Mood/Depressive Disorders Flashcards
What are the 4 unipolar depressive disorders?
Major depressive disorder
Persistent depressive disorder
Premenstrual dysphoric disorder
Disruptive mood dysregulation disorder
What is the lifetime prevalence of MDD?
15%
What is the common age of onset for depession?
Early 20s
2 examples of co-morbidity of MDD
- 5-30% with MDD experience PDD
2. 60% of those with MDD will also meet criteria for anxiety disorder at some point
DSM-5 Criteria for MDD
- Sad mood OR loss of interest and pleasure
- Plus 4 other symptoms:
-Sleeping too much or too little
-Psychomotor retardation or agitation
-Poor appetite and weight loss, or increased
appetite and weight gain
-Loss of energy
-Feelings of worthlessness or excessive guilt
-Difficulty concentrating, thinking, or making decisions
-Recurrent thoughts of death or suicide - Symptoms are present:
-Nearly every day
-Most of the day
-For at least 2 weeks - Symptoms are distinct and more severe than a normative response to significant loss
DSM-5 Criteria for PDD
1. Depressed mood for at least 2 years
(1 year for children/adolescents)
2. Plus 2 other symptoms:
-Poor appetite or overeating
-Sleeping too much or too little
-Low energy
-Poor self-esteem
-Trouble concentrating or making decisions
-Feelings of hopelessness
3. Symptoms do not clear for more than 2 months at a time
4. Bipolar disorders are not presentWhat is mania?
State of intense elation, irritability, or activation
What is hypomania?
hypo = “under”
Symptoms of mania (intense elation, irritability, or activation) but less intense
-Does not involve significant impairment
DSM-5 criteria for manic and hypomanic
episodes
- Distinctly elevated or irritable mood
- Abnormally increased activity and energy
- Plus 3 other symptoms (four if mood is irritable):
-Increased goal-directed activity or psychomotor agitation
-Talkativeness or rapid speech
-Flight of ideas or racing thoughts
-Decreased need for sleep
-Increased self-esteem or grandiosity
-Distractibility
-Excessive involvement in activities that are likely to have undesirable consequences - Symptoms are present most of the day, nearly
every day - For a manic episode:
-Symptoms last at least 1 week, require hospitalization, or include psychosis
-Symptoms cause significant distress or functional impairment - For a hypomanic episode:
-Symptoms last at least 4 days
-Clear changes in functioning that are observable to others, but impairment is not marked
-No psychotic symptoms are present
DSM-5 criteria for bipolar I
At least one episode of mania
DSM-5 criteria for bipolar II
- At least one major depressive episode
- At least one episode of hypomania
- No episodes of mania
DSM-5 criteria for cyclothymic disorder (cyclothymia)
(Milder, chronic form of bipolar disorder)
1. Symptoms lasts at least 2 years in adults
(1 year in children/adolescents)
2. Numerous periods with hypomanic and depressive symptoms
3. Does not meet criteria for hypomania or major depressive episode
4. Symptoms do not clear for more than 2 months at a time
5. Symptoms cause significant distress or impairment
What are the prevalence rates for bipolar disorders?
- 1% in U S; 0.6% worldwide for Bipolar I
- 0.4% – 2% for Bipolar II
- 4% for Cyclothymia
What are the 3 bipolar depressive disorders?
- Bipolar I
- Bipolar II
- Cyclothymia
What is the average age of onset for bipolar disorders?
20s
Are there gender differences in rates of bipolar disorders?
- No gender differences
- Women experience more depressive episodes
Are there gender differences in rates of unipolar disorders?
Twice as common in women than in men
Factors contributing to the onset of mood disorders
- Genetic factors
- Neurotransmitters
- Brain function
- Neuroendocrine System
- Social factors
- Psychological factors
What are the heritability estimates of MDD?
37%
What are the heritability estimates of bipolar disorder?
93%
Which NTs are (likely) related to mood disorders?
- Norepinephrine
- Dopamine
- Serotonin
What 3 brain regions are related to mood disorders and how?
elevated/decresed activity and the main relevant function of the region
- Oversensitivity to emotional stimuli (elevated activity in the amygdala)
- Interference with emotion regulation (elevated activity in anterior cingulate, diminished in prefrontal cortex and hippocampus)
- Motivation to pursue rewards (striatum)
- Disruptions in the connectivity of these regions
How are life events related to depression?
- 42-67% report a stressful life event in year
prior to depression - 40% risk of developing depression when
experiencing stressful life event without
support (4% risk with support)
Which 2 interpersonal difficulties predict depression or relapse?
- High levels of expressed emotion predict relapse
2. Marital conflict also predicts depression
How is neuroticism related to depression?
- Neuroticism is expressed by the tendency to experience frequent and intense negative affect.
- Neuroticism predicts the onset of anxiety, which is highly comorbid with depression.
What is the common belief of cognitive theories about depression?
Negative thoughts and beliefs cause depression
Name 3 cognitive theories relevant to depression.
- Beck’s Theory
- Hopelessness Theory
- Rumination Theory
What are the 3 main components of Beck’s theory and what is their meaning?
- Negative triad (negative view of self, world, future)
- Negative schema (underlying tendency to see the world negatively)
- Cognitive biases (tendency to process information in negative ways due to negative schema)
The components all influence each other and then lead to depression
What are the main 2 causes for depression according to the Hopelessness theory?
- Most important trigger of depression is
hopelessness:
-Desirable outcomes will not occur
-Person has no ability to change situation - Attributional Style
-Negative life events are due to stable and global causes
What does rumination theory say about depression?
- A specific way of thinking: tendency to repetitively dwell on sad thoughts
- Most detrimental form is to brood regretfully over causes of events
What is the treatment of sepression according to the Interpersonal psychotherapy (IPT)?
- Focus on major interpersonal problems (e.g., role
transitions) - Identify feelings, make decisions, and resolve problems related to interpersonal issues
What is the treatment of sepression according to the Cognitive therapy (CT)?
- Altering maladaptive thought patterns
- Monitor and identify automatic thoughts
-Challenge and replace negative thoughts with
more neutral or positive thoughts
What is the treatment of depression according to Mindfulness-based cognitive therapy (MBCT)?
Use of strategies, including meditation, to detach
from depression-related thoughts and prevent relapse
What is the treatment of depression according to Behavioral activation (BA) therapy?
Increase participation in positively reinforcing
activities to disrupt spiral of depression, withdrawal, and avoidance.
- BA is also one component of cognitive therapy
What is the treatment of depression according to Behavioral couples therapy?
Enhance communication and relationship satisfaction.
What do Psychoeducational approaches recommend for the treatment of bipolar disorder?
Provide the patients with information about symptoms, course, triggers, and treatments.
What does Cognitive Therapy (CT) recommend for the treatment of biopolar disorder?
Similar to depression treatment with additional content to address early signs of mania.
(approach to depression:
- Altering maladaptive thought patterns
- Monitor and identify automatic thoughts)
What does Family-focused treatment (FFT) recommend for the treatment of biopolar disorder?
Educating the family about disorder, enhancing the family communication, improving the problem solving in the family.
What are the 2 different biological treatments of Mood Disorders?
- Electroconvulsive therapy (ECT)
- Transcranial Magnetic Stimulation for Depression
(rTMS)
Name 4 main points regarding Electroconvulsive therapy (ECT).
(who get the treatment? what does it cause? what are the side effects? how does it work?)
- Reserved for treatment non-responders.
- Induce brain seizure and momentary unconsciousness.
- Side effects: Short-term confusion and memory loss.
- Unclear how ECT works.
Name 3 main points regarding Transcranial Magnetic Stimulation for Depression (rTMS).
(what is the procedure? what happens to the body? who is treated?)
- Electormagnetic coil placed against scalp.
- Pulses of magnetic energy increase activity in the
brain. - For those that fail to respond to first antidepressant.
Name 4 different categories and exaples for antidepressants.
- MAO inhibitors - tranylcypromine (trade name: Parnate)
- Tricyclic antidepressants - Imipramine, amitriptyline (trade name: Tofranil, Elavil)
- Selective serotonin reuptake inhibitor (SSRI) - fluoxetine, sertraline (trade name: Prozac, Zoloft)
- Serotonin norepinephrine reuptake inhibitor (SNRI) - venlafaxine, duloxetine (trade name: Effexor, Cymbalta)
Name 3 different categories and exaples for mood stabilizers.
- Lithium
- Anticonvulsants - divalproex sodium (trade name: Depakote)
- Antipsychotics - olanzapine (trade name: Zyprexa)
Name one upside and one downside of antidepressants.
- Effective at treating severe, persistent depression.
2. May not be helpful for those with mild or moderate symptoms.
What is the STAR-D according to Rush et al., 2006? What were the researchers thying to measure? what are 3 main results?
Sequenced Treatment Alternatives to Relieve
Depression.
Attempted to evaluate effectiveness of antidepressants in real-world settings (comorbid mental disorders).
- Only 33% achieved full symptom relief with citalopram. - About 30% of non-responders achieved remission with a different anti-depressant. - Remission rates were low and relapse rates were high.
What is the most useful way of treating depression?
Combining psychotherapy and antidepressant
medications increases odds of recovery over either
alone by 10-20%
- Medications quicker, therapy longer-lasting effects
later studies show that:
- CBT is as effective as medication for severe depression
- CBT is more effective than medication at preventing relapse
Name one upside and one downside of Lithium.
- Up to 80% receive at least some relief
2. Potentially serious side effect - Lithium toxicity
What are other options, besides Lithium, for treating bipolar disorder? and when should one use them instead of Lithium?
- Anticonvulsants - Divalproex (Depakote)
- Antipsychotics (offer immediate calming effect) - Olanzapine (Zyprexa)
Recommended if people are unable to tolerate lithium
side effects
Could medications like Anticonvulsants or Antipsychotics be administered to a person already taking Lithium?
Yes. Anticonvulsants and Antipsychotics can be combined with Lithium.
What is the definition of Major Depressive Disorder (MDD)?
Five or more depressive symptoms, including sad mood or loss of pleasure, for 2 weeks.
What is the definition of Persistent Depressive Disorder (PDD)?
Low mood and at least two other symptoms of depression at least half of the time for 2 years.
What is the definition of Premenstrual Dysphoric Disorder?
Mood symptoms in the week before menses.
What is the definition of Disruptive Mood Dysregulation Disorder?
Severe recurrent temper outbursts and persistent negative mood for at least 1 year beginning before age 10.
What is the definition of Bipolar I disorder?
At least one lifetime manic episode.
What is the definition of Bipolar II disorder?
At least one lifetime hypomanic episode and one major depressive episode.
What is the definition of Cyclothymia?
Recurrent mood changes from high to low for at least 2 years, without hypomanic or depressive episodes.
