PSYC 2020 Midterm 2

mood disorders

group of disorders involving severe and enduring disturbances in emotionality ranging from elation to severe depression, more likely in women than men, in dsm5tr they’re grouped into two categories: depressive disorders and bipolar and related disorders

major depressive episode

most common and severe experience of depression, extremely depressed mood state that lasts at least two weeks and includes cognitive symptoms (e.g., feelings of worthlessness, indecisiveness) and disturbed physical functions (e.g., altered sleep patterns, significant changes in appetite and weight, very notable loss of energy) to the point that even the slightest activity or movement requires an overwhelming effort, typically accompanied by a marked general loss of interest and of the ability to experience any pleasure from life (anhedonia)

mania

period of abnormally excessive elation or euphoria, associated with some mood disorders, individuals become hyperactive, require very little sleep, and may develop grandiose plans, speech is typically very rapid and may become incoherent because they’re attempting to express so many exciting ideas at once (flight of ideas)

manic episode

mania that lasts for a duration of at least one week, less if the episode is severe enough to require hospitalization, irritability and being anxious or depressed are a commonly part of a manic episode, usually near the end

hypomanic episode

less severe and less disruptive version of a manic episode that is one of the criteria for several mood disorders, doesn’t cause marked impairment in social or occupational functioning, only needs to last four days

unipolar vs bipolar mood disorder

unipolar: individuals who experience either depression or mania, mood remains at one “pole of the depression-mania continuum

bipolar: someone who alternates between depression and mania, travel from one pole to the other and back again

mixed features

condition in which the individual experiences both elation and depression or anxiety at the same time, also known as dysphoric manic episode or mixed manic episode, dsm-5-tr requires specifying whether a predominantly manic or predominantly depressive episode is present and then noting if enough symptoms of the opposite polarity are present to meet the mixed features criteria

major depressive disorder

mood disorder involving one (single episode) or more (separated by at least two months without depression, recurrent) major depressive episodes, involves no manic or hypomanic episodes, recurrence is very important in predicting the future course of the disorder and choosing appropriate treatments, single episodes are rare, individuals with recurrent major depression usually have a family history of depression (individuals with single episodes don’t)

persistent depressive disorder

aka dysthymia, mood disorder involving persistently depressed mood with low self esteem, withdrawal, pessimism, or despair; present for at least two years with no absence of symptoms for more than two months; similar symptoms to major depressive disorder but differs in its course

double depression

severe mood disorder, major depressive episodes superimposed over a background of dysthymic disorder (persistent depression), more difficult to treat than either of the disorders alone

eight specifiers to describe depressive or bipolar disorders

with psychotic features (mood congruent or mood incongruent), with anxious distress (mild to severe), with mixed features, with melancholic features, with atypical features, with catatonic features, with peripartum onset, with seasonal pattern

specifiers of depressive/bipolar disorders: psychotic features specifiers

some individuals in the midst of a major depressive (or manic) episode may experience psychotic symptoms: hallucinations, delusions, somatic (physical) delusions, auditory hallucinations; most of these symptoms are called mood congruent (hallucinations and delusions are directly related to the depression), sometimes the individuals may have delusions of grandeur (e.g., believing they are supernatural) which is mood-incongruent (not consistent with depressed mood)

specifiers of depressive/bipolar disorders: peripartum onset specifier

occurs in the period of time just before or just after giving birth, can apply to both major depressive and manic episodes

specifiers for depressive/bipolar disorders: seasonal pattern specifier

applies to recurrent major depressive disorder and bipolar disorders, accompanies episodes that occur during certain seasons (e.g., winter depression), most usual pattern is a depressive episode that begins in the late fall and ends with the beginning of spring, for individuals with bipolar disorder depressive episodes typically occur in winter and manic episodes in the summer

seasonal affective disorder (sad)

mood disorder involving a cycling of episodes corresponding to the seasons of the year, typically with depression occurring during the winter, episodes must have occurred for at least two years with no evidence of nonseasonal major depressive episodes occurring during that period of time

integrated grief

grief that evolves from acute grief into a condition in which the individual accepts the finality of a death and adjusts to the loss

premenstrual dysphoric disorder (pmdd)

mood disorder, symptoms include physical symptoms, severe mood swings, and anxiety that causes incapacitation during most menstrual cycles, starting in the final week before the onset of menses, improving within a few days after the onset of menses, and becoming absent in the week post-menses

disruptive mood dysregulation disorder

condition in which a child has chronic negative moods such as anger and irritability without any accompanying mania, negative moods have to be out of proportion to the situation, outbursts are inconsistent with developmental levels, diagnosis should not be made before the age of six or after the age of eighteen

bipolar ii disorder

alternation of major depressive episodes with hypomanic episodes (not full manic episodes), requires both depressive episodes and hypomania for a diagnosis, average age of onset is 19-22

bipolar i disorder

alternation of major depressive episodes with full manic episodes, can be diagnosed based on a manic episode only, average age of onset is 15-18

cyclothymic disorder

chronic (at least two years) mood disorder characterized by alternating mood elevation and depression levels that are not as severe as manic or major depressive episodes, individuals tend to be in one mood state or the other for many years with relatively few periods of neutral (or euthymic) mood

specifier for bipolar disorder: rapid-cycling specifier 

moving quickly in and out of depressive or manic episodes, individuals with bipolar disorder who experiences at least four manic or depressive episodes within a year, severe variety that doesn’t respond well to standard treatment, ultra rapid cycling = cycle lengths that only last for days to weeks, ultra-ultra rapid cycling = cycle lengths are less than 24 hours (manic during the day, depression at night)

mood disorders: children and adolescents

fundamentally similar to mood disorders in adults, depressive disorders occur less frequently in children than adults but rise dramatically in adolescence where it is more frequent than in adults, in young children persistently depressive disorders is more prevalent than major depressive disorder (reversed in adolescence), bipolar disorder is rare in childhood but it may be mistaken for conduct disorder or adhd

dexamathasone suppression test

thought to be a biological test for depression, dexamethasone suppresses cortisol secretion in healthy individuals but causes less suppression in patients with depression, the thinking was that in patients with depression the adrenal cortex secreted too much cortisol, this was thought to overwhelm the suppressive effects of dexamethasone in people with depression, later research demonstrated that individuals with other disorders (e.g., anxiety disorders) also demonstrated this nonsuppresion effect, test was no longer thought to be useful for diagnosing depression

neurohormones

hormones that affect the brain and are increasingly the focus of study in psychopathology

depression and sleep

people with depression enter rem sleep more quickly, experience rem activity that is more intense, and slow-wave sleep doesn’t occur until later (if at all), may not be specific to depression

learned helplessness theory of depression

seligman’s theory that people become anxious and depressed when they make attribution that they have no control over the stress in their lives (whether in reality they do or not), the depressive attributional style is:

1) internal: the individual attributes negative events to personal failings

2) stable: even after a particularly negative event passes, the attribution that “additional bad things will always be my fault” remains

3) global: the attributions extend across a wide variety of issues

cognitive triad

aaron t beck’s theory that depression may result from a tendency to think negatively about three areas: the self, the immediate world, and the future

deep-seated negative schema

theorized by aaron t beck, occurs after a series of negative events in childhood, an enduring negative cognitive belief system about some aspect of life, negative self-evaluation schema = the belief that they can never do anything correctly, self-blame schema = individuals feel personally responsible for every bad thing that happens, beck says these cognitive errors and schemas are automatic and not necessarily conscious, underlying negative schemas are stable in individuals prone to depression

antidepressants

medication used to treat depressive disorders, three basic types: tricyclic antidepressants, monoamine oxidase (mao) inhibitors, and selective serotonin reuptake inhibitors (ssris)

tricyclic antidepressants

widely used treatment, unclear how these drugs work but initially at least they block the reuptake of certain neurotransmitters, allowing them to pool in the synapse and desensitize or down regulate the transmission of that particular neurotransmitter, seem to have their greatest effect by downregulating norepinephrine (other neurotransmitter systems such as serotonin are also affected), complex effect on both presynaptic and postsynaptic regulation of neurotransmitter activity, often takes 2-8 weeks to work, only effective in patients with severe depression

mao inhibitors

block the enzyme monoamine oxidase that breaks down neurotransmitters such as norepinephrine and serotonin, because they’re not broken down the neurotransmitters pool in the synapse, ultimately leading to a downregulation or desensitization, only prescribed when tricyclics aren’t effective because of their consequences when taken with other things (foods and beverages containing tyrosine, cold medications, etc)

ssris

first choice of drug treatment for depression, e.g., fluoxetine, specifically block the presynaptic reuptake of serotonin, this temporarily increases levels of serotonin at the receptor site

venlafaxine

related to tricyclic antidepressants but acts in a slightly different manner, reduces some of the associated side effects and the risk of damage to the cardiovascular system

nefazodone

related to ssris but seems to improve sleep efficiency instead of disrupting sleep

st. john’s wort (hypericum)

popular natural treatment, has antidepressant properties, possible negative drug interactions

lithium carbonate

type of antidepressant drug, a common salt widely available in the natural environment, side effects of therapeutic doses are potentially more serious than the side effects of other antidepressants, dosage has to be carefully regulated to prevent toxicity and lowered thyroid function, major advantage: often effective in preventing and treating manic episodes, often referred to as mood-stabilizing drug, treatment of choice for bipolar disorder 

electroconvulsive therapy (ect)

biological treatment for severe, chronic depression involving the application of electrical impulses through the brain to produce seizures, the reasons for its effectiveness are unknown, there is some evidence that ect increases levels of serotonin, blocks stress hormones, and promotes neurogenesis in the hippocampus

transcranial magnetic stimulation (tms)

works by placing a magnetic coil over the individual’s head to generate a precisely localized electromagnetic pulse, promising treatment for depression, ect is still more effective

vagus-nerve stimulation

involves implanting a pacemaker-like device that generates pulses to the vagus nerve in the neck, which, in turn, is thought to influence neurotransmitter production in the brain stem and limbic system, developing therapy for depression

deep brain stimulation

has been used with a few patients with severe depression, electrodes are surgically implanted in the limbic system, electrodes are connected to a pacemaker-like device that generates pulses

cognitive therapy

founded by aaron t beck, treatment approach that involves identifying and altering negative thinking styles related to psychological disorders, such as depression and anxiety, and replacing them with more positive beliefs and attitudes and, ultimately, more adaptive behaviour and coping styles, therapist takes a socratic approach (make it clear that therapist and client are working as a team)

behavioural experiment

part of cognitive therapy, therapist instructs the client to make a hypothesis about what’s going to happen (usually a depressing outcome) and then, most often, discovers it is incorrect 

cognitive-behavioural analysis system of psychotherapy (cbasp)

integrates cognitive, behavioural, and interpersonal strategies and focuses on problem solving skills, particularly in the context of important relationships, designed for individuals with persistent (chronic) depression

interpersonal psychotherapy (ipt)

therapy that focuses on resolving problems in existing relationships and learning to form important new interpersonal relationships, current interpersonal problems typically include one or more of: dealing with interpersonal role disputes (e.g., marital conflict), adjusting to the loss of a relationship (e.g., grief over the death of a loved one), acquiring new relationships (e.g., establishing professional relationships), and identifying and correcting deficits in social skills that prevent the perosn from initiating or maintaining important relationships

three stages of dispute in interpersonal therapy (ipt)

negotiation stage: both partners are aware of the dispute, and they’re trying to renegotiate it

impasse stage: the dispute smoulders beneath the surface and results in low-level resentment, but now attempts are being made to resolve it

resolution stage: the partners are taking some action, such as divorce or separation

maintenance treatment

combination of continued psychosocial treatment or medication designed to prevent relapse following therapy

interpersonal and social rhythm therapy (ipsrt)

psychological treatment that regulates circadian rhythms by helping patients regulate their eating and sleep cycles and other daily schedules and cope more effectively with stressful life events, particularly interpersonal issues, used to treat bipolar disorder

suicidal attempts

efforts made to kill oneself, the person survives

suicidal ideation

serious thoughts about committing suicide

emile durkheim: altruistic suicide

”formalized” suicides that were approved of

emile durkheim: egoistic suicide

suicide provoked by the loss of social supports

emile durkheim: anomic suicides

suicide due to the result of marked disruptions, such as the sudden loss of a high-prestige job, anomie = feeling lost and confused

emile durkheim: fatalistic suicides

result from a loss of control over our own destiny

psychological autopsy

post-mortem psychological profile of a suicide victim constructed from interviews with people who knew the person before death

personality disorder

enduring maladaptive pattern for relating to the environment and oneself, exhibited in a wide range of contexts that cause significant functional impairment or subjective distress, ten specific personality disorder in the dsm-5-tr

three advantages of dimensional model over categorical model of personality disorders

it would retain more information about each individual, it would be more flexible because it would permit both categorical and dimensional differentiations among individuals, it would avoid the often arbitrary decisions involved in assigning a person to a diagnostic category

five factor model of personality (“big five”)

rates people on a series of personality dimensions, the combination of five components describes why people are so different, five factors:

1) extroversion: talkative, assertive, and active vs silent, passive, and reserved

2) agreeableness: kind, trusting, and warm vs hostile, selfish, and mistrustful

3) conscientiousness: organized, thorough, and reliable vs careless, negligent, and unreliable

4) neuroticism: nervous, moody, and temperamental vs even-tempered

5) openness to experience: imaginative, curious, and creative vs shallow and imperceptive 

three personality disorder clusters: cluster a

odd or eccentric cluster; includes paranoid, schizoid, and schizotypal personality disorders

three personality disorder clusters: cluster b

dramatic, emotional, or erratic cluster; consists of antisocial, borderline, histrionic, and narcissistic personality disorders

three personality disorder clusters: cluster c

anxious or fearful cluster; includes avoidant, dependent, and obsessive-compulsive personality disorders