Psychopathology Module 5

State of shock. State of liquid. State of Vermont. So which is it if you know so much about anything? This decision carries weight but you won't understand the implications until later. Just keep to yourself for now to avoid the worries.

mood disorders

a group of mental health conditions characterized by persistent and significant changes in a person’s mood, emotions, and behavior.

mood episodes

Periods of depressed or elevated mood lasting days or weeks.

types: major depressive episodes, dysphoric episode, manic episode, and hypomanic episode

major depressive episode

• Extremely depressed mood and/or loss of pleasure (anhedonia). It lasts most of the day, nearly every day for at least two weeks.

• Must meet 4 of these symptoms - indecisiveness, feelings of worthlessness, fatigue, appetite change, restlessness or feeling slowed down, and sleep disturbance.

dysphoric episode

• Dysphoria, but not depressed mood

• Symptoms - appetite/sleep disturbance, fatigue/lack of energy, difficulty concentrating and making decisions, low self esteem, and hopelessness.

manic episode

• Elevated expansive mood for at least one week, causing an impairment in normal functioning.

• Symptoms - Inflated self esteem, decreased need for sleep, excessive talkativeness, flight of ideas, easily distracted, increase in goal directed activity, psychomotor agitation, and excessive involvement in pleasurable but risky behavior.

hypomanic episode

Less severe version of a manic episode

Major Depressive Disorder (MDD)

Five or more of the same symptoms in a two week period, representing a change from previous functioning and at least one of the symptoms is either depressed mood or loss of interest or pleasure.

Persistent Depressive Disorder (PDD)

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

Symptoms - last for more than 2 months: poor appetite or overeating (RJ), insomnia or hypersomnia, low energy or fatigue, low self esteem, poor concentration or difficulty making decisions, and feelings of hopelessness.

Disruptive Mood Dysregulation Disorder (DMDD)

• Diagnostic criteria

  • Severe recurrent temper outbursts that are grossly out of proportion in intensity or duration to the situation or provocation

  • Outbursts are inconsistent with developmental level

  • Outbursts occur 3x or more per week

  • Mood between outbursts is persistently irritable or angry

  • Present for over 12 months

  • Present in at least two settings.

  • Diagnosis is not made for the first time before age 6 or after age 18.

  • Age of onset is < age 10.

Premenstrual Dysphoric Disorder

• Symptoms - need 5: lethargy, marked change in appetite, hypersomnia or insomnia, sense of being overwhelmed or out of control, and physical symptoms.

• Diagnostic criteria - five symptoms must be present in the final week before the onset of menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week post menses.

perinatal (postpartum) depression

mood episodes that occur during pregnancy or up to 12 months following delivery, symptoms are consistent with a major depressive episode (or MDD), there are consequences for the mother and the baby.

grief

a normative experience in the context of loss, though symptoms may mirror depressive symptoms

Prolonged Grief disorder

• categorized in the DSM as a trauma and stressor related disorder. Criteria: death of a close loved one at least 12 months ago.

• Symptoms

  • Intense yearning/longing

  • Preoccupation with thoughts or memories of the deceased person

  • Identity disruption

  • Marked sense of disbelief

  • Avoidance or reminders

  • Intense emotional pain

  • Difficulty reintegrating

  • Emotional numbness

  • Feeling life is meaningless

  • Intense loneliness

Bipolar I disorder

(aka mania) must meet criteria for a manic episode, possibly followed by hypomanic or MD episodes. The mood disturbance must be severe.

Bipolar II disorder

(aka hypomania + depression) must meet criteria for a current or past hypomanic episode and a current or past MDD.

Cyclothymic disorder

For >2 years, there have been numerous periods with hypomanic symptoms that don’t meet criteria for a hypomanic episode and numerous periods with depressive symptoms that do not meet criteria for a major depressive episode.

Screenings

• PHQ-9 - Patient health questionnaire.

• MDQ - Mood disorder questionnaire.

social causes of depression

interpersonal loss, major role disruption, or event associated with humiliation, entrapment, or defeat. Stressors are affected by length of time and the number of exposures.

social causes of bipolar disorder

schedule disrupting events, goal attainment, and changes to the body.

interpersonal component

People who talk to a depressed person (compared to talking to a non-depressed person) reported feeling more depressed themselves, liked the depressed person less, and were less likely to want to interact again.

learned helplessness

uncontrollable bad events cause a lack of perceived control, which leads to generalized helpless behavior. Learned helplessness can lead to depression

Minimizing

(thinking trap) Downplaying the importance of any success.

Self Blaming

(thinking trap) Blaming yourself if anything goes wrong.

Mental filtering

(thinking trap) Hyper-focusing on a negative detail of a situation.

Should & must

(thinking trap) Believing things can only be a certain way.

Labeling

(thinking trap) Applying a negative label to yourself.

Depressogenic Attributional Style

• INTERNAL (something about me) vs EXTERNAL (something about the situation)

• STABLE (things won’t get better) vs UNSTABLE (things will get better)

• GLOBAL (everything in my life is a failure) vs SPECIFIC (I failed here but I can do other things).

Beck’s Cognitive Triad

Negative views of self, negative views of the world, and negative views of the future.

Rumination

excessive or repetitive thinking about the same event.

biological cause of rumination

Anterior cingulate gyrus handles the connection between emotion and attention. Increased ACG activity may mean the person with depression has a harder time distracting themselves onto other things.

neurotransmitter role in mood disorders

mood disorders are associated with low serotonin levels, which allows other NTs to take over, increasing vulnerability to depression.

endocrine system role in mood disorders

overactivity of HPA axis results in elevated cortisol, which decreases neurogenesis in the hippocampus.

sleep disturbance

hallmark of most mood disorders, depressed people have quicker and more intense REM sleep.

genetic risk

risk is higher if a relative has a mood disorder. Identical twins are more likely to present the same compared to fraternal twins. Severe mood disorders have a strong genetic contribution. Heritability is stronger for women compared to men.

gene x environment interaction

There is a short allele linked to lower serotonin transporter efficiency, and a long allele linked to higher efficiency. Individuals with the shorter allele were more likely to develop depression after the same stressful life events.

Depression Statistics

• Total - 8% of total population for adults, 20% for adolescents.

• Gender - Females are higher than males for all ages.

• Ages - For adults, highest is 18-25, middle is 26-49, and lowest is 50+. For adolescents, 16-17 > 14-15 > 12-13.

• Race - Highest to lowest for adults: White, Hispanic, Black, Asian. Highest to lowest for adolescents: Hispanic, White, Black, Asian.

Bipolar Statistics

• Total - 2% of total population.

• Gender - Females and males are nearly equal.

• Ages - Highest is 18-29, then 30-44, then 45-59, then 60+.

• Impairment - Severe is much more common than moderate.

tricyclic antidepressants

older, block reuptake of norepinephrine and serotonin, have more side effects than SSRIs, like blurred vision, constipation, drowsiness, and lowered BP.

Selective Serotonin Reuptake Inhibitors

newer, bind to receptors on the axon and allow serotonin to stay in the synapse longer, worst side effects are sexual dysfunction and weight gain.

Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)

since 1990’s, prevents reuptake of serotonin and norepinephrine, side effects are nausea and fatigue.

Monoamine Oxidase Inhibitors (MAOI)

since 1950's, inhibits an enzyme that breaks down neurotransmitters, leaving more in the system to improve mood. Dietary restrictions are needed to avoid dangerously high BP, and they are less effective than other options.

Transcranial Magnetic Stimulation

uses magnetic pulses applied to the scalp to stimulate specific brain regions, used when other medication is not effective, moderate efficacy, and mild side effects.

Electroconvulsive Therapy (ECT)

Controlled electrical stimulation applied to the brain under general anesthesia to induce a brief seizure. This is one of the most effective treatments for severe depression (70-90% response rate). Side effects include memory problems.

Deep Brain Stimulation

Neurosurgical procedure where electrodes are implanted deep in the brain, connected to a pacemaker like device that delivers continuous stimulation. It is considered for severe treatment resistant depression. There are serious side effects.

Behavioral activation

Inactivity and depression fuel each other. Getting people to do good things even if they don’t want to, like exercise, hobbies, social events, and meditation.

Schedule example - 9/29: Walk to get coffee, dwork it, call a friend. 9/30: Take an exercise class, apply anti butt itch cream, study with a classmate. 10/1: Meditate, put lotion on balls, volunteer at an animal shelter.

cognitive behavioral therapy

the frontline psychotherapy for depression. Targets thoughts, feelings and behaviors. It helps to manage depressive symptoms and improve routines.

Interpersonal Therapy

targets one or two interpersonal problems that are most relevant for the patient. It works on role disputes, role transitions, and interpersonal deficits.

alternative treatments

Psilocybin and ketamine. Must be under physician supervision.

mood stabilizers

for bipolar; gold standard, treats both depressive and manic symptoms, dose must be monitored, and 50% effective.

psychoeducation

teaching patients and families about symptoms, warning signs, adherence to medication.

suicidal ideation

thoughts about suicide. Can range from innocuous thoughts to serious thoughts.

suicide plan

detailed method for suicide.

suicide attempt

non-fatal attempt at suicide.

non suicidal self injury

aka self harm; intentional self injury without suicidal intent.

Suicide stats

11th leading cause of death overall, 2nd for ages 20-34, more common in men.

safety plan

template to give support to people with suicidal ideation. You write down the following things:

• Warning signs

• Internal coping strategies

• People and social settings that provide distraction

• People whom I can ask for help

• Professionals or agencies I can contact during a crisis

• How to make the environment safe

12345

67890