Psychopathology chapter 7: mood disorders and suicide

depressive disorders

a group of mental health conditions, characterized by persistent low mood, loss of interest (anhedonia), and changes in thinking, behavior, and physical functioning

major depressive disorder (MDD)

a mood disorder characterized by one or more major depressive episodes with symptoms severe enough to cause distress or functional impairment, and not attributable to another medical condition or substance

mdd episode length

usually about 2 months

major depression specifiers

1. anxious distress - prominent anxiety symptoms

2. mixed features - presence of 3+ manic/hypomanic symptoms, but doesn’t meet criteria for manic episode.

anxious distress (MDD specifier)

prominent anxiety symptoms

mixed features (MDD specifier)

presence of 3+ manic/hypomanic symptoms, but doesn’t meet criteria for manic episode

seasonal affective disorder (SAD)

major depressive disorder with a seasonal pattern. history of at least two years in which major depression episodes occur during one season of the year (usually winter) and remits when the season is over.

persistent depressive disorder (PDD)

depressed mood for most of the day, for more days than not, for at least two years.

premenstrual dysphoric disorder (PMDD)

characterized by cognitive-affective and physical symptoms that occur in the week before period

disruptive mood dysregulation disorder (DMDD)

characterized by severe and chronic irritability, persistently negative mood, and severe temper outbursts. chronic, non-episodic irritability and temper tantrums disproportionate to the situation

bipolar disorder

characterized by the recurrent episodes of depression that alternate with mania or hypomania producing intermittent periods of typical mood.

bipolar 1

defined by the presence of at least one MANIC episode

mania

a distinct period of abnormally and persistently elevated, expansive, or irritable mood AND increased energy or activity, leasing at least one week.

bipolar 2

defined by at least one HYPOMANIC episode, at least one major depressive episode, and no history of mania.

hypomania

a milder form of mania seen in bipolar spectrum disorders. involves an elevated, expansive, or irritable mood, but is less severe than full mania and usually doesn’t cause sever impairment or psychotic features.

cyclothymic disorder

chronic mood disorder involving many periods of hypomanic symptoms and many periods of depressive symptoms that don’t meet the full criteria for hypomanic episodes or major depressive episodes

rapid cycling bipolar disorder

four or more mood episodes that meet criteria for manic, hypomania, or major depressive episodes within one year

dysphoria

a state of unease, dissatisfaction, or generalized unhappiness.

peripartum onset

a specifier for mood disorders indicating act the depressive episode begins during pregnancy or within 4 weeks after delivery

emotional lability

how quickly and unpredictably emotions shift

hypothalamic-pituitary-adrenal axis (HPA axis)

involved in the fight or flight response. Activation of the HPA axis causes secretion of glucocorticoids, which act on multiple organ systems to redirect energy resources to meet real or anticipated demand. normally, where we are confronted with a stressor, the hypothalamus releases corticotropin-releasing hormone (CRH) onto receptors on the anterior pituitary. this results in the secretion off corticotropin into the plasma in the bloodstream, stimulation got adrenal cortex to release cortisol into the blood. this process helps the body fight the stressor or flee from it. the hypothalamus has cortisol receptors that detect when cortisol levels have increased and normally responds by decreasing CRH to regulate the stress response. thus, this bio feedback loop both helps activate the hPA system during stress and calms the system when the stress is over. people with depression tend to show elevated levels, indicating chronic hyperactivity in the HPA acid and difficulty in the HPA axis retuning to normal functioning following a stressor.

neuroinflammation

inflammatory response within the brain or spinal cord that occurs in response to disease, injury, infection, or stress. it is likely that inflammation is a critical disease modifier that may promote susceptibility to depressive symptoms. research suggests that controlling inflammation in MDD clients may provide an overall therapeutic benefit, regardless of whether the inflammation is related to early life trauma. response to acute stressors, microbiome alterations, genetic predispositions, or a combo of trans diagnostic risk factors.

rumination

repetitive, passive focus on one’s distress, problems, or negative feelings without active problem solving

rejection sensitivity

a tendency to anxious expect, readily perceive, and strongly react to rejection from others

black box warning

the strongest safety warning required by the US FDA for perception meds

monoamines

a group of neurotransmitters derived from amino acids that contain one amine group, crucial for mood, arousal, and cognition.

• serotonin - mood regulation, anxiety, sleep, identity

• norepinephrine - alertness, stress response, energy, attention

• dopamine - motivating, rewards pleasure, movement

serotonin (monoamine)

modd regulation, anxiety, sleep, identity

norepinephrine (monoamine)

alertness, stress response, energy, attention

dopamine (monoamine)

motivation, reward, pleasure, movement

selective serotonin reuptake inhibitors (SSRIs)

a class of antidepressants that increase serotonin availability in the brain by blocking its reuptake into the presynaptic neuron

select e serotonin-norepinephrine reuptake inhibitors (SNRIs)

designed to affect levels of norepinephrine as well as serotonin

norepinephrine-dopamine reuptake inhibitor (NDRI)

a type of antidepressant medication that blocks the reuptake of the neurotransmitters norepinephrine and dopamine in the brain. this increases their levels in the synaptic cleft, which can improve mood, energy, and motivation.

tricyclic antidepressants

an older class of antidepressants that block the reuptake or norepinephrine and serotonin, increasing their availability in the synapse

monoamine oxidase inhibitors (MAOIs)

antidepressants no longer used that increase monoamine levels by inhibiting the enzyme monoamine oxidase, which normally breaks down neurotransmitters.

lithium

naturally occurring salt that is successfully in the prevention and treatment of mania and is regarded as the only substance that prevents both new depressive and new manic episodes, and reduces suicidal thoughts.

deep brain stimulation

a neurosurgical treatment in which electrodes are implanted into specific brain regions and connected to a pacemaker-like device to deliver continuous electrical shocks.

electroconvulsive therapy, or ECT

a medical treatment in which a controlled, electrical current is applied to the brain to induce a brief seizure under anesthesia which is used to treat severe psychiatric illness

repetitive transcranial magnetic stimulation (rTMS)

a noninvasive brain stimulation method where electrodes are surgically implanted at the vagus nerve, a part of the nervous system that carries info to several areas of the brain, including the hypothalamus and amygdala which are involved in depression.

light therapy

a treatment that uses bright artificial light to stimulate natural sunlight and regulate circadian rhythms

negative cognitive triad

negative view of self, of the world, and the future

cohort effect

differences between age groups are caused by the historical or social experiences of a particular generation and no having itself

impulsivity

the general tendency to act on one’s own impulse rather than to inhibit them when it is appropriate to do so.

hopelessness

the future is bleak and there’s no way to make it more positive

behavioral theories of depression

suggest that life stress leads to depression because it reduces the positive reinforcements in a person’s life

learned helplessness theory

repeated exposure to uncontrollable and unavoidable negative events leads a person to learn that their actions dont matter, resulting passivity, withdrawal, and depressive symptoms.

reformulated learned helplessness theory

depression develops not just from uncontrollable negative events, but from how people explain them.

interpersonal theories of depression

focuses on the idea that depression is influenced by social relationships, interpersonal skills, and communication patterns rather than only biological or cognitive factors. these theories form the foundation for interpersonal therapy.

behavioral therapy

focuses on increasing positive reinforcements and decreasing aversive experiences in an individuals life by helping the depressed person change their patterns of interaction with the environment and with other people. designed to be short term

interpersonal and social rhythm therapy (ISRT)

a type of psychotherapy designed primarily for bipolar disorder. it focuses on stabilizing daily routine and interpersonal relationships to prevent mood episodes

family-focused therapy (FFT)

a structured, evidence-based psychotherapy for bipolar disorder that actively involves the patient and their family.

suicide

death from injury, poisoning, or suffocation where there is evidence that the injury was self inflicted and they wanted to kill themselves.

suicide attempts

a non-fatal, self-directed behavior carried out with at least some intent to die as a result of the behavior

suicidal ideation

thoughts about wanting to die or killing oneself, without a specific plan

nonsuicidal self-injury (NSSI)

thoughts about wanting to die or killing oneself, without a specific plan

suicide cluster

a group of suicides and/or suicide attempts that occur close together in time and place, at a rate higher than would normally be expected.