mood disoders Flashcards
main symptoms of depression
- mood out of proportion to any cause
- anhedonia
- changes in appetite, sleep & activity (more or less)
- psychomotor retardation or agitation
- lack of energy & fatigue
- thoughts of worthlessness, guilt, shame
psychomotor retardation vs agitation
retardation = everything they do is slowed down - walk, talk & gesture slowly
agitation = feel physically agitated, cannot sit still & may move around or fidget aimlessly
major depressive disorder
a severe bout of depressive symptoms lasting 2 weeks or more
- diagnosis require depressed mood or anhedonia + at least 4 other symptoms for at least 2 weeks
- symptoms must be sever enough to interfere with daily life
1 depressive episode = MDD, single episode
more than 2 (separated by at least 2m) = MDD, recurrent episode
persistent depressive disorder
more chronic form - depressed mood for most of the day, for more days than not, for at least 2 years
- in children & teens - at least 1 year
- must not have been without symptoms for more than 2 months
comorbidity of depression
substance abuse
anxiety disorders
eating disorders
may be cause or result of another disorder
what are the 8 subtypes of depression
depression with anxious distress
depression with mixed features
depression with melancholic symptoms
depression with psychotic features
depression with catatonic features
depression with atypical features
seasonal affective disorder
depression with peripartum onset
depression with anxious distress
prominent anxiety symptoms as well as depressive symptoms
depression with mixed features
meet the criteria for MDD & have at least 3 symptoms of mania, but don’t meet criteria for manic episode
depression with melancholic features
the physiological symptoms of depression are very prominent
depression with psychotic features
people experience delusions & hallucinations
content may be consistent with typical depressive themes (mood-congruent)
or content may be unrelated to depressive themes or mixed (mood-incongruent)
depression with catatonic features
show strange behaviors known as catatonia
can range from a complete lack of movement to excited agitation
depression with atypical features
an odd assortment of symptoms
seasonal affective disorder
a history of at least 2 years of experiencing & fully recovering from major depressive episodes (MDE)
become depressed when daylight hours are short & recover when they are long
depression with peripartum onset
when the onset of an episode occurs during pregnancy or in the 4 weeks following birth
prevalence, age & gender of depression
life prevalence ranges from 3% (japan) – 16% (US)
children - 2.5% & teens 8.3% (US)
age: 18-29 most likely, lowest rates over 65, rise again over 85
gender - twice as common in women
genetic factors for depression
multiple genetic abnormalities likely contribute
abnormalities in serotonin transporter gene = dysfunction in regulation of ST = affects stability of moods
neurotransmitter theories for depression
monoamines like ST, NE & dopamine
- large amounts found in limbic system (sleep, appetite & emotion)
- many processes within brain cells that affect functioning of NTs may go awry in MDD – e.g. abnormalities in synthesis of ST & NE may contribute
- release process of ST & NE (regulated by STG) may be abnormal in depression + receptors may be less sensitive or sometimes malfunction
prefrontal cortex in depression
(attention, planning, problem solving, memory)
reduced metabolic activity, reduction in volume of grey matter & lower brain-wave activity, especially in LH
anterior cingulate in depression
(stress response, emotional expression, social behavior)
different levels of activity = problems in attention, planning of appropriate responses, coping & anhedonia
hippocampus in depression
(memory, fear-related learning)
smaller volume & lower metabolic activity – damage could be result of chronic arousal of body’s stress response (cortisol)
amygdala in depression
(directing attention to stimuli that are emotionally significant)
increased activity = may bias people toward aversive or emo arousing info = rumination over neg memories & neg aspects of env
neuroendocrine factors for depression
3 key components: hypothalamus, pituitary & adrenal cortex = work together in bio feedback system = HPA axis (fight-or-flight)
- depression = show elevated levels of cortisol & corticotropin-releasing hormone (CRH) = chronic hyperactivity in HPA axis + difficulty in HPA returning to normal after a stressor
behavioral theory of depression
life stress leads to depression bcuz it reduces the pos reinforcers in a persons life
- person begins to withdraw = further reduction in reinforcers = more withdrawal – self-perpetuating chain
- once person begins engaging in depressive behaviors – reinforced by sympathy & attention they receive
learned helplessness theory of depression
the type of stressful event most likely to lead to depression is an uncontrollable neg event
- leads people to believe they are helpless to control imp outcomes in their env = lose motivation & reduce actions that might control
negative cog triad theory of depression
people with MDD look at the world through a neg cog triad
- have neg views of themselves, the world & the future = commit error in thinking that support the neg cog triad
- e.g. ignore good events & exaggerate bad events
- neg thinking causes & perpetuates their depression
reformulated learned helplessness theory of depression
explains how cog factors might influence whether a person becomes helpless & depressed following a neg event
- focuses on people’s causal attributions for events
- people who explain neg events by internal, stable & global causes = blame themselves, expect neg event to recur & expect to experience neg events
- leads to long-term learned helplessness deficits + loss of self-esteem
interpersonal theory of depression
interpersonal relationships of people with MDD are fraught with difficulty
- interpersonal difficulties/losses often precede MDD & are most commonly reported as triggering depression
- depressed ppl more likely to have chronic conflict in relationships + act in ways that create conflict
engage in excessive reassurance seeking but never believe affirmations = go back for more = family/friends become weary of this behavior & may become frustrated = person picks up on cues = feels more insecure & engages in more seeking
cohort differences in depression
historical changes may have put more recent generations at higher risk for MDD
- could be bcuz of rapid changes in societal values
- younger gens have unrealistically high expectations for themselves that older gens did not
gender difference theories for depression
hormone theory = hormonal factors & differences
life stress = women more likely to be victims of violence
rumination theory = men more likely to cope with alcohol, women more likely to ruminate
gender roles theory = women more interpersonally oriented - troubles in relationships = more likely to develop symptoms
artefact theory = clinicians more biased to diagnose women with depression
what is mania
an elated mood often mixed with irritation & agitation
- have unrealistically pos & inflated self-esteem, & experience racing thought & impulses
- speak rapidly & forcefully
manic episode diagnosis
must show an elevated, expansive or irritable mood for at least 1 week + at least 3 of the other symptoms of mania – symptoms must impair functioning
bipolar I diagnosis
people who experience manic episodes eventually fall into a depressive episode
- for some the depressions are as severs as MDE, for other the depressions are relatively mild & infrequent
- some people have mixed episodes = experience full criteria for manic episodes & at least 3 symptoms of MDE in the same day, every day for at least 1 week
bipolar II disorder
severe episodes of depressions that meet criteria for MDD, but episodes of mania are milder = hypomania
what is hypomania
involves same symptoms as mania but they are not severe enough to interfere w daily functioning + last at least 4 consecutive days
rapid cycling bipolar I/II disorder
4 or more episodes that meet criteria for manic, hypomanic or MDE with 1 year
disruptive mood dysregulation disorder
severe temper outbursts that are grossly out of proportion in intensity & duration to a situation & inconsistent w developmental level
- added to distinguish children w temper tantrums from children w BP
- must have at least 3 temper outbursts per week for at least 1 year & in at least 2 settings
prevalence, age & gender of BP
prevalence: 0.6% BP I, 0.4% BP II
age: late adolescence, early adulthood
gender: men & women equally likely
comorbidity of BP
anxiety disorders
substance abuse
structural & functional brain abnormalities for BP
striatum (processing of env cues of reward): becomes active when rewarding stimuli are perceived
– activated abnormally in BP = inflexible responses to reward (excessively seek reward during manic phase, insensitive to reward in depressive phase)
abnormalities in white matter in prefrontal cortex = difficult communicating with & exerting control over other areas = disorganized emotions & extreme behaviors
neurotransmitters for BP
dysregulation in dopamine system contributes to BP
- high levels of dopamine associated with high reward seeking (manic), low levels with insensitivity (depressive)
drug treatments for depression
drugs have slow-emerging effects on intracellular processes in the NT systems & on actions of genes that regulate neurotransmission, limbic system & stress response
- antidepressants reduce depression in 50-60% of ppl
- takes a few weeks to know wether person will respond to the drug & many try more than one
what are the 5 drugs for treating depression
- SSRIs - very effective, fewer difficult side effects
- SNRIs - slight advantage over SSRI in preventing relapse but more side effects
- NE dopamine reuptake inhibitor - especially useful for ppl w psychomotor retardation
- tricyclic antidepressants - used less freq bcuz of numerous side effects
- MAOIs - decrease action of MAO = increase levels of NTs, no longer freq used
drug treatments for BP
Mood stabilizers: relieve or prevent symptoms of mania
- ppl w BP may take both antidepressants & mood stabilizers
Lithium – may work by improving functioning of the intracellular processes that are abnormal in mood disorders
- difference between effective dose & lethal dose is small
- side effects range from annoying to life threatening
anticonvulsant & atypical antipsychotic medications – anti-epileptic medication (carbamazepine/Valproate) used in treating BP
- valproate induces fewer side effects & used more often
- may work by restoring balance between NT systems in amygdala
- atypical antipsychotic medications: reduce functional levels of dopamine & useful in treatment of psychotic manic symptoms
electroconvulsive therapy (ECT) for depression
brain seizure is induced by passing electrical current through patients head
- patients first anesthetized & given muscle relaxants
- typically have a convulsion that lasts 1 minute – 6-12 session
- decreases metabolic activity in several regions of the brain – including frontal cortex & anterior cingulate
repetitive transcranial magnetic stimulation (rTMS)
- expose patients to repeated high-intensity magnetic pulses focused on particular brain structures
- treating depression = target left prefrontal cortex
- few side effects
vagus nerve stimulation (VNS)
- vagus nerve is stimulated by a small electronic device that is surgically implanted under the skin in left chest wall
- results in increased activity in hypothalamus & amygdala = antidepressant effects
deep brain stimulation (DBS)
- electrodes surgically implanted in specific areas of brain – connected to a pulse generator placed under the skin & stimulates brain areas
- very small trials shown promise in relieving intractable depression
light therapy
exposing people with SAD to bright light for a few hours each day during winter months – significantly reduces some ppl’s symptoms
- resets circadian rhythms – depression sometimes causes dysregulation of circadian rhythms = normalizes production of hormones & NTs
- decreases levels of melatonin = increases NE, ST = decreases symptoms
behavioral therapy for depression
focuses on increasing pos reinforcers & decreasing aversive experiences by helping change patterns of interaction w the env & other people
1. functional analysis of the connections between specific circumstances & symptoms
2. therapist helps client change aspects of env that are contributing to symptoms – teach skills for changing their neg circumstances
CBT for depression
2 general goals: change neg, hopeless patterns of thinking + help patients solve problems & develop skills for being more effective in their world
- focus on specific problems that clients believe are connected to MDD + urges clients to set own goals & make own decisions
1: help client discover neg automatic thoughts & understand the link between thoughts & depression
2: help clients challenge neg thoughts
3: help clients recognize the deeper, basic beliefs or assumptions they might hold that are fueling their depression
interpersonal therapy for depression
therapist looks for 4 types of problems in depressed individuals:
1. grieving loss – help client face loss & explore feelings about it
2. interpersonal role disputes – help client recognize dispute then guide them in making choices about the relationship
3. role transitions – help client develop more realistic perspective towards role that is lost + learn to regard new roles in more pos manner
4. deficits in interpersonal skills – reviews clients past relationships + help them understand these relationships & how they might affect current ones
interpersonal & social rhythm therapy for BP
enhancement of IPT designed specifically for people with BP
- combines IPT techniques w behavioral techniques to help patients maintain regular routines & stability in personal relationships
- patients self-monitor their patterns over time = understand how changes can provoke symptoms – develop a plan to stabilize routines & activities
family-focused therapy for BP
designed to reduce interpersonal stress in people with BP, particularly within the context of families
- educate patients & families about BPD & train them in communication & problem solving skills
