Exam 1 -- Mood Disorders

What are the common characteristics of mood disorders? What are the two categories in the DSM-5?

• prolonged and marked disturbances in mood that affect feelings, beliefs, thoughts and verbal statements, and interactions with others

• Bipolar disorders and depressive disorders

What are the types of depressive disorders

• major depressive disorder

• dysthymia (persistent depressive disorder)

• premenstrual dysphoric disorder

• disruptive mood dysregulation disorder

• specified/unspecified depressive disorder

  • doesn’t quite meet full criteria for another disorder

  • unspecified because can’t see cause

What is the prevalence of depression?

• women are 2x more likely to be diagnosed

• average onset- mid-20s

• up to 20% of Americans

Random facts about depression

• heterogenous (will look diff in diff people)

• 50-60% of those with one major depressive episode will have a second, 70% with two will have a third, 90% will have a fourth

Characteristics of MDD

• 1 MDE at least

• duration of at least 2 weeks

• 5 or more affective, behavioural, and cognitive symptoms

• ***must include depressed mood or anhedonia

  • ^^unspecified without these

What is anhedonia

don’t have the same pleasure you typically would with the same stimuli

• often leads to social withdrawal because you anticipate lack of pleasure

Cognitive symptoms of MDD

• feelings of worthlessness/guilt

• negative self-evaluation with no reason

• rumination

• poor concentration, difficulty thinking and remembering

What are specifiers?

sets of symptoms that occur together in patterns

What are specifiers of depression?

• melancholic features (complete anhedonia)

• mixed features (2+ subtypes)

• atypical features

  • psychomotor retardation, weight gain, hypersomnia

• catatonic features

• mood-incongruent psychotic features

  • not in a negative mood state and experience psychotic features

• mood-congruent psychotic features

  • in a negative mood state and experience psychotic features

• chronic depression

  • not the same as dysthymia (PDD)

  • major depressive episode with 2+ years no remittance

• peripartum onset

  • within four weeks of giving birth

• seasonal pattern

What is the diagnosis nomenclature for depression? 

number-of-disorder.specifier diagnosis — severity, specifier

• e.g., 196.31 MDD: Mild, reccurent episode with peripartum onset

Dysthymia

• involves fewer MDE symptoms

• symptoms persist for longer than MDD

  • at least 2 years

  • no symptom remittance of a period of longer than 2 months

  • less likely to experience vegetative symptoms

• eeyore from Winnie the Pooh

What is double depression?

when people have dysthymia then experience a MDE

What is Disruptive Mood Dysregulation Disorder

• child disorder

• severe recurrent temper outbursts in children (3x+ in a week)

• developmentally inconsistent

• 12+ months

• could be caused by trauma, abuse in the home, other environmental factors

• could be depressed, but MDD symptoms must be exact or its DMDD

Frontal lobe involvement in depressive disorders

• left-frontal lobe hypoactivation

  • reduction in motivated behaviour

  • pleasure centers not reactive to positive stimuli (particularly in anhedonia)

Explain the neurological factors of depressive disorders

• frontal lobe hypoactivated, leading to reduction in motivated behaviour

• amygdala hyperactivated

• thalamus and basal ganglia overactive

  • thalamus (attention) makes people hyperattentive to negative affect in other people (mood-affected belief)

  • basal ganglia overactivation results in psychomotor agitation and retardation

What is the catecholamine hypothesis in depression studies? (hint: neurotransmitters)

• norepinephrine levels too low in several brain regions 

Explain the stress-diathesis model

stress diathesis broadly maps the catecholamine hypothesis

• brain is in compromised state, so HPA (hypothalamus-pituitary-adrenal) axis is pumping out too much cortisol

• according to this model, people with depression have an excess of cortisol, making their brain prone to overreacting to stress

• stress alters serotonin and norepinephrine systems

explain the diathesis-stress model

a psychological disorder is triggered when a person with a diathesis (genetic predisposition) for a particular disorder experiences a triggering stressor

How do depressed people think in terms of attribution style?

Internal (personal), global, stable

• e.g., “he broke up with me because I am inherently unlovable”

• you are more at risk to become depressed if this is how you think

What are thought distortions (Aaron Beck) in depressed people?

• forming a negative triad

  • seeing the world, the self, and the future as negative

• get stuck on things: rumination

What is hopelessness and learned helplessness in depressed people? 

• hopelessness may be the central element in depression

• consistently making global and stable attributions for negative events: “my situation won’t improve”

• undesirable outcomes will occur, desirable ones won’t, and I am helpless to change my situation

  • learned helplessness results from this thinking: you tried before and it didn’t work, so why try again; hopeless to save your situation

Depressive disorders: social factors

• stressful life events

  • endogenous depression is when we cannot find why patient is depressed

• social exclusion

• social interactions and attachment styles

• culture

  • collectivist vs. individualistic

• gender

  • females > males

  • women taught to internalize emotions, men taught to externalize

What is the best option for treating depressive disorders

fundamental change in attitude

• medication and therapy have same results/success rates

What medications are available for depressive disorders?

• SSRIs

• Tricyclic antidepressants (TCAs)

  • almost never first-line treatment because has greater side effects

  • given after SSRIs

• Monoamine oxidase inhibitors (MAOs)

  • 2nd or 3rd line of defense

  • weird interactions with food and substances

  • treating atypical depression

  • breaks down monoamines (like serotonin, dopamine, and norepinephrine) in the synapse to increase availability

• Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)

  • might be 1st line of defence for anhedonia

• Norardrenergic and specific serotonergic antidepressants (NaSSAs)

What wired/more sciencey treatments are there for depression? (like magnetics etc) 

• Transcranial Magnetic Stimulation (TMS)

  • high-intensity magnetic pulses through the brain

  • perpendicular circles shooting energy through brain

  • never first line of defence

• Deep Brain Stimulation (DBS)

  • electrode implanted in brain surgically

  • rarely used, only for severe depression and highly suicidal patients, last resort treatment

• Electroconvulsive Therapy (ECT)

  • very common and very effective in treating severe depression

  • 2-3 times a week for ~6-12 sessions

  • side effects rare, sometimes minor memory loss

Psychological treatments for depression

• CBT

  • examine and challenge cognitive distortions

  • behavioural interventions

    • behavioural activation

      • activate yourself—do something to improve your mood

    • charting, self-monitoring, journaling

Social treatments for depressive disorders

Interpersonal Therapy (IPT)

• target one or more significant relationships

Family systems therapy

What is critical in diagnosing bipolar disorders

MUST HAVE

• (BP1) 1 manic episode OR

• (BP2) hypomanic episode and MDE

Explain mania

• expansive mood

  • unceasing, indiscriminate enthusiasm for interpersonal, sexual, or occupational interactions

during a manic episode, an individual may:

• begin projects with no skills or training

• believe they have superior abilities or special relationships with famous people

• have less need for sleep, inability to sit still, talk rapidly or loudly, pressured speech

manic episodes last about 1 week

Explain a hypomanic episode

• manic symptoms, but severity is less pronounced

• hypomania does not impair functioning like mania does

• symptoms of an episode must last for a minimum of four days

Criteria for Bipolar I

• must have at least one manic episode

• an MDE may also occur

• you only need to have had one manic episode for a bipolar I diagnosis

Criteria for Bipolar II

• must alternate between hypomanic episodes and MDEs

• less severe because of absence of manic episodes

Bipolar Disorder specifiers

rapid cycling

• four or more episodes that meet the criteria for any type of mood episode within 1 year

• more common with BPII and in women

• associated with more difficulty in finding effective treatment

What is Cyclothymia disorder

• chronic, fluctuating mood disturbance 

• numerous periods of hypomanic symptoms 

• numerous periods of depressive symptoms that do not meet criteria for an MDE

• unfolds slowly during early adolescence or young adulthood and has a chronic course

• 15-50% of people with cyclothymia end up developing another type of bipolar disorder

What are the differences between Bipolar II and Cyclothymia

• BPII have to have one major depressive episode

  • cyclothymia with an MDE would just be BPII rapid cycling

What are the neurological factors of bipolar disorders?

• brain systems

  • enlarged amygdala (less enlarged in depression, more dysfunction, here it is enlarged)

    • more active during a manic episode

• neurotransmitters

  • serotonin, norepinephrine, glutamate, and dopamine are implicated

• genetics

  • 40-70% chance for monozygotic twins

Social factors of bipolar disorders

• stress

  • first episode more likely when under stress

  • worsening of condition

  • relapse

• people with bipolar do much better when under a routine

Neurological treatments for bipolar disorders

• medication

  • mood stabilizers e.g., lithium

  • anti-psychotics e.g., risperdal

Why is CBT good for Bipolar disorders?

• increases medication compliance during mania

• promotes better sleep

• teaches early signs of symptoms

What are social treatments for bipolar disorders

• Interpersonal and Social Rhythm Therapy (IPSRT)