mood disorders Flashcards
what are the five mood disorders?
- major depressive disorder
- bipolar I disorder (manic/mixed episodes)
- bipolar II disorder (major depressive and hypomanic episodes)
- dysthymia (chronic/less severe unipolar depressive)
- cyclothymia (2+ yr between hypomanic and depression)
how do you distinguish between unipolar and bipolar?
polarity; is mania present?
cyclicity; goes between two or one
severity; how many symptoms
duration; how long does it last
symptoms of major depression (how many needed)
at least one of 1-2, and 5/9 in total
-depressed mood
-loss of interest in activities and/or people
-marked insomnia or hypersomnia
-low energy
-increased or decreased appetite leading to weight gain or loss
-psychomotor retardation or agitation
-feelings of worthlessness or guilt
-poor concentration or indecision
-thoughts of death and/or suicide
what is the duration of depression?
symptoms must last 2 weeks at a time (average of 6 months) and cause significant distress or impairment
what is the depression course for MDD single episode and recurrent episode?
single episode; 2 weeks long
recurrent; 2 months in between episodes of 2 weeks
-episodes can last 6-9 months on average to years
-50% experience a second episode
-90% experience recurrent episodes after the second
symptoms of persistent depressive disorder
-persistently low mood that continues for at least 2 years (don’t go without symptoms for >2 months, +2 additional symptoms
-poor appetite or overeating
-insomnia or hypersomnia
-low energy or fatigue
-low self-esteem
-poor concentration or indecision
-feelings of hopelessness
symptoms of hypomania (how many needed?)
A distinct period of persistently abnormally elevated, expansive, or irritable mood, lasting at least 4 days
3 or more of the following symptoms (4 if mood is only irritable)
-inflated self-esteem or grandiosity
-decreased need for sleep
-pressured speech
-flight of ideas
-distractibility
-increase in goal-directed activity or agitation
-excessive involvement in risky activity
symptoms of mania (how many needed?)
A distinct period of abnormally and persistently elevated, expansive, or irritable mood and persistently increased goal-directed activity or energy, lasting at least a week
3 or more of the following symptoms (4 if mood is only irritable)
-inflated self-esteem or grandiosity
-decreased need for sleep
-pressured speech
-flight of ideas
-distractibility
-increase in goal-directed activity or agitation
-excessive involvement in risk
what is bipolar I?
mania + major depression
what is bipolar II?
hypomania + major depression
what is cyclothymia?
hypomania + subthreshold depression over 2 year period
what is seasonal affective disorder?
occur in both unipolar MDD and bipolar, recurrent depressive episodes tied to seasons changing, 11% of MDD patients, 2-3% prevalence
what is peri- and post-partum mood disorder?
peripartum is the last month of gestation of first few months after delivery, postpartum is anytime after delivery/peripartum period, both meet the criteria for major depressive or manic episode
what is premenstrual dysphoric disorder?
marked affective lability, irritability/anger, depressed mood, and/or anxiety, plus additional similar to MDD, significant impairment and during most cycles in a year
what are the four cognitive theories/distortions?
- All or nothing thinking; seeing black-and-white, if you performance falls short of perfect you see yourself as failure
- Overgeneralization; seeing a negative event as a never-ending pattern of defeat using words such as always or never
- Magnification; exaggerate the importance of errors or problems
- Jumping to conclusions; interpret things negatively when there is no definite facts to support your conclusion
what is suicide?
the intentional taking of ones own life
-ideation
-gestures
-attempt
-completed attempt
-self harm
what is the diathesis-stress model?
diathesis (a predisposition or vulnerability) + a stress (environmental) leads to the development of a disorder (higher diathesis, less stress needed)
what are the risk factors for suicide?
-male, culture, and age
-15% of depressed people complete a suicide
-70% suffer from major depression
-alcohol and substance abuse
-schizophrenia
-hereditary
-low serotonin levels
what is anomic suicide?
one’s relationship to society has changed so radically that its values and norms are no longer personally relevant
what is egoistic suicide?
bonds which unite groups weaken and individuality increases, stemming from the absence of social integration
what is altruistic suicide?
bonds between groups are too strong, so individuals sacrifice themselves
what are the three neurotransmitters?
serotonin, norepinephrine, and dopamine
what is serotonin’s function? (5-HT)
functional disturbances, low activity, fewer receptors, activation and disinhibition of some behaviours
what is norepinephrine’s function?
excessive happiness and grandiosity
what is dopamine’s function?
regulation of reward processing and motor behaviour, hyperactivity and psychosis
what happens to the brain with depression?
amygdala (identifies the significance of emotional stimuli) becomes overactive, smaller volumes, inability to disengage from negative information
what happens to the brain with mania?
overactive amygdala, diminished activity in hippocampus and prefrontal cortex (goal setting, planning, and inhibition), and basal ganglia is overactive (reward pathway)
what is the treatment for mood disorders?
-psychological
-pharmacologic
-neurostimulation and neurosurgical
what is cognitive-behavioural therapy?
challenges negative thinking and the resulting behaviours
what is interpersonal therapy?
examines interpersonal disputes, role transitions, grief, interpersonal deficits
what is the function of tricyclic antidepressants?
moa unclear, downregulate norepinephrine and affect serotonin, effects take up to 8 weeks, 50% of patients, 40% discontinue against medical advice, lethal with overdose
what is the function of moa inhibitors?
inhibits the mechanism that breaks down neurotransmitters (synapse longer), downregulates norepinephrine and serotonin, fewer but more severe side effects
what is the function of selective serotonin reuptake inhibitors?
block reuptake, primary treatment, effective for 50-70% of people with depression
what medications treat bipolar disorder?
lithium, anticonvulsants, antipsychotics, and antidepressants (w/ mood stabilizers)
what is lithium’s function?
mood stabilizing salts, dosage to be monitored carefully, high toxicity, 30-60% good response, 70% relapse
what are anticonvusants function?
prescribed alone or with lithium/antipsychotic drugs
what are antipsychotics function?
short-term treatment during an acute manic or depressive episode
what are antidepressants function?
used to treat the depressive phase in bipolar disorder
what is phototherapy?
for seasonal affective disorder. Sad; affects patients during time of low light, phase delayed circadian rhythms, phototherapy resets circadian clock by stimulating sun
what is neurostimulation and neurosurgical treatment?
electroconvulsive therapy, transcranial magnetic stimulation, vagus nerve stimulation, and deep brain stimulation
