Mood Disorders Flashcards
Group of disorders describing the range of depression to mania
Mood disorders
List the DSM-5 TR’s criteria (A-E) for major depressive disorder
Criterion A: significant depressive symptoms
Criterion B: significant distress or impairment in social, occupational, or other important areas of functioning
Criterion C: The episode is not caused by the physiological effects of a substance or medical condition
Criterion D: Not better explained by another disorder
Criterion E: There has never been a manic or hypomanic episode
For criterion A of the DSM-5 TR’s diagnostic criteria for major depressive disorder, which/how many symptoms need to be present in order for a diagnosis to be made?
Five (or more) of the symptoms have been present during the same 2-week period and represent a change from previous functioning
At least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure (anhedonia)
Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
Anhedonia
What are the 9 symptoms of major depressive disorder as identified by criterion A of the DSM-5 TR for this disorder?
Depressed mood most of the day, nearly every day,
Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (anhedonia)
Significant weight loss when not dieting or weight gain
Insomnia (limited sleeping) or hypersomnia (oversleeping) nearly every day.
Psychomotor agitation or retardation nearly every day
Fatigue or loss of energy nearly every day.
Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day
Diminished ability to think or concentrate, or indecisiveness, nearly every day
Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
What can produce symptoms similar to MDD and as such must be considered when making a diagnosis?
Significant loss/grief
What are two major specifiers with respect to MDD?
Severity (mild, moderate, severe) and single episode vs recurrent
Compare mild, moderate, and severe MDD.
Mild: Few, if any, symptoms in excess of those required to make the diagnosis are present, the intensity of the symptoms is distressing but manageable, and the symptoms result in minor impairment in social or occupational functioning.
Moderate: The number of symptoms, intensity of symptoms, and/or functional impairment are between those specified for “mild” and “severe.”
Severe: The number of symptoms is substantially in excess of that required to make the diagnosis, the intensity of the symptoms is seriously distressing and unmanageable, and the symptoms markedly interfere with social and occupational functioning.
Which factors contribute to someone experiencing recurrent MDD?
Individuals with recurrent major depression usually have a family history of depression, unlike people who experience single episodes
Up to 85% of single-episode cases later experience a second episode
Name and describe three notable “other” MDD specifiers
With seasonal pattern (commonly known as Seasonal Affective Disorder)
With peripartum onset: before or after giving birth
With psychotic features: negative beliefs can become extreme and delusional
List the diagnostic criteria (A-G) for persistent depressive disorder as outlined by the DSM-5 TR.
A. Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years.
B. Presence, while depressed, of two (or more) of the listed symptoms
C. Criteria for major depressive disorder may be continuously present for 2 years.
E-G: no manic symptoms; better explained by another disorder; not explained by medical condition or substances; distress and dysfunction
List the six symptoms of PDD under criterion B of the diagnostic criteria outlined in the DSM-5 TR.
Poor appetite or overeating.
Insomnia or hypersomnia.
Low energy or fatigue.
Low self-esteem.
Poor concentration or difficulty making decisions.
Feelings of hopelessness.
Meeting diagnostic criteria for Major Depressive Disorder AND Persistent Depressive Disorder (happens in about 1/5 of PDD patients)
Double depression
List three reasons as to why the prognosis for PDD is often worse than MDD
Higher rates of comorbidity with other mental disorders
Are less responsive to treatment
Show a slower rate of improvement over time
Appropriate sadness that re-emerges around key dates, triggers, in addition to ability to remember positives and accept the finality of the loss
Integrated grief
Debilitating grief that lasts longer than culturally expected and interferes with functioning
Complicated grief
Not a formal mood disorder, newly added to the DSM-5 under Trauma and Related disorders
Prolonged grief disorder
Approximately what percent of the global population will experience MDD at some point in their life?
16%
What gender differences exist concerning the prevalence of mood disorders?
Women are about twice as likely to have mood disorders as men; Men are more likely to commit suicide
What is the average age of onset of depression?
25 (Risk increases dramatically during adolescence)
What is the average duration of the first episode of untreated MDD?
Two to nine months
What is the median duration of an episode of PDD?
Approximately five years in adult (can last as long as 30 years)
Name three biological factors that could contribute to the onset of depression
Genes (e.g. serotonin transporter)
Sleep and circadian rhythms
Hormonal system (e.g. hypothyroidism)
List five psychosocial factors that could contribute to the onset of depression
Life stressors (e.g., poverty)
Developmental: transitions to new stages of life
Relationship issues (e.g., divorce, bullying, abuse)
Negative cognitive styles
Social isolation: the risk of depression for people who live alone is almost 80% higher than for people who live with others
Describe the stepped-care approach to treating depression
Triaging system: How much support does this person need?
Steps:
1. All known and suspected presentations of depression
2. Persistent subthreshold depressive symptoms (mild to moderate)
3. Persistent subthreshold depressive symptoms or mild to moderate depression with inadequate response to initial interventions (moderate and severe)
4. Severe and complex depression; risk to life; severe self-neglect
What are the three key techniques used in cognitive behavioural therapy?
Behavioural activation: Action before motivation
Cognitive restructuring: Challenging negative thinking patterns
Behavioural experiments: Testing negative beliefs
Anything that provides a sense of joy (e.g. seeing friends, going to the movies) (CBT)
Pleasure activities
Anything that provides a sense of accomplishment (e.g. doing chores, working out, going to work) (CBT)
Mastery activities
Name and describe four “thinking traps” common to depression (CBT)
All-or-nothing thinking: “I’m either a failure or a success”
Discounting the positive: ignoring the positives in a situation or minimizing them
Negative filter: only attending to the negative information
Mindreading: assuming what others are thinking
Form of therapy that focuses on the way interpersonal relationships affect mood
Interpersonal psychotherapy (IPT)
According to IPT, what are four relationship issues common in depression?
Role disputes (e.g. in a romantic relationship)
Adjusting to the loss of a relationship or loss of a role (e.g. after a serious injury)
Adapting to new relationships (e.g. being single)
Learning the social-emotional skills needed for healthy relationships
What are three types of IPT interventions concerning relationships and depression?
Identifying the key relationships in one’s life (interpersonal inventory)
Identifying the key roles that were in place prior to the loss and after the loss
Finding strategies to maintain interpersonal roles despite the loss
The most commonly prescribed medications for depression are a drug class called…
Selective-serotonin reuptake inhibitors (SSRIs)
How do SSRIs work?
Inhibit the reuptake of serotonin in the presynaptic neuron, increasing the supply of serotonin
What are two common side effects of SSRIs?
Sexual dysfunctions
Gastrointestinal problems
What does current evidence suggest concerning combining treatments for depression?
The current evidence does not suggest that there are significant benefits for combining medications with psychotherapy for depression (which is surprising)
There is strong evidence that both can be effective
The choice between medications and/or therapy should be based on informed client preference
Name three less common treatments for depression
Electro-convulsive therapy
Light therapy
Mindfulness-based cognitive therapy
List the DSM-5 TR criteria (A-D) for a manic episode
A. Distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary).
B. During the period of mood disturbance and increased energy or activity, three (or more) of the listed symptoms (four if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior
C. The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
D. The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment) or another medical condition.
List the seven symptoms under criterion B for a manic/hypomanic episode according to the DSM-5 TR
Inflated self-esteem or grandiosity
Decreased need for sleep
More talkative than usual or pressure to keep talking.
Flight of ideas or subjective experience that thoughts are racing
Distractibility as reported or observed.
Increase in goal-directed activity or psychomotor agitation
Excessive involvement in activities that have a high potential for painful consequences
List the criteria (A, B) for a bipolar I diagnosis according to the DSM-5 TR
A. Criteria have been met for at least one manic episode
B. The occurrence of the manic and major depressive episode(s) is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.
(Depressive symptoms are not required for a Bipolar Disorder I diagnosis)
List the criteria (A-E) for a hypomanic episode according to the DSM-5 TR
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day.
B. During the period of mood disturbance and increased energy and activity, three (or more) of the listed symptoms (same as manic) have persisted (four if the mood is only irritable), represent a noticeable change from usual behavior, and have been present to a significant degree
C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic.
D. The disturbance in mood and the change in functioning are observable by others.
E. The episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization. If there are psychotic features, the episode is, by definition, manic
List the criteria (A-D) for bipolar II disorder as outlined in the DSM-5 TR
A. Criteria have been met for at least one hypomanic episode and at least one major depressive episode.
B. There has never been a manic episode.
C. The occurrence of the hypomanic episode(s) and major depressive episode(s) is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.
D. The symptoms of depression or the unpredictability caused by frequent alternation between periods of depression and hypomania causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
(Past or current hypomanic episode and past or current major depressive episode)
List the four key bipolar specifiers
Rapid cycling
With mixed features
Specify if current episode is hypomanic/manic or depressed
Also: With Anxious Distress, Peripartum Onset, Seasonal Pattern, Melancholic Features
What defines rapid cycling with respect to bipolar disorder?
At least 4 manic or depressive episodes within a year (20-50% of people with bipolar disorder)
There are also cases of ultra-rapid cycle lengths that only last for days to weeks
Ultra-ultra-rapid cycling in cases where cycle lengths are less than 24 hours
Depressive and manic symptoms are experienced simultaneously (bipolar disorder)
Mixed features
Chronic alternation of mood elevation and depression that does not reach the severity of manic or major depressive episodes including numerous periods of subthreshold hypomanic and depressive symptoms (for at least 2 years), in which the criteria for a major depressive, manic, or hypomanic episode have never been met.
Cyclothymic disorder
What is the average age of onset for bipolar disorder?
Average of onset is late adolescence/early adulthood (18 for bipolar I; 22 for bipolar II)
What is the relative frequency of bipolar disorder in the global population?
Relatively rare: 1-2% of global population
True or False: There are gender differences with respect to the prevalence of bipolar disorder
False
Give three reasons as to why bipolar disorder is considered a “serious” mental illness
Shorter life expectancy
Considered more of a “chronic” mental health condition that will likely require management throughout life
A substantial source of the disease burden in bipolar disorder is suicide-related (Between 25% and 60% of individuals with bipolar disorder will attempt suicide at least once in their lives and between 4% and 19% will die by suicide)
Compare the genetic contribution associated with bipolar disorder to that of unipolar depression (MDD)
Slightly higher genetic contributions for bipolar disorders
Provide two examples of acute triggers for manic episodes
Substance use: at least 40% of people with bipolar disorder also have a substance use disorder
Circadian rhythms: Changes in sleep can be a risk factor for triggering manic episodes (e.g. lack of sleep)
Identify three main treatment challenges for bipolar disorder
Identification can be challenging (often seek treatment when they are depressed, not manic)
Different strategies needed for different stages of the disorder
Bipolar is considered a relatively chronic disorder that must be monitored
— and — are frontline treatments for bipolar disorder
Medications, psycho-education
What is the classic medication for bipolar disorder?
Lithium carbonate
What is the percentage of patients with bipolar disorder who respond well to lithium initially?
50 % of bipolar patients respond well to lithium initially, with at least a 50% reduction in manic symptoms
What are some major concerns regarding lithium carbonate?
Has a narrow therapeutic index (the dose required for effective response is close to the dose for toxicity)
Potentially serious side effects (e.g. kidney damage)
Requires regular blood monitoring tests
What is the current most prescribed mood stabilizer for bipolar disorders?
Valproate
What are three “other” types of medications that can be prescribed for bipolar disorder (besides lithium carbonate and Valproate)
Anti-depressants (including SSRIs)
Anti-psychotics (e.g. Seroquel)
Anti-convulsants (e.g. carbamazepine)
What five things does psycho-education involve with respect to bipolar disorders?
Learning about bipolar disorder
Receiving accurate information about the course of the disorder
Learning about the medication possibilities and psychosocial interventions
Support and information for family members
The role of sleep, eating, triggers, substances, and routine in preventing manic and depressive episodes
What four things are associated with psychosocial interventions for bipolar disorders?
Monitoring
Psychotherapy
Relapse prevention
Social work suppory
A plan for slowing down when manic symptoms emerge
Behavioural de-activation
True or False: bipolar disorder is necessary for creative achievement
False
Severe mood symptoms that significantly impact functioning during menstruation, but are minimal or absent the rest of the time
Premenstrual dysphoric disorder
Diagnosis created in response to substantially increased diagnosis rates of childhood bipolar, describes temper outbursts in children (cannot be diagnosed after 19), ot often diagnosed in practice
Disruptive Mood Dysregulation Disorder
Attempt to take one’s own life
Suicidal attempt
Serious thoughts about dying by suicide
Suicidal ideation
The psychological profile of an individual who has died by suicide is reconstructed and examined for clues
Psychological autopsy
