Mood Disorders Flashcards
What defines a mood in the context of mood disorders?
A mood is a pervasive and sustained emotional response. Within individuals, it represents a change from their usual state.
Describe mania
elevated mood and inflated self-esteem: marking the “ups” in mood disorders.
What is hypomania?
A clinical expression of increased energy that has less severe features than mania.
Define euphoria.
An intense feeling of well-being, excitement, and over-optimism without any obstacles to one’s goals.
What does euthymia refer to?
A ‘normal’ mood, neither depressed nor elevated.
What is dysphoria/dysthymia?
It’s the experience of an unpleasant (usually low) mood that, when worsened, can lead to depressed mood.
What distinguishes depression from normal sadness?
Depression is pervasive and persistent relative to ‘normal’ sadness.
Mood change may occur without a precipitating event or it may appear disproportionate for the circumstances.
Depression is usually accompanied by cognitive, somatic, and behavioural signs that impair functioning.
Mood change is not enough to warrant a diagnosis.
Mood Disorders impact 4 domains; emotional, cognitive, somatic, and behavioural/affective.
What are some emotional impacts?
Dysphoria/Euphoria (and associated mood extremes)
Mood Disorders impact 4 domains; emotional, cognitive, somatic, and behavioural/affective.
What are some Cognitive impacts?
Abilities - disturbed concentration
Appraisals;
a. grandiosity and inflated self-esteem
b. depressive/’negative’ triad: hopeless view of self, environment, future
Thinking processes can change
Mood Disorders impact 4 domains; emotional, cognitive, somatic, and behavioural/affective.
What are some Somatic impacts?
Fatigue
changes in energy levels, appetite, and sleep
pain threshold is lowered/increased
Mood Disorders impact 4 domains; emotional, cognitive, somatic, and behavioural/affective.
What are some Behavioural/Affective impacts?
Psychomotor slowing versus agitation; limited behaviours vs. careless activities
Might be symptomatic or emblematic of the affective state
The amount of behaviour and how it manifests can be an indicator of the internal state.
What does the relationship between mood and affective disorders in the DSM-5 tell us? why would this be important?
There are some symptom overlaps between depressive disorders and bipolar disorders, meaning they are related in some way. This could be important when doing a differential diagnosis.
What is the common feature across all of the depressive disorders and how do they differ?
note. This is all of the depressive disorders in the DSM-5 chapter
Presence of sad, empty or irritable mood, accompanied by somatic and cognitive changes.
What differs is their duration, timing, severity, and presumed aetiology.
The DSM-5 introduced some new changes into the categorisation of mood disorders in the new publication. What two new disorders were introduced, and why were they controversial?
- Disruptive Mood Dysregulation Disorder
- Premenstrual Dysphoric Disorder
Both disorders are considered controversial due to over-pathologising and over-medicalisation of behaviour and hormonal responses that could be a part of normal developmental or biological processes.
Alongside MDD, what was the other disorder that was included alongside it? what was the difference between MDD and this added disorder?
Major Depressive Episode
MDE rarely occurs on its own so was included with MDD, the difference between these two is MDD has recurrent episodes.
What was dysthymia renamed to in the DSM-5?
Persistent Depressive Disorder
The DSM-5 added the “catch-all” category for depressive disorders, whereby the primary impairment for mood disorders is present however considered secondary. What are the three reasons a mood disorder may be considered secondary as categorised by the DSM-5?
- Another medical condition, or
- Substance or medication induced, or
- We cannot tell how to specify the disorder
How does the DSM-5 categorise disorders that it cannot label yet? use the mood disorders as an example.
It categorises it as, not-otherwise-specified (NOS)
Thus, the mood disorder example would be depressive disorder NOS
The DSM-5 added “unspecified mood disorder”, when would you apply this diagnosis?
When the presentation does not meet criteria for any specific mood disorder and when it is difficult to choose between unspecified depressive disorder or, depressive disorder NOS and unspecified bipolar disorder, or bipolar NOS.
In terms of the “unspecified mood disorder” diagnosis that was added to the DSM-5, if you were to think critically about this, what might this reveal about categorising and the conceptual thinking of bipolar and depressive disorder?
This diagnosis means that conceptually, bipolar and depressive disorder are related in some way, tat they are not entirely split or divided.
Meaning there is a merged disorder category that tries to capture the full spectrum of presentations we may see clinically.
In criterion A of MDE/MDD, the DSM-5 is trying to categorise the scope of this disorder through a syndrome. How does this criterion capture the primary feature, pervasive and/or sustained mood state, of this disorder?
Every symptom except for symptom 9 has a durational component that attempts to operationalise the primary feature by labelling the symptoms as being “every day” or “nearly every day”.
Thinking about the four domains of an individual that are affected by mood disorders, i.e. emotional, cognitive, behavioural, and somatic.
How is the emotional domain mapped onto the 9 symptoms of MDE/MDD?
Symptom 1: Depressed mood most of the day, nearly every day (subjective or observed)
Symptom 7: Feelings of worthlessness or excessive or inappropriate guilt nearly every day
Symptom 9: Recurrent thoughts of death, suicidal ideation, or suicide attempt
Thinking about the four domains of an individual that are affected by mood disorders, i.e. emotional, cognitive, behavioural, and somatic.
How is the cognitive domain mapped onto the 9 symptoms of MDE/MDD?
Symptom 8: Diminished ability to think or concentrate, or indecisiveness, nearly every day (subjective or observed)
Thinking about the four domains of an individual that are affected by mood disorders, i.e. emotional, cognitive, behavioural, and somatic.
How is the behavioural domain mapped onto the 9 symptoms of MDE/MDD?
Symptom 2: Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (observable through behavior)
Symptom 5: Psychomotor agitation or retardation nearly every day (observable)
Thinking about the four domains of an individual that are affected by mood disorders, i.e. emotional, cognitive, behavioural, and somatic.
How is the somatic domain mapped onto the 9 symptoms of MDE/MDD?
Symptom 3: Significant weight loss or weight gain, or changes in appetite nearly every day
Symptom 4: Insomnia or hypersomnia nearly every day
Symptom 6: Fatigue or loss of energy nearly every day
Bereavement has been a
contentious experience to classify within the DSM’s. What is stated about this experience in the DSM-5? and how does it relate to the mood disorder of MDE/MDD?
Bereavement may induce great suffering, however this does not typically result in MDE/MDD. However, it may co-occur with the disorder meaning if the diagnostic criteria is met it can be treated with anti-depressant medication.
In terms of thinking critically about the DSM-5’s classification system and the polythetic approach to diagnosis. What could this mean when diagnosticians or clinicians are trying to apply symptoms to an individuals experience?
Use MDD as an example and think about commonality of language which the DSM-5 tries to adhere to.
To diagnose someone with MDD they need ≥ 5 of 9 symptoms, two of which must be symptom 1 and 2.
The polythetic approach means that diagnosticians or clinicians may have different ideas, language, or understanding when applying the symptoms to an individuals experience. This also brings in complexities for reification.
The DSM-5-TR added prolonged grief disorder, however not as a mood disorder. How was grief categorised and what does this mean for pathology?
This disorder was added as a trauma and stressor related disorder rather than a mood disorder.
This brought up issues for over-pathologysing regular human experiences.
Persistent depressive disorder is considered a chronic disorder with a mild presentation, what is the period of time, and how many symptoms are needed to qualify for this diagnosis?
It is a period of 2 or more years, where depressed mood is exhibited for most of the day more days than not.
An individual must have 2 or greater of any 6 symptoms.
When would you NOT diagnose persistent depressive disorder?
- When symptoms are absent for more than 2 months at a time during the 2-year period.
- If at any time during the first 2 years MDE/MDD criterion is met.
- The presence of a manic episode
What is the difference between MDE/MDD and persistent depressive disorder?
The duration of PDD is longer, and the symptoms are more mild than MDD.
In terms of the polythetic approach to the DSM-5, a criticism has been of the differences in language across diagnosticians. In what case would the polythetic symptom approach be sensitive to ones experience?
Use MDD as an example.
Cultural Factors
Cultural presentations or notions of depression across the four domains could be represented differently than the western perspectives. Therefore, the polythetic approach might be helpful to understand the nuance of cultural presentations and how these conditions are experienced or expressed.
In cross-cultural considerations of MDD, the prevalence, risk factors, and greater somatic symptoms in some cultures may be different. What are some examples of symptoms of MDD in Chinese culture compared to Western culture according to the findings of Kleinman (2004).
Chinese:
Boredom, discomfort, feelings of inner pressure, pain, dizziness, and fatigue
West:
Crying, feeling sad or down, fatigue/decreased energy, change in appetite and sleep, loss of pleasure.
What are the features of disruptive mood dysregulation disorder?
Diagnosed in children
Chronic, severe, persistent irritability and frequent episodes of extremely out-of-control behaviour
What are the features of premenstrual dysphoric disorder?
Severe from of PMS, characterised by mood lability, irritability, dysphoria, anxiety, difficulty concentrating, changes in appetite, sleep, and pain.
This is a disorder that needed further clinical utility and research.
In terms of the DSM-5 controversy around disruptive mood disorder, what did Allen Frances (a former task force operative of the DSM) say about this disorders inclusion in the DSM?
- Turns temper tantrum’s into a mental disorder
- Exacerbates the inappropriate use of medicalisation in young children.
- Could result in a new fad that over-medicalises a child’s experience
What did Allen Frances say about the inclusion of bereavement in the MDE/MDD diagnostic criterion?
- Normal grief will become MDD
- Medicalising and trivialising our necessary emotional reactions to loss
- Pills and superficial medical rituals will be the substitute for deep consolations and resiliency
What is Wakefield and colleagues (2007) counterpoint to Allen France’s view about bereavement?
Bereavement-triggered depression and depression triggered by loss were very similar on eight of nine symptoms of depression. The assumption that any depressive response to the loss of a loved one is “normal” could lead to delays in receiving needed treatment.
There is no “special” category for bereavement in MDD, this may have concerns for considering bereavement as MDD, what is the major difference between this type of loss and the depressive disorder?
People who are bereaving a loss are not at an elevated risk of major depression occurring later in life like people who have the disorder or episodes are.
What is the primary impairment in bipolar disorder?
it involves changes in mood however with a manic or hypomanic component.
What is the primary feature and the severity of bipolar 1?
Key Feature: At least one full manic episode, which involves elevated, expansive, or irritable mood with increased energy that lasts for at least 7 days, or requires hospitalization.
Severity: Manic episodes are more severe and can cause significant impairment in daily functioning, often leading to hospitalization.
What is the primary feature and severity of bipolar 2?
Key Feature: At least one episode of hypomania (a less severe form of mania) and one major depressive episode.
Severity: Hypomania does not cause as much impairment as full mania and does not require hospitalization, but the depressive episodes are severe.
What is the primary feature and severity of cyclothymia?
Key Feature: Chronic mood fluctuations involving periods of hypomanic and depressive symptoms that are not severe enough to meet the criteria for a full hypomanic episode or major depressive episode.
Duration: Symptoms must persist for at least 2 years (1 year in children/adolescents).
Severity: Less severe than Bipolar I or II but can still cause disruptions in daily life due to constant mood swings.
What is the primary feature and severity of hypomania?
Key Feature: A milder form of mania, lasting at least 4 days. Symptoms include elevated mood, increased activity, and energy but without major impairment in functioning.
Severity: Less intense than full mania, no psychosis, and usually no need for hospitalization. It is common in Bipolar II.
There is also a “catch all” category for bipolar similar to the depressive disorders. what does this include?
Bipolar NOS
Symptoms due to another medical condition
Symptoms due to substance or medication induced
For someone to be considered to have a manic episode diagnosis, what are the primary behavioural signs needed to support this hypothesis?
Abnormality and persistently elevated, expansive, or irritable mood and increased goal-directed activity/energy for AT LEAST a week.
Sufficiently severe symptoms to cause marked impairment in functioning
What are the similarities between and the major difference of a manic episode and a hypomanic episode?
The symptoms are the same in both experiences.
Differences:
1. Mania lasts at least a week, hypomania is over at least 4 consecutive days
- In hypomania, there is a change in function however not severe enough to cause ‘marked impairment’ like mania.
What are the four key features of cyclothymic disorder?
- Chronic, fluctuating mood disturbance for 2 or more years
- Numerous periods of hypomanic and depressive symptoms (not enough to meet criteria for episodes)
- Never symptom free for more than 2 months
- Onset usually in adolescence or early adulthood
Specifiers exist all across the disorders in the DSM-5, what do “specifiers” allow us to understand about disorders?
They help us convey something more about the diagnosis and the presentation, the additional features that allow us to add more richness to the characterisation.
Related to reification, how could this concept guide a critique of the DSM-5’s reliance on the categorical system? how might the categorical system and criteria misrepresent ones experiences?
The categorisation of symptoms is the DSM-5 attempting to operationalise a state that exists irrespective of the syndrome or list.
The criteria are mistakenly taken for the condition, however they merely describe it. Therefore, the qualitative experience of an individual is greater than the DSM-5’s parts.
In terms of course and outcomes for depressive disorders, what are some at a glance statistics about the disorders?
They are alarmingly common, women are more likely to be diagnosed, and the typical age of onset is around early 30s, with 5 to 6 lifetime episodes.
In terms of treatment phases of DD people usually begin with euthymia (normal mood) and progress through phases of the clinical presentation of the disorder. What are the phases called and what is typically associated with each phase?
- Acute phase (6 - 12 weeks)
Response to treatment, achievement of euthymia and then a relapse - Continuation phase ( 4 - 9 months)
Usually begins with remission and around 9 months post treatment there is a relapse - Maintenance phase (equal to or greater than 1 year)
Usually begins with recovery however a recurrence of clinical symptoms is likely
Because there is a high amount of DD in the population, what is something we need to consider alongside this disorder when making a differential? what else is common and what are the risks of recurrence after each episode?
Comorbidity with other pathologies like anxiety, and substance abuse.
1st episode: 50% recurrence
2nd episode: 70% recurrence
3rd episode: 90% recurrence
What are some at a glance statistics for the course and outcome for bipolar?
Onset is younger than depression typically between 18 and 22.
Manic or depressive episodes may occur first, with 90% of individuals who have a single manic episode will have further mood episodes.
There are usually more episodes over the lifetime than with depressive disorders.
What percentage of Australians had a lifetime mental disorder, and what percentage had a 12-month mental disorder according to the 2007 National Survey of Mental Health and Wellbeing?
45% had a lifetime mental disorder, and 20% had a 12-month mental disorder.
What are the prevalence rates for anxiety and mood disorders in Australia from the 2007 survey?
Anxiety disorders: 14.4%
PTSD: 6.4%
Affective/Mood disorders: 6.3%
Depressive Episode: 4.1%
Bipolar I/II: 1.8%
What is the economic and societal impact of depression in Australia?
$12.6 billion in costs per year, 6 million working days lost, and 80% of suicides preceded by mood disorders.
What are some of the gender and age differences in mental health conditions according to research?
Women are 2-3 times more vulnerable to depression.
Bipolar disorder has an almost equal gender ratio, but women are at higher risk for Bipolar II, hypomania, rapid cycling, and mixed episodes.
What trends suggest that depression will continue to rise as a public health issue?
Younger age of onset
Higher rates among young people
What factors could contribute to an increase in depression diagnoses?
Decrease in stigma leading to more help-seeking
Social trends like major events (e.g., COVID-19)
Expansion and lowering of diagnostic categories in the DSM, as pointed out by Allen Frances.
What life events contribute to the development of depressive disorders?
Interpersonal loss, loss of social roles, feelings of entrapment, humiliation, and defeat, as well as stressful life events.
How do Indigenous peoples face additional social influences in depressive disorders?
Influences like dispossession, cultural genocide, displacement, segregation, and the “stolen generation” can contribute to depression.
What are the key features of cognitive vulnerability in depression i.e. maladaptive schemas?
- Assigning global personal meaning’s to failures
- Overgeneralising conclusions about the self from events
- Drawing arbitrary inferences about self without supporting evidence
- Selective recall of events with consequences
What is the “depressogenic attribution style” in causal attributions of psychological factors related to depressive disorder?
It is when individuals attribute negative events to internal, stable, and global causes, increasing vulnerability to depression.
How do behavioral theories explain the cycle of depression?
Depressed individuals experience less positive reinforcement, leading to reduced behaviour and social engagement, which perpetuates negative feelings.
What are the two common response styles in depressive disorders?
The ruminative style (focusing on negative thoughts) and the distracting style (diverting attention from problems).
What are the common precipitating factors in bipolar disorder?
Schedule-disrupting events (e.g., disrupted sleep/wake patterns) and goal attainment events (surging energy and desperation)
How do social factors influence recovery or relapse in bipolar disorders?
Emotional climate within families and social support can help manage social rhythms and control manic episodes.
What genetic factors are associated with bipolar disorders?
Higher concordance rates in MZ twins compared to DZ twins, with approximately 8-10% of first-degree relatives of someone with Bipolar I developing the condition.
What biological factors are implicated in bipolar disorders?
Dysregulation in the HPA axis, neurotransmitter imbalances (serotonin, norepinephrine, dopamine), sleep disruptions, and anomalies in brain regions like the PFC, basal ganglia, and amygdala.
What are some social approaches used in the treatment of depressive disorders?
Social approaches include meaning-making and the reassessment of life roles.
What is the focus of cognitive therapy in treating depressive disorders?
Cognitive therapy focuses on challenging and changing unhelpful cognitive distortions and behaviours, improving emotional regulation, and developing personal coping strategies that target solving current problems.
How are bipolar disorders typically treated with mod stabilisers and psychotherapy?
Mood stabilisers: lithium carbonate, anticonvulsant medications
Psychotherapy: Cognitive therapy and interpersonal and social rhythm therapy, focusing on stabilising social rhythms and mood
What insights do studies provide on the effectiveness of treatments for depressive disorders?
Treatment effectiveness: Depressive disorders are treatable with high success rates using psychotherapy and pharmacotherapy. Combination therapies often yield the best outcomes.
Network meta-analysis findings: Combination therapies are the most effective and have the highest acceptance rates in treating moderate depression.
What should one understand about suicide risks and interventions?
Recognising suicide risk involves understanding the high-risk groups and the necessity for interventions at multiple levels, such as community and healthcare settings, to effectively address these risks.
What are some “at a glance” statistics of suicide?
(ages, groups, ratios)
Ratio of attempts to completion: adults, 10:1 and adolescents 100:1 (higher risk in adolescents)
Attempts are more frequent in women than men 3.9:1
Suicide rates in older Australians are higher than any other age group.
Rates for young Aboriginal and Torres Strait Islander men is about 40% higher than men in the general population
What is a psychopathological risk factor for suicide?
Depression is the strongest risk factor for attempted or complete suicides; lifetime risk of suicide in people with mood disorders is 19%
Apart from psychopathological factors, what are some other risk factors for suicide?
Recent life events (e.g., ill health, relationship breakdown, death of loved one, other significant losses, social isolation
Previous suicide attempts; communication of intent
Restriction of options; increase burdensomeness and decrease of belongingness (Joiners interpersonal - psychological model) for why people might commit suicide
Regarding some theories of suicide, what are some causes according to Durkheim’s classification and the idea of the social context?
Big social changes, drivers, events, circumstances that can increase rates overtime
sociological perspective and correlate with the data of deaths with suicide. The sociological factors shows a lot of power in the link of suicide.
In terms of the individual factors associated with suicide, what are some psychological factors?
“an attempt to escape from unbearable psychological pain”
Associated with prolonged frustration of psychological needs, social isolation, sense of burden to others AND
The means/ability to enact lethal self-injury
In terms of the individual factors associated with suicide, what are some biological factors?
genetic/neurotransmitter via increased risk of mood or substance use disorders; more directly, by increasing tendency to self-destructive behaviour
What interventions are recommended at the population and individual levels for suicide prevention?
Population level: Implementing gun control and other measures to limit access to lethal means
Individual level: Psychotherapy, treatment of underlying psychopathology, and hospitalisation if needed to prevent access to means.
What are the warning signs that immediate action is needed to prevent a potential suicide?
Note. There is an argument that these lists can add to peoples distress and puts the onus on peoples responsibility.
Immediate action is recommended if someone is threatening to harm themselves or seeking means to commit suicide or talking or writing about death.
Additional signs include hopelessness, rage, recklessness, social withdrawal, anxiety, sleep disturbances, and dramatic mood changes
What is the Integrated Model of Care to Strengthen Older Australian’s Social Connections?
An active area of investigation by the Australian government, this model addresses the specific needs to prevent suicide among older generations through strengthened social connections and community support.
How can suicide intervention for younger adults be optimized?
Traditional suicide education, which may increase depression and anxiety, should be revised to promote emotional well-being, resilience, self-esteem, and coping skills.
Schools and homes should create supportive environments, and young people at risk should be targeted with early interventions.
What are effective suicide prevention strategies for Indigenous Australians?
The implementation of public health programs tailored to the cultural and community-specific needs of Aboriginal communities.
Focus on community approach, connectedness, and cultural heritage as core elements of suicide prevention strategies.
