Lecture 3 - Mood disorders Flashcards
What are the types of Mood disorders?
- DSM-5 depressive disorders
2. DSM-5 Bipolar disorders
Overview of the DSM-5 Mood disorders
- Major depressive disorder
- Persistent depressive disorder
- Premenstrual dysphoric disorder
- Disruptive mood dysregulation disorder
- Bipolar I disorder
- Bipolar II disorder
- Cyclothymia
What is the DSM-5 Criteria for Major depressive disorder?
- Sad mood or loss of interest or pleasure
plus 4 of the following symptoms:
a. Sleeping too much or too little
b. Psychomotor retardation or agitation
c. Poor appetite and weight loss or increased appetite and weight gain
d. Loss of energy
e. Feelings of worthlessness or excessive gullt
f. Difficulty concentrating, thinking or making decisions
g. Recurrent thoughts of death or suicide
What is the DSM-5 criteria for Persistent Depressive Disorder?
Depressed mood for at least 2 years; 1 year for children/adolescents
Plus 2 other symptoms:
1. Poor appetite or overeating
2. Sleeping too much or too little
3. Poor self-esteem
4. trouble concentrating or making decisions
5. Feelings of hopelessness
Symptoms do not clear for more than 2 months at a time
Bipolar disorders are not present
What is the DSM-5 criteria for Premenstrual Dysphoric Disorder?
In most menstrual cycles during the past year, at least five of the following symptoms were present in the final week before menses and improved within a few days of menses onset:
a. affective liability
b. Irritability
c. depressed mood, hopelessness or self-deprecating thoughts
d. Diminished interest in usual activities
e. Lack of energy
f. Changes in appetite, overeating or food craving
g. Sleeping too much or too little
h. Subjective sense of being overwhelmed or out of control
i. Physical symptoms such as breast tenderness or swelling , joint or muscle pain or bloating.
What are the DSM-5 criteria for Disruptive Mood Dysregulation Disorder?
Severe recurrent temper outbursts
Temper outburst inconsistent
Outbursts 3 times per week
Negative mood between outbursts
Symptoms present for at least 12 months
Temper outbursts and negative mood present in two settings
Age 6 or older
Onset before age 10
Behavior does not occur during the course of a major depressive disorder
The diagnosis cannot coexist with other disorders like: defiant disorder, attention-deficit, hyperactivity disorder, intermittent explosive disorder, bipolar disorder
There has never been a period lasting more than 1 day during which elevated mood and at least 3 other manica symptoms were present.
What is the Epidemiology of Depression?
1. Depression is common Lifetime prevalence 16.2% MDD 2.5% Dysthymia Twice as common in women as in men 3 times as common among people in poverty
- Prevalence varies across cultures
MDD
1.5% In Taiwan
19% Beirut, Lebanon
What are the 3 types of Bipolar Disorder?
Bipolar I
Bipolar II
Cyclothymia
What is the DSM-5 criteria for Manic and Hypomanic Episodes?
Distinctly elevated or irritable mood for most of the day nearly every day.
Abnormally increased activity and energy
At least 3 of the following:
a. Increase in goal directed activity
b. Unusual talkativeness - rapid speech
c. Flight of ideas or subjective impression that thoughts are racing
d. decreased need for sleep
e. Increased self-esteem - belief that one has special talents powers or abilities
f. distractibility- attention easily diverted
g. Excessive involvement in activities that are likely to have undesirable consequences
What is the DSM-5 Criteria for Bipolar Disorders?
Bipolar I - At least one episode of Mania
Bipolar II - At least one major depressive episode with at least one episode of hypomania
Cyclothymic disorder - Milder, chronic form of bipolar disorder - Lasts at least 2 years in adults , 1 in children /adolescents - numerous periods with hyomaniac and depressive symptoms - does not meet criteria for mania or major depressive episode - Symptoms do not clear for more than 2 months at a time - Symptoms cause distress or impairment
Epidology?… of Bipolar disorder?
Prevalence rater lower than MDD
Average age of onset in 20s
No gender differences in rates of bipolar disorders
Severe mental illness
What are the subtypes of Major Depressive Disorder and Bipolar disorders?
- Seasonal pattern
- Rapid cycling
- Mood-congruent psychotic features
- Mixed features
- Catatonia
- Melancholic features
- Atypical features
- Peripartum onset with anxious distress
- Suicide risk severity
What factors contribute to onset of mood disorders?
Neurobiological factors
Psychosocial factors
What are the Neurobiological factors of Mood disorders?
- Genetic factors
DRD4.2 gene which influences dopamine function - Neurotransmitters (NTs): norepinephrine, dopamine and serotonin
MDD - low levels of norepinephrine, dopamine and serotonin
Mania - high levels of norepinephrine and dopamine, low levels of serotonin - New models focus on sensitivity of postsynaptic receptors
Dopamine receptors may be overly sensitive in BD but lack sensitivity in MDD
Depleting tryptophan causes depressive symptoms in individuals with personal or family history of depression
What are the Neurobiological Hypotheses about Major depression and Bipolar disorder?
- Genetic contribution
- Serotonin and dopamine receptor dysfunction
- Cortisol dysregulation
- Changes in activation of emotion-relevant regions in the brain
- Activation of the striatum in response to reward
Activity of brain structures involved in Emotion responses among people with mood disorders
Brain structure……………………Level in depression……………………Level in Mania
Amygdala Elevated Elevated
Subgenual anterior
cingulate Elevated Elevated
Dorsolateral prefrontal
cortex Diminished Diminished
Hippocampus Diminished Diminished
Striatum Diminished Elevated
Etiology of Mood disorders: Neuroendocrine system
- Overactivity of HPA axis
Triggers release of cortisol, stress hormone
Amygdala overreactive - Findings that link depression to high cortisol levels
Cushing’s syndrome
Causes oversecretion of cortisol
Symptoms include those of depression
Injecting cortisol in animals produce depressive symptoms
Dexamethasone suppression test
Lack of cortisol suppression in people with history of depression
Etiology of Mood disorders: Social factors
- Life events
stressful life events
Lack of social support - Interpersonal difficulties
High levels of expressed emotion by family members
Marital conflicts also predicts depresssion - Behavior of depressed people often leads to rejection by others
Excessive reassurance seeking
Few positive facial expressions
Negative self-disclosures
Slow speech and long silences
Why do some people become depressed after a stressful life event and others do not? Psychological factors of mood disorders
- Social support
- Neuroticism
- Cognitive theories
What is Neuroticism?
Tendency to react with higher levels of negative affect
Predicts onset of depression
What are the main Cognitive theories?
- Beck’s theory
- Hopelessness theory
- Rumination theory
What is Beck’s theory?
- Negative triad
- Negative schema
Negative schema cause cognitive biases: tendency to process information in negative ways.
What is Hopelessness theory?
- Most important trigger is hopelessness
- Desirable outcomes will not occur
- Person has no ability to change situation
- Attributional style
- Stable and global attributions can cause hopelessness
What is Rumination theory?
A specific way of thinking : tendency to repetitively dwell on sad thoughts (Nolen-Hoeksema, 1991)
Most detrimental is to brood over causes of events
What are the psychological treatments for mood disorders?
- Interpersonal psychotherapy (IPT)
- Cognitive therapy
- Mindfulness-based cognitive therapy (MBCT)
- Behavioral activation (BA) therapy
- Behavioral couples therapy
What is Interpersonal psychotherapy (IPT)?
- Short term psychodynamic therapy
2. Focus on current relationships
Cognitive therapy
- Monitor and identify automatic thoughts
2. Replace negative thoughts with more neutral or positive thoughts
Mindfulness-baed cognitive therapy (MBCT)
- Strategies, including meditation to prevent relapse
Behavioral activation (BA) therapy
Increase participation in positively reinforcing activities to disrupt spiral of depression, withdrawal and avoidance
Behavioral couples therapy
Enhance communication and satisfaction
Psychological treatment of bipolar disorder
- Psychoeducational approaches
provide information about symptoms, course, triggers, and treatments - Family focused treatment (FFT)
educate family about disorder, enhance family communication, improve problem solving
Biological treatment of mood disorder
- Electroconvulsive therapy (ECT)
2. Transcranial magnetic stimulation for depression (sTMS)
What is Electroconvulsive therapy (ECT)?
- Reserved for treatment non-responders
- Induce brain seizure and momentary unconsciousness - Unilateral ECT
- Side effects - memory loss
- ECT more effective than medications - unclear how ECT works
What is Transcranial Magnetic Stimulation for Depression (rTMS)?
Electormagnetic coil placed against scalp
For those that fail to respond to first antidepressent
What are the medications for treating mood disorders?
- Antidepressants
2. Mood stablizers
Medications for Bipolar disorder
1. Lithium Lithium toxicity 2. Newer mood stabilizers Anticonvulsants Depakote Antipsychotics Zyprexa
What increases the odds of recovery of Major depressive disorder?
Combination of psychotherapy and antidepressant medications
CT as effective as medication for severe depression
CT more effective than medication at preventing relapse
What is Suicide ideation?
thoughts of killing oneself
What is suicide attempt?
Behaviour intended to kill oneself
What is Suicide?
Death from deliberate self-injury
What is non-suicidal self-injury?
Behaviors intended to injure oneself without intent to kill oneself
What are risk factors for suicide?
- Psychological disorders
- Neurobiological models
- Social factors
- Psychological models
Preventing suicide
Talk about suicide openly and matter-of-factly
Most people are ambivalent about their suicidal intentions
Treat the associated mental disorder
Treat suicidality directly
Suicide prevention centers
