Mood Disorders Flashcards
How do mood disorders differ from mood?
Disorders involve disabling mood disturbance. Differs from sadness/happiness in intensity, duration, impairment and associated symptoms.
What qualifies as a major depressive episode?
≥ 5 symptoms, nearly daily, for ≥ 2 weeks
Defining characters of major depressive episode
Sad/depressed OR loss of interest in usual activities (anhedonia)
Symptoms of major depressive episode
- Significant change in weight or appetite
- Difficulties in sleeping
- Psychomotor retardation/agitation (slow down/can’t sit still)
- Loss of energy or fatigue
- Worthlessness or guilt
- Difficulty concentrating or making decisions
- Recurrent thoughts of suicide or death
Major depressive disorder (MDD)
≥ 1 episode of depression
Lifetime prevalence of MDD
16% (most common in 18-29 year olds)
Average age of onset of MDD
25 years
Sex/cultural differences in MDD
- Affects rates and presentation of symptoms
- Greater in women, Latinx/Hispanic
- Less in African Americans
Persistent depressive disorder
Milder depressed mood for most of the day more days than not for ≥ 2 years
Premenstrual dysphoric disorder
Severe, disabling form of PMS
Biological factors for MDD
35% heritability. Involves genetic, neuroendocrine and neurotransmitter related factors.
Genetic factors for MDD
- Multiple genes
- Interact with environmental stress
Neuroendocrine factors for MDD
- Chronically elevated cortisol
- HPA hyperactivity
- Related to early stress (childhood stress)
- Reduces neurogenesis (generation of neurons)
Neurotransmitters involved in MDD
- Low serotonin = poor regulation of sleep, emotion, appetite
- Permissive hypothesis = serotonin -> dysregulation of norepinephrine and dopamine
- Balance of NTs important
Beck’s negative cognitive triad
Negative views of self, world, future
Cognitive distortions
- All or nothing: it’s all bad
- Catastrophizing: thinking the worst will happen
- Mental filter: dwelling on negative details
- Overgeneralization: a negative event is likely to happen again and again
- Personalization: self-blame
Learned helplessness theory
Serves as a behavioral explanation. People may become depressed because they learn to view
themselves as helpless to control their environment.
Cognitive vulnerabilities
- Negative cognitive triad
- Internal, stable and global attributions
- Rumination
Internal attribution
Blaming oneself for a situation
Stable attribution
Event was due to unchanging, permanent factors and will happen again
Anxious features subtype of depression
Prominent anxiety symptoms as well as depressive symptoms
Mixed features subtype of depression
Meet the criteria for a major depressive disorder and have at least 3 symptoms of mania, but they do not meet the full criteria for a manic episode.
Melancholic features subtype of depression
Physiological symptoms of depression are particularly prominent (e.g. weight loss, psychomotor retardation); anhedonia
Psychotic features subtype of depression
Experience delusions and hallucinations; can be mood-congruent (related to typical themes of depression such as worthlessness) or mood-incongruent
Catatonic features subtype of depression
Catatonic behaviors: not actively relating to environment, mutism, posturing, agitation, mimicking another’s speech or movements
Atypical features subtype of depression
Odd assortment of symptoms (e.g. positive mood reactions to some events, significant weight gain or increase in appetite, hypersomnia, sensitivity to interpersonal rejection)
Seasonal pattern subtype of depression
History of at least two years in which major depressive episodes occur during one season of the year (usually the winter) and then the person fully recovers when the season is over (e.g. SAD)
Peripartum onset subtype of depression
Onset during/after pregnancy
Global attribution
Will happen in many situations (e.g. I lost my job, so everything else in my life will also go wrong)
Rumination
Repetitive focus on emotions and symptoms of distress and their causes and consequences - lead to increased awareness and reduced problem solving
Beck’s model
Negative core beliefs (about self, world or future) + negative event -> automatic negative thoughts (cognitive distortions) -> emotion (depression)
Basic cognitive model of depression
Stressful life events -> negative automatic thoughts = cognitions -> depression
Reformulated learned helplessness theory
Negative event -> causal attribution (internal, stable or global) -> depression/helplessness
CBT Treatment Targets
Targets automatic negative thoughts through cognitive restructuring and withdrawal through behavioral action
Behavioral activation
Pleasant activity scheduling, and tracking and planning the engagement in activities that are reinforcing
Cognitive restructuring
Learn to recognize and change distorted thinking patterns. Identify automatic thoughts and distortions, rationally dispute them (Socratic method) and develop rational rebuttal to automatic thoughts.
Methods to cognitive restructuring
- Thought diaries to monitor negative automatic thoughts.
- Challenge the validity of thoughts
- Replace cognitive distortions with more adaptive thoughts
- Change core beliefs
Medications for depression
- SSRIs (e.g. prozac)
- SNRIs (e.g. cymbalta)
- Atypical antidepressants (e.g. trazodone)
- Tricyclic antidepressants (e.g. doxepin)
- MAOIs (e.g. phenelzine)
Bipolar I
Experiences full symptoms of mania and their manic episodes last 7+ days; depressive aspects may be more infrequent or mild.
Bipolar II
Experience severe episodes of depression that meet the criteria for major depression, but their episodes of mania are milder and are known as hypomania; hypomania is not severe enough to interfere with daily functioning, does not involve hallucinations or delusions, and lasts at least 4 consecutive days
Characteristics of bipolar disorder
Persistent elevated mood/euphoria OR irritability
Symptoms of mania
- Inflated self-esteem
- Decreased need for sleep
- Talkative, rapid speech
- Racing thoughts
- Distractibility
- Increased goal-directed activity/ psychomotor agitation
- Excessive pleasurable, potentially damaging activities
Factors involved in bipolar disorder
- Heritable; relatives 5-10x likelier to have bipolar disorder
- Neural
- Neurotransmitters
- Psychosocial
Neural factors for bipolar disorder
- Reduced prefrontal cortex
- Abnormal amygdala
- Abnormal striatum (involved in motor and reward systems)
Neurotransmitters implicated in bipolar disorder
Dysregulation of dopamine
Psychosocial factors of bipolar disorder
- Stress
- Positive events
- Changes in routine (e.g. sleep, eating, social)
Cyclothymic disorder
Milder but more chronic form of bipolar disorder
Biological treatments for bipolar disorder
- Lithium
- Anticonvulsants
- Atypical antipsychotics
Psychological treatment for bipolar disorder
- Psychoeducation (providing information to those seeking/receiving mental health services)
- Interpersonal and Social Rhythm: Social skills, reduce social stress; regular sleep, eating, activity; self-monitoring
Does bipolar relate to creative eminence?
Studies examining biographies suggest it is overrepresented in famous artists
Are those with bipolar rated as highly creative?
- Those with cyclothymic had more creative achievements than controls
- Those with bipolar I no different from controls
Bipolar and creativity: personality characteristics
- Impulsivity
- Openness to experience
- Confidence
Bipolar and creativity: positive emotions
- Relaxes inhibition
- Increases awareness and flexibility
Bipolar and creativity: specific symptom presentation
Elevated mood, decreased sleep, increased energy
Suicide
The intentional ending of one’s own life
Suicide attempt
Harm with intent to die
Ideation
Thoughts about suicide
Non-suicidal self-injury (NSSI)
Harm without intent to die
Suicide statistics
- 11th leading cause of death in the United States
- 3rd leading cause of death in teenagers in US
- 2nd leading cause of death for age 15-34 in Canada
Suicide in males
- More likely to die by suicide
- Highest ages 40-59
- Firearms most common method in US/Hanging in
Canada
Suicide in females
- More likely to attempt suicide (3-4x more likely in Canada)
- Highest ages 40-59
- Poisoning most common method in US and Canada
(hanging close behind in Canada)
Demographic risk factors for suicide
Male; widowed, divorced, single; increases with
age; born in Canada, indigenous
Genetic and familial risk factors for suicide
Family history of suicide, mental illness, or abuse
Psychiatric risk factor for suicide
Substance abuse
Psychosocial risk factors for suicide
Lack of social support; unemployment; drop in
socio-economic status; firearm access
Behavioral dimensions risk factors for suicide
Impulsivity; prior suicide attempt; NSSI
Myths about suicide
- Talking about suicide increases the likelihood someone will kill themselves
- People who attempt suicide are intent on dying
- If they’re talking about it, they won’t actually do it
- People are often most vulnerable when they are at their most severely depressed
