Mood Disorders Flashcards
DSM5 4 mood disorders
disruptive mood dysregulation disorder
major depressive disorder
persistent depressive disorder (dysthymia)
premenstrual dysphoric disorder
DSM5 bipolar and related disorders
bipolar I
bipolar II
cyclothymic
moved into their own category away from depression to refelct differences in symptoms, family history and genetics
disruptive mood dysregulation disorder overview
aged 6-18
seen in at least 2 settings for 12 months
more than or equal to 3 temper outbursts a week
persistent irritable mood
severe, recurrent temper outbursts
inconsistent with developmental level
overview of major depression
depressed mood
anhedonia - inability to experience pleasure (don’t need both anhedonia and depressed mood)
cognitive symptoms - guilt, suicidal ideation, attention and memory problems etc
vegetative symptoms - bio (appetite, sleep, sex, energy)
2 weeks of symptoms - variable duration 3-12 months on avergae
recurrence is most common
dysthymia overview
depressed mood for at least 2 weeks may meet criteria for major depressive disorder (new) chronic base level = bit depressed late onset - early 20s early onset - pre 21, poorer prognosis
premenstrual dysphoric disorder overview and defining features
5 or more symptoms:
lability (cry or nager for no reason), irratibility, depressed mood, anxiety / tension
loss of interest, concentration, lethargy, appetite, sleep, sense of dyscontrol (can’t deal with demands placed on you), physical symptoms
for most cycles in the past year
bipolar 1 overview and defining features
full manic episodes
major depressive episodes (not needed for diagnosis but gonna happen in pretty much every case)
hypomanic episodes are common
facts and stats bipolar I
18 yo = average age of onset
chronic
bipolar II overview and defining features
hypomainc episodes and major depression requried
facts and stats bipolar II
average age of onset is 22
longer severe depression than bipolar I
chronic
cyclothymic disorder overview and defining features
hypomainc and depressive symptoms
pattern must last at least 2 years
facts and stats cyclothymic dis
high risk of developing bipolar I or II
equal gender distribtuion
average age of onset = early adolescence
major depression mnemonic and what it all stands for
SIGECAPS Sleep Interests Guilt Energy Concentration Appetite Psychomotor Suicide
difference between full mania and hypomania
hypomaina = no sleep problems or risky behaviour
eg hypomaina = pressured speech, madly peppy
suicide risk is higher in
bipolar than depression as risky behaviour / impulsivity
all depressed people are…
anxious but not all anxious people are depressed
8 subtypes of mood disorders and explain where needed
anxious distress
mixed features
melancholic features
atypical features - no low appetite, too little sleep etc
pscyhotic features - only during episodesl consistent with mood
catatonic features - can’t move limbs, stay in weird position
postpartum features - post child birth, bio and hormones. more than just stressed and tired as new baby
seasonal onset (SAD) - treated by light exposure
mood disorders sex differences
MDD 2(even3):1 female:male bipolar 1:1
genetic influences of mood disorders
strong familial inheritance for both depression and bipolar
serotnin transporter gene 5HTT = a candidate
depression in MDD and bipolar = same genetics
mania = separate genetics
serotonin transporter gene vulnerablity explained
ss allelle and 4 major life stressors = now at risk
mice with altered 5HTT = susceptible to stress
macaques with 5HTT s gene susceptible to stress and show lower serotonin levels
humans with 5HTT s show increased amygdala activation to fearful stimuli
neurobio influences on mood disorders
neurotransmitter systems = serotonin
endocrine system
sleep and circadian rhythms as sleep disturbances = a hallmark (melatonin can regulate sleep patterns)
serotonin levels explained
normal = at peace
low = aggression, impulsivity
regulatory role - modulates other neurotransmitters (norepinephrine, dopamine)
what is the permissive hypothesis
serotonin allows dysregulation of other neurotransmitters
treating serotonin imbalance brings down the others
norepinephrine is for
excitatory
role in vegetive symptoms of depression
new SSRIs treat this too
explain the endocrine system in mood disorders
cortisol (fight or flight) and dexamethansane (supresses cortisol) supression test (DST)
isn’t a diagnostic test
learned helplessness animal research
dogs learn to avoid shock by jumping a barrier
dogs who previously cannot control shock do not learn to avoid shock
instead dogs become helpless / depressed looking
learned helplessness theory of depression (seligman)
related to a lack of perceived control over life events
3 depressed attributional styles
-internal
-stable
-global
all 3 domains contribute to a sense of hopelessness
internal attributions
negative outcomes are one’s own fault
stable attributions
believing future negative outcomes will be ones own fault - pessimism
global attribution
believing negative events will disrupt many life activites
explain Beck’s cognitive triad
negative cognition about
self
world
future
Beck background
psychoanalytical when his patients free associating noticed weird cognitive leaps from a got a B in a class to gonna fail, dopr out, be homeless and die
Beck’s cognitive model of depression
progresses down this list early experience formation of depressogenic schemas criticl incidents schemas activated negative automatic thoughts (NATs) and symptoms (behavioural, cognitive, motivational, somatic, affective) in a cycle
depressive cognitions according to Beck
negative cognitive triad (pessimistic views of the self, world and future)
depressongenic (negative) schema - triggered by negative life events
cognitive biases (systemtic logical errors)
= depression
7 cognitive biases in Beck’s theory (named)
arbitrary inference selective abstraction overgeneralizatoin magnification and minimization personalization absolutistic dichotomous thinking should and must statements
Beck’s cognitive biases what is?
- arbitrary inference
prof must think i am stupid because i got a d
Beck’s cognitive biases what is?
- selective abstraction
i did poorly in test because i am stupid
Beck’s cognitive biases what is?
- overgeneralization
i got a d on the test, i am going to flunk out of school
Beck’s cognitive biases what is?
- magnification and minimization
that a was a fluke
Beck’s cognitive biases what is?
- personlization
prof didn’t call on me - he must think i am dumb
Beck’s cognitive biases what is?
- absolutistic dichotomous thinking
if i don’t get an a i am a loser
Beck’s cognitive biases what is?
- should and must statements
i have to get the highest grades
integrative theory of mood disorders
shared bio vulnerability = overreactive neurobio response to stress
exposure to stress
- stress activates hormones that affect neurotransmitter systems
-stress turns on certain genes, affects circadian rhythms, awakens dormant psych vulnerabilities, contributes to a sense of uncontrolability, fosters a sense of helplessness and hopelessness
social and interpersonal support are moderators
name the 4 drug classes used to treat mood disorders
tricylic
MAO-I
SSRIs
lithium - bipolar / mania
tricyclic meds
widely used
block the re-uptake of norepinphrine and other neurotransmitters
takes 2 - 8 weeks for therapeutic effects to be known
negative side effects are common and start straight away so before getting any benefit are getting side effects
may be lethal in excessive doses
MAO-I
monoamine oxidase inhibitors
blocks monoamine oxidase - an enzyme that breaks down serotonin / neuropinephrine
MAO inhibitors are slightly more effective than tricyclics
but must avoid foods contianing tyramine (beer, ref wine, cheese)
also drug interactions with loads of drugs
SSRIs
selective serotonin re-uptake inhibitors
prozac = most popular
pose no unique risk of suicide of or violence despite media - was an illusionary correlation
negative symptoms are common but temporary
-decreased sexual arousal / functioning
-jittery
-sleep disturbances
no better than placebo for mild depression
lithium
is a common salt with small amounts found in our water
primary choice in bipolar
treats mania - so also often need an anti-depressant too
can have severe side effects = must monitor dose carefully
unclear why it works
common alternative = depakote = anti-seizure, mood stabilizer
bipolar = must use meds. psych then can be used to but must be medicated
ECT
effective in severe cases of depression
brief electrical current to the brain resulting in temporary seizure
6-10 out patient treatments required
side effects = few but include short term memory loss
uncertainty why it works and relapse is common
now we can use just unipolar (right side) placement instead of bilateral
still some confusion 24hr after but much better
pscyhosocial treatments
cognitive therapy
-adresses errors in cognitive therapy
-also includes behavioural components
interpersonaly psychotherapy
-focuese on problematic interpersonal relationships
-also teach social skills / skills to build social network
outcomes with pscyh are comparable to medication
alot of trial and error carried about by therapist - need a large toolbox
suicide facts and stats
11th biggest killer in the US
white, native american phenomena
rates are increasing, particulalry in the young
gender = males are moe successful at comitting suicide (more violent methods), females attemot suicide more often
risk factors in suicide
in the family
low serotonin
psych disorder
alcohol use and abus
past suicidal behaviour increases subsequent risk
experiences of shameful/ humiliating stressor increases risk
publicity about suicide and media coverage increases risk
what to do as a therapist about suicide
research shows threats of suicide should be taken seriously
do not be afradi of discussint he topic - better to talk than not becuase worried about triggering it
get assisstance - don’t accept responisibliity
consider hospitalization
