L2 - Mood Disorders Flashcards
What are the two types of mood disorders?
Unipolar - one polar mood. i.e. depression
Bipolar - 2 polar moods fluctuating between periods of depression and mania. –> Bipolar I, Bipolar II or Cyclothymia
How do we differentiate between normal and abnormal depression?
- INTENSITY of mood change.
- If mood change pervade all aspects of the person & impairs social and occupational function
- Can they function despite being sad - sleep, appetite, pleasure, socialising, fulfilling role obligations.
- ABSENCE OF PRECIPITANTS
- mood may develop with no real reason, or be grossly out of proportion to a reason
- QUALITY
- the mood change is different from normal level of sadness. palpable
- ASSOCIATED FEATURES
- The mood change might be accompanied by a cluster of signs and symptoms - somatic (sleep disturbance, appetite) + cog (Self esteem).
List the DSM5 Depressive disorders
Disruptive Mood Dysregulation Disorder
Major Depressive Disorder
Persistent Depressive Disorder (Dysthymia)
Substance/Medication-induced Depressive Disorder
Depressive disorder due to another medical condition
Other specificed Depressive Disorder
Unspecified Depressive Disorder
What is disruptive mood dysregulation disorder/
This disorder is new, and was added to the DSM to reduce the diagnosis of bipolar in children.
- Restricted to under 18’s
- Severe recurrent outbursts of anger, out of proportion for situation and doesn’t line up with development level
- general mood is irritable/angry
other facts:
some argue this is pathologising normal behaviour/development
What is MDD?
Major Depressive Disorder
5 or more of these in 2 week period, representing a change form previous functioning:
- depressed mood most of the day
- diminished pleasure
- insomnia/hypersomnia
- fatigue
- psychomotor agitation/retardation
- diminished ability to think/concentrate
- recurrent thoughts of death/suicidal ideation
- feelings of worthlessness/guilt
most common comorbidity - anxiety
What is Persistent depressive disorder?
Persistent Depressive Disorder
Depressed mood for most of the day for more days than not - 2 years. 2 or more of the following:
- poor appetite /under/overeating
- low self esteem
- low energy/fatigue
- feeling hopeless
- poor concentration
It is CHRONIC. not as intense as MDD but impact on functioning as much or more.
What are the protective factors of of depression?
Exercise
normal body weight
car ownership –> socioeconomic status? independence?
genetic factors
Physically attractive/tall
Old age
positive social support -STRONGEST P FACTOR
What is the course of PDD in relation to MDD?
MDD can precede Persistent Depressive Disorder.
MDD episodes can occur during Persistent Depressive Disorder.
Persistent Depressive Disorder often precedes MDD and can serve as a risk factor for MDD.
What are the causes of depression?
- Genetics
- risk increases by 5-25% wen first-degree relative has unipolar depression
- 40-70% heritability
- Neurobiology
- Neurotransmitters - serotonin, dopamine, NA.
- Stress hormones cortisol, ACTH.
- Personality factors
- Neuroticism = more emotionally reactive to events
- Introversion
- Negative self esteem
- Interpersonal sensitivity (react more strongly to interpersonal events)
- Stressful Events
- LOSS, abuse, natural disaster
- 80% of depressed cases were preceded by major life event.
- Stress generation
Vulnerability to depression model?
Broad model that states that all of us have a level of vulnerability to depression.
Says that our vulnerability is made up of genetic and early loss vulnerability
recent stress leads to depressed mood
and maintaining factors are depressed physical state, relationships, action and thinking.
Describe the 3 main components of Beck’s Cognitive Model (1976).
3 Main levels of cognitive components to the maintenance and aetiology of depression.
DEPRESSOGENIC SCHEMAS
- core beliefs
- enduring assumptions that are formed from early life experiences and over time
- may not be evident to the individual, activated by stressors
SYSTEMATIC LOGICAL ERRORS
- info processing biases that sustain -ve thoughts
- conclusions that are reached through:
overgeneralisation, magnification and minimisation, arbitrary inference, personalisation.
NEGATIVE AUTOMATIC THOUGHTS (NATs)
- automatic, unprompted, immediate, unchallenged.
- Negative Triad: -ve thoughts about self, world and future.
What is an example of Beck’s Cognitive Model (1976)?
Early experience - unfavourable comparisons with sister
Formation of dysfunctional assumptions (DEPRESSOGENIC SCHEMA) - i am inferior, and my worth depends on what others think of me
Critical incident - marriage breaks down
Assumptoms are activated
NATs - it’s my fault. i’ll be alone forever.
Symptoms of depression occur
How does CBT work?
it targets NATs and underlying assumptoms.
also incorporates basic problem solving, assertiveness training and activity scheduling
What are treatments other than CBT for depression
medication ECT TMS St johns wort omega-3-fatty acids
what is Premenstrual Dysphoric Disorder (PDD)?
legitimises women’s suffering.
must monitor for 2 months. not done retrospectively.
a. In majority of menstrual cycles, at least 5 symptoms must be present in the week before onset of menses, and improve within a few days after the onset.
b. 1 or more of the following
- marked affectivity lability
- marked irritability/anger/conflict
- marked depressed mood
- marked anxiety/tension
c. one or more of:
- decreased interest in activities
- difficulty concentrating
- lethargy
- change in appetite
- hyper/insomnia
- overwhelmed
- physical symps - breast tenderness/joint pain/muscle pain