Moods Disorders Flashcards
1
Q
Symptoms
A
5+ symptoms during two week period
- Depressed mood most of the day
- Anhedonia
- Substantial weight loss/gain
- Insomnia or hypersomnia
- Psychomotor agitation or retardation
- Fatigue or loss of energy
- Feeling of worthlessness or excessive guilt
- Diminished ability to think or concentrate, indecisiveness
- Recurrent thoughts of death/suicide
2
Q
Persistent Depressive Disorder (dysthymia)
A
Chronic but less severe than MDD
3
Q
Bereavement exclusion
A
- Removed from DSM-5
- Greater professional autonomy or widening the boundaries of illness
4
Q
How is depression different than sadness?
A
- Mood change pervasive and persistent - doesn’t get better when engaging in activities that are usually pleasant
- No stimulus needed for mood change or change of mood disproportionate to stimulus
- Impaired social/occupational functioning
- Sensation different, like being “consumed by black cloud”
- No biomarkers yet
5
Q
Bipolar disorder
A
- Cycling between manic and depressive episodes
- Mania - exaggerated good mood
- Unrealistic belief in own abilities, extra creativity
- Talkativeness, gregariousness, and flirtatiousness
- Decreased need for sleep, psychomotor agitation
- Irritability
- Flight of ideas, distractibility
- Increase in goal-directed activity (socially, professionally)
- Excessive involvement in pleasurable activities with high potential for painful consequences
- Crash
- Individual may experience psychosis
- Hypomania - “super-functional semi-mania” (bipolar II)
- From 1996-2004, 56% spike in BD diagnosis. Over last decades, increase from 1% of general population to 4%
6
Q
Benefits?
A
Does mania inspire greatness?
Does depression give a pause for thought?
Do we celebrate mood disorders? Fetish for “mentally ill art”
7
Q
Premenstrual dysphoric disorder
A
In most menstrual cycles during past year, 5+ symptoms in week before menses:
- Affective liability (ex. mood swings, sensitivity to rejection)
- Irritability or increased interpersonal conflicts
- Depressed mood, feelings of hopelessness
- Anxiety, tension, feeling on edge
- Decreased interest in usual activities
- Subjective sense of difficulty in concentration
- Lethargy
- Change in appetite, overeating, or specific food cravings
- Hypersomnia or insomnia
- A subjective sense of being overwhelmed or out of control
- Physical symptoms (breast tenderness or swelling, joint or muscle pain, a sensation of “bloating,” weight gain)
8
Q
PMDD controversies
A
- What is the line between PMDD and PMS?
- Included in the DSM only after the launch of Sarafem
- Are we stigmatizing women and their bodies?
- Culture bound? A local language for expressing distress in an acceptable way
9
Q
Disruptive Mood Dysregulation Disorder (DMDD)
A
- Severe and recurrent temper outbursts, grossly disproportionate to situation
- Child must be between age 6-18 with symptoms beginning at age 10
- Between outbursts, children irritable and angry
- Observable by parents, teachers and peers (must be observed in 2/3 settings)
10
Q
DMDD controversies
A
- Replacement for for BD? Lack of improvement led to DMDD.
- Oppositional Defiant Disorder II? Described as “an ongoing pattern of anger guided disobedience, hostilely defiant behavior toward authority figures that goes beyond the bounds of normal childhood behavior”?
- Medicalizing childhood? Since 1990, 3x ADHD rates, 20x in autism diagnoses, 40x increase in childhood BD.
- An “untested diagnosis” –little field work done.
- Members of the DSM group on childhood resigned -Frances: “number one diagnosis to ignore…violates ‘Do no harm!
11
Q
Women and mood disorders
A
Women 3x more likely for depression, slightly more likely for BD (3:2 ratio).
– Gender differences in seeking treatment?–Hormones?
– Stressful life events, especially childhood adversity?
– Roles? Women play fewer roles or roles less fulfilling (tend to work in ‘marginal’ industries).
– Diagnostic bias
12
Q
The “Great Depression”
A
- From 1/10 000 to 1/10, diagnosed at a must younger age, making up 10% of global disability. …how can we explain this?
- Modernization (obesity, physical activity).
- Individualism and inequality –things that kept depression in check on the wane.
- “Victimology” –assigning blame to others and learned helplessness.
- “Preventing failure” may neutralize “good uses” of feeling bad:–Catapulting us into action.–“Flow.” –Failure makes successes much more real.
- By stressing that bad feelings should be avoided altogether, are we telling people not to persevere when life is difficult?- Or is this a false epidemic, based on diagnostic changes, greater recognition, and less stigma
13
Q
Theorized causes of mood disorders
A
- Life events related to loss & harm (depression) or disruption (mania).
- Beck’s negative schemes (learned misinterpretations of reality and the future).
- Interpersonal strife (isolation, self-criticism prompts hostility).
- Substance use (alcohol & depression; stimulants, anti-depressants & mania).
- Biological theories–Genetics (BP and MDD may share genetic risk), what role of environment?–Gut bacteria–Neurotransmitters
- Differences in experience & treatment point to multiple pathways to mood disorder
14
Q
Treatments
A
- Beck’s CBT (avoiding absolutes, negative self-perception)
- Psychodynamic (greater self-awareness)
- Drugs (SSRIs, SNRIs, tricyclics, MAOIs)–SSRIs purpose designed. Fewer side effects (weight gain, sexual dysfunction) than earlier drugs. Seen as less dangerous.
- Questions over safety (Healy) and efficacy (Kirsch, Moncrieff)–Mood stabilizers, anticonvulsants for BD.•Side effects (nausea, impaired coordination) limit compliance.
- ECT (contested)
15
Q
Why aren’t we getting happier?
A
- People living “more fulfilling” lives, greater access and ownership of “things.”
- Massive increase in availability of psychotherapies and antidepressants (but questions over safety [Healy] and efficacy [Kirsch, Moncrieff]).
- Were we just secretly miserable in the past? Are we ‘hardwired’ for misery? How can we explain the continual increase in depression in light of these ‘benefits?’
