Chapter 5: Mood Disorders

Anhedonia

inability to experience pleasure

Anterior Cingulate

activity level is elevated in both depression and mania affecting emotional regulation and stress response 

Attribution

the explanations a person forms about why a stressor has occurred

Attribution Style

leads them to believe that negative life events are due to stable and global causes are likely to become hopeless and this hopelessness will set the stage for depression 

Overactive Amygdala 

causes people to exhibit and experience a more intense and sustained reaction (ie. emotion-relevant stimuli)

behavioral activation

people are encouraged to engage in pleasant activities that might bolster positive thoughts about one’s self and life

Behavioral Couples Therapy

researchers work with both members of a couple to improve communication and relationship satisfaction.

Bipolar I Disorder

At least one episode of mania during a person’s life

Bipolar II disorder

at least one hypomanic episode and at least one depressive episode during a person’s life

Cortisol Awakening Response (CAR) 

Cortisol levels increase sharply as people wake and then in the 30-40 minutes after waking. A larger CAR relates to higher risk of a major depressive episode 

Cyclothymic Disorder

a chronic mood disorder where a person experiences frequent but mild symptoms of depression, alternating with mild symptoms of mania. Symptoms present for at least 2 years (1 in adolescence) 

Cushing Syndrome

involves overly high levels of Cortisol, and people frequently experience depressive symptoms

Dorsolateral prefrontal cortex

plays a critical role in executive functions and emotional regulation dysfunction is linked to deficits in emotional regulation, cognitive control and working memory. Can be targeted in TMS which aims to increase DLPFC activity

Expressed Emotion

an adverse family environment characterized by criticism, hostility, and emotional over-involvement. It is a significant predictor of psychiatric disorders

flight of ideas

shifting rapidly from topic to topic

hopelessness theory

the belief that desirable outcomes will not occur and that there is nothing a person can do to change this. Places emphasis on 2 dimensions of attributions: stable (permanent) and global (relevant to all life domains) 

Hypomanic Episode

symptoms last at least 4 days, clear changes in functioning are observable to others but impairment is not marked. No psychotic symptoms are present

information - processing biases

Tendencies to process information in a certain way, in Beck’s Theory it is a negative way

lithium

the first line of treatment for those with bi-polar, taking this decreases the severity of relapse but can have serious side effects and can be potentially toxic

Major Depressive Disorder

An episodic disorder in which 5 symptoms of depression are presented with functional impairment lasting at least two weeks - depressive episodes often recur and likelihood of experiencing another episode is high

Mania

a state of intense elation or irritability along with abnormally increased activity and other symptoms shown in the diagnostic criteria. Can come on suddenly over a period of a day or two

Manic Episode

symptoms must last at least 1 week, require hospitalization or include psychosis and cause significant distress or functional impairement

Means Restriction

suicide prevention strategy involving access to lethal methods and creating delay between suicidal thoughts and ability to act

Mindfulness-based cognitive therapy

based on the idea that a person is vulnerable to relapse because of repeated associations between sad mood and patters of self devaluing and hopeless thinking, it focuses on preventing relapse after successful treatment for recurrent episodes of major depression 

Monoamine oxidase inhibitors (MAOIs)

first type of anti-depressant developed not used anymore due to high side effects

Mood Disorders

profound disturbances in emotion

Negative Triad

negative views of the self, the world and the future, in this model people with depression have negative schemas through experiences

Neuroticism

a personality trait that involves the tendency to experience frequent and intense negative affect - it predicts the onset of depression 

persistent depressive disorder

chronically depressed more than half the time for at least two years. They experience little pleasure in activities and past times and have at least 2 symptoms of depression

Predictors of Mania

reward sensitivity and sleep deprivation

psychoeducation

designed to help people learn about the symptoms of the disorder, the expected time course of symptoms, the triggers for symptoms and treatment strategies - can help people adhere to treatments 

psychomotor agitation

not being able to sit still, fidgeting, wringing their hands

psychomotor retardation

thoughts and movements are slowed 

reward system 

guides pleasure, motivation and energy in the context of opportunities to obtain rewards

rumination

a tendency to repetitively dwell on sad experiences and thoughts or to chew on material again and again - most detrimental form is the tendency to brood regretfully about why a sad event happened 

seasonal affective disorder

mood disorder has a consistent seasonal pattern, often depressive episodes occur in the fall or winter. 

Selective serotonin reuptake inhibitors (SSRIs)

First line of treatment for depressive disorders, they block the reuptake of serotonin

Serotonin-norepinephrine reuptake inhibitors (SNRIs)

Inhibit reuptake of serotonin and norepinephrine, it is a first line of treatment for depression and anxiety. Generally perscribed if SSRI’s aren’t effective

Serotonin transporter gene

short alleles of the serotonin transporter gene relate to a higher risk for depression but only when childhood maltreatment is present

striatum role in depression

activity levels are diminished in depression which is the reason why depressed individuals show less reactivity to reward stimuli (ie. money) and positive feedback. It could explain why they feel less motivated by positive events in life. 

tricyclic anti-depressants

medications for MDD that increases levels of serotonin and norepinephrine, however they have many side effects and generally aren’t prescribed anymore

Symptoms of Manic and Hypomanic Episodes (at least 3 for baseline, 4 if mood is irritable)

1. increase in goal directed activity or psychomotor agitation 

2. Unusual talkativeness; rapid speech 

3. Flight of ideas or subjective impression that thoughts are racing 

4. Decreased need for sleep 

5. Increased self-esteem (one has special talents, powers or abilities) 

6. Distractibility

7. Excessive Involvement in pleasurable activities that are likely to have painful consequences, such as reckless spending, sexual indiscretions or unwise business investments

Which of the following is a core symptom of major depressive disorder (MDD)?

A) Grandiosity
B) Anhedonia
C) Flight of ideas
D) Pressured speech

B) Anhedonia

According to the DSM-5, which of the following is required for a diagnosis of major depressive disorder?
A) Symptoms lasting at least 2 days
B) Presence of five or more symptoms during the same 2-week period
C) History of manic episodes
D) Mood reactivity and increased appetite

B) Presence of five or more symptoms during the same 2-week period

Which group is most likely to be diagnosed with major depressive disorder?
A) Men over 65
B) Children under 10
C) Women in early adulthood
D) Men and women are equally affected

C) Women in early adulthood

Which of the following symptoms is most characteristic of a manic episode?
A) Insomnia due to nightmares
B) Sadness and social withdrawal
C) Inflated self-esteem or grandiosity
D) Decreased concentration due to anxiety

C) Inflated self-esteem or grandiosity

To meet DSM-5 criteria for a manic episode, symptoms must last at least:

A) 1 day
B) 3 days
C) 1 week (or any duration if hospitalization is necessary)
D) 2 weeks

C) 1 week (or any duration if hospitalization is necessary)

Which of the following statements about the epidemiology of bipolar disorder is TRUE?
A) Bipolar I disorder affects men and women at approximately equal rates.
B) Bipolar II is more common in men than women.
C) The onset of bipolar disorder is usually after age 50.
D) Bipolar disorder has a lower heritability than major depressive disorder.

A) Bipolar I disorder affects men and women at approximately equal rates.

Which neurotransmitter system is most commonly associated with mood regulation and implicated in depression?
A) Acetylcholine
B) Serotonin
C) GABA
D) Glutamate

B) Serotonin

Which of the following is an example of a psychological factor contributing to mood disorders?
A) Learned helplessness
B) Family history of bipolar disorder
C) Low levels of norepinephrine
D) Thyroid hormone dysregulation

A) Learned helplessness

According to the diathesis-stress model, mood disorders are most likely to occur when:
A) A person has high levels of serotonin.
B) A genetic predisposition is triggered by environmental stressors.
C) There is no family history of mood disorders.
D) Stressful events are avoided.

B) A genetic predisposition is triggered by environmental stressors.

Which of the following treatments is considered a first-line pharmacological treatment for major depressive disorder?
A) Antipsychotics
B) Benzodiazepines
C) Selective serotonin reuptake inhibitors (SSRIs)
D) Beta-blockers

C) Selective serotonin reuptake inhibitors (SSRIs)

Which psychological treatment is most evidence-based for treating depression?
A) Psychoanalysis
B) Hypnosis
C) Cognitive-behavioral therapy (CBT)
D) Exposure therapy

C) Cognitive-behavioral therapy (CBT)

Which of the following is TRUE about electroconvulsive therapy (ECT)?
A) It is no longer used in modern psychiatry.
B) It is a first-line treatment for all mood disorders.
C)It causes permanent brain damage in most patients.
D) It is often used for treatment-resistant depression.

D) It is often used for treatment-resistant depression.

Which demographic group has the highest suicide rate in the United States?
A) Adolescent females
B) Older white males
C) African American teenagers
D) Middle-aged women

B) Older white males

Which of the following is a well-established risk factor for suicide?
A) Previous suicide attempt
B) High socioeconomic status
C) Strong social support
D) Regular exercise

A) Previous suicide attempt

A key component of suicide prevention in clinical practice includes:
A) Avoiding discussion of suicide to prevent triggering thoughts
B) Prescribing benzodiazepines immediately
C) Conducting a thorough risk assessment and creating a safety plan
D) Advising family to isolate the patient for monitoring

C) Conducting a thorough risk assessment and creating a safety plan

Which of the following best reflects a current understanding of the role of neurotransmitters in depression?

A) Altered sensitivity of postsynaptic receptors may be more relevant than neurotransmitter quantity.

B) Depression is caused solely by low serotonin levels.
C) Neurotransmitter abnormalities are entirely genetic in origin.
D) Dopamine has no involvement in depressive symptoms.

A) Altered sensitivity of postsynaptic receptors may be more relevant than neurotransmitter quantity.

Which neurotransmitter is most strongly associated with the pleasure-reward system and often found to be dysregulated in anhedonia?
A) Norepinephrine
B) Serotonin
C) Dopamine
D) GABA

C) Dopamine

According to Beck’s cognitive theory, a person with depression is likely to:
A) View themselves, the world, and the future negatively.
B) Overestimate their ability to control events.
C) Use positive attributional styles.
D) Lack a stable sense of personality traits.

A) View themselves, the world, and the future negatively.

The hopelessness theory of depression emphasizes:
A) Emotional dysregulation and poor coping strategies.
B) Negative attributional styles for uncontrollable, stable, and global causes.
C) Childhood trauma as the only cause of depression.
D) The neurochemical imbalance model.

B) Negative attributional styles for uncontrollable, stable, and global causes.

Which of the following statements is TRUE regarding neuroticism and depression?
A) Neuroticism is unrelated to mood disorders.
B) Neuroticism protects against depression by increasing social interaction.
C) Neuroticism increases vulnerability to depression following stress.
D) Neuroticism is another term for low extraversion.

C) Neuroticism increases vulnerability to depression following stress.

Individuals high in neuroticism are likely to:
A) Have fewer mood fluctuations.
B) React strongly to negative life events and perceive them as more threatening.
C) Use problem-focused coping exclusively.
D) Be at reduced risk of anxiety and depressive disorders.

B) React strongly to negative life events and perceive them as more threatening.

Which of the following best distinguishes cyclothymic disorder from bipolar I and II disorders?
A) Hypomanic and depressive symptoms that do not meet full criteria for episodes
B) Presence of at least one manic episode
C) Presence of psychosis
D) Depressive episodes lasting at least two weeks

A) Hypomanic and depressive symptoms that do not meet full criteria for episodes

Which of the following treatments is specifically indicated for treatment-resistant depression?
A) SSRIs
B) Repeated transcranial magnetic stimulation (rTMS)
C) Antipsychotics
D) CBT alone

B) Repeated transcranial magnetic stimulation (rTMS)

Which of the following statements about lithium treatment in bipolar disorder is accurate?
A) Lithium is only effective for depressive symptoms.
B) Lithium helps reduce the risk and severity of future mood episodes.
C) Lithium is used only during acute manic episodes.
D) Lithium works by increasing dopamine levels.

B) Lithium helps reduce the risk and severity of future mood episodes

A major advantage of electroconvulsive therapy (ECT) is:
A) It permanently alters neurotransmitter levels.
B) It eliminates the need for long-term medication.
C) It is effective for severe or treatment-resistant depression, especially with psychotic features.
D) It has no side effects.

C) It is effective for severe or treatment-resistant depression, especially with psychotic features.

Which of the following is considered a protective factor against suicide?
A) Strong social support
B) Access to lethal means
C) History of substance use
D) Family history of suicide

A) Strong social support