Psych 221 Exam 2- Mood Disorders & Schizophrenia/Psychotic Disorder

Depressive Disorders

disorders where there is significantly low mood

Bipolar Disorders

having significantly elevated moods (to the degree that has a negative effect on them)

Major Depressive Episode

• For 2 weeks, either depressed mood or loss of interest or pleasure most of the day nearly every day

  • plus at least 4 of the following:

a. Change in appetite/ weight

b. Change in sleep

c. Psychomotor agitation or retardation (sluggishness)

d. Fatigue or loss of energy

e. Feelings of worthlessness or excessive guilt

f. Difficulty thinking or concentrating; indecisiveness

g. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideas without a specific plan, OR an actual suicide attempt/specific plan for committing suicide

• Significant distress or impairment of functioning

• Symptoms are distinct from or more severe than a normal response to a significant loss

MDE Diagnostic Criteria

• 2 months for diagnostic criteria

• Episode typically lasts 6 months - 1 year

Major Depressive Disorder: Single Episode

ONE major depressive episode (and no history of mania)

• If you had one episode, you are more vulnerable to have another

Major Depressive Disorder: Recurrent

At least TWO episodes

• around 16% of ppl in the US meet diagnostic criteria for major depressive disorder at some point in their lives

Dysthymia / persistent depressive disorder

Less intense than Major Depressive Disorder, but has more chronic depression

• At least 2 years of symptoms, including more days than not of depressed mood

• At least 2 of the following:

  i. Loss of appetite or overeating

  ii. Problems with sleep (too much or too little)

  iii. Low levels of energy

  iv. Low self esteem

  v. Difficulty with concentration or making decisions

  vi. Feelings of hopelessness

• Symptoms do not clear up for more than 2 months at a time

• About 2.5% of people in US will meet diagnostic criteria at some point in their lives

When Major Depressive Disorders should be specified:

• Postpartum Onset (Depression)

  • Often accompanied by postpartum anxiety

• Psychotic Features

  • Ex: Hallucinations, Delusions, etc.

• Seasonal Affective Disorder (SAD)

  • Depression most felt in winter; less sunlight

Bipolar Disorders

Abnormally elevated extreme moods (Up & Down)

• Diagnosis is based on the type of episodes the person has had

Bipolar I

At least one manic or mixed episode

• Mixed episode: both manic & depressive symptoms at once

Bipolar II

The occurrence of at least 1 hypomanic episode and at least 1 major depressive episode.

• No full manic episodes (if a manic episode occurs, diagnosis changes).

Cyclothymia

At least 2 years of alternating between periods of hypomania and dysthymic mood (low-level mood episodes)

Manic Episodes

A period in which there is an elevated or irritable mood present and lasts at least one week

• Must be impairment in functioning with 3 or more symptoms:

  • Inflated self-esteem or grandiosity

  • Decreased need for sleep

  • Excessive talking

  • Flight of ideas/racing thoughts

  • Extreme distractibility

  • Increase in goal-directed activity (ends up having too many goals and becomes overwhelming, or ends up focusing on a goal that isn’t a priority)

  • Psychomotor agitation (Jittery)

  • Excessive involvement in pleasurable activities that have a high potential for painful consequences

Hypomanic Episode

Period of elevated, expansive, or notably irritable mood.

• Must last for at least 4 days.

• At least 3 symptoms from the Manic Episode criteria

• Functioning must be different from usual, but not impairing

Rapid Cycling

Subtype of Bipolar Disorder

• 4 or more distinct mood episodes over the course of 1 year

Suicide Statistics

• Greatly increased risk with all mood disorders

  • Most increased risk w/ Major Depressive Disorder

• Women are almost twice as likely to attempt

  • Dangerous assumption as a cry for help / not actually serious

• Men are 4-5x more likely to die from attempt

  • Also more likely to use violent methods

  • Women likely to use quieter, less messy methods

• Highest rate is among elderly white men

• Worrisome signs

  • Giving things away

  • Suddenly in good mood

  • Engaging in more risky behaviors

Mood Disorder Demographics

• Comorbidity

  • Often co-occurs with anxiety, substance abuse, and personality disorders

• Age

  • Depression often manifests itself differently in children and the elderly

    • Typically begins in early adulthood.

  • Bipolar disorders have an earlier onset, often in late adolescence or early adulthood.

• Gender

  • Bipolar Disorder: Roughly equal rates in males and females.

  • Depression: More common in women than men

Mood Disorders: Biological Components

• Genetic Predisposition

  • Depression: Shows moderate heritability.

    • Family history increases risk.

  • Bipolar Disorder: Has a very high heritability (strong genetic link).

    • Twin studies show high concordance rates.

• Neurotransmitters

  • Monoamine Hypothesis: Depression caused by low levels of monoamines

  • Involves imbalances in:

    • Norepinephrine

    • Serotonin

    • Dopamine

• Receptor Sensitivity

  • The way receptors respond to neurotransmitters has changed

Structural Findings in Depression & Bipolar Disorder

• Increased activation of the amygdala

  • Associated w/ fear and other negative emotions

• Decreased activation of the prefrontal cortex

  • Affects decision-making, attention, and concentration

• Decreased activation of the hippocampus

  • Related to memory and stress regulation.'

• Neuronal Function in Bipolar Disorder

  • Differences in how neurons fire and communicate.

  • Possible abnormalities in ion channel functioning (affecting neuron excitability and stability).

• Neuroendocrine System

  • Key player in mood and depression

  • Associated w/ glands and brain signals

  • HPA Axis (Hypothalamic-Pituitary-Adrenocortical Axis)

    • All 3 send messages to each other to release cortisol

      • Cortisol is associated w/ stress and sadness

      • High blood levels of cortisol in depressed patients

Biological Interventions: Depression & Bipolar Disorder

Pharmacological Treatments:

• For Depression:

  • SSRIs (Selective Serotonin Reuptake Inhibitors)

  • SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors)

• For Bipolar:

  • Lithium (Mood Stabilizer)

    • Too high = fatal

  • Anticonvulsants (Mood stabilizer; prevents seizures)

  • Antipsychotics (Mood stabilizers; prevents psychosis)

Non-Pharmacological Biological Treatments:

• Transcranial Magnetic Stimulation (TMS)

  • Uncommon; Magnetically stimulating the brain

• Electroconvulsive Therapy (ECT)

  • Shock Therapy

Social Components of Mood Disorders

• Contributors:

  • Lack of Social Support

  • Negative Social Skills or Interpersonal Problems

  • High Expressed Emotion (EE) in Family:

    • Criticism

    • Hostility

    • Over-involvement

• Intervention

  • Interpersonal Psychotherapy

    • Incorporates aspects of multiple perspectives

    • Structured, goal-oriented, and typically time-limited and short

Beck’s Cognitive Theory of Depression

• Negative Cognitive Triad:

  • Negative views about:

    • Self ("I am worthless")

    • World ("The world is unfair")

    • Future ("Things will never get better")

  • Negative schemas cause cognitive bias (Fail to notice the positive)

Hopelessness Cognitive Theory of Depression

• Hopelessness is a key trigger for depression.

• Person holds the belief that:

  • Desirable outcomes won’t happen.

  • They are powerless to change the situation.

• Attributions: Tendency to explain negative events in certain ways:

  • Stable vs. Unstable:

    • Stable = "This problem is permanent."

    • Unstable = "This is temporary."

  • Global vs. Specific:

    • Global = "This affects everything in my life."

    • Specific = "This only affects this one situation.

Rumination Cognitive Theory of Depression

• Tendency to repeatedly dwell on negative feelings and thoughts

• Constant What-If’s

  • Leads to depression

  • Difficult to correct or treat

Cognitive Intervention: Depression

• Beck’s Cognitive Theory

  • Identify, challenge, and substitute negative automatic thoughts

  • Behavioral Activation

    • Do more productive, active things that increase positive experiences

• Other Cognitive Therapies

  • ACT (Acceptance and Commitment Therapy)

    • Becoming more aware of the negative thoughts (NOT get rid of them)

    • Goal is to give more control and focus on helpful thoughts

Behavioral Theories of Depression

• Interruption of reinforcement from environment causes depression

  • Poor social skills; Hard to build relationships

  • Environment; Few opportunities for rewarding experiences

  • Diminished ability to enjoy things (anhedonia) or being overly sensitive to negative events -

    • Leads to a lack of motivation to engage with the world, creating a cycle where things feel worse the more you withdraw.

• Intervention:

  • Behavioral Activation Therapy

    • Increase engagement in activities that are likely to provide positive

      reinforcement.

Factors in Bipolar Disorder

• Treatment

  • Biological: Mood - stabilizing meds. (Ex: Lithium)

  • Psychological: Psychoeducation and Psychotherapy (With meds.)

• Depression Triggers

  • Similar with other mood disorders

    • Loss of family

    • Bad experience

    • Stress, etc.

• Mania Triggers

  • Sleep disruption; Not enough sleep

  • Reward Sensitivity: A feeling of success

    • May lead to manic episode

    • Need to be taught to recognize manic feelings after

Psychotic Disorders

• Main defining symptoms involve psychosis (split from reality)

  • Psychosis can occur in other disorders

Schizophrenia

• Schizo: split

• Phrenia: mind

• NOT split personality

• Scattered pattern of thinking

Positive Symptoms: Schizophrenia

• A symptom that should NOT be present

  • Hallucinations: False Perceptions

    • Gustatory (Taste)

    • Auditory (Hearing)

    • Visual (Sight)

    • Tactile (Feeling)

    • Olfactory (Smell)

  • Delusions: Bizarre beliefs not supported by reality

    • Persecution: Believing one is being targeted or harmed by others.

    • Thought insertion: Believing that someone is putting thoughts into their

      mind.

    • Thought broadcasting: The belief that others can hear or know their

      thoughts.

    • Grandiose: Having an inflated sense of self-importance or abilities.

    • Ideas of reference: Believing that unrelated events or people are directly

      related to oneself

  • Disorganized speech

  • Disorganized behavior

  • Catatonia: A state of abnormal movement or lack of movement.

Negative Symptoms: Schizophrenia

• A decrease or loss of normal functioning

  • Flat/Blunted Affect: LACK of emotion

  • Alogia: Lack of speech

  • Avolition: Lack of drive/motivation

  • Asociality: Not social

  • Anhedonia: Lack of enjoyment

Schizophrenia: Diagnostic Criteria

• 2 or more of the following symptoms:

• AT LEAST 1 MUST be one of the first 3 symptoms

• Each present for most of the time during 1-month period

  • Delusions

  • Hallucinations

  • Disorganized Speech

  • Disorganized/Catatonic Behavior

  • Negative Symptoms

• Decreased level of functioning in at least one major area of life

  • work, social relationships, self-care, etc.

• Duration: The symptoms must persist for at least six months, including the 1-month period

Schizoaffective Disorder

A combination of mood disorder (depression or mania)

and psychotic symptoms (delusions, hallucinations).

Schizophreniform Disorder

Similar to schizophrenia, but the duration of symptoms lasts

between 1 and 6 months.

Brief Psychotic Disorder

Involves psychotic symptoms (delusions, hallucinations, disorganized speech, etc.) that last for less than 1 month.

Delusional Disorder

Characterized by the presence of delusions for at least 1 month, but without the full range of psychotic symptoms seen in schizophrenia.

• Ex: Being watched, infidelity, para-social relationships, etc.

Demographics of Schizophrenia

• Onset tends to follow after a stressful/difficult experience

• Gender & Age

  • Relatively equal rates between men and women across lifetime

  • Fewer negative symptoms and better prognosis for women

  • Onset around early adulthood

    • Women: Mid - to - late 20s

    • Men: Early 20s (Symptoms more negative and severe)

• Socioeconomic Class

  • Rates are higher in the poorest populations

Biological Predisposing Factors in Schizophrenia

• Extreme genetic influence (NOT completely)

  • Higher concordance rate in monozygotic (MZ) twins compared to dizygotic (DZ) twins, suggesting a strong genetic component.

  • Adoption Studies: Biological are more at risk

    • Adopted child could be raised by parent with schizo., then get it

  • Polygenic

• Second Trimester Factors

  • Extreme Stress: Associated with increased risk

  • Virus/Infections during pregnancy

• Seasons

  • Higher rates with babies born in winter or spring

Brain Abnormalities in Schizophrenia

• Enlarged Ventricles: Fluid-filled spaces in the brain

  • Bigger spaces in brain because loss of tissue

• Prefrontal Cortex: Decreased volume and activation

  • may contribute to the disorganized thinking, impaired judgment, etc.

Neurotransmitter Abnormalities in Schizophrenia: Dopamine Theory

• Suggests that dopamine dysregulation plays a significant role in the development and symptoms of schizophrenia ; Very complex

• Too much or too little Dopamine??

  • BOTH!!

  • Schizophrenia seems to involve dopamine

    dysregulation—too much dopamine in some brain regions and too little in others. This complex imbalance leads to the diverse symptoms seen in the disorder

Glutamate Dysfunction in Schizophrenia

• Glutamate receptors regulate neurotransmitters, including dopamine

  • Involved in brain communication

  • Studies are finding decreased Glutamate activity in schizophrenic brains

• Glutamate dysfunction plays a role in both positive and negative symptoms of schizophrenia.

Pharmacological Intervention in Schizophrenia

• Neuroleptics/Antipsychotics

  • Treats positive symptoms

  • Side Effects:

    • Dry mouth

    • Sedation

    • Sexual dysfunction

    • Movement dysfunction

• Atypical/Second-generation Antipsychotics

  • Also targets positive symptoms

  • Have a lower risk of movement-related side effects

  • Side Effects:

    • Side effects:

      • Weight gain

      • Diabetes

Cognitive Components in Schizophrenia

• Deficits in attentional processes

  • Ex: ADHD, trouble focusing

  • In non-schizophrenic relatives as well

• Intervention

  • Cognitive restructuring for mild delusions

  • Cognitive rehabilitation for attention, memory, and verbal skills

Other Interventions in Schizophrenia

• Psychoeducation

  • Teaching patient and family members about schizophrenia

• Social Skills Training

• Family Counseling