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PSYO 3129 > Depressive and Bipolar Disorders > Flashcards

Depressive and Bipolar Disorders Flashcards

1
Q

2 categories of mood disorders

A

1) depressive disorders: dysphoria (excessive unhappiness) and anhedonia (loss of interest)
2) bipolar disorders: mood swings between deep sadness to euphoria and mania

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2
Q

3 meanings of depression

A

1) as a symptom
2) as a syndrome
3) as a disorder

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3
Q

90% of young people with depression show…

A

significant impairment in daily functioning

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4
Q

Depression for children under 7

A

Diffuse symptoms, harder to identify

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5
Q

Preschoolers depression

A

May be extremely somber and tearful, lacking exuberance; may display excessive clinging and whiney behaviour around mothers

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6
Q

School-age children depression

A

Same as preschoolers, plus irritability, disruptive behaviour, tantrums

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7
Q

Preteens depression

A

The same as preschooler and school-age, plus self-blame, low self-esteem, persistent sadness and social inhibition

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8
Q

Diagnostic criteria for MDD: Criterion A

A

A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

1) Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)
(2) Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by sub­jective account or observation).
(3) Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gains).
(4) Insomnia or hypersomnia nearly every day.
6) Fatigue or loss of energy nearly every day.
(7) Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
(8) Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
(9) Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

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9
Q

Diagnostic criteria for MDD: Criterion B

A

The symptoms cause clinically significant distress or impairment in social, occupation or other important areas of functioning

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10
Q

Diagnostic criteria for MDD: Criterion C

A

(C) The episode is not attributable to the physiological effects of a substance or to another medical condition.

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11
Q

Criteria A-C of MDD represent…

A

a major depressive episode

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12
Q

Diagnostic criteria for MDD: Criteria D and E

A

D)The occurrence of the major depressive episode is not better explained by schizoaffective disorder, schizophrenia, schizophreni­form disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders.
(E)There has never been a manic episode or hypomanic episode.
Note: This exclusion does not apply if all of the manic-like or hypomanic-like episodes are substance-induced or are attributable to the physiological effects of another medical condition.

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13
Q

MDD Diagnosis in children

A

Same criteria for school-age and adolescents
Depression often overlooked because other behaviours attract attention
Some features such as irritability are more common in children and adolescents than in adults

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14
Q

Prevalence of MDD

A

2 – 8% of children aged 4 – 18 experience MDD
Rare among preschool and school-aged children (1 – 2%)
Sharp increase in adolescence may result from interaction of biological aspects of puberty with developmental changes

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15
Q

Comorbidity with MDD

A

Up to 90% of depressed youth have 1+ disorders
Usually anxiety related
Also: dysthymia, conduct problems, ADHD, substance use disorder, personality disorder

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16
Q

Onset, course and outcome of MDD

A
  • Gradual or sudden
  • Average age onset b/w 13-15 years
  • Length of episode around 8 months
  • Usually recover from first episode, but disorder doesn’t go away (25% of recurrence in 1 year; 40% in 2 yr, 70% in 5yrs. About 1/3 develop bipolar disorder in 5 years).
  • Overall outcome is not optimistic
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17
Q

Depression - gender differences

A

Age 11-13: same (around 3%)
Age 15: female around 5%, male around 3%
Age 18-21: female around 24%, male around 11%

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18
Q

Persistent Depressive Disorder P-DD: Criteria for adults

A
  • Depressed mood for most of the day, for more days than not, for at least 2 years
  • Presence of (2): poor appetite/overeating, insomnia/hypersomnia, low energy/fatigue, low self-esteem, poor concentration, hopelessness
  • No mania
  • Significant distress or impairment in social, occupation or other areas of functioning
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19
Q

P-DD characteristics

A

Characterized by poor emotion regulation
Constant feelings of sadness, being unloved, self-deprecation, low self0esteem, anxiety, irritability, anger, temper tantrums

Children with both MDD and P-DD are more severely impaired than children with just one

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20
Q

P-DD prevalence

A

P-DD less common than MDD: ~1% of children, 5% adolescents
Most common comorbidity is MDD: nearly 70% of children with P-DD may have MDD episode
~50% of children with P-DD also have one ore more disorder unrelated to mood prior to onset

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21
Q

Onset, Course, Outcome of P-DD

A

11/12 years onset
Childhood-onset associated with prolonged duration (2-5 years)
Most recover, but high risk of developing other disorders
Adolescents with P-DD receive less social support than those with MDD

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22
Q

Disruptive Mood Dysregulation Disorder (DMDD)

A

Central feature: chronic, severe, persistent irritability
Irritability takes two forms: temper outbursts & irritable/angry mood
Cannot be diagnosed along with ODD or bipolar disorders
New to DSM-5

23
Q

Associated difficulties with depression: intellectual/academic

A

Cognitive difficulties:
- Difficulty concentrating, loss of interest/motivation, slowed thought and movement
- Problems with tasks requiring attention, coordination speed
Interference with academic performance
-Lower test scores, poorer teacher rating, lower grades

24
Q

Cognitive biases and distortions with depression

A

Selective attentional biases
Negative beliefs, attributions of failure, self-critical, maladaptive automatic thoughts, faulty conclusions
Depressive ruminative style, pessimistic outlook, negative self-esteem
Comes to feelings of worthlessness, hopelessness

25
Q

Social difficulties with depression

A

Few close friendships  loneliness and isolation
Social withdrawal
Ineffective coping styles in social situations

26
Q

Family difficulties with depression

A

Typically has less supportive, more conflictual, familial relationships
Feels isolated from from family
Prefers to be alone – often hear that they are withdrawing (e.g., spending all their time in their room, etc.)

27
Q

Suicide

A

Most youth with depression think about suicide
As many as 1/3 of those who think about it will attempt it
Worldwide, strongest risk factors are having a mood disorder and being a young female
Ages 13 – 14 are peak periods for first suicide attempt by those with depression

28
Q

Theories of depression (8)

A
  1. Psychodynamic - symbolic loss of love object
  2. Attachment - insecure attachment
  3. Behavioural -lack/loss of reinforcement
  4. Cognitive - depressive mindset
  5. Self-Control - problems in organizing behaviour for long term goals
  6. Interpersonal - impaired interpersonal functioning
  7. Socio-environmental - stressful life circumstances
  8. Neurobiological - various abnormalities
29
Q

Behavioural Theory

A

Emphasis on importance of learning, environment, skills/deficits during onset and maintenance of depression
See depression as being related to a lack of response-contingent positive reinforcement

30
Q

Cognitive Theory

A

Negative thinking -> mood
Negative thinking styles: a pattern of negative perceptions and attributions and beliefs lead to depressive symptoms
Hopelessness: depression-prone individuals engage in self-blame thinking, leads to hopelessness that things can get better
Beck’s Model

31
Q

Beck’s model of depression

A

Individuals with depression interpret life events negatively
These biases/negative beliefs act as ”interpretive filters” for how they understand events, the world
Three main areas of cognitive problems:
Information-processing biases
Negative outlook regarding self, world, future
Negative cognitive schemata

32
Q

Causes of depression

A

Complex interaction between many factors -> many pathways to a diagnosis

33
Q

Genetic risk

A

Heritability estimates ranging from 30 – 45%
Children with parents who have depression have about 3X the risk
Likely inherit the vulnerability to depression and anxiety more generally, which then interacts with the environment

34
Q

Neurobiological causes

A

Abnormalities in structure, function of brain regions associated with regulating emotions
Amygdala, cingulate, prefrontal cortex, hippocampus
Cortical thinning in right hemisphere
HPA axis dysregulation, sleep architecture, growth hormone, neurotransmitters have all been implicated

35
Q

Family causes

A

When parents are depressed, parent’s ability to meet child’s needs are impaired
Increases chance pf child having depression, anxiety, substance use disorders in adolescence and adulthood

When children are depressed, families tend to display more critical and punitive behaviour towards them than other children

36
Q

Stressful life events causes

A

Often act as triggers (precipitating factors)
Interpersonal stress, personal losses (perceived or actual)
Life changes
Violent family environment
Persistent daily hassles or stressful life events
Traumatic event

37
Q

Emotion regulation causes

A

Prolonged periods of emotional distress and sadness, or exposure to maternal negative moods:
May lead to problems regulating negative emotional states, leading to higher likelihood of experiencing depression
May lead youth to use negative coping strategies (e.g., avoidance, negative behaviours) to regulate themselves

38
Q

Treatment types (5)

A
  1. Behavioural therapy
  2. Cognitive therapy
  3. CBT
  4. interpersonal Psychotherapy for Adolescent Depression (ITP-A)
  5. Medication
39
Q

Medication for depression

A

Tricyclics consistently fail to treat youth with depression
SSRIs most commonly prescribed for childhood depression
Can have side effects, some serious ones: suicidal thoughts, self-harm
Lack of information re: long-term effects in youth
As many as 60% of youth with depression respond to placebo medication
Consideration of the risks of side effects needs to be balanced with benefits of the use of medication and the risks that are associated with not using medications

40
Q

Behaviour Therapy for depression

A

Focus on increasing positive behaviour – behavioural activation
Small steps towards increasing pleasurable activities and events
Manageable – want feelings of success, positive reinforcement for their efforts
Support skills building to facilitate this process

41
Q

Cognitive therapy for depression

A

Focus on changing the negative thinking styles/patterns
Teach skills such as:
Identifying automatic thoughts
Challenging those thoughts (e.g., thought records, detective thinking)
Challenging core beliefs, biases that drive automatic thoughts

42
Q

CBT for depression

A

Combines behavioural and cognitive approaches
Most common psychosocial intervention for depression
Research suggests it’s the most effective approach
Some flexibility in where to start treatment – behavioural or cognitive?

43
Q

Systems treatment for depression

A

Interpersonal: focuses on improving interpersonal functioning, combines individual (cognitive, behavioural activation, skills-building) and family-based sessions

Family based sessions: supporting the family system. Teaching communication, skills to support depressed youth, working on relationships within family (can address attachment issues, emotion validation)

44
Q

Prevention of Depression

A

CBT-based programs have been shown to lower risk of depression, as well as lowering risk of re-occurring episodes

School-based initiatives have been a focus in this area – opportunity to enhance protective factors, promote resiliency skills, and identify those at risk

45
Q

Bipolar Disorder (BD)

A

Alternating between MDD episodes and striking periods of unusually and persistently elevated, expansive or irritable mood.

Elation and euphoria can quickly change to anger and hostility if they experience barriers to behaviour

46
Q

Symptoms of mania

A

Symptoms of mania include restlessness, agitation, sleeplessness, pressured speech, flight of ideas, racing thoughts, sexual disinhibition, surges of energy, expansive grandiose beliefs

47
Q

3 subtypes of BD

A

Bipolar I disorder
Bipolar II disorder
Cyclothymic disorder

48
Q

Bipolar I

A

Periods of severe mood episodes: full mania and MDD
Episodes last at least 1 week with symptoms present most of the day, nearly every day
OR episodes that required hospitalization, regardless of duration

49
Q

Bipolar II

A

Requires at least one MDD episode and one hypomanic episode during lifetime

Periods of mood episodes: hypomania and MDD
hypomanic episodes : similar to mania in symptoms, but only needs to last at least 4 days with symptoms present most of the day, nearly every day

Often referred to as “milder bipolar”
Not accurate – significant time spent in MDD episodes and the instability still results in major impairment in functioning

50
Q

Cyclothymic disorder

A

Experience at least 1 year (in children, adolescents) of cycling between numerous hypomanic and depressive periods without ever reaching full criteria for hypomania or MDD
Spent at least ½ of that year with one of these periods present
No consistent two month period without any symptoms
Have never met criteria for mania, hypomania, or MDD

51
Q

BD in Youth

A

Significant impairment in functioning
Can include previous hospitalizations, MDD, medical treatment, disruptive behaviour
History of psychotic symptoms and suicidal ideation/attempts is common
Mania in youth may present atypically

Mixed manic-depressive symptoms may be more frequent than euphoria

52
Q

Atypical mania symptoms

A 
Volatile and erratic mood changes
Psychomotor agitation
Mental excitation
Irritability
Belligerence
53
Q

Manic symptoms in children

A

manic symptoms often include pressured speech, racing thoughts, flight of ideas

PSYO 3129 (9 decks)

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