -> mania (bij mensen met biological predisposition)
- sleep deprivation
3 treatments for depression
interpersonal psychotherapy
cognitive therapy
behavioural activation therapy
interpersonal psychotherapy
focuses on improving relationships. very social.
It addresses current problems and relationships rather than childhood or developmental issues. Therapists are active, non-neutral, supportive and hopeful, and they offer options for change.
cognitive therapy
altering maladaptive thought patterns, change opinions about the self, congitive restructuring.
adaptation of CT to prevent relapse
mindfulness-based cognitive therapy MBCT
behavioural activation therapy
increasing participation in positively reinforcing activities, to disrupt the cycle of depression.
difference CT and BA-T
BA-T is a subcategory of CT. Behavioral activation is as effective as and less costly than cognitive behavioral therapy (CBT) for patients with depression.
3 therapies for bipolar disorder
psychoeducation
family focused therapy
cognitive therapy
psychoeducation
help people learn about symptoms of the disorder, expected time course of symptoms, biological and psychological triggers, treatment strategies
family focused therapy
educate family about disorder, enhance communication, develop problem solving skills
3 therapies for bipolar disorder
psychoeducation
family focused therapy
cognitive therapy
ECT wordt veel gebruikt voor…
depressie (voltage, inducing momentary seizure and unconsciousness)
medications for depression
SSRI, monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants.
populairste = ssri, minste bijwerkingen
TMS for depression
increase activity in the brain! (bv delen die onderactiviteit laten zien bij depressie)
aantal mensen werkt het voor, voor mensen die geen goede werking van antidepressiva hadden.
ook gebruikt voor OCD
hoeveel % gaat de efficacy omhoog na combinatie AD en PT
10-20%
verschil in effect ad en psychotherapy
ad: immediate relief, maar geen oplossing
pt; kan langer duren, learn skills that protect against recurrence
medications for bipolar disorder
lithium
anticonvulsants
antipsychotic medication
mood stabilizers voor mensen die lithium niet aankunnen
suicide psych disorders relatie?
meeste mensen die suicide plegen hebben een disorder, of which more than half have depression
suicide heritable?
deels wel ja
biologische deel van suicide
serotonin, overactivity of the HPA, minder dopamine, downregulation of glutamate, abnormal cortisol
social risk factors suicide
dus wereldwijd
social isolation
celebrity suicides
economic recessions
psychological risk factors suicide
poor problem solving
hopelessness
lack of reasons to live
impulsivity
how to prevent suicide
treating mental illnesses
treating suicidality directly
CBT can help suicidal ideation
verschillen persistent depressive disorder en major depressive disorder
pdd = 2jaar
mdd = 2 weken
pdd = low self esteem
mdd= psychomotor agitation or retardation, worthlessness, thoughts bout death
