mood disorders

Question 1

mood states

Answer 1

• differentiated based on severity and duration
• euthymia: the goal of treatment; living without mood disturbances and achieving baseline again
• feeling sad/upset/grief
• major depressive episode
• dysthymia
• hypomania: extroverted/energetic/intensely emotional people
• mania

Question 2

polarity of mood states

Answer 2

• average length of time for the first major depressive episode is 9 months
• untreated MDE= 4-5 months
• untreated manic episode= 2-6 months but often noted well before then

Question 3

major depressive episode criteria *

Answer 3

• 5 or more symptoms of the 9, during the same two-week period: depressed mood, significantly diminished interest/pleasure in all activities (anhedonia), significant weight loss or gain, insomnia/hypersomnia, psychomotor agitation/retardation, fatigue or loss of energy, feeling worthless/excessively guilty, diminished ability to think or concentrate, recurrent thoughts of death/suicide
• at least one of the symptoms have to be depressed mood or anhendonia

Question 4

major depressive disorder criteria

Answer 4

• one or more MDE
• single episode or recurrent (more than one episode, needs to be at least 2 months symptom free between episodes)
• cannot be a normal response to a significant loss (can still be diagnosed with MDD)
• no history of mania/hypomania
• women are more likely than men
• mean age of onset is early pubery - early twentie

Question 5

persistent depressive disorder (dysthymia) criteria

Answer 5

• depressed mood for most of the day, nearly every day, for 2 years
• additional symptoms (2 or more of the 6): poor appetite, insomnia/hypersomnia, low energy, low self-esteem, poor concentration, feelings of hopelessness
• incredibly chronic
• no history of mania/hypomania
• women are twice as likely as men
• mean age of onset is early adulthood

Question 6

manic episode (mania)

Answer 6

• a week period of significantly elevated, expansive, or irritable mood and significantly increased goal-directed activity or energy
• can have psychosis features
• component of many mood disorders
• if the individual is hospitalized, then they do not need to experience the mania for the full 7 days*

Question 7

mania criteria

Answer 7

• additional symptoms (need 3 of 7):
• inflated self-esteem or grandiosity
• decreased need for sleep
• more talkative than usual or pressure to keep talking
• flight of ideas (racing thoughts)
• distractibility
• increased goal-directed activity or psychomotor agitation (restless)
• excessive involvement in risky behaviours (buying sprees, gambling)

Question 8

hypomania criteria

Answer 8

• 3-7 symptoms
• identical to a manic disorder, except: typically shorter in duration but must last at least 4 days, not severe enough to cause hospitalization*
• no significant impairment in daily functioning, no psychotic features

Question 9

bipolar I disorder

Answer 9

• only one requirement, and it’s mania!
• MDE is not a requirement of BPD I but are very common in it
• highly recurrent, 90% of people who have an episode will have another
• 60% of people will then go on to have a MDE
• equal rates for men and women
• mean age of onset is 18

Question 10

bipolar II disorder

Answer 10

• criteria: has had a hypomanic (low) episode, has had a MDE
• no history of mania
• equal rates for men and women

Question 11

other BPD notes

Answer 11

• people BPD I have more hypOmanic episodes than people with BPD II
• people with BPD II will have more total episodes than people with BPD I
• main issues with treating BPD is that individuals enjoy mania

Question 12

cyclothymic disorder

Answer 12

• 2 year period where individuals are cycling between the highs and lows of BPD
• numerous hypomanic SYMPTOMS, numerous depression SYMPTOMS
• between 15-50% of people will go on to develop BPD I or II
• equal rates for men and women (but women more likely to seek treatment)
• mean age of onset is similar to BPD, early adolescence and early adulthood

Question 13

mood disorder specifiers

Answer 13

• psychotic features: hallucinations/delusions, rare but if present they may predict worse outcomes
• melancholic features: anhedonia, excessive guilt, severe somatic symptoms (weight loss, loss of libido)
• atypical features: overeating/sleeping but no anhedonia
• peripartum: just before or after death
• seasonal pattern: depression/mania associated with a particular season
• rapid cycling: experiencing four episodes of mania, hypomania, or MDE within 12 months

Question 14

biological approaches to mood disorders (genetics)

Answer 14

• tends to run in families, especially in twins
• more recurrent forms of depression and BPD tend to be stronger in families

Question 15

biological approaches to mood disorders (behavioural activation system)

Answer 15

• sensitivity to rewards and motivation
• linked to dopamine
• individuals can have a global reaction to activity happening in the environment (ie. something motivating or rewarding)
• positive emotions and hope

Question 16

biological approaches to mood disorders (neurotransmitters)

Answer 16

• theory*
• low levels of serotonin
• allows NE and dopamine to range wildly

Question 17

biological approaches to mood disorders (sleep)

Answer 17

• sleep disruptions may lead to depression or mania

Question 18

mood disorder medications

Answer 18

• tricyclic antidepressants: increase the amount of NE and serotonin in the synaptic cleft, can be lethal if overdosed
• MAOIs: increase the amount of NE, serotonin and dopamine, lots of dietary precautions (no beer, red wine or cheese) and risks of severe reactions if mixed with other drugs
• SSRIs: increased amount of seretonin
• mood stabilizers: lithium (reduce frequency and intensity of manic episodes), anticonvulsants, prevents and threats manic episodes

Question 19

mood disorder non-pharmaceutical methods (ECT)

Answer 19

• electroconvulsive therapy
• unilateral vs bilateral (unilateral has less side effects than bilateral but less effective)
• shock administered for less than a second, once every other day 6-10 times
• 50% respond
• relapse tends to be common, people go on medication after
• acutely suicidal or depressed with psychosis individuals will be directed straight to this

Question 20

psychological approach to mood disorders (interpersonal psychotherapy)

Answer 20

• etiology: perceived stressful life event triggers onset, stressful relationships worsen the disorder, relationship problems significant factor for women
• for men, depression damages a relationship and for women, its the relationship that causes depression

Question 21

interpersonal psychotherapy treatment of mood disorders

Answer 21

• resolve problems in current relationships and form new important relationships
• tends to be more effective than support groups/psychodynamic therapy/placebo
• 60-70% effective

Question 22

psychological approach to mood disorders (beck’s CBT etiology)

Answer 22

• etiology: percieved stressful life event or automatic thoughts trigger onset
• lack of mastery (ability to accomplish much)
• numerous cognitive distortions (ie. overgeneralization, arbitrary inference [jumping to negative conclusions without evidence], catastrophizing)

Question 23

psychological treatment to mood disorders (beck’s CBT)

Answer 23

• decrease the plausibility and strength of negative thoughts by: behavioural activation (helps people identify the smallest thing they can do, have them do it, and then they gain a sense of mastery to do greater things), identify dysfunctional thinking styles (may use tools like thought record), correct negative thoughts and substitute more realistic thoughts, challenge deeper held schemas

Question 24

CBT treatments for bipolar disorder

Answer 24

• standard CBT for depression symptoms
• decreasing desire for mania
• increasing medical compliance
• find ways to make patient see pros of not being manic

Question 25

family therapy for mood disorders

Answer 25

- decreasing family tension - helps family members understand the disorder

Question 26

combined approaches of mood disorders

Answer 26

- possible advantages: medication may work faster but its debated, IPT improves interpersonal relationships, CBT changes negative thinking styles and prevents relapse - no definitive advantage for combining medication and psychotherapy

Question 27

relapse/recurrence of mood disorders

Answer 27

- most individuals have multiple episodes - 50% of clients who stop their antidepressants relapse within 4 months - CBT generally leads to less relapse: check in sessions, mindfulness based cognitive therapy - combining CBT and meds may bring relapse lower

Question 28

suicide

Answer 28

- women attempt more often - men die more often - theory about these specifics is because men tend to choose more lethal options - other high risk groups: minorities, elderly, teenagers (3rd leading cause of death)

Question 29

risk factors of suicide

Answer 29

- degree of current ideation and planning - previous attempts - hopefulness - depression, comorbid depression - when working with clients, the best predictor for if they're going to harm themselves is asking, which does not increase the risk for suicide