Mood Disorders Flashcards
1
Q
Major Depressive Disorder
A
2 weeks of depressed mood and/or anhedonia plus 4+ or more of the following:
- Weight change
- Sleep disturbance
- Psychomotor agitation/retardation
- Fatigue
- Worthlessness or guilt
- Pxs concentrating
- Thoughts of death/suicide
2
Q
MDD and Grief/Loss
A
- Removal of the bereavement exclusion from DSM-IV (had to be after 2 months of loss of loved one)
- Use clinical judgment to consider MDD in addition to normal response to a significant loss
- In grief, predominant affect is feelings of emptiness and loss while with MDD it is persistent depressed mood and inability to anticipate happiness or pleasure
- Grief also tends to decrease in intensity over time and occur in waves (pangs of grief)
- Depressed mood of an MDE not tied to specific thoughts of the deceased
3
Q
MDD Specifiers
A
- Mild/Moderate/Severe
- In partial remission/in full remission/unspecified
- Single or recurrent episode
- With anxious distress
- With mixed features
- With melancholic features
- With atypical features
- With mood-congruent (or mood-incongruent) psychotic features
- With catatonia
- With peripartum onset
- With seasonal pattern
4
Q
Persistent Depressive Disorder DSM-5 Diagnostic Criteria
A
Depressed mood for at least 2 years plus 2 or more of the following:
- Eating disturbance
- Sleep disturbance
- Fatigue
- Low self-esteem
- Concentrations pxs
- Hopelessness
Never without symptoms for more than 2 months
Used to be called dysthymia
PDD doesn’t include certain MDD symptoms (e.g., weight change, thoughts of suicide) so it’s possible that some people will have depressive symptoms for more than 2 years but not meet criteria for PDD
5
Q
Persistent Depressive Disorder Specifiers
A
- Similar ones to MDD
- Early onset (before age 21) and late onset (after age 21)
- With pure dysthymic syndrome (full criteria for MDD not met)
- With persistent major depressive episode (full criteria for MDD met throughout 2 years)
- With intermittent major depressive episodes, with (or without) current episode
- Mild/Moderate/Severe
6
Q
Premenstrual Dysphoric Disorder
A
During majority of cycles, at least 5 of the following during the final week before menses:
- At least one of following: affective lability/mood swings, irritability/anger, depressed mood/hopelessness, anxiety/tension
- One or more from the following: decreased interest in usual activities, concentration pxs, lethargy, change in appetite, sleep disturbance, sense of being overwhelmed, physical symptoms (e.g., breast tenderness, bloating)
Clinically significant distress/interference with functioning
7
Q
Disruptive Mood Dysregulation Disorder in DSM-5
A
- Added to DSM-5 in attempt to capture the kids who were being misdiagnosed with bipolar disorder due to irritability and anger outbursts etc.
- Evidence suggests sever mood dysregulation (SMD) more associated with later depression and anxiety but not bipolar disorder
- Neurological differences in BD vs SMD
- Some are critical of this new diagnosis
8
Q
DMDD DSM-5 Diagnostic Criteria
A
- Severe temper outbursts that are inconsistent with developmental level
- Outbursts occur more than 3x/week
- Persistent irritability/anger between outbursts
- At least 12-months and in at least 2 settings (home, school, with peers); no period of 3 months or more without symptoms
- 1st time diagnoses between 6 & 18 years, age of onset before 10 years
9
Q
MDD Epidemiology
A
- 2-7% point prevalence; 6-25% lifetime prevalence
- Twice as common in women
- Higher rates among younger age cohorts and low SES
- High recurrence rate
- Age of onset: 20s (but ranges)
10
Q
Double Depression
A
- Major depressive episodes and dysthymic disorder (usually dysthymia first)
- Now called Persistent Depressive Disorder with intermittent MD episodes
- Very common: 75-95%
- Poor prognosis
11
Q
Domains of Depression
A
- Emotional: depressed mood, crying, worthlessness
- Motivational: anhedonia, lethargy
- Behavioral: inactivity, psychomotor retardation
- Cognitive: negative bias, blame internalization
- Physical/somatic: appetite and libido affected, sleep and weight disturbances
- Interpersonal: frequent conflicts, dependence, etc.
12
Q
Mood Disorders and Cultural Factors
A
- Same symptoms, different meanings across cultures
- Western cultures: individuality, autonomy, feel-good society (depression = internal)
- Non-Western cultures: collectivism, connectedness (depression = interpersonal); somatic complaints more common in some non-Western cultures
13
Q
Etiology of Depression
A
- Genetics: family studies, twin studies (MZ 60%, DZ 10%), molecular studies (5HTTLR gene)
- Neurotransmitters (too low): serotonin related to negative emotionality (maybe myth?), norepinephrine related to fatigue, dopamine related to anhedonia
- Hormones: HPA axis & increased cortisol via adrenal gland
- Reduced volume of hippocampus
- Underactivity of Brodman’s Area: implant a pacemaker for the brain that “wakes up” this area
14
Q
Cognitive Theory and Negative Cognitive Triad
A
- Aaron Beck
- Negative automatic thoughts about self, world, and future (overgeneralization)
- Cognitive errors (e.g., all-or-nothing thinking, catastrophizing)
- Negative schemas
- Good research support
15
Q
Rumination
A
- Susan Nolen-Hoeksema
- Person appraises something in negative way and keeps playing it over and over in mind; repetitive nature
- Usually level of truth to the thought
16
Q
Learned Helplessness
A
- Martin Seligman: experiments where shock dogs & they stop trying to change things because they think there’s nothing they can do about it
- Learned helplessness & a depressive attributional/explanatory style (Abramson et al.): internal attribution (personalization; “I caused this”), global attribution (pervasiveness; “I’m bad at everything”), stable attribution (permanence; “It won’t change”)
- —- All three leads to sense of hopelessness
- —- Hopelessness Theory (Lauren Alloy & Lyn Abramson)
17
Q
Interpersonal Theory of Depression
A
- Depressed people elicit rejection from others
- Also low in social skills across situations/settings
- Seek reassurance from others, but reassurance is time-limited
- Poor social skills –> acquire fewer reinforcers (like good friends), court rejection because of irritability and pessimism, gravitate to people who confirm negative self-views –> Increased vulnerability to depression
18
Q
Integrative Model of Depressive Disorders
A
Biological vulnerability –> Psychological vulnerability –> Stressful life events –> Activation of stress hormones, negative attributions/sense of hopelessness/negative schemas, problems in interpersonal relationships –> Mood Disorder
19
Q
Childhood Depression
A
-Similar symptoms as adults but are more likely to include irritability, psychomotor agitation, somatic complaints, vegetative symptoms (e.g., weight loss, loss of appetite, hypersomnia) starting in adolescence
20
Q
DSM-5 Bipolar and Related Disorders
A
- Bipolar I
- Bipolar II
- Cyclothymic disorder
- Substance/medication-induced bipolar disorder
- Bipolar and related disorder due to another medical condition
- Other specified bipolar and related disorder
- Unspecified bipolar and related disorder
21
Q
Bipolar I Disorder DSM-5 Diagnostic Criteria
A
At least one manic episode, which is at least 1 week of elevated/expansive/irritable mood and increased goal-directed activity 3 or more during manic episode: - Inflated self-esteem/grandiosity - Decreased need for sleep - Pressured speech - Flight of ideas - Distractibility - Increase in goal-directed activity - Dangerous/risky behavior
22
Q
Bipolar I Specifiers
A
- Mild/Moderate/Severe
- With anxious distress
- With mixed features (manic episode but also symptoms of depression)
- With rapid cycling (4 mood episodes in past 12 months)
- With melancholic features
- With atypical features
- With mood-(in)congruent psychotic features
- With catatonia
- With peripartum onset
- With seasonal pattern
23
Q
Bipolar II DSM-5 Diagnostic Criteria
A
At least one hypomanic episode, which is at least 4 days of elevated/expansive/irritable mood and increased goal-directed activity. At least one major depressive episode. 3 or more during hypomanic episode: - Inflated self-esteem/grandiosity - Decreased need for sleep - Pressured speech - Flight of ideas - Distractibility - Increase in goal-directed activity - Dangerous behavior Hypomania not severe enough to cause marked impairment or hospitalization, but does lead to a change in functioning
24
Q
Cyclothymic Disorder DSM-5 Diagnostic Criteria
A
- For at least two years (1 year children/adolescents), hypomanic symptoms and depressive symptoms (neither of which meet full criteria for hypomanic or major depressive episodes)
- Hypomanic/depressive periods present at least half the time and not without symptoms for more than 2 months at a time
- Criteria for manic, hypomanic, or major depressive episode have never been met
25
Q
Other Specified Bipolar and Related Disorder
A
- Bipolar symptoms with significant impairment but does not meet full criteria for a specific bipolar disorder
26
Q
Unspecified Bipolar and Related Disorder
A
- Same as other specified except clinician does not indicate reason (also includes presentations with insufficient information)
27
Q
Mania Symptoms and Domains
A
- Emotional: energetic, elated mood, intensified pleasure, sometimes anger/irritability etc.
- Cognitive: grandiose, overly optimistic, deny problems, poor judgment
- Motivational: reward-oriented, impulsive
- Behavioral: productivity, hyperactivity, impulsive behaviors
- Physical/Somatic: insomnia, increased libido, appetite, very energetic
28
Q
Bipolar Disorders Epidemiology
A
- About 2% lifetime for Bipolar I and II
- About 1% lifetime for Cyclothymic
- Mean age onset: 18 (usually 12-25 years old)
- Equal rates men and women
- Later episodes typically more severe
- Presence of mood incongruent psychotic symptoms is associated with worse outcome
29
Q
Bipolar Comorbidity
A
- Anxiety disorders: 63%
- Impulse-control/disruptive disorders: 45%
- Substance Use Disorders: 37%
- In youth: ADHD 60-90% (why so much overlap?)
30
Q
Bipolar Differential Diagnosis
A
- Rapid shift in mood instability (may be Borderline PD if shifts within couple hours or same day)
- Hyperactivity, impulsivity (and even sleeplessness), but no grandiosity or expansive mood in ADHD
- Intense anger, irritability, and/or aggression; short duration could be intermittent explosive disorder or DMDD?
31
Q
Childhood Onset Bipolar
A
- May lack acute onset, periods of normal functioning (more time at poles), distinct episodes of elevated mood/irritability, some classic adult symptoms (euphoria)
- Rather, some suggest continuous mood disturbance with mix of mania and depression or longer, more mixed episodes
- Strong indicators of BD in children: grandiosity, decreased need for sleep, and high-risk sexual behavior
32
Q
Recent Controversies in Child-Onset Bipolar
A
- Why the increase in diagnosis?
- Is this the same syndrome or something different?
- Is severe, non-episodic irritability how mania presents in children?
- Will etiology, prognosis, or response to treatment differ?
- Ultra-rapid cycling or better characterized as “mixed” episodes?
- Can bipolar disorder be reliably distinguished from other disorders such as ADHD? Are these disorders distinct or comorbid?
33
Q
Stringaris article
A
US vs. UK → why is US diagnosing more pediatric bipolar?
- US need diagnosis for services and insurance billing purposes
- May be $ incentives for doctors to sell medications vs. therapy
- US may focus on chronic irritability as a hallmark of bipolar
34
Q
Bipolar Etiology
A
- Biological/genetic component likely strong: chance of having a child with bipolar is 25% for single parent and 75% for both parents with bipolar; twin studies .85 to .93
- Neurotransmitters: norepinephrine levels fluctuating (overactive during mania); low levels of serotonin & enhanced dopamine function during mania
- Ion activity in the brain: overactive firing (sodium pump?) of neurons; why lithium works
- Abnormal brain structures: hyperactivity of amygdala (emotionality), underactivity of prefrontal cortex (emotion regulation), hyperactivity of basal ganglia (reward)
- Stressful life events: having many stressors associated with 4.5x greater increase in relapse within 2 years
35
Q
Joiner article
A
- Suicide clusters: two or more completed or attempted suicides nonrandomly “bunched” in space or time
- Mass clusters: media-related (unclear if these occur)
- Point clusters: local phenomenon (e.g., kids attempting suicide around the same time at a high school; appear to occur)
- Contagion as a possible explanation for why clusters develop
- Alternative explanation for clusters: People who are vulnerable to suicide cluster well before the occurrence of any overt suicidal stimulus; when they experience negative events, including but not limited to the suicidal behavior of another member of the cluster, all members of the cluster are at increased risk for suicidality.
36
Q
Claes et al. article
A
- Examine differences in personality, coping skills, and select psychopathology symptoms in psychiatric patients with and without NSSI and/or suicide attempts
- Results support a continuum of self-harm
- NSSI + SA group showed highest level of psychopathology and relied more on depressive reaction patterns when confronted with stressful life events
- NSSI: showed less conscientiousness, more avoidance behavior and internalized anger
- SA: higher on depression, hopelessness, SI, neuroticism, and lower on extraversion; more passive or depressive reaction patterns
- Individuals who self-injure but do not attempt suicide are more active, albeit avoidant, in their coping and they tend to have less severe symptoms of depression, hopelessness, and neuroticism
37
Q
Gotlib & LeMoult article
A
- Changes from DSM-IV to DSM-5
- 3 new depressive disorders: disruptive mood dysregulation disorder, premenstrual dysphoric disorder, and persistent depressive disorder
- controversial decision to remove the bereavement exclusion
- Replacement of depressive disorder NOS with other specified depressive disorder and unspecified depressive disorder
- Two new specifiers: “with anxious distress” and “with mixed features”
38
Q
Healy article
A
- Myth: the notion that SSRIs restored serotonin levels to normal
- No correlation between serotonin reuptake inhibiting potency and antidepressant efficacy
- Patient representatives pushing the myth, not psychopharmacology
- Co-opted doctors and patients
- More effective and less costly treatments were marginalized; older tricyclic antidepressants out of the market
- SSRIs don’t work well for suicidal depressed and impulsive patients
