exam 2 Flashcards

1
Q

What are the three major Mood Disorders

A

3 major mood disorders
Major depressive disorder
persistent depressive disorder
Bipolar disorder

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2
Q

Major depression(unipolar depression)

A

the common cold of pyschopatholgy
lifetime prevalence is 16%
twice as many women as men experience a clinical depression
age of onset is late teens to early twenties
evidence the average age of onset is decreasing(not quite sure why)
this is in all countries

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3
Q

Symptoms of Major depression

A

Sad affect(affect=mood)
loss of interest or pleasure in usual activities (anhedonia)
weight and appetite changes
forget to eat
or eat to much
sleep disturbances
early morning awakening

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4
Q

Pyschomotor changes associated with Major depression

A

Pyschomotor changes
agitated all the time
people get very slowed down in speech in movements
**THESE CHANGES ARE OBJECTIVE (people can tell these things)
Loss of energy and fatigue
feelings of worthlessness and guilt
difficulty concentrating

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5
Q

suicidal ideation associated with Major Depression (2 kinds)

A

Active-I am going to kill myself if I don’t get better
Passive-If I just didn’t wake up tomorrow that would be okay (my kids would be better off If I were not alive)

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6
Q

Frequency/ Stats about Major Depression

A

Need to have at least one of the first two five symptoms total
YOU DO NOT NEED TO FEEL SAD IN ORDER TO BE DIAGNOSED WITH DEPRESSION
For sadness to be a symptom it has to be 14 days sad most of the day
Average duration of single episode == 5-9 months

Single vs recurrent episode
85% of single episode cases later experience a second episode
4 is the median lifetime number of episodes
the median duration of a current episode is about 4-5 months
often comorbid with anxiety(60% of those that meet criteria for major depression will be diagnosed with anxiety)

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7
Q

PERSISTENT DEPRESSIVE DISORDER (new to the dsm 5)

A

combination of depressive disorder and dysthymia

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8
Q

Criteria for persistent depressive disorder

A

depressed mood most of the day for at least 2 years
average duration is 4-5 years
TWO ADDITIONAL SYMPTOMS (many of the same symptoms as major depressive disorder)
never without depressed mood for more than two months at a time

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9
Q

Why did the DSM 5 add Persistent depressive disorder as a mood disorder

A

THE NEW DIAGNOSIS COMES FROM THE CHRONICITY OF THE SYMPTOMS NOT THE NUMBER OF SYMPTOMS
YOu only need 3 symptoms for a very long time (this is worse than having 5 or 6 symptoms for only 2 months)
Tremendous overlap between dysthymia and major depression (double depression)
95% of people with dysthymia suggests that there is a lot of overlap between dysthymia and major depression so we now call it persistent depressive disorder

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10
Q

BIPOLAR SYMPTOMS

A

1% of the population is BI polar
very rare for someone to develop bipolar disorder after 40 years of age
Course-chronice (depression and mania alternate chronically)
17% of the those with bi polar attempt suicide
NO gender difference with bi polar disorder
depressive episode are shorter milder and more frequent then major depressive disorder
manic episode may last several days or several months
rapid cylcers vs slow cyclers
If you have any mania what so ever you still diagnosed with bi polar

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11
Q

SYMPTOMS OF MANIA

A

elevated or euphoric or irritable mood
extraordinary increase in activity level
3 of the following are noticeable changed
talkativeness/rapid/speech
racing thoughts
decreased need for sleep
inflated self esteem
distractibility
involvement in impulsive activities
shopping sprees
use of alcohol and drugs

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12
Q

COMORBIDTY AND MANIA

A

2/3 of those with bipolar have anxiety
1/3 report substance abuse

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13
Q

Genetic Factors for Major depression

A

2/3x greater rate of depression in the relatives of pro bands compared to controls

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14
Q

Genetic FActors for Bipolar disorder

A

8-10% of relatives have bi polar as well
67% monozygotic
DZ 19DZ

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15
Q

Genetic facts concerning unipolar depression

A

46 mz 20% dz

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16
Q

5 HTT gene in major depression

A

this is the gene that is responsible for the brains production of serotonin transporters
proteins that help serotonin cary message from one neuron to the next

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17
Q

Heritability estimates in unipolar and bipolar depression

A

37% of variance in UNIPOLAR is thought to be genetic
80-90% of variance is Bipolar is genetic

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18
Q

Catecholamine thoery

A

major depression is a result of low epinephrine eactivy
bi polar is caused by too much norepinpehrine

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19
Q

Indoleamine theory

A

both mania and depression are caused by too little serotonin activity

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20
Q

Mono amine depletion model

A

The monoamine hypothesis of depression predicts that the underlying pathophysiologic basis of depression is a depletion in the levels of serotonin, norepinephrine, and/or dopamine in the central nervous system.

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21
Q

is dperessive associated with a change in brain activity?

A

1.) amygdala scane indicate that activity and blood flow in this area is 50% greater than those with depression
somewhat elevated activity is found in the relatives of those with depression
2.) prolonged depression leads to decreases hippocampal volume
found in never depressed people who are at high risk for depression

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22
Q

NUERO ENDOCRINE SYSTEM

A

**plays an important role in regulating a persons response to stress**
recent research has focus on over activity of the HPA axis and CORTISOL
**WHEN ONE DETECHS A THREAT THE HYPOTHALAMUS signals pituitary secretes acth
acth modulates secreation of cortisol into your blood stream.

PEOPLE WHO HAVE INCREASES LEVELS OF CORTISOL ARE READY TO FIGHT OR FLEE
IN PEOPLE WITH DEPRESSION
CORTISOL LEVELS ARE OFTEN POORLY REGULATED

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23
Q

dexamethazone suppression tests

A

dexamethazon is a steroid medication most who take it show suppression of cortisol secretion
hypothalamus is fooled into think there is already enough cortisol in ones system.
50% of depressed patients show a failure of suppression in response to the DST
ONCE THEY ARE NO LONGER DEPRESSED MOST SHOW A NORMAL RESPONSE

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24
Q

BECKS THEORY

A

depression may results from the tendency to interpret everyday events in a negative way
THEY MAKE THE WORST OUT OF everything
WHen he did therapy he noticed a lot of cognitive errors in his patients

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25
Becks Cognitive Errors
**Selective perception** **MAGNIFICATION** **Personalization**
26
**Negative cognitive Triad**
**1. thoughts about self** **2. world** **3. future**
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3 learned helplessness theroes
1.) orignial learned helplessness Attributional reformulation 3.) hopelessness depression
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1.) orignial learned helplessness
depression is a result of feeling helpless and lacking a sense of control based off early dog experiments PROBLEM: many depressed people blame themselves for their problems
29
Attributional reformulation
explanations for events dimensions of attributions 1. internal vs external attributions internal-I failed because I didn't study enough external I failed because she's a bitch 2. stabel vs unstable stable- 3. global vs specific depressed people make ISG attributions
30
METALSKY STUDY
asked intro psych students what grade to you expect on that first mid term exam selected a sub sample who significant lower than they expected time 1: all depressed after failing first exam time 2: those who made SG attributions were still depressed those who didn't make SG were better \*\*showed the durability of the negative mood in those who made SG attributions
31
hopelessness depression
focused on a specific subset of depression - hopelessness depression bad things are going to happen to me and there is nothing I can do about it chain of events 1. negative life event 2. SG attribution (place a lot of importance on this event) 3. other cognitive factors 4. expectation of hopelessness 5. hopelessness depression
32
RESEARCH
study that followed low/high risk students high risk = rutine SG attributions followed both groups for two years high risk group were four times more likely to develop an episode of major depressive disorder
33
Klerman and Weissman four interpersonal problem areas that may lead to major depressive disorder
loss may trigger grief reaction. Children who experience death of a parent are at high risk of developing major depressive disorder as an adult 2. interpersonal role dispute 3. interpersonal role transition (a good social support network) 4. interpersonal defficits (people who lack social skills,)
34
GENDER DIFFERENCES IN DEPRESSION
no gender differences in children gender differences emerge around 13-15 Women also tend to have more frequent and long lasting episodes also respond less successfully to treatment options WHY do women become more depressed?
35
5 explanations for gender differences in men and womena
Artifact Theory Hormone Explanation Life Stress Theory Lack of Control Theory Cognitive Vulnerabilty Stress Model
36
impact of marriage on depression for males and females
married women in traditional marriages(STAY AT HOME AND STUFF) have higher rates of depression than either single women or married women in equal relationship married men in traditional marriages have lower rates of depression then men who are in egalitarian marriages Married women who work at least part time have lower rates of depression then stay at home moms (eggs in a basket theory) if all you do is stay at home with the kids and the kids are bad you do not get a lot of satisfaction and there is no where else to get your happiness from
37
artifact theory
women and men are equally prone to depression but clinicians dont diagnose correctly because women are much more likely to admit to feelings of sadness in our culture(its not that men are speaking up It’s really a true fact that women
38
hormone explanations
maybe hormone changes are causing depression (period, menapuas) research suggests that hormone changes alone are not responsible for the high levels of depression (some women do get depressed but not all during these times) Other people criticize this as sexist Pre menstral disforic disorder is a new diagnosis for depression around period time
39
life stress theory
women in our society experience more stress than men do women face more poverty 75% of those living in poverty are women face more menial jobs(how many male house cleaners do you know?) less adequate housing experience more discrimination then men do in many homes women are responsible for higher % of house work and child care
40
lack of control theory
women may feel less control over there lives they are more likely to be victims (attributional formulation-learned helplessness(maybe I deserve a black eye)
41
cognitive vulnerability stress model(developed by Hankin and Abramson)
adolescents likely to become depressed when pessimistic attributional style + stressful life event
42
When it comes to depression girls differ from boys in three different ways
girls demonstrate ISG attributions more than boys girls show more rumination GIRLS ACTUALLY EXPERIENCE MORE NEGATIVE LIFE EVENTS
43
Synergistic Effect
the combination of all these is the greater than the sum of all the others
44
interpersonal therapy (interpersonal theory)
Treatment for unipolar depression try to improve problem solving trying to improve communication treating adolescents releaves symptoms prevents relapse
45
Becks Cognitive therapy
trying to get the person to increase pleasurable activities Examining invalidate automatic thoughts change distorted thinking/biases (isg attributions)
46
Behavioral activation Therapy
increase those pleasurable activities this one component can be effective on its own changing the way you think about things is not necessary
47
THE THREE CATS OF ANTI DEPRESSANTS
MAO Tricyclis SSRI
48
MAO (monoamine inhibitors)
nardil, Marplan these were the earliest anti depressants slow down the bodies production of MAO those who have too high levels of Norepinephrine or Serrotonin YOU HAVE TO RESTRICT YOUR DIET (otherwise you can get high blood pressure or sudden death )
49
Tricyclics
trofranil Elavil developed in the 1960s drug of choice until 1990 Correct the receptors sensitivity to norepinephrine and serotonin they tend to be more effective than MAO inhibs (they tend to have more problematic side effects) (dry mouth, constipation, weight gain, sexual dysfunction) (toxic in large doses)
50
SSRI (selective serotonin reuptake inhibitors
prozac zoloft paxil developed 1989 currently the most prescribed account for more than 80% of all prescriptions not as toxic if you take it in a large dose (problems with orgasm and lowered sexual interest) inhibit the reuptake of serotonin into presynaptic nerve ending increase serotoning in synaptic cleft called selective because they have no effect on the uptake of other neurotransmitters In general 50-70% of those who take medication get better. Which medication is going to be effective for any person is completely a mystery
51
New anti depressants
wellbutrin no sexual side effects activiating effect effexor
52
Which treatment is best?
s therapy or anti depressant the way to go a combination of the two increases the chance of recovery by 10-20%
53
pros and cons of different treatment
anti depressants work fast that cbt cbt is better at preventing relapse especially if you have done 12 weekly session you go in once a month
54
Electroconvulsive therapy
electric current is sent through the brain creating seizure WHy does this work we do not know and thus this is a controversial treatment effectiveness (its very effective for people who are severely impressed and do not respond to medication) higher relapse rate if you do not starting taking anti depressants following ect possible memory loss caused by ext
55
Treatment for bi polar
lithium we do not know why lithium works for bi polar but it is very effective. Helps about 80% of people with bi polar have fewer manic episodes as well between 40-60% avoid recurrence completely Risk of relapse is 28 times greater if patients stop taking lithium Major issue is medication compliance 50% of people with bi polar do not take their medication as prescribed or they stop taking it all together (they miss the highs) the rapid thoughts and decreased need for sleep it helps to combine lithium treatment with psychotherapy
56
Obessession
repetive thoughts ideas impulses or images that intrude into a persons cnscionessnot in a persons control they do not choose to do this they realize that this obsession is senseless but they cannot get rid o these thoughts influences or images
57
compulsions
actions that a person feels compelled to repeat again and again engage in compulsion in order to prevent some disaster from occurring in order for a diagnosis of OCD you need to have recurrent obsessions or compulsions they have to be severe enough to be time consuming need to cause distress or impairment actions that a person feels compelled to repeat again and again engage in compulsion in order to prevent some disaster from occurring in order for a diagnosis of OCD you need to have recurrent obsessions or compulsions they have to be severe enough to be time consuming need to cau se distress or impairment
58
Most common obsessions
Symmetry one needs to have things in a particular order Aggressive or horrific obsession to hurt your child Sexual imagery Symmetry one needs to have things in a particular order Aggressive or horrific obsession to hurt your child Sexual imagery
59
MOST COMMON COMPULSIONS
checking people feel compeled to check that the door is locked over and over again cleaning behaviors include the hand washers/shower multiple times a day/ symmetry if you have 8 magazines they need to be ordered and fanned in a certain way
60
Exposure Therapy
let clients listen to their silly thought over and over again people can improve from this therapy in 3-6 months
61
behavioral etiology of ocd
compulsions are learned behaviors that are reinforced by their consequences consequence == anxiety goes down ex. superstitious behavior
62
4 factors that may lead some to develop OCD
1. depressed mood increased intensity of unwanted thoughts increase # of unwanted thoughts 2. Strict code of acceptability 3. Dysfunction beliefs about responsibility and harm 4. Dysfunctional beliefs about the control of thoughts
63
2 additional characteristics that people with OCD also have
1. the probability BIAS the belief that having a thought increases the chance of the behavior occurring 2. Morality bias the view that having an imoral thought is just as bad as if you had done it
64
BIOLOGICAL ETIOLOGY of OCD
Neurotransmitters could be increased serotonin sensitivity Diathesis could be some defect in the way your brain metastasizes serotonin Some research argue that serotonin acts as a neuromodulator its primary function is to increase or decrease the activity of other things
65
Genetic etiology of ocd
MZ twins have higher concordance rates as DZ twins IT HAS A GENETIC component Brain Scan findngs ## Footnote pet scans show high activity in several areas of in the brain in OCD patients caudate nucleus and basal ganglia thalamus This three part make the cortical stratal thalamic circuit THis is where primitive impulses arise impulses goe to caudate nucleus which filters things and only allows the most powerful impulses if the impulses reach the thalamus t