PSY 183 Depression, Mania, and Bipolar DIsorder (M)

What cognitive/motivational vs. neurovegetative signs/symptoms of Major (Unipolar) Depression, and how are they cultural specific?

cognitive/motivational: hopelessness, built, slowed thoughts, poor concentration, loss of motivation

neurovegetative: sleep/appetite changes, fatigue, psychomotor changes, loss of libido 

cultural specificity: in some cultures, depression is often expressed more somatically (fatigue, aches) than emotionally

What is the psychodynamic account of major depression and what are its problems?

fried believed that depression = anger turned inward after loss; regression to oral stage

problems: not well supported empirically, doesn’t explain biological or cross-cultural findings

How does post-partum depression differ from “baby blues”?

baby blues: mild, transient mood lability after birth (very common)

post partum depression: severe, persistent mood disorder impairing functioning. etiologies may include hormonal shifts, psychosocial stress, and sleep deprivation 

What are common patterns of occurrence in major depression?

episodes may last months, disorder can persist, remit or recur. recurrence is common, especially without treatment

What is the sex ratio in prevalence of major depression, possible reasons, and what do Amish findings suggest?

women are 2x more likely than men

possible reasons: hormones, social stress, coping styles

amish studies shower lower rates overall but same sex differences persists because of biological and cultural influences

What does genetic evidence show about the prevalence of depression?

family, twin, and adoption studies: heritability is 35%. multiple genes contribute small effects and environment interacts with genetics

What is the “kindling” hypothesis in depression?

initial depressive episodes triggered by stress, but later episodes occur more autonomously, increasing recurrence risk 

What is persistent depressive disorder and “double depression”?

persistent depressive disorder: chronic low grade depression (2 or more years)

double depression: major depressive episodes superimposed on persistent depressive disorder

What psychotic features may occur in severe major depression?

delusions (ex. guilt, somatic, nihilistic) and hallucinations, usually mood congruent

What are main types of psychotherapy for major depression and are they effective?

CBT (challenge negative thinking), IPT (focus on relationships), psychodynamic, behavioral activation

all effective, espeically in mild-moderate depression

How does natural remission of major depressions affect theories of depression?

many cases remit within 6 months without treatment, suggesting biological rhythms and questioning purely psychogenic theories

What are problems with psychogenic theories of the causation and treatment of major depression?

don’t explain biological findings, recurrence, or natural remission, overemphasize environment/psychology

What are ACT and MBCT and how do they treat depression? 

“third” wave CBT approaches that emphasize mindfulness, acceptance, and reducing relapse risk 

What brain changes are found in in depression, and the possible mechanisms of action of major classes of antidepressant drugs?

reduced BDNF, smaller neocortical volume, neurotransmitter dysregulation (serotonin, norepinephrine, dopamine)

antidepressants may work by increasing BDNF and normalizing transmitters

What are the major classes of antidepressants, their uses, and side effects?

classes: SSRIS, SNRIs, tricyclics, MAOIs, atypicals

used for depression, anxiety, OCD, chronic pain

side effects: GI distress, weight gain, sexual dysfunction, cardiovascular risks

What is pharmacogenomics in depression treatment?

genetic testing to predict medication response/tolerance, aiming for personalized treatment

What is the relationship between antidepressant medication and suicide risk?

in early treatment (esp. adolescence/young adults), suicide risk may rise as energy returns before mood improves

careful monitoring required

What is ECT, and what are its effectiveness and side effects?

electroconvulsive therapy: induces seizures under anesthesia

highly effective for severe depression

side effects: temporary memory loss, confusion

What are TMS, VNS, and ketamine treatments for depression? 

TMS: magnetic stimulation of brain regions (ex. Stanford protocol)

VNS: implanted vagus nerve stimulator 

ketamine treatment: rapid-acting antidepressant effect via glutamate modulation 

How do medications compare to psychotherapy in effectiveness for depression?

meds are more effective in severe depression; psychotherapy equally effective in mild-moderate

combined treatment often best

What is SADs and how is it treated?

seasonal affective disorder: depression in winter months

treated with phototherapy (bright light exposure)

What other disorders are often treated with antidepressants?

anxiety disorders, ocd, bulimia, chronic pain, premenstrual dysphoric disorder

What are signs/symptoms of mania?

irritable/elevated mood, decreased sleep, pressured speech, racing thoughts, distractibility, grandiosity, increased activity/risk-taking 

What hypotheses explain the etiology of bipolar disorder? 

neurochemical dysregulation (dopamine, norepinephrine, glutamate), structural brain abnormalities, stress triggers

What is known about genetics and prevalence in bipolar disorder?

highly heritable, equal sex ratio unlike unipolar depression

What is the typical course and prognosis of bipolar disorder? 

recurrent episodes of mania and depression

prognosis improved with treatment but high relapse risk

What are the differences between major depression and bipolar depression?

bipolar depression more likely to have hypersomnia, hyperplasia, psychomotor retardation, psychotic features

What are antimaniac medications (mood stabilizers), their uses, and precautions?

mood stabilizers (lithium, anticonvulsants, atypical antipsychotics) 

side effects: weight gain, tremor, metabolic problems, toxicity

require monitoring

What is the special efficacy of lithium carbonate?

effectively treats and prevents maniac episodes and is shown to reduce suicide risk

reduces intensity or frequency of mood swings

especially useful for patients with classic (euphoric) mania rather than rapid-cycling types

What non-medication treatments are used for bipolar disorder?

psychoeducation, DBT, family-focused therapy, lifestyle regularity (sleep, circadian stabilization) 

What are general features of pediatric bipolar disorder?

more irritability than euphoric, rapid cycling, comorbidity with ADHD, diagnostic controversy

What is the relationship between bipolar disorder and/or depression to creativity?

hyposomanic states may enhance productivity/creativity, higher rates of bipolar traits in artists/writers

What disorders are associated with bipolar disorder?

anxiety disorders, ADHD, substance use disorders, eating disorders