CLP4143 Abnormal Psych Exam 3

Mood episodes and mood disorders are…

different

Episode

a discrete period of time characterized by certain experiences

Major depressive episode (MDE)

A discrete period of time (start and end) when an individual has a feeling of sadness, low mood, etc

Hypomanic episode

 Less extreme of manic episode. Not as severe as manic episode. Causes some impulsive behavior but not all.

Manic episode

\- A discrete period of time where a person has a lot of energy. Intense impulsivity. Elevated period. - 4 days - 2 weeks.

Most mood episodes require what? What is the exception?

At least one or the combination of some episodes to meet criteria for diagnosis. \n exception is Persistent depressive disorder.

MDE

Major depressive episode

What are the symptoms of MDE (ATLEAST 1 OF SICH MUST BE \*)

1\. Depressed mood\* \n 2. Anhedonia\* \n 3. Significant decrease/increase in appetite or weight \n 4. Insomnia or hypersomnia (changes in sleep) \n 5. Psychomotor agitation or retardation (changes in speed of motor movements) \n 6.Fatigue or loss of energy \n 7.Feelings of worthlessness or excessive/inappropriate guilt \n 8.Problems concentrating, or indecisiveness \n 9.Recurrent thoughts of death or suicide

Anhedonia

loss of interest or pleasure in normally enjoyed activities

MDE symptoms must be present how and for how long?

Must be present together, most of the day, nearly every day, and for at least 2 weeks.

MDE symptoms must represent what?

A marked change

MDD

major depressive disorder

MDD must have

A) Presence of a major depressive episode \n B) Not better accounted for by another disorder \n C) No history of a manic, mixed or hypomanic episode \n D) Distress and/or impairment

MDD, Single MDE

Only one 2 week occurrence of MDE

MDD recurrent

Two 2 week occurrences with two or more months of no activity in between

key difference between MDD and PDD

PDD is more chronic (longer lasting) and typically less severe than MDE's

PDD Symptoms must have at least 3 of the following symptoms (1 of which must be \*)

1\.Depressed mood\* \n 2.Decrease/increase in appetite \n 3.Sleep problems \n 4.Low Energy \n 5.Low self-esteem \n 6.Problems concentrating \n 7.Feelings of hopelessness

How long must PDD symptoms last?

most of the day, more days than not, for at least 2+ years (without reprieve lasting more than 2 months at any time during 2-year period)

Automatically disqualified from PDD if…

history of manic, mixed or hypersonic episode

PDD if

not better accounted for by another disorder

Symptoms of PDD must cause

distress or impairment

Can PDD patients feel okay at times?

Patients can start to feel okay during the 2+ years with PDD but it should not last more than two years

PDD with Major Depressive Episode

Low mood with extremely low mood that last about 2 weeks

PDD with Persistent Major Depressive Episode

Person meets criteria for A MAJOR DEPRESSIVE EPISODE for 2+ years but becomes a PDD not MDD.

Depressed mood at least half the time for 2 years w/out MDE

PDD

Does not meet criteria for PDD when not experiencing MDE

MDD

At least 2 years w/ depressed mood at least half the time even when not experiencing MDE

PDD w/ MDE

MDE that lasts at least 2 years

PDD w/ Persistent MDE

Mdd: MDE occurs in 1 in how many people or what % ?

1 in 6 or 16%

On average, how long does MDD go untreated?

4-9 months

For MDD, what is the percentage of occurrence for single episodes?

20-50%

For MDD, what is the percentage of occurrence for recurrent episodes?

50-75%

What is the severity for MDD?

Longer MDEs, shorter OK periods, presence of symptoms (sxs) between episodes

MDD is twice as common in women or men?

women

Where is MDD more likely in?

LGBTQ+ communities

MDD is the leading cause in?

Disease burden

PDD occurs in 1 in how many people?

1 in 20

What is the average time PDD goes untreated for?

30 years

Depressive Disorders: Race/Ethnicity

White is less depressed than Hispanic, black, and American Indian

Age Differences in Depression

Lowest in greater than 65 years old because the younger you are the more you need to think about and deal with. \n Older than 85: Older people are dying, less socially and physically active

What's the difference between a "disorder" and an episode?

Disorders are made of different episodes, episodes differ in severity and length. Certain episodes have to occur in order to be categorized as a disorder.

What some differences between PDD and MDD?

PDD is longer in time than MDD. PDD last more than 2 years while MDD last about 6-18 months. MDD is more common. Differences in severity and frequency. Different symptoms.

What are the four biological theories of depression?

1\. Genetic factors \n 2. Brain structure & function \n 3.HPA axis (neuroendocrine factors) \n 4.Biological treatments

How have family studies supported the genetic factors theory?

They have provided strong evidence for genetic causes.

First degree relatives of people with MDD…

are 2-3 times more likely to also have depression when compared to those without depression

How have twin studies supported the genetic factors theory?

There is a Higher concordance in mono (identical) than dizygotic twins

What is the HPA Axis involved in?

Involved in fight or flight responses and release of stress hormones \n this is the system where stress hormones like cortisol and adrenaline are sent between three organs

How is chronic hyperactivity of the HPA affected in depression?

They are higher

How are the levels of cortisol affected in depression?

They are higher

How do higher levels of cortisol and chronic hyperactivity affect a person?

It constantly wears peoples out and could possible involve damage to the hippocampus. (snowball effect)

What is the hippocampus important for?

important role in learning and memory -> bodies over-react to stress, take longer to return to normal feeling -lots of cortisol receptors in hippocampus - elevated cortisol may kill or inhibit new cells -> memory issues

Selective serotonin reuptake inhibitors (SSRIs) - Prozac, Zoloft

\- most widely used medication \n - also used to treat anxiety and eating disorders \n - can cause relief in a couple of weeks \n - few side effects (not fatal)

Selective serotonin & norepinephrine reuptake inhibitors (SSNRIs) - Cymbalta, Effexor

\- better w people who are slow \n - have more stimulant effects, so they are better for people who have the psychomotor retardation symptoms of depression. This is because norepinephrine has some stimulant effects, so keeping more of that in the synapse

Monoamine oxidase inhibitors (MAOIs) - Nardil/ Emsam

\- More broad class of neurotransmitters \n o includes serotonin, norepinephrine, and dopamine \n - Act on different levels \n - Can be fatal when used with other drugs such as alcohol. \n Can cause liver damage or can overdose on them \n aren't used often

Tricyclic antidepressants - Amitriptyline, Norpramin

\- can overdose and potentially be fatal \n - Not commonly prescribed anymore \n - Act on serotonin, norepinephrine, and more \n - Cause problems in people with heart problems and steep drop in blood pressure. \n Not used anymore

What does ECT Stand for?

• Electroconvulsive therapy

What is ECT, when is it used, and how long does the treatment last?

Electroconvulsive therapy (ECT) (brief seizures) \n - Shock therapy \n - Viewed as last line of intervention. \n - W persons permission, zapping their brain to treat depression \n - Works for really depressed people \n - 2-3 session a week \n - Lasts 3-4 weeks

Pros of ECT

pretty good at treating very severe depression \n 50-80%

Cons of ECT

learning and memory difficulty; high relapse rate \n - Giving mini seizures which can lead to memory difficulty. \n - Sedating people \n - Once treatment stops, severe depression comes back within a couple of weeks. 85%

What does rTMS stand for?

Repetitive transcranial magnetic stimulation

What is rTMS, when is it used, and how long does the treatment last?

noninvasive brain stimulation with electromagnet \n -4-5 times a week. For 4-6 weeks \n - 50% effective \n - no sedation is needed

What are the 3 psychological theories of depression?

• Cognitive \n • Cognitive-behavioral \n • Behavioral

Cognitive Theory

People with depression have Inaccurate (often negative, automatic) thoughts (maladaptive attitudes) and it is these thoughts that make them depressed.

What is the negative cognitive triad and what are the 3 parts?

Typical negative inaccurate thoughts in depressed people fall into three categories: thoughts about the self, the world, and the future.

\

Cognitive theories are?

Inaccurate thoughts maintained by cognitive errors.

What is black and white thinking?

\- people either think it is perfect or terrible (no in between) \n - not healthy

What is fortune telling?

\- no one can actually tell the future \n - self-sabotage \n - the way we think influences how we behave

What is mind-reading?

\- assuming you know what other people are thinking \n - filling in blanks but thoughts are inaccurate

What is discounting the positive?

\- cognitive error where you fail to look at growth and focus on negative things, not the positives.

What is emotional reasoning?

\- Knowing there are other options

Behavioral theories:

• Depression involves interaction between reduced positive reinforcers & behavioral withdrawal -Self-perpetuating cycle!

What is learned helplessness?

• Depression happens when people feel unable to control/impact the events/outcomes in their lives \n -Reduced actions (behavioral) to impact environment/outcomes \n - think elephant example

What does EBT stand for?

Evidence based therapy

What is EBT?

Lots of evidence backing its effectiveness \n Effective therapy:

• Clear goals Determined by both client and therapist. \n • Structure & homework \n • Time-limited

How long does EBT usually last?

\- Last a couple of weeks \n o 8-12 weeks \n § Usually gets expanded \n § Not intended to last forever

What are the two psychological treatments we went over?

CBT and BA

What does CBT suggest?

The way we think, feel, and behave are all interconnected.

Monitoring thoughts in CBT

client and therapist work together \n "homework"

Cognitive restructuring in CBT

A. Identify thinking errors \n B. Challenge thoughts \n C. Generate rational responses

A. Identify thinking erorrs

• Thought - I am an idiot (I didn't do well on that quiz) - e.g. black and white thinking

B. Challenge Thoughts

• Evidence/for and against thought (e.g. Is there any evidence that you are not an idiot?)

C. Generate ration responses

• e.g. Even though I did poorly on that quiz, my overall average is still an A- (I can do poorly on one exam without being an idiot)

Behavioral experiments

The thinking here is that if we engage in more enjoyable and meaningful behaviors when we're feeling down, even though we don't feel like it, our thoughts and feelings will change too, and the depression will decrease

What does BA stand for?

Behavioral Activation or Behavioral Activation Theory

What is BA based on?

is based on the same model as CBT, where thoughts, feelings, and behaviors are interrelated. BA acts on the behaviors in hopes that changing behavior will decrease depressive symptoms in the realms of thoughts and feelings.

BA actions

1) Generate list of values in multiple domains (e.g. being good friend/mom/pet owner, working hard in my abnormal psych class) \n 2) Generate activities in line with those values (e.g. calling a friend once a week, attending my classes) \n 3) Track behaviors/mood to determine how client is using their time and effect of specific behaviors on mood \n 4) Change behaviors to incorporate more that are in line with values (continue tracking to see impact on mood)

What is the first step of BA?

identifying the client's values.. this will help give a path forward to start generating activities…

What is the second step of BA?

client and therapist then work to brainstorm activities that are enjoyable or important to the client and schedule those activities into their day.

What is the idea behind BA?

By changing behaviors, the mood can lift and thoughts become less pessimistic. This is a pretty simple way to get a really solid mood boost.

BA recap

Monitor behaviors and add enjoyable/important activities.

What are the symptoms of manic and hypomanic episodes?

Must experience a time of...1) Very elevated (or irritable) mood \n 2)Very high energy \n Both are required \n \*NOT DUE TO SUBSTANCE \n 3+ additional symptoms: 3)Grandiosity \n •Unrealistic sense of superiority, specialness \n 4)Reduced need for sleep \n 5)Talkativeness \n 6) Racing thoughts 7) Distractibility8) Increased goal-directed activity 9) Impulsive, risky behavior

Manic episode characteristics

•7+days \n • Marked impairment \n • Often hospitalized \n • May include psychosis

hypomanic episode

•4-6days \n • Observable by others, but not much impairment \n • No hospitalization or psychosis

Which is more severe, hypomanic or manic?

manic

Characteristics of Bipolar I

\- Marked impairment OR hospitalization required. \n - Manic episode needed. \n - At least 7 days (can be less if hospitalized)

Is MDD required to be diagnosed with Bipolar I?

no

Characteristics of Bipolar II

\- No marked impairment/hospitalization (during hypomanic episode) \n - At least 4 days = hypomanic episode \n - MDE = major depressive episode required

Is MDE required to be diagnosed with bipolar II?

YES!

Does Bipolar I need distress?

No, but it can be distressing

Does Bipolar II need distress?

• Hypomania may not be distressing, and does NOT result in MARKED impairment, BUT common for depressive episodes to be distressing and/or impairing