Mood Disorders Flashcards
Major depressive disorder
- severely depressed mood
- last 2 or more weeks
- feeling of worthlessness and lack of pleasure, lethargy and sleep and appetite disturbances
- significant loss or gain of weight
- agitation or retardation
- insomnia, hypersomnia
Dysthymia (unipolar)
- same cognitive an bodily problems as depression
- less severe
- Last longer (2 yrs or more)
- can function
- poor appetite; insomnia; low self esteem; feelings of hopelessness; poor concentration; can’t make decisions
Double depression
- major depression
- dysthymia
- major periods of major depression
Seasonal affective disorder
- seasonal pattern of depression
- due to reduced levels of light during some seasons
- higher latitudes
Biological factors of depression
- heritability depends on severity
- inc levels of NE and serotonin-linked with depression
- less activity in left prefrontal Cortex (process emotions)
- stroke patients have high incidence of depression
Psychological factors
- helplessness theory
- negative thoughts must precede this disorder
Helplessness theory
Individuals prone to depression automatically attribute neg experiences to causes that are internal, stable and global
- depressive biases in thinking and memory
- Aaron beck
Suicide risk and prevention
- 11th leading cause of death in us 3rd in hs and college
- variety of motives: biological or contagious (werther effect)
- white males: higher risk earlier in life
- black males: higher risk later in life
Bipolar disorder
Unstable emotional condition cycles of high mood (mania) and low mood (depression)
-also includes cyclothymia
Manic episodes
- persistent elevated, expansive or irritable mood
- secrecy need for sleep
- more talkative
- racing thoughts
- attention to irrelevant stimuli
- high potential for painful consequences
- marked impairment always and sometimes psychotic features
Hypo manic episode
- restless, consumed with confidence
- not as prone to gloom following mania
- can cause bursts of creative work
- problem: can lose balance between right amount of energy and too much
- no psychotic features
- no marked impairment
Types of bipolar disorder
- bipolar I: history of manic and depressive episodes
- bipolar II: hypo manic episodes and major depressive episodes
Cyclothymia
-2 yr duration of numerous alternating periods of hypomanic symptoms and depressive symptoms
Bipolar disorder without psychotic features
Mental state can be
-manic episode
-mixed episode
-major depressive episode
The diagnosis is bipolar as long as there’s a history of mania
-ie: if person is depressed and has history of mania, diagnosis will be bipolar disorder, depressed
Mixed episode
- alternating between mood states within an episode
- special case of rapid cycling
Psychotic features
specifier: add to end of diagnosis
presence of psychotic features in mood disorders seen in:
- mood congruent delusions
-hallucinations
-add to bipolar or major depression: so severe it leads to psychotic disorders
Mood congruent delusions
- depressive delusions of worthlessness/repulsion of self
- manic delusions of grandeur
- unlimited power and influence
- delusions match mood: ie depressed, should feel worthless
- ie depressed and have hallucinations that CIA is on roof, that’s consistent with schizophrenia
Hallucinations
Typically auditory
Video-latiffa
- bipolar I
- delusional; scattered, distracted; grandiose; doesn’t sleep
- treatment: medication
Video-psychomotor retardation
- major depressive episode; bipolar I disorder; not psychotic
- understands that she went too far with mania bc now she is depressed
- being dead isn’t much different
- no emotional response
Unipolar vs bipolar
- unipolar: more time in normal state; less oscillation
- bipolar: less time in normal state, oscillating between manic and depressed
Biological component of depression
- twins: 4 times higher rate in monozygotic twins
- medicine targets NE and serotonin to modulate mood
- heritability is 33-45%
- mz accordance: 40%
- dz accordance: 11%
Part of brain affected in depression
-dec activity in left prefrontal cortex and increased activity in right prefrontal cortex
Biological factors in bipolar disorder
- heritability is 40-70%
- NE and serotonin can contribute to roller coaster of emotions
- take lithium to dec symptoms, but don’t know why
- mz accordance: 72%
- dz accordance: 13%
Cause of mood disorders
- diathesis stress model
- not doomed by genes, but they are important
Situational components of mood disorders
- social support-lack of can lead to mood disorder
- downward spiral- caused by negative reactions from others–>isolation
Cognitive components
- Beck’s cognitive triad: negative an irrational views of self, present ad future
- errors in logic: magnify depressive negativity
Treating mood disorders
- psychodynamic approach
- humanistic approach
- cognitive behavioral approach
- eclecticism
Psychodynamic approach
- anger turned inwards
- push role of superego
- insight, expand ego control
- how? Free association, analysis of transference, dream analysis
Behavior learning theory
- positive environment
- change behavioral responses to increase reinforcement of non-depressed behavior
Cognitive and social learning
- emotions and moods are cognitive processes
- depression and moods result from irrational thinking
- use optimism (ABCs)
Seligman’s ABC model (borrowed from Ellis)
Adversity (what we do when we encounter it)
Beliefs (thoughts become beliefs)
Consequences (results, behaviors based on beliefs)
-learn to argue with yourself
-changing pessimism to optimism
-we make ourselves more miserable with our thinking
Beck’s cognitive triad-3 distortions in rational processing
- negative view of self
- negative view of the world
- negative view of the future
Dissociative disorder
- normal cognitive processes are fragmented and disjointed
- significant disruptions in memory, awareness and personality
Cognitive processes in depression
- expectations of uncontrollability-pessimism
- bandura-self-efficacy: low motivation, low expectations, low effort
Dissociative identity disorder
-presence of two or more identities that take control at different times
Goal of treatment in cognitive processes in depression
- explore rationality to alter expectations
- alter behavior to change reinforcement
Dissociative amnesia
- sudden loss of memory for significant personal information
- usually for a traumatic event
Summary of cognitive approaches
- use ABCDE
- appraisal
- belief
- consequence
- dispute
- evaluate
Dissociative fugue
- sudden loss of memory for ones personal history
- abrupt departure from home
- assume new identity
Cycle of sustaining depression
Stressful experience–>negative explanatory style–>depressed mood–>cognitive and behavioral change
Repeat
Biological therapies-drugs
- anti anxiety drugs: GABA
- depression drive: serotonin and NE
- antipsychotic drugs: dopamine
Antidepressant drugs-3 types
1) MAO
2) trycyclins
3) SSRIs
MAO inhibitors
-slow down enzyme breakdown process of NE and serotonin
Trycyclics
- inhibit reuptake of NE
- more side effects
- easier to OD
- work on 60% of medications
Electro convulsive therapy
- can lose memory
- rarely used now
- why does it work, we don’t know
- jump start someone out of depression
Lithium carbonate
- treatment for bipolar disorder
- antimanic properties
- side effects
Adjunctive psychotherapy-bipolar disorser
- medication management
- family and social relations
- education
- reality testing
