Week 6 Flashcards
What is a major depressive episode?
- Major depressive with melancholic features
- Severe major depressive episode with psychotic features
- Major depressive episode with atypical features
- Recurrent depressive episode with a seasonal pattern
What is a manic episode? (6)
A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week
3 or more symptoms (4 if mood is irritable) need to be present
Inflated self-esteem
Decreased need for sleep
More talkative than usual
Flight of ideas or racing thoughts
Distractibility
Increase in goal directed activity, or psychomotor agitation
Excessive involvement in pleasurable activities that have a high potential for painful consequences
Mood disturbance causes significant impairment in functioning or social activities or relationships with other or necessitates hospitalization or psychotic features
What is a hypomanic episode?
Same criteria of manic episode although duration is a minimum of 4 days
What is a mixed episode
– where a person experiences symptoms of depression and mania together
What is Major Depressive Disorder?
Five or more present for 2-week period (one has to be 1 or 2)
Depressed mood most of the day, nearly every day (in children/adolescents can be irritable mood)
Markedly diminished interest or pleasure in all, or almost all activities most of the day, nearly everyday
Significant weight loss or gain or decrease or increase in appetite
Insomnia or hypersomnia everyday
Psychomotor agitation or retardation (don’t move) nearly everyday
Fatigue or loss of energy nearly every day
Feelings of worthlessness or excessive guilt nearly every day
Diminished ability to think or concentrate or indecisiveness nearly everyday
Recurrent thoughts of death, suicidal ideation, suicide attempt
What is Cyclothymic Disorder
Mild depressive symptoms alternating with hypomanic symptoms over 2 years
Hypomanic and depressive periods present for half the time and not absent for more than two months at a time.
Milder chronic version of bipolar disorder
Not being abstinence for more than 2 months at a time
What is Persistent Depressive Disorder?
Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years
Note: in children and adolescents, mood can be irritable and duration must be at least 1 year
Presence, while depressed, of two (or more) of the following
Poor appetite or overeating
Insomnia or hypersomnia
Low energy or fatigue
Low self-esteem
Poor concentration or difficulty making decisions
Feelings of hopelessness
What is double depression?
Major depressive episodes and dysthymic disorder
Dysthymic disorder usually develops first
What is Bipolar 1?
Full blown mania (with or without depression)
Presence of at least 1 manic or mixed episode
Specify nature of most recent episode
Specifiers for current episode
Mild
Moderate
With psychotic features
Over 50% experience psychotic features at some point in lifetime
Course specifiers
Seasonal pattern
Rapid-cycling (at least 4 mood episodes in 12 months)
What is Bipolar 2?
Milder version of mania (hypomania)
Presence of one or more MDE
Presence of at least one hypomanic episode
Same criteria of manic episode although duration is a minimum of 4 days
The episode causes change in functioning which is observable by others
No marked impairment of functioning or hospitalization
There has never been a manic episode
Symptoms cause a change in functioning observable by others
What events may lead to depression?
Genetic vulnerability
Link between cortisol and depression
There are differences in the brain as well
Left anterior prefrontal cortex damage leads to depression
Depressed individuals show lower levels of electroencephalographic activity in the left hemisphere and higher levels in the right hemisphere ie left frontal asymmetry
Stressful life events
Context of event
Meaning of event
Recall bias
Severe and/or traumatic life events
Onset of depression
Poorer treatment response, delayed remission and greater likelihood of recurrence when life stress occurs before or early in the episode
Types of events likely to lead to depression
Break up of relationship
Twin studies show that 10 times increased risk if death of loved one
20 times increased risk if humiliated by loss
What is the reciprocal gene environment model?
Depressed individuals create or seek out stressful situations
Stress triggers depression
What is beck’s theory of depression
Negative coping styles
Depressed persons engage in cognitive errors
Tendency to interpret life events negatively
Types of cognitive errors
Arbitrary inference → overemphasize the negative
Overgeneralization → negative apply to all situations
Cognitive errors and the negative cognitive triad
Think negatively about oneself
Think negatively about the world
Think negatively about the future
At the core of all cognitive theories: maladaptive thinking
What medications are used for major depression
Tricyclics
Was frequently used for severe depression
Blocked reuptake of norepinephrine
Worked about 50% but had many side effects and could be used to overdose
MAO-I
Selective serotonin Reuptake inhibitors
Prozac, paxil
Intranasal esketamine- acts rapidly on depression symptoms
Antipsychotic and anticonvulsants
What medications are used for bipolar
Lithium
Common salt
50% respond (a significant reduction 50% in mania)
May help in prevention of future episodes in over 60% of patients
Some unpleasant side effects can be seen such as lethargy, decreased motor coordination, and GI difficulties; long term use can cause kidney damage
Difficult to comply
Unsure of mechanism of action
Narrow therapeutic window
Too little → ineffective
Too much → toxic, lethal
Anticonvulsants (carbamazepine, divalproex, and valproate)
If lithium doesn’t work
Not as effective in reducing suicide
