PSYC 100 Winter W20

Psychopathology II

Mood Episodes

Brief periods of sadness, irritability, or euphoria are different than having a mood disorder such as MDD or BD

Major Depressive Episode

Refers to symptoms that co-occur for at least two weeks + cause significant distress or impairment in functioning, such as interfering with work, school, or relationships

Core symptoms include feeling down or depressed or experiencing anhedonia

Anhedonia

Loss of interest or pleasure in activities one previously found enjoyable or rewarding

DSM Criteria for a Major Depressive Episode

Requires five or more of the nine symptoms, including one or both of the first two symptoms, for most of the day, nearly every day

Depressed mood, diminished interest or pleasure in all activities, significant weight loss or gain (or ± in appetite), insomnia or hypersomnia, psychomotor agitation or retardation, fatigue, feeling worthless, diminished ability to concentrate, recurrent thoughts of death + suicidal ideation

Hypersomnia

Excessive daytime sleepiness, including difficulty staying awake or napping, or prolonged sleep episodes

Psychomotor Agitation

Increased motor activity associated with restlessness, including physical actions (e.g., fidgeting, pacing, feet tapping, handwringing)

Retardation

A slowing of physical activities in which routine activities (e.g., eating, brushing teeth) are performed in an unusually slow manner

Suicidal Ideation

Recurring thoughts about suicide, including considering or planning for suicide, or preoccupation with suicide

Manic/Hypomanic Episode

Core criterion is a distinct period of abnormally + persistently euphoric, expansive, or irritable mood + persistently increased goal-directed activity or energy

Mood disturbance must be present for one week or longer in mania or four days or longer in hypomania

Symptoms needing to be present for diagnosis for Manic/Hypomanic Episode

Three in context of euphoric mood, four in irritable mood

Inflated self-esteem or grandiosity

Increased goal-directed activity or psychomotor agitation

Reduced need for sleep

Racing thoughts or flight of ideas

Distractibility

Increased talkativeness

Excessive involvement in risky behaviours

Grandiosity

Inflated self-esteem or an exaggerated sense of self-importance and self-worth

Distinction between Manic + Hypomanic Episode

Distinguished by their duration and associated impairment

Manic Episode Duration + Functioning

Must last one week, defined by a significant impairment in functioning

Hypomanic Episode Duration + Functioning

Shorter, not necessarily accompanied by impairment in functioning

Unipolar Mood Disorders

MDD and Persistent Depressive Disorder

MDD Criteria

One more more MDE’s, but no history of manic or hypomanic episodes

PDD Criteria

Feeling depressed most of the day for more days than not, for at least two years

Symptoms of poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, feelings of hopelessness

Need to cause significant distress or impairment

Major Types of Bipolar Mood Disorders

Bipolar I, Bipolar II, Cyclothymic Disorder

Bipolar I Disorder (BD I)

Was previously known as manic-depression, characterized by a single (or recurrent) manic episode

Depressive episode is not necessary but commonly present

Bipolar II Disorder (BD II)

Characterized by single (or recurrent) hypomanic episodes + depressive episodes

Cyclothymic Disorder

Characterized by numerous + alternating periods of hypomania + depression, lasting at least two years

Periods of depression cannot meet full diagnostic criteria for an MDE, person must experience symptoms at least half the time w. no more than 2 consecutive symptom free months, symptoms must cause significant distress or impairment

Early Adversity

Single or multiple acute or chronic stressful events, which may be biological or psychological in nature, occurring during childhood and resulting in a biological and/or psychological stress response

Attributional Styles

The tendency by which a person infers the cause or meaning of behaviours or events

Chronic Stress

Discrete or related problematic events and conditions which persist over time + result in prolonged activation of the biological and/or psychological stress response (e.g., unemployment, ongoing health difficulties, marital discord)

Social Zeitgeber Theory

Environmental cues such as meal times and interactions with other people, that entrain biological rhythms and thus sleep-wake cycle regularity

Monoamine Oxidase Inhibitors (MOAIs)

Earliest antidepressant medications, inhibit monoamine oxidase

Side effects include high BP if they take certain drugs or eat food containing tyramine

Tricyclics

Second-oldest class of anti-depressant medications

Block the reabsorption of norepinephrine, serotonin, or dopamine at synapses

Are most effective for treating vegetative and somatic symptoms

Selective Serotonin Reuptake Inhbitors (SSRIs)

Drugs like fluoxetine, block the reabsorption of serotonin

Are less cardiotoxic, less lethal in overdose, and produce fewer cognitive impairments

Serotonin & Norepinephrine Reuptake Inhibits (SNRIs)

Block the reabsorption of serotonin and norepinephrine

Other Biological Treatments for People with Depression

Electroconvulsive Therapy (ECT), Transcranial Magnetic Stimulation (TMS), Deep Brain Stimulation

Electroconvulsive Therapy (ECT)

Inducing a seizure after a patient takes muscle relaxants and is under general anesthesia

Viable treatment for patients with sever depression or who show resistance to antidepressants

Although the mechanisms through which it works remain unknown

Common side-effect is confusion and memory loss, usually short term

Repetitive Transcranial Magnetic Stimulation (TMS)

Noninvasive technique administered while a patient is awake

Brief pulsating magnetic fields are delivered to the cortex, inducing electrical activity

Has fewer side effects than ECT

Promising treatment for those with MDD who’ve shown resistance to other treatments

Deep Brain Stimulation

Treatment option for patients who did not respond to more traditional treatments

Involves implanting an electrode in the brain, electrode is connected to an implanted neurostimulator, which electrically stimulates that particular brain region

Behaviour Therapies

Focus on increasing the frequency + quality of experiences that are pleasant or help the patient achieve mastery

Cognitive Therapies

Primarily focus on helping patients identify and change distorted automatic thoughts + assumptions

Based on rationale that thoughts, behaviours + emotions affect and are affected by each other

Interpersonal Therapy for Depression

Focuses largely on improving interpersonal relationships by targeting problem area, specifically unresolved grief, interpersonal role disputes, role transitions, and interpersonal deficits

Short-Term Psychodynamic Therapy for Depression

Focused on a limited number of important issues

Therapist tends to be more actively involved than in more traditional psychodynamic therapy

Lithium

First line treatment choice for bipolar disorder

Acts on several neurotransmitter systems in the brain through complex mechanisms, including reduction of excitatory (dopamine + glutamate) neurotransmission, + increasing of inhibitory (GABA) neurotransmission

Number of side effects (nausea, tremor, weight gain and fatigue)

Anticonvulsant Medications

Examples of carbamazepine and valproate

Commonly used to treat patients with BD, either alone or in conjunction with lithium

Interpersonal & Social Rhythm Therapy (IPSRT)

Psychosocial intervention focused on addressing the mechanism of action posited in social zeitgeber theory to predispose patients who have BD to relapse, namely sleep disruption

How can we distinguish between manic and hypomanic episodes?

By the duration and level of impairment

Symptoms of Psychotic Disorders

Delusions, hallucinations, disorganized speech and behaviour, abnormal motor behaviour (including catatonia)

Negative Symptoms of Psychotic Disorde

Anhedonia/amotivation, blunted affect/reduced speech

Catatonia

Behaviours that seem to reflect a reduction in responsiveness to the external environment. Can include holding unusual postures for long periods of time, failing to respond to verbal or motor prompts from another person, or excessive and seemingly purposeless motor activity

Anhedonia/Amotivation

A reduction in the drive or ability to take the steps or engage in actions necessary to obtain the potentially positive outcome

Delusions

False beliefs that are often fixed, hard to change even in the presence of conflicting information, and often culturally influenced in their content (e.g., delusions may involve false beliefs about important figures in a person's culture such as political leaders, popular culture icons, key religious figures, or famous athletes)

Most common are persecutory

Grandiose Delusions

The person believes they have some special power or ability

Referential Delusions

Person believes that events or objects in the environment have special meaning for them

Hallucinations

Perceptual experiences that occur even when there is no stimulus in the outside world generating the experiences. Can be auditory, visual, olfactory (smell), gustatory (taste), or somatic (touch)

Disorganized Speech

Speech that is difficult to follow, either because answers do not clearly follow questions or because one sentence does not logically follow from another; can be present even when the person is writing

Disorganized Behaviour

Behaviour or dress that is outside the norm for almost all subcultures; would include odd dress, odd makeup, or unusual rituals

Flat Affect

A reduction in the display of emotions through facial expressions, gestures and speech intonation

Alogia (Reduced Speech)

A reduction in the amount of speech and/or increased pausing before the invitation of speech

Schizophrenia (Diagnostic Criteria)

Impairment in one or more areas of function (social, occupational, educational self care) for a significant time since onset of illness

Two or more of the following for at least one month: hallucinations, delusion, disorganized speech, grossly disorganized or catatonic behaviour, negative symptoms

Continuous signs of the illness for at least six months

Schizophreniform Disorder (Diagnostic Criteria)

Same symptoms of schizophrenia, present for at least one month but less than six

Schizoaffective Disorder (Diagnostic Criteria)

A period of illness where the person has both the psychotic symptom necessary to meet schizophrenia + either a major depression or manic episode

Person experiences either delusions or hallucinations for at least two weeks when they are not having a depressive or manic episode

Symptoms that meet criteria for depressive or manic episodes are present for one half of the illness duration

Delusional Disorder (Diagnostic Criteria)

Presence of at least one delusion for at least a month

Person has never met criteria for schizophrenia

Person’s function is not impaired outside the specific impact of the delusion

Duration of any depressive or manic episodes have been brief relative to the duration of the delusion(s)

Brief Psychotic Disorder (Diagnostic Criteria)

One or more of the following symptoms present for at least one day but less than one month: delusions, hallucinations, disorganized speech, grossly disordered or catatonic behaviour

Attenuated Psychotic Disorder (Diagnostic Criteria)

One of more of the following symptoms in an “attenuated” form: delusions, hallucinations, or disorganized speech

Symptoms must have occurred at least once a week for the past month and must have started or gotten worse in the past year

Symptoms but be severe enough to distress or disable the individual or other suggest to others that the person needs clinical help

Person has never met diagnostic criteria for a psychotic disorder, and the symptoms are not better attributed to another disorder, to substance use, or to a medical condition

Functional Capacity

The ability to engage in self-care, work, attend school, and/or engage in social relationships

Episodic Memory

The ability to learn and retrieve new information or episodes in one's life

Working Memory

Form of memory we use to hold onto information temporarily, usually for the purposes of manipulation

Processing Speed

The speed with which an individual can perceive auditory or visual information and respond to it

Magnetic Resonance Imaging (MRI)

A non-invasive technique that uses magnetic energy to generate brain images

Positron Emission Tomography (PET)

An invasive procedure that captures brain images with positron emissions from the brain after the individual has been injected with radio-labeled isotopes

Neurodevelopmental

Context of factors; Processes that influence how the brain develops either in utero or as the child is growing up

Types of Antipsychotic Medications

Typical and atypical

Typical Antipsychotic Drugs

Drugs that all share a common feature of being a strong block of the D2 type of dopamine receptor

Atypical Antipsychotic Drugs

Newer generation of antipsychotics; drugs that have more mixed mechanisms of action in terms of the receptor types that they influence, thought most of them also influence D2 receptors

What parts of the brain activate when important events happen, and would be low with people who have schizophrenia?

Ventral striatum and the anterior prefrontal cortex