Lisa - Mood Disorders Flashcards
Types of Mood Disorders
Unipolar: one polar mood (i.e. depression).
⭐️Major Depressive Disorder (MDD)
⭐️Dysthymia
Bipolar: two polar moods fluctuating between periods of depression and mania.
⭐️Bipolar I
⭐️Bipolar II
⭐️Cyclothymia
⬅️ ➡️
Occur on a continuum from “major depression” to “full blown mania”
😥Linked to up to 60% of suicides
When does ‘normal’ depression become ‘clinical’ depression?
Normal depression: characterised by feeling of sadness, despair, or unhappiness
Grief 😥: appropriate affective sadness in response to recognised external loss.
Normal because it’s realistic, appropriate to what has been lost, self-limiting.
✖️However if prolonged for 1-2 months, it may affect normal functioning and require clinical assistance.
‘Clinical’ depression
✖️Intensity: the mood change pervades all aspects of the person and impairs social and occupational function.
✖️Absence of precipitants: mood may develop in absence of any discernible precipitants or be grossly out of proportion to precipitants.
✖️Quality: the mood change is different from that experienced in normal sadness.
✖️Associated features: the mood change might be accompanied by a cluster of signs and symptoms including somatic and cognitive features.
DSM-5: Depressive Disorders
- Disruptive Mood Dysregulation Disorder
- Major Depressive Disorder
- Persistent Depressive Disorder (Dysthymia)
- Premenstrual Dysphoric Disorder
😥THE leading cause of disability worldwide; no. 4 in global burden of disease
😥The threshold at which depression can be triggered decreases with second and subsequent episodes, so that for people who have experienced 3/+ episodes, only minor stresses may precipitate a full-blown major depressive episode.
DSM-5: Depressive Disorders:
Disruptive Mood Dysregulation Disordsr
⭐️Recent addition
Diagnosis for this disorder involves severe recurrent temper outbursts manifested verbally (e.g. verbal rages) and/behaviourally (e.g. physical aggression toward people or property) that are grossly out of proportion in intensity or duration to the situation or provocation.
Inconsistent with developmental level.
Occur on average, 3/+ times per week.
Mood between outbursts is persistently irritable or angry most of the day, nearly everyday, and is observable by others.
⭐️This criteria was made up to replace manic or hypomanic episode with irritability and anger.
DSM-5: Depressive Disorders:
Major Depressive Disorders
Episodic disorder in most cases
⭐️5/+ symptoms over a 2-week period:
😥Depressed mood most of the day, nearly every day
😥Anhedonia
😥Significant weight loss when not dieting or weight gain
😥Insomnia or hypersomnia nearly everyday
😥Psychomotor agitation or retardation
😥Fatigue or loss of energy
😥Feelings of worthlessness of excessive/inappropriate guilt
😥Diminished ability to think or concentrate; indecisiveness
😥Recurrent thoughts of death, suicidal ideation, or a suicide attempt or specific plan for committing suicide
DSM-5: Mood Disorders:
Persistent Depressive Disorder (aka Dysthymia)
😥Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years.
Present alongside 2/+ 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
Depressive Disorders:
❤️❤️❤️Protective Factors❤️❤️❤️
❤️Exercise
❤️Normal body weight
❤️Car ownership (related to adequate SES)
❤️Being physically attractive or tall (related to employment, being paid more)
❤️Genetic factors
❤️Old age (if you’ve reached an old age and have succeeded in not developing a depressive disorder, you are more likely to have established ways of effectively coping, and may be more resilient)
❤️Positive social support (single most important indicator of wellbeing, mental health and overall life satisfaction)
Persistent Depressive Disorder (Dysthymia):
Longitudinal course
✖️No clear trajectory
a) It may precede persistent depressive disorder (dysthymia),
b) MDD episodes may occur during persistent depressive disorder (dysthymia), or
c) PDD often precedes MDD and may be a risk factor for MDD
😥Nonetheless, effects on social and occupational functioning as great if not greater than MDD.
Depressive Disorders:
Comorbidity
With Anxiety Disorders (and pretty much everything) - both experience: 😥Fatigue 😥Nervous 😥Can't sleep 😥Can't cope 😥Tense
With physical illness:
😥At least half that are seen in primary care occur in patients with other major medical disorders
😥Depression can be precipitated by medical conditions AND medical treatment (eg. heart attack, stroke, some side effects of chemotherapy treatment and cancer) It is therefore important to know and inquire before a depression diagnosis is made.
Depressive Disorders:
Causes
👨👩👧Genetics
- Risk of depression in first-degree relatives of patients with unipolar major depression is between 5 and 25%
- Heritability of unipolar depression is between 40 and 70%
Neurobiology
- Neurotransmitter dysregulation: serotonin(⬇️), dopamine (⬇️), noradrenaline
- Stress hormones: cortisol ACTH
😢Stressful events (2.5 x more likely)
-Community samples: 80% of depressed cases were preceded by a major life event
-‘Loss’ experiences
-Stress generation: role of the individual in contributing towards stress occurrence (i.e. it is their choices, surrounding context/environment giving rise to depression).
E.g. Women with depression significantly more likely to experience high levels of episode like evens to which they had contributed (such as remaining in an abusive relationship) than women with bipolar, medical illness or no health problems.
👦🏼👧🏻👨🏻👩🏼Personality factors:
- Neuroticism (tendency to experience negative feelings)
- Introversion
- Negative self-esteem/self-scheme
- Interpersonal sensitivity (react strongly to things around them)
Beck’s Cognitive Model of Depression
3 main cognitive components to the maintenance and aetiology:
1. Negative automatic thoughts (NATs): automatic, unprompted, immediate, unchallenged.
🔼Negative Cognitive Triad:
Negative thoughts about ‘self’ (I am a failure)
Negative thoughts about the ‘world’ (This neighbourhood is a dump)
Negative thoughts about the ‘future’ (Everything will be shit forever)
- Systematic logical errors: conclusions about the self, the world and the future are reached by:
👎All-or-nothing thinking
👎Mental filtering
👎Should statements
👎Personalisation (thinking they’re to blame for a negative incident)
👎Mental filtering
👎Overgeneralisation - Depressogenic schemas (core beliefs): ensuring assumptions that represent the way an individual organises their past and current experience. They develop over many years and may not be evident to an individual. They are activated by stressful circumstances (diathesis-stress model).
Examples include:
😥Fear of losing control
😥Fear of abandonment
😥Social undesirability
😥Incompetence
😥Deserve to be punished
😥”I must do well at everything I do or I will be rejected”
😥”If someone thinks badly of me I cannot be happy”
DSM-5: Depressive Disorders: Premenstrual Dysphoric Disorder
⭐️At least 5 symptoms must be 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:
😥Marked affective lability (mood swings, feeling suddenly sad, increased sensitivity to rejection)
😥Marked irritability or anger or increased interpersonal conflicts
😥Marked depressed mood
😥Marked anxiety
And 1/+ of the following combined with the previously mentioned to total 5:
😥Anhedonia
😥Difficulty concentrating
😥Lethargy
😥Marked change in appetite
😥Hypersomnia/insomnia
😥Sense of feeling overwhelmed/out of control
😥Physical symptoms (weight gain, breast tenderness)
Prevalence: ranges from ~1 - 8%
👨👩👧Heritability: between 30 and 80%
History of interpersonal trauma may increase risk of PDD
Post natal depression
🚫Risk Factors:
👎A history of depression and/or anxiety
👎A stressful pregnancy
👎Depression during the current pregnancy
👎A family history of mental disorders
👎Experiencing severe “baby blues”
👎A prolonged labour and/or delivery complications
👎Problems with the baby’s health
👎Difficulty breastfeeding
👎Lack of practical, financial and/or emotional support
👎Past history of abuse
👎Difficulties in close relationships
👎Being a single parent
👎Having an unsettled baby (i.e. difficulties with feeding and sleeping)
👎Having unrealistic expectations about motherhood (e.g. mothers bond with their babies straight away, mothers know instinctively what to do, motherhood is a time of joy, etc.)
👎Moving house
👎Making work adjustments (e.g. stopping or re-starting work)
Mania
⭐️Abnormally and persistently elevated, expansive or irritable mood;
⭐️Expansive quality of mood characterised by unceasing and indiscriminate enthusiasm for interpersonal, sexual or occupational interactions.
May also include: 😥Inflated self-esteem (ranging from uncritical self-confidence to delusional intensity grandiosity) 😥Decreased need for sleep 😥Pressured speech 😥Racing thoughts 😥Distractibility 😥Increase in goal-directed activities 😥Psychomotor agitation
Manic Episode
⭐️A distinct period of abnormally and persistently elevated, expansive or irritable mood, lasting at least 1 week (or any duration if hospitalisation necessary)
During the period of abnormality, 3/+: 😥Impaired regard for consequences 😥Agitated, excessively goal directed 😥Flight of ideas 😥Distractibility 😥Inflated self-esteem or grandiosity 😥Decreased need for sleep
