integ: abpsych (mood disorder)

Emotion

• refers to a brief, intense, and specific psychological state triggered by a particular event or circumstance.

• typically more focused and have a clear cause.

Mood

• more prolonged and generalized emotional state that is not necessarily tied to a specific stimulus

• more diffuse and can last for a more extended period

Mood Disorders

When mood episodes become intense and prolonged, cause distress and dysfunction

Major Depressive Episode

2

• Lowest point of mood. Intense form of low affect. 

• most commonly diagnosed and most severe depression

• extremely depressed mood state that last at least how many weeks

Major Depressive Episode

includes cognitive symptoms

includes disturbed physical functions

somatic or vegetative symptoms

distrubed physical functions in major depressive episode is also called?

disturbed physical functions and cognitive symptoms

most central indicators of a full major depressive episode

disturbed physical functions

altered sleeping patterns, significant changes in appetite and weight, or a notable loss of energy

cognitive symptoms in major depressive episode

feelings of worthlessness and indecisiveness is called?

anhedonia

• episode is typically accompanied by a general loss of interest in things and a inability to experience any pleasure in life

• more characteristic of severe episodes of depression than are reports of sadness and distress

4-9 months

duration of a major depressive episode, if untreated

5 or more

how many symptoms should be present in the 2-week period to be classified as major depressive episode?

major depressive episode

Mania

• individuals find extreme pleasure in every activity

• they become extraordinarily active (hyperactive), require little sleep, and may develop grandiose plans, believing they can accomplish anything they desire

• “persistently increased goal-directed activity or energy”

• flight of ideas

1 week and less

manic episode criteria require a duration of only how many if the episode is severe enough to require hospitalization

flight of ideas

speech is typically incoherent, because the individual is attempting to express so many exciting ideas at once

irritability

often part of a manic episode, usually near the end duration of a manic episode

3-4 months

if manic episode is untreated, it could persist until how many months

Hypomania

• less severe version of a manic episode that does not cause marked impairment in social or occupational functioning

• the episode is below the level of a manic episode

4 days

hypomania need to only last how many days to fit to the criteria

3

4

how many symptoms are needed for manic episide

how many are needed if the mood is only irritable

manic episode, therefore a bipolar i diagnosis

a full manic episode that emerges during antidepressant treatment (medication, electroconvulsive theraot) but persists at a fully syndromal level beyond the physiological effect of that treatment is sufficient evidence of a?

manic episode

Unipolar Depressive Disorders

• disorders in which a person experiences only depressive episodes

• individuals who experience either depression or mania

• their mood remains at one “pole” of the usual depression—mania continuum

• mania by itself (unipolar mania) probably does occur but seems to be rare, because most people with this disorder develop depression

Disruptive Mood Dysregulation Disorder

• chronic, severe persistent (non-episodic) irritability through frequent verbal and/or behavioral temper outbursts in response to frustration and persistent irritable or angry mood between the outbursts

• pervasive irritability, and intolerance of frustration

6 years

Disruptive Mood Dysregulation Disorder should not be applied to children with a developmental age of less than?

Disruptive Mood Dysregulation Disorder

Must be before age 10 years and likely to change as children mature

disruptive mood dysregulation disorder

oppositional defiant disorder (ODD)

what disorder is the stronger overlap of disruptive mood dysregulation disorder

Integrated Grief

• an acute form of grief in which the finality of death and its consequences are acknowledged and the individual adjusts to the loss

• Often recurs at significant anniversaries

• Considered as a natural way of confronting and handling loss

• Occasional hallucinatory experiences of the deceased may occur

Complicated Grief

• persistent intense symptoms of acute grief

• Can develop without a preexisting depressed state

• Presence of thoughts, feelings, or behaviors reflecting excessive or distracting concerns about the circumstances or consequences of the death

Psychodynamic theory of depression

• Freud believed we unconsciously hold negative feelings toward those we love, in part because of their power over us

• Depression is anger turned inward

Behavioral theory of depression

People become depressed when their responses no longer produce positive reinforcement or when their rate of negative experiences increase

beck’s cognitive theory theory of depression

Negative cognitions lead to dysfunctional beliefs

Ruminative Response Styles Theory

tend to dwell too much (ruminate) on how they feel and why they feel that way

Attributional Style

ways in which people explain the cause of events within their lives

Internal-External

• Who or what is responsible for the event

• Whether something unique about the person or something about the situation caused the event

Stable-Unstable

• Perceived permanence of the cause

• An event can be viewed as constant and likely to happen again (stable) or it only happens once (unstable)

Global-Specific

Universal throughout your like or specific to a part of your life

Cognitive Theory of Depression

• persons susceptible to depression develop inaccurate/unhelpful core beliefs about themselves, others, and the world as a result of their learning histories

• Depressed people constantly think in illogical ways and keep arriving at self-defeating conclusions

• They tend to overgeneralize / draw broad negative conclusions on the basis of single insignificant event

Depressive Cognitive Triad

depressed people make cognitive errors in thinking negatively about themselves, immediate world, and their future

Negative Schema

• a deep belief or mindset you develop about yourself, others, or the world—usually from past experiences—that makes you see things in a negative or distorted way.

• a learned negative belief that affects how you think, feel, and behave.

ex: “The world is unsafe” (World schema)

Situation: You meet new people

Thought: “They might hurt or judge me”
👉 Leads to fear or avoidance

Self-Blame Schema

people feel personally responsible for every bad happenings

Negative Self-Evaluation Schema

“can never do anything correctly”

False Consensus Effect

• Also called False Consensus Bias

• People tend to overestimate the extent to which their opinions, beliefs, preferences, values, and habits are normal and typical of the others

• believing your opinions, choices, or behaviors are more common than they really are

ex: You dislike a certain teacher

You think: “Almost everyone hates that teacher”
👉 But others might actually like them

Dichotomous Thinking

• Also called absolutist / black and white thinking

• Seeing only of the extremes of things, never the middle (e.g., good or bad, success or failure)

ex: Your friend forgets to reply

Thought: “They’re a bad friend”
👉 No consideration of other reasons

Overgeneralization

• Making generalizations about a negative aspect

• when you take one experience and make a broad conclusion as if it always happens.

ex: One person rejects you

• Thought: “No one will ever like me”
  👉 You generalize to everyone

Personalization

• Tendency for individuals to relate external events to themselves, even when there is no basis for making this connection

• Egocentric thinking

Selective Abstraction

• when you focus only on one negative detail and ignore all the positive or important parts of a situation

ex: People applaud, but one person looks bored

Thought: “My presentation was terrible”
👉 Focusing only on one reaction

Arbitrary Inference

• You make a conclusion without enough evidence (or even with evidence against it)

ex: Your teacher looks serious
→ “She’s mad at me” (no proof)

Labeling and Mislabeling

Portraying one’s identity on the basis of imperfections and mistakes made in the past and allowing them to define one’s true identity

Minimization

• Downplaying the significance of an event or emotion

• Common strategy in dealing with feelings of guilt

Magnification

Effect of one’s behaviors are magnified

Stress-Appraisal/Cognitive Appraisal Theory

stress is a two-way process, it involves a production of stressors and the response of an individual subjected to these stressors

Primary Appraisal

understanding the stressor

Secondary Appraisal

involves those feelings related to dealing with the stressor or the stress it produces

Monoamine Theory of Depression

depression as a result of a deficiency in serotonin, norepinephrine, and dopamine

Suicide

process of killing oneself

Suicide Ideation

thinking seriously of suicide

Suicidal Plans

formulation of a specific method for killing oneself

Suicidal Attempts

person survives

Egoistic

Stemming from absence of social integration

Committed by social outcasts

Suicide is a solution to free themselves from loneliness

Altruistic

• when a person takes their own life because they believe it will help others or benefit a group.

• ex: A person in a very strict community feels they must die to bring honor to their family

Anomic

• when a person feels lost, confused, or without direction because of sudden changes in their life or society.

• ex: Someone loses their job and feels their life has no purpose

Fatalistic

• Occurs when individuals are kept under tight regulation

• When extreme rules or high expectations set on them

Interpersonal Psychological Theory of Suicidal Behavior

• Proposed that an individual will not die by suicide unless they have both the desire to die by suicide and the ability to do so

• Attempts to explain why individuals engage in suicidal behavior and to identify individuals who are at risk

• Developed by Thomas Joiner

Fluoxetine (Prozac) – best known

SSRIs treatemtn for depression

Venlafaxine (Effexor) – best known

Mixed Reuptake Inhibitors TREATMENT FOR DEPRESSION

Tricyclic Antidepressants

Most widely used treatment before SSRI

Imipramine (Tofranil) and amitriptyline (Elavil) – best known

Tricyclic Antidepressants

Monoamine Oxidase (MOA) Inhibitors

• Block the enzyme MAO that breaks down such neurotransmitters as norepinephrine and serotonin

• Used far less often because of two potentially serious consequences: hypertensive episodes or death, when eating and drinking foods and beverages containing tyramine

Lithium Carbonate (Lithium)

• Found in drinking water

• Side effects: toxicity (poisoning), lowered thyroid functioning, substantial weight gain

• Major advantage: effective in preventing and treating manic episodes

• Most often referred to as a ‘mood-stabilizing drug’

Cognitive-Behavioral Therapy (CBT)

• Learn to replace negative depressive thoughts and attributions with more positive ones

• Develop more effective coping behaviors and skills

Interpersonal Psychotherapy (IPT)

• Focus on the social and interpersonal triggers for their depression (such as the loss of a loved one)

• Develop skills to resolve interpersonal conflicts and build new relationships

Electroconvulsive Therapy (ECT)

• Most controversial treatment for psychological disorders after psychosurgery

• Electric shock is administered directly through the brain for less than 1 second, producing a seizure and a series of brief convulsions that usually lasts for several minutes

Major Depressive Disorder

• persistent depressed mood and/or loss of interest or pleasure nearly most of the day every day for at least two weeks

• require that a person must be in a major depressive episode and never have had a manic, hypomanic, or mixed episode

Recurrent Episode

preceded by one or more previous episodes

Single Episode

first depressive episode

2 months

While most depressive episodes remit (at least how many months), depressive episodes often return at some point

Relapse

return of symptoms within a fairly short period of time

Recurrence

onset of a new episode of depression

puberty

Likelihood of onset increases markedly with

major depressive disorder

Considered as the most common mood disorder and second most prevalent type of disorder following anxiety disorders

2:1 ratio

major depressive disorder is higher for women than for men at a how many ratio

major depressive disorder

Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning: at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

Note: Do not include symptoms that are clearly attributable to another medical condition.

1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)

2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).

3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day.

(Note: In children, consider failure to make expected weight gain.)

4. Insomnia or hypersomnia nearly every day.

5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).

6. Fatigue or loss of energy nearly every day.

7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).

8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).

9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C. The episode is not attributable to the physiological effects of a substance or to another medical condition.

Note: Responses to a significant loss (e.g., bereavement, financial ruin, losses from a natural disaster, a serious medical illness or disability) may include the feelings of intense sadness, rumination about the loss, insomnia, poor appetite, and weight loss noted in Criterion A,which may resemble a depressive episode. Although such symptoms may be understandable or considered appropriate to the loss, the presence of a major depressive episode in addition to the normal response to a significant loss should also be carefully considered. This decision inevitably requires the exercise of clinical judgment based on the individual’s history and the cultural norms for the expression of distress in the context of loss.

Chronic

Used when a person meets the criteria for a Major Depressive Episode continuously for the past two years

Anxious Distress

Used when a person also exhibits abnormal movements, immobility, abnormal behaviors, and withdrawal

Melancholic Features

3 of the following:

• Early morning awakening

• Depression worse in the morning

• Marked psychomotor agitation/retardation

• Loss of appetite/weight

• Excessive guilt

• Quantitatively different depressed mood

More heritable

Associated childhood trauma

Psychotic Features

• Delusions or hallucinations (usually mood congruent)

• Feelings of guilt and worthlessness are common

• Poorer long-term prognosis

Atypical Features

• Mood reactivity: brightens to positive events

• 2 of the 4 following symptoms:

  • Weight gain/increase in appetite

  • Hypersomnia

  • Leaden paralysis

  • Acutely sensitive to interpersonal rejection

• More common in females

• Responds to different class of antidepressant (MAOI)

Mood-Congruent Psychotic Features

• Material of the hallucinations is related to being depressed

• Ex. seeing demons or dark characters

Mood-Incongruent Psychotic Features

• When material of hallucinations has nothing to do with being depressed

• Ex. delusions of grandeur

• Associated with poorer prognosis

Catatonic Features

Range of psychomotor symptoms from motoric immobility to extensive psychomotor activity, as well as mutism and rigidity

Peripartum Onset

• Used if the onset of MDD occurs in close proximity (within 4 weeks) to childbirth

• mood fluctuations and excessive preoccupation with the infant's well-being

Seasonal Pattern (recurrent episode only)

• At least 2 or more episode in the past 2 years that have occurred at the same time (usually fall or winter)

• Full remission at the same time (usually spring)

• No other nonseasonal episodes in the same 2-year period

• Also called seasonal affective disorder

Mixed Features

Experiences of manic symptoms but feel somewhat depressed or anxious at the same time

Neuroticism

• a well-established risk factor for the onset of major depressive disorder

• High levels appear to render individuals more likely to develop depressive episodes in response to stressful life events

Females

have higher risk in suicide attempts

Suicide Risk

have higher risk in suicide completion due to violent forms

Persistent Depressive Disorder

depressed mood most of the day, for more days than not, for at least 2 years