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Mood Disorders (COMPLETE) Flashcards

1
Q

What is mood?

A

A prolonged emotional state

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2
Q

What are mood disorders?

A

Gross deviations in mood

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3
Q

What are mood disorders composed of?

A

Different types of mood episodes that last days or weeks.

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4
Q

What are the types of mood episodes?

A

Major depressive episodes-lose limit of normal mood

Manic episodes- top limit of normal mood

Hypomanic episodes- upper limit of normal mood

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5
Q

What is the DSM 5 criteria for Major Depressive Mood Disorder?

A

A5 or more of the following symptoms which:

Must be present almost everyday during the same 2 week period.
Represent a change from previous functioning
NB: At least one symptom must be depressed mood or loss of interest/pleasure

1.Depressed mood
2. Diminished interest/pleasure
3. Weight gain/loss of appetite
4. sleep disturbance
5. Psychomotor agitation/ psychomotor retardation
6. Fatigue/loss of energy
7. Feelings of worthlessness/guilt
8. diminished ability to think/concentrate
9. recurrent thoughts of death/suicide idealation

B. Must cause significant distress/impairment

C. Cannot be attributable to any other medical condition

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6
Q

Why is clinical judgement important when diagnosing major depressive disorder?

A

You shouldn’t diagnose MDD if it could be better explained by another disorder, ie. schizophrenia.

Responses to a loss may resemble a depressive episode under the 1st criteria

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7
Q

What did persistent depressive disorder used to be called?

A

dysthymia

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8
Q

What is the DSM 5 criteria for persistent depressive disorder?

A

Depressed mood for most of day/more days than not for at least 2 years/ 1 for children and adolescents

At least 2 of the following:
1. Poor appetite/overreating
2. insomnia/ hypersomnia
3. Low energy/fatigue
4. Low self esteem
5. Poor concentration
6. Feeling hopeless

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9
Q

What’s the defining feature of persistent depressive disorder?

A

Chronicity

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10
Q

What are the new depressive disorders?

A

Disruptive mood dysregulation disorder

Premenstrual dysphoric disorder

Prolonged grief disorder

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11
Q

What is Disruptive mood dysregulation disorder

A

Recurrent temper outbursts and persistent negative mood for at least 1 year BEGINNING BEFORE AGE 10

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12
Q

What is premenstrual dysphoric disorder?

A

Mood symptoms the week before menses
Can get hormonal treatments or SSRIS

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13
Q

What’s the prevalence of depressive disorders?

A

6-21% lifetime prevalence.

2:1 female to male ratio

Age of onset from late teens to 20s

3 times higher in low socio-economic status

2nd leading contributor to the global burden of disease.

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14
Q

What are the possible reasons for gender differences in depressive disorders?

A

Stress in adolescence- body image, puberty etc

Girls are more likely to be victims of sexual abuse

Rate of reporting may be higher

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15
Q

What are common misconceptions about bipolar disorder?

A

MISCONCEPTION: That they shift back and forth from depression to mania very often

TRUTH: They experience one to two cycles a year.

MISCONCEPTION: Bipolar is just another term for mood swings

TRUTH: the changes in mood are more severe, last longer and interfere with important aspects of functioning.
Manic episodes usually involve reckless behaviour.

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16
Q

What is the criteria for manic and hypomanic episodes?

A

Distinct periods of abnormally and persistently elevated, expansive or irritable mood.

Abnormally increased activity/energy

At least 3 of the following being noticeably changed from the baseline (4 if mood is irritable):

  1. increased self esteem- belief that one has special talents
  2. Decreased need for sleep
  3. Unusual talkativeness
  4. Flight of ideas/thoughts racing
  5. Distractability
  6. Increase in goal directed activity
  7. excessive involvement in activities that have high pain consequence
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17
Q

What’s the difference between manic v hypomanic?

A

Hypomania is a lesser mania

Manic:
Longer in duration
Can experience/ not experience psychosis
Significantly impaired functioning

Hypomanic
Less duration
no psychosis
implied functioning not significant

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18
Q

What are the 3 kinds of bipolar disorder?

A

Bipolar 1 disorder: At least 1 manic episode during the courts of their life

Bipolar 2 disorder: At least one major depressive episode
At least one episode of hypomania
No lifetime episode of mania

Cyclothymic disorder
For at least 2 years or 1 for children and adolescents

numerous periods of hypomanic symptoms but no hypomanic episode

numerous periods of depressive symptom but no major depressive episode

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19
Q

What’s the prevalence of bipolar disorder?

A

Less than 1 percent
Bipolar 1 disorder is more common

Less than 50% of bipolar spectrum disorders begin before 25 years

No evidence for sex differences

Very high rates of comorbidity with other disorders, ie. substance most common for bipolar than any other

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20
Q

What are some specifiers for the subtypes of depressive and bipolar disorders?

A

Seasonal pattern

Psychotic features

Suicide risk

Atypical features

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21
Q

What is the genetic aetiology for Major depression and bipolar disorders?

A

Heritability of major depression is 37%

Bipolar disorders are amongst the most heritable of all psychiatric disorders - 80- 93

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22
Q

What is the controversy over single gene studies

A

Heritability data suggests there is a substantial genetic
contribution to depression

Lots of studies have implicated the serotonin transporter
gene.

However, complex traits like depression are hugely polygenic

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23
Q

Does stress have an effect on depression risk?

Does the s allele have an effect on depression risk?

Does the stress x gene have an effect on depression risk?

A

Yes

no

No

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24
Q

What do most people believe depression is caused by

A

A chemical imbalance

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25
What neurotransmitters are said t be involved in the aetiology of mood disorders
Monoamine neurotransmitters: Dopamine Noradrenaline Serotonin
26
What's the evidence that serotonin is involved in mood disorders? Is it true?
Drugs that treat depression fix the activity of serotonin Low serotonin cerebrospinal fluid in depressed patients Not true- no consistent evidence to show associations between serotonin and depression
27
What are the most researched areas of the brain?
Amygdala Striatum Hippocampus Frontal cortex
28
What's the amygdala responsible for
Evaluating the salience of stimuli and regulating emotions
29
What was found in relation to MDD and the amygdyla
Increased amygdala activity in response to negative stimuli in MDD patients Abnormalities found in patients with a familial risk for MDD
30
What's the stratum responsible for
Reward processing and motivation
31
What was found in relation to MDD and the stratium
Reduced activation of the stratum linked to impaired reward learning This may explain why people with depression experience a loss of motivation and pleasure
32
What was found in relation to Bipolar disorder and the stratium
Show increased activity in the stratum and they are highly sensitive to rewards
33
What is the HPA axis in the neuroendocrine system
Endocrine system regulates our response to stress Cortisol is produced during stress However, prolonged levels of high cortisol can cause harm to the body: can cause: increased blood pressure Chronic muscle tension
34
What was found in relation to Bipolar disorder and MDD and the HPA axis?
HPA axis dysregulation found in both MDD and bipolar disorder patients High levels of cortisol are a risk factor for future MDD in high risk populations
35
What can trigger the HPA axis
Increased amygdyla reactivity
36
What does the hippocampus do?
Its partially susceptible to stress cuz its densely concentrated with cortisol receptors
37
What was found in relation to MDD and the hippocampus
Smaller hippocampal volumes in MDD patients
38
What are the key cognitive assumptions in relation to MDD and BPD?mood disorders?
How one thinks about the problem than just the problem itself that causes the depression Mood disorders can be overcome by cognitive bias
39
What are the 2 major cognitive theories in relation to mood disorders
Becks theory: Negative triad Hopelessness theory
40
What's Becks theory: Negative triad
A person gets negative schema in childhood through adverse experiences And the schema differs from conscious thoughts The schema influences how info is processed, ie. causes cognitive bias schema îs confirmed and maintain And the cycles of depression continues
41
What's Becks theory Negative triad
Negative view of self Negative view of future Negative view of the world
42
How's Beck's Theory Supported
People with depression demonstrate negative thinking People with negative cognitive styles are at an elevated risk of developing MDD Example: I am a failure
43
What is the hopelessness theory
1. Hopelessness is the expectation that a desirable outcome won't occur and nothing that the person will do will change that 2. Attribution: When someone experiences failure, they attribute it to a cause Internal Unstable Global
44
How's the hopelessness theory supported?
Example: college students said what exam result they hoped to get then the ones that did worse than expected had a negative mood 2 days later ppl who had a negative attributional style were still down Person w high levels of hopelessness 6 times more likely to experience MDD within 2 years
45
What's childhood adversity and its relation to mood disorders?
Adverse childhood experiences like abuse, neglect, parental loss, household dysfunction have been identified as major risk factors for mood disorders
46
Stressful life events and mood disorders
Stressful life events are a well established risk factor for depression more than half people report the experience of a serious life event in the year before their depression began NOTE: REVERSE CAUSATION- SOME STRESSFULL LIFE EVENTS MAY BE CAUSED BY SYMPTOMS OF DEPRESSION
47
What's the pharmacotherapy treatment for mood disorders?
Antidepressants like SSRIs Serotonin-noradrenaline reuptake inhibitors SNRIs
48
How to SSRIs work
Prevent the reuptake of serotonin so it can pass through neurotransmitters into the post-synaptic neutron.
49
How many people in the US who are receiving treatment for depression prescribed antidepressants?
75%
50
What's the efficacy of antidepressants?
Good but not great 37% of MDD patients achieve remission 30 percent respond to placebo selective reporting makes them look more effective than they are- publication bias
51
What are the issues with antidepressants?
Relapse after discontinuation of the drug 40% stop taking it in the 1st month due to side effects They're prescribed on the basis of trial and error and financial considerations Placebo response is a thing, but they do work( meta analysis shows every antidepressant on the market works better than placebo)
52
What are the medications for bipolar disorders 1 and 2?
Mood stabilisers- reduce manic symptoms Lithium typically given alongside other medication depending not he phase of illness
53
How do medications for bipolar disorder work?
How lithium works is largely unknown But it may help stabilise the mood by lowering excess noradrenalin in manic episodes and triggering serotonin In depressive ones
54
Whats the efficacy of lithium
up to 80 percent of bipolar 1 experience mild benefits for lithium
55
Concerns about lithium
High levels can be toxic Side effects: weight gain Increased thirst Giving antidepressants without lithium can cause a manic episode to begin in a bipolar patient.
56
What are the forms of therapy to treat mood disorders?
Electroconlcusive Therapy Psychological therapy
57
What's electroconvulsive therapy
Inuding a seizure by passing 130 volt current through the patients brain used to treat severe depression
58
Why is electroconvulsive therapy controversial
consent issueus Intesity may cause impairment Brutal experience: They're awake for it and experience bone fractures
59
Is electroconvulsive therapy still used today
Yeah but consent has improved and muscle relaxants and general anesthesia is given Highly effective for severe depression- better than medicine for resistant depression
60
What types of Psychological therapy is used
Psychoeducation CBT
61
What's CBT
examines thoughts feelings and behaviours and challenges them and finds ways to deal with them
62
What's the case example of CBT
John married man and father of 3, worked in a bank and then got fired For really depressed and feels different about his life Thought to be challenged: Loser Supporting evidence: Lost his job Evidence against: supported family for many years Balanced though: going through a rough patch but its up to me to turn it around
63
Which is better, psychological therapy or pharmacotherapy for depression?
Both effective Cognitive is better for preventing relapse Should be used combined: Antidepressants offer symptom relief quickluy Psychological therapy takes longer but skills learnt
64
Psychological treatment and bipolar
Medicine is necessary but can use targeted therapy or intervention to help
65
What's the treatment for disruptive mood dysregulation disorder?
Medication No medication approved Antidepressants-for irratiabilty and mood Stimulations- for irritability Antipsychotic medication- for aggression CBT for disruptive behaviour Behaviour therapy Parent training
66

Psychological disorder (20 decks)

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