Psych Disorders Test 2

Mood Disorders

Depressive Disorders and Bipolar Disorders

Bipolar I

the individual experiences a manic episode that may have been preceded by and may be followed by hypomanic or major depressive episodes

Bipolar II

The individual has experienced in the past or is currently experiencing a hypomanic episode, and has experienced in the past or is currently experiencing a major depressive episode

Major Depressive Disorder (MDD)

Discrete episodes lasting at least two weeks in which there are substantial changes in affect, cognition, and neurovegetative functions

Persistent depressive disorder (PDD)

• less acute

• symptoms tend to ebb and flow over a long period of time

Premenstrual dysphoric disorder

confirmed as a specific and treatment-responsive form of depressive disorder that begins sometime following ovulation and remits within a few days of menses and has a marked impact on functioning

Disruptive mood dysregulation disorder

• For children up to 18 years of age, to address the potential for overdiagnosis and treatment of bipolar disorder in children

• Children present with persistent irritability and frequent episodes of extreme behavioral dyscontrol and so develop unipolar depressive disorder or anxiety disorders as they move into adolescence and adulthood.

Depressive mood

Most, if not all, individuals with depression will report significant mood disturbances such as a depressed mood for most of the day and/or feelings of anhedonia

Depressive behaviors

• Behavioral issues such as decreased physical activity and reduced productivity

• Disruption in daily functioning

Depressive cognitions

• serious disruption in cognition

• negative view of themselves and the world around them

• quick to blame themselves when things go wrong

• feel worthless

• negative feedback loop

• difficulty concentrating

• perform worse on tasks of memory, attention, and reasoning

• thoughts of suicide and self-harm,

Physical depression symptoms

• hypersomnia

• insomnia

• change in weight or eating behavior

• psychomotor agitation or retardation

Major Depressive Disorder criteria

• 5 symptoms across 4 categories

• depressed mood most of the day, almost every day

• loss of interest or pleasure in all, or most activities

• symptoms must be present for at least two weeks and cause clinically significant distress or impairment in important areas of functioning

Persistent depressive disorder criteria

• Must experience a depressed mood for most of the day, more days than not, for at least two years

• Two or more additional symptoms

• Causes clinically significant distress or impairment in important areas of functioning

• can’t be without symptoms for more than two months

Premenstrual dysphoric disorder criteria

• At least five symptoms must be present in the final week before the onset of menses, begin improving a few days after menses begins, and disappear or become negligible in the week after menses

• increased mood swings, irritability or anger, depressed mood, anxiety/tension, anhedonia, difficulty concentrating, lethargy, changes in appetite, sleep changes, feelings of being overwhelmed or out of control, breast tenderness or swelling

MDD prevalence

• 7% in the U.S.

• 21.0 million adults in the U.S. have at least one major depressive episode

• More females than males

• 18-25

Persistent depressive disorder prevalence

• blend of dysthymic disorder and chronic major depressive disorder

• 1.5%

• higher in females vs. males

• 2.5% life time prevalence

Bipolar I prevalence

• 1.5% 12-month prevalence

Bipolar II prevalence

• 0.8% in the U.S. and 0.3% internationally

• Most common in women

• 4.4% of U.S. adults experience bipolar disorder at some point in their lives

suicidality

• Individuals with a depressive disorder have a 17-fold increased risk of suicide

• women attempt suicide at a higher rate

• Men are more likely to be successful

• Those who have bipolar disorder are estimated to have a 20- to 30- fold greater risk to suicide

Depressive disorders comorbidity

• Substance use disorder

• panic disorders

• generalized anxiety disorder

• PTSD

• OCD

• eating disorder

• borderline personality disorder

Bipolar disorder comorbidity

• anxiety disorder

• alcohol use disorder

• substance use disorder

• ADHD

• borderline personality disorder

• schizotypal

• antisocial personality disorder

Depression as biological

• genetic predisposition

• gene abnormalities 5HTT on chromosome 17

• low activity levels of norepinephrine and serotonin

• cortisol and melatonin levels

• reduced activity and altered connectivity with the prefrontal cortex, reduced hippocampus volume, and increased activity in the amygdala

Bipolar as biological

• Genetic predisposition

• Increased dopamine and norepinephrine levels and disruption in serotonin function

• cortisol and melatonin levels

• Altered communication

• within emotion regulation networks

• differences in activity within the prefrontal cortex, anterior cingulate cortex, amygdala, hippocampus and other limbic structures

Mood disorders as cognitive

• learned helplessness

• negative attribution style

• rumination

• maladaptive attitudes

• cognitive distortions

• automatic thoughts

rumination

the tendency to repeatedly think about one’s negative emotions, the cause of those emotions, and the possible consequences without actively working toward a solution

the cognitive triad

individuals interpret negative thoughts about their experiences, themselves, and their futures

cognitive disotrtions

catastrophizing, overgeneralization, black and white thinking

mood disorders as behavioral

• depression develops and is maintained when individuals experience a reduction in positive reinforcement from their environment

• When rewarding experiences become less frequent or more difficult to obtain, individuals gradually withdraw from activities they once found enjoyable or meaningful

Sociocultural explanation of depression

a lack of meaningful social connections can contribute to the development and maintenance of depression, while depressive symptoms can also make it more difficult for individuals to maintain relationships due to withdrawal, irritability, and decreased emotional availability

artifact theory

suggests that the difference between genders is due to clinical or diagnostic systems being more sensitive to diagnosing women with depression than men

hormone theory

variations in hormone levels trigger depression in women more than men

life stress theory

women are more likely to experience chronic stressors than men, thus accounting for their higher rate of depression

gender role theory

Social and/or psychological factors related to traditional gender roles also influence the rate of depression in women

SSRIs

• Selective serotonin reuptake inhibitors

• selectively block serotonin reuptake, increasing serotonin availability in the synapse

Tricyclic antidepressants

• Originally developed to treat schizophrenia

• three-ring structure

• work by affecting brain chemistry, altering the number of neurotransmitters available for neurons

• block the absorption or reuptake of serotonin and norepinephrine, thereby increasing their availability for postsynaptic neurons

Monoamine oxidase inhibitors

• Safety concerns with hypertensive crises

• Monoamine oxidase is released in the brain to remove excess neurotransmitters: norepinephrine, serotonin, and dopamine

Ketamine and Esketamine

works through different brain systems involving glutamate, a neurotransmitter involved in communication between brain cells. The effect on glutamate helps produce antidepressant effects much quicker than traditional medications

Cognitive Behavioral Therapy

• thoughts, emotions, and behaviors

• Improves emotions in depressed patients by changing both cognitions and behaviors, which in turn enhances mood

Behavioral activation

• Focuses on the relationship between behavior, environmental reinforcement, and mood

• helps individuals increase participation in meaningful and rewarding activities while reducing patterns of avoidance and withdrawal that often maintain depressive symptoms

Interpersonal therapy

• Establish effective strategies to manage interpersonal issues, which in turn, will ameliorate depressive symptoms

multimodal treatment

while both pharmacological and psychological treatment alone are very effective in treating depression, a combination of the two treatments may offer additional benefits, particularly in the maintenance of wellness

Lithium

effective for treating acute manic episodes and preventing future mood episodes, including both manic and depressive recurrences

Bipolar treatment

• Typically, medications like lithium, Depakote, and sometimes antidepressants

• Therapy is used to help with medication adherence

stressor

• Can be any event witnessed firsthand, experienced personally, or experienced by a close family member that increases physical or psychological demands on an individual

• poses a threat, whether real or imagined, to the individual

Posttraumatic Stress Disorder

• Identified by the development of physiological, psychological, and emotional symptoms following exposure to a traumatic event

• must have been exposed to a situation where actual or threatened death, sexual violence, or serious injury occurred

• Symptoms across four categories: recurrent experiences, avoidance of stimuli, negative alteration in cognition or mood, alteration in arousal and reactivity

Acute Stress Disorder

• Symptoms must be present from day 3 to 1 month following exposure to one or more traumatic events

• Nine symptoms across 5 categories: negative mood, dissociative symptoms, avoidance symptoms, arousal symptoms, intrusion symptoms

Adjustment disorder

• Occurs following an identifiable stressor that happened within the past 3 months

• does not have a set of specific symptoms an individual must meet for diagnosis

• includes a modifier: with depressed mood, with anxiety, with mixed anxiety and depressed mood, with disturbance of conduct, with mixed disturbance of emotions and conduct, or unspecified if the behaviors do not meet criteria for one of the aforementioned categories

Prolonged Grief Disorder

• Defined as an intense yearning/longing or preoccupation with thoughts or memories of the deceased who died at least 12 months ago

• Maladaptive cognitions, guilt, and negative views about life

PTSD prevalence

• Lifetime prevalence is 6.8% for adults and 5.0%-8.1% for adolescents

• Higher in veterans and first responders

• Higher in females

Acute Stress Disorder prevalence

• difficult to determine

• and where between 7-30% of people who experience a traumatic events

• 50% will have PTSD

Adjustment disorder prevalence

• relatively common

• 5-20% of individuals in outpatient mental health treatment facilities as a principal diagnosis

• higher in women

Prolonged Grief Disorder prevalence

• 1.2% of the general population

• 3.3% of bereaved people

PTSD comorbid disorder

• depressive, bipolar, anxiety, or substance abuse symptoms

• major neurocognitive disorder

ASD comorbid disorders

has not been studied

Adjustment disorder comorbidity

• Various other medical conditions

• Individuals with adjustment disorder with depressed mood must not meet the criteria for MDD

prolong grief disorder comorbidity

• PTSD if the death occurred in violent or accidental circumstances

• substance use disorders

• separation anxiety

Stressor-Related Disorder etiology

• Hypothalamic-Pituitary-Adrenal Axis

• Pre-existing conditions

• persistent rumination

• Increased exposure due to social conditions

Psychological debriefing

• crisis intervention

• encourages individuals to discuss and process their thoughts and emotions shortly after experiencing a traumatic event

psychological first aid

• An early intervention that promotes safety, meets immediate needs, provides social support, and monitors symptoms

• does not require individuals to discuss the traumatic event and has become the preferred early intervention for post-traumatic events

Exposure therapy

• Helps individuals gradually confront trauma-related memories, thoughts, feelings, and situations that they have been avoiding due to trauma-related fear

• imaginal

• vivio

• typically gradual and prolonged

Trauma-focused cognitive behavioral therapy

• An adaptation of CBT specifically designed to treat children and adolescents who have experienced trauma

• incorporates cognitive-behavioral techniques with trauma-sensitive care

• PRACTICE

Eye Movement Desensitization and Reprocessing

• Developed by Francine Shapiro

• Combines cognitive behavioral therapy, exposure-based approaches, and bilateral stimulation

• helps individuals process distressing traumatic memories and develop more adaptive beliefs about the traumatic experiences

Medication for Stressor-Related Disorders

• Shown to provide some relief for PTSD

• SSRIs and SNRIs

• tricyclic antidepressants (second line)

• monoamine oxidase inhibitors (second line)

Dissociative disorders

• A group of disorders characterized by symptoms of disruption and/or discontinuity in consciousness, memory, identity, emotion, body, representation, perception, motor control, and behavior

• likely to appear following a significant stressor or years of ongoing stress

Dissociative Identity Disorder

• Presence of two or more distinct personality states or an experience of possession

• Typically not overtly displayed or only subtly displayed

• Gap in the recall of events, information, or trauma due to the switching of personalities

Dissociative amnesia

• Identified by the inability to recall important autobiographical information, usually of a traumatic or stressful nature

• Often consists of selective amnesia for a specific event or events, or generalized amnesia for identity and life history

Localized amnesia

the inability to recall events during a specific period

selective amnesia

a component of localized amnesia in that the individual can recall some, but not all, of the details during a specific period

systematized amnesia

occurs when an individual fails to recall a specific category of information such as not recalling a specific room in their childhood home

generalized dissociative amnesia

complete loss of memory for most or all of their life history, including their own identity, previous knowledge about the world, and/or well-learned skills

Depersonalization/Derealization Disorder

• Categorized by recurrent episodes of depersonalization and/or derealization

• Episodes can last anywhere from a few hours to days, weeks, or even months

• Can cause significant emotional distress, as well as impairment in one’s daily functioning

Depersonalization

• A feeling of unreality or detachment from oneself

• out-of-body experience

• distortion of one’s physical body

• One may feel detached from their feelings, lacking the ability to feel emotions despite knowing they have them

Derealization

• Feelings of unreality or detachment from the world

• Unfamiliar with surroundings even when they are familiar

• feeling emotionally disconnected from close friends or family members

• sensory changes

• distortion of time, distance, and objects

Epidemiology

• DID: 1.5%

• Dissociative Amnesia: 1.8%

• it is estimated that about .5 of all adults experience an episode of depersonalization/derealization in their life

• 1-2% for the actual disorder

Comorbidity for dissociative disorders

• PTSD

• depressive disorders

• somatic symptom disorder

• conversion disorder

• dependent, obsessive-compulsive, avoidant, and borderline personality traits'/disorders

• substance-related disorder

• eating disorders

• anxiety disorder

Dissociative Disorders etiology

• Both genetic and environmental factors

• Severe stress disrupts the retrieval of memories

• Differences in brain activity (prefrontal cortex, hippocampus, amygdala)

• Defense against trauma or overwhelming psychological distress

Dissociative Identity Disorder treatment

• phases-oriented approach

• safety and psychoeducation

• processing and integrating traumatic memories

• integrating new experiences and developing a consistent sense of self

Dissociative amnesia treatment

• hypnosis

• use of barbiturate or truth serums

Depersonalization/Derealization treatment

• diagnosis alone can cause relief

• goal is to alleviate secondary mental health symptoms

• SSRIs

• CBT

Anxiety disorders

marked by excessive fear and anxiety and related behavioral disturbances

fear

an emotional repsonse to a real or percieved immenent threat that leads to surgues of autonomic arousal necessary for fight or lights, thoughts of immediate danger, and escape behaviors

anxiety

the anticipation of a future threat leads to muscle tension and vigilance in preparation for future danger and cautious or avoidant behavior

generalized anxiety disorder

• An underlying excessive anxiety and worry related to a wide range of events or activities, lasting for more days than not for at least six months

• Worry of greater intensity and for longer periods than the average person

• unable to control their worry through various coping strategies

• Three or more symptoms

Specific phobia

• Distinguished by fear or anxiety specific to an object or situation

• Varies with proximity

• Excessive, irrational, and persistent, lasting at least six months

agoraphobia

• Intense fear or anxiety triggered by two or more of the following

  • public transportation

  • being in large spaces

  • being in enclosed spaces

  • being in a crowd

  • being outside of the home alone

• concerned over not being able to escape

Social anxiety disorder

• The anxiety or fear relates to social situations, particularly those in which an individual can be evaluated by others

• worried that they will be judged negatively and viewed as stupid, anxious, crazy, boring, or unlikeable

Panic disorder

• consists of a series of recurrent, unexpected panic attacks coupled with fear of future panic attacks

panic attack

a sudden or abrupt surge of fear or impending doom along with at least four physical or cognitive symptoms

Generalized anxiety prevalence

• 2.9%

• occurs more in women

specific phobia prevalence

8-12%

2:1 ratio of females to males

agoraphobia prevalence

• 1 - 1.7% worldwide

• Women are twice as likely to be diagnosed

social anxiety prevalence

• Significantly higher in the U.S.

• 7%

• females more than males

panic disorder prevalence

2-3%

generalized anxiety comorbidity

• other anxiety-related disorders

• unipolar depressive disorder

• substance use

• neurodevelopmental, neurocognitive, psychotic, and conduct disorders are less common

• higher levels of suicide

specific phobia comorbidity

• other anxiety disorders

• depressive and bipolar disorders

• substance-related disorders

• somatic symptom disorder

• personality disorders

• associated with the transition from suicidal ideation to attempt

agoraphobia comorbidity

• other anxiety disorders

• depressive disorders

• PTSD

• alcohol use disorder

• suicidal thoughts or behavior (15%)

social anxiety comorbodity

• Other anxiety disorders

• major depressive disorder

• substance-related disorders

• body dysmorphia

• avoidant personality

panic disorder comorbidity

• other anxiety disorders

• major depressive disorder

• bipolar I and II

• alcohol use disorder

• substance-related disorders

• suicidal thoughts and behaviors

• general medical symptoms

5-HTTLPR

a serotonin transporter gene believed to influence serotonin regulation and emotional reactivity, which affects anxiety

• not the only gene involved

gene-environment interaction

Environmental experiences may influence genetic expression through epigenetic mechanisms, meaning stressful experiences can later affect how genes involved in stress regulation are expressed without changing the underlying DNA sequence