Mood Disorders Flashcards
what is major depressive disorder?
five or more depressive symptoms, including sad mood anhedonia, for 2 weeks
what is persistent depressive disorder?
low mood and at least two other symptoms of depression at least half of the time for 2 years
what is premenstrual dysphoric disorder?
mood symptoms in the week before menstruation
what is disruptive mood dysregulation disorder?
severe recurrent temper outbursts and persistent negative mood for at least 1 year beginning before age 10
what is bipolar 1 disorder featured as in the DSM-5-TR?
at least one lifetime manic episode (depressive episodes may/may not occur)
what is bipolar II featured as in the DSM-5-TR?
at least one lifetime hypomanic episode and one major depressive episode. no lifetime manic episode
what is cyclothymia featured as in the DSM-5-TR?
recurrent mood changes from high to low for at least 2 years, without hypomanic or depressive episodes
what is the lifetime prevalence for MDD and depression?
16.2% MDD (5-20%)
5% depression more than 2 years
what are the gender differences in the epidemiology of depression?
twice as common in women as in men 2:1
three times as common among people in poverty
what is the age onset for depression?
early 20s, decreased over past 50 years
what is the co-morbidity of depression?
5-30% with MDD experience PDD
60% of those with MDD will also meet criteria for anxiety disorder at some point
can you give 9 symptoms for depression?
anhedonia
guilt
grief
feeling worthless
loss of sexual desire
psychomotor retardation (slowed mental and physical activities)
psychomotor agitation
neglect of personal hygiene
self-injury, suicide
the DSM-5-TR states that to meet criteria for MDD, at least 5 symptoms out of 9 must be total. What are they?
- depressed mood for most of the day and/or
- diminished/loss of interest/pleasure
- weight change (not dieting or other medical reasons)
- insomnia/hypersomnia nearly every day
- shift in activity level - lethargic (psychomotor agitation or retardation)
- loss of energy, fatigue
- negative self-concept, feeling of worthlessness, guilt
- difficulty concentrating, decision problems, suicidal thoughts
- recurrent thoughts of death, suicidal ideation
the DSM-5-TR states that ‘symptoms are present…’
symptoms are present:
nearly every day
most of the day
for at least two weeks
what other 4 criteria (not symptom based) does the DSM-5-TR state for MDD?
B. significant impairment in functioning
C. not due to substances, medical conditions
D. not due to other psychological conditions
E. no manic/hypomanic episode
what is the timeline of episodic MDD?
single episode, up to 5 months, symptoms dissipate over time
what is the timeline for recurrent MDD?
once depression occurs, future episodes likely
15% persistent depressive symptoms
50% at least one additional episode
what is seasonal affective disorder (SAD)?
winter blues, latitude interacts with genetics (melatonin)
what is the DSM-5-TR criteria for PDD? (6)
depressed mood for at least 2 years (1 year children/adolescents)
PLUS 2 OTHER SYMPTOMS
poor appetite or overeating
sleeping too much/too little
low energy
poor self-esteem
trouble concentrating or making decisions
feelings of hopelessness
symptoms do not clear for more than 2 months at a time
bipolar disorders are not present
what is the DSM-5 dx criteria of manic/hypomanic episodes? (7)
elavated or irritable mood
PLUS THREE ADDITIONAL SYMPTOMS, 4 IF MOOD IS IRRITABLE
increased activity level (social, work, sexual)
talkative, rapid speech
thoughts racing
decreased need of sleep
inflated self-esteem, belief that special abilities/talents
distractibility: attention easily distracted
involvement in pleasurable activities with undesirable consequence
what is cyclothymia?
milder, chronic form of bipolar disorder, symptoms last at least 2 years in adults, 1 year child and adolescents
symptoms do not clear for more than 2 months at a time
symptoms cause significant distress or impairment
can you explain 5-HTT polymorphism and what mood disorder this impacts?
serotonin transporter gene (5-HTT)
short allele combination of the 5-HTT gene AND childhood maltreatment or adulthood stressful life events increased risk of MDD
could you tell me about dopamine and its interaction with BD and MDD?
overly sensitive in BD
but lack sensitivity in MDD
what risks does levels of noradrenaline have?
low levels leads to depression
high levels lead to mania
what risk does levels of serotonin have?
low levels of serotonin leads to MDD depressive symptoms
what are is the main functional brain abnormality in mood disorders?
abnormal activity in (and connectivity between) emotion and reward centres:
- amygdala is oversensitive to negative stimuli and decreased cortical emotion regulation processes, out of control
can you explain neuroanatomical changes in the limbic system with mood disorders?
amygdala: increased activation - increased sensitivity to negative stimuli
hippocampus : decreased activation (along with DL-PFC) - emotion regulatory processes
can you explain neuroanatomical changes in the neocortical system of people with mood disorders?
emotional regulation
increased activation of the (anterior) cingulate cortex
DLPFC: decreased activity
what system is overactive in depression?
the hypothalamo-pituatary-adrenocotrical system
what brain region is affected in depressed and what does this have a result of?
amygdala - HPA axis - elevated cortisol
the level of cortisol (hormone) is high in depression. what does this do? (4)
exhausts the body
causes enlargement of the adrenal glands
lowers the density of serotonergic rec
cortisol depletes dopamine
what is the interpersonal theory of depression (Coyne, 1976)
people with depression act in a way that elicit negative reactions from others, unsure which is cause/consequence
what is Aaron Beck’s (1967) theory of depression?
cognitive theory: depressed people’s thinking biased toward negative interpretation
unsure of cause/consequence, depressed mood elevates negative schemas
what is the hopelessness theory (Abramson et al. 1989)?
the desirable outcome won’t occur and the undesirable will: attributions + low self esteem + neg life events contribute to depression
negative event that one foresees causes anxiety.
A treatment of MDD is MAOIs, what is this?
medication that reduce synaptic breakdown of serotonin, norepinephrine and dopamine
TCAs are a treatment of MDD, what is it?
Tricyclic antidepressants: block reuptake of mainly serotonin and norepinephrine (SSRIs and SNRIs)
what is the Pfeiffer spectrum of suicide behaviour?
- nonsuicidal
- suicidal ideation
- suicidal threat
- mild attempt
- severe attempt
