Mood Disorders Flashcards
Sigmund Freud - Depression and grief
Imagined loss
Oral stage
Thought mourners unable to resolve their grief would turn their anger from their lost loved one towards themselves
Imagined loss: Individual interprets other types of events as severe loss events (when there’s no grief)
Most likely to become depressed following a loss when needs were not or were excessively met during oral stage
Average age of onset of major depressive disorder (MDD)
Early to mid twenties
But increasingly affecting children and adolescents now too
Prevalence of MDD between genders
Rates increase through adolescence for girls but level off for boys
Difference of persistent depressive disorder to MDD
Lasts 2 years
Higher level of impairment, younger age of onset, higher comorbidity, stronger heredity, lower social support, higher stress, higher dysfunctional personality traits
Lower response to treatment
Typical symptoms of mania
Increased energy, less sleep, problems with attention, decreased judgment
Feel that they’re special in some way
Bipolar I disorder vs Bipolar II disorder
History of manic episodes w/ depressive episodes
History of hypomanic episodes w/ depressive episodes
- Harder to diagnose because less severe
Prevalence of bipolar disorder between boys and girls
Age of onset
No difference
20 years old but increasing prevalence in children
Cyclothymia
Rapid cycling specifier
Chronic but less severe bipolar disorder
2 year history of alternating hypomanic and depressive episodes
Presence of 4+ manic and/or depressive episodes in 1 year
- Can occur or be worse by antidepressant medications so mood stabilizers important
Seasonal affective disorder (SAD)
Can occur in uni-polar MDD and bipolar disorder
Recurrent depressive episodes tied to changing seasons
Nights grow longer in winter - Less melatonin decrease
- Ppl with SAD need more melatonin to wake up so lack of sunlight makes them more drowsy
More likely to be phase-delayed circadian rhythms
Peri-partum and post-partum disorder
Peri - Last month of gestation or first few months after delivery
Post - Any time after that
Risk factors: Family history of depression, history of depressive episodes, poor marital relationship, low social support, stressful life events following childbirth
- Some more sensitive to rapid changes in reproductive hormones at delivery
Premenstrual dysphoric disorder (PMDD)
Marked affective liability, irritability/anger, depressed mood/anxiety
Loss of interest in activities, lower concentration, low energy, changes in appetite/sleep, feelings of loss of control, physical symptoms
- Need 5 symptoms
SSRIs and birth control medications (containing novel prostegins) useful to suppress ovarian cyclicity
Sidney Blatt and David Zuroff
Dependency and self-criticism
(Depression)
Rely excessively on interpersonal relationships for sense of identity
- Excessively needy, fears abandonment, feeling helpless in relationships
Prone to fears of failure, self-blame, inferiority, and guilt
Aaron Beck
Cognitive distortions
Cognitive triad, schemas
Diathesis-stress model
More likely to appraise situations negatively
- All-or-nothing thinking
- Overgeneralizations
- Magnification/Catastrophizing
- Jumping to conclusions
Schemas (structures in mind) contain beliefs about the self, world, and future (cognitive triad) - More negative in depression
Negative cog schemas remain inactive in mind and act as silent vulnerability factors
- Will trigger after event related to it happens
Dozois and Dobson
Organization of negative and positive schemas in depression
Negative schemas more organized than normal
Positive schemas more diffused
Individuals with bipolar disorder have been shown to display preferential attention to ___ stimuli
Positive stimuli
- Especially cues of rewards or incentive during mania
Negative feedback seeking
Excessive reassurance seeking
Stress generation hypothesis
Tendency to actively seek out criticism and negative feedback from others consistent to their self-schema
Tendency to seek assurance about one’s worth from others regardless of whether it’s already been provided
Depressed individuals tend to contribute to stressful life events because of maladaptive interpersonal behav
Role of serotonin transporter gene (HTT) in depression
Impacts reactivity to stress
- Higher rates of MDD in response to stress for s/s and s/l
Norepinephrine
Serotonin
Dopamine
(Depression)
Low serotonin receptors
- Serotonin theory of depression is not true
Low norepinephrine
- Leads to bipolar and unipolar depression
Dopamine transmission linked to serotonin receptors
- Linked to regulation of reward processing and motor behav
Hypothalamic pituitary adrenal (HPA) axis
(Depression)
Hippocampus inhibits HPA axis releasing cortisol by negative feedback
- Chronic stress caused by sustained release, causing permanent damage to hippocampus and killing brain cells
Support:
- HPA more reactive in females
- Depressed/traumatized adults have smaller hippocampus
- Child abuse causes cell death in hippocampus and amygdala
- Amygdala and cinngulate cortex involved in rumination
Sleep in depression and bipolar disorder
Depression:
- Enter REM earlier (by serotonin receptors and norepinephrine)
BPD:
- Sleep deprivation and events disrupting sleep schedule
Cognitive distortions
Beck’s cognitive model (diathesis-stress model)
1) All or nothing thinking
2) Overgeneralization
3) Magnification/Catastrophizing
4) Jumping to conclusions
Model:
1) Negative view of self
2) Negative view of future
3) Negative view of world
Therapies to treat unipolar depression:
Cognitive behavioural therapy (CBT)
Interpersonal psychotherapy (IPT)
CBT:
- Emphasizes that emotional reactions are caused by thoughts about the situation
IPT:
- Focuses on disruptions that occur in person’s interpersonal world because of depression
- Caused by:
negative feedback seeking
excessive reassurance seeking
stress generation hypothesis (Person causes own problems that cause stress)
