Mood Disorders Flashcards
what are analogue experiments
to study something in a controlled environment
create clinical situations or sympotm manifestation in lab setting
fear conditioning
when induce a specific fear in a healthy subject - to understand physiology and techniques which help to unlearn fear
definition of mood
prolonged emotional state
definition of disorder
a gross deviation in mood from what is considered the normal range
which characteristics of mood disorders determine diagnosis
major depressive, manic, and hyponmanic episodes
major depressive disorder needs how many symptoms
5/9
what are the necessary features for depression diagnosis
present nearly everyday during same 2 week period
represents change from previous functioning
at least one symptoms is depressed mood or loss of interest/pleasure
symptoms of MDD
- depressed mood
- diminished interest/pleasure in almost all activities
- weight/appetite change (weight loss/gain, increase/decrease in appetite)
- sleep disturbance (insomnia, hypersomnia)
- psychomotor agitation (fidgeting) or retardation (slow)
- fatigue or loss of energy
- feelings of worthlessness or excessive guilt
- diminished ability to think/concentrate/indecisive
- recurrent thoughts of death, suicidal ideation, suicide attempts/plans
important feature criteria for all disorders
must cause clinically significant distress/impairment in functioning
departure from normal state
episode is not attributable to effects of substance or other medical condition
clinical judgements which are not in diagnostic criteria
responses to significant loss may include sadness, rumination, insomnia, appetite
persistent depressive disorders (dysthymia) - necessary for diagnosis
depressed mood for most of the day, for more days than not, for at least 2 years (1 year for children and adolescents)
criteria for pDD
- poor appetite or overeating
- insomnia, or hypersomnia
- low energy/fatigue
- low self esteem
- poor concentration or diffculty making decisions
- feelings of hopelessness
how many symptoms of criteria needed for PDD
2 of 6
disruptive mood disregulation disorder
severe recurrent temper outbursts
persistent negative mood (anger, irritability) for at least 1 year before age 10
issues with diagnosis of DMDD
limited evidence base
poor reliability
issues with over diagnosis
only considers behavioural interventions
captures irritability but not mania
what was DMDD designed to reduce
diagnosis of bipolar disorder in children
premenstrual dysphoric disorder and treatment
mood symptoms in week before menses
hormonal treatments (SSRIs used for part of the month)
what is the most popular mental disorder
depression
sex differences in depression
females 2x more likely to get depression
reasons for sex differences in depression
stresses occur in adolescent different for sexes
female puberty more pronounced
social roles
body image
rate of reporting
victims of sexual abuse
age of onset of depression
late teens to early 20s
SES and depression
depression rates 3x higher in low SES
bipolar disorder description
distinct periods of abnormally and persistently elevated, expansive (expression of emotion, feelings of grandiosity and friendly or excuberant) or irritable mood
manic symptoms of bipolar disorder
- increased self esteem; belief one has special powers
- decreased need for sleep
- unusual talkativeness
- flight of ideas (racing thoughts)
- distractibility
- increase in goal directed activity / psychomotor agitation
- excessive involvement in activities with high potential for severe consequences
hypomania
a lesser form of mania
- lasts less time, no psychosis, not significant impaired functioning
how many kinds of bipolar disorder
3
bipolar 1 disorder
at least 1 manic episode in life
often severe MDD episodes but not required for diagnosis
bipolar 2 disorder
at least one MDD episode
at least one hypomanic episode (no lifetime episode of mania)
cyclothymic disorder
for at least 2 years
- numerous period of hypomanic symptoms that do not meet criteria for hypomania
- numerous periods of depressive symptoms that do not meet criteria for MDD
lifetime prevalence of BP
~1%
how many cases of BP onset before 25 y/o
more than 50%
does BP have higher comorbidity and with which ones
~60% have 3 or more comorbidities
substance use most common in BP (40-60%)
subtypes and specifiers for BP
seasonal patterns
rapid cycling forms
psychotic features
mixed features - depression and mania at same time
catatonia
melancholic features - lack of pleasure in anything
atypical features - over/under eating
peripartum onset
anxious distress
aetiology ?
study of causes of disorders
BP and heritability
2x more heritable
estimate of heritability of depression
37%
how do we get estimates of heritability
population studied
twin studies
effect of stress on depression risk
more stress more risk
which neurotransmitters are implicated in aetiology of mood disorders
dopamine
noradrenaline
serotonin
what is the evidence for role of serotonin in disorders
drugs which improve disorder symptoms modulate the activity of serotonin
which brain structures are associated with depression
amgdala, striatum, hippocmapus, frontal cortex, ACC
what is the issue with brain structure aetiology
observations take place after incidence is identified and endured
behaviours and emotion can impact the structure and function of brain
cause and effect cannot be determined
amygdala is responsible for?
emotional experience and assigning emotional relevance to stimuli
findings about the amygdala
increased activity in response to negative stimuli
abnormalities in responsibility of amygdala found in those with familial risk for depression
what is the striatum for
rewward processing and motivation
findings about striatum
reduced activity in ventral striatum may be linked to learning from reward and issues with motivation
increased striatum activity in BP - play role in impulsive behaviours
what happens with HPA axis in prolonged stress states
increased blood pressure
chronic msucle tensions
neurotoxicity and neural atrophy
disturbances in neurotransmitters
increased high cortisol levels risk?
MDD
cortisol responses in MDD and BP
consistent dysregulation in HPA axis
what does increased amygdala reactivity do
triggers HPA axis
why is stress good for the hippocampus
improves functionality
what happens when hippocampus is overactivated with stress
goes into poor functioning and loss of neurons
MDD patients and hippocampus
MDD have smaller hippocampal volumes
cognitive theories and assumption made? of aetiology
bad things happen, but what is important is how we think about them
what is the negative triad
person has negative view of self
negative view of future
negative view of world
what happens when we have negative schemas
influences how we evaluate information
when are schemas activated
when someone encounters as situation similar to the ones which caused the schema to form
when are schemas acquired
in childhood and exacerbated by childhood experiences
what is beck’s theory of schemas
schemas activated by events which influence information processing - cognitive bias
- MDD patients attend to negative informaiton more than positve, schema of world is confirmed and maintained
negative cognitive styles and MDD
negative cognitive styles elevate risk of developing MDD
what is hopelessness theory
idea that good things wont happen and we cannot change this
hopelessness theory and attribution
when something bad happens, we attribute a cause
what we determine as cause is considered correct
hopelessness theory and therapy
to adjust cognitive styles around attributions
hopelessness and MDD
high levels of hopelessness 6x more likely to experience MDD episodes in future
major risk factor for mood disorders
childhood adversity
stress diathesis model
experience of seriosu life event before MDD begins
effect of stressful events
reduce resilience, problems more likely to occur
what is the first line of medication for MDD
antidepressants
SSRIs are
most prescribed
increase level of serotonin available
blocks reuptake
results of antidepressants
37% achieve remission with first antidepressant
around 50% reduction in disorder
30% of people respond to placebo
medications for BP
mood stabilisers
lithium
antipsychotic medications
anticonvulsant
antidepressants
mood stabilsiers
medications for BP reducing manic symptoms
lithium
first line treatment for BP, 80% of BP cases experience mild benefits
lowers excess noradrenaline in manic episodes and triggers serotonin in depressive episodes
antipsychotic medication
given during manic episodes
anticonvulsant medication
given for rapid cycling in BP
antidepressants for BP
given during depressive episodes
issues with lithium as BP medication
must be closely monitored as high levels can be toxic
affects many bodily functions (weight gain, increased thirst, tremors, circulatory problems)
antidepressants in BP patients without lithium
can initiate manic episode
what is ECT
Electroconvulsive therapy
v effective in treating severe depression
why is ECT controversial
used to be done without consent
long side effects of memory loss, impairments in cognitive function
why is ECT used and response rate
effective for treatment resistant depression
- reduces the suicide risk associated with severe depression
70% response rate
psycho-education
helping to understand the symptoms, nature and course of disorders etc
what is CBT
combo of cog and behavioural approaches
key components of CBT
- thoughts, feelings and behaviours are all interconnected and trap individuals in a cycle
- reevaluates negative views or interpretations
- breaks cycle, challenges cognitive beliefs and schemas, feelings of negativity
- develop strategies to think about and deal with problem in more positive way
psychodynamic therapy
focuses on thought pattern existing today rather than from the past
what influences how people view world in a biassed way, and how to overcome
negative automatic thoughts
- understand link between thoughts and emotions, estimate evidence for and against NAT, challenge NAT, and generate more balanced alternative thoughts
combination of psych therapy and medication for MDD?
best approach
improves odd of recovery by 10-20%
why are antidepressants good
offer relief from symptoms quicker
why is therapy good
takes longer but imparts skills they can use after treatment is over - preventative
psychotherapy treatments of BP - methods
concurrent psychosocial and psychotherapy address associated social and psychological problems
psychotherapy for BP - what does it do
improves ability to detect mania
encourages acceptance of illness
improves adherence to drug regimen
enhance ability to cope with stressors
fosters daily routines of sleep
improves communications with family
eliminates drug or alcohol misuse
treatment for disruptive mood dysregulation disorder and what does it do
CBT for anger and disruptive behaviour - relabels perceptions that lead to outbursts, tolerate frustration, coping skills
dialectical behaviour therapy -skills to regulate emotions, targets irritability
medications for disruptive mood dysregulation disorder
antidepressants for irritability and mood
stimulations for irritability
atypical antipsychotic medications for aggression)
