Psych 430 Chapter 8 DSM-5 Mood Disorders

What are the two main sections of mood disorders in the DSM-5?

Depressive disorders, bipolar and related disorders.

What are common feelings associated with depression?

Lack of motivation, apathy, hopelessness, and depletion of energy.

What is psychomotor retardation?

A symptom of depression characterized by slow movement.

How can depression impact daily life?

It can affect sleep, eating, sex, motivation, pleasure, social interactions, and self-esteem

Can affect work, marriage, family life

What constitutes a Major Depressive Episode?

Presence of 5 or more symptoms for at least 2 weeks

- depressed mood and/or anhedonia most of the day nearly everyday

- physical symptoms: increased or decreased sleep, eating, and psychomotor agitation/retardation

- cognitive symptoms: feelings of worthlessness, guilt, suicidal ideation

What is anhedonia?

The inability to feel pleasure from activities that are usually enjoyable.

What are some physical symptoms of a Major Depressive Episode?

Changes in eating and sleeping patterns, and psychomotor agitation or retardation.

What cognitive symptoms are associated with depression?

Feelings of worthlessness or guilt, concentration difficulties, and indecisiveness.

What is suicidal ideation?

Thoughts, plans, intent, or actions related to suicide.

What should be treated first if an older patient shows signs of early dementia that might actually be depression?

The depression should be treated first to see if cognitive symptoms (concentration, indecisiveness) improve

- very hard for a person to think straight when depressed, can spend hours making one decision

How long must symptoms persist to qualify for a Major Depressive Episode?

Symptoms must persist for at least 2 weeks.

What is the duration of depressive episodes if left untreated?

Approximately 9 months - can become incredibly dangerous if left unaddressed

How many episodes must you have to reach diagnostic criteria for Major Depression?

Only have to have one to meet criteria - there are usually more episodes after the first so it is good to catch it

What are the emotional impacts of depression on relationships?

Depression can lead to withdrawal from social interactions and affect family and marital relationships.

What does the term 'continuum of depression' refer to?

The range of sadness that can escalate into a depressive episode.

What characterizes a manic episode?

Mood persistently elevated, expansive, or irritable with heightened energy/activity for most of the day nearly every day for one week or perhaps less

What is the diagnostic criteria for a Manic episode?

3+ of the following for 1 week or less:

- cognitive symptoms: grandiosity, flight of ideas, distractibility

- physical dysfunction: reduced sleep/need for sleep, hyperactivity, pressured speech

- engagement in risky behaviour

What is the minimum duration for a manic episode?

1 week (or less).

Why is the diagnostic criteria timeline for a Manic Episode so short?

Major decisions can be made in a week or less while manic that can cause great disfunction - gambling large sums of money, selling belongings etc

What are cognitive symptoms of a manic episode?

Grandiosity, flight of ideas, and distractibility.

What physical dysfunctions may occur during a manic episode?

Reduced sleep, hyperactivity, and pressured speech.

What is the duration of an untreated manic episode?

2-6 months.

What distinguishes a hypomanic episode from a manic episode?

Hypomanic episodes have similar symptoms but are less severe and last for at least 4 days without necessarily causing impairment.

What are unipolar disorders?

Disorders characterized by either depression or mania alone - typically see depression alone more than mania alone (mania alone would be diagnosed as bipolar)

What defines bipolar disorders?

Alternating episodes of depression and mania, episodes with "mixed features"

- either predominately depressed or manic with some symptoms of the other - typically back and forth between the two

What is Major Depressive Disorder?

A mood disorder with no mania or hypomania, characterized by depressive episodes

- with added specifiers Ex. single episode, recurrent, mild-severe etc

A single episode of Major depressive disorder is

rare - typically recurrent with 2+ episodes spaced 2+ months apart, average 4-7 episodes over lifespan

What is the average duration of a recurrent major depressive episode?

4-5 months

- are typically shorter the first episode

What is Persistent Depressive Disorder (Dysthymia)?

A chronic form of depression lasting 2+ years with fewer and often milder symptoms than major depression.

Cyclothymic disorder

A milder but more chronic version of bipolar - chronic alternation of mood elevation and depression that does not reach the severity of mani or major depressive episodes

• incaresed risk of developing Bipolar I or II

What is SAD?

Seasonal affective disorder - depressive episodes beginning in the late fall and ending in the beginning of spring

• episodes must occur for at least 2 years

What is the diagnostic criteria for PDD?

Depressed mood and 2+ persistent symptoms for 2+ years

- reduced appetite, sleep, fatigue, low self esteem, concentration/indecisiveness, hopelessness

- chronic

- no mania/hypomania

- median duration of 5 years

Compared to Major Depressive Disorder, PDD has

greater chronicity, poor prognosis/response to treatment, stronger family history/heritability

What is the onset of PDD?

Early 20s, with early onset before 21

What is double depression?

The occurrence of major depressive episodes in individuals with dysthymia (PDD)

- dysthymia usually occurs first

- is considered a severe psychopathology with a poor course and high recurrence rates

What are symptoms of grief?

Depression, anxiety, emotional numbness, and denial

Possible psychosis, suicidal ideation, severe weight loss

What is integrated grief?

grief that evolves from acute grief into a condition in which the individual accepts the finality of a death and adjusts to the loss

- sadness with positive memories, often recurs on meaningful anniversaries

- normal and healthy reaction to loss

When can acute grief shift to integrated grief?

A few months to a year after the loss

What is Prolonged Grief Disorder?

Severe, long-lasting grief persisting at least 1 year after a loss

- symptoms nearly every day for at least the past month with impairment in functioning

What are the symptoms of prolonged grief disorder?

1 or both of the following:

- intense longing for deceased person

- preoccupation with thoughts or memories

Along with 3 of the following:

- identity disruption

- sense of disbelief about the death

- avoidance of reminders

- intense emotional pain

- feeling that life is meaningless

- difficulty resuming life

- emotional numbness, loneliness

What is the worldwide lifetime and annual prevalence of Major Depressive Disorder (MDD)?

Approximately 16% lifetime, approximately 6% annual

What is the Canadian lifetime prevalence of MDD?

8%, higher among first nations

What is the female to male ratio for MDD?

2:1.

What is the lifetime prevalence of Bipolar Disorder?

Approximately 1%

- seems rare but is relatively large in the context of the world

- same levels across cultures points to biological etiology

What is the female to male ratio of Bipolar Disorder?

1:1

What is disruptive mood dysregulation disorder?

given in case of children and adolescents, often misdiagnosed as bipolar but no mania present

Symptom presentation of mood disorders in children and adolescents

More irritability in mania, often mistaken as hyperactive/ADHD, conduct disorder, more persistent than adults

Prevalence of mood disorders in children and adolsecents

early childhood - less common than adults

adolescence - MORE common than adults

What is the heritability of mood disorders?

Approximately 20% for men and 40% for women.

What neurotransmitter activity is associated with depression and mania in bipolar/mood disorders?

Depression - decreased serotonin

Mania - increased dopamine

What are the pharmacological treatments for mood disorders?

SSRIs

Tricyclics

MAOIs - can have severe interactions with common food, cold meds

Lithium - very significant weight gain, can take people off the high of mania

What is Electroconvulsive Therapy (ECT)?

A treatment involving brief electrical currents to induce seizures, high efficacy for severe depression with few side effects

What psychological factors can trigger depressive episodes?

Stress and negative life events

Learned helplessness/hopelessness

Negatively biased attributional processes - global, stable, internal

Cognitive triad

Automatic thoughts

Negative schemas/core beliefs

Global, stable, internal attributions

Affects everything, will not change, is a personal problem

What is Beck’s Cognitive Triad in depression?

Negative thoughts about self, world, and future.

What are automatic thoughts?

Beliefs about moment-to-moment occurrences in life.

4 phases of Cognitive Behavioral Therapy

1. Behavioural activation - encourage the client to get out of bed, take a shower, go for a walk

- have to monitor for suicidal ideation as this may give them energy to carry out a plan

2. Challenging automatic thoughts

3. Identifying negative thinking biases

4.Changing primary attitudes

What is the purpose of cognitive therapy's thought records?

To identify and challenge automatic thoughts and their emotional impact.

Thought record process

Situation - describe actual events or stream of thoughts leading to unpleasant emotion

Emotions - specify emotions and rate 1-100

Automatic thoughts - write thoughts the preceded emotions rate belief 1-100

Rational Response - write rational response to automatic thoughts and rate belief 0-100%

Outcome - re-rate belief in automatic thoughts 0-100% and specify + rate subsequent emotions 1-100

What is Interpersonal Psychotherapy focused on?

Resolving existing problems and forming valuable new interpersonal relationships

Often focus on:

- conflict in relationships

- adjusting to loss of a loved one/grief

- acquiring new relationships in personal/work life

- addressing social deficits

Benefits of combined medications and psychotherapy

Largest study found that 48% benefit from meds of CBT alone while 78% benefit from combined

- though some say benefit may limited to severe cases only

Demographic with highest risk of suicide worldwide

Elderly

- adolescence and divorcees also have increased risk

What are some common suicide risk factors?

Family history of suicide, psychiatric disorders, substance abuse, history of dangerous or impulsive behaviors, status/relationship loss, medical illness and social isolation.

What should be assessed in suicidal ideation?

The nature of thoughts (fleeting, imminent, passive), intent, rehearsal of plan, plan feasibility, lethality of plan, previous attempts and attitude towards suicide

What is a 'no suicide contract'?

An agreement where the individual commits to not harm themselves.

Suicide intervention techniques

Validate feelings and give person a chance to express thoughts/emotions

Take away means

Hotlines

Psychotherapy, Meds

Hospitalization as last option

What is the male to female ratio for suicide completion in Canada?

3.3:1.

What is the difference between Bipolar I and Bipolar II?

Bipolar I involves episodes of severe mania, while Bipolar II involves milder episodes of hypomania

• hypomania - minimum duration of 4 days, does not caused marked impairment in functioning, no psychotic features

What is learned helplessness in the context of depression?

When people make an attribution that they have no control over the stress in their lives because they see no change from their actions and stop trying, leading to depression

What did Beck believe about depression?

Recognized all his patients with depression made cognitive errors that made everything worse for them - including arbitrary inferences (emphasizing the negative) and overgeneralizations

What is an integrative theory of depression?

The integration of psychological vulnerabilities (Ex. Cognitive errors, schemas) genetic vulnerabilities, and stressful life events

Pros and cons of different drug treatments for mood disorders

Tricyclics - efficacy for treating depression, but takes awhile to work and can be lethal in excessive doses

MOAIs - as effective as tricyclics with less side effects, but interact with many common foods and cold medicines

SSRIs - considered first choice treatment, some side effects with prozac though less than tricyclics

Lithium - treatment of choice of bipolar, effective at preventing and treating manic episodes, but dosage has to be carefully regulated and can cause substantial weight gain

Proposed risk factors for suicide

Family history of suicide, neurobiology (decreased serotonin), existing psychological disorders (>90% of people who commit suicide have a psych disorder), stressful life events