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Abnormal Behavior > Lecture 8 - Mood Disorders (Depressive Disorders) > Flashcards

Lecture 8 - Mood Disorders (Depressive Disorders) Flashcards

1
Q

Mood Disorders

A

also known as affective disorders

  • extremes of emotion (or affect) are common to all mood disorders (deep depression or soaring elation)
  • other symptoms or co-occurring disorders may also be present, but abnormal mood is the defining feature
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2
Q

types of mood disorders

A

the two key moods involved are mania and depression

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3
Q

in unipolar depressive disorders the person experiences …

A

… only depressive episodes

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4
Q

in bipolar disorders the person experiences …

A

… both manic and depressive episodes

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5
Q

DSM-5 Depressive Disorders

A
  • Disruptive Mood Dysregulation Disorder
  • Major Depressive Disorder
  • Persistent Depressive Disorder (Dysthymia)
  • Premenstrual Dysphoric Disorder
  • Substance/Medication-Induced Depressive Disorder
  • Depressive Disorder Due to Another Medical Condition
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6
Q

Disruptive Mood Dysregulation Disorder

A

chronic, severe persistent irritability marked by temper outbursts and persistent irritable or angry mood behavior outbursts for children up to 12 years of age

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7
Q

Premenstrual Dysphoric Disorder

A

symptoms present in the final week before the onset of menses, start to improve within a few days after the onset of menses and become minimal or absent in the week post menses

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8
Q

new classification of Depressive Disorders in DSM-5

A

separated from Bipolar and Related Disorders

  • previously, these disorders fell under the broad heading of Mood Disorders
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9
Q

features of Depressive Disorders

A
  • sad, empty, or irritable mood
  • somatic and cognitive changes that significantly affect the individual’s capacity to function
  • they differ across issues of duration, timing, or presumed etiology
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10
Q

the adaptive significance of Depression

A
  • mild, brief depression can be normal and adaptive
  • sadness, hopelessness, and pessimism are common human experiences
  • mild depression allows us to be still and reflect
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11
Q

Major Depressive Episodes (Major Depressive Disorders)

A

mood episodes do not have their own diagnostic codes and cannot be diagnosed as separate entities

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12
Q

mood Episodes serve as building blocks for the Disorder diagnoses

A
  • Major Depressive Disorder, single episode (presence of a single Major Depressive Episode)
  • Major Depressive Disorder, recurrent (presence of two or more Major Depressive Episodes)
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13
Q

Major Depressive Disorder: DSM-5 Diagnostic Criteria A

A

five (or more) 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 1) depressed mood, or 2) loss of interest or pleasure

  1. depressed most of the day, nearly every day, as indicated by either subjective report or observation made by others; note: in children and adolescents, can be irritable mood
  2. markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation)
  3. significant weight loss (when not dieting) or weight gain (e.g. change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day; note: in children, consider failure to make expected weight gain
  4. insomnia or hypersomnia nearly every day
  5. psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
  6. fatigue or loss of energy nearly every day
  7. feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
  8. diminished ability to think or concentrate, or indecisiveness, nearly every day
  9. recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation w/o a plan, or a specific plan for committing suicide
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14
Q

Major Depressive Disorder: DSM-5 Diagnostic Criteria B

A

the symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

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15
Q

Major Depressive Disorder: DSM-5 Diagnostic Criteria C

A

the episode is not attributable to the physiological effects of a substance or another medical condition

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16
Q

Major Depressive Disorder: DSM-5 Diagnostic Criteria A-C represents a …

A

… Major Depressive Episode

  • “Responses to a significant loss (e.g. bereavement, financial ruin, losses from a natural disaster, a serious medical illness or disability) may include the feelings of intense sadness, rumination about the loss, insomnia, poor appetite, and weight loss noted in Criterion A, which may resemble a depressive episode . Although such symptoms may be understandable or considered appropriate to the loss, the presence of a major depressive episode in addition to the normal response to a significant loss should also be carefully considered. This decision inevitably requires the exercise of clinical judgment based on the individual’s history and the cultural norms of the expression of distress in the context of loss.”
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17
Q

Diagnostic Recording of a Major Depressive Episode

A

severity/psychosis/course specifier

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18
Q

the diagnostic code for MDD is based on whether this is …

A

… a single or recurrent episode, current severity, presence of psychotic features and remission status

  • mild, moderate, severe, with psychotic features, in partial remission, in full remission
  • current severity and psychotic features are only indicated if full criteria are currently met in a MDE
  • remission specifiers are only indicated if the full criteria are not currently met for a MDE (2 months duration)
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19
Q

dimensional conceptualization of Severity

A

severity is based on the number of criterion symptoms, the severity of those symptoms, and the degree of functional disability

  • mild, moderate, and severe
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20
Q

mild severity

A

few if any symptoms in excess of those required to make the diagnosis are present, the intensity of the symptoms is distress but manageable, the symptoms result in minor impairment in social or occupational functioning

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21
Q

moderate severity

A

the number of symptoms, intensity of symptoms, and/or functional impairment are between those specified “mild” and “severe”

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22
Q

severe severity

A

the number of symptoms is substantially in excess of that required to make the diagnosis, the intensity of the symptoms is seriously distressing and unmanageable, and the symptoms markedly interfere w/ social and occupational functioning

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23
Q

specifiers of Major Depressive Episode

A
  • DSM-5 specifiers
  • w/ melancholic features
  • w/ psychotic features
  • w/ atypical features
  • w/ catatonic features
  • w/ seasonal pattern
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24
Q

Major Depressive Episode Specifiers: DSM-5 specifiers

A

w/ anxious distress, w/ mixed features, w/ melancholic features, w/ atypical features, w/ mo0d congruent psychotic features, w/ catatonia, w/ peri-partum onset, w/ seasonal pattern

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25
Q

Major Depressive Episode Specifiers: w/ melancholic features

A

3 of the following: early morning awakening, depression worse in the morning, marked psychomotor agitation or retardation, loss of appetite or weight, excessive guilt, qualitatively dif. depressed mood

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26
Q

Major Depressive Episode Specifiers: w/ psychotic features

A

delusions or hallucinations (usually mood congruent); feelings of guilt and worthlessness common

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27
Q

Major Depressive Episode Specifiers: w/ atypical features

A

mood reactivity - brightens to positive events

2 of the 4 following symptoms: weight gain or increase in appetite, hypersomnia, leaden paralysis (arms and legs feel as heavy as lead), being acutely sensitive to interpersonal rejection)

28
Q

Major Depressive Episode Specifiers: w/ catatonic features

A

a range of psychomotor symptoms from motoric immobility to extensive psychomotor activity, as well as mutism and rigidity

29
Q

Major Depressive Episode Specifiers: w/ seasonal pattern

A

at least 2 or more episodes in past 2 years that have occurred at the same time (usually fall or winter), and full remission at the same time (usually spring)

  • no other non-seasonal episodes in the same 2-year period
30
Q

in recording the name of the diagnosis (for Major Depressive Disorder), terms should be listed in the following order:

A

Major Depressive Disorder, Single/Recurrent, Severity/Psychotic/Remission Specifiers, Additional Specifiers

  • e.g. Major Depressive Disorder, recurrent, moderate, w/ melancholic features
31
Q

Persistent Depressive Disorder (Dysthymia)

A

essential feature is a depressed mood that occurs for most of the day, for more days than not, for at least 2 years, or at least 1 year for children and adolescents

  • patients describe mood as “sad or down in the dumps”
  • individuals whose symptoms meet major depressive disorder criteria for 2 years should be given a diagnosis of persistent depressive disorder as well as major depressive disorder
32
Q

What is the hallmark of Persistent Depressive Disorder?

A

chronicity (persistent over years)

  • patients may report, “I’ve always been this way”
  • intermittent normal moods occur briefly
  • average duration 4-5 years, but can persist for 20 years or more
  • often begins in adolescence: 50% onset before 21
33
Q

Persistent Depressive Disorder: DSM-5 Diagnostic Criteria A

A

depressed mood for most of day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years

34
Q

Persistent Depressive Disorder: DSM-5 Diagnostic Criteria B

A

presence, while depressed, of two or more of the following:

poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, feelings of hopelessness

35
Q

Persistent Depressive Disorder: DSM-5 Diagnostic Criteria C

A

during the 2 year period (1 year in children or adolescents) of the disturbance, the individuals has never been without symptoms in Criteria A and B for more than 2 months at a time

36
Q

Persistent Depressive Disorder: DSM-5 Diagnostic Criteria D

A

criteria for a major depressive disorder may be continuously present for 2 years

37
Q

Persistent Depressive Disorder: DSM-5 Diagnostic Criteria E

A

there has never been a manic or hypomanic episode

38
Q

Persistent Depressive Disorder: DSM-5 Diagnostic Criteria F

A

disturbance not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and psychotic disorders

39
Q

Persistent Depressive Disorder: DSM-5 Diagnostic Criteria G

A

symptoms are not due to physiological effects of a substance

40
Q

Persistent Depressive Disorder: DSM-5 Diagnostic Criteria H

A

the symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

41
Q

major depression may _____ persistent depressive disorder, and major depressive episodes may _____ persistent depressive disorder

A

precede, occur during

42
Q

causal factors in unipolar disorders

A
  • biological causal factors (focus on psychopharmacology)
  • psychological causal factors
43
Q

biological causes of unipolar disorders (depression)

A
  • family studies and twin studies suggest a moderate genetic contribution
  • altered neurotransmitter activity in several systems is associated w/ major depression
  • stress hormones
  • depression may be linked to low activity in the left anterior or prefrontal cortex
44
Q

Monoamine Theory of Depression

A
  • original theory: depression is due to the depletion of norepinephrine and most recently serotonin
  • in contrast: not all individuals respond to antidepressants, the time for alleviating symptoms is a question and not all depressed individuals show decreased levels of monoamines
45
Q

other biological causal factors of depression

A

a specific gene that might be implicated in major depressive disorder is the serotonin-transporter gene

disruptions of the following may also play a role:

  • sleep
  • circadian rhythms
  • exposure to sunlight (seasonal)
  • biological explanations for sex differences
46
Q

psychological causal factors of depression

A
  • stressful life events are linked to depression
  • diathesis-stress models
47
Q

Which life events have a stronger impact on your risk for getting MDD, independent or dependent life events?

A

dependent life events have a stronger impact

  • If you feel that you are to be blamed for something, more likely to get depressive symptoms (DEPENDENT)
48
Q

severe stressful life events often serve as …

A

… precipitating factors for unipolar depression

  • most often involve loss of a loved one, serious threats to close relationships or occupation, severe economic or health problems
49
Q

minor stressful events are generally …

A

… NOT associated w/ MDD

50
Q

chronic stress generally …

A

… INCREASES risk for the onset, maintenance, and recurrence of MDD

51
Q

vulnerability and responses to stressors: personality and cognitive diatheses

A

neuroticism (sensitivity to negative stimuli, introversion, negative thinking)

52
Q

early adversity as a diatheses

A

family turmoil, parental psychopathology, abuse

  • biological and psychological, increased sensitivity to stressful life events
53
Q

psychodynamic/psychoanalytic theories (Freud) of depression

A

Freud felt depression was related to mourning and loss (real or imagined loss)

  • anger originally directed outward, now turned inward, need to redirect in order to alleviate depression
54
Q

behavioral theories of depression

A
  • responses no longer lead to positive reinforcement
  • rate of negative experiences increases
  • efforts are not rewarded (lots of effort, no reward given, so negative outcome)
  • rewards the state of depression?
55
Q

Learned Helplessness and Reformulated Helplessness Theory

A

what results from feelings of lack of control after a person has experienced a stressful situation repeatedly; they believe that they are unable to control or change the situation, so they do not try, even when opportunities for change are available

  • Pessimistic Attributional Style: Internal/External, Global/Specific, Stable/Unstable
56
Q

Hopelessness Theory

A

A pessimistic attributional style; one or more negative life events will not produce depression unless one first experiences a state of hopelessness

  • “Hopelessness Expectancy”
57
Q

ruminative response styles

A

repetitive, passive

58
Q

depression has significant interpersonal correlates

A
  • lack of social support, social isolation, or social skills deficits can contribute to depression
  • depression can elicit sympathy and care, but it can also elicit hostility and rejection from others
59
Q

how depression impacts marriage and family life

A
  • criticism may be associated w/ relapse (hypothesis: activates neural circuitry in depression)
  • spouse may trigger negative affect
  • parental depression increases risk for children
60
Q

Beck’s Cognitive Model of Depression

A

early experience –> formation of dysfunctional beliefs –> critical incident(s) –> beliefs activated –> negative automatic thoughts –> symptoms of depression (behavioral, motivational, affective, cognitive, somatic) –> cycle of symptoms of depression leading to negative automatic thoughts, leading to symptoms of depression, leading to negative automatic thoughts, etc.

61
Q

Beck’s Negative Triad

A

negative views of the self, negative views of the world, and negative views of the future are connected in a triangle and can lead to depression

62
Q

dichotomous or all-or-none reasoning

A

tendency to think in extremes

63
Q

selective abstraction

A

a tendency to focus on one negative detail

64
Q

arbitrary inference

A

jumping to a conclusion w/ minimal evidence

65
Q

automatic thoughts

A

tend to flow from core negative beliefs

  • we want to know what these are to get at the core negative belief

Abnormal Behavior (8 decks)

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