VII - Mood Disorders I

Question 1

Defining feature of mood disorders

Answer 1

Abnormal mood/affect

Question 2

Two key moods

Answer 2

Mania and depression

Question 3

Unipolar depressive disorders

Answer 3

Person experiences only depressive episodes

Question 4

Bipolar disorders

Answer 4

Both manic and depressive episodes

Question 5

Loss/Bereavement

Answer 5

In DSM-IV, there was a 2 month bereavement exclusion for depression. In DSM-V, exclusion removed.

Question 6

Postpartum “blues”

Answer 6

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.

Question 7

6 Depressive Disorders

Answer 7

(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

Question 8

Mild depression - adaptivity

Answer 8

Brief periods of depression can be adaptive and normal. Allow us to be still, reflect

Question 9

Persistent depressive/dysthymic disorder

Answer 9

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

Question 10

Episodes - diagnostic codes

Answer 10

Mood episodes alone do not have diagnostic codes - not diagnosed as separate entities. They are building blocks for disorder.

Question 11

Major depressive disorder - two types

Answer 11

Single Episode and Recurrent

Question 12

Major depressive episode criteria

Answer 12

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

Question 13

Significant loss

Answer 13

Decision of whether it is depression rests on judgment based on individual’s history and cultural norms in context of the loss.

Question 14

Major Depressive Disorder Criteria

Answer 14

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

Question 15

Specifiers for major depressive episodes

Answer 15

Episodes may have melancholic, psychotic, atypical, catatonic, seasonal features.

Question 16

Recurrence

Answer 16

Most episodes remit (meaning no symptoms for 2+ months) for average period of 9 months. Usually will recur/chance high. Recurrence vs relapse.

Question 17

Biological Causal Factors of unipolar mood disorders

Answer 17

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.

Question 18

Neurochemical factors of unipolar mood disorders

Answer 18

Monoamine Theory of Depression - depletion of norepinephrine, serotonin. However, not all individuals resp to antidepressants, not all show decreased monoamines

Question 19

SSRIs

Answer 19

Selective Serotonin Reuptake Inhibitors - prevent serotonin reuptake to treat depression according to monoamine theory.

Question 20

Psychological factors in unipolar mood disorders

Answer 20

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.

Question 21

Psychoanalytic theories of depression

Answer 21

Anger turned inwards due to real or imagined loss

Question 22

Behavioral theories of depression

Answer 22

Responses no longer lead to positive reinforcement, so rate of negative experiences increase. State of depression may be rewarded.

Question 23

Learned helplessness and reformulated helplessness

Answer 23

If you shock a dog and prevent it from ever escaping, it will lose the will to escape when given the chance.

Question 24

Hopelessness Theory

Answer 24

Pessimistic attributional style and negative events not enough - must also have hopelessness

Question 25

Ruminative responses towards depression

Answer 25

Repetitive, passive responses that may drive depression.

Question 26

Interpersonal correlates of depression

Answer 26

Isolation, lack of support, skill deficits may contribute. Spouse may trigger relapse with criticism. Depressed parent -> at-risk children

Question 27

Beck’s Negative Cognitive Triad

Answer 27

The self; the world; the future

Question 28

Beck - negative cognitive biases in depression

Answer 28

Dichotomous reasoning (extremes); selective abstraction (focusing on one negative); arbitrary inference

Question 29

CBT Thought Record

Answer 29

Challenge automatic negative thoughts that flow from a core negative belief