PSY 254 Mood Disorders, Suicide, Anxiety Disorders, and Obsessive Compulsive Disorders

This is part of the study guide for PSY 254 Exam 2

What should mood disorders be thought of as?

as episodic in that people generally experience depression (or mania) during relatively discrete periods of time

What are depressive disorders?

the person experiences only episodes of depression

what is bipolar disorder (previously manic-depression)?

the person experiences episodes of depression and mania  

What are the depressive disorders?

• Major depressive disorder (MDD)  

• Persistent depressive disorder (PDD)  

• Premenstrual dysphoric disorder (PMDD)  

• Disruptive mood dysregulation disorder (in children) (DMDD)  

what are the bipolar disorders?

• Bipolar I disorder 

• Bipolar II disorder  

• Cyclothymia

What are the major features of major depressive disorder?

Five or more depressive symptoms, including sad mood or loss of pleasure, for 2 weeks 

What are the major features of persistent depressive disorder?

Low mood and at least two other symptoms of depression at 
least half of the time for 2 years 

what are the major features of Premenstrual dysphoric disorder?

Mood symptoms in the week before menses 

what are the major features of Disruptive mood dysregulation disorder?

Severe recurrent temper outbursts and persistent negative 
mood for at least 1 year beginning before age 10 

What are the major features of Bipolar I disorder?

At least one lifetime manic episode 

What are the major features of Bipolar II disorder?

At least one lifetime hypomanic episode and one major 
depressive episode 

What are the major features of cyclothymia?

Recurrent mood changes from high to low for at least 2 years, without hypomanic or depressive episodes 

What are the common symptoms of depressive disorders?

• emotional symptoms

• cognitive symptoms

• somatic symptoms

• behavioral symptoms

what are emotional symptoms?

• dysphoric

• anhedonia

what does it mean to be dysphoric?

feeling gloomy, dejected, despondent, despairing  

what does it mean to have anhedonia?

the inability to experience pleasure

what do cognitive symptoms include?

• Thinking slowed down; poor concentration  

• Guilt and worthlessness  

• Focusing on negative aspects of the self, the environment and the future  

• Suicidal thoughts and actions  

What do somatic symptoms include?

• Fatigue, lethargy, aches and pains  

• Changes in appetite and sleep patterns – usually loss of weight/disturbed sleep  

• Loss of sexual desire  

What do behavioral symptoms include?

Psychomotor retardation

What is Psychomotor retardation?

slowing down of motor responses  

Major Depression Vs. Normal Sadness

1. The mood change is pervasive across situations and persistent over time  

2. The mood change may occur in the absence of precipitating events  

3. The depressed mood is accompanied by impaired ability to function in usual social and occupational roles  

4. The change in mood is accompanied by additional signs and symptoms  

5. The nature or quality of the mood change may be different from that associated with normal sadness  

What is Major Depressive Disorder (MDD)?

• Sad mood or loss of interest or pleasure (anhedonia)  

  • Symptoms are present nearly every day, most of the day, for at least 2 weeks  

  • Symptoms are distinct and more severe than a normative response to significant loss  

  • Plus at least 4 of the following:  

    • Sleeping too much or too little  

    • Psychomotor retardation or agitation  

    • Poor appetite and weight loss or increased appetite and weight gain  

    • Loss of energy  

    • Feelings of worthlessness or excessive guilt  

    • Difficulty concentrating, thinking, or making decisions 

    • Recurrent thoughts of death or suicide  

What is Persistent Depressive Disorder (Dysthymia)?

• Depressed mood for at least 2 years; 1 year for children/adolescents  

  • Plus 2 other symptoms:  

    • Poor appetite or overeating  

    • Sleeping too much or too little  

    • Poor self-esteem  

    • Trouble concentrating or making decisions  

    • Feelings of hopelessness  

• Symptoms do not go away for more than 2 months at a time  

What is Premenstrual Dysphoric Disorder (PMDD)?

• Cluster of severe and disabling affective, behavioral and somatic symptoms that occur in the final week before menses and improved within a few days of menses onset  

  • Can include:  

    • Affective lability, irritability, depressed mood, hopelessness, anxiety  

    • Diminished interest in activities, difficulty concentrating, lack of energy  

    • Changes in appetite, overeating, food craving  

    • Sleeping too little or too much  

    • Feeling overwhelmed or out of control  

    • Body pains  

 

What is Disruptive Mood Dysregulation Disorder ?

• Severe recurrent temper outbursts, including verbal or behavioral expressions of temper, that are out of proportion in intensity or duration to the provocation 

  • Outbursts are inconsistent with developmental level  

  • Negative mood between outbursts most days  

  • Outbursts occur at least 3 times a week  

• Symptoms present for at least 12 months and are never gone for more than 3 months at a time  

• Onset before age 10  

What kind of conditions are the depressive disorders?

Chronic and recurrent

What is the mean number of lifetime incidents for depressive disorders?

5-6, but most will have at least 2 depressive episodes

What is the length of the depressive episodes?

• Minimum duration is two weeks; can be much longer  

• One half recover within six months; longer the remission period, lower the risk of relapse  

What is remission? (in terms of depressive disorders)

when a person's symptoms are diminished or improved  

What is relapse? (in terms of depressive disorders)

• a return of active symptoms in a person who has recovered from a previous episode  

How many people have major depressive disorder?

16%

How many people have persistent depressive disorder?

Approximately 3%

Are depressive disorders more common in women or men?

Twice as common in women than in men.

What else is also common with depression?

Comorbidity

What is the average onset for depressive disorders?

30 years

What are the complaints in latino culture?

nerves and headaches  

what are the complaints of the asian cultures?

weakness, fatigue, and poor concentration

What is associated with lower rates of MDD?

Smaller distance from equator (longer day length) and higher fish consumption

What are the causes of the depressive disorders?

• Biological Factors

• Psychological Factors

• Social Factors

What do genetics have to do with depressive disorders?

family studies and twin studies suggest a moderate genetic influence for unipolar depression 

What does heritability have to do with depressive disorders?

estimate for unipolar depression is 37-52% 

What does serotonin have to do with depressive disorders?

appears particularly important, as levels are related to mood, hopefulness, sleep, and appetite  

• Serotonin transporter (5-HTT) gene has been studied because several drugs used to treat depression have a direct impact on this particular neurotransmitter  

• Individuals who are vulnerable to depression may have less sensitive serotonin receptors  

• However, many neurotransmitters are likely to be involved  

What are biological factors in relation to depressive disorders?

• Genetics

• Heritability

• Serotonin  

• Overactivity of hypothalamic-pituitary-adrenal (HPA) axis may play a role in the development and maintenance of depression  

  • Overproduction of cortisol may lead to changes in brain structure and function  

• Brain imaging studies the differences in brain structure and activity in people with depression. Found some changes in pre-frontal cortex (PFC):  

  • Decreased activity on left side of the brain (dorsolateral prefrontal cortex)  

  • Abnormally elevated activity in orbital PFC and ventromedial PFC  

What are psychological factors of the depressive disorders?

• Cognitive Vulnerability

• Cognitive theory

What is Cognitive Vulnerability?

• Humans are not only social but also thinking organisms.  

• Ways in which people perceive, think about, and remember events influence feelings  

• Negative thoughts about self and pessimistic view of the environment maintain depression-especially how hopeless people are  

What is cognitive theory?

suggests that distortions such as overly negative views of the self, environment and future, and assigning global, personal meaning to failures play important role in developing depression 

What are the social factors in relation to depressive disorders?

• Loss (of significant others, of social role, of self-esteem, etc.) plays an important role in the onset of depression

• Experiencing a stressful life event

  • Gender differences in experience of stressful events may explain some of the gender differences in the prevalence of depressive disorders  

  • Lack of social support may be one reason a stressor triggers depression  

  • Interpersonal difficulties  

    • High levels of expressed emotion by family member predict relapse  

    • Marital conflict also predicts depression  

  • Behavior of depressed people often leads to rejection by others  

    • Excessive reassurance seeking  

    • Few positive facial expression  

    • Negative self-disclosures  

    • Slow speech and long silences  

 

What are treatment options for depressive disorders?

• Cognitive therapy

• Interpersonal therapy (IPT)

• Selective Serotonin Reuptake Inhibitors (SSRIS)

• Tricyclics (TCAs)

• Monoamine oxidase inhibitors (MAOIs)

• Medication and Therapy

What is cognitive therapy?

focuses on recognizing, challenging, and overcoming cognitive distortions and errors in logic  

• Patients are encouraged to replace self-defeating cognitions with more rational self-statements  

  • Role of therapist is active/direct  

  • CBT is effective in treatment of nonpsychotic depression  

What is Interpersonal Therapy (IPT)?

focuses on interpersonal factors in current relationships that cause and maintain depression 

• Treatment focuses on building communication and problem-solving skills  

What are selective serotonin reuptake inhibitors (SSRIs)?

inhibit the reuptake of serotonin without affecting other neurotransmitters  

• Fewer side effects for patients while remaining as effective as other antidepressants  

• By far the most commonly prescribed antidepressant

What are tricyclics (TCAs)?

block the uptake of neurotransmitters (especially norepinephrine) from the synapse  

• Not as widely used today because of the side effects (blurred vision, drowsiness, blood pressure drops)  

What is monoamine oxidase inhibitors (MAOIs)?

not as widely used because of the dietary restrictions necessary for patients  

• Not as effective as TCAs  

• Also used in some anxiety disorders  

What is another form of treatment for unipolar or bipolar disorder?

Electroconvulsive therapy (ECT)

What is ECT?

A medical treatment that involves electrically inducing seizures to alleviate severe mental health conditions, primarily used when other treatments fail.

• Most patients receive two or three treatments/week, totaling 6-8 sessions  

• The mechanism of action is unknown but ECT is effective for those with severe depression  

• Also an appropriate treatment for those with paid cycling bipolar disorder and depression with psychotic features  

What is Bipolar I Disorder?

• A person who has experienced at least one manic episode  

• Most people with this diagnosis have episodes for major depression 

• Episode of major depression not required for diagnosis  

What is Bipolar II Disorder?

• A person who has experienced at least one major depressive episode, one hypomanic episode, and no full-blown manic episodes 

What is Cyclothymic Disorder (Cyclothymia)?

• Chronic but less severe form of bipolar disorder  

• Lasts at least 2 years in adults, 1 year in children/adolescents  

• Numerous periods with hypomanic and depressive symptoms – does not meet criteria for mania or major depressive episodes  

  • Symptoms do not disappear for more than 2 months at a time  

  • Symptoms cause significant distress or impairment  

What is mania?

a state of intense elation or irritability

What are symptoms of mania?

exaggerated feelings of physical and emotional well-being, inflated self-esteem, pressured speech, and racing thoughts 

How long does a manic episode last and what does it cause?

symptoms last for 1 week or longer and cause significant distress/impairment  

What is hypomania?

symptoms of mania but less intense

• Does not involve significant impairment, mania does  

• During hypomanic episode, symptoms last for at least 4 days but impairment is not as great as manic episode  

What are the symptoms of mania?

Emotional, cognitive, somatic, behavioral

What are emotional symptoms of mania?

including feeling elated, optimistic and cheerful, even euphoric, but irritable; easily provoked to anger  

What are cognitive symptoms of mania?

experience racing thoughts, high distractibility, grandiosity, and inflated self-esteem  

What are the somatic symptoms of mania?

such reduced need for sleep, dramatically increased energy  

What are the behavioral symptoms of mania?

gregariousness, high energy and activity levels, impulsivity, flirtatious and provocative behavior  

How many episodes do people with bipolar disorder?

Most will have more than one episode?

How long is the average manic episode?

2-3 months, but the length of intervals between episodes varies and is difficult to predict

Do people with a bipolar disorder ever achieve a sustained recovery?

• Long-term prognosis is mixed  

• It is typically considered a severe mental illness  

How many people in the US and worldwide have Bipolar I?

1% in U.S.; 0.6% worldwide

What is the prevalence rate of Bipolar II?

0.4% - 2%

What is the prevalence rate of cyclothymia?

4%

What are the causes of the bipolar disorders?

• Biological factors

• Psychological factors

• Social factors

What are biological causes in the bipolar disorders?

• Genetics: family studies and twin studies suggest a strong genetic influence for bipolar depression  

  • The heritability estimate for bipolar is very high  

• Newer research provides evidence for a specific genetic marker for bipolar disorder (chromosome 18)  

  • However, most researchers believe the transmission of mood disorders is polygenic and that there is not strong evidence of a single gene responsible for mood disorders  

What are the psychological causes of bipolar disorder

• Triggers of depressive episodes in bipolar disorder appear similar to the triggers of major depressive episodes  

  • Negative life events, neuroticism, negative cognitions, expressed emotion, and lack of social support  

• Sleep disruption can be a predictor of mania  

What are the social causes for the bipolar disorders?

• Manic episodes may be precipitated by stressful (positive or negative) life events  

  • May also play role in increasing probability of relapse  

• Mania may also be more likely to reoccur due to patterns of negative familial interactions (e.g., hostile, critical)  

 

What is treatment for the bipolar disorders?

• Medication

  • Lithium carbonate

  • Anticonvulsant medication

• Therapy

What is lithium carbonate in bipolar disorders?

• Effective treatment in alleviation of manic symptoms  

• Reduces relapse in patients who continue taking lithium between episodes  

• 40% do not respond to lithium, especially rapid cycling patients and those who show schizophrenic features  

• Negative side effects (e.g., nausea, weight gain, memory problems) contribute to poor compliance rate  

  • Approximately 50% do not take as prescribed  

What is anticonvulsant medication used to treat in the bipolar disorders?

• Used to treat cycling  

• Patients who do not respond well to lithium are often prescribed valproate or carbamazepine  

• 50% of bipolar patients respond positively to the anticonvulsants  

• Side effects include GI distress and sedation 

How does therapy work with the bipolar disorders?

• Can be an effective supplement to medication  

• Interpersonal and cognitive therapies focus on stress and the onset of symptoms, the regulation of sleep, relationships, and work patterns  

• Little research to support the value of psychotherapy alone  

• Data suggests that medication and psychotherapy together are also more effective than medication alone  

What can suicidal ideation be a symptom of?

A mood disorder

In what context do 50% suicides occur in?

Typically in the context of mood disorders or mental illness, often associated with conditions like depression or bipolar disorder.

How many patients with mood disorders will eventually complete suicide?

15-20%

What is suicide?

death from deliberate self-injury

What is a suicide attempt

behavior intended to complete suicide

What is suicidal ideation?

thought about or planning suicide

What is non-suicidal self-injury?

• behaviors intended to injure oneself without intent to complete suicide  

  • Some people deliberately harm themselves without trying to end their lives  

  • Self-harm is a reflection of frustration and anger  

  • It may be a way to punish the self, to combat extended periods of emptiness, or to regulate one's negative emotional states  

  • Most frequent forms of non-suicidal behaviors involve cutting, burning, or scratching the skin  

 

What are the most common type of psychiatric disorders?

Anxiety disorders

What happens with anxiety disorders?

• People with anxiety disorders share a preoccupation with, or persistent avoidance of, thoughts or situations that provoke anxiety  

• Excessive worry is common, crucial symptom that all anxiety disorders share  

• Anxiety disorders share similarities with mood disorders  

  • Close relationship between symptoms of anxiety and depression  

  • Stressful life events seem to play a role in onset of both  

What is the difference between anxiety and fear?

• Distinction between normal and pathological worry hinges on quantity and quality or worrisome thoughts.

• both involve physiological arousal; both can be adaptive

What is anxiety?

• Anxiety is associated with the anticipation of future problems  

  • Involves more general or diffuse emotional reactions  

  • The emotional experience is out of proportion to the threat  

What is fear?

experienced in the face of real, immediate or perceived danger  

• Usually builds quickly in intensity  

• Helps behavioral responses to threat  

• Fear triggers "fight or flight" - may save life  

What anxiety disorders does the DSM-5-TR recognize?

• Specific Phobia  

• Social Anxiety Disorder (previously Social Phobia)  

• Panic Disorder  

• Agoraphobia  

• Generalized Anxiety Disorder (GAD) 

 

What is specific phobia?

"marked fear or anxiety about a specific object or situation that provokes immediate fear or anxiety"  

• Exposure to phobic stimulus must be followed by an immediate fear response  

  • Avoidance is an important component of the definition  

  • Reactions are irrational and unreasonable  

• Avoidance/distress associated with phobia must interfere significantly with person's normal activities, relationships with others; must be persistent  

What are the different types of phobias?

• Zoophobia

• Acrophobia 

• Claustrophobia

• Hemophobia

• Aerophobia  

What is zoophobia?

fear of small animals

what is acrophobia?

fear of heights

what is claustrophobia?

fear of enclosed spaces

what is hemophobia?

fear of blood