Mood Disorders (COMPLETE) Flashcards
What is mood?
A prolonged emotional state
What are mood disorders?
Gross deviations in mood
What are mood disorders composed of?
Different types of mood episodes that last days or weeks.
What are the types of mood episodes?
Major depressive episodes-lose limit of normal mood
Manic episodes- top limit of normal mood
Hypomanic episodes- upper limit of normal mood
What is the DSM 5 criteria for Major Depressive Mood Disorder?
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
Why is clinical judgement important when diagnosing major depressive disorder?
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
What did persistent depressive disorder used to be called?
dysthymia
What is the DSM 5 criteria for persistent depressive disorder?
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
What’s the defining feature of persistent depressive disorder?
Chronicity
What are the new depressive disorders?
Disruptive mood dysregulation disorder
Premenstrual dysphoric disorder
Prolonged grief disorder
What is Disruptive mood dysregulation disorder
Recurrent temper outbursts and persistent negative mood for at least 1 year BEGINNING BEFORE AGE 10
What is premenstrual dysphoric disorder?
Mood symptoms the week before menses
Can get hormonal treatments or SSRIS
What’s the prevalence of depressive disorders?
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.
What are the possible reasons for gender differences in depressive disorders?
Stress in adolescence- body image, puberty etc
Girls are more likely to be victims of sexual abuse
Rate of reporting may be higher
What are common misconceptions about bipolar disorder?
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.
What is the criteria for manic and hypomanic episodes?
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):
- increased self esteem- belief that one has special talents
- Decreased need for sleep
- Unusual talkativeness
- Flight of ideas/thoughts racing
- Distractability
- Increase in goal directed activity
- excessive involvement in activities that have high pain consequence
What’s the difference between manic v hypomanic?
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
What are the 3 kinds of bipolar disorder?
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
What’s the prevalence of bipolar disorder?
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
What are some specifiers for the subtypes of depressive and bipolar disorders?
Seasonal pattern
Psychotic features
Suicide risk
Atypical features
What is the genetic aetiology for Major depression and bipolar disorders?
Heritability of major depression is 37%
Bipolar disorders are amongst the most heritable of all psychiatric disorders - 80- 93
What is the controversy over single gene studies
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
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?
Yes
no
No
What do most people believe depression is caused by
A chemical imbalance
What neurotransmitters are said t be involved in the aetiology of mood disorders
Monoamine neurotransmitters:
Dopamine
Noradrenaline
Serotonin
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
What are the most researched areas of the brain?
Amygdala
Striatum
Hippocampus
Frontal cortex
What’s the amygdala responsible for
Evaluating the salience of stimuli and regulating emotions
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
What’s the stratum responsible for
Reward processing and motivation
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
What was found in relation to Bipolar disorder and the stratium
Show increased activity in the stratum and they are highly sensitive to rewards
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
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
What can trigger the HPA axis
Increased amygdyla reactivity
What does the hippocampus do?
Its partially susceptible to stress cuz its densely concentrated with cortisol receptors
What was found in relation to MDD and the hippocampus
Smaller hippocampal volumes in MDD patients
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
What are the 2 major cognitive theories in relation to mood disorders
Becks theory: Negative triad
Hopelessness theory
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
What’s Becks theory Negative triad
Negative view of self
Negative view of future
Negative view of the world
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
What is the hopelessness theory
- Hopelessness is the expectation that
a desirable outcome won’t occur and nothing that the person will do will change that - Attribution: When someone experiences failure, they attribute it to a cause
Internal
Unstable
Global
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
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
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
What’s the pharmacotherapy treatment for mood disorders?
Antidepressants
like SSRIs
Serotonin-noradrenaline reuptake inhibitors SNRIs
How to SSRIs work
Prevent the reuptake of serotonin so it can pass through neurotransmitters into the post-synaptic neutron.
How many people in the US who are receiving treatment for depression prescribed antidepressants?
75%
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
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)
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
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
Whats the efficacy of lithium
up to 80 percent of bipolar 1 experience mild benefits for lithium
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.
What are the forms of therapy to treat mood disorders?
Electroconlcusive Therapy
Psychological therapy
What’s electroconvulsive therapy
Inuding a seizure by passing 130 volt current through the patients brain
used to treat severe depression
Why is electroconvulsive therapy controversial
consent issueus
Intesity may cause impairment
Brutal experience:
They’re awake for it and experience bone fractures
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
What types of Psychological therapy is used
Psychoeducation
CBT
What’s CBT
examines thoughts feelings and behaviours
and challenges them and finds ways to deal with them
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
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
Psychological treatment and bipolar
Medicine is necessary but can use targeted therapy or intervention to help
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
