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
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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
