Mood Disorders Flashcards

1
Q

Distinguish between the broad classes of mood disorders

A

Unipolar depressive disorders - Involve only depressive symptoms. E.g. MDD, persistent depressive disorder.

Bipolar Depressive Disorders - Both depressive and mania symptoms E.g. bipolar 1 and 2.

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2
Q

Describe some of the cardinal symptoms of mood disorders

A
  • Profound sadness/guilt
  • Anhedonia - Inability to experience pleasure
  • Attentional deficits
  • Insomnia
  • Loss of interest
  • Social withdrawal
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3
Q

Define the DSM-5 criteria for MDD

A
  • Sad mood or loss of pleasure and 5 symptoms for at least 2 weeks
  • Sleeping too much or too little
  • Weight loss
  • Loss of energy
  • Feelings of worthlessness
  • Difficulty concentrating
  • Thoughts of death or suicide

Episodic disorder - Periods of depression which leave and then come back. Likely to return if happens once.

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4
Q

Define the DSM-5 criteria for persistent depressive disorder

A
Depressed mood for most of the day more than half of the time for 2yrs.
At least two of these
- Poor appetite or overeating
- Sleeping too much or little
- Low energy
- Poor self-esteem
- Trouble concentrating or decision making
- Feelings of hopelessness
  • Symptoms usually don’t clear for 2 months
  • No manic periods
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5
Q

What is the lifetime prevalence of mood disorders?

A
  • 10-20% of the general population experience MDD and 5% experience dysthymia
  • Differs across cultures e.g. Kessler et al. (2005) 16.2% in the US meet the criteria for MDD at some point. Chang et al. (2008) - South Koreans more likely to describe a sad mood or suicidal thoughts compared to US.
  • Twice as common in women than men
  • Usually onsets in late teens to early 20s
  • High comorbidity with other disorders
  • Associated with other physical health problems
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6
Q

Explain the relationship between suicide and mood disorders

A
  • 2% treated in outpatient setting will die by suicide
  • 4% hospitalised
  • 60% of those who commit suicide have a mood disorder
  • Klein et al. (2007) - Those with dysthymia more likely to be hospitalised, attempt suicide and have impaired functioning compared to MDD
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7
Q

Explain some cardinal symptoms of bipolar disorders

A
  • Intense elation or irritability
  • Psychomotor agitation
  • Extroverted behaviour
  • Sociable to point of intrusiveness
  • Excessive self-confidence
  • Risky behaviours
  • Surge in goal pursuit

Main defining symptom is manic symptoms which is a state of intense elation or irriability

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8
Q

Describe the different types of bipolar disorders

A

Bipolar 1 - At least one episode of mania in lifetime and episodes of depression

Bipolar 2 - At least one major depressive episode and one hypomania which is less severe than mania

Cyclothymia - Mild symptoms of depression and mania. Symptoms don’t reach full severity, 2yrs+

Hypomania - Less extreme, feel more social and productive. Change in functioning

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9
Q

Explain the DSM-5 criteria for manic and hypomanic episodes

A

Elevated or irritable mood and abnormally increased activity or energy.

At least 3 of these, 4 if mood is irritable

  • Increase in goal-directed activity or psychomotor agitation
  • Unusual talkativeness, rapid speech
  • Racing thoughts
  • Decreased need for sleep
  • Incr self-esteem
  • Attention easily diverted
  • Excessive involvement in pleasurable activities likely to have painful consequences e.g. unwise business investments.

Manic episode

  • Symptoms last 1 week, require hospitalization or include psychosis
  • Symptoms cause significant distress or functional impairment

Hypomanic episode

  • Symptoms last at least 4 days
  • Changes in functioning observable to others, impairment not marked
  • No psychotic symptoms
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10
Q

Explain the DSM-5 criteria for cyclothymic disorder

A

For at least 2yrs, 1yr in children

  • Numerous periods with hypomanic symptoms that do not meet criteria for hypomanic episode
  • Numerous periods with depressive symptoms that do not meet criteria for major depressive episode

Symptoms do not clear for more than 2m at a time.

Criteria for major depressive. manic or hypomanic episode have never been meet.

Symptoms can cause significant distress or functional impairment.

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11
Q

Describe the epidemiology of bipolar disorders

A
  • Bipolar 1 = 0.6% of general population
  • Bipolar 2 + Cyclothymia - 1-4%
  • Usually seen before 25yrs
  • Equally frequent in men and women but women experience more depressive episodes
  • High rates of unemployment 80-90%
  • Highest rates of suicide
  • Dramatic reduction in life expectancy
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12
Q

Describe the etiology and relationship with genes in mood disorders

A
  • MDD shows moderate heritability at .37 for identical twins.
  • Difficult to identify specific genes and none have been found identified with MDD which is believed to be bc there are so many symptoms so caused by a set.
  • Believed to be due to genes associated with the production of serotonin
  • Bipolar heritability = .93
  • Many overlap with schizophrenia
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13
Q

Explain how medications can be used in mood disorders

A
  • Medications take 7-14 days to relieve symptoms
  • Modern theories look at the sensitivity of postsynaptic receptors that respond to presence of neurotransmitter in synaptic cleft.
  • Dopamine
  • Depressed less responsive to drugs which include this
  • Bipolar - Drugs that increase dopamine trigger mania symptoms. Suggests that dopamine receptors are overly sensitive.
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14
Q

What role do the neurotransmitters serotonin and dopamine play in the brain?

A

Serotonin - Mood regulation

Dopamine - Reward system

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15
Q

Explain the etiology of mood disorders in regards to abnormality within emotion and reward centres

A
  • Abnormalities in blood-oxygenated flow
  • Oversensitivity to emotional stimuli and difficulty regulating emotions
  • There is also an impaired response to rewarding stimuli and a lack of motivation.
  • But it is difficult to replicate these effects.
  • Suggested that the amygdala is hyperactive to emotional stimuli in depression.
  • Mayberg et al. (2005) - Planted electrodes in area next to subgenual anterior cingulate cortex of depressed. Reported feeling a relief of symptoms. Activity decreased.
  • Hippocampus - Depressed report decreased activity when seeing emotional stimuli
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16
Q

Provide examples of brain structures and their activity differences in mania and depression

A

Amygdala - Elevated in depression and elevated in mania

Hippocampus - Diminished in depression and diminished in mania

Striatum - Diminished in depression and elevated in mania

17
Q

Explain the etiology of mood disorders in regard to cortisol dsyregulation

A
  • MDD strongly associated with an abnormal stress response in the brain and body.

Crushing syndrome - Causes over secretion of cortisol, people usually experience depressive symptoms and reduced levels of cortisol reduce the symptoms. Suggesting that there is a link.

HPA axis is overly active during episodes of MDD. Amygdala is too which triggers release of cortisol

Cortisol awakening response - Rising when waking up associated with increased chance of developing MDD.

18
Q

How can environmental and social factors play a role in mood disorders?

A
  • If experience trauma in childhood, more likely to develop a negative cognitive style. Usually experience increased life stress which alters brain activity.
  • Negative life events - 42-67% report experiencing an event in the year before depression began.

Lack of social support - More likely to develop if cannot turn to ppl during negative events.

Brown and Andrews (1986) - Women experiencing stressful event without support had a 40% risk of depression compared to those with who had a 4% risk

19
Q

How can personality and cognitive factors account for mood disorders?

A
  • Neuroticism

Cognitive style

  • Beck argued that depression is associated with a negative triad, negative views of the self, world and future.
  • Negative schemas cause cognitive biases - tendencies to process info in neg ways. Usually formed during childhood.
  • Leads to a negative information processing bias

Hopelessness theory

  • Belief that desirable outcomes will not occur and cannot change this.
  • Individuals interpret from one area of life and bring this into all domains

Rumination theory

  • Tendency to dwell on negative experiences.
  • Watkins (2008) - It can interfere with problem solving and increase negative moods
20
Q

Explain the biological (medication) approach to treatment of MDD

A

MAOIS - Reduce synpatic breakdown of serotonin, norepinephrine and dopamine (work on all). They work by acting on enzymes, however can have dangerous food and other drug interactions.

Tricyclic antidepressants - Block reuptake of serotonin and norepinephrine but others too. Highly toxic if overdose and have cardiovascular and neurological effects.

SSRIs - Selectively block reuptake of serotonin. Have less serious side-effects, not as toxic and more tolerated.

SNRIs - Selectively block reuptake of serotonin and norepinephrine, however no evidence that are more effective

21
Q

Explain some of the biological treatments to MDD

A

ECT

  • Seizure is induced as current passes through cerebral hemisphere.
  • Can be more effective than medication, but used as a last-resort due to side-effects such as memory loss.

rTMS

  • Magnetic induction with coil. Current passes through the coil which reduces the firing of the neurons underneath
  • Well tolerated and has less side-effects

Psychosurgery

  • E.g. cingulotomy where a bilateral lesion created in white matter tracts of anterior cingulate cortex which processes emotion
  • Only used when everything else has failed and life in danger.
22
Q

Describe and explain psychological treatments used for MDD

A

Interpersonal psychotherapy - Improve social skills and have a better approach to conflict

Cognitive therapy e.g. CBT

  • Monitor and identify negative thought patterns and challenge negative beliefs
  • Try to boost self-esteem
  • Mindfulness approaches

Psychodynamic approaches

  • Focused on understanding the unconscious conflicts underlying the disorder e.g. childhood.
  • Hypnosis, dream interpretation
  • Time-consuming

Psychological treatment has a 60-80% response rate.

23
Q

Describe and explain the biological treatment of bipolar disorders

A

Lithium

  • Mood stabilising effect
  • 80% response rate
  • Can still have some mild symptoms
  • Taken for rest of life
  • Side effects mean monitoring takes place e.g. blood tests, thyroid function
  • Used with other medications such as antidepressants, however can increase risk of manic episode
24
Q

Describe and explain the psychological treatments of bipolar disorders

A
  • Usually used in combination with medication
  • Psychoeducation - Help understand disorder
  • Cognitive therapy
  • Family focussed therapy