Bipolar and Depressive Disorders

What is the minimum duration for an abnormally elevated, expansive, or irritable mood to be classified as a manic episode?

At least one week

What is a hypomanic episode?

Characterized by an elevate mood and increased energy for at least four consecutive days but it is not severe enough to cause marked impairment in functioning or require hospitalization

To be diagnosed with a major depressive episode, a person must have ___ or more characteristic symptoms for at least ___

five; two weeks

What is the core diagnostic requirement for Bipolar I Disorder?

At least one manic episode

What is the core diagnostic requirement for Bipolar II Disorder?

At least one hypomanic and at least one major depressive episode

What is the minimum duration of symptoms for a diagnosis of Cyclothymic Disorder in adults?

At least two years

According to twin studies, what is the estimated heritability range for bipolar disorder?

60 - 90%

What are the concordance rates for bipolar disorder in monozygotic (identical) twins?

40 - 80%

What are the environmental risk factors for bipolar disorder?

Early parental loss, childhood maltreatment, medical comorbidity, substance use, highly stressful life events

What are the most manic-specific symptoms in youth that help differentiate bipolar disorder from ADHD?

Elation, grandiosity, flight of ideas / racing thoughts, decreased need for sleep, hypersexuality

In adults, how does the distractibility seen in a manic episode differ from that seen in ADHD?

In a manic episode, distractibility is caused by thought acceleration, whereas in ADHD it is due to wandering thoughts

Family-focused therapy for bipolar disorder is based on the assumption that ___ by family members can trigger a relapse

High expressed emotion

For which type of bipolar disorder is lithium generally most effective?

‘Classic bipolar disorder,’ with low likelihood of mixed states or rapid cycling

For a diagnosis of MDD, at least one of the five required symptoms must be ___ or ___

Depressed mood; loss of interest or pleasure in most or all activities

What is the minimum duration of a depressed mood for a diagnosis of Persistent Depressive Disorder in children and adolescents?

At least one year

What are the two core features of Disruptive Mood Dysregulation Disorder?

1. Severe recurrent temper outbursts

2. Persistently irritable or angry mood between outbursts

When does the ‘with peripartum onset’ specifier for MDD apply?

When symptoms occur during pregnancy or in the four weeks following delivery

What are two evidence-based psychotherapies for the prevention and treatment of peripartum depression?

1. Cognitive behavioral therapy (CBT)

2. Interpersonal therapy (IPT)

The specifier' ‘with seasonal pattern’ (SAD) has been linked to a lower than normal level of ___ and a higher than normal level of ___

Serotonin; melatonin

What is the primary treatment for Seasonal Affective Disorder (SAD)?

Phototherapy, which involves exposure to bright light

At what developmental stage does the rate of depression begin to differ significantly between females and males?

The rate for females increases in early adolescence, while the rate for males remains fairly stable

What is the average reported concordance rate for MDD in monozygotic twins?

46%

Depression is associated with hyperactivity of the HPA axis, leading to hypersecretion of which hormone?

Cortisol (primary stress hormone)

Remission of depressive symptoms is associated with decreased activity in the vmPFC and increased activity in the ___

Dorsolateral prefrontal cortex (dlPFC)

Lewinsohn’s social reinforcement theory describes depression as the result of a low rate of what?

Response-contingent reinforcement for social behaviors

The reformulated learned helplessness model attributes depression to attributing negative life events to ___, ___, and ___

Stable, internal, and global factors

Beck’s cognitive triad

A feature of depression consisting of negative thougths about oneself, the world, and the future

For older adults, what has been identified as one of the strongest risk factors for MDD?

Chronic medical illness, especially when it decreases physical functioning and contributes to social isolation

Compared to members of Western cultures, members of some non-Western cultures are more likely to report which types of symptoms for depression?

Somatic

Which sleep abnormality associated with depression involves a shortened time from sleep onset to REM sleep?

Reduced REM latency

What is the recommended intervention approach for patients with comorbid MDD and substance use disorder?

A concurrent approach that addresses the two disorders simultaneously

According to APA guidelines, what is the recommended first-line medication for adolescents with depression?

Fluoxetine (Prozac)

For adults with depression, what two initial treatment options do APA guidelines recommend clinicians offer to patients?

Psychotherapy or a second-generation antidepressant (SSRI or SNRI)

Taking St. John’s wort with an SSRI can cause ___

Serotonin syndrome

What fast-acting treatment is used for treatment-resistant depression and exerts its effects by increasing glutamate levels?

Ketamine, prescribed as esketamine nasal spray

What is a major disadvantage of Electroconvulsive Therapy (ECT) compared to rTMS?

ECT can cause both anterograde and retrograde amnesia, while rTMS does not

Compared to psychotherapy and pharmacotherapy, how quickly does ECT typically produce remission?

ECT remission is within 1-3 weeks, compared to 4-12 for other treatments

Retrograde amnesia caused by ECT is more severe for ___ placement of electrodes than for ___ placement

Bilateral; right unilateral

According to 2022 CDC data, the suicide rate for males in the US was how many times higher than the rate for females?

Four

Among males in the US, which age group had the highest suicide rate in 2022?

75 and older

In 2022, for both males and female, which racial / ethnic group had the highest suicide rates?

Non-Hispanic American Indian / Alaskan Native individuals

The suicide rate for previously incarcerated individuals is ___ than the rate for currently incarcerated individuals

Higher

How does the gender difference in suicide rates among previously incarcerated individuals compare to the general population?

Unlike the general population, men and women released from incarceration have similar suicide rates

Transgender adults report a lifetime suicide attempt rate of 42%, compared to what rate for cisgender adults?

11%