mood disorders Flashcards
mood disorders
disabling disturbances in emotion — from extreme sadness to extreme elation and irritability of mania.
Temporal patterning important in determining diagnoses &
treatment
physical symptoms of depression
- fatigue and low energy
- physical aches and pains. (psychosomatic symptoms; doctors may initially think its a medical disorder)
- hard to fall asleep and wake up frequently; Others sleep throughout the day.
- food tastes bland or that their appetite is gone, or increase in appetite.
- Sexual interest disappears.
- limbs feel heavy.
- Thoughts and movements slow (psychomotor retardation; but others cannot sit still — they pace, fidget and wring their hands (psychomotor agitation).
- lack on initiative
MDD DSM criteria
unipolar disorders
At least 5 symptoms (which MUST includE (1) depressed mood and (2) loss of pleasure)
weight loss or change in appetite
Sleeping too much or too little
Psychomotor retardation or agitation
Fatigue or loss of energy
Feelings of worthlessness or excessive/inappropriate guilt
Difficulty concentrating, thinking or making decisions
Recurrent thoughts of death or suicide (or attempt/plan)
Symptoms are present for at least 2 weeks and represent a change from
previous functioning
• Symptoms are present nearly every day, most of the day, for at least two weeks. Symptoms are distinct and more severe than a normative response to significant loss.
- have to take other disorders into account
MDD is…
an episodic disorder symptoms present for a period of time and then clear. (an untreated episode may stretch on for five months or even longer) subclinical depression for years..
but has to last at least 2 weeks
risk of episode increases after every episode
Controversial criteria re: number of symptoms
• But impairment appears higher with greater number of symptoms
Persistent Mood disorder DSM (dysthymia)
- having a depressed mood for most of the day more than half of the time for two years (or one year for children and adolescents).
experience at least 2 of the following symptoms during that time:
- poor appetite or overeating
- sleeping too much or too little
- low energy
- poor self-esteem
- trouble concentrating or making decisions
- feelings of hopelessness.
- symptoms do not clear for more than two months at a time and bipolar disorders are not present.
- central feature: chronicity of symptoms, which has been shown to be a stronger predictor of poor outcome than the number of symptoms.
gender differences in depression
Women are twice as likely to experience major depression and persistent depressive disorder
THIS IS PRONOUNCED IN COUNTRIES AND CULTURAL GROUPS WITH TRADITIONAL GENDER ROLES
HORMONAL FACTORS
- hormonal factors that could explain the vulnerability of women, findings have been mixed tho
o Exposure to childhood and chronic stressors, as well as the effects of female hormones, could change the reactivity of the HPA axis, a biological system guiding reactions to stress.
SOCIAL FACTORS
o Twice as many girls are exposed to childhood sexual abuse.
o During adulthood, women are more like exposed to chronic stressors (poverty and caretaker responsibilities)
o Acceptance of traditional social roles intensify self-critical attitudes about appearance.
o worry more body image,
o the need for approval and closeness in women, may intensify reactions to interpersonal stressors
o Social roles promote emotion-focused coping among women, which may then extend the duration of sad moods after major stressors.
o women tend to spend more time ruminating about sad moods or wondering about why unhappy events have occurred.
o Men tend to spend more time using distracting or action-focused coping
disruptive mood dysregulation disorder
Severe recurrent temper outbursts in response to common stressors
o Temper outbursts are inconsistent with developmental level
o Temper outbursts tend to occur at least 3 times per week
o Persistent negative mood between temper outbursts most days, & the negative mood is observable to others
o Symptoms present for at least 12 months, do not clear for more than 3 months at a time
o Temper outbursts or negative mood present in at least 2 settings
o Age 6 +
o Onset before age 10
o In past year, no distinct period lasting >1 day where elevated mood & at least 3 other manic symptoms present
oppositional defiant disorder, ADHD and bipolar confused with this one
Seasonal affective disorder
experience depression during two consecutive winters and that the symptoms clear during the summer.
- common in northern than in southern climates;
- show greater changes in melatonin in the winter
- show a change in their retinal sensitivity to light (genetic)
- Some people, though, seem to respond to those physical changes (of the winter) self-critically
- excessive sleep & and increased appetite in winter
can apply to BD
– Biplolar disorders = depressed in winter, manic in summer
treatment
- antidepressant medications and CBT
- light therapy has been shown to help relieve depression
Catatonic depression
Stuporous state or catalepsy » End state reaction to imminent doom?
- echolalia (fitting on spectrum with schizophrenia)
- psychomotor disturbances
Melancholic depression
Melancholic: » Full criteria met for MDD »
BUT More severe somatic symptoms e.g. loss of libido, anhedonia, guilt
* its the complete loss of pleasure whereas is MDD its a reduced loss not a complete loss
Atypical depression
Depressive episodes and dysthymia
- Oversleep, overeat, can still find pleasure
- More common in women, early onset
- More: symptoms, severe, suicide, comorbidity
Postpartum depression
Postpartum:
Onset within first 4 weeks of childbirth
* 13% post-childbirth, hormonal?
NOT “baby blues” – 80% for few days, normal stress response (but it only goes for a couple of nights as people with PP depression it doesn’t go away
comorbidity among depression
- MDD and persistent depressive disorder are often associated, or comorbid, with other psychological disorders.
- About 60 percent for anxiety disorder at some point
- Other common comorbid conditions include substance-related disorders, sexual dysfunctions and personality disorders.
- MDD - world’s leading causes of disability
- MDD is also related to a high risk of other health problems, including death from medical
Rapid cycling:
– Move quickly in & out of depressive or manic episodes
– >3 manic or depressive episodes
– ↑ suicide attempts and episodes of depression
– 20-40% of people with bipolar (60-90% female more common)
– ↑ in frequency over time
– Can transform to ‘rapid switching pattern’ without breaks
mood disorders aetiology
genetics
- Probability of having a mood disorder 2-3 x greater if relative (sibling, mother or aunty) has a mood disorder
- studies of MZ (identical) and DZ (fraternal) twins heritability estimates around 37% (quite high)
- Bipolar disorder is among the most heritable of disorders. (but can be for any mood disorder)
» Severity, recurrence, age at onset predict rate - Bipolar→ any mood disorder up to 90%
IDENTIFYING GENES
>160 loci (genes located) linked – few well studied or replicated
» Serotonin transporter gene
» DRD4.2 gene
» Likely a set of genes that confers vulnerability
neurotransmitters in mood disorders
- norepinephrine, dopamine and serotonin.
- Past –> mood disorders would be related to having too much or too little of a neurotransmitter,
- More recent –> mood disorders might involve changes in receptors that respond to the presence of neurotransmitters in the synaptic cleft (focused on dopamine and serotonin.
serotonin
Serotonin thought to regulate emotional reaction
» ↓ serotonin dysregulates others neurotransmitters (the imbalance is what creates problems)
» balance rather than absolute levels?
» dysfunction = altered sensitivity of postsynaptic
receptors?
Amygdala
- elevated activity of the amygdala among people with MDD.
- when shown negative words or pictures of sad or angry faces, people with current MDD have a more intense and sustained reaction in the amygdala than do people with no MDD
Striatum
- people with depression- diminished activation of the striatum during exposure to emotional stimuli, particularly when they are receiving positive feedback that they have earned a reward
- A specific region of the striatum (called the nucleus accumbens) is a central component of the reward system in the brain and plays a key role in motivation to pursue rewards
The neuroendocrine system: cortisol dysregulation
- amygdala is overly reactive among people with MDD and the amygdala sends signals that activate the HPA axis
- people with Cushing’s syndrome: which causes oversecretion of cortisol, frequently experience depressive symptoms.
- Even among people who are depressed but do not have Cushing’s syndrome, cortisol levels are often poorly regulated — that is, the system does not seem to respond well to biological signals to decrease cortisol levels.
Social factors in depression:
- Childhood adversity, such as early parental death, physical abuse or sexual abuse, increases the risk that later, in their adolescence or adulthood, the person will develop depression and that the depressive symptoms will be chronic
- there is much evidence that stress can cause depression.
diatheses
some people must be more vulnerable to stress than others.
- Diatheses could be biological, social or psychological.
lack of social support
o People who are depressed tend to have sparse social networks and to regard those networks as providing little support
o Low social support may lessen a person’s ability to handle stressful life events.
Family problems
oexpressed emotion (EE) — defined as a family member’s critical or hostile comments towards or emotional overinvolvement with the person with depression.
o High EE strongly predicts relapse in depression.
Interpersonal style
o an excessive need for reassurance has been found to predict depression.
o depressive symptoms seem to elicit negative reactions from others
-
personality aetiology
Neuroticism
- neuroticism tendency to experience frequent and intense negative affect, predicts the onset of depression
- neuroticism is also associated with anxiety
Longitudinal studies → predicts onset of depression
Trait most associated with depression
» Support in twin studies
Positive affect as a predictor = less clear
» Low extraversion doesn’t always precede
depression
Rumination theory
emphasises the tendency to dwell on negative moods and thoughts.
Beck’s theory aetiology cognitive
- negative triad: negative views of the self, their world and the future
- acquired negative schemas through experiences
- negative schema is activated whenever the person encounters situations similar to those –> cause cognitive biases, or tendencies to process information in certain negative ways
Rumination theory
- Susan Nolen-Hoeksema (1991) suggested that a way of thinking called rumination may increase the risk of depression.
- tendency to repetitively dwell on sad experiences and thoughts, or to chew on material again and again.
- women tend to ruminate more than men do, perhaps because of sociocultural norms about emotion and emotion expression.
- evolutionarily adaptive to focus on negative events in order to solve problems
Depression in bipolar disorder
- The triggers of depressive episodes in bipolar disorder appear to be similar to the triggers of major depressive episodes negative life events appear to be important in precipitating depressive episodes in bipolar disorder.
- Similarly, neuroticism, negative cognitive styles expressed emotion and lack of social support predict depressive symptoms in bipolar disorder.
Predictors of mania
- reward sensitivity
- sleep deprivation.
Reward sensitivity
- disturbance in the reward system of the brain
- people with bipolar disorder describe themselves as highly responsive to rewards on a self-report measure
- specifically, life events that involve attaining goals, such as gaining acceptance to university or getting married trigger for B1 (for those who are biologically vulnerable)
Sleep deprivation
- Experimental studies indicate that sleep deprivation can precede the onset of manic episodes. I
Beck’s theory aetiology cognitive
- negative triad: negative views of the self, their world and the future
- acquired negative schemas through experiences
- negative schema is activated whenever the person encounters situations similar to those –> cause cognitive biases, or tendencies to process information in certain negative ways
