Psychopathology Flashcards
Manic episode
- abnormally and persistently elevated, expensive, or irritable mood
- increased activity or energy
- lasts at least one week
- 3or + sxs: inflated self-esteem or grandiosity, decrease need for sleep, flood of ideas,
- marked impairment and functioning, a need for hospitalization to avoid harm to solve for others, and or the presence of psychotic features
Hypomanic
- abnormally and persistently elevated, expansive, or irritable mood
- increased activity or energy
- three or more symptoms of mania for at least 4 consecutive days
- symptoms are not severe enough to cause marked impairment or functioning, no psychotic features, and no need for hospitalization
Major depressive episode
- five or more characteristic symptoms
- at least one symptom being depressed, mood or loss of interest or pleasure in most are all activities
- symptoms last at least 2 weeks and cause significant distress or impairment in functioning
Bipolar 1
- at least one manic episode that may or may not have been followed by our proceeded by one or more major depressive or hypomanic episode
Bipolar II
- at least one hypomanic episode and at least one major depressive episode
Cyclothymic disorder
- numerous periods of depressive and hypomanic symptoms that do not meet the criteria for episodes
Etiology of bipolar disorder
- heredity
- neurotransmitter and brain abnormalities
- circadian rhythm, irregularities
Bipolar disorder and heredity
- twin, family, and adoption studies= strong genetic component
- twin studies report concordance rates of .67 to 1.0 for monozygotic twins and .20 for dizygotic twins
Neurotransmitters and bipolar disorder
Never Give Dogs Salad
- Norepinephrine
- glutamate
- dopamine
- serotonin
Brain abnormalities and bipolar disorder
- PHAB
-prefrontal cortex
- amygdala
- hippocampus
- basal ganglia
Circadian, rhythm regularities and bipolar disorder
- abnormalities in the sleepwake cycle, secretion of hormones, appetite, and core body temperature
Bipolar disorder and ADHD similarities
- distractibility
- irritability
- accelerated speech
Dxing ADHD & bipolar disorder in kids & adolescents
- consider symptoms that do not overlap with ADHD, symptoms and children and adolescents
- for youth 7 to 16, manic specific symptoms are elation, grandiosity, flight of ideas/ racing. Thoughts, decreased need for sleep, and hypersexuality
Hypersexuality
- preoccupation with sex
-using sexually explicit language, engaging
-developmentally inappropriate sexual behaviors
Differential diagnosis of ADHD and bipolar disorder and adults
- euphoric, elevated, or irritable mood
- increase self-esteem or grandiosity
- distractibility caused by thought. Acceleration
- decreased need for sleep usually without physical discomfort
ADHD symptoms in adults
- label, dysphoric mood
- increased self-esteem or grandiosity
- distractibility due to wandering of thoughts
- fatigue
- discomfort after loss of sleep
Increase sexuality and bipolar disorder and adults
- confirmed by research to be common during a manic episode.
ADHD and increased sexuality
- inconsistent findings and research
- finding suggest ADHD is not associated with increased sexual activity but higher rates of sexual disorders and greater involvement in risky sexual behaviors
Treatment of bipolar disorder
- combination of psychosocial interventions and pharmaco therapy
Evidence-based psychosocial interventions for bipolar disorder
- psycho education
- interpersonal and social rhythm therapy
- CBT
- family focus therapy (high expressed emotion by family members. Trigger relapses)
Pharmacotherapy in bipolar disorder
- lithium
- anti-convulsive drug
Lithium
- most effective for classic bipolar disorder
Classic bipolar disorder
- Low likelihood of mixed moon states and rapid cycling
- long periods of recovery between episodes
- on set between 15 and 19 years old
Anti-convulsant drugs
- carbamazepine
- valparic acid
- second generation antipsychotic drugs
- most effective for a typical bipolar disorder
Atypical bipolar disorder
- mixed mood states
- rapid cycling
- lack of full recovery between episodes
- on set between 10 to 15 years old
Specifiers of bipolar disorder
- with a typical features
- mood reactivity and at least two of the following: significant weight gain or increase in appetite, hypersomnia, lead in paralysis, and interpersonal rejection sensitivity
Major depressive disorder
- 5 or more symptoms of a major depressive episode for at least 2 weeks
- at least one symptom is depressed, mood or loss of interest or pleasure in most or all activities
Sigecaps
Persistent depressive disorder
- depressed mood with two or more characteristics symptoms
- loss of appetite or overeating
- insomnia or hypersomnia
- feelings of hopelessness
- for at least 2 years in adults and one year and kids are adolescents
Disruptive mood dysregulation disorder
- severe and reoccurrent temper outburst that are verbal and or behavioral
- grossly out of proportion to situation or provocation
- occur three or more times a week
- persistently irritable or angry mood that is absorbable to others most of the day, nearly every day between outbursts
- sxs present for at least a year
Specifiers for major depressive disorder
- with peripartum onset
- with seasonal pattern
With peripartum onset
- symptoms begin during pregnancy or 4 weeks after delivery
Baby blues
- up to 80%
Major depressive disorder with peripartum onset
- 9% of pregnant people experience major depressive episode between conception and birth
- 7% experience a major depressive episode between birth and 12 months postpartum
Treatment of peripartum depression
- CBT
- interpersonal therapy
Both evidence-based practice
Antidepressants and peripartum depression
- effective especially sertraline
- several factors must be considered: effects of developing for developing fetus & newborns who are breastfed
& impact of untreated maternal depression on parent and child
Exercise and peripartum depression
- evidence that exercises reduces symptoms.
- research has found inconsistent results about the magnitude of effect due to differences in methodology
- meta analysis found that exercise alone has a non -significant beneficial effect on symptoms but exercise with co intervention with significantly more effective than co intervention alone
With seasonal pattern
- applies when there’s a temporal relationship between mood episode and time of year
- usually occurs in the winter
- hypersomnia, overeating, weight gain, and craving for carbohydrates
Cause of seasonal depression
- lower the normal serotonin and higher than normal levels of melatonin
Treatment of seasonal depression
- responsive to phototherapy
- exposure to bright light suppresses the production of melatonin
Depression in childhood
- Rachel of depression similar for boys and girls
Depression in adolescents
- females increase rate for males remain stable
- increase of hormone levels at puberty. Sense of times is females but desensitizes males to the stress of negative life events
Depression rates in adulthood
- higher rate for females persist into adulthood
- female adolescents and adults 1.5 to 3 times higher than male adolescents or adults
Etiology of major depressive disorder
- heredity
- neurotransmitter abnormalities
- hormone abnormalities
- brain abnormalities
- cognitive & behavioral factors
Heredity and major depressive disorder
- twin and adoption studies confirm genetic component
- concordance rate for unipolar depression.50 for monozygotic twins and .20 for dizygotic twins
. - concordance rates larger for female twin pairs equal sign.50 (Mono) and .34 (dy,) female and .40 (mono) .28 (diz) male
Neurotransmitters and major depressive disorder
- low serotonin, dopamine, and norepinephrine
Brain abnormalities and depression
- abnormous in the hypothalamic- adrenal access (HPA)
- structural and functional abnormalities in the cerebral cortex, singulate cortex, hippocampus, claudate nucleus, put them in, amygdala, thalamus, and other areas of the brain
HPA axis and depression
-exposure to chronic stress, especially in early life, leads to persistent hyperactivity of the HPA access and hypersecretion of cortisol, associated with increased risk for depression
Prefrontal, cortex and depression
- abnormally high levels of activity in the ventral medial, prefrontal cortex and abnormally low levels in the door. Cilateral prefrontal cortex
- commission of depression and response to psychotherapy or antidepressant leads to opposite pattern
Behavioral and cognitive explanations for depression
- Lewisohn’s social reinforcement theory
- selegmans learned helplessness model
- Beck’s cognitive theory
Lewinsohn’s social reinforcement theory
- low rate of response contingent reinforcement for social behaviors due to lack of reinforcement in the environment and or poor social skills cause depression
- lead to social isolation, low self-esteem, pessimism, and other symptoms of depression which further decrease the likelihood of positive reinforcement in the future
Seligman’s learned helplessness model
Original model: repeated exposure to uncontrollable negative events results in a sense of helplessness
- reformulation: negative cognitive style involves attributing negative life events to stable, internal, and global factors
- helplessness is approximal insufficient cause of depression which results in exposure to negative events and a negative cognitive style
Beck’s cognitive theory
- depression is caused by a cognitive triad that consists of negative thoughts about the self, world, and future
Age and depression
- factors are somewhat age related
- younger adults: genetics, stressful life events, limitations and problem solving, and other cognitive abilities
- older adults : chronic medical illness, especially likely when illness decreases physical functioning and contributes to social isolation
Major depressive do and culture & age
- older adults more likely to refer to somatic symptoms, cognitive changes, and loss of interest in usual activities
- younger adults affective symptoms
- non-western cultures report a larger number of somatic symptoms
- members of Western culture report a larger number of psychological symptoms
Comorbidity of major depressive disorder
- substance use disorder (alcohol use disorder)
- anxiety disorder
- personality disorder
Sleep abnormalities and major depressive disorder
- prolonged sleep latency (takes longer to fall asleep)
- reduced rem latency (shorter time from sleep on set to REM sleep
- reduced slow wave sleep (stages 3 &4)
- increased rem density (more rapid eye movements per unit of time)
Medical conditions and depression
- linked to coronary heart disease, stroke, diabetes, Parkinson’s disease, and other conditions
- bidirectional
Depression and heart attacks
- independently predictive of increased risk for myocardial infraction
- depression and anxiety most commonly developed after a myocardial infraction with depression more common
Treatment of major depressive disorder
- psychotherapy and/or pharmacotherapy
Research on the treatment of major depressive disorder
- combined treatment more effective than either psychotherapy alone or pharmacotherapy alone in terms of response and remission rates
- no significant difference between psychotherapy alone and pharmacotherapy alone
APA guidelines for treating children with depression
- insufficient evidence to recommend any particular psychosocial or pharmacological treatment
APA guidelines for treating adolescents with depression
- CBT or interpersonal psychotherapy for adolescence
- fluoxetine
- there is insufficient evidence to recommend either of these treatments over the other
APA guidelines for treating adults with depression
- offer patients either psychotherapy or a second generation antidepressant (SSRI or SNRI)
-CBT, mindfulness-based cognitive therapy (MBCT), IPT, behavioral therapy, psychodynamic therapy, and supportive therapy
- CBT or IPT + 2nd generation antidepressant as a combined treatment
Treatment of older adults with depression
- either group cognitive behavioral therapy or combination of IPT and a second generation antidepressant
- insufficient evidence for recommended self-guided bibliotherapy or life review therapy for older adults
St. John’s wort for depression
- research has shown it has similar therapeutic effects as SSRI for mild and moderate depression
- lower dropout rates and fewer side effects
- has not been shown to be effective for severe depression and can interact with certain drugs
Negative effects of St. John’s wort
- If taken with an SSRI can cause serotonin syndrome
- If taken with Xanax (alprazolam) or Wellbutrin (bupropion) or statin/immunosuppressant drugs can reduce effectiveness of those drugs
Ketamine and the treatment of depression
- effective as a fast acting treatment for treatment resistant, depression and suicidal ideations
-increases glutamate levels
- prescribed as a nasal spray (esketamine) and using conjunction with an oral antidepressant
- due to potential for severe side effects is self-administered under supervision of a healthcare provider and a healthcare setting
Electroconvulsive therapy for depression
- high success rate when you used to treats of your depression
- used when other treatments have not been affective or severity of symptoms requires a quick treatment response
Advantages of ECT
- higher response rate
- higher remission rate
- faster remission time
Response rate
- clinically meaningful reduction in symptoms
Remission rate
- the absence or near absence of symptoms
Reported response rate and remission rates for ECT
Response rate 80%
Permission rate 70%
Response rates and remission rates for psychotherapy and pharmacotherapy
-Response rate 30 to 60%
- remission rate 25 to 45%
Remission time of ECT
- one to three weeks
Remission rates for psychotherapy and pharmacotherapy
IPT, CPT 6 to 10 weeks
Antidepressants 4 to 12 weeks
Disadvantages of ECT
- can cause anterograre amnesia and retrograde amnesia
- anterograde amnesia resolves within a few weeks after last ECT session
- retrograde amnesia affects recently acquired memories more than remote memories and resolves weeks to several months after last ECT session with older memories returning before recent ones
-
Memory gaps and ECT
- many patients experience persistent gaps and memory for events that occurred pre-ECT
Retrograde amnesia and ECT
- more severe for bilateral placement of electrodes than for right unilateral placement and for larger number of treatment sessions and less time between sessions
Repetitive transcranial magnetic stimulation (rTMS)
- non-invasive technique
- uses magnetic fields to stimulate the left dorsolateral prefrontal cortex
- most often used for treatment resistant depression
Disadvantage of rTMS
- lower response and remission rates then ECT
ECT vs rTMS
-rTMS require sedation or memory loss
Tell a psychology and face to face psychotherapy for depression
- meta-analysis found to approaches had similar outcomes in terms of depressive symptoms. Severity, quality of life, client satisfaction, and the therapeutic alliance
Suicide in the US
- increased from 2000 to 2018
- decreased from 2018 to 2020
- rates consistently higher for males and females (three to four times higher for males from 2000 to 2020)
Overall suicide rates in 2020
Higher for individuals. 75 years old and up and American Indians/ Alaskan natives
- whites, Hispanics, blacks, Asian Pacific Islanders
Suicide rates and gender 2020
- highest rates for males was 75 years old and up
- highest rates for females was 45 to 64 years old
Suicide raids and ethnicity and age and 2020
- highest rates for American Indian/ Alaska natives, Hispanics, and black were 25 to 34 years old
- highest rates for whites was age 45 to 54
- highest rates for Asian Pacific Islanders was 85 and older
