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507 midterm > Mood disorders > Flashcards

Mood disorders Flashcards

1
Q

Depressive Disorder

A
  • Multiple symptoms, plus depressed mood or loss of interest/pleasure
  • Causes significant distress or impairment
  • 2+ weeks
  • Represents decline (not necessarily from healthy and happy)
  • Not accounted for by general medical condition or bereavement
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2
Q

Unipolar Depression

A

2+ weeks
Depressed mood/decreased interest plus 4 of these:
-emotional * sad and dejected
* lose sense of humor, report getting little pleasure from anything
* anhedonia- inability to experience any pleasure at all
* anxiety, anger, agitation (esp. among older people)
-motivational
-behavioral
-cognitive: confused, unable to remember things, easy distracted, unable to solve even the smallest problems
-physical: headaches, indigestion, constipation, dizzy spells, general pain, disturbances in appetite and sleep

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3
Q

Persistent Depressive Disorder

A
  • 2 yrs

- depressed mood most of the day + 2 symptoms

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4
Q

Grief v. depression

A

Grief: painful feelings come in waves with moments of happiness, self-esteem preserved.
Depression: Worthlessness, suicidal ideation, impairment in functioning, mood and ideation almost constantly negative.

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5
Q

Risk factors for progression

A

Previous MDE, limited coping skills, limited support network

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6
Q

Severity specifiers

A

Mild: symptoms barely meet criteria
Moderate
Severe: number of symptoms exceeds minimum; marked impairment

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7
Q

Psychotic features in depression

A
  • if psychotic features, it is severe
  • mood-congruent: hallucinations or delusions are consistent with depressed mood (e.g. feeling so guilty you imagine you committed an awful sin)
  • mood-incongruent: not consistent with mood (e.g. depressed woman being persecuted by the FBI)
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8
Q

Specifiers of most recent episode

A

Atypical- reactive, weight gain, increased eating, excessive sleep
Melancholic- somatic, guilt, lack of appetite, weight loss, worse in morning
Catatonic (rare)
Postpartum onset
Seasonal Pattern
Anxious distress: tense, restless, difficulty concentrating, fear something awful will happen. (risk for suicide indicator)

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9
Q

Persistent Depressive Disorder specifiers

A

With pure dysthymic syndrome
With persistent major depressive episode
With intermittent major depressive episode

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10
Q

Prevalence and demo info for depression

A 
Childhood: boys=girls
Adulthood: women>men
Older adults: women=men
19% lifetime prevalence: 26% women, 12% men
16-20% in nursing homes
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11
Q

Biological dimensions of depression

A

Heritability- 30%
Related to increased risk for anxiety disorders
Serotonin transporter gene
short-short allelle=susceptibility to stressful life events
long-long allele-protection

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12
Q

Neurotransmitters indicated in depression

A

Low serotonin, dopamine, norepinephrine

Serotonin regulates activity of NE and DA: Low NE=less activity, low DA=less pleasure

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13
Q

Endocrine system implications

A

Increased cortisol associated with depressoin

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14
Q

Sunlight and depression

A

Melatonin suppresses serotonin. Excessive daytime melatonin causes depressed affect. Exposure to sunlight during the day suppresses melatonin and thus increases serotonin.

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15
Q

Behavioral factors in depression

A

Lewinsohn said that it’s related to decreased reinforcement and/or increase in punishment

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16
Q

Cognitive factors in depression

A

Learned helplessness theory (Martin Seligman dog study): attribution style to life events related to vulnerability to depression.
-internal, stable, global

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17
Q

Beck’s negative cognitive styles

A
  • cognitive errors: distorted thinking that leads to depressed mood
  • Depressive cognitive triad: negative views about self, world, and future.
  • Schemas: enduring negative core belief about some aspect of life
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18
Q

Cognitive Errors

A
  • All or nothing thinking
  • mental filter: overemphasizing negatives, discounting positives
  • taking feelings too seriously (as reality)
  • generalized “shoulds”
  • self-blame
  • jumping to conclusions: mind reading and fortune telling
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19
Q

CBT treatment for depression

A

Aaron Beck

  • relationship between thoughts, feelings, behavior
  • 10-20 sessions, present focused
  • most widely studied psych tx, very effective
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20
Q

Key elements of CBT treatment for depression

A
  • Monitoring thoughts, moods, and behavior (awareness)
  • Cognitive restructuring
  • hypothesis testing, challenging beliefs
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21
Q

Behavioral activation

A

Based on behavioral principles that depression is due to decrease of reinforcement, increase in punishment. A therapy for depression in which the therapist works systematically to increase the number of constructive and pleasurable activities and events in a client’s life. (increasing reinforcement and decreasing punishment)

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22
Q

Interpersonal treatment (IPT)

A
  • Kleman
  • 15-20 sessions, present focused
  • Identify main interpersonal conflicts
  • Better for people whose relationships are contributing to depression.
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23
Q

Mindfulness based treatment

A

Trying to “fix” what’s “wrong” with you pulls you deeper, so this approach encourages acceptance and mindfulness skills. Stop judging self, and gain self awareness and engagement with feelings

24
Q

Types of third wave treatments

A

ACT, Unified Protocol, DBT

25
Q

MAOi

A

An antidepressant drug that prevents the action of the enzyme monoamine oxidase

  • results in a rise in the activity levels of serotonin and norepinephrine
  • dangerous side effect: blood pressure will rise dangerously if people on these drugs eat foods with tyramine (cheese, bananas, certain wines)
  • Good for depression with atypical features like mood reactivity, increased eating and increased sleeping.
26
Q

Tricyclics

A

Inhibits reuptake of monoamines, allowing serotonin and norepinephrine to remain in their synapses longer.
- should be taken at least five months after symptoms are reduced to avoid relapse
- Good for depression with insomnia and weight loss
Elavil, Tofranil, Surmontil, Clomipramine, Remeron

27
Q

SSRIs

A

A group of second-generation antidepressant drugs that increase serotonin activity specifically, without affecting other neurotransmitters.
Choice is based on side effect profile
Also affective for many anxiety disorders
Takes several weeks to work (mood is last symptom to improve)
Side effects: weight gain, loss of libido, sleep disturbances, pregnancy complications, increase in suicidal ideation
Prozac, Paxil, Zoloft, Celexa, Lexapro

28
Q

SNRI’s

A

Effexor, Cymbalta

29
Q

Wellbutrin

A

Side effects: weight loss and insomnia

30
Q

Antipsychotics

A

Typically in treatment of depression with older adults

31
Q

ECT

A

controversial but effective (60-80% of patients improve). Particularly effective in severe depression with delusions

32
Q

Demographics for bipolar

A
  • equally common in men and women
  • onset 15-30 years (avg 25)
  • prevalence 2.5%
33
Q

Manic episode

A

length 1+ week (or earlier if hospitalized before 1 week)

  • abnormal mood: high, irritable, expansive
  • 3 or more of these features:
  • inflated self esteem
  • increased energy, decreased sleep
  • racing thoughts
  • pressured or increased speech
  • impulsivity and poor judgment
34
Q

Hypomanic episodes

A

Less time (3-4 days), less symptom severity, less psychosis

35
Q

Mixed episode

A

Fulfill symptom criteria for both MDE and manic episode nearly every day for a week or more.

36
Q

Bipolar severity specifiers

A

Mild, moderate, severe- determined by current state they are in

37
Q

Course of recurrent episodes

A
  • With or without full interepisode recovery

- with rapid cycling: in 1 year, at least 4 episodes of MD, mania, mixed, and/or hypomania

38
Q

Bipolar I

A
  • At least one manic episode
  • More time in MDE than manic
  • Most common presentation is an alternation of MDE and manic episodes
  • Mania is frequently experienced as pleasurable, so medication compliance can be a problem.
39
Q

Bipolar II

A

Involves MDE and hypomanic episodes
Later onset (20’s vs. teens)
Risk for bipolar I

40
Q

Cyclothemia

A

Mild form of bipolar.

  • less severe but more chronic (at least 2 yrs)
  • hypomania tends to involve more irritability than euphoria
  • at risk for MDE or manic episode
41
Q

Biological factors in bipolar disorder

A

Heritability - 50%

  • Increased glucose metabolism during mania
  • Low serotonin and high norepinephrine=mania
42
Q

Permissive theory

A

Low serotonin activity sets the stage for mood disorder and norepinephrine activity defines the particular form it takes.

43
Q

Kindling

A

Manic episodes may be damaging to the brain

44
Q

Lithium

A

Very effective medication used to prevent manic episodes, though mechanism for action is unknown.

45
Q

Mood stabilizers

A

Newer drugs used to treat bipolar, also used to treat seizures. Mechanism of action is unknown, they are increasingly common, and may work because of secondary messengers.

46
Q

Antipsychotics

A

Older drugs that have been used to treat acute mania (Haldol)

47
Q

Is psychotherapy alone helpful in treating bipolar?

A

Rarely- medication is necessary.

48
Q

What does psychotherapy treatment for bipolar look like?

A

It focuses on medication management, social skills, and relationship issues. It helps reduce hospitalization, improves social functioning, and increases ability to get and keep a job.

49
Q

Prevalence and demographics of depression

A
  • 8% of adults in the US suffer from a severe unipolar pattern in any given year, while as many as 5% suffer from mild forms
  • higher rate among poor people
  • women twice as likely as men to have severe depression (26% of women at some point in their lives, only 12% of men)
50
Q

Anhedonia

A

inability to experience any pleasure at all

51
Q

Brain circuit involved in depression

A

subgenus cingulate is distinctly part of the depression-related circuit

52
Q

Automatic thoughts

A

numerous unpleasant thoughts that help to cause or maintain depression, anxiety, or other forms of psychological dysfunction.

53
Q

Learned helplessness

A

the perception, based on past experiences, that one has no control over the reinforcements in one’s life. (internal v. external, global v. specific attributions)

54
Q

Developmental psychopathology perspective on depression

A

The road to unipolar depression begins with inherited predisposition, and individual is subjected to traumas early in life- many factors interacting.

55
Q

Neurotransmitters involved in bipolar

A

low serotonin activity paired with high norepinephrine activity may lead to mania; low of both may lead to depression

56
Q

Psychodynamic therapy approach to depression

A
  • Believes that unipolar depression results from unconscious grief over real or imagined losses, compounded by excessive dependence on other people.
  • uses free association, interpretations, resistance and transference
  • long term approach (short term approaches work better)
  • helps most in modest or moderately severe cases that involve a clear history of childhood loss or trauma, a long standing sense of emptiness, feelings of perfectionism and extreme self criticism.

507 midterm (8 decks)

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