Mood Disorders and Suicide Flashcards
What is a mood disorder?
Gross deviations in mood, which last at least a few days (either an elevated of flattened mood).
FIVE symptoms - present during 2 week period
- depressed mood, loss of pleasure
AND - weight
- sleep
- psychomotor agitation / retardation
- fatigue
concentration - suicidal ideation
Manic episode
elevated / irritable mood, increased goal directed activity / energy, lasting at least 1 week
need 3 symptoms:
- selfesteem
- decreased sleep
- talkative
- flight of ideas
- distractibility
- increase in goal directed activity
- excessive involvement in high pain activities
Hypomanic episode
- shorter, less severe version of a manic episode
- 4 days
- fewer and milder symptoms
Mood disorders
Unipolar = one extreme of mood experienced (depression or mania - but depression alone is much more common than mania alone)
Bipolar mood disorder = both depressed and manic moods
What are the 4 depressive disorders?
Major Depressive Disorder
Persistent Depressive Disorder
Premenstrual Dysphoric Disorder
Disruptive Mood Dysregulation Disorder
Outline Major Depressive Disorder
at least 1 major depressive episode
there has never been a manic / hypomanic episode
specifications:
- single episode or recurrent episode
- mild / moderate / severe / with psychotic features / in partial/full remission, unspecified
- with anxious distress: several significant symptoms of anxiety
- mixed features specifier: several manic symptoms (not episodes)
- melancholic features: additional severe
- symptoms such as lack of reactivity to positive stimuli
- atypical features specifier: presence of several symptoms less common in depression
- psychotic features specifier (hallucinations, delusions)
- peripartum onset: around the time of giving birth
- seasonal pattern
- catatonic features (rare muscular symptoms such as waxy limbs, repetitive or purposeless movement)
Persistent Depressive Disorder (Dysthymia)
Depressed mood (irritable for kids) most of the day, more often than not, at least 2 years (or 1 year for kids).
2+ of:
- appetite
- sleeping
- fatigue
- low self-esteem
- poor concentration
- hopelessness
less than 2 months without symptoms in the span of 2 years
specifiers: with anxious distress, mixed features melancholic features, mood incongrudent psychotic feature, peripartum onset
Premenstrual Dysphoric Disorder
5+ symptoms occur week before menses / majority of cycles / improve with menses / disappear after menses
- moodswings
- irritability / anger
- depressed mood
- anxiety
- decreased interest
- difficulty concentrating
- lethargy, lack of energy
- change in appetite
- sleep
- overwhelmed
- physical symptoms
Criterion A must be confirmed by prospective Daily Ratings (only criteria in the DSM that requires this)
Disruptive Mood Dysregulation Disorder
Only for 6-18 year olds - and the age of onset < 10 years
- severe recurrent temper outburts
- developmentally inconsistent
- happening 3_ times a week
- 12 months or more, with less than 3 months without
Depressive disorder statistics (gender and nationality)
- MDD is more commonly diagnosed than PDD (lasts 2 years) in the US
- for all countries other than china, women have 2x increase of experiencing a depressive disorder
- depressive disorder sky rockets at age 15 for girls
- MDD has the highest comorbidity with any disorder
What are the 3 bipolar disorders?
Bipolar I
Bipolar II
Cyclothymic Disorder
Outline Bipolar I
- At least 1 manic episode
- rapid cycling specifier = at least 4 mood episodes within the last 12 months that must switch polarity
Bipolar II disorder
- at least 1 hypomanic episode and at least 1 major depressive episode
- there has never been a manic episode
Cyclothymic disorder
- for at least 2 years there have been numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic episode, and numerous periods with depressive symptoms that do not meet criteria for a major depressive episode (1 year for adolescents)
What are the prevalences of bipolar disorders
Bipolar 1: more severe mania
- low <1%
Bipolar 2: depressive episodes and hypomania
- low <2%
cyclothymia = <4 %
begins before the age of 25
women experience more depressive episodes than men
93% variance explained by genes
brain function activity in depression vs mania
Amygdala: elevated for both
Anterior cingulate: elevated or both
Prefrontal Cortex: diminished for both
Hippocampus: diminished for both
Striatum: diminished in depression, elevated in mania
DIscuss the striatum and MDD
diminished activation of striatum when exposed to emotional stimuli - particularly when receiving positive feedback / reward (as it involves the nucleus accumbens)
Interpersonal and psychological factors
- childhood adversity
- negative life events
- lack of social support
- neuroticism
- learned helplessnes
- hopelessness
- cognitive triad
- rumination
- reward sensitivity
- sleep deprivation
Outline behavioural activation theory - i.e. the theory for why depression is maintained?
A depressed environment is characterised by excessive aversive stimuli (punishers and negative reinforcers), as well as decreased positively reinforcing stimuli.
Keep engaging in unhealthy behavoiurs to avoid aversive events - does not get the opportunity for many healthy behaviours of positive reinforcers.W
i.e.
- reduced positive reinforcers for healthy behaviour (combined with increased reinforcers for depressed behaviour) result in an increased of depressed mood
- reduced activation results in an increased avoidance, and increased in depressed behaviour
- which cycles back to reinforcement and mood
- ultimately resulting in increased depressive symptoms
Whats the medication for depression
Antidepressants
- SSRIs: block the reuptake of serotonin so there’s more available in the synapse to use
–> however: SSRI use in teenagers is associated with an increase in suicide risk, decrease in sleeping, decrease in sexual drive
- Tricyclic antidepressants: negative side effects, can be lethal in excessive doses
- Monoamine oxidase inhibitors (breaks down serotonin and norepinephrine)
Only about 50% of patients benefit
Medication for Bipolar Disorder
Mood stabilizers such as lithium (effective for 50-80% of patients)
- anticonvulsants
- antipsychotics
Treatments for medication resistant depression
- electronconvulsive therapy (unilateral - side effects are less pronounced) - usually have to receive 6-12 treatments before it ‘works’
- transcranial magnetic stimulation (uses magnets to generate a precise localized electromagnetic pulse), 30 minutes for 5-10 days
Cognitive therapy, third wave therapies, behavioural activation (decrease avoidant behaviour and increase interaction with positive reinforcers)
Which NT seem to play a role in depression?
Polymorphism of the serotonin transporter gene, combined with a stressful life event = greater risk of MDD
What are of the brain is differentially activated for depression and mania?
Striatum (diminished for MDD = less motivation, elevated for Manic = more goal oriented behaviour)
Explain why cortisol is elevated in depressed individuals?
HPA axis is overly active during MDD episode - an overactive amygdala (responds when there’s a threatening stimuli) may send sign to the HPA axis, resulting in elevated cortisol to prep the body for stress
Explain how interpersonal factors might be a cause and consequences of depression
Causes: childhood adversity, negative life events, lack of social support
Consequence: depressed individuals also contribute to the occurrence of stressful life events
What psychological factors contribute to mania?
Neuroticism
learned helplessness
cognitive traid (negative view of self, world, future)
rumination
Bipolar:
reward sensitivity
sleep deprivation
Suicide: prevalence
- high income countries have higher rates of suicide than low and middle income countries
- leading cause of death among women 15-19 years
- leading cuase of death among 15-29 year olds
- for every death, estimated 30 attempts
- 65000 attempts annually
- highest age suicide is 85+ for men
Suicidal models
- internal motivations associated with a greater desire to die
- external motivations may be protective
3 step theory of suicide: ideation to action
- pain and hopelessness
- pain exceeding connectedness
- capacity (not fearful)
