lecture 6 material Flashcards
Mood Disorders and Suicide
What are the ABC Characteristics of Major Depressive Episode
A) 5+ of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least
one of the symptoms is either:
- depressed mood or
- loss of interest or pleasure
AND - Significant weight loss when not dieting or weight gain or decrease
or increase in appetite nearly every day - Insomnia or hypersomnia nearly every day
- Psychomotor agitation or retardation nearly every day
- Fatigue or loss of energy nearly every day
- Feelings of worthlessness or excessive or inappropriate guilt nearly every day
- Diminished ability to think or concentrate, or indecisiveness, nearly
every day - Recurrent thoughts of death, recurrent suicidal ideation without a
specific plan, or a suicide attempt or a specific plan for committing suicide
B) The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
C) The symptoms are not due to the direct physiological effects of a
substance (e.g., a drug of abuse, a medication) or a general medical
condition (e.g., hypothyroidism)
What are the ABCD Characterisations for Manic Episodes
A) A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal directed activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is
necessary)
B) During the period of mood disturbance and increased energy or
activity, 3+ of the following symptoms (four if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior:
- Inflated self-esteem or grandiosity
- Decreased need for sleep
- More talkative than usual or pressure to keep talking
- Flight of ideas or subjective experience that thoughts are racing
- Distractibility, as reported or observed
- Increase in goal-directed activity or psychomotor agitation
- Excessive involvement in activities that have a high potential for painful consequences
C) The mood disturbance is sufficiently severe to cause marked
impairment in social or occupational functioning or to necessitate
hospitalization to prevent harm to self or others, or there are psychotic features
D) The episode is not attributable to the physiological effects of a
substance or to another general medical condition
What is the difference between a manic episode and a hypomanic episode
A hypomanic episode is:
* Shorter, less severe version of a manic episode
* Lasts at least four days
* Has fewer and milder symptoms
* Associated with less impairment than a manic episode
* May not be problematic in and of itself, but usually
occurs in the context of a more problematic mood disorder
What are the two categories of mood disorders
unipolar mood disorders and bipolar mood disorders
What are the differences between Unipolar and Bipolar mood disorders
Unipolar mood disorder: Only one extreme of mood is
experienced
- e.g. only depression OR only mania
- Depression alone is = more common than mania alone
Bipolar mood disorder: Both depressed and elevated moods are experienced
- e.g. some depressive episodes and some manic or hypomanic episodes
What are the DSM-5 Classified Depressive Disorders
- Major Depressive Disorder
- Persistent Depressive Disorder
- Premenstrual Dysphoric Disorder
- Disruptive Mood Dysregulation Disorder
What are the ABC characteristics of Major Depressive Disorder (MDD)
A) At least one major depressive episode
B) The occurrence of the major depressive episode is not
better explained by schizoaffective disorder, schizophrenia,
schizophreniform disorder, delusional disorder, or other
specified and unspecified schizophrenia spectrum and other psychotic disorders
C) There has never been a manic episode or hypomanic
episode
What are ways to classify the status of a depressive episode
- single episode or recurrent episode
- mild, moderate, severe
- With anxious distress; With mixed features; With melancholic features; With atypical features; With moodcongruent psychotic features; With mood-incongruent
psychotic features; With catatonia; With peripartum onset; With seasonal pattern (recurrent episode only)
What does it mean if MDD has anxious distress specifiers
Anxious Distress Specifier = Depression is accompanied by several significant symptoms of anxiety
What does it mean if MDD has mixed features specifiers
Mixed features specifiers = Depressive episodes which also include several
manic symptoms
What does it mean if MDD has melancholic features specifiers
Melancholic features specifiers = Major depressive episode accompanied by additional severe symptoms such as early morning awakenings,
lack of reactivity to positive stimuli
What does it mean if MDD has atypical features specifiers
Typical features specifiers = Presence of several symptoms less common in depression, including oversleeping and overeating
What does it mean if MDD has psychotic features specifiers
Psychotic features specifiers = Major depressive episodes which also include some
psychotic features
- Hallucinations: Sensory experience in the
absence of sensory input - Delusions: Strongly held inaccurate beliefs
What does it mean if MDD has peripartum onset specifiers
Peripartum onset specifiers = Depression occurring around the time of giving birth
What does it mean if MDD has seasonal pattern specifiers
Seasonal pattern specifiers = Depression occurring primarily in certain seasons (usually winter)
- Result of phase-delayed circadian misalignment,
meaning that the patient’s circadian rhythm is misaligned with the environmental day-night cycle
What does it mean if MDD has catatonic features specifiers
Catatonic features specifiers = Extremely rare muscular symptoms such as
remaining in a still stupor, “
waxy ” limbs that remain in place when manipulated, repetitive or purposeless
movement
How are the A-H Characterisations of Persistent Depressive Disorder (Dysthymia)
A) Depressed mood (irritable for kids), most of the day, more days than not – at least 2 years (1 year for kids)
B) Two or more of:
1.Poor appetite or overeating
2.Insomnia or hypersomnia
3.Fatigue or loss of energy
4.Low self esteem
5.Poor concentration or indecisiveness
6.Feelings of hopelessness
C) < 2 months without symptoms
D) May have MDD at same time
E) No manic or hypomanic episode ever
F) Not better explained by persistent schizoaffective disorder,
schizophrenia, delusional disorder, or other specified or
unspecified schizophrenia spectrum and other psychotic
disorder
G) The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hypothyroidism)
H) The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
What are the specifications needed to be made for Persistent Depressive Disorder (Dysthymia)
Specify if: disorder is With anxious distress; With mixed features; With melancholic features; With atypical features; With moodcongruent psychotic features; With mood-incongruent
psychotic features; With peripartum onset
Specify if: Early onset: onset before age 21 OR Late onset:
onset after age 21
If full criteria are met, specify if disorder is: mild/moderate/severe
If full criteria is NOT met, specify if disorder is: In partial remission/in full remission
What are the ABCD characteristics of Premenstrual Dysphoric Disorder
A) 5+ symptoms (at least 1 from B and 1 from C); occur week before
menses; majority of cycles; improve with menses; (almost) disappear after
menses
B) One or more of:
1. Marked affective lability (e.g., mood swings, crying, sensitivity)
2. Marked irritability or anger
3. Marked depressed mood, hopelessness, self-deprecation
4. Marked anxiety, tension, on edge
C) one or more of:
1. Decreased interest
2. Difficulty concentrating
3. Lethargy, lack of energy
4. Marked change in appetite
5. Hypersomnia or insomnia
6. Feeling overwhelmed or out of control
7. Physical symptoms (e.g., breast tenderness, muscle pain, weight
gain)
D) Cause clinically sig distress or impairment
E) Not due to another mental disorder
F) Criterion A must be confirmed by prospective daily ratings
G) Symptoms not due to substance use or other medical condition
What are the A-I characterisations of Disruptive Mood Dysregulation Disorder
A) Severe, recurrent temper outbursts – out of proportion to the situation
B) Developmentally inconsistent
C) Occur 3+ times per week (average)
D) Persistent anger and irritability, most of the day, between outbursts
E) 12 months or more and < 3 months without
F) Present in at least 2 of: home, school, peers
G) Can only be applied to 6-18 y.o.
H) Age of onset < 10 years.
I-J. Not manic or major depressive episode. Cannot co-exist with ODD, Intermittent Explosive Disorder, or Bipolar Disorder
Which of men or women have higher odds ratio of major depressive episode
Women
What is the risk of onset for most depressive disorders
- Rare in childhood
- Risk increases in adolescence and young adulthood, decreases in middle adulthood, increases again in old
age
What are the DSM-5 Classified Bipolar Disorders
- Bipolar I Disorder
- Bipolar II Disorder
- Cyclothymic Disorder
What are the AB Characteristics of Bipolar I Disorder
A. Criteria have been met for at least one manic episode
B. The occurrence of the manic and major depressive episode is not better explained by schizoaffective disorder, schizophrenia,
schizophreniform disorder, delusional disorder, or other specified and
unspecified schizophrenia spectrum and other psychotic disorders
What are the specifications needed to be made for Bipolar I and Bipolar II Disorder
- Specify current/most recent episode severity (i.e. mild, moderate, severe)
Further specifications:
** Manic: If currently (or most recently) in a manic episode
** Hypomanic: If currently (or most recently) in a hypomanic episode
** Depressed: If currently (or most recently) in a major depressive episode
** Unspecified: If currently (or most recently) is unknown
- Also specify if disorder is: with anxious distress; With mixed features; With moodcongruent psychotic features; With mood-incongruent psychotic features;
With catatonia; With peripartum onset; With seasonal pattern, With rapid cycling
***If full criteria for a mood episode are not currently met, specify if: In full remission or in partial remission
What are the ABCD Characteristics of Bipolar II Disorder
A. Criteria have been met for at least one hypomanic episode and
at least one major depressive episode
B. There has never been a manic episode
C. The occurrence of the hypomanic episode(s) and major depressive episode(s) is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional
disorder, or other specified or unspecified schizophrenia spectrum
and other psychotic disorder
D. The symptoms of depression or the unpredictability caused by frequent alternation between periods of depression and hypomania causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
How do Bipolar I Disorder and Bipolar II Disorder Differ
Main difference:
- severity of symptoms: People with bipolar I disorder experience more severe highs (mania) and may not have depressive episodes. Whereas people with bipolar II experience a less severe high (hypomania), their diagnosis includes depressive episodes lasting at least 2 weeks (tends to be longer)
- Bipolar II involves NO manic episodes –> only possible hypomania whereas Bipolar I involves at least one episode of mania lasting at least one week
- People with Bipolar I may experience delusions or hallucinations while people with Bipolar II do not
What is Cyclothymic DIsorder
Cyclothymic disorder is a milder form of bipolar disorder involving many “mood swings,” with hypomania and depressive symptoms that occur frequently. People with cyclothymia experience emotional ups and downs but with less severe symptoms than bipolar I or II disorder
What are the A-F Characteristics of Cyclothymic Disorder
A) For at least 2 years (at least 1 year in children and adolescents) there have been numerous periods with hypomanic symptoms that do not meet
criteria for a hypomanic episode and numerous periods with depressive symptoms that do not meet criteria for a major depressive episode
B) B. During the above 2-year period (1 year in children and adolescents), the hypomanic and depressive periods have been present for at least half the time and the individual has not been without the symptoms for more than 2 months at a time
C) C. Criteria for a major depressive, manic, or hypomanic episode have never been met
D) D. The symptoms in criterion A are not better explained by
schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder
E) E. The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism)
F) F. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
What is the Prevalence of Bipolar I vs Bipolar II
0.6% for Bipolar I, 0.4% for bipolar II
Therefore Bipolar I is slightly more prevalent
Both typically begin before the age of 25
Women experience more depressive episodes than men do
Fill in the blank:
Amygdala brain function activity is __1__ during depression and __2__ in Mania
- Elevated
- Elevated
Fill in the blank:
Anterior Cingulate brain function activity is __1__ during depression and __2__ in Mania
- Elevated
- Elevated
Fill in the blank:
Dorsolateral Prefrontal Cortex brain function activity is __1__ during depression and __2__ in Mania
- Diminished
- Diminished
Fill in the blank:
Hippocampus brain function activity is __1__ during depression and __2__ in Mania
- Diminished
- Diminished
Fill in the blank:
Striatum brain function activity is __1__ during depression and __2__ in Mania
- Diminished
- Elevated
What are some Interpersonal Factors that Impact Mood Disorders
- Childhood adversity
- Negative life events
- Lack of social support
What are some Psychological Factors that Impact Mood Disorders
- Neuroticism
- Learned helplessness
- Hopelessness
- Cognitive Triad
- Rumination
- Reward sensitivity
- Sleep deprivation
Selective serotonin reuptake inhibitors, Monoamine oxidase inhibitors, Mixed reuptake inhibitors (e.g., serotonin/norepinephrine
reuptake inhibitors) are some examples of what type of medication and for what mood disorder
medication = antidepressants
mood disorder = depression
What is the effectiveness of antidepressants for Depression
Only 50% of patients benefit and only 25% achieve normal functioning
Lithium, Anticonvulsants (e.g., Sodium valproate, carbamazepine), Antipsychotics (e.g., Olanzapine, Quetiapine, Aripiprazole) are some examples of what type of medication and for what mood disorder
medication = mood stabilisers
mood disorder = Bipolar Disorder
What treatments can be used for medication-resistant depression
1) Electroconvulsive Therapy (ECT)
- Unilateral
- Results in temporary seizures
- Side effects: short term memory loss which is usually restored, some patients suffer long-term memory loss
2) Transcranial Magnetic Stimulation
- Uses magnets to generate a precise localized
electromagnetic pulse
- May be combined with medication
- Side effects: occasional headaches
What are some examples of psychological treatments for Depression
- Interpersonal psychotherapy
- Cognitive therapy
- Third-wave therapies (e.g., mindfulness-based cognitive
therapy, acceptance and commitment therapy) - Behavioural activation
What are some examples of psychological treatments for Bipolar Disorder
- Cognitive therapy
- Family focused therapy
Fill in the blank:
1) Worldwide, suicide is the ___ leading cause of death
2) In Australia, suicide is the ___ leading cause of death
3) _____ income countries have higher rates of suicide than _____ and _____ income countries
4) Suicide is the leading cause of death among ____ aged 15-19 years
1) 15th
2) 13th
3) high, low, middle
4) women
What percentage of individuals who die by suicide have mental
disorders
over 90%
What disorders are most predictive of suicide attempts in developed countries vs developing countries
Developed countries: Bipolar dx, PTSD, and MDD
Developing countries: PTSD, conduct dx, and drug use disorder
What are 3 factors that predict suicidal ideation
1) depression
2) hopelessness
3) impulsivity
What are internal vs external motivations that people report towards suicide
Internal Motivations: Hopelessness, extreme emotional pain, a need to escape
External Motivations: Desire to communicate with, influence, or seek help from others
- Most people report internal motivations which are associated with a greater desire to die
- However a smaller subset of people report external motivations which can be protective such as
- They are associated with lower suicidal intent and a greater likelihood of attempts being interrupted
- Socially oriented motivations may signify a continued connection
to people and a desire to maintain these relationships
How can suicide be prevented
- Do a risk assessment: Ideation, plan, intent, means
- Develop a safety plan: Who to call, sign a safety contract, remove access to means
*Talking to someone about suicide does not increase their risk for suicide
