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239 - Midterm 2 > Mood disorders > Flashcards

Mood disorders Flashcards

1
Q

general characteristics of mood disorders

A
  • disturbances in emotion
  • assoc with panic attacks, subs abuse, sexual dysfunction, personality disorders
  • co-morbidity increases severity + increases poor prognosis
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2
Q

signs + symptoms of depression

A
  • emotional state marked by great sadness and feelings of worthlessness + guilt
  • withdrawal from others, loss of sleep, appetite, sexual desire, loss of interest and pleasure in unusual activities
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3
Q

symptoms of depression across the lifespan

A

children: more somatic complaints

older adults: distractability, mem loss

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4
Q

symptoms vary across cultures

A

canada: emphasize somatic symptoms rather than emotional

- hard to have convos, neglect hygiene + appearance

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5
Q

length of depressive episodes

A
  • recurrent, may dissipate with time
  • if untreated, stretches for longer
  • chronic? no snap-back to earlier functioning
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6
Q

what is mania

A

emotional state or mood of intense but unfounded elation accompanied by irritability, hyperactivity, talkativeness, flight of ideas, distractibility and impractical, grandiose plans

  • sudden
  • lasts days to months
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7
Q

two major mood disorders in DSM

A 
major depressive disorder (bereavement exclusion dropped)
bipolar disorder (bridge btw schizo + unipolar depression)
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8
Q

other mood disorders?

A

disruptive mood dysregulation disorder + Premenstrual dysphoric disorder.

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9
Q

DSM criteria for diagnosis of depression

A

5+ symptoms for at least 2 weeks

  1. Must have depressed mood or loss of interest/pleasure
    a. sad,depressed mood
    b. loss of interest/pleasure
    c. difficulty sleeping
    d. lethargic, shift in activity level
    e. poor appetite + weight loss or increase both
    f. loss of energy, fatigue
    g. negative self-concept, worthlessness + guilt
    h. difficulty concentrating
    i. recurrent thoughts of death or suicide.
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10
Q

diagnosis of depression - controversy

A
  • categorical (y/n), but dsm-5 incorporates dimensional ratings
  • is 5 symptoms in 2-weeks distinctly different from 3 symptoms for 10 days.
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11
Q

is depression a category or continuum?

A

research suggests continuum

  • diagnostic criteria = severe end of continuum.
  • in children, continuum
  • in adults, categorical evidence
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12
Q

prevalence of depression

A
  1. 2-17.1%: lifetime prevalence
    - 2x more common in W >M
    - gender gap emerges at age 14, maintained across the lifespan
    - higher among younger than older persons
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13
Q

persistent depressive disorder

A

combining chronic depression + dysthymia
- lifetime prevalence of chronic depression lasting at least 2 years was 4.6% (co-morbid diagnosis, younger AoO, history of more frequent episodes of depression

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14
Q

financial cost of depression

A
  • leading cause of disability-adjusted life years
  • effects on work performance: 27 days off (uni), 65 days off (bipolar)
  • 2.6 bill lost in 1998
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15
Q

DSM definition of bipolar disorder

A

episodes of mania or mixed episodes that include symptoms of both mania and depression.
- formal diagnosis requires the presence of elevated or irritable mood + abnormally + persistently increased goal-directed activity

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16
Q

symptoms of manic episode

A
  • impair social + occupational functioning
    • increase in goal-directed activity
    • more talkative
    • flight of ideas, subjective impression
    • less than usual sleep
    • inflated self-esteem
    • distractibility
    • excessive involvement in pleasurable activities
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17
Q

prevalence of bipolar disorder

A
  • less often than mdd (uni)
  • 4.4%
  • onset: 20’s
  • occurs equally in M+W
  • tends to recur: 50% have recurrence in 12 months, 50% 4+ episodes
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18
Q

violent behaviours + bipolar disorder

– symptoms

A
  • violence can occur during severe manic episodes

- lose insight into condition + can result in difficulties, subs abuse, marital/occupational failure

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19
Q

co-morbidity of bipolar disorder

A

anxiety - great impact on quality of life

- personality disorders predict poor outcome

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20
Q

heterogeneity in mood disorders

A
  • problem in classification

- - diff symptoms btw ppl, mixed episode = full range in one day

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21
Q

bipolar II disorder

A

episodes of major depression accompanied by hypomania

- less extreme than full-blown mania

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22
Q

mood disorders with psychosis

A
  • may be subject to delusions + hallucinations
    • more severe than depression without delusions : more social impairment + less time between episodes
    • delusion + depression wont respond to anti-D. other psycho-meds
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23
Q

what are melancholic features of heterogeneity?

A
  • no pleasure in activity, unable to feel better temporarily when something good happens
  • depressed mood is worse in the morning
  • awaken about two hours too early, lose appetite + weight, lethargic or agitated
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24
Q

what is seasonal affective disorder?

A

seasonal if there is a regular relationship between an episode + particular time of the year

  • most depression in winter
  • linked to decrease in number of daylight hours
  • detected in 11% of ppl diagnosed with depression
  • inuit have high prevalence, icelanders have low
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25
Q

SAD + NT?

A

5-ht decreases due to reduced light

- reduced activity of 5-ht neurons of hypothalamus

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26
Q

what is cyclothymic disorder

A

frequent periods of depressed mood (inadequate, withdrawn, trouble concentrating) + hypomania (inflated self-esteem, sleep too little), alternating with period of normal mood.
- lifetime prevalence of 2.5%

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27
Q

what is postpartum depression

A
  1. 3% depressed during pregnancy
  2. 8% depressed after.
    - half of those with PD, were depressed during pregnancy
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28
Q

onset of PD predicted by?

A

levels of depression in pregnancy period

- reported lack of warmth + care from one’s own parents while growing up

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29
Q

research to reduce PD

A
  • telephone-based peer support helped
  • peer support yielded very surprising results: mothers receiving coaching from other mothers who had PD did worse than coaching from trained nurses.
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30
Q

who has PD?

- stress in pregnancy on children

A

emotion-oriented coping style

  • high stress = children with lower cognitive ability
  • higher stress = behavioural problems + anxiety at 4yoa
  • high stress had abnormalities in fingerprint profiles.
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31
Q

Psychiatric disturbance in fathers after pregnancy

A

3/5 of mom+dads have PD at 6 months postpartum.

- no excess of severe mental disorders in fathers

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32
Q

psychoanalytic theory of depression

A
  • created in early childhood
  • fixation at oral period
  • tendency to be excessively dependent on other ppl for maintenance of self-esteem
33
Q

personality orientations in depression

A
  • sociotropy: dependent on others, concerned with pleasing others
  • autonomy: achievement-related construct that focuses on self-critical goal striving, desire for solitude and freedom from control
34
Q

what is the congruency hypothesis

A
  • if non-depressed has vulnerable personality style experiences negative life event = depressed; diathesis

hypothesis highlights distinction btw interpersonal + achievement-based vulnerabilities
- mixed support for this hypothesis

35
Q

predictor of poor response to CT

A

self-criticism

36
Q

3 psychological theories

A
  1. beck’s theory of depression (thinking biased toward [-] interpretations)
  2. negative triad ([-] view of self, world, future)
  3. principle cognitive biases (4 components)
37
Q

what are the 4 components of principle cognitive biases

A
  1. arbitrary inference
  2. selective abstraction
  3. overgeneralization
  4. magnification + minimization
38
Q

what is arbitrary inference

A

conclusion drawn without sufficient evidence or no evidence at all

39
Q

what is selective abstraction

A

conclusion drawn on one of many elements in the situation

40
Q

what is overgeneralization

A

sweeping conclusion on a single trivial event

41
Q

what is magnification

A

little event, blown up

42
Q

what is minimization

A

downplay successes

43
Q

cognitive patterns in depressed individuals

A

more [-] words, fewer [+] words

  • cognitive bias: recall of adjectives with depressive content
  • greater attention to negative stimuli
44
Q

what is learned helplessness

A

individual’s passivity + sense of being unable to act and control own life is acquired through unpleasant experiences and trauma that were unsuccessfully controlled

45
Q

attribution + learned helplessness

A

concept of attribution

- global attributions: attributes things that happen to them as stable factors + internal characteristics

46
Q

what is depressive paradox?

A

depressed see themselves as helpless, how can they blame themselves?
- hopelessness + feelings of self-blame

47
Q

hopelessness theory

A
  • expectation that desirable outcome will not occur, or that undesirable one will occur and that the person has no responses available to change this situation
48
Q

what are the diatheses of the hopelessness theory?

A
  1. attributional pattern: attirbute to self or external to self
  2. low self-esteem
  3. tendency to infer that negative life events will have severe negative consequences
49
Q

what is depressive predictive certainty?

A

belief that negative occurrences are almost certainly gonna happen in the future

  • expectation of helplessness creates anxiety and depression
  • certainty of occurrence of negative even = hopelessness depression develops
50
Q

what is interpersonal theory of depression

A
  • sparse social networks, little support
  • reduced social support increases vulnerability to depression
  • depressed people elicit negative reactions, including rejection
  • depressed have autonomous orientation are oriented toward themselves rather than toward other people
51
Q

depression + social skills

A

low social skills, speech patterns are poor, maintain eye contact is poor
- seek reassurance that others truly care, only temporarily satisfied from reassurance.

52
Q

psychological theories of bipolar disorder

-

A

life stress important in precipitating episodes

  • cognitive factors may also play a role
  • elevated dysfunctional attitudes, problems in autobiographical mem, problem with ability to generate solutions.
  • manic phase: defense against debilitating psych state: protective function, have low self-esteem
53
Q

behavioural activation system: dysregulation theory
= mania associated with?
- what is BAS?

A
  • mania associated with excessive goal-striving + greater cognitive reactivity
  • hyperresponsiveness to cues = high BAS activation
  • BAS is reward-sensitive system that mediates goal-directed behaviour
  • BAS activates emotions to encourage approach behaviours.
  • high BAS sensitivity follows differential exposure hypothesis: seek out rewarding sitmuli more often
54
Q

biological theory of bipolar disorder: genes

A

concordance rate is high = 85%

  • adoption studies provide support for strong heritable component: high risk of experiencing mania or depression
  • linked to 11th chromosome
  • Brain-derived neurotrophic factor gene also implicated
55
Q

bioological theory of mdd: genes

A

heritable: 35%
- unipolar proband relatives have 6 risk for unipolar depression
5-httlpr gene - short: higher level of depression + suicidality following stressful event

56
Q

biological theories: mdd + NT

A

decrease NA, DA => depression + mania

5-ht => depression +mania
not critical, but deff have influence, confusing mechanism

57
Q

tricyclics + MAO inhibitors as treatment

A

increase NA, 5-HT, DA at first, but back to original levels by 7-14 days.
- how does it work then?

58
Q

brain structures implicated in MDD + bipolar?

A

amygdala, hippocampus, pfc, anterior cingulate

- hyperative amyg + hypoactive PFC = diminished cog appraisal + depression

59
Q

what is MAO-A?

A

enzyme that metabolizes monoamines ( 5-ht, NA, DA)

- elevated in ppl with major depression

60
Q

recurrent/ untreated depression on brain

A

decreased hippocampal volume + neurocognitive impairment.

  • greatest change if had mdd 2+ years
  • fMRI study shows greater metabolism of glucose as CA25 in dysphoria. reduce this with anti-D drug
61
Q

stress on depression?

A

stress = distorted appraisal = hpa axis engaged = cortisol leads to depressive symptoms

62
Q

right vs left hemisphere dysfunction in depression causes what symptoms?

A

r: indifference, flat affect
l: overt symptoms of agitation + sadness

63
Q

depression therapy

A
  • most episodes lift, but can be difficult when untreated.
  • psychological + biological
  • 92% who received diagnosis treated by primary care physician alone.
  • clinical course is highly variable
64
Q

psychodynamic therapy of depression

A

depression from sense of loss + from anger unconsciously turned inward.

  • achieve insight
  • presently: concentrate on interactions between person + social environment (effective)
65
Q

cbt for depression

A

alter maladaptive though patterns

  • change opinions of events + of self
  • behavioural components: small things/activities
  • effective, prophylactiv effect, better in 6 sessions
66
Q

when is cbt not effective for depression?

A

high levels of dysfunctional attitudes

  • high pre-treatment severity scores on measures of depression
  • chronic forms, increased number of previous episodes
  • earlier onsets
  • comorbid personality disorder
67
Q

Mindfulness based ct: depression

A

relaxation to increase awareness of changes in mind + body with standard cog intervention techniques

68
Q

what is meta-cognitive awareness?

A

sense of how cognitive sets are related to emotional feeling + vice versa.

69
Q

success of mbct as treatment for depression?

A

successful in reducing current symptoms in ppl suffering from chronic-recurrent depression with a history of suicidal ideation.
- reduces overgenerality effect

70
Q

what is overgenerality effect

A

when asked to recall events in life, depressed people provide broad, categorical memories lacking specificity

71
Q

mbct - id-ing specific mechanisms

- thoughts?

A

reduce tendency to ruminate

- due to greater ct therapist experience

72
Q

psychological treatment

for bipolar

A
  • treat stress
  • target thoughts + interpersonal behaviours
  • psychoeducation about bipolar + its treatment can improve adherence to meds, educate family, reduce stress
73
Q

what is ect?

A

electroconvulsive therapy

  • if it works, faster than anti-D and psychotherapy
  • deliberate induction of seizure + momentary unconsciousness.
  • pass current of 70-130V thru brain
74
Q

bilateral vs unilateral ect

A

bi: electrodes on both sides of forehead, both hemispheres
uni: pass current thru non-dominant (usually right) hemisphere.

75
Q

risks with ECT?

A

confusion, mem loss, high relapse rate

  • may be optimal for some when other options dont work
  • several studies say ists safe, safeguards in place to protect informed consent
76
Q

DBS

A

deep brain stimulation

  • last option, disrupts focal pathological activity in limbic-cortical circuits
  • safe + effective in MDD + BD
  • expensive
77
Q

rTMS

A

magnetic pulses pass thru skull and produce electric current in underlying cortex
- therapeutic response in depressed, chronic pain.

78
Q

drug therapy

A

most common

  • dont work for everyone, large side effects
  • more effective with higher levels of social support

239 - Midterm 2 (5 decks)

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