Mood disorders Flashcards
general characteristics of mood disorders
- disturbances in emotion
- assoc with panic attacks, subs abuse, sexual dysfunction, personality disorders
- co-morbidity increases severity + increases poor prognosis
signs + symptoms of depression
- 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
symptoms of depression across the lifespan
children: more somatic complaints
older adults: distractability, mem loss
symptoms vary across cultures
canada: emphasize somatic symptoms rather than emotional
- hard to have convos, neglect hygiene + appearance
length of depressive episodes
- recurrent, may dissipate with time
- if untreated, stretches for longer
- chronic? no snap-back to earlier functioning
what is mania
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
two major mood disorders in DSM
major depressive disorder (bereavement exclusion dropped) bipolar disorder (bridge btw schizo + unipolar depression)
other mood disorders?
disruptive mood dysregulation disorder + Premenstrual dysphoric disorder.
DSM criteria for diagnosis of depression
5+ symptoms for at least 2 weeks
- 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.
diagnosis of depression - controversy
- categorical (y/n), but dsm-5 incorporates dimensional ratings
- is 5 symptoms in 2-weeks distinctly different from 3 symptoms for 10 days.
is depression a category or continuum?
research suggests continuum
- diagnostic criteria = severe end of continuum.
- in children, continuum
- in adults, categorical evidence
prevalence of depression
- 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
persistent depressive disorder
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
financial cost of depression
- 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
DSM definition of bipolar disorder
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
symptoms of manic episode
- 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
prevalence of bipolar disorder
- 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
violent behaviours + bipolar disorder
– symptoms
- violence can occur during severe manic episodes
- lose insight into condition + can result in difficulties, subs abuse, marital/occupational failure
co-morbidity of bipolar disorder
anxiety - great impact on quality of life
- personality disorders predict poor outcome
heterogeneity in mood disorders
- problem in classification
- - diff symptoms btw ppl, mixed episode = full range in one day
bipolar II disorder
episodes of major depression accompanied by hypomania
- less extreme than full-blown mania
mood disorders with psychosis
- 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
what are melancholic features of heterogeneity?
- 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
what is seasonal affective disorder?
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
SAD + NT?
5-ht decreases due to reduced light
- reduced activity of 5-ht neurons of hypothalamus
what is cyclothymic disorder
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%
what is postpartum depression
- 3% depressed during pregnancy
- 8% depressed after.
- half of those with PD, were depressed during pregnancy
onset of PD predicted by?
levels of depression in pregnancy period
- reported lack of warmth + care from one’s own parents while growing up
research to reduce PD
- 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.
who has PD?
- stress in pregnancy on children
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.
Psychiatric disturbance in fathers after pregnancy
3/5 of mom+dads have PD at 6 months postpartum.
- no excess of severe mental disorders in fathers
psychoanalytic theory of depression
- created in early childhood
- fixation at oral period
- tendency to be excessively dependent on other ppl for maintenance of self-esteem
personality orientations in depression
- 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
what is the congruency hypothesis
- 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
predictor of poor response to CT
self-criticism
3 psychological theories
- beck’s theory of depression (thinking biased toward [-] interpretations)
- negative triad ([-] view of self, world, future)
- principle cognitive biases (4 components)
what are the 4 components of principle cognitive biases
- arbitrary inference
- selective abstraction
- overgeneralization
- magnification + minimization
what is arbitrary inference
conclusion drawn without sufficient evidence or no evidence at all
what is selective abstraction
conclusion drawn on one of many elements in the situation
what is overgeneralization
sweeping conclusion on a single trivial event
what is magnification
little event, blown up
what is minimization
downplay successes
cognitive patterns in depressed individuals
more [-] words, fewer [+] words
- cognitive bias: recall of adjectives with depressive content
- greater attention to negative stimuli
what is learned helplessness
individual’s passivity + sense of being unable to act and control own life is acquired through unpleasant experiences and trauma that were unsuccessfully controlled
attribution + learned helplessness
concept of attribution
- global attributions: attributes things that happen to them as stable factors + internal characteristics
what is depressive paradox?
depressed see themselves as helpless, how can they blame themselves?
- hopelessness + feelings of self-blame
hopelessness theory
- 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
what are the diatheses of the hopelessness theory?
- attributional pattern: attirbute to self or external to self
- low self-esteem
- tendency to infer that negative life events will have severe negative consequences
what is depressive predictive certainty?
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
what is interpersonal theory of depression
- 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
depression + social skills
low social skills, speech patterns are poor, maintain eye contact is poor
- seek reassurance that others truly care, only temporarily satisfied from reassurance.
psychological theories of bipolar disorder
-
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
behavioural activation system: dysregulation theory
= mania associated with?
- what is BAS?
- 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
biological theory of bipolar disorder: genes
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
bioological theory of mdd: genes
heritable: 35%
- unipolar proband relatives have 6 risk for unipolar depression
5-httlpr gene - short: higher level of depression + suicidality following stressful event
biological theories: mdd + NT
decrease NA, DA => depression + mania
5-ht => depression +mania
not critical, but deff have influence, confusing mechanism
tricyclics + MAO inhibitors as treatment
increase NA, 5-HT, DA at first, but back to original levels by 7-14 days.
- how does it work then?
brain structures implicated in MDD + bipolar?
amygdala, hippocampus, pfc, anterior cingulate
- hyperative amyg + hypoactive PFC = diminished cog appraisal + depression
what is MAO-A?
enzyme that metabolizes monoamines ( 5-ht, NA, DA)
- elevated in ppl with major depression
recurrent/ untreated depression on brain
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
stress on depression?
stress = distorted appraisal = hpa axis engaged = cortisol leads to depressive symptoms
right vs left hemisphere dysfunction in depression causes what symptoms?
r: indifference, flat affect
l: overt symptoms of agitation + sadness
depression therapy
- 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
psychodynamic therapy of depression
depression from sense of loss + from anger unconsciously turned inward.
- achieve insight
- presently: concentrate on interactions between person + social environment (effective)
cbt for depression
alter maladaptive though patterns
- change opinions of events + of self
- behavioural components: small things/activities
- effective, prophylactiv effect, better in 6 sessions
when is cbt not effective for depression?
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
Mindfulness based ct: depression
relaxation to increase awareness of changes in mind + body with standard cog intervention techniques
what is meta-cognitive awareness?
sense of how cognitive sets are related to emotional feeling + vice versa.
success of mbct as treatment for depression?
successful in reducing current symptoms in ppl suffering from chronic-recurrent depression with a history of suicidal ideation.
- reduces overgenerality effect
what is overgenerality effect
when asked to recall events in life, depressed people provide broad, categorical memories lacking specificity
mbct - id-ing specific mechanisms
- thoughts?
reduce tendency to ruminate
- due to greater ct therapist experience
psychological treatment
for bipolar
- treat stress
- target thoughts + interpersonal behaviours
- psychoeducation about bipolar + its treatment can improve adherence to meds, educate family, reduce stress
what is ect?
electroconvulsive therapy
- if it works, faster than anti-D and psychotherapy
- deliberate induction of seizure + momentary unconsciousness.
- pass current of 70-130V thru brain
bilateral vs unilateral ect
bi: electrodes on both sides of forehead, both hemispheres
uni: pass current thru non-dominant (usually right) hemisphere.
risks with ECT?
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
DBS
deep brain stimulation
- last option, disrupts focal pathological activity in limbic-cortical circuits
- safe + effective in MDD + BD
- expensive
rTMS
magnetic pulses pass thru skull and produce electric current in underlying cortex
- therapeutic response in depressed, chronic pain.
drug therapy
most common
- dont work for everyone, large side effects
- more effective with higher levels of social support
