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Semester 1 2024 > Mood Disorders and Suicide > Flashcards

Mood Disorders and Suicide Flashcards

1
Q

What is a mood disorder?

A

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
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2
Q

Manic episode

A

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

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3
Q

Hypomanic episode

A
  • shorter, less severe version of a manic episode
  • 4 days
  • fewer and milder symptoms
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4
Q

Mood disorders

A

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

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5
Q

What are the 4 depressive disorders?

A

Major Depressive Disorder
Persistent Depressive Disorder
Premenstrual Dysphoric Disorder
Disruptive Mood Dysregulation Disorder

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6
Q

Outline Major Depressive Disorder

A

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)
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7
Q

Persistent Depressive Disorder (Dysthymia)

A

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

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8
Q

Premenstrual Dysphoric Disorder

A

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)

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9
Q

Disruptive Mood Dysregulation Disorder

A

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
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10
Q

Depressive disorder statistics (gender and nationality)

A
  • 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
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11
Q

What are the 3 bipolar disorders?

A

Bipolar I
Bipolar II
Cyclothymic Disorder

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12
Q

Outline Bipolar I

A
  • At least 1 manic episode
  • rapid cycling specifier = at least 4 mood episodes within the last 12 months that must switch polarity
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13
Q

Bipolar II disorder

A
  • at least 1 hypomanic episode and at least 1 major depressive episode
  • there has never been a manic episode
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14
Q

Cyclothymic disorder

A
  • 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)
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15
Q

What are the prevalences of bipolar disorders

A

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

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16
Q

brain function activity in depression vs mania

A

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

17
Q

DIscuss the striatum and MDD

A

diminished activation of striatum when exposed to emotional stimuli - particularly when receiving positive feedback / reward (as it involves the nucleus accumbens)

18
Q

Interpersonal and psychological factors

A
  • childhood adversity
  • negative life events
  • lack of social support
  • neuroticism
  • learned helplessnes
  • hopelessness
  • cognitive triad
  • rumination
  • reward sensitivity
  • sleep deprivation
19
Q

Outline behavioural activation theory - i.e. the theory for why depression is maintained?

A

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

20
Q

Whats the medication for depression

A

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

21
Q

Medication for Bipolar Disorder

A

Mood stabilizers such as lithium (effective for 50-80% of patients)
- anticonvulsants
- antipsychotics

22
Q

Treatments for medication resistant depression

A
  • 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)

23
Q

Which NT seem to play a role in depression?

A

Polymorphism of the serotonin transporter gene, combined with a stressful life event = greater risk of MDD

24
Q

What are of the brain is differentially activated for depression and mania?

A

Striatum (diminished for MDD = less motivation, elevated for Manic = more goal oriented behaviour)

25
Q

Explain why cortisol is elevated in depressed individuals?

A

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

26
Q

Explain how interpersonal factors might be a cause and consequences of depression

A

Causes: childhood adversity, negative life events, lack of social support
Consequence: depressed individuals also contribute to the occurrence of stressful life events

27
Q

What psychological factors contribute to mania?

A

Neuroticism
learned helplessness
cognitive traid (negative view of self, world, future)
rumination

Bipolar:
reward sensitivity
sleep deprivation

28
Q

Suicide: prevalence

A
  • 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
29
Q

Suicidal models

A
  • 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)

Semester 1 2024 (13 decks)

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