Psychopathology Test 3

mood disorder

involve much more severe alterations in mood for much longer periods of time.

two key moods involved in mood disorders

mania and depression

mixed-episode

a condition in which a person is characterized by symptoms of both full-blown manic and major depressive episodes for at least 1 week, whether the symptoms are intermixed or alternate rapidly every few days

unipolar depressive disorder

mood disorder in which a person experiences only depressive episodes, as opposed to bipolar disorder, in which both manic and depressive episodes occur

bipolar disorders

disorders marked by alternating or intermixed periods of mania and depression

manic episode

a mood disorder marked by a hyperactive, wildly optimistic state

hypomanic episode

a person experiences abnormally elevated, expansive, or irritable mood for at least 4 days

Major mood disorders are at least 15-20 times more frequent than

schizophrenia

major depressive disorder

A mood disorder in which a person experiences, in the absence of drugs or a medical condition, two or more weeks of significantly depressed moods, feelings of worthlessness, and diminished interest or pleasure in most activities.

Major Depressive Episode

state in which a person experiences a lingering depressed mood or diminished interest in pleasurable activities, along with symptoms that include weight loss and sleep difficulties

Lifetime prevalence rates of unipolar disorders

are nearly 17%. 12-Month prevalence rates were nearly 7%

Mood disorders are

the second most prevalent type of disorder following anxiety disorders

Mood disorders have a 12-month prevalence range from

1-10 percent across different countries

Rates of major depression are always

much higher for females than males (usually 2:1)

mood disorders occur

less frequently with black people

For bipolar disorders

there is no significant difference between males and females

By slowing us down,

mild depression saves us from wasting a lot of energy in the futile pursuit of unobtainable goals

single episode

presence of only one depressive episode (no history of previous episodes)

recurrent episode

presence of more than one depressive episode with an interval of at least 2 consecutive months between episodes

In approximately 10-20 percent of people with MDD,

the symptoms do not remit for over 2 years, in which case persistent depressive disorder is diagnosed

Although most depressive episodes remit (which occurs when symptoms have largely been gone for at least 2 months),

depressive episodes often return at some point.

relapse

A falling back into an old illness within a short period of time

recurrence

the onset of a new episode of depression, occurs in approximately half of people who experience a depressive episode

Incidence of depression rises sharply

during adolescence, with approximately 15-20% of adolescents experiencing major depressive disorder at some point, and subclinical levels of depression affect a further 10-20%

Prevalence of major depression is significantly lower among

those over 65

specifiers

different patterns of symptoms that sometimes characterize major depressive episodes which may help predict the course and preferred treatments for the condition

major depressive episode with melancholic features

A type of major depressive episode which includes marked symptoms of loss of interest or pleasure in almost all activities, plus at least three of six other designated symptoms.

Major depression in adolescence is

highly likely to recur in adulthood

depression in later life

is difficult to diagnose and may overlap with those of several mental illnesses of neurological disorders

severe major depressive episode with psychotic features

loss of contact with reality coupled with false beliefs and hallucinations. May be accompanied with other symptoms

mood congruent

the tendency to recall experiences that are consistent with one's current good or bad mood

major depressive episodes with atypical features

Mood reactivity—brightens to positive events; two of the four following symptoms: weight gain or increase in appetite, hypersomnia, leaden paralysis (arms and legs feel as heavy as lead), being acutely sensitive to interpersonal rejection. More common among females, higher comorbidity with psychiatric and cardiovascular disorders

What is seasonal affective disorder (SAD)?

A controversial disorder in which a person experiences depression during winter months and improved mood during spring.

What is one treatment for seasonal affective disorder?

Phototherapy, using bright light and high levels of negative ions.

What are the diagnostic criteria for seasonal affective disorder?

Must have at least 2 episodes of depression in the past two years occurring at the same time every year.

What is a requirement regarding nonseasonal depressive episodes for a diagnosis of seasonal affective disorder?

The person cannot have had other, nonseasonal depressive episodes in the same 2-year period.

What is a characteristic of the lifetime depressive episodes in individuals with seasonal affective disorder?

Most of the person's lifetime depressive episodes must have been of the seasonal variety.

Who is more commonly affected by seasonal affective disorder?

Younger people.

How does living at high altitudes affect seasonal affective disorder?

Winter season affects the disorder more

Persistent depressive disorder (formerly called dysthymic disorder or dysthymia)

characterized by a persistent depressive mood for most of the day, for more days than not for at least 2 years (1 year for children and adolescents). Periods of normal mood may occur briefly, but they usually last for only a few days to a few weeks (and for a maximum of 2 months).

What is double depression?

A moderately depressed mood that persists for at least 2 years and is punctuated by periods of major depression.

What is the relationship between major depressive episodes and double depression?

Nearly all individuals diagnosed with double depression appear to recover from their major depressive episodes, but recurrence often happens.

What type of disorder is double depression classified as?

It is a form of persistent depressive disorder.

What is the estimated lifetime prevalence of double depression?

Between 2.5-6%.

What is the average duration of double depression?

4-5 years, but it can last for 20 years.

How does chronic stress affect double depression?

Chronic stress has been shown to increase the severity of the symptoms over a 7.5 year follow-up period.

When does persistent depressive disorder, including double depression, often begin?

During adolescence.

What percentage of individuals with double depression present for treatment with an onset before age 21?

Over 50%.

four phases of normal response

numbing and disbelief, yearning and searching for the dead person, disorganization and despair upon learning that a person's loss is permanent, some reorganization as the person gradually begins to rebuild their life

major depressive disorder should not be diagnosed

for 2 months after loss

postpartum blues

a mild, transient emotional letdown experienced by a majority of women after giving birth. Occurs in as many as 50-70% of women.

How much higher are mood disorders among blood relatives?

2-3 times

Which gene is implicated in unipolar mood disorders?

The serotonin-transporter gene.

What are the two types of alleles involved in the serotonin-transporter gene?

Short alleles and long alleles.

What neurochemical factors are associated with unipolar mood disorders?

Serotonin and Norepinephrine Deficiency, Dopamine Dysfunction, GABA and Glutamate Imbalance, Endorphin Deficiency.

What hormonal and immune system abnormalities are linked to unipolar mood disorders?

Failure of feedback mechanisms, elevated cortisol, low thyroid levels, and inflammatory responses.

What neurophysiological influence is observed in the left hemisphere in unipolar mood disorders?

Lower activity in the left hemisphere.

What is the relationship between hippocampal volume and unipolar mood disorders?

Decreased hippocampal volume is observed.

What is the activity level of the amygdala in individuals with unipolar mood disorders?

Increased amygdala activity.

What is observed in the dorsolateral prefrontal cortex in unipolar mood disorders?

Lower activity and decreased volume.

What is the condition of the orbital prefrontal cortex in unipolar mood disorders?

Decreased volume and abnormally low levels of activation.

What sleep disturbances are common in patients with depression?

Difficulty falling asleep, periodic awakening during the night, and early morning awakening.

How quickly do patients with depression enter REM sleep?

Patients enter the first stage of REM sleep after only 60 minutes or less of sleep.

What is the amount of deep sleep like in patients with unipolar mood disorders?

Lower-than-normal amount of deep sleep, with most deep sleep occurring during stages 3 and 4.

What circadian rhythm issues are associated with unipolar mood disorders?

Circadian rhythm errors.

What biological explanations exist for sex differences in unipolar mood disorders?

Hormonal fluctuations.

What are some environmental stressors associated with unipolar mood disorder?

Environmental stressors

What types of disorders are linked to unipolar mood disorder?

Anxiety disorders

Which serious mental illness is mentioned as a factor in unipolar mood disorder?

Schizophrenia

What type of personality trait is considered a vulnerability factor for unipolar mood disorder?

Neuroticism

What personality trait, possibly related to vulnerability in unipolar mood disorder, is mentioned?

Levels of introversion

What cognitive factor is associated with vulnerability to unipolar mood disorder?

Cognitive diatheses

What negative outlook is considered a vulnerability factor for unipolar mood disorder?

Pessimism

What psychodynamic theory is associated with unipolar mood disorder?

Anger and hostility

What behavioral theory relates to unipolar mood disorder?

Lack of positive reinforcement

What is a behavioral factor that affects energy levels in individuals with unipolar mood disorder?

Lower energy to do activities

Beck's cognitive theory

Certain cognitive style is a pre-existing condition that makes people vulnerable to depression

dysfunctional beliefs

negative beliefs that are rigid, extreme, and counterproductive

depressogenic schemas

dysfunctional beliefs that are rigid, extreme, and counterproductive and that are thought to leave one susceptible to depression when experiencing stress

Beck's cognitive model of depression

early experience -> formation of dysfunctional beliefs -> critical incident(s) -> beliefs activated -> negative automatic thoughts -> symptoms of depression

negative cognitive triad

negative thoughts about the self, the world, and the future

negative automatic thoughts

thoughts that are just below the surface of awareness and that involve unpleasant pessimistic predictions

Dichotomous or all-or-nothing reasoning

tendency to think in extremes

Selective abstraction

A cognitive distortion that involves forming conclusions based on an isolated detail of an event.

arbitrary inference

distortion of thinking in which a person draws a conclusion that is not based on any evidence

learned helplessness

the hopelessness and passive resignation an animal or human learns when unable to avoid repeated aversive events

pessimistic attributional style

cognitive style involving a tendency to make internal, stable, and global attributions for negative life events

Reformulated Helplessness Theory

postulates that depressed individuals may use pessimistic attributional style when faced with uncontrollable, negative life events that can lead to symptoms of depression

**Doesn't postulate that pessimistic attributional style has a CAUSAL role

hopelessness theory of depression

The view that whether a person becomes hopeless and depressed depends upon a person making a stable and global attribution for negative life events and the severity of those negative life events

Ruminative Responses Styles Theory of Depression

focuses on responses that people have when they experience feelings and symptoms of sadness and distress and how their differing response styles affect the course of their depression. Some people have feelings and focus intently on them. Women are more likely to engage than men as men are more likely to engage in distracting activities.

Comorbidity of Anxiety and Mood Disorders

Just over half of the patients who receive a diagnosis of a mood disorder also receive a diagnosis of an anxiety disorder at some point in their lives, and vice versa. The shared genetically based factor among these disorders seems to be at least in part the personality trait of neuroticism as a major risk factor. Close relationship between anxiety and unipolar depressive disorders.

Interpersonal effects of mood disorders

- lack of social support and social skill deficits

- depression effects those around the depressed person

- marraige and family issues

Bipolar and related disorders

cyclothymic disorder, bipolar with seasonal pattern, mixed episode

cyclothymic disorder

a disorder marked by numerous periods of hypomanic symptoms and mild depressive symptoms

bipolar disorder 1

characterized by full blown episodes of mania

bipolar disorder 2

recurrent major depressive episodes alternating with hypomanic episodes

mixed episode

a condition in which a person is characterized by symptoms of both full-blown manic and major depressive episodes for at least 1 week, whether the symptoms are intermixed or alternate rapidly every few days

bipolar disorder with a seasonal pattern

bipolar disorder with recurrences in particular seasons of the year

rapid cycling

a pattern of bipolar disorder involving at least four manic or depressive episodes per year

biological causal factors of bipolar disorders

8-10% of the first-degree relatives of a person with bipolar I can be expected to have bipolar disorder, compared to the 1% of the general population. First degree relatives of a person with bipolar disorder also are at elevated risk for unipolar major depression. The average concordance rate is about 40-70 percent for monozygotic twins and only about 5-10% for first degree relatives. Genes account for about 60-90% of the variance in the liability to develop bipolar I disorder. There is a greater genetic risk for schizophrenia for those with bipolar i than ii.