VII - Mood Disorders I Flashcards
Defining feature of mood disorders
Abnormal mood/affect
Two key moods
Mania and depression
Unipolar depressive disorders
Person experiences only depressive episodes
Bipolar disorders
Both manic and depressive episodes
Loss/Bereavement
In DSM-IV, there was a 2 month bereavement exclusion for depression. In DSM-V, exclusion removed.
Postpartum “blues”
More common than postpartum depression - emotional lability, easy crying, irritability mixed with happy feelings. Major depression in women who have given birth no more frequent than matched women who have not given birth. DSM has a “postpartum onset” specifier if depressive symptoms within 4 weeks of birth.
6 Depressive Disorders
(1) Disruptive Mood Dysregulation Disorder
(2) Major Depressive Disorder
(3) Persistent Depressive Disorder (Dysthymia)
(4) Premenstrual Dysphoric Disorder
(5) Substance/Medication-Induced Depressive Disorder
(6) Depressive Disorder Due to Another Medical Condition
Mild depression - adaptivity
Brief periods of depression can be adaptive and normal. Allow us to be still, reflect
Persistent depressive/dysthymic disorder
Mild/moderate version of depression that lasts a long time - chronicity. Symptoms must persist more than 2 years. Intermittent, brief normal moods. Lifetime prevalence - 2.5-6%. Average duration - 4-5 years. 50% onset before 21
Episodes - diagnostic codes
Mood episodes alone do not have diagnostic codes - not diagnosed as separate entities. They are building blocks for disorder.
Major depressive disorder - two types
Single Episode and Recurrent
Major depressive episode criteria
A. 5 or more of following symptoms in period of 2 weeks; one must be 1 or 2 - (1) Depressed most of day, nearly every day; (2) Diminished interest/pleasure in most activities; (3) Weight loss or gain; (4) Insomnia or hypersomnia nearly every day; (5) Psychomotor agitation or retardation; (6) Feelings of worthlessness/guilt; (7) Fatigue; (8) Diminished cognitive powers or indecisiveness; (9) Suicidal thoughts
B. Clinically significant distress or impairment
C. Symptoms not from medication or another medical condition
Significant loss
Decision of whether it is depression rests on judgment based on individual’s history and cultural norms in context of the loss.
Major Depressive Disorder Criteria
At least one Major Depressive Episode; MDE not better accounted for my Schizoaffective Disorder and not superimposed on a psychotic disorder; never manic or hypomanic
Specifiers for major depressive episodes
Episodes may have melancholic, psychotic, atypical, catatonic, seasonal features.
Recurrence
Most episodes remit (meaning no symptoms for 2+ months) for average period of 9 months. Usually will recur/chance high. Recurrence vs relapse.
Biological Causal Factors of unipolar mood disorders
Family/twin studies suggest moderate genetic contribution. Altered neurotransmitter activity in several system. Cortisol. May be low activity in left anterior or prefrontal. Serotonin-transporter gene.
Neurochemical factors of unipolar mood disorders
Monoamine Theory of Depression - depletion of norepinephrine, serotonin. However, not all individuals resp to antidepressants, not all show decreased monoamines
SSRIs
Selective Serotonin Reuptake Inhibitors - prevent serotonin reuptake to treat depression according to monoamine theory.
Psychological factors in unipolar mood disorders
Stressful life events (independent vs dependent life events, which have stronger impact). Diathesis-stress model. Genetics, gender, neuroticism, early adversity/parental loss can be risk factors. Chronic stress.
Psychoanalytic theories of depression
Anger turned inwards due to real or imagined loss
Behavioral theories of depression
Responses no longer lead to positive reinforcement, so rate of negative experiences increase. State of depression may be rewarded.
Learned helplessness and reformulated helplessness
If you shock a dog and prevent it from ever escaping, it will lose the will to escape when given the chance.
Hopelessness Theory
Pessimistic attributional style and negative events not enough - must also have hopelessness
Ruminative responses towards depression
Repetitive, passive responses that may drive depression.
Interpersonal correlates of depression
Isolation, lack of support, skill deficits may contribute. Spouse may trigger relapse with criticism. Depressed parent -> at-risk children
Beck’s Negative Cognitive Triad
The self; the world; the future
Beck - negative cognitive biases in depression
Dichotomous reasoning (extremes); selective abstraction (focusing on one negative); arbitrary inference
CBT Thought Record
Challenge automatic negative thoughts that flow from a core negative belief
