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mood disoders Flashcards

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1
Q

main symptoms of depression

A
  • 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
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2
Q

psychomotor retardation vs agitation

A

retardation = everything they do is slowed down - walk, talk & gesture slowly

agitation = feel physically agitated, cannot sit still & may move around or fidget aimlessly

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3
Q

major depressive disorder

A

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

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4
Q

persistent depressive disorder

A

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

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5
Q

comorbidity of depression

A

substance abuse
anxiety disorders
eating disorders

may be cause or result of another disorder

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6
Q

what are the 8 subtypes of depression

A

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

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7
Q

depression with anxious distress

A

prominent anxiety symptoms as well as depressive symptoms

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8
Q

depression with mixed features

A

meet the criteria for MDD & have at least 3 symptoms of mania, but don’t meet criteria for manic episode

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9
Q

depression with melancholic features

A

the physiological symptoms of depression are very prominent

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10
Q

depression with psychotic features

A

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)

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11
Q

depression with catatonic features

A

show strange behaviors known as catatonia

can range from a complete lack of movement to excited agitation

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12
Q

depression with atypical features

A

an odd assortment of symptoms

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13
Q

seasonal affective disorder

A

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

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14
Q

depression with peripartum onset

A

when the onset of an episode occurs during pregnancy or in the 4 weeks following birth

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15
Q

prevalence, age & gender of depression

A

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

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16
Q

genetic factors for depression

A

multiple genetic abnormalities likely contribute

abnormalities in serotonin transporter gene = dysfunction in regulation of ST = affects stability of moods

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17
Q

neurotransmitter theories for depression

A

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

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18
Q

prefrontal cortex in depression

A

(attention, planning, problem solving, memory)
reduced metabolic activity, reduction in volume of grey matter & lower brain-wave activity, especially in LH

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19
Q

anterior cingulate in depression

A

(stress response, emotional expression, social behavior)
different levels of activity = problems in attention, planning of appropriate responses, coping & anhedonia

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20
Q

hippocampus in depression

A

(memory, fear-related learning)
smaller volume & lower metabolic activity – damage could be result of chronic arousal of body’s stress response (cortisol)

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21
Q

amygdala in depression

A

(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

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22
Q

neuroendocrine factors for depression

A

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
23
Q

behavioral theory of depression

A

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

24
Q

learned helplessness theory of depression

A

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

25
Q

negative cog triad theory of depression

A

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

26
Q

reformulated learned helplessness theory of depression

A

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

27
Q

interpersonal theory of depression

A

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

28
Q

cohort differences in depression

A

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

29
Q

gender difference theories for depression

A

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

30
Q

what is mania

A

an elated mood often mixed with irritation & agitation
- have unrealistically pos & inflated self-esteem, & experience racing thought & impulses
- speak rapidly & forcefully

31
Q

manic episode diagnosis

A

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

32
Q

bipolar I diagnosis

A

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

33
Q

bipolar II disorder

A

severe episodes of depressions that meet criteria for MDD, but episodes of mania are milder = hypomania

34
Q

what is hypomania

A

involves same symptoms as mania but they are not severe enough to interfere w daily functioning + last at least 4 consecutive days

35
Q

rapid cycling bipolar I/II disorder

A

4 or more episodes that meet criteria for manic, hypomanic or MDE with 1 year

36
Q

disruptive mood dysregulation disorder

A

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

37
Q

prevalence, age & gender of BP

A

prevalence: 0.6% BP I, 0.4% BP II

age: late adolescence, early adulthood

gender: men & women equally likely

38
Q

comorbidity of BP

A

anxiety disorders
substance abuse

39
Q

structural & functional brain abnormalities for BP

A

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

40
Q

neurotransmitters for BP

A

dysregulation in dopamine system contributes to BP
- high levels of dopamine associated with high reward seeking (manic), low levels with insensitivity (depressive)

41
Q

drug treatments for depression

A

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

42
Q

what are the 5 drugs for treating depression

A
  1. SSRIs - very effective, fewer difficult side effects
  2. SNRIs - slight advantage over SSRI in preventing relapse but more side effects
  3. NE dopamine reuptake inhibitor - especially useful for ppl w psychomotor retardation
  4. tricyclic antidepressants - used less freq bcuz of numerous side effects
  5. MAOIs - decrease action of MAO = increase levels of NTs, no longer freq used
43
Q

drug treatments for BP

A

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

44
Q

electroconvulsive therapy (ECT) for depression

A

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

45
Q

repetitive transcranial magnetic stimulation (rTMS)

A
  • expose patients to repeated high-intensity magnetic pulses focused on particular brain structures
  • treating depression = target left prefrontal cortex
  • few side effects
46
Q

vagus nerve stimulation (VNS)

A
  • 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
47
Q

deep brain stimulation (DBS)

A
  • 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
48
Q

light therapy

A

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

49
Q

behavioral therapy for depression

A

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

50
Q

CBT for depression

A

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

51
Q

interpersonal therapy for depression

A

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

52
Q

interpersonal & social rhythm therapy for BP

A

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

53
Q

family-focused therapy for BP

A

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

clinical psych (7 decks)

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