Mood Affective Disorders - Depression

Question 1

What are the two types of mood affective disorders

Answer 1

1)Bipolar disorder
2)Depressive disorder

Question 2

Both Bipolar disorder and Depressive disorder are characterized by episodes of particular types of moods

what episodes are these?

Answer 2

1)Depressive episode
2)Manic episode
3)Mixed episode
4)Hypomanic episode

Question 3

What is the ICD-11 criteria for a depressive episode

Answer 3

1) Concurrent (simultaneous) presence of at least 5 characteristic symptoms , occurring for most of the day , nearly everyday for at least two weeks.

-At least one symptom must be from the affective cluster symptoms.

The characteristic symptoms are:
a)Affective cluster symptoms
b)Cognitive behavioural clusters
c)Neurovegetative cluster symptoms

2)The symptoms are not better accounted for by bereavement (grief/sadness).

3) The symptoms are not a manifestation of another medical condition e.g a brain tumor and are not due to the effect of a substance or medication on the CNS
e.g anti anxiety drugs (Benzodiazepines)

4)The mood disturbances results in significant impairments in personal , family , social , educational , occupational , or other important areas of functioning.

Question 4

What are the affective cluster symptoms

Answer 4

1) Depressed mood (melancholy /sadness)

2)Significant diminishes interest in activities e.g a reduction in sexual desire

Question 5

What are the Cognitive behavioural clusters as part of the characteristic symptoms for depression

Answer 5

1)Reduced ability to concentrate and sustain attention on tasks.

2)Beliefs of low self worth or excessive and inappropriate guilt.

3)Hopelessness about the future

4)Recurring thoughts of death or suicidal ideation/evidence of attempted suicide.

Question 6

What are the neurovegetative cluster symptoms as part of the characteristic symptoms for depression

Answer 6

1)Significantly disrupted sleep e.g delayed sleep onset , increases frequency of waking in the night/early morning awakening. Sometimes the individual has excessive sleep.

2)Significant change in appetite , (diminished or increased leading to significant weight change (gain or loss)

3)Psychomotor retardation
Slowed down or decreased movement and psychomotor agitation (restlessness)

4) reduced energy, fatigue and marked tiredness

Question 7

What is the ICD-11 criteria for a manic episode;

Answer 7

1)Both of the following features occur concurrently and persist for most of the day nearly everyday. During a period of at least 1 week.

2) an extreme mood state characterized by euphoria, irritability or expansiveness. Individuals commonly exhibit rapid changes among different mood states (mood lability)

3) increased activity or a subjective experience of increased energy

Additional symptoms:
-increased talkativeness or pressured speech
- flight of ideas or experience of rapid (racing thoughts)
-increased self esteem or grandiosity
- Decreased need for sleep
- distractibility
-Impulsive reckless behavior

4) The symptoms are not a manifestation of another medical condition e.g Brain tumor
And are not due to the effect of a substance or medication on the CNS e.g anxiety drugs

5) The mood disturbances result in significant impairments in personal , family , social , educational or other important areas of functioning

Question 8

What is the ICD-11 criteria for a mixed episode

Answer 8

1)Several prominent manic and several prominent depressive symptoms consistent with those observed in manic episode and depressive episode must be present.
They can occur simultaneously or alternate very rapidly from day to day or within the same day.

2) the symptoms are not a manifestation of a medical condition and are not due to the effects of substance misuse or medication.

3) the mood disturbances result in significant impairments in the core areas of functioning e.g family , academics, personal etc

Question 9

What is the ICD-11 criteria for a hypomanic episode

Answer 9

-Both of the following symptoms must occur concurrently and persist for most of the day , nearly everyday for at least several days
a) persistent elevation of mood or increased irritability
b) increased activity or a subjective experience of increased energy

In addition several of the following symptoms must be present;
-> increased talkativeness
-> increased self esteem
-> decreased need for sleep
-> distractibility
-> impulsive reckless behavior

-2) the symptoms are not a manifestation of another medical condition and are not due to the effects of substance misuse or medication

3) The mood disturbance is not sufficiently severe to cause marked impairments in the core areas of functioning, personal , family etc

4) the clinical representation does not meet the diagnostic requirement for a mixed episode

Question 10

What is the ICD-11 criteria for unipolar depression/depressive disorder

Answer 10

-A diagnosis of depressive disorder can only be made if a person has never experienced a manic , mixed or hypomanic episode

-Depressive disorder is characterised by the symptoms of the depressive episode excluding the symptoms of mania.
These symptoms must occur most of the day , nearly everyday for at least two weeks.

-The symptoms are not better accounted for by bereavement

-the symptoms are not a manifestation of another medical condition and are not due to the effects of substance misuse or medication

-The mood disturbances results in significant impairments in personal , family , social , educational , occupational , or other important areas of functioning.

Question 11

Bipolar disorder is characterised by ……

Answer 11

the occurrence of at least 1 manic or mixed episode

Question 12

The diagnostic criteria for bipolar type 1 is similar to the criteria of what episodes?

Answer 12

Manic and mixed episodes

Question 13

What psychometric can be used by healthcare professionals to identify depressive symptoms in patients

Answer 13

-BDI , Beck depression inventory

Question 14

What is the criteria for bipolar type 2

Answer 14

-You must have experienced one or more hypomanic episodes and at least 2 depressive episodes

Question 15

What is the BDI

Answer 15

• 21 item questionnaire that measures attitude and symptoms related to depressive disorder.

-Each question is based on the known symptoms of depression e.g melancholy
-A four point rating scale is anchored on each item from 0-3
-The minimum score you can get is 0 mad the maximum 63.
-Each item consists of four statements describing a known symptom in increased severity from 0-3.
-

Question 16

Give an example of an item in BDI

Question 17

How is a total score of the BDI calculated

Answer 17

-It is calculated by adding up the scores in the 21 categories
-The higher the score in the BDI the more severe the depressive disorder.

Question 18

What do the BDI scores represent

Question 19

Give 3 strengths of the BDI

Answer 19

1)Useful application to everyday life ;
-The psychometric is administered to patients to access entry symptoms . It could also be administered at termination of therapy to access progress with therapy. Also clinicians could use it to access the long term effectiveness of intervention

2)High objectivity ;
-Bdi generates quantitative data in the form of scores rated on a 4 point rating scale. Such data is objective as the researcher cannot contaminate it with bias such as opinions , religion , training , stereotypes

3) High validity ;
Research has shown that BDI has concurrent validity with other validated tools such as MMPI-I for adolosent depression.

Question 20

what are weaknesses of the BDI

Question 21

what are the psychological explanations of depressive disorder

Answer 21

1)The cognitive theory - Aaron T Beck
2)Learned helplessness and attributional style - Seligman

Question 22

Explain the cognitive theory Aaron t beck

Answer 22

-According to cognitive psychologists our problems stem from the way we think about our everyday experiences especially the bad events

-Aaron T Beck argues that a depressive trait stems from negative self schemas (belief system) developed in childhood

Question 23

When is a negative self schema formed/what causes it

Answer 23

-Formed when a person is exposed to difficult early childhood experiences such as abuse , neglect , deprivation

Question 24

What is a cognitive distortion

Answer 24

-A cognitive distortion is a bias in thinking caused by a distortion pf reality.
Our early childhood experiences especially the negative early childhood experiences have a negative impact in our adult personality therefore negative self schemas are implicated in the development of a depressive trait

Question 25

How is a person’s negative self schema activated

Answer 25

• when we are faced with events in adult life a persons negative schema is activated and we expect things to turn out badly.
  we evaluate our experiences with pessimism we have a pessimistic view of the world , the self and the future called triad.

Question 26

What is a cognitive distortion

Answer 26

a bias in thinking caused by a negative self schema

Question 27

What is catastrophizing

Answer 27

Expecting the worst-case scenario or blowing things out of proportion. For instance, someone may think, “If I make a mistake at work, I’ll lose my job and my life will fall apart.”

Question 28

what is over generalisations

Answer 28

: Drawing broad conclusions from a single negative event. For example, “I failed this test, so I’ll never succeed in life.
(focusing on one negative thing at the expense of several positives)

Question 29

What is a negative triad

Answer 29

-When we are faced with events in adult life a persons negative schema is activated and we expect things to turn out badly.
We evaluate our experiences with pessimism.

We have a pessimistic view of the world , the self and the future called a negative triad

Question 30

what is learned helplessness

Answer 30

• Learned helplessness is when one has to endure suffering because they feel trapped in an inescapable unpleasant situation.
• when an individual perceives a lack of control over their suffering , they relent into a state of helplessness the victim stops trying to resist suffering because they learn that they are unable to overcome the outcome of their situation/their suffering.

Question 31

What is attributional style

Answer 31

• Attributional style refers to the way we explain causes of events in our life.

-when suffering is perceived to be inescapable the victim develops negative attributional style. Attributional styles are also known as explanatory styles

Question 32

What are the two types of attributional style

Answer 32

1. internal , stable and global profile/style
2. External , unstable and specific profile/style

Question 33

Explain internal , stable and global style

Answer 33

1. this is a maladaptive (life threatening)attributional style. It’s a risk factor to depression.
   -> Internality is when the individual explains bad events internally . They are self critical. (You are responsible for the bad events)
   -> stability is when the individual thinks that the bad event will not go away. (The bad event is stable)
   -> Globality is when the individual thinks that when one area of functioning is impaired then they are globally impaired ( impaired as a whole).

Question 34

What type of medications are used to treat depression

Answer 34

Antidepressants

Question 34

What is the biochemical explanation for depression

Answer 34

-Focuses on the neurotransmitters dopamine , serotonin and norepinephrine

-Dopamine processes motivation , pleasure and satisfaction. It is therefore logical to conclude that low levels of brain dopamine impair these functions , this leads to sadness , lethargy , anhedonia etc.

-There is evidence for the involvement of dopamine in depressive disorder from antidepressants.

-Serotonin regulates sleep , appetite , anxiety and sexual drive.
Low serotonin levels impair these functions this leads to disturbed sleep , disturbed appetite etc. which are known symptoms of depressive disorder.

-Evidence from the involvement of serotonin comes from antidepressants. Most antidepressants e.g SSRIs are serotonin agonists.

Question 35

What are the three types of antidepressants

Answer 35

1)Tricyclics
2) SSRI’s
3)MAOI’s

Question 36

Describe SSRI’s

Answer 36

-It stands for selective serotonin reuptake inhibitors
-It is the most popular of all antidepressants and it has fewer side effects
-Examples of SSRIs ; Citalopram , Dapoxetine

Question 37

How do SSRI’s work?

Answer 37

-They are selective as they only target the serotonergic pathways i.e the pathways that modulate sleep , anxiety , sex drive etc

-They work by preventing the reuptake and breaking down of synaptic serotonin hence increasing brain serotonin.

-

Question 38

What are the side effects of SSRI’s

Answer 38

-Feeling agitated
-Indigestion
-Loss of appetite = weight loss
-Blurred vision
-Dizziness

Question 39

Describe Tricyclics

Answer 39

-They are the most potent type of antidepressants as they target both serotonin and norepinephrine pathways

Examples of tricyclics ; Doxepin , imipramine

Question 40

How do tricyclics work

Answer 40

They work by preventing the reuptake of serotonin and norepinephrine within the presynaptic terminals.

-When this happens the level of serotonin and norepinephrine increase in the synaptic gap

Question 41

What are the side effects of tricyclics

Answer 41

-They have numerous side effects and are not recommended as first line treatment

-The unpleasant side effects may cause non adherence to tricyclics lowering the validity of the treatment

side effects;
-Drowsiness
-Blurred vision
-Weight gain
-Vomiting / nausea

Question 42

Describe MAOIs

Question 43

How do MAOIs work

Answer 43

-They work by inhibiting the activity of the MAO enzyme
The MAO enzyme is known to break down and remove the neurotransmitters dopamine , norepinephrine , and serotonin

-MAOIs inhibit the activity of the MAO enzyme from breaking down the catecholamines , hence increasing the level of brain Catecholamines

Question 44

What are the side effects of MAOIs

Answer 44

-They tend to have less severe side effects ;
-Involuntary muscle jerks
-Low blood pressure
-Weight gain
-Muscle cramps

Question 45

What are the psychological treatments of depressive disorder

Answer 45

-Cognitive restructuring (Aaron T Beck)
-Rational emotive behaviour Therapy (REBT)

Question 46

What is cognitive restructuring

Answer 46

-Cognitive restructuring is premised on the idea that our problems stem from the way we think about our experiences especially bad events.

Question 47

How is cognitive restructuring done

Answer 47

step 1 ; Explain the cognitive theory of depressive disorder to the patient

Step 2 ; Train patients to observe and catch automatic dysfunction thoughts using a thought diary

Step 3 ; Reality testing

Step 4 ; Therapy/treatment

Question 48

Explain the first step of cognitive restructuring
1) Explain the cognitive theory of depressive disorder to the patient

Answer 48

-This involves letting patients understand the origin of their pessimism. For example negative self schemas caused by difficult early childhood experiences i.e abuse , neglect leading to cognitive distortions and pessimism

Question 49

Explain the second step of cognitive restructuring
2) Train patients to observe and catch automatic dysfunctional thoughts using thought diary

Answer 49

• This is done outside therapy sessions to increase ecological validity
• Using thought diary the patient understands the link between thoughts, emotions and behavior and how they are intertwined.
• In the diary the patient records:
  -> the situation they were in,
  -> the thoughts they had
  -> the emotions they experienced.
  Eg. Having a Job interview (situation) and thinking ‘I am going to mess up’ (thought), I feel anxious (emotion)

Question 50

Explain the third step of cognitive restructuring
3) Reality testing

Answer 50

-Put the thoughts on trial.

The therapist works with the patient to gather evidence for and against their thoughts. Only factual evidence should be considered.

Question 51

Explain the fourth step of cognitive restructuring
4) Therapy/treatment

Answer 51

• Techniques such as reattribution and re-framing (discovering irrational thinking and replacing them with more rational thoughts) are used to help patients to overcome dysfunctional thinking.

Question 52

What is Rational Emotive Behaviour Therapy (REBT) - Ellis

Answer 52

-It is based on the philosophy of stoicism which partially states that , all human behaviours and emotions are the result of what people think or believe about their experience

-The problem is how we construct our experiences , especially the bad events

Question 53

What is the ABC mode in REBT

Answer 53

Ellis used the ABC mode to explain the relationship between the bad event , the belief system and the consequence on emotion and behaviour.

A - Stands for activating event ,
e.g a friend passed me in the street without acknowledging me , he is ignoring me , he doesn’t like me

B- Beliefs about A ,
(rigid and irrational evaluations) e.g i am unacceptable as a friend so i must be worthless as a person

C- stands for consequence
emotional and behavioral e.g depression = emotional and social withdrawal = behavioural

A triggers B the B causes C

Question 54

According to Ellis what makes us more at risk of depression

Answer 54

When we hold irrational demands about one self e.g “ i must do well” , “i must not fail” (having an absolute attitude) and irrational demands about others e.g “people must treat me right” “ My circumstances must be the way i want them to be” we are more at risk of depression

Question 55

The goal of REBT is to help patients do what?

Answer 55

is to help patients
1) Uncover their irrational thoughts and core beliefs e.g irrational inferences and evaluations i.e self-drowning , catastrophizing

2)To move patients from irrational self defeating core beliefs and thoughts to more rational thinking using CBT techniques such as rational analysis. (pointing out irrationality in the patients story line), re framing (involves training patients to evaluate their experiences more positively), devils advocate (aka: reverse role playing) (the therapist acts out the irrational thinking of the patient while the patient defends themselves with a more rational thinking). Behavior techniques could also be used such as exposure session, and paradoxical behavior.