Mood Disorders Overview

Flashcards covering key vocabulary and definitions related to mood disorders.

Mood Disorders

Disorders characterized by strong changes in mood over a long period of time.

Depressive Disorders

A type of mood disorder where patients experience only depressive episodes.

Bipolar Disorder

Also known as manic depression, it involves alternating manic and depressive periods.

Mania

An intense, unrealistic feeling of euphoria and excitement.

Depression

A state of extraordinary sadness and dejection.

Major Depressive Disorder (MDD)

A mood disorder characterized by prolonged depressive episodes for more than two weeks without any manic episodes.

Persistent Depressive Disorder

A chronic form of depression lasting for at least two years with a depressed mood most days.

Anhedonia

A loss of interest or pleasure in most activities.

Psychomotor Retardation

A condition involving slowed behavior and cognitive functions, often seen in depression.

Psychomotor Agitation

A state of physical agitation with fidgeting and inability to remain still.

Recurrence in Depression

When depressive episodes return after an initial recovery; can be categorized into relapse and recurrence.

Relapse

The return of depressive symptoms within a short time when the initial episode hasn't fully resolved.

Recurrence

The complete return of depression after a period of being symptom-free.

• 40-50% of MDD patients have this

dsm-5 for mdd

At least five of the following symptoms are present for at least two weeks and represent a change in functioning. At least one of the symptoms is a depressed mood or loss of interest or pleasure:

• A notable decrease in interest or enjoyment in all, or almost all, activities on most days (almost all days);

• Recurring thoughts of death, recurring ideas of suicide without a specific plan, a suicide attempt or a specific plan to commit suicide;

• Almost every day insomnia (sleeplessness) or hypersomnia (sleeping a lot);

• Significant weight loss without dieting or weight gain;

• Being tired or having little energy almost every day;

• A depressed mood for most days (almost every day) that is indicated by subjective report or observations of others;

• Impaired ability to think or concentrate or indecisiveness almost every day;

• Almost every day, psychomotor retardation or agitation;

• Feelings of worthlessness or excessive guilt almost every day.

• The period is not due to physiological effects of a drug or any other medical condition;

• There has never been a (hypo)manic period;

• The occurrence of the major depressive episode cannot be better explained

• The symptoms cause clinically significant distress

MDD with anxiety

anxiety is very common with depression, and people with this subtype have both prominent anxiety symptoms and depressive symptoms

MDD with mixed features

• people with this subtype meet the criteria for a depressive disorder and have at least three symptoms of mania, but they do not meet the full criteria for a manic disorder

mdd with atypical features

• mood reactivity. This means that the mood improves in response to potential positive events.

• Most people with this subtype are women.

• the person has at least two of the following symptoms:

  • Acutely sensitive to interpersonal disapproval;

  • Weight gain or loss of appetite;

  • Hypersomnia;

  • The feeling that limbs are leaden

mdd with melancholic features

• a person with this subtype of MDD has, in addition to all the symptoms of MDD, no interest in or enjoyment of all activities and makes no response to pleasurable stimuli.

• This form of MDD is more hereditary than other forms and is related to childhood trauma.

• In addition, the person has at least three of the following symptoms:

  • Notable psychomotor decline;

  • Wake up early in the morning;

  • A noticeably depressed mood;

  • In the morning, the depression is the worst;

  • Loss of appetite or weight;

  • Extreme guilt.

mdd with catonic features

• this subtype involves multiple psychomotor disturbances, such as motor immobility, selective mutism (a disturbance in spoken language) and rigidity.

mdd with psychotic features

• in addition to the symptoms of MDD, the patient also has psychotic symptoms, such as loss of contact with the outside world, loss of reality or hallucinations.

• These psychotic symptoms are mood congruent. This means that these features have a negative tone and content and therefore correspond to the depressive mood.

• In addition, the patient has a feeling of guilt and worthlessness.

mdd with a seasonal pattern

• a form of a persistent MDD in which individuals are usually fully recovering from major depressive episodes.

• They become depressed as the days get shorter and there is less sunlight.

• They recover when the days get longer. Some sufferers also develop mild forms of mania during summer time. It is more common in areas where there are fewer hours of daylight in winter.

mdd with a peripartum onset

• MDD in women that experience a depressive episode during pregnancy or in the 4 weeks following after birth.

premenstrual dysphoric disorder

• women with this disorder experience significant increases in distress during the premenstrual phase of their cycle.

• only 2% of women get diagnosed with this disorder. The symptoms must disappear at the postmenstrual phase.

comorbidity

• Nearly 75% of individuals in a study had at least one other mental disorder;

• Often co-occurs with substance-related disorders, panic disorder, generalized anxiety disorder, PTSD, OCD, anorexia, bulimia, and borderline personality disorder.

gender differences

• Men: More often comorbid with alcohol and substance abuse;

• Women: More often comorbid with anxiety disorders, bulimia, and somatic disorders.

prevalence mdd

• can begin at any time of life.

• 16% of adults in America.

• It is fifteen to twenty times more common than other mental disorders

• more and more people have been diagnosed with major depressive disorder.

age

• more difficult to detect depression in older people, since they grew up in a society less accepting

• Depression can also begin at a younger age: 1% to 3% of schoolchildren meet the criteria for some unipolar depressive disorders, and 8.3% of adolescents.

• During adolescence, the risk of depression increases.

• For example, 15% to 20% of adolescents have MDD and 10% to 20% have some symptoms.

• From adolescence onwards, there are gender differences in the prevalence of depression.

• Women are twice as likely to be depressed as men are.

biological factors

• The hypothalamus, pituitary gland and adrenal cortex (HPA axis) are involved in the fight-or-flight response and are more active in depressed people.

• High levels of cortisol lead to chronic hyperactivity

• this overreaction of the HPA axis then affects the normal functioning of monoamine neurotransmitters.

neurochemical factors

• Norepinephrine, serotonin and dopamine, which are monoamines, are all important neurotransmitters for mood regulation.

• Increased activity of dopamine in different brain areas is probably related to manic symptoms

• In depressed periods, there is less dopamine and norepinephrine activity.

• Sleep and other biological rhythms may also be causal factors. Some patients experience abnormalities in their daily rhythm.

two theories about sleep in depressed people

• The first states that the size or scope of the daily rhythm is blurred.

• The second states that the previously synchronised rhythms are now out of sync.

prefrontal cortex

• During a depressive period, blood flow to the left side of the prefrontal cortex, involved in cognitive and emotional functions, is reduced.

• During a manic episode, the blood flow in other parts of the prefrontal cortex is stronger.

hippocampus, basal ganglia and amygdala

• smaller volume and lower metabolic activity in the hippocampus.

• The brain area also secretes chronically high levels of cortisol, usually in response to stress.

• inhibits development of new neurons, leading to decreased activity (affects memory and learning).

• The volume of the basal ganglia (function: control of movements, motivation and belonging) and the amygdala was found to be enlarged with increased activity.

• This leads people with MDD to feel every negative emotion even more intensely.

genetics

• the first-degree relatives of people with MDD are two to three times more likely to also have depression, or develop it.

• There were also higher concordance rates for monozygotic twins compared to dizygotic twins.

• genetic abnormalities can contribute to depression, with the serotonin gene being a probable one involved in this.

psychological factors

• marital problems

• lack of social support, and a lack of social skills, increase the susceptibility to mood disorders.

• women without a close and secure relationship are more prone

• Neurotic people

• introverts and people with a negative thinking pattern

freuds psychodynamic theory

• many similarities between clinical depression and the process of mourning.

• When someone dies, the grieving person enters the oral phase again.

• In this phase, people cannot distinguish between their own feelings and the feelings of others.

• This can lead to anger and hostility, because suppressed negative feelings are released when someone dies.

• This makes depression inverted anger.

• Criticism of this theory is that it is too subjective and untestable.

dependant vs independant life events

• A dependent life event is at least partially caused by the person's own behaviour or personality.

• An example is ending a relationship oneself.

• An independent life event is completely independent of a person's behaviour and personality.

• This could be the death of a loved one.

learned helplessness theory

• individuals believe they cannot control their situation

becks cognitive theory

• a diathesis-stress theory, in which people with depression perceive reality through the negative cognitive triad: they view themselves, the world and the future, negatively.

• there must already be an existing susceptibility to a disorder, which in combination with a stimulus or stress can develop into an actual disorder.

depressogenic schemas/dysfunctional beliefs/errors in thinking

• the first thing that comes into play

• underlying dysfunctional beliefs that are extreme and strict and maintain the depression.

• An example of this is, “No one thinks I'm important, so my life is worthless.”

reformed helplessness theory

• when people experience negative and uncontrollable events, they attribute their failures to global (‘I fail at everything’), internal (‘It is all on me’) and stable (‘I always fail’) factors.

• If a person has a stable and consistent pessimistic attributional style, this person is susceptible to developing depression when negative life events occur.

hopelessness theory

• a pessimistic attributional style and a negative event are not sufficient to trigger a depression, a feeling of hopelessness must first precede.

• The pessimistic attribution style can be learned through observation

• offers an explanation for the gender differences in the prevalence of depression:

• because of their role in society, women are more insecure about having control over negative events. This makes them susceptible

ruminative response style theory

• focuses rather on the ways individuals think, not on the content of their thoughts.

• People suffering from depression when feeling blue, tired and lonely rather focus on how they are feeling and do not attempt to do anything against it

interpersonal theories

• focus on interpersonal relationships

• heightened need for expression of support and approval.

• rejection sensitivity

cohort effect

• due to the rapidly changing social value

• Social circumstances like poverty, unemployment and discrimination

• In the USA, Hispanic individuals show a higher prevalence of depression than non-Hispanic white people.

family-social perspective

• little or no social support can be a cause of depression

ethnicity differences

• Latino cultures and Native Americans show a higher prevalence of depression,

• likely due to high rates of poverty, unemployment, and discrimination against them.

• Non-Western countries often focus on the physical symptoms of depression rather than on the cognitive symptoms.

bipolar 1

• In a manic episode, the mood is elevated

• Violence stems from the frustration when people in the environment do not go along with the euphoric behaviour.

• There is increased activity or energy and rapid mood swings also known as the mood lability.

• If these symptoms persist for at least one week, a diagnosis of a manic episode can be made.

• depressive episodes follow

bipolar 2

• experience severe depressive episodes and milder mania episodes described in the following paragraph.

• Bipolar II disorder does not cause psychosis or delusions.

cyclothymic disorder

• a less severe form of bipolar disorder, but it is more chronic.

• alternate between hypomanic periods and depressive periods, over a course of at least 2 years.

• The person can function normally during the hypomanic periods, but the depressive periods are likely to interfere with daily functioning

Rapid cycling bipolar I or bipolar II disorder

the diagnosis someone gets when they have four or more episodes that meet the criteria for manic, hypomanic or depressive episodes within one year.

hypomanic episode

• a milder variant of a manic episode.

dsm5- mania

• A period of abnormally elevated or irritable mood and increased goal-directed activity or energy, lasting at least 1 week and present most of the day, for nearly every day (or any duration if the individual is hospitalized);

• During the period of mood disturbance and increased energy or activity, three (or more) of the symptoms noted here (four if the mood is just irritable) are present:

• Inflated self-esteem or grandiosity;

• More talkative

• Flight of ideas

• Distractibility

• Decreased need for sleep

• Increase in goal-directed activity

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

• The mood disturbance is severe enough to cause marked impairment

• The episode is not attributable to something else

bipolar prevalence

• Bipolar II disorder is more common than Bipolar I disorder

• more common in women

disruptive mood dysregulation disorder

• A diagnosis is made when children of 6 years old or older experience temper tantrums that closely resemble symptoms of the classic bipolar disorder.

• The child must experience at least 3 severe tantrums per week for at least 12 months and in at least two different settings.

genetics

• very large

brain abnormalities

• abnormal functioning of the amygdala, the prefrontal cortex

• therefore cognitive control of emotion,

• The ventral striatum, which is responsible for the processing of environmental cues for rewards, functions abnormally in bipolar people.

• They are hypersensitive to rewarding cues and have an abnormal circuit to the amygdala.

• increased activity in brain areas that are important for processing emotions, such as the thalamus and the amygdala

neurotransmitters/endocrine

• In manic states, high levels of dopamine have been found

• during depressive periods, cortisol levels are elevated

biological treatments

• Antidepressants first-line treatment

• help in 50% to 60% of people

SSRIS

• improve depression symptoms by blocking the reuptake of norepinephrine and/or serotonin into presynaptic neurons

behavioral activation treatment

• the therapist helps the patient deal more actively with the environment and interpersonal relationships.

• The focus is on changing behaviour, by drawing up a list of pleasurable activities they can do outside of treatment

CBT

1. the patient should engage in more pleasurable activities.

2. the psychologist provides psycho-education about the negative automatic thoughts

3. identifying the thoughts

4. challenging the negative thoughts

mindfulness-based CBT

• used with people who suffer from recurring depression,

• People with negative thoughts learn that these thoughts are not necessarily the truth

• the person accepts that they are there and that they are not true.

interpersonal therapy

• grief over the loss of a loved one —> help them come to terms

• interpersonal role conflict —> recognize the disagreement and to help make choices about concessions

• role transitions —> gain a realistic perspective of the lost role, and to teach the person to see the new role in a more positive light

• deficiencies in interpersonal skills —> review previous relationships, and possibly learn new social skills such as assertiveness

electroconvulsive therapy

• involves administering an electric current to one side of the brain

• causes a decrease in activity in parts of the brain, including the frontal cortex and the anterior cingulate

vagus nerve stimulation

• the stimulation of the vagus nerve by a small electronic device implanted in the breast.

• This has antidepressant effects