Psychopathology Exam 3 Study Set

What is the official definition of a mood disorder?

A group of mental health conditions characterized by persistent changes in mood, emotions, and behavior

Criteria sets for mood disorders require the presence of at least one mood episode. What are the mood episodes?

• Major Depressive Episode

• Manic Episode

• Hypomanic Episode

What are the types of mood disorders?

• Unipolar

• Bipolar

What disorders fall under Unipolar?

• Major Depression

• Dysthymia

What disorders fall under Bipolar?

• Bipolar 1

• Bipolar 2

• Cyclothymia

Major Depressive Episode (MDE) needs at least 5 of the following symptoms…

• Depressed mood

• Anhedonia

• Appetite or weight changes

• Sleep problems

• Psychomotor changes

• Loss of energy

• Feelings of worthlessness or Inappropriate guilt

• Concentration problems

• Suicidal thoughts

What is Major Depressive Disorder?

• Presence of a major depressive episode

• Not better accounted for by another disorder

• No history of a manic, mixed, or hypomanic episode

What is Persistent Depressive Disorder?

• More chronic (can be less severe)

• Depressed mood most of the day, more days than not, for 2 years

• At least 2 of the following for at least 2 years

  • Appetite problems

  • Sleep problems

  • Low energy

  • Low self-esteem

  • Poor concentration

  • Feelings of hopelessness

What is the difference between Major Depressive Disorder and Persistent Depressive Disorder?

• Major Depressive Disorder = depressed mood everyday for a short period of time

• Persistent Depressive Disorder = depressed mood almost everyday, but not, for a long period of time

(LOOK AT SLIDES FOR GRAPH COMPARISON)

Major Depressive Disorder: Course & Prevalence

• MDE last 6-9 months after no treatment

• 12 month prevalence of MDD is 7%

• Ages 18-29 have 3x higher prevalence than ages 60+

• ~50% people will have recurrent MDE

• Women 2x more common than men

• Gender differences don’t emerge til puberty

• Increase mortality (not just from suicide)

What is Seasonal Affective Disorder?

Major Depressive Episodes occur in a seasonal pattern

• MDE starts same time every year

• MDE ends same time every year

What is Premenstrual Dysphoric Disorder?

Symptoms appear the week before menstruation & improve during menstruation

• 5 symptoms total

  • One must be:

    • marked affective lability

    • marked irritability

    • marked depressive mood

    • marked anxiety

  • One must also be:

    • decreased interest

    • difficulty concentrating

    • lethargy

    • marked change in appetite

    • hypersomnia or insomnia

    • feeling overwhelmed

    • physical symptoms

• Must be assessed prospectively

What are the biological theories of depression?

• Genetics

• Monamine theory of depression

• Hypothalamic-Pituitary-Adrenal-Axis (HPA axis)

What are the GENETIC biological theories of depression?

• If blood relatives have depression, then 2x more likely the person will have depression

• Twin studies = 31-42% heritability

• More severe, early onset, & recurrent depression = 70-80% higher heritability rate

• Specific genes? - serotonin transporter gene (5HTTLP-R)

What are the MONAMINE biological theories of depression?

• Depletion of serotonin & norepinephrine caused depression

  • We no longer think this is true

  • Limited evidence that serotonin is suppressed or low in people with depression; norepinephrine might actually be high for people with depression

  • Working hypothesis: complex interactions of neurotransmitters

What are the HPA biological theories of depression?

• Activation ultimately releases cortisol

• Depression associated with increased reactivity & failure of feedback mechanisms to turn the HPA axis “off”

• Increased cortisol levels linked to memory impairments via damage to the hippocampus

• Asymmetry in activity of the prefrontal cortex

  • Risk factor → predicts onset of first episode of depression

• Smaller hippocampus

  • Important to memory

• Low activation of the anterior cingulate cortex (acc)

  • Important in selective attention

• Increased activation of the amygdala

  • Important for threat protection

What is the risk factor for asymmetry in activity of the prefrontal cortex?

Risk factor → predicts onset of first episode of depression

A smaller hippocampus is important to…?

Memory

Low activation in the anterior cingulate cortex (acc) is important to…?

Selective attention

Increased activation of the amygdala is important for…?

Threat protection

What are the psychological/behavioral/cognitive theories of depression?

• Stressful life events

• Developed depression = might have worsened problem solving skills

• History of MDE = possibly sensitized to have more a response to less stressful event

• May generate more stressful life events

• Reduced positive reinforcers

• Learn helplessness/hopelessness theories

What could be the possible learned helplessness/hopelessness theories?

• Unpredictable negative events serve as punishers → cause behavioral withdrawal

• Pessimistic attributional style → attributions that negative event was internal, stable, & global may underlie this effect

  • Response to rejection: “It’s my fault”, “Something has always been wrong with me”, “Nothing about me is likable”

• Hopelessness relates to the stable part

• Gender differences in depression rates = b/c women tend to be more likely to experience uncontrollable negative life events

What is the cognitive model of depression?

• Internal (e.g. “It must be my fault”)

• Stable (e.g. “I won’t ever be able to change”)

• Global (e.g. “Nothing will work out for me”)

What the the cognitive (only) theories of depression?

• Negative Cognitive Triad

  • Self (I’m incompetent and undeserving)

  • World (The world is hostile)

  • Future (I will always be in emotional pain)

• Negative beliefs & schemas are developed in childhood & “latent” until activated by a stressful life event

• Cognitive biases change people perception of the world & interpretation of events around them

What are the interpersonal theories of depression?

• Rejection sensitivity

• Excessive reassurance seeking

Both could lead to more stress being generated

What is Rumination?

Repetitive and relatively passive mental activity

What are the biological treatments for depression?

• Monamine Oxidase Inhibitors (MAOIs)

• Tricyclic antidepressants

• Selective Serotonin Re-uptake Inhibitors (SSRIs)

• Selective Serotonin and Norepinephrine Re-uptake Inhibitors (SSNRIs)

• Electroconvulsive therapy (ECT)

• Transcranial Magnetic Stimulation (TMS)

• Deep brain stimulation

• Light therapy

How long does it take for pharmacological treatments to have effect?

3-5 weeks

What is the relapse rate during the maintenance phase?

About 25%

6-9 months to relapse

Pharmacological treatments are more effective for _____ depression, and are less effective for _____ & _____ depression.

severe; mild; moderate

What are the problems with Monoamine Oxidase Inhibitors (MAOIs)?

Dangerous + potentially fatal interactions with other medications and certain foods ​

What are the problems with Tricyclic antidepressants?

• Only about 50% have clinically significant improvement​

• Unpleasant side effects​

• Higher toxicity​

What are the facts with Selective Serotonin Re-uptake Inhibitors (SSRIs)?

• Relief within a couple of weeks​

• Side effects better tolerated, but can be unpleasant (sexual side effects, insomnia, GI distress)​

• Equally (or maybe less) effect that tricylic antidepressants​

What are the fact(s) with Selective Serotonin and Norepinephrine Re-uptake Inhibitors (SSNRIs)?

Similar advantages as SSRIs, but has more stimulant effects​

What is Electroconvulsive therapy (ECT)​?

• brief seizures

• treatment-resisted major depression disorder (MDD)

• memory loss

• high relapse rate

What is Transcranial Magnetic Stimulation (TMS)​?

• noninvasive brain stimulation with electromagnet​

• treatment-resistant depression​

• Small effects? 14% remitted with rTMS compared to 5% in placebo​

What is deep brain stimulation?

• electrodes placed within brain

• under investigation for intractable depression

• infection risk

What is light therapy used for?

Seasonal Affective Disorder

What are the psychological treatments for depression?

• Behavioral activation

• Cognitive therapy

• Interpersonal therapy (IPT)

What is behavioral activation for psychological treatments?

• targeting positive reinforcers

• schedule enjoyable and meaningful activities

What is cognitive therapy for psychological treatments?

• identify maladaptive beliefs or thinking traps

• challenge thoughts/core beliefs

• often includes some behavioral activation (CBT)

What is interpersonal therapy (IPT) for psychological treatments?

Goal: Identify & address 1 of 4 interpersonal sources of depression.

• grief, loss

• interpersonal role disputes

• role transitions

• interpersonal skill deficits

What is the success difference between medication & therapy for treatment of depression?

Therapy has less relapse than medication.

What is a Manic Episode?

• distinct period of elevated or irritable mood for at least 1 week

• marked impairment

• often results in hospitalization

• can have psychotic symptoms

• grandiosity

• talkativeness

• distractibility

• racing thoughts

• reduced need for sleep

• impulsive activities

• increased goal directed activity

What is a Hypomanic Episode?

• distinct period of elevated mood or irritability for a least 4 days

• some impairment, but not marked

• no psychotic symptoms

• no hospitalization

What is Bipolar 1?

• marked impairment or hospitalization required

• episodes at least 7 days

Major Depressive Episodes = NO

Full Manic Episodes = YES

Hypomanic Episodes = OK

What is Bipolar 2?

• no marked impairment or hospitalization required

• episodes at least 4 days

• present depressive episode

Major Depressive Episodes = YES

Full Manic Episodes = NO

Hypomanic Episodes = YES

What is Cyclothymia?

• Cyclical mood changes between high & low over a 2 year period

• No manic, hypomanic, or major depressive disorder

• Potentially a precursor to Bipolar 1 or Bipolar 2

What is a Mixed Episode?

• meets criteria for a manic & major depressive disorder

• duration of at least 1 week

• present in at least ¼ of patients w/ bipolar 1

• associated w/ a worse course

What is the lifetime prevalence for Bipolar 1 & Bipolar 2?

Bipolar 1: 1%

Bipolar 2: 2-3%

What is the onset for Bipolar Disorder?

Late adolescent & Early adulthood

Bipolar 2 has an _____ onset, _____ depressive episodes, & _____ risk of suicide than Bipolar 1.

earlier; more; greater

What is the gender prevalence for Bipolar Disorders?

No gender differences in prevalence

What is the cycle of episodes for Bipolar Disorders?

4 episodes in a year

What is the heritability/genetic theories for Bipolar Disorders?

• 1st degree relative of someone w/ Bipolar 1, then 8-10x more likely to have bipolar disorder

• Heritability = 60-90%

• Shared & unique genetic factors for Bipolar 1 & Bipolar 2

• Bipolar 1 is more strongly genetically related to schizophrenia than Bipolar 2

What is the Neurotransmitter & Hormone theories for Bipolar Disorders?

• Serotonin may be low during both depressive & manic episodes

• During manic episodes there may be an increase in Norepinephrine & Dopamine

• HPA axis dysregulated during depressive episodes/ when remitted from depressive episodes

• HPA axis dysregulation may be decreased during manic episodes

What is the difference between depression & manic episodes?

Activity in the prefrontal cortex decreased during depressive state, increased during manic state.

What regions of the brain increase in activity?

Emotional Processing from the thalamus & amygdala.

Why are there disruptions in circadian rhythms in Bipolar Disorder?

• Sensitive to circadian rhythm disruptions

• More likely to have evening chronotype

• Some evidence problems in sleep entrainment/regulating wakefulness

• Sleep disruption predicts manic episode onset for some

What are the psychosocial theories of Bipolar Disorder?

• Positive or negative stressful life events predict episodes​

  • Perhaps by changing biological rhythms?​

• Poorer social support linked to worse outcomes​

• Increased sensitivity to reward​

• Difficulty regulating responses/emotions to reward and goal-related events​

• Set more ambitious goals​

• Positive life events predict mania onset​

What are the biological treatments for Bipolar Disorder?

• Lithium

• Anticonvulsants​

• Atypical Antipsychotics​

• Antidepressants might increase manic epsiodes in those with bipolar disorder​

Patient often remain on medication to prevent recurrence.

What are the psychological treatments for Bipolar Disorder?

• Interpersonal and Social Rhythm Therapy​

  • Combine interpersonal and behavioral techniques to helpmaintain routine​

• Cognitive Behavioral Therapy​

  • Address problematic cognitions to reduce vulnerability todepression and mania​

  • Self-referential, positive cognitions​

  • e.g., “I feel good, I must be GREAT.”​

Suicide vs. Self-harm:

Self-inflicted Unintentional Death

Outcome = Fatal injury

Intent = No intent to die

Suicide vs. Self-harm:

Death by Suicide

Outcome = Fatal injury

Intent = Intent to die

Suicide vs. Self-harm:

Self-harm (NSSI)

Outcome = Non-fatal injury or no injury

Intent = No intent to die

Suicide vs. Self-harm:

Suicide Attempt

Outcome = Non-fatal injury or no injury

Intent = Intent to die

Suicide rates _____ by 37% between 2000-2018 & _____ by 5% between 2018-2020. However, rates returned to their peak in _____.

increased; decreased; 2022

What are the most common methods in attempts in suicide?

1. Firearms

2. Suffocation

3. Poisoning

4. Other

What is the ratio of suicidal attempts by gender?

3:1

(women:men)

What is the ratio of suicidal deaths by gender?

4:1

(men:women)

What age group was their an increase in suicidal ideation?

Adolescents

What are the top 5 risk factors for suicidal ideation?

1. Prior suicidal ideation

2. Hopelessness

3. Depression diagnosis

4. Abuse history (any kind)

5. Anxiety diagnosis

What are the top 4 risk factors for suicide attempts?

1. Prior non-suicidal self-injury

2. Prior suicide attempt

3. Personality disorder

4. Prior psychiatric hospitalization

What are the top 5 risk factors for death by suicide?

1. Prior psychiatric hospitalization

2. Prior suicide attempt

3. Prior suicide ideation

4. Lower socioeconomic status

5. Stressful life events

What are additional risk factors for suicide?

Genetics

• Low serotonin levels (independent of psychiatric diagnosis)

Psychache

What is the interpersonal theory of suicide?

What are the treatments & preventions for suicide?

• Interpersonal Therapy

• Crisis intervention

• Addressing underlying concerns

What is interpersonal therapy for suicide treatments & preventions?

• Decrease burdensomeness and increase belongingness​

  • Interpersonal coping skills​

  • Challenging distorted beliefs​

  • Activities that foster connectedness, effectiveness, & feelings ofself-efficacy​

What is the crisis intervention for suicide treatments & preventions?

• Hospitalization (stabilization)

• Suicide Hotlines

• Means safety/restriction

What is a social issue that leads to suicide?

Access to Guns

What is the definition of a personality?

• styles of thinking, feeling, & behaving that make each of us unique.

• includes sense of self & how you relate to others

What are the Big 5 Personality Traits?

O - Openness

C - Conscientiousness

E - Extroversion

A - Agreeableness

N - Neuroticism

What are the facets of Openness?

• Fantasy

• Aesthetics

• Feelings

• Actions

• Ideas

• Values

What are facets of Conscientiousness?

• Competence

• Order

• Dutifulness

• Achievement Striving

• Self Discipline

• Deliberation

What are facets of Extroversion?

• Warmth

• Gregariousness

• Assertiveness

• Activity

• Excitement Seeking

• Positive Emotion

What are facets of Agreeableness?

• Trust

• Straightforwardness

• Altruism

• Compliance

• Modesty

• Tendermindedness

What are facets of Neuroticism?

• Anxiety

• Hostility

• Depression

• Self consciousness

• Impulsiveness

• Vulnerability to stress

What is Personality Disorder?

• A long standing pattern of problematic attitudes, thoughts, & feelings

  • onset in adolescents/early adulthood

• Can affect relationships, identity, &/or behavior

• Present in a variety of contexts

  • Ex: romantic relationships, work settings, friendships

• Causes significant functional impairment or distress

• Sometimes referred to as “Axis 2”

What makes people want to seek treatment for personality disorder?

• Comorbid Psychopathology

• Romantic relationship at a breaking point

• Vocational problems

• Arrested or Hospitalized

What are the Personality Disorder Clusters?

• Cluster A: odd/eccentric

• Cluster B: dramatic/emotional

• Cluster C: anxious/fearful

What is Cluster A Personality Disorder

Odd/Eccentric

• unusual behaviors or perceptual experiences

• sub-threshold psychotic symptoms

• no full-blown psychosis, delusions, hallucinations

What are the Cluster A Personality Disorders?

• Paranoid Personality Disorder

• Schizoid Personality Disorder

• Schizotypal Personality Disorder

What is Paranoid Personality Disorder?

• mistrust & suspiciousness of others

• motives interpreted as malevolent

• may accuse others of mistreating them

What is the prevalence & course of Paranoid Personality Disorder?

• 2-4% of general population

• In treatment, 3x more likely in men than women

• Chronic cause

• Transient psychotic symptoms (minutes or hours)

• Often comorbid with other disorders

What are the theories of Paranoid Personality Disorder?

• Biology: Moderate heritability

• Environmental: Parental neglect/abuse may increase risk.

• Cognitive: Maladaptive beliefs that others are malevolent & deceptive

Describe the biological theory of Paranoid Personality Disorder.

Moderate heritability

• somewhat more common for folks with family history of schizophrenia, although data are mixed

Describe the environmental theory of Paranoid Personality Disorder.

Parental neglect/abuse may increase risk​

• traumatic brain injury and chronic cocaine use may increase risk​