PSYCH 2AP3 Final

Mood Disorders

• large scale deviations in mood.

  • tends toward the negative.

Major Depressive Episode

• most commonly diagnosed and most severe.

Anhedonia

• inability to experience pleasure.

  • might do usual pleasurable behaviours but won’t feel the dopamine hit.

Mania

• extreme pleasure in every activity; excessive euphoria.

• short period of time → big deviation from normal mood.

Hypomanic Episode

• less severe version of manic episode.

  • still significant deviation from baseline.

Unipolar Mood Disorder

• mood remains at one side of depression/mania continuum.

  • either only depression or only mania.

Bipolar Mood Disorder

• experience two ends of the same continuum.

• alternate between depression and mania.

  • very high and low.

Mixed Features

• experience both mania and depression at the same time.

  • may feel euphoria and hopeless at the same time.

Major Depressive Disorders

• depressed mood for most of the day, more than two weeks.

• disruptions in sleep, appetite, sexual drive.

• feelings of worthlessness, guilt.

Major Depressive Disorders Criteria

• depressed mood.

• diminished interest or pleasure.

• weight loss or gain.

• insomnia.

• psychomotor agitation.

  • deficiencies of serotonin cause fast/slow muscle movement.

• fatigue or loss of energy.

• worthlessness.

• diminished ability to think or concentrate.

• recurrent thoughts of death.

Major Depressive Disorders between Genders

• women:

  • feel sadness, changing mood, etc.

• men:

  • feelings of anhedonia, aggression, etc.

Persistent Depressive Disorder

• aka Dysthymia.

• chronic state of depression (20-30 years).

• same but less severe symptoms than MDD.

• lasts 2+ years, never without symptoms for longer than 2 months.

• persistence of symptoms = most severe outcomes.

  • social isolation, suicide risk.

• higher rates of comorbidity and less responsive to treatment than MDD.

Persistent Depressive Disorder Criteria

• depressed mood.

• while depressed also:

  • poor appetite/overeating.

  • insomnia/hypersomnia.

  • low energy/fatigue.

  • low self-esteem.

  • poor concentration.

  • feelings of hopelessness.

• criteria present for 2 years.

Double Depression

• suffer with both major depressive episodes and PDD.

• more severe psychopathology and problematic course.

• start at baseline → have depressive episode → don’t return to baseline → stay depressed.

Depressive Disorders Severity

• mild, moderate or severe.

Depressive Disorders Specifiers

• with psychotic features

  • hallucinations, delusions.

• with anxious distress

  • mild to severe.

• with mixed features

  • primarily depression, may have some mania.

• with melancholic features

  • subtype of depression.

• with atypical features

• with catatonic features

  • catelepsy.

• with peripartum onset

  • postpartum depression.

• with seasonal pattern

  • SAD.

MDD with Peripartum Onset

• 80% of mothers develop “baby blues”.

  • generally goes away after 2 weeks.

• 6-12% prevalence.

  • peaks 2-6 months after delivery.

• mothers’ functional impairment.

• can cause temperamental, social, emotional, cognitive, behavioural difficulties in children.

  • genetic predisposition.

• can occur in non-birthing parents.

• rare: postpartum mood episode with psychotic features.

Depressive Dosorders Epidemiology

• MDD: 11.3% of Canadians (3.2 million people).

• PDD: 2.5%

• depression ranks 4th on global burden of disease (physical and psychological)

  • amount of healthy life lost due to death or disability.

• depression carries large burden for individuals and society.

  • 5x more likely to take time off work if depressed.

Mean age of onset for MD is…

• 25 years old.

  • may be decreasing significantly → closer to late high-school/early 20s.

    • why: social media, cost of living, bleak future, etc.

Subtypes of PDD

• adult vs child onset.

  • depression during development becomes wrapped up in who that person is → more difficult to treat.

Depression in Women

• twice as many diagnosed with MDD.

• depressive symptoms more common among those:

  • with few financial difficulties.

  • with less education.

  • who are unemployed.

• reproductive events are risks for mood disturbances.

• societies impact:

  • objectifying/sexualizing, dismissing, etc.

Grief to Depression: Integrated Grief

• learn to live with new ‘normal’.

Grief to Depression: Complicated Grief

• lasts beyond normal time, more distress/dysfunction than expected.

• included in DSM-5.

Normal Amount of Time to Grieve?

• depends on relationship with person → who are they to you, how long did you know them, how did it happen?

Premenstrual Dysphoric Disorder (PMDD)

• severe emotional reactions before period.

  • significant deviation from ones typical mood.

• contentious:

  • symptoms labeled pathological when they could just be normal human experience.

Disruptive Mood Dysregulation Disorder

• affects children/adolescents.

• recurrent temper tantrums that are out of proportion to what’s going on.

Manic Episode Criteria

• period of abnormally and persistent elevated, expansive, or irritable mood.

• abnormally increased goal-directed activity or energy, lasting at least 1 week.

• inflated self-esteem/grandiosity.

• decreased need for sleep.

• more talkative.

• distractibility.

• increased goal-directed activity or psychomotor agitation.

• involvement in activities with possible painful consequences.

• causes marked impairment in social/occupational functioning.

Bipolar I

• onset: 18 years old.

• major depressive episodes and full manic episodes.

• previously known as manic depression.

• symptom free for 2 month period.

Bipolar II

• onset: 22 years old.

• major depressive episodes and hypomanic episodes.

• criterial for hypomanic episode:

  • min. duration 4 days.

  • change in functioning, not severe enough for impairment or hospitalization.

  • no psychotic features.

  • no manic episode.

Cyclothymic Disorder

• chronic alteration of mood elevation and depression.

  • doesn’t meet severity of manic or major depressive episodes.

  • chronic: at least 2 years.

Rapid-cycling Specifier: Bipolar I & II

• at least 4 depressive/manic episodes in a year.

Life-Span Developmental Influences on Depressive and Bipolar Disorders

• children and adolescents.

• elderly.

• across cultures.

• among the creative.

Biological Dimension of Mood Disorders

• familial and genetic influences.

• joint heritability of anxiety and depression.

• neurotransmitter system.

  • serotonin, dopamine.

• endocrine system.

  • cortisol, neurohormones.

• sleep and circadian rhythms

  • intense REM, reduction of deep sleep.

Psychological Dimensions of Mood Disorders

• stressful life events.

• learned helplessness.

  • lack of control.

  • depressive attributional style: internal, stable, global.

• negative cognitive styles.

  • depressive cognitive triad: selves, immediate world, future.

Social and Cultural Dimension of Mood Disorders

• marital dysfunction

  • gender differences.

• mood disorders in women.

  • uncontrollability

  • value of social relationships

  • rumination

  • poverty & abuse

  • social support

• an integrative theory.

Treatment of Mood Disorders

• Meds

  • antidepressants.

  • mood stabilizers.

• ECT

• Transcranial Magnetic Stimulation

  • localized electromagnetic pulse.

• Psychosocial Treatment

  • CBT.

  • interpersonal therapy.

• Combined Treatment

  • psychosocial + meds.

Suicide Ideations

• serious thoughts of suicide.

Suicidal Attempts

• the behaviour → trying to end one’s life.

Parasuicide

• intent to die.

Non-suicidal Self-Injury (NSSL)

• intentional self-harm without the intent to die.

Suicide Completion

• “commit” came from a time when suicide was considered a criminal/moral act.

  • lots of stigma.

Psychological Autopsy

• want to know risk factors that cause people to end their lives.

• look at life of individual.

  • what they said to family, wrote in journals, posted on social media, letter, etc.

Risk Factors of Suicide: Family History

• strong predictor.

• if family member completes → puts individual at risk.

  • no genetic basis for suicide but may indicate MDD in family.

Risk Factors of Suicide: Neurobiological

• low serotonin → taking SSRIs?

  • people taking antidepressants at risk.

Risk Factors of Suicide: Psychological Disorders

• elevated risk.

  • ~90% of completed suicides individual had mood disorder, alcohol use, borderline PD.

Risk Factors of Suicide: Stressful Life Events

• really stressful thing happened before completion.

  • breakup, moved far away, flunked out of university, bereavement, etc.

Is Suicide Contagious?

• yes, for young people…

  • fear of talking about it in social media because it may cause people to think about it themselves.

Treatment: Before Suicide

• problem-solving cognitive-behavioural interventions.

• coping-based interventions.

• stress reduction techniques.

Sleeping

• 1/3 of our lives.

• many don’t meet recommended hours.

  • 12+ babies * young adolescents.

  • 9-10 adolescents.

  • 7-9 adults.

• energizes mentally and physically.

• poor/lack of leads to social, psychological, and health problems.

Sleep Stages

• Slow-wave (deep) sleep.

• Rapid eye movement (REM) → brain is active.

• stages 1-4 & REM.

• 90 minute cycles.

• normal sleepers:

  • 20% in deep sleep, 30% dreaming, 50% light sleep.

Sleep Problems

• contribute to psychological disorders.

• limbic system involved with anxiety and sleep.

  • mutual neurobiological connection suggests anxiety and sleep may be connected.

  • poor sleep can raise cortisol.

  • sleep deprivation has temporary antidepressant effects.

    • for non-depressed, may cause depressed mood.

Sleep-wake Disorders: Dyssomnias

• difficulty getting enough sleep.

Sleep-wake Disorders: Parasomnias

• atypical events that occur during sleep.

  • sleep walking/talking/etc.

Sleep Efficiency

• percentage of time actually spent awake.

Major Dyssomnia Disorders

• insomnia

• hypersomnolence

• narcolepsy

• breathing-related

• circadian rhythm

Hypersomnolence Disorder

• disorders involve sleeping too much.

• less successful academically, complain of tiredness, personally upsetting.

• not due to insomnia, sleep apnea.

• causes: genetic factors or viral infection (mono, viral pneumonia, hepatitis).

Hypersomnolence Disorder Criteria

• recurrent periods of sleep/lapses into sleep in same day.

• more than 9 hours of sleep.

• difficulty being awake after abrupt awakening.

• significant distress.

Narcolepsy

• rare.

  • 1 in 2000 people.

• uncontrollable sleep attacks.

• may lapse into REM sleep at bad times.

• usually lasts < 5 mins.

• some people experience cataplexy: sudden loss of muscle tone.

• genetic, recessive trait; cluster of genes on chromosome 6.

• treated with stimulus meds.

Narcolepsy DSM Criteria

• episodes of cataplexy:

  • brief episodes of muscle tone causing sudden laughter or joking.

  • in children or people within 6 months of onset: spontaneous grimaces or jaw opening with tongue thrusting.

• hypocretin (neuropeptide) deficiency.

• nocturnal sleep polysomnography showing low REM.

• “old hag” and being “ridden by the witch”

  • body is asleep but mind is awake → can’t move or speak.

    • sudden onset of REM causes sleep paralysis and hypnogogic hallucinations (feels like falling).

Circadian Rhythm

• when to sleep or be awake.

Circadian Rhythm Sleep-Wake Disorder

• sleepiness or insomnia.

• due to body’s inability to synchronize with current pattern of day/night.

• our biological clock: superachiasmatic nucleus (SCN) in the hypothalamus.

  • responsible for sending.

• melatonin → dracula hormone.

Circadian Rhythm Sleep-Wake Disorder Types

• jet-lag type

• shift-work type

• delayed sleep phase type → night owls

• irregular sleep-wake type → varied sleep cycle

• non-24 hour sleep-wake type - results in 24- or 26-hour cycles.

Breathing Related Sleep Disorders

• breathing disrupted during sleep.

• experience brief arousal throughout night.

Hypoventilation

• laboured breathing.

Sleep Apnea

• 6% of Canadians.

• men twice as likely.

• sleep attacks during during the day.

• three types:

  • obstructive sleep apnea hypopnea syndrome, central sleep apnea (due to CNS), sleep-related hypoventilation (decrease in airflow without complete pause).

Insomnia Disorder: Sleep Deprivation

• fatigue and subsequent death.

• impaired concentration.

• emotional irritability.

• depressed immune system.

• greater vulnerability.

Insomnia Disorder Criteria

• difficult initiating and/or maintaining sleep.

• significant distress or impairment.

• at least 3 nights a week for 3 months.

• not due to another underlying condition.

Insomnia Disorder

• subjective sleep difficulty.

• inability to concentrate.

• after being awake 1-2 nights → micro-sleeps of several seconds or longer.

  • can cause major issues → when driving, working, etc.

Fatal Familial Insomnia

• degenerative brain disorder where you’re not able to sleep → leads to death.

• very rare.

Insomnia Disorder Statistics

• ¼ of population.

• 24% of Canadians have experienced it for at least a year.

• 15% of older adults report daytime sleepiness.

• associated with other disorders.

• women twice as likely to have it.

  • reproductive milestones → pregnancy, postpartum, etc.

  • gender norms → often take on more child care.

  • more women have anxiety disorders → comorbid.

Insomnia Disorder Causes

• medical/psychological disorders.

• pain, discomfort, physical activity.

• biological clock and temperature control.

• light and/or noise exposure.

• drug use.

• psychological stressors.

• cognitions.

• learned behaviour.

• cultural factors.

• biological vulnerability.

Integrative Model of Insomnia

• biological vulnerability interacts with sleep stress.

• extrinsic influences (poor sleep habits, daily activities, jet lag).

• perpetuating factors:

  • too much time in bed, conditioning, worry.

• precipitating factors:

  • job loss, acute depression, caring for newborn.

• predisposing factors:

  • night-type, stress reactive.

• cycle created from not being able to sleep, stressing over that, leading to lack of sleep.

Rebound Insomnia

• daytime naps disrupt night sleep; anxiety.

Medical Treatment for Sleep-Wake Disorders

• 10% of adults use meds.

• benzodiazepine.

  • short-acting drugs.

    • longer acting drugs still active in morning → may cause sleepiness during day.

• stimulants prescribed for narcolepsy.

• weight loss recommended for breath-related disorders.

  • CPAP machine improves breathing.

Environmental Treatments → Phase Delay

• moving bedtime later.

  • easier than phase _______.

Environmental Treatments → Phase Advances

• moving bedtime earlier.

  • bright light used to trick brain into readjusting the internal clock.

    • 2 hour window in morning when you wake up when light is really sensitive.

      • same at night.

Psychological Treatment for Sleep-Wake Disorders

• cognitive relaxation

• paradoxical intention

• progressive relaxation

• stimulus control

• combination of meds and CBT

• bedtime routines (young children)

Cognitive Relaxation

• helps people with racing thoughts that keep them awake.

Paradoxical Intention

• telling body to sleep makes it do the opposite → do the opposite → tell body you don’t want to sleep and you will easier.

Progressive Relaxation

• progressive muscle calming allows body to calm down → clench and release muscles a few at a time.

  • add cognitive relaxation for optimal effects.

Stimulus Control

• strengthen the bed as a cue for sleep and weaken it as a cue for wakefulness.

Sleep Restriction Therapy

• targets sleep extension (compensating for lost sleep by increasing time in bed) which creates a mismatch between sleep ability and sleep opportunity.

• goal is to limit sleep opportunity to mach the individual’s average sleep ability.

Preventing Sleep Disorders

• educate young parents to prevent later difficulties.

  • parents help children develop good sleep habits.

    • don’t wake infants more than necessary, optimal room temperature, dark room, quiet space, etc.

• sleep hygiene.

Sleep Hygiene

• changes in lifestyle to avoid insomnia.

  • institute a set of behaviours every day (instrumental conditioning).

  • alcohol interferes with our sleep (REM) a lot.

Sleep Terrors: Parasomnias

• not REM cycle related.

• mostly effects little kids but can persist.

• body goes into fight or flight mode → not due to nightmares b/c they’re not in REM.

• don’t respond to parents.

• body on high alert.

• have no memory of event when they wake up.

Sleepwalking: Parasomnias

• not REM cycle related.

• related to talking, and eating in sleep.

• category of behaviours not related to the REM cycle.

• gets up and walks around while asleep.

• effects little kids, often grow out of it but can persist in some people.

• you can gently wake them, turn them around and put them back to bed.

• behaviour doesn’t impact sleep (takes place in stages 3 or 4 of sleep).

Nightmares: Parasomnias

• REM cycle disorder.

• scary dreams, with a plot.

• waking up frequently and they’re causing daytime distress and dysfunction.

• wake up exhausted because it disrupts REM.

Genetics of Parasomnias

• if a parent has a non-REM sleep disorder, their child is more likely to have one too.

• if parent has a nightmare disorder, child is also likely to have one.

Causes of Parasomnias

• trauma → especially associated with nightmares.

• medication → especially associated with sleep walking and nightmares.

  • benzodiazepines.

Treatment of Parasomnias

• psychological intervention (CBT) and meds.

  • limited effect.

Nocturnal Eating Syndrome

• individuals rise from bed and eat while they’re sleeping.

  • sometimes don’t eat typical foods.

  • may light house on fire trying to cook.

Sexsomnia

• non-REM sleep disorder.

• acting out sexual behaviours (i.e., masturbating and sex) with no memory of the event.

REM Sleep Behaviour Disorder

• individual talks or moves while sleeping, sometimes acting out a dream.

  • dream tells us its during REM.

Somatic Symptoms

• 85-95% of people have at least 1 physical symptom every 2-4weeks.

Common Physical Complaints

• chest pain

• abdominal pain

• dizziness

• headache

• back pain

• fatigue

• organic cause only found about 10% of the time.

Somatic Symptom & Related Disorders

• group of disorders characterized by excessive thoughts, feelings, and behaviours related to _____ ______.

• individuals experience real physical symptoms but the pain can’t be fully explained by medical condition.

  • exception → illness anxiety disorder.

Somatic Symptom Disorder (SSD)

• presence of physical symptoms.

• preoccupation with symptoms.

  • presence + worry.

• continuously feeling weak and ill.

• pain can be severe.

  • back pain, chest pain, headaches.

• gastrointestinal distress.

• psychogenic seizures.

• can’t figure out medical reason.

  • maybe a physical reason but doctors don’t know.

• become resentful that they’re not being taken seriously.

• spend lots of time at doctors.

Somatic Symptom Disorder Criteria

• one or more distressing somatic symptoms that disrupt daily life.

• excessive thoughts, feelings and behaviours related to the symptoms or associated health concerns.

  • disproportionate and persistent thoughts about the seriousness of one’s symptoms.

  • persistently high level of anxiety about health or symptoms.

  • excessive time and energy devoted to the symptoms or health concerns.

• state of being symptomatic is persistent.

Illness Anxiety Disorder (IAD)

• used to be called hypochondriasis.

• physical symptoms absent or mild.

• preoccupation in “idea” of being sick.

  • obsessed that they’re sick or will become sick.

• often illicit negative reactions from physicians.

  • reassurance doesn’t feel helpful.

• repetitive behaviours similar to OCD rituals.

  • reassurance seeking, self-monitoring, avoidance of feared situation.

• comorbid with anxiety and depressive disorders (78%).

• somatic symptoms not present (if present only mild).

Severe Illness Anxiety

• late age of onset; develops in adolescence.

• more common in unmarried women.

• lower socioeconomic status.