Mood Disorders Flashcards
What are moods?
Emotional “climate” Pervasive and sustained Influence our perception of the world Occurs in a person for a length of time Not as intense as affect
How are mood disorders characterized?
On a continuum
Severity
Duration
=> Maladaptive
How is major depressive disorder diagnosed based on the DSM-5?
Presence of 5 or more symptoms for at least 2 weeks
Note: Depressed mood or loss of interest and pleasure must be 1 of the 5 symptoms
What are the symptoms of depression?
Sad, depressed mood, most of the day, nearly every day
Loss of interest and pleasure in usual activities (ex. sex)
Difficulties in sleeping
Shift in activity level
Changes in appetite and weight
Loss of energy, great fatigue
Feeling worthless/excessive guilt
Difficulty in concentrating
Recurrent thoughts of death or suicide
Somatic symptoms with no apparent physical basis
Negative self-concept, self-reproach and self-blame
What are the specifiers for major depressive disorder?
Melancholic features Atypical features Psychotic features Catatonic features Seasonal pattern (Seasonal Affective Disorder) With postpartum onset Mixed episode Rapid cycling
What are the characteristics of melancholic features?
Pervasive anhedonia (no joy) Don’t feel better even when pleasant or good things happen Significant appetite and weight loss Depression worse in the morning Early morning awakenings Psychomotor retardation or agitation Inappropriate or excessive guilt
What are the characteristics of atypical features?
Mood reactivity – positive events Weight gain or increased appetite Hypersomnia Physically burdened - paralysis Sensitivity to interpersonal rejection
What are the characteristics of psychotic features?
Delusions (false beliefs)
Hallucinations (false sensory perceptions)
Mood congruent (e.g., internal organs rotten)
More likely to suffer from melancholia
Poor prognosis
What are the characteristics of catatonic features?
Motoric immobility or purposeless movement
Physical rigidity
Echolalia (repeat what they hear)
Posturing – sit hunched, away from world, sometimes bizarre statue like poses
What are the characteristics of Seasonal Affective Disorder (SAD)?
MDD with seasonal pattern
At least 2 MDEs in past 2 yrs occurring at the same time of the year (mostly winter)
No non-seasonal episode in past 2 years
More seasonal than non-seasonal lifetime episodes
What are the characteristics of Postpartum depression?
MDE with postpartum onset
Onset of MDE within 4 wks after childbirth
Impact of maternal depression on children
Different from “postpartum blues”:
mother is emotionally labile, irritable, but does not meet criteria for MDD
occurs in 50-70% of new mothers (not MDD)
What are the characteristics of Dysthymic Disorder?
Low grade depression
Depressed mood most of the day, more days than not, for at least 2 years. Never without symptoms more than 2 months at a time.
No Major Depressive Episode during the first 2 years
Significant distress or impaired functioning
Not due to substance or general medical condition
Two (or more) of the following:
Appetite disturbance
Sleep disturbance
Low energy or fatigue
Low self-esteem
Diminished concentration
Feelings of hopelessness
What is double depression?
When a MDE occurs on top of dysthymia
What is the danger with the reoccurence of depression?
Each MDE increases the risk of a subsequent episode. After:
1 episode – 50-60% will have another
2 episodes – 70% will have another
3 episodes – 90% will have another
With each subsequent MDE, the length of time to recurrence is shortened
What is the diathesis stress model for depression?
Depressive episodes often follow stressful life events
Not everyone becomes depressed following stressful life events.
Some are possibly biologically predisposed
What is the cognitive model for depression?
Cognitive diathesis: latent dysfunctional cognitive patterns (e.g., self-schemas)
Models differ in how the cognitive diathesis is conceptualized
Stress: broadly defined – severe life events, sad mood
Cognitive models of vulnerability to depression.
Beck’s negative triad
Response styles theory
Hopelessness theory
What is Beck’s theory of depression?
Negative triad: Self, World, Future
Negative schemata develop in childhood
Information-processing, Memory and Attentional biases:
Depression is not associated with greater initial orientation toward negative stimuli
Depression is associated with difficulties in disengaging attention from negative material: Inhibitory dysfunction
Inhibitory dysfunction linked to rumination.
What is the response styles theory of depression?
The way a person responds to a negative mood can have an impact on the severity and/or duration of depression symptoms.
Rumination:
Passively focusing one’s attention on a negative emotional state, and thinking repetitively about the causes, meanings and consequences of that state.
Depressed individuals tend to ruminate more than non-depressed individuals when in a negative mood.
What is the hopelessness theory of depression? (Based on Seligman’s theory of learned helplessness)
An individual’s passivity and sense of being unable to act and control his or her own life is acquired though unpleasant experiences and traumas that the individual tried unsuccessfully to control.
Depressogenic attributional style: negative events due to causes that are:
Internal – “It’s all my fault”
Stable – “I’ll always be this way”
Global – “I’m a total loser”
Now thought to explain only “hopelessness depression”
Depressive paradox: Feeling helpless yet blaming oneself
Depressive predictive certainty: Perceived probability of the future occurrence of negative events becomes certain
What are the biological theory for depression?
Heritability
Neurobiological dysfunction
Neuroendocrine system
Potential gene candidate: promoter of the serotonin transporter gene (5-HTT)
Lowered sensitivity of serotonine receptors makes some individuals more vulnerable to depression.
What is the Monamine theory of depression?
Depression once thought to be caused by low levels of:
Norepinephrine
Dopamine
Serotonin
Not supported by empirical research: more complex.
What clues for theories of depression are based on drug effectiveness ?
Tricyclic drugs prevent some of the reuptake of norepinephrine, serotonin, and/or dopamine by the presynaptic neuron after it has fired. Monoamine oxidase (MAO) inhibitors keep the enzyme monoamine oxidase from deactivating neurotransmitters therefore increase the levels of serotonin, norepinephrine, and/or dopamine in the synapse. Selective serotonin reuptake inhibitors inhibit the reuptake of serotonin
