mood disorders

does a mania only disorder exist ?

no

what is bipolar disorder ?

mood disorder where patient experiences periods of mania, often with with periods of major depression following it

what is needed to diagnosis someone with bipolar disorder ?

manic episodes (bipolar I), depressive episode isn't required

what characterizes a manic episode ?

inflated self-esteem/grandiosity (elated mood, capable of unrealistic things), decreased need for sleep (body needs sleep, mind doesn't), pressured speech, flight of ideas, distractibility, increase in goal-dated activity or psychomotor agitation, excessive involvement in impulsive/reckless activities

what is pressured speech ?

rapid and unrelenting speech, even leading to the patient stumbling over their words

what is flight of ideas ?

racing thoughts causing the patient to jump from topic to topic, sometimes resulting in delusions

what is distractibility ?

attention too easily drawn to unimportant or irrelevant external stimuli (superficially similar to ADD/ADHD)

what are differential diagnoses for manic episodes ?

drug intoxication (psychostimulants), paranoid schizophrenia (also have delusions, but are more bizarre)

what is the prevalence rate for bipolar disorder ? is it different between men and women ?

1%; no

what is the suicide rate for those with bipolar disorder ?

20%

what does the twin study research say about bipolar disorder as a genetic/heritable disorder ?

possibly genetic based;

monozygotic twins have a 72-80% concordance rate, dizygotic twins have a 14-20% concordance rate

what are criticisms for the bipolar disorder twin studies and the genetic model ?

genetic predispositions does not imply destiny; these rates very widely— use of "spectrum" disorders (rate of other disorders, not just bipolar) and uncontrolled adoption (shared environment / grow up together when separated)

what is bipolar disorder II ?

no evidence of manic episode—hypomanic episode followed by depressive episode instead;

not as extreme + fewer manic episodes symptoms criteria

how do clinicians classify a patient with hypomania episodes with no depressive episodes ?

there is no classification; it is not bipolar I or II

what is the main prescribed drug for bipolar disorder ? why ?

lithium;

effectively decreases mood fluctuations

what are the consequences of lithium ?

hard on the body— can eventually cause severe kidney damage and death from toxicity, so blood levels must be monitored

why are there compliance issues with lithium ?

people miss their "highs;" side effects requires monitoring which is a nuisance

what are other medications bipolar disorder can be treated with ?

anticonvulsants and antipsychotics (atypicals)

what is cyclothymic disorder ?

chronic (2+ yrs) mood fluctuations between bipolar disorder and normal experience (hypomanic episodes + some depressive symptoms, not as severe)

besides symptomology, how else does cyclothymic disorder differ from bipolar I or II ?

medications not as useful, not same evidence of genetic component, sometimes mood swings faster

what is the criteria for major depressive disorder (MDD) ?

1+ major depressive episode (MDE), 2+ weeks, 5/9 MDE criteria met (sleep disturbance, eating disturbance, psychomotor changes, fatigue, worthlessness, inability to think, self-death related issues), symptoms present every day (one of which must be sad/depressed mood or anhedonia)

how does mania interact with MDD ?

to be diagnosed with MDD, patient can never have had a manic episode

what is anhedonia ?

loss of pleasure in things that used to give pleasure most of the time

what is hyposomnia ? terminal insomnia ? initial insomnia ? hypersomnia ?

lack of sleep; early morning awakening; sleep onset is delayed; excessive sleeping

what is psychomotor agitation/retardation ?

restless/agitation; slow movement

what is the lifetime prevalence rate for MDD in adults ? is there a gender difference ?

12-20%; 2:1 female to male ratio

with who is MDD more commonly seen in ?

adolescents, elderly (white men), lower-class levels (downward drift explanation)

what are the improvement and relapse rates for untreated MDD ?

90% improve within 5 yrs;

75-90% will have second episode if left untreated

what are the genetic concordance rates for MDD ?

36% for monozygotic twins; 17% for dizygotic twins

how does MDD episode amount affect treatment effectiveness ?

the more episodes one has, the less likely will treatment work

what are specifiers for depression ?

single or recurrent episodes; mild, moderate, severe based on # of criteria met (if severe, psychotic or no)

what is MDD with postpartum onset (PPD) ?

symptoms of depression with onset of episode within 4 was postpartum

do hormone levels explain PPD ?

no, they're not correlated;

fathers have PPD symptoms at relatively high rates as well + only 10-15% of women experience PPD despite all undergoing similar hormonal changes

historically, what are the two types of depression ?

endogenous (genetic/biochemical imbalances) and exogenous (trauma/stress caused)

why are depression rates in single men and married women of significance ?

single men are more likely to be depressed than married men;

married women are more likely to be depressed than single women

how does the biological perspective explain MDD ?

monoamine hypothesis— functional deficit of neurotransmitters at critical synapses (serotonin, norepinephrine, dopamine)

how are signals sent between neurons

electrical signal down axon, chemical transmission (NT release) between neurons)

what is the synaptic cleft ?

space between two neurons

what are ways NTs can be cleared from the synapse ?

enzyme degradation, reuptake, washed away

what breaks down norepinephrine and serotonin ?

monoamine oxidase (MAO)

what is a functional deficit ? what would cause it ?

lack of NT (may not be a real deficit, but communication is not enough)

not enough being produced, too much MAO, receptor blocked/damaged, not enough receptors

is the serotonin theory for depression backed ?

no, it is not backed by literature reviews or empirically

what are MAOIs ? what are their drawbacks ?

prevents the breakdown of certain NT / enzymatic by nature (serotonin, norepinephrine);

rough side effects, interacts with other SSRIs and OTC medications, reacts to food with tyramine

what are tricylics ? what are their drawbacks ?

block the reuptake of norepinephrine and serotonin;

various side effects (blurry vision, dry mouth, fuzzy head, sedation), take 3-5 weeks to work, requires cumulative effects at pre/post synaptic receptor sites, lethal (easy to overdose through cardiac arrhythmia)

what are SSRIs ? what are their drawbacks ?

block serotonin reuptake;

not as lethal/different side effects

what did the clinical efficacy trials say about SSRIs ? what about recent research ?

57% response rate at the end of 16-weeks use;

indicates strong placebo effect (50-75%) rather than pharmaceutical one

what is the relationship between SSRIs and children ?

no scientific link between suicide completion and SSRI use (untreated depression NOT on SSRIs);

FDA still advises against minors using paxil

what is the relationship between SSRIs and suicidality ?

close observation needed in case of suicidal ideation, esp. when beginning/discontinuing drug or switching dose

how do newer antidepressants differ from the older ones ?

go free specific receptors or additional neurotransmitter sites of action rather than NT as a whole (aka atypical antidepressants)

what psychotherapies are empirically supported for MDD ?what is their response rate after therapy ?

behavioral therapies, cognitive therapies, cognitive-behavior therapies, interpersonal psychotherapies;

55-65% response rate

in the clinical efficacy trials with CT, SSRIs, and placebo, what were the response rates after 16 weeks ? relapse rates 16 weeks post-treatment ?

CT and SSRIs both had a 57% response rate;

CT — 25% relapse rate, medication — 40% relapse rate, placebo — 81% relapse rate

in the study comparing CBT and antidepressants, what were the relapse rates 1 year post-treatment ?

CBT — 31% relapse rate

medication stopped — 76% relapse rate

medication continued — 47% relapse rate

in the study comparing CBT, medication, and CBT + medication, what were the relapse rates 1 year post-treatment ?

CBT and CBT + meds — 10% relapse rate

medication only — 80% relapse

what is electroconvulsive therapy (ECT), and who is it typically used for ?

induces tonic clonic/grand mal seizure activity in brain to cause massive change in brain's NTs; severely depressed (melancholic), those who are unresponsive to other treatment methods

is ECT effective ? how long does it last, and what are some side effects ?

research mixed on effectiveness;

3-5x a week for several months;

retrograde amnesia (memory loss for events prior to treatment)

how does the behavioral perspective explain and treat MDD ?

learned behaviors that get us into difficulties + haven't learned things to prevent these;

therapies focus on social activities and interpersonal skills (based on lewinsohn's idea that depressed people do not have enough reinforcement)

how does the cognitive perspective explain and treat MDD ?

learned helplessness (seligman);

cognitive therapy

what is behavioral therapy designed to do ?

behavioral activation to increase activity level of client

what is the attribution theory (MDD)?

idea that depressive people's view events negatively through internal (personal), stable (long-term), global (trans-situational) rather than external (universal), unstable (short-term), and specific (situational)

what is the negative cognitive triad (MDD) ?

coined by aaron beck, depressed patients have a negative view of themselves, their environment, and the future which they combine with cognitive distortions/logical errors (overgeneralizations, all-or-none thinking, arbitrary inferences)

how does the cognitive perspective treat MDD ?

changing how the patient thinks by recognizing illogical thoughts/cognitive disortions, look for truth evidence, and replace faulty thinking with more accurate thoughts

what theory is cognitive therapy based on ?

idea that feelings and actions will follow from improved thinking patterns, though this isn't always the case + data shows CT changes little behavior

what is persistent depressive disorder (aka dysthymic disorder) ?

some characteristics of depression present for at least 2 yrs without ever having prolonged time with normal mood

what are two symptoms of persistent depressive disorder than MDD doesn't require ?

low self-esteem and feelings of hopelessness

what are treatment options for persistent depressive disorder ?

treatment implications are unclear as it's not especially responsive to medications + not consistently responsive shorter term psychotherapy

what criteria does premenstrual dysphoric disorder have (PMDD) ?

over course of a year in most menstrual cycles, must have 5/8 symptoms, disturb normal functioning, not related by to another medication condition

what is the history of PMDD in the DSM ?

rejected in DSM 3-4, accepted in DSM 5 after fluoxetine (sarafem) approved for PMDD treatment

what controversy surrounds PMDD ?

if psychopathologizing a natural process really help women or divide them

what is disruptive mood dysregulation disorder ?

chronic, severe, persistent irritability + frequent temper outbursts + irritable mood persistent between temper outbursts