Depressive/Bipolar Disorders Flashcards
What is the history of Melancholia?
In Ancient Greece, ‘melancholia’ was a mental condition characterised by fear and depression –now used to refer to a depressed personality style
What is the difference between mood and emotion?
Moods are broader than singular emotions.
Emotion = sadness, mood = longer emotional experience.
Moods don’t have a specific trigger.
What is the criteria for a major depressive disorder?
Depressed mood for more than two weeks
Feeling depressed, sad, empty or hopeless
Loss of interest in previously enjoyed activities (anhedonia)
Plus at least four of: weight loss/gain or decreased/increased appetite; insomnia or hypersomnia; loss of energy or excessive fatigue; motor restlessness or slowed movements; diminished concentration, ability to think, or indecisiveness; feelings of worthlessness or guilt; recurrent thoughts of death, suicidal ideation or a suicide attempt
How does the DSM-5 describe variability in depression diagnosis?
Severity of depression (mild, moderate or severe)
Number of episodes of depression (single, recurrent
Degree of recovery between episodes (full or partial)
Depression with or without psychotic features
What are three changes the DSM-5 has recently made to Depressive Disorders?
Bereavement no longer excluded from a diagnosis of major depression
Dysthymic disorder renamed ‘persistent depressive disorder’
The addition of ‘disruptive mood dysregulation disorder’
What is the prevalence of Depression?
Around 3.1 per cent in men and 5.1 per cent in women over a one-year period
What problems are associated with depression?
Increased risk of suicide attempts and death by suicide
–Rate of suicide in the community from depressive disorders is approximately 3.5 per cent
-Higher rate for male suicides (6.9 per cent), than female suicides (1.1 per cent)
Impaired social and occupational functioning
Co-morbid anxiety disorders
Increased physical health problems
How much does a family history of depression increase the risk of an individual getting depression?
By two to three times
What stressful life events may cause causal triggers for depression?
Acute: financial disaster
Chronic: living with an abusive partner
Pass
Pass
What interpersonal difficulties have been linked to depression?
High expressed emotion, relationships involving hostility, high levels of criticism, and over-involvement
Lack of intimate relationships: Particularly a risk factor for women
What are Protective factors for Depression?
Good interpersonal skills High levels of family cohesion Being connected with one’s community Achievement in a valued pursuit Optimism and low anxiety Openness to experience Effective coping skills Psychological resilience (PFRS: Harms, Cohen &Pooley)
How can Depression be treated (Pharmacological and physical approaches)?
Medication
Repetitive transcranial magnetic stimulation
Vagus nerve stimulation
Bright light therapy for seasonal affective disorder
Electroconvulsive therapy (for severe depression)
How can Depression be treated (Psychological approaches)?
Cognitive behaviour therapy
Interpersonal psychotherapy
Psychodynamic therapy
What are some of the relapse prevention methods for Depression?
Most common method is antidepressant medication.
Continue active phase of psychological treatment, e.g., CBT and IPT
–Plan how to cope with future triggers to depressed mood
–Develop a plan for how to respond if symptoms re-emerge
Treatments specifically for relapse:
–Wellbeing cognitive therapy
–Preventive cognitive therapy
–Mindfulness-based cognitive therapy
When did mania and depression begin to be seen as a single entity?
During the late nineteenth century
How is Bipolar Disorder diagnosed?
Bipolar disorders embrace a spectrum of disorders including bipolar I, bipolar II and cyclothymic disorder
These three disorders all share symptoms of pathologically elevated mood
These elevated mood states are referred to as ‘manic’ and ‘hypomanic episodes’
What are manic and hypomanic episodes?
A manic episode is defined by the DSM-5as elevated, expansive or irritable mood with increased goal-directed activity or energy for at least 1 week, plus at least three of the following: Inflated self esteem or grandiosity, sleep disturbance, decreased need for sleep, pressure of speech, flight of ideas, distractibility, heightened activity, risk taking
A hypomanic episode only requires symptoms to be present for at least 4 days, and symptoms tend to be less severe
What are the different types of Bipolar Disorder?
Bipolar I disorder:
–Presence of one or more manic episodes
–Major depression may be present but not required for the diagnosis
Bipolar II disorder:
–At least one episode of major depression
–At least one period of hypomania
–Must not have had a manic episode
Cyclothymic disorder:
–Symptoms are less severe but more chronic than bipolar I or II
–Numerous periods of elevated and depressed mood, but not severe enough to meet criteria for hypomanic, manic or major depressive episode
What are key problems with underdiagnosis and overdiagnosis of bipolar disorder?
Patients with bipolar disorder may be misdiagnosed as having schizophrenia (men) or major depressive disorder (women):
–Misdiagnosis as schizophrenia may be because of similarities between psychotic features of acute mania and schizophrenia (e.g., delusions and hallucinations)
–Misdiagnosis as major depressive disorder may be because past episodes of hypomania or mania are not adequately explored by the clinician
Brief periods of elevated mood may be wrongly diagnosed as hypomania
–Common for those with borderline personality disorder
–Could mean inappropriate use of mood-stabilising medications
What is the lifetime and 12 month prevalence of Bipolar Disorder?
Lifetime prevalence of 1.3 per cent
12-month prevalence of 0.9 per cent
What are key problems are associated with Bipolar Disorder?
Anxiety disorders
Substance misuse:
Reported in 39 per cent of people with bipolar disorder
Social and economic costs:
Those with bipolar disorder are almost five times more likely to have disrupted relationships
Suicide: Suicide rate is nearly 15 times that of the general population
What is the relationship between Bipolar Disorder and Creativity?
Research findings are inconsistent but many people with bipolar disorder identify as creative
Subjective value of creativity has implications for treatment of bipolar disorder, e.g., addressing concerns that bipolar medication might blunt creativity
Shared vulnerability model – Vulnerability to pathology and creativity share factors such as cognitive disinhibition, an attentional bias towards novel stimuli, and neural hyperconnectivity
What do twin studies suggest the heritability rate of Bipolar Disorder disorder is?
85 per cent
How is Bipolar Disorder treated?
Mood stabilising medication
Psychological approaches:
–Psychoeducation
–Cognitive behaviour therapy
–Interpersonal and social rhythm therapy (IPSRT)
–Family interventions
–Hospitalisation—when patients are suicidal or psychotic
–Mindfulness-based cognitive therapy
What did Emil Krapelin (1896) identify as a major category of mental illness?
Manic depressive insanity
Who made the distinction between depression and biploar disorder in 1957?
Karl Leonhard (1957)
Are women twice as likely to experience depression?
Yes
What increases the risk of young people developing depression?
High levels of anxiety Substance abuse History of depression Ongoing family conflict A history of sexual or physical abuse Residing in a rural area Being of Aboriginal or Torres Strait Islander descent Having a parent with a psychological disorder
What is the median age of onset for Depression?
Approximately 30 years
What percentage of those with a depressive disorder will recover within six months?
50%
For those who recover from their first episode of depression, many will have another episode within how many years?
5
What increases the disk of Depression relapse?
Earlier age of onset Continued experience of some symptoms Multiple prior depressive episodes Ongoing life stressors History of depression in family members
What Polymorphism on what gene is associated with an increased risk of depression in combination with aversive life events?
Polymorphism on the 5-HTTLPT gene
Hyperactivity in what axis can cause depression?
Hypothalamic-pituitary-adrenal (HPA) axis
What brain components may cause depression?
Structural or functional abnormalities in the prefrontal cortex, hippocampus, anterior cingulate cortex and the amygdala
Growing up in what kind of environment increases the risk of depression?
A hostile, disruptive and violent family environment
What are the three components of an individuals life that interact to trigger depression?
Environmental risks
Biological vulnerabilities
Psychological vulnerabilities
Is it possible to reduce the impact of stressful life experiences by increasing social support
Yes
What do Behavioural Theories say about cause of depression?
Focus on contingencies associated with depressed and non-depressed behaviours
Highlight the role of poor coping skills
What do Psychoanalytic Theories say about the cause of depression?
Depression is a form of pathological grief
When did Karl Leonhard change the term ‘manic depressive insanity’ to Biploar Disorder?
1957
What Australian psychiatrist discovered lithium as an effective treatment for mania—which revolutionised the treatment of bipolar disorder?
John Cade
What is the difference between men and women in meeting the criteria for Bipolar Disorder?
Men and women are equally likely to meet criteria for bipolar I disorder, women are more likely to meet criteria for bipolar II disorder
What is the median age of onset of Bipolar Disorder?
Around 25 years
Is the most time spent in depressive episodes, manic episodes or hypomanic episodes?
Depressive episodes
What is the main reason for high rates of relapse?
Poor medication compliance
What is the Diathesis–stress model of Bipolar Disorder?
Disorders result from interaction between underlying vulnerability and stressful life events
What is the Goal dysregulation model model of Bipolar Disorder?
Mania is the result of excessive goal engagement
How do Psychological factors impact Bipolar?
Greater negative beliefs about oneself and the world, temperamental tendencies
What measures of states and traits are related to bipolar disorder?
Depression Anxiety Stress Scale Dysfunctional Attitudes Scale 24 BIS/BAS scales Response Style Questionnaire Internal State Scale
