Lecture 6: Depressive and Bipolar Related Disorders

Major Depressive Disorder

Presence of one or more major depressive episodes, no manic episodes, and impairment in functioning

Median number of episodes in MDD ___, median duration of ___ months per episode

• 4

• 4.5

_____-____ & ____ adults have been shown to have higher rates of depression than White adults

• African-Americans

• Hispanic

Women __ times as likely to develop depression than men

2

Persistent Depressive Disorder (Dysthymia)

• Two or more years of depressed mood, for most of the day, for more days than not

• Two or more of the symptoms

• Never without symptoms for more than two months at a time

Bipolar I Disorder

at least 1 manic episode

Bipolar II Disorder

• at least 1 hypomanic episode and 1 MDD episode

• no hx. of manic episodes

Cyclothymic Disorder

• At least 2 years of fluctuating between hypomanic symptoms and depressive symptoms without meeting criteria for a hypomanic or depressive episode

• Person has not been without symptoms for more than two months

___% of individuals with MDD had a history of episodes with ___ features

• 19% (1 in 5)

• psychotic

Prevalence of psychotic features during at least one manic episode of those with Bipolar I

50-75%

True or False: Researchers continue to debate whether mood disorders with psychotic features are distinct disorders or simply on the more severe end of a spectrum

true

True or False: Generally speaking, the earlier the age of onset, the poorer the outcomes

true

reason: Childhood onset has been associated with a more chronic, severe, and recurrent course of disorder, with poorer functioning and quality of life than adult onset

Co-rumination

• the engagement in repetitive, non-productive, and emotion-focused, dyadic discussions of problems

• tends to be problem-focused and reinforce rumination

Excessive reassurance seeking

• persistently seeking reassurance that others care about and value them

• Constantly asking for reassurance → Irritates others and drives them away

  → seems like evidence in favor of negative thoughts (“People don’t like

  me”)

Negative feedback seeking

Idea that depressed individuals find rejection and negative feedback more predictable and in line with their negative self-views and actually seek it out

Extinction

• once behaviors are no longer rewarded (reinforced), individuals will cease to perform these behaviors, resulting in extinction of the behaviors

• based on learning theory

Criticism of extinction

depressed individuals may lack the ability to have a pleasurable response to positively reinforcing stimuli (anhedonia) rather than just lacking positively reinforcing stimuli themselves

Hopelessness Theory

depression depends not just on the belief that there is a lack of control over reinforcement (a helplessness expectancy), but also on the belief that negative events will persist or recur (a negative outcome expectancy)

People most at risk are those who see negative life events as due to causes that are (3 things)

1. Stable or permanent (vs. temporary)

2. Global or generalized (vs. specific)

3. Internal (vs. external or environmental)

True or False: Hopelessness is a better predictor of suicide than depression

true

Beck’s Negative Self-Schema Model

When confronted with a negative life event, individuals with this type of cognitive style are hypothesized to

1. Develop negatively biased perceptions of

themselves (low self esteem),

2. Their personal world,

3. Their future (hopelessness)

True or False: The biological contribution to mood disorders CAN be represented as a single genetic abnormality

false

answer: Gene analyses identified 153 significant genes

Individuals with a first-degree relative with MDD are almost ____ times more likely to develop the disorder

3

Those who have a first-degree relative with bipolar disorder are almost ___ times more likely to develop bipolar disorder

10

Hormone imbalance

• Hypersecretion of cortisol

• Thyroid and gonadal/ovarian hormones

Neurotransmitter dysfunction (3)

1. Serotonin (5HT)

2. Norepinephrine (NE)

3. Dopamine (DA)

Medication used for Depression

• SSRIs

• SNRIs

True or False: antidepressants are as effective as psychotherapy for MDD, whereas medication yields better results for Dysthymia

true

Medication used for Bipolar

• Mood stabilizer medications (particularly lithium)

True or False: Antidepressants sometimes trigger rapid cycling and initiation of manic, hypomanic, or mixed episodes

true

Electroconvulsive Therapy (ECT)

• 70-130 volts of electric shock applied directly to the brain shock, resulting in a convulsion

• There is evidence it improves severe depression

• Most common side effect is memory dysfunction

Behavioral Activation (BA) Therapy

treatment for depression is designed to increase activity and develop more positively reinforcing behavior patterns in depressed individuals

Cognitive Behavioral Therapy (CBT)

identifies, challenges, and ultimately aims to modify cognitive schemata to generate less negative information processing

The 3 C’s of CBT

1. Catch

2. Check

3. Change

True or False: CBT has been shown to be at least as effective as medication

true

True or False: A combination of CBT and pharmacotherapy may have a slight advantage when compared with either treatment by itself

true

True or False: Studies have supported less relapse and recurrence

for CBT than for pharmacotherapy

true

Acceptance and Commitment Therapy (ACT) and mindfulness-based interventions involve:

• learning to live in the present moment

• living a values-based lifestyle

• nonjudgmentally accepting all of one’s emotions and experiences

Cognitive defusion

detaching meaning from anxiety-provoking, negative thoughts

In order to meet criteria for a Major Depressive Episode, an individual must have at least 5 of the 9 listed symptoms in Criterion A over a two week period. Name TWO of the 9 symptoms listed in Criterion A for a Major Depressive Episode

1. Depressed mood

2. Diminished interest in activities

3. Significant weight loss or gain

4. Insomnia or hypersomnia

5. Psychomotor agitation or retardation

6. Fatigue or loss of energy

7. Feelings of worthlessness or excessive or inappropriate guilt

8. Diminished ability to think or concentrate, or indecisiveness

9. Recurrent thoughts of death

Which of the following is NOT a symptom of a manic or hypomanic episode?

• Decreased need for sleep

• Inflated self-esteem or grandiosity

• More talkative than usual

All of the above are symptoms of a manic or hypomanic episode

True or False: Individuals who have first-degree relatives with Bipolar Disorder are more likely to develop Bipolar Disorder themselves.

true

The _____________ Theory of depression is the idea that depression depends not just on the belief that there is a lack of control over reinforcement (a helplessness expectancy), but also on the belief that negative events will persist or recur (a negative outcome expectancy).

hopelessness

True or False: African-American & Hispanic adults have been shown to have higher rates of depression than White adults, and parental education and differences in poverty level may account for some the differences in prevalence rates.

true