Mood Disorders Flashcards
Major depressive episode (MDE)
2 week period marked by depressed mood every day, loss of interest or pleasure, physical/behavioral symptoms, and cognitive symptoms
Either depressed mood or loss of pleasure must be present
Anhedonia
Loss of interest or pleasure
No longer finding enjoyment in favorite activities
Physical/behavioral symptoms of MDE
Weight loss/gain or disturbed appetite
Insomnia or hypersomnia
Psychomotor agitation or retardation (slowing down of psychological and motor functioning)
Fatigue/loss of energy
Cognitive symptoms of MDE
Feelings of worthlessness or excessive guilt
Concentration difficulties
Hopelessness
Recurrent thoughts of death or suicide
Manic episode
1 week period (shorter if hospitalized) marked by 3 of following: Inflated self-esteem or grandiosity Decreased need for sleep Talkativeness Flight of ideas Distractibility Increased goal directed behavior (not increase in productivity- can't focus on details) Reckless, risk taking behavior
Hypomanic episode
4 day period marked by elevated, expansive, or irritable mood and increased goal-directed behavior (same symptoms as manic episode, but less severe)
No impairment present
Major depressive disorder (MDD) description
1 or more MDE
No manic episodes or hypomanic episodes
Usually recurrent episodes, but can exist with only 1 episode
Bipolar I disorder
1 or more manic episode
MDE and hypomanic episode not required
Bipolar II disorder
1 or more MDE and hypomanic episode
No manic episode
Fluctuation from high to low
Not so high that it’s impairing
MDD epidemiology
17% lifetime prevalence (one of most common disorders)
2:1 female to male
Age of onset: usually 20’s, but can occur in retirement age
Course: episodic (average episode 4-9 months and 80-90% experience subsequent episodes)
Problem with treating MDD
Because disorder is episodic, it’s hard to tell if treatment caused end of episode or if episode just ended on its own
MDD specifiers
Psychotic features (delusions and hallucinations) Peripartum onset (after childbirth) Seasonal pattern (winter: lack of sunshine)
Delusion
Thoughts with no basis in reality
Hallucination
Sensory experience without stimuli
MDD biological causes/contributors
Genetic vulnerability (~50%)
Low levels of serotonin in relation to other neurotransmitters
HPA
Increased REM sleep (contributor; don’t know why this happens)
Higher activity on right side of brain than left
Highly comorbid with other disorders, especially anxiety disorders
Life stressors that can lead to MDD
Marital distress
Life changes/stresses: school, death, losing job, holidays, etc.
Lack of social support
MDD psychological causes/contributors
Learned helplessness ("I don't have any way to get out of this, so why even try?")
Lack of reinforcement from environment (putting forth an effort doesn't change anything)
Maladaptive beliefs ("I am worthless" or "I am unlovable")
Cognitive triad (negative beliefs about self, present, and future)Medications used to treat MDD
Tricyclic antidepressants
Monoamine oxidase inhibitors (MAOIs): inhibit MAO that breaks down serotonin; seldomly used due to drug interactions
SSRIs and SNRIs
Last ditch effort treatments of MDD
Electroconvulsive therapy (ECT) Transcranial magnetic stimulation
Electroconvulsive therapy (ECT)
Last resort in treating MDD, but highly effective (treats ~70% of untreatable cases)
How it treats depression is unknown
Side effects: short-term memory loss; sometimes nausea, dizziness, or headaches
Transcranial magnetic stimulation
Last ditch effort treatment of MDD
Magnet directs pulse to brain, stimulating it
Therapeutic techniques used to treat MDD
Behavioral activation: get people out doing fun things Cognitive restructuring: attack defeatist thoughts Interpersonal therapy (IPT): focus on relationships/loss and building new relationships
Combining medicine and therapy in treating MDD
Similar success rates of therapy and meds
Combining treatment is beneficial: decreased recurrence of depressive episodes
Persistant depressive disorder (dysthymia)
Depressed mood lasting at least 2 years (no 2 month period without symptoms)
Similar symptoms to MDD: poor appetite, poor sleep, low energy, low self-esteem, poor concentration, feelings of hopelessness
Long-term low level depression
Bipolar disorders epidemiology
Very small lifetime prevalence: 0.4-1.6% Age of onset: early adulthood (18-22) Equal occurrence in males and females Course: episodic Bipolar II can develop into bipolar I Average 4 episodes occur in 10 years (not daily fluctuations in mood)
Bipolar disorders as severe mental illnesses
Chronic
Unpredictable
Severe impact to individual (in manic state, can behave recklessly and doesn’t seek help)
Bipolar disorders specifiers
Psychotic features
Rapid cycling: more frequent episodes
Bipolar disorders causes and contributors
Vastly unknown
~50% genetic influence
Excess dopamine in manic state (reward system: feeling invincible)
Medications used to treat bipolar disorders
Lithium salts: mood stabilizer; don’t know why they work
Anticonvulsants: used more often than lithium- slightly less increase in suicidality
Medication compliance poor (don’t want to take something that will bring person down from manic state)
Medicating depression can induce manic episode
Therapeutic treatments of bipolar disorders
CBT treats depression, but not mania
Hospitalization is often necessary: protect person from own risky behavior
Cyclothymia
2 years of numerous periods of hypomanic symptoms and depressive symptoms
No MDE, manic episode, or hypomanic episode
No 2 month period without symptoms
Not much is known about disorder
Persistent depressive disorder epidemiology
Age of onset: late 20’s
Course: chronic (average lasts about 5 years)
Equal in males and females
Cyclothymia epidemiology
Very small lifetime prevalence: 0.4%
Course: chronic
Equal occurrence in males and females
Age of onset: adolescence- early adulthood
