module 5 Flashcards
1
Q
mood states
A
- euthymia
- feeling sad/upset/grief
- major depressive episode
- dysthymia
- hypomania/hypomanic personality
- mania
2
Q
euthymia
A
- the goal of treatment aka living without mood disturbances and achieving baseline again
3
Q
hypomanic personality
A
individuals are extroverted, energetic, intensely emotional, hyper confident, ambitious, impulsive, need less sleep and tend to be rude, irritable and irresponsible
4
Q
polarity of mood states
A
- average length of tome for the first untreated major depressive episode is 9 months
- treated MDE = 4-5 months
- untreated manic episode lasts between 2-6 months but will often be noted well before
5
Q
major depressive episode
A
- a component of various mood disorders
- must experience 5 or more symptoms out of 9, during the same two-week period
- at least 1/5 symptoms experienced must be either depressed mood or anhedonia
6
Q
major depressive episode symptoms
A
- depressed mood
- significantly diminished interest or pleasure in all activities
- significant weight loss or gain
- insomnia or hypersomnia
- psychomotor agitation or retardation
- fatigue/loss of energy
- feeling worthlessness or guilt
- diminished ability to think or concentrate
- recurrent thoughts of death, suicidal ideation or suicide attempt
7
Q
major depressive disorder criteria
A
- one or more MDE (must be at least 2 months symptom free between episodes)
- cannot be a normal response to a significant loss
- no history of mania/hypomania
- women are more likely to be diagnosed then men
- age of onset is high in early puberty to late twenties
- 12mo% = 5-8%
- life% = 10-20%
8
Q
persistent depressive disorder (dysthymia)
A
- individual experiences depressed mood for most of the day, nearly every day, for 2 years
- incredibly chronic
- no history of mania/hypomania
- can not be symptoms free for more than 2 months to receive a diagnosis
- can have MDE and still have PDD but if both are experienced simultaneously it is called double depression
- women are twice as likely as men to be diagnosed
- onset can start in childhood but is typically in early adulthood
- 12mo% = 1%
- life% = 2-5%
9
Q
PDD symptoms
A
- 2/6 symptoms needed to receive a diagnosis on top of a depressed mood:
1. poor appetite or overeating
2. insomnia or hypersomnia
3. low energy or fatigue
4. low self-esteem
5. poor concentration or difficulty making decisions
6. feelings of hopelessness
10
Q
manic episode
A
- a 1 week period of significantly elevated, expansive, or irritable mood, and significantly increased goal-directed activity or energy
- one week period doesn’t apply if they have been hospitalized
- commonly leads to hospitalization
- involve hallucinations or delusions
11
Q
mania criteria
A
- additional symptoms; need 3/7 or 4/7 if the primary presentation is the irritable component:
1. inflated self-esteem or grandiosity
2. decreased need for sleep
3. more talkative than usual or pressure to keep talking
4. flight of ideas
5. distractibility
6. increased goal-directed activity or psychomotor agitation
7. excessive involvement in risky behaviour
12
Q
hypomania episode
A
- identical to a manic episode, except for the following differences:
1. typically shorter in duration, but must last at least 4 days
2. not severe enough to cause hospitalization
3. no significant impairment in daily functioning
13
Q
bipolar 1 disorder
A
- has had a manic episode
- highly recurrent
- people will bipolar 1 have more hypomanic episodes then bipolar 2
- often begins with a major depressive episode
- rates are equal between men and women
- average age of onset for the first manic episode is 18
- 12mo% = 0.6%
- life% - 1%
14
Q
bipolar 2 disorder
A
- has has a hypomanic episode
- has had a major depressive episode
- no history of mania
- people with bipolar 2 have more total mood episodes then people with bipolar one
- equal in men and women
- average age of onset is mid 20s
12mo% = 0.6-0.8% - life% = 1%
15
Q
cyclothymic disorder
A
- numerous periods of hypomanic symptoms and numerous periods of depressive symptoms for 2 years
- can not been without symptoms for more than 2 months
- no history of mania, hypomania, or major depressive episode
- half of people with cyclothymia will go on to develop a bipolar disorder
- rates are equal between men and women
- age of onset is typically adolescents or early adulthood
- 12mo% = 0.3-0.5%
- life% = 0.4-1%
16
Q
mood disorder specifiers
A
- psychotic features (hallucination/delusions)
- melancholic features anhedonia, guilt)
- atypical features (overeating, oversleeping)
- peripartum (before/after giving birth)
- seasonal pattern
- rapid cycling ( 4 episodes in 12 mo)
17
Q
etiology - biological approaches
A
- genetics
- behavioural activation system (BAS)
- neurotransmitters
- sleep
18
Q
genetics - etiology
A
- tends to run in families, especially in twins
- more recurrent in families
- BPD tends to be stronger in families (passed on)
19
Q
BAS - etiology
A
- sensitivity to rewards and motivation
- positive emotions and hope
- linked to dopamine
- individuals can have a global reaction to activity happening in the environment (i.e. finding things rewarding or less sensitized); this occurs by getting a signals from the environment that something may be rewarding
- designed to increase our contact with positively rewarding activities
20
Q
neurotransmitters - etiology
A
- low levels of serotonin; allowed norepinephrine and dopamine to range wildly
- serotonin helps achieve homeostasis
21
Q
sleep - etiology
A
sleep disruptions may lead to depression or mania
22
Q
mood disorders etiology - biological approaches
A
- tricyclic antidepressants
- monoamine oxidase inhibitors (MAOIs)
- selective serotonin reuptake inhibitors (SSRIs)
- mood stabilizers
23
Q
tricyclic antidepressants - mood disorder etiology
A
- increase the amount of norepinephrine and serotonin in synaptic cleft so they get more reuptake for overtime effects
- can be lethal if overdosed
24
Q
MAOIs - mood disorder etiology
A
- increase the amount of norepinephrine, serotonin and dopamine
- lots of dietary precautions and risks of severe reactions if mixed with other drugs
- used less frequently than SSRIs
25
Q
SSRIs - mood disorder etiology
A
increase amount of serotonin
26
Q
mood stabilizers - mood disorder etiology
A
- lithium is used to helped decrease the frequency and intensity of manic episodes
- anticonvulsants (e.g. valproate)
- prevents and treats manic episodes
27
Q
electroconvulsive therapy - mood disorders - biological approaches
A
- unilateral vs. bilateral
- shock is administered for less than 1 second, once every second day 6-10 times
- last line of defense for people with treatment resistant depression or BPD
- relapse tends to be common and people have to go on medication after ECT
- couple circumstances where individuals may not try medication and referred directly to ECT
- 50% respond
28
Q
psychological approaches etiology - interpersonal psychotherapy (IPT)
A
- perceived stressful life event triggers onset of mood disorders
- stressful relationships worsen the disorder or relationships can also be a result of these mood disorders
- relationship problems significant factor for women
- there is also an assumed genetic vulnerability that can bring the onset of these disorders too
- for men depression is what damages a relationship
29
Q
psychological approaches treatment - interpersonal psychotherapy (IPT)
A
- resolve problems in current relationships and form new important relationships
- address role disputes and address the loss of relationships
- correct social skills
- tend to be more effective than support groups, brief psychodynamic therapy, placebo
- takes about 15-20 weeks
- 60-70% effective
30
Q
psychological approaches etiology - beck’s CBT
A
- perceived stressful life event or automatic thoughts trigger onset of a mood disorder
- recognizes the interplay of thoughts, feelings and behaviours
- some people may be more prone to having more negative thoughts, leading to the onset of a mood disorder
- lack a sense of mastery/achievement
- numerous cognitive distortions
- depression can exacerbate them
31
Q
numerous cognitive distortions - becks cbt etiology
A
- overgeneralization; such as taking one instance of something and applying it to many instances
- arbitrary inference; such as jumping to negative conclusions without evidence
- catastrophizing; such as thinking the worst possible outcome will happen
32
Q
psychological approaches treatment - beck’s CBT
A
- decrease the plausibility and strength of negative thoughts
- behavioural activation
- identify dysfunctional thinking styles
- correct negative thoughts and substitute more realistic thoughts
- challenge deeper held schemas
33
Q
behavioural activation as a psychological approaches treatment
A
- for people who lack mastery, behavioural activation is a good place to start
- helps people identify the smallest thing they can do, do that small thing and then you get a sense of mastery of having done something which can build momentum for doing greater things
- focused on getting people active and developing a sense of mastery - this can be a standalone treatment
34
Q
identifying dysfunctional thinking styles as a psychological approaches treatment
A
- may use tools such as a thought record
- a thought record involves identifying what was happening before the thought, what the thought was, and what impact the thought had
35
Q
treatments for bipolar disorder - psychological approaches
A
- CBT
- family therapy
36
Q
CBT as a treatment for bipolar disorder
A
- standard CBT for depression symptoms
- decreasing desire for mania because of medication by showing the pros to it
- increasing medication compliance
- interpersonal and social rhythm therapy
37
Q
family therapy as a treatment for bipolar disorder
A
- decreasing family tension because mania affects the family of the individuals with mood disorders
- help family members understand the disorder
38
Q
interpersonal and social rhythm therapy for BPD
A
- individuals all have social rhythms/schedules, and so people that experience mood disorders can be triggered with sudden changes in their social rhythms/schedules
- interpersonal and social rhythm theory helps individuals stick to their schedule
39
Q
combined approaches
A
- there is no definite advantage to combining both medication and psychotherapy
- possible advantages include:
1. medication may work faster (debate)
2. IPT improves interpersonal relationships
3. CBT changes negative thinking styles and prevents relapse
40
Q
relapse/recurrence
A
- most individuals have multiple episodes
- 50% of clients who stop their antidepressants relapse within 4 months
- CBT generally leads to less relapse so combining it with meds may bring relapse rates lower
41
Q
suicide
A
- women attempt suicide more often
- men die due to suicide more often because they choose more lethal means
- other high risks groups include minorities, elderly and teenagers
- when working with clients, the best predictor of if they’re going to harm themselves is if they tell you
42
Q
risk factors of suicide
A
- degree of current ideation and planning
- previous attempts
- hopelessness
- depression or comorbid disorders
- emerging from severe depression
- low levels of serotonin
- impulsivity & recent significant stressors
- family history
