depressive and bipolar disorders Flashcards
disruptive mood dysregulation disorder
age related, but extreme versions of mood swings
major depressive disorders
a pattern of significant disturbance in mood
persistent depressive disorders (dysthymia)
a problem of long lasting lows in mood “ive always been this way”
Does depression stem from chemical imbalance?
Depression has many causes including faulty mood regulation in brain, genetic vulnerability, life events, medical problems. Not just a matter of one chemical being high or low
Amygdala, thalamus, and hippocampus significant roles:
A: higher activity in clinically depressed people (CDP)
T: strong links with Bipolar
H: smaller in CDP; sluggish production of new neurons. Takes weeks to improve nerve growth and form new connections
Serotonin
regulate mood; inhibit pain. Low in CDP
Norepinephrine
associated with reward/motivation. Low in CD
Dopamine
Reality perception/motivation. Low in CDP
MDD
Significant lack of energy, can’t get out of bed
*Life is tasteless
*Eat or sleep too much or too little
*Agitation, irritation, raging at cards dealt
*Melancholia: no interest, flat experience
*Responsible for another’s death or event
*Feeling persecuted
*Feeling worthless
*Inability to concentrate, indecisive
*Recurrent thoughts of death, suicide
*Several symptoms present for 2 weeks
persistent depressive disorder
Mild but always present, at least 2 years
*Some good, some bad, mostly dull days
*Symptoms of MDD are present but less severe
*Daily functioning possible
*If criteria met for PDD and MDD, assign PDD with specifier.
*No mania present
*Always consider substance use, medical illness, chronic stressor
Premenstrual Dysphoric Disorder
Cycles are consistently preceded by depression, irritability, reactive mood, anxiety.
*Various other physical symptoms
*Physical pain and discomfort is common and should not receive a mental diagnosis. This disorder is assigned when prominent psychological symptoms cause significant impairment
*Consider when dysphoria occurs most times over year
*Consider contraception side effects9
DMDD
Chronic (6 months to year) and severe irritability which often result in frequent temper outbursts which are not easily categorized into clear episodes (mania then depression)
*Used for those between 6-18 (but must start before 10) as a way to account for age related behaviors that manifest in extreme ways.
*In others words, teenagers and young children often exhibit irritability and outbursts of emotion. This doesn’t mean Bipolar anymore. Extreme versions of normal age related behaviors is now DMDD
Treatment for depressive disorders
Cognitive-Behavioral Therapy
*Interpersonal Psychotherapy
*Psychotropic medication in some instances
*Encourage physical activity
*Encourage pleasurable activities
Bipolar Disorders
Criteria now includes changes in mood and energy
*Standalone category
*Biggest change with attempts to reduce the over-diagnosis of Bipolar in children (noted in Depressive Disorders now)
*Diagnosis in children increased 40x over past 20 years. Mostly due to misunderstanding disorder, drug company pressure, help explain a variety childhood emotional dysregulation
Bipolar 1 Disorder
(highly comorbid with alcohol substance abuse and substance abuse in general)
Bipolar I represents classic manic-depressive state
*Mania: flamboyant, antisocial, aggressive
*Mania: lofty ambitions, high confidence, high energy
*Mania: racing thoughts, belief to accomplish anything
*Impulses run wild: big new projects, adventures, reckless choices, restlessness
*“So much to do, so little time”
*Then irritability and exhaustion
*MD: anger, sadness, worthless
*MD: insomnia, loss of energy and appetite
*MD: recurrent thoughts of death, suicidal thoughts or attempts
*“I hate my life; life sucks”
Bipolar 1 Diagnostic Tips
Mania is a diagnostic emergency that the client doesn’t see
*Clinicians likely won’t see clients in mania, more likely to see depression
*History gathering important
*Review substance usage (alcohol, drugs, meds, supplements). These can trigger mania in depressed (or more depression) clients
Note age of onset. Too old or too young something else going onUnderstand weight of the label-be careful
Bipolar 2 Disorder
B II is characterized by a clinical course of recurring mood episodes consisting of one or more major depressive episodes (lasting at least 2 weeks) and at least one hypomanic episode (lasting at least 4 days)
*Also, B II will not have Manic episode. If mania, then B I
*The mood swing has to be a significant shift. Hypomanic episode not likely to cause clinical impairment and likely isn’t viewed as pathology…the savvy clinician will know better
*One diagnostic code. Specifiers are written out instead of coded like B I and MDD
Bipolar 2 disorder diagnostic tips
B II is a boundary land disorder with clear depression present, yet difficulty identifying hypomania*Investigate history, substance use, and medication
*Investigate description of hypomania carefully to tease out normal reaction to “lifting” of depression
*Family history will be big clue
*Increase of agitation and irritation in response to antidepressant meds is a red flag
Opt down for MDD when confused about presenceDon’t assume B II is lesser of the two, can be just as damaging to one’s life even if no trips to the hospital
Cyclothymic Disorder
Consistent mood swings, alternating between hypomania and depressive symptoms
*Clinical significant, but not enough to move into B I or II
*Manic episode make this B I
*MDD makes this B II
*Beyond normal emotional intensity, but not too much
*Essentially criteria for MDD, Manic, Hypomanic have not been met, but there are symptoms
*For 2+ numerous periods of hypo and depressive symptoms
*For most of those 2 years, the symptoms are present
*Can’t go more than 2 months without something
Bipolar 1 and 2 differences
Hypomanic episodes are less severe than Manic. They last less time (min. 4 days vs. 7) and have less impact on social or occupational functioning (no hospitalizations)
*One with MDD has not experienced Manic or Hypomanic
*One with II doesn’t experience Manic, only Hypomanic
*One with Cyclo doesn’t experience MDD or Manic
*Schizoaffective has similarities but psychosis with or without mood symptoms
Treating bipolar disorders
- pyschotrophic medication in combonation with cousneling
Mood stabilizers: Abilify or Risperdal (anti-psychotic), Depakote (anti-convulsant), Lithium (anti-manic)
*Cognitive-Behavioral Therapy
*Interpersonal Psychotherapy
*Encourage physical activity
*Encourage pleasurable activities13
The difference between schizoaffective and bipolar 1 with psychotic features
You only have psychotic features when you are really high (maniac) whereas schizoaffective, you have psychotic features “normally”
