Mood / Personality Disorders Flashcards
Major Depressive Disorder Symptoms
Depressed mood or diminished interest/pleasure for Symptoms: weight gain/loss, sleep issues, psychomotor agitation/retardation, fatigue, feelings of worthlessness or excessive guilt, loss of concentration recurrently morbid thoughts/plans.
Diagnosis of MDD
5 of 9 symptoms for 2 week episodic period, as well as a noticeable change from previous function. Codes as mild/moderate/severe, with/without psychotic symptoms, with/without postpartum onset, and with/without seasonal patterns.
Persistent Depressive Disorder (Dysthymic Disorder)
Mild or severely depressed throughout most of the day most days for >2 years. No manic episodes unlike MDD, and generally milder symptoms than MDD. Onset: often follows major depression in early adulthood (75% within five years of MDD). High rates of self-medicating substance abuse.
MDD Prevalence and Onset
2F:M. 3x risk factor to poor, though unrelated to race or education. Onset: 1st episode often in early 20s, and at least 60% of those with 1st episode have a second (70% to have third, 90% have fourth)
MDD Specifiers
Anxious mood concurrent with insomnia, concentration issues. Psychotic features. Seasonal patterns (Seasonal Affect Disorder, maybe linked to circadian rhythm). Post-/Peri-Partum Onset (3-6% of women. Often anxious with panic attacks due to hormonal changes and sleep deprivation).
Premenstrual Dysphoric Disorder
Depressive symptoms the week before menstruation that recede afterwards. Total 5 symptoms from two lists of 4 and 7 respectively, including mood swings, irritability, depression, anxiety, lethargy, appetite changes, overwhelmed, etc. 1.8-5.8% of menstruating women. Controversial in that it medicalizes normal moods in menstruating women.
Culture and Depression
In some non-western civilizations, depression is expressed as a somatic issue rather than an emotional one, characterized by fatigue, sleep loss, headaches, etc. In Africa, it is the 2nd leading cause of disability, and is more common in Zimbabwe than US, despite the closest translation for a word for depression being “thinking too much” or “heavy heart”
Depression in Children and Adolescents
m.
<20% of teens may have depressive episode of one point. Children present symptoms as irritability, aggression.
Disruptive Mood Dysregulation Disorder
Severe pattern of irritability or rage with outburts 3x a week for >1 yr in more than one setting ******
Freud’s Psychodynamic Theory of Depression
Early or imagined loss -> early needs not met -> early trauma -> hypersensitivity to loss.
Klerman’s Interpersonal Approach (Psychodynamic) to Depression
Past and present relationships associate with depression. People are most vulnerable to depression when bonds are disrupted or there is a threat of loss. Based on Bowlby’s Attachment Theory
Psychodynamic Research in Depression
Death of a parent can lead to depression. Variables of severity include quality of parenting before/after loss, and psychopathology. If it is a parent of the same sex, it is more intense.
Learning and Behavioral Theory of Depression
Reduction in number and frequency of social reinforcers. Backed up by evidence of a positive correlation between social rewards and depression
Learned Helplessness (Learning/Behavioral) + Seligman’s Dogs
Three groups of dogs who were shocked on the paws. 1st could escape, 2nd could not, 3rd was control. When given the opportunity to escape, 1 and 3 did so, but 2 was slow to learn to escape and had human depressive symptoms. In humans: external locus of control.
Negative Cognitive Set (Cognitive Theory)
Theory of Beck. Thinking patterns associated with depression are known as a negative cognitive set, and change in thoughts leads to change in mood. Contains the “negative triad”: Negative thoughts about self, world, and future.
Distressed Patterns of Thinking (Cognitive)
Overgeneralization, Selective Abstraction (occupation with minor negatives despite major positives), Arbitrary Inferences (conclusion based on no evidence), Magnification/Minimization (magnify mistakes, minimize achievements)
Factors Related to Depression (Research)
Stress, marital dissatisfaction, interpersonal problems with family (high EE -> relapse), social support, intimacy, if a caretaker to children, unemployed.
Stress and Depression
High relation with depression. A strong indicator of initial depression rather than later relapses. Reciprocal pattern: depressed individual purposefully places themselves in stressful environments
Employment/Marriage/Gender and Depression
Highest rates: unemployed, divorced women. Lowest rates: employed, married men. No difference in widows
Genetics and Depression
Twin studies: 37% heritability, higher in inpatients and women. Thus, a moderate to minor role in depression. Gene: 5HTT on Chrom 17
Biogenic Amines
Catecholamines (DA, NE) and Indole Amines (5HT)
Early NT Theories of Depression
1) Low levels of NE -> depression, high levels -> mania
2) Low levels of 5HT -> Depression.
Theories were based on antidepressant actions, but debunked as the action of the drugs would take over a week to work despite the neurotransmitters improving immediately.
Anti-Depressants
Tricyclics: Raise NE and 5HT by blocking reuptake.
MAOIs: Raise NE and 5HT by preventing breakdown.
Reserpine: Causes depression by reducing levels of all biogenic amines
Revised NT Theories of Depression
Focus on post-synaptic receptor sensitivity as well as the insides of neurons. Focus on deficiencies in Brain Derived Neurotrophic Factor which is a growth factor for neurons, possibly helped by exercise.
Hormonal Imbalance and Depression
Malfunction of hyptothalamus (4 F Drives), high cortisol levels can affect depression. The hypothalamus pituitary axis (HPA Axis) can also affect MDD and PTSD if it is disregulated by childhood stress or maltreatment.
Sleep Disturbance and Depression
Common to have hyper or hyposomnia, also abnormalities in sleep stages, known as “shortened REM latency” when it takes longer to enter REM sleep.
Bipolar Affective Disorder
Includes manic episodes, hypomanic episodes, depressive episodes, and normals states with varied cycle times.
Manic Episode
Elevated, expansive, irritiable mood for < 1 week.
Diagnosis: 3+ of list (4 if irritable): increased self esteem, less sleep, more talkativeness, scattered thoughts, distractability, increased activity or agitation, excessive pleasurable activities with high risks, marked impairment in function, and possibly psychotic features.
Hypomanic Episode
Same symptoms as manic episode, but less severe and for < 4 days. Uncharacteristic behavior noticeable by others, but no psychosis.
Bipolar I
At least one manic episode and one depressive episode. 50% have 4+ manic episodes of mixed moods.
Bipolar II
> 1 manic and > 1 depressive episode
Cyclothymic Disorder (Cyclothymia)
> 2 years of frequent mild depression and hypomania where symptoms are felt at least half the time.
Onset of Bipolar Disorder
Bipolar I: 18 (DSM V)
Bipolar II: 19-22 (DSM V)
15-44 most common.
Prevalence of Bipolar Disorder
Lifetime Bipolar: s 1st episode: depression (usually more depressive with more common rapid cycling).
Comorbidity of Bipolar Disorder
Substance Abuse, eating disorder, ADHD, panic, social anxiety, borderline personality disorder (II)
Suicide: rate is 15x gen. pop. 1/3 attempt, 15-20% are successful (esp. BPI)
Bipolar Disorder and Chidlren
Increased diagnoses since 90s, ‘03. 33% of BP adults reported symptoms for tantruming kids (DMDD). Overmedicalized as 1/2 get antipsychotics, 1/2 get mood stabilizers, others.
Psychological Theories of Bipolar Disorder
Mania acts as a defense against depression/low self-esteem.
Biological Theories of Bipolar Disorder
Sodium Ion Instability Theory: Issues with action potential membrane potential as neurons fire too easily, leading to mania, or don’t fire enough, leading to depression. Treated with Lithium and protein Kinase C helps with membrane permeability.
NT theory not certain.
Genetic Theories of Bipolar Disorder
High heritability, even higher than unipolar depression. Among 1st degree relatives, <25% have mood disorder, likely depression.
Twin Studies: MZ: 40-70%. DZ: 5-25%
Tricyclic Therapy for Depression
Block NE and 5HT reuptake, altering receptor sensitivity. Helps 50-60% of patients, though none with dysthymia. Takes 10 days to kick in with some low risk side effects. Ex: Imipramine
MAOI Therapy for Depression
Block MAO coenzyme from degrading NE. Side effects: increased blood pressure with high tyramine foods (aged foods, bananas). Also inhibits the MAO in the liver and digestive system.
2nd Gen. Antidepressant Therapy for Depression
SSRIs (5HT inhibitors). Helps 50%. Ex: Prozac, Zoloft, Lexapro, Celexa. Better than MAOIs with less severe, though similar side effects.
Newer Gen. Reuptake Inhibitor Therapy for Depression
NRI (NE only): Straterra. SNRI (5HT and NE): Effexor, Cymbalta. NDRI (NE and DA): Welbutron.
Efficacy of Drug Therapy on Depression
50-70% of adults improve after drug therapy from any of the 3 major types of drugs. Less research and less effectiveness in children.
Electroconvulsive Therapy
Unilateral electrode on brain induces a seizure. Used as a last ditch therapy after drug and cognitive therapies have failed. While successful as a therapy, can lead to memory problems. .5-6 min shock for 6 sessions.
Transcrainal Magnetic Stimulation (Brain Stimulation Therapy)
Electric coil sends a current through the prefrontal cortex in daily sessions. Very new therapy (2008). Other versions: Vagus Nerve Stimulation, Deep Brain Stimulation.
Lithium Therapy for Bipolar Disorder
A blood salt, lithium reduces mania and some depression by affecting (substituting) sodium ions, often coupled with psychotherapy. Issues: Therapeutic dose is very close to toxic dose requiring blood tests, and it does not help unipolar depression. Side effects: shaky hands, weight gain, nausea and vomiting and diarrhea (toxicity).
Anti-seizure Drug Therapy for Bipolar Disorder
Acts as a stabilizer
Cognitive Therapy for Depression
Have the client recognize and change automatic negative thoughts as behavior and feelings are determined by understanding of the world. 50-60% with depression helped. Therapy includes: increasing activity, exploring automatic thoughts by asking open ended questions, and developing and practicing alternative cognitions in the real world.
New-Wave Cognitive Therapy for Depression
Acceptance and Commitment Therapy.
Interpersonal Psychotherapy for Depression
Based on the work of Klerman and Weisman, IPT focuses on relationships in a psychodynamic format. Explores 4 problem areas in depression: Grief, Interpersonal Disputes, Role Transitions, and Interpersonal Deficits. 50% improve.
NIMH Study on Treatment
Of four groups of bipolar clients, each was given CBT, IPT, Tricyclics and support, or a placebo and support. Results found that all three treatments were equally beneficial and better than the placebo.
Bipolar Research
Keller et al (2000):
Meds: 48% improvement
CBT: 48% improvement
Combined: 73% improvement
Personality Disorders
Inflexible, maladaptive, enduring patterns of perceiving, thinking about, and relating to an environment/people
Diagnosis of Personality Disorders
Enduring pattern of inner experience and behavior. A pattern in 2+ of: cognition, affectivity, interpersonal function, and impulse control.
Prevalence of Personality Disorders
9-13% of adults (questionable because many with PD do not come into much contact with law/medicine)
Interrater Reliability of Personality Disorders
.69-/97 depending on disorder. High reliability tied to tighter definitions and use of structured interviews.
Categorical Problems of Personality Disorders
1 Not as stable as DSM suggests, due to varied test-retest reliability (high: anti-social dis. low: schizotypal)
2 50% diagnoses meet criteria for other personality disorder
3 High comorbidity with other types of disorders (2/3 meet “lifetime criteria”, meaning they will meet criteria of another at some point in life)
Clusters of Personality Disorders
Cluster A: Odd, Eccentric, Detached. More common in males.
Cluster B: Dramatic, erratic, extremely emotional, attention seeking.
Cluster C: Anxious, fearful, obsessive
Paranoid Personality Disorder
Cluster A. Pervasive, unwanted suspiciousness, cold, jealous (males). Rarely seek relationships, have problems at work.
Schizoid Personality Disorder
Cluster A. Withdrawn, reclusive, cold, apathetic, rarely seek treatment
Schizotypal Personality Disorder
Cluster A. Scattered thoughts, mild schizophrenic tendencies, poor social skills.
Histrionic Personality Disorder
Cluster B. Overly reactive/emotive, egocentric, perceive self as “star” or “victim”. Does seek therapy, though often due to drug use.
Narcissistic Personality Disorder
Cluster B. Extreme self of self-importance or entitlement.
Borderline Personality Disorder
Cluster B. Instability of moods, self-image. Impulsive, has fears of abandonment. Some genetic component (5x higher among family members). Major etiological theory: Diathesis Stress Model wherin biological vulnerability leads to emotional dysreguation combined with “invalidating environment”. 75% women. 2% lifetime. 1-2.5% gen pop.
Antisocial Personality Disorder
Cluster B. Lack of remorse and high tendency towards lying. High rates of sub abuse, rarely seek therapy outside of mandates. High association with crime and violation of others’ rights. Often has a conduct disorder before 15. 3% of M, <1% of F.
Avoidant Personality Disorder
Cluster C. Symptoms include fear of rejection, restricted activity, and fear of being seen in a bad way.
Dependent Personality Disorder
Cluster C. Passively allows other to assume responsibility for life decisions due to lack of confidence/ a belief that they can’t function independently. Subordinate own needs to others. Anxiety, helpless, empty feeling when alone. More common in F
Obsessive Personality Disorder
Cluster C. Rigid, restricted, inflexible, often overly serious behavior. Perfectionistic, occupied with work, rules, efficiency, and doing things own way. Not obsessive like OCD. Twice as common in men. Tend to not seek treatment
Treatment for Personality Disorders
PD generally resistant to treatment, varies by disorder. Difficulties in relationships -> difficulties establishing trust with therapist. Medication varies by disorder and comorbidity. Often anti-depressants, anti-anxiety, mood stabilizers, some anti-psychotics
Outpatient Therapy for Personality Disorder
Cognitive especially, though some use of behavioral and psychodynamic therapy.
Dialectic Behavior Therapy for BPD
Dialectic: Acceptance of what you have done and changing the behavior. Integrates cog, beh, mindfulness, and client centered therapy with some psychodynamic. Outcome research shows that it can be very helpful.
