Depression and Bipolar Disorder

Question 1

4 types of Mood Disorders (DSM IV)

Answer 1

• Depressive Disorders:
• • Major Depressive Episode
• • Unipolar depression
• Bipolar disorders:
• • Bipolar I: extreme depression and mania
• • Bipolar II: depression and hypomania (less severe)
• Dysthymic Disorder: Milder depressive symptoms that are very long-lasting -> come to believe it’s part of personality
• Cyclothymic Disorder: Less extreme swings between depression and mania -> appear moody

Question 2

2 types of depressive disorders (DSM 5)

Answer 2

• Major Depressive Episode

- Persistent Depressive Disorder (chronic depression; previously known as Dysthymia)

Question 3

Depression Basics

Answer 3

• Previously known as “unipolar depression”
• Been studied for a long time – ie. Anatomy of Melancholy (by Robert Burton, 1600s)
• Affects various aspects of person’s functioning (body, mood, eating, sleeping, etc.)
• Recurrent disorder: If you have depression once, you’re likely to get it again
• • But if you do psychotherapy, likelihood of relapse is reduced
• Naturally improves on its own
• Heterogenous: one person’s depression will look different from another’s (different moods, ex. Some feel sad, numb, irritable, etc.)
• Slow-onset: creeps up on a person

Question 4

Major Symptoms of Depression

Answer 4

• Mood Symptoms: feeling rejected, unloved, anxious, tense, upset, etc.
• Cognitive Symptoms: low self-esteem, viewing self in critical/harsh ways, hopeless/pessimistic, reduction in motivation, delusions, slower cognitive processes, etc.
• Motor Symptoms:
• • psychomotor retardation (slowing of all motor behaviour); lack of energy; less talkative/more monotone
• • Paradoxical symptoms: lack of energy in facial muscles vs. psychomotor agitation (unable to sit still)
• Somatic Symptoms:
• • Compromised immune system, loss of sex drive
• • Paradoxical symptoms: difficulty falling asleep or staying asleep (early morning awakening -> becomes more severe as depression becomes more severe) vs. sleeping almost all day; eating disturbance (loss of interest in eating vs. eating too much)

Question 5

Concepts in Depression

Answer 5

• Retarded Depression (psychomotor retardation)
• Agitated Depression (psychomotor agitation)
• Melancholia
• • 2 characteristics:
• – Anhedonia (loss of ability to experience pleasure)
• – No capacity to feel better
• Seasonal Affective Disorder (experiencing depression symptoms in fall/winter)

Question 6

PDM - Depressive Disorders

Answer 6

• Affective: Two general emotional orientations:
• • Anaclitic: feelings of helplessness, fears of abandonment, difficulty tolerating delay (dependency)
• • Introjective: harsh, punitive, unrelenting self‐criticism (achievement)
• Cognitive Patterns: Guilt, fantasies of loss of approval, recognition and love, inability to make decisions, low self‐regard, suicidal ideas, impaired memory
• Somatic States:
• • Loss of sexual desire, physical irritability, restlessness, physical complaints (e.g., headache, back pain) with no pathophysiology to account for.
• • Change in appetite -> weight gain or loss
• • Fatigue, low energy, and lethargy
• Relationship Patterns: Insatiable neediness and/or demanding hostility

Question 7

Risk Factors Leading to Depression Vulnerability

Answer 7

• Past depression
• Object loss in childhood
• Poor social skills
• Genetic components
• Personality
• Dysfunctional Attitudes

Question 8

Other “Depressions”

Answer 8

• Grief/loss (similar symptoms to depression, can lead to bereavement disorder if you don’t let yourself feel grief)
• Adjustment disorders (depressed mood)
• Completion of major task (dissertation)
• Postpartum depression (dramatic and psychotic)
• College life

Question 9

Bipolar Disorder Basics

Answer 9

• Bipolar disorder = swinging between depression and mania
• Prevalence equal amongst men and women (unlike depression, which is more common amongst women)
• Usually begins with a manic episode and appears in adolescence (unlike depression, which usually appears in adulthood)
• Bipolar disorder has strong genetic component (much more than depression) and higher suicide risk
• Treatment: responds well to lithium

Question 10

Major Symptoms of Manic Episode

Answer 10

• Mood Symptoms: elevated/euphoric mood or irritable/angry mood
• Cognitive: inflated/unrealistic self-esteem, talkative, flirtatious, etc. And have “flight of ideas” -> many thoughts/ideas happening at same time, changing topics constantly, etc., hypersexual interest
• Motor Symptoms: buying sprees, reckless driving
• Somatic Symptoms: not needing to sleep

Question 11

PDM - Bipolar Disorder Manic States

Answer 11

• Affective: intense pleasure or euphoria, intense irritability, hypersensitive to insult and rejection; excessive energy (disruptive); a sense of infinite power, ability and creativity
• Cognitive Patterns: fantasies of invincibility and exceptional talent; difficulty thinking clearly, logically; fear that they cannot hold onto their thoughts; sometimes thoughts are highly disoriented, sometimes are freeing and joyful
• Somatic States: restlessness and sleeplessness; physically invigorated and aroused; intense and frequentsexual desire; physical exhaustion (may evoke suicidal depression)
• Relationship Patterns: unpredictable, chaotic, impulsive, and sexualized