Untitled Flashcards Set

PSYCH 341 - EXAM 2 STUDY GUIDE – MOOD DISORDERS & SUICIDE DR. MORI

A. Clinical Depression
1. What is Clinical Depression?

• Definition: A mood disorder characterized by persistent feelings of sadness, hopelessness, and a lack of interest or pleasure in activities.

• Symptoms: Includes changes in appetite, sleep disturbances, fatigue, feelings of worthlessness or excessive guilt, difficulty concentrating, and recurrent thoughts of death or suicide.

  2. Discriminating Normal Low Moods and Grief from Clinical Depression

• Duration & Persistence: Clinical depression lasts for at least two weeks and is

  persistent, whereas normal low moods are temporary.

• Functional Impairment: Depression significantly impairs daily functioning, while

  normal grief or sadness does not.

• Severity: Clinical depression involves more intense symptoms that interfere with

  social, occupational, or other important areas of functioning.

  3. Mania

• Definition: A state of abnormally elevated arousal, affect, and energy levels.

• Symptoms: Increased activity or energy, euphoria or irritability, grandiosity,

  decreased need for sleep, racing thoughts, distractibility, and impulsive behaviors.

  4. Hypomania

• Definition: A milder form of mania.

• Symptoms: Similar to mania but less severe, without significant impairment in

  social or occupational functioning or the need for hospitalization.

  5. Identifying Different Mood Disorders

• Assessment: Based on symptomatology, duration, and impact on functioning.

• Diagnosis: Utilizes DSM-5 criteria to differentiate between various mood disorders

  like Major Depressive Disorder (MDD), Bipolar I and II, Cyclothymic Disorder, etc.

  6. Key Terms to Know

• Mood Syndrome: A cluster of symptoms related to mood disturbances.

• Mood Episode: A distinct period characterized by a specific mood state (e.g.,

  depressive, manic).

• Mood Disorder: A category of mental health issues involving significant mood

  disturbances.

• Seasonal Affective Disorder (SAD): Depression related to seasonal changes,

  typically winter.

• Melancholia: A severe form of depression with specific symptoms like profound

  despondency and lack of reactivity to pleasurable stimuli.

• Manic Episode: A period of abnormally elevated mood and energy levels.

• Hypomanic Episode: A less severe form of a manic episode.

• Major Depressive Episode: A period of at least two weeks with significant

  depressive symptoms.

• Anhedonia: Inability to feel pleasure.

• Serotonin & Norepinephrine: Neurotransmitters involved in mood regulation.

  7. Medications to Know

• Mood Stabilizers:

Psy 341 – Exam 2 Study Guide – Dr. Mori Page 2

o Lithium
o Anticonvulsants: e.g., Valproate (Depakote), Carbamazepine (Tegretol) o Antipsychotics: e.g., Quetiapine (Seroquel)
o Combo Drugs: e.g., Lamotrigine (Lamictal)

• Antidepressants:
o SSRIs: e.g., Fluoxetine (Prozac), Sertraline (Zoloft) o SNRIs: e.g., Venlafaxine (Effexor)
o MAOIs: e.g., Phenelzine (Nardil)
o Tricyclics: e.g., Amitriptyline
o Esketamine
o Auvelity
o Zuljanone

• Other Biological Treatments:
o Electroconvulsive Therapy (ECT)
o Light Therapy
o Transcranial Magnetic Stimulation (TMS) o Vagus Nerve Stimulation (VNS)
o Deep Brain Stimulation (DBS)

8. Guest Speakers: Lou & Jade
• Key Points: Review notes and recordings from guest lectures for additional

insights and real-world applications.

B. Bipolar Disorder
1. Diagnostic Criteria and Symptoms

• Bipolar I Disorder: Presence of at least one manic episode, which may be preceded by or followed by hypomanic or major depressive episodes.

• Bipolar II Disorder: At least one hypomanic episode and one major depressive episode, without any full manic episodes.

• Cyclothymic Disorder: Chronic fluctuating mood disturbances with periods of hypomanic and depressive symptoms that do not meet the full criteria for hypomania or major depression.

  2. Differences Between Bipolar I, Bipolar II, and Cyclothymic Disorder

• Severity of Episodes: Bipolar I involves more severe manic episodes, while

  Bipolar II involves hypomania.

• Duration: Cyclothymic Disorder involves a longer duration of mood fluctuations.

  3. Etiological Models

• Biological Factors: Genetic predisposition, neurotransmitter imbalances.

• Psychological Factors: Stressful life events, cognitive patterns.

• Environmental Factors: Family dynamics, socio-cultural influences.

  4. Biological Findings

• Brain Circuit Dysfunction: Abnormalities in the prefrontal cortex, amygdala,

  hippocampus.

• Neurotransmitter Abnormalities: Imbalances in serotonin, norepinephrine,

  dopamine.

• Family Studies: Higher prevalence in first-degree relatives.

• Risk Rates in Relatives: Increased risk compared to the general population.

Psy 341 – Exam 2 Study Guide – Dr. Mori Page 3

• Concordance Rates Across Twin Pairs: Higher in monozygotic twins than dizygotic twins, indicating genetic influence.

5. Statistics
• Gender Risk: Men and women are at equal risk of developing bipolar disorder.

6. Course and Prognosis

• Course: Typically chronic with episodes of mania/hypomania and depression.

• Prognosis: Varies; with proper treatment, many individuals can manage symptoms

  effectively.

  7. Treatment (Tx)

• Primary Treatment: Medication (mood stabilizers, antipsychotics).

• Secondary/Complementary Treatment: Talk therapy (CBT, IPT).

• Empirically Supported Treatments (ESTs): Combination of medication and

  cognitive-behavioral therapies.

• Medication Compliance Issues: Side effects, stigma, complexity of regimen.

  8. Types of Medications

• Mood Stabilizers: Lithium, anticonvulsants (e.g., Tegretol, Depakote)

• Antipsychotics: e.g., Quetiapine (Seroquel), Risperidone (Risperdal)

• Combo Medications: Lamotrigine (Lamictal), Luvox

• Antidepressants: SSRIs, SNRIs, Wellbutrin, Esketamine, Auvelity, Zuranolone,

  Tricyclics, MAOIs

  9. Rationale Behind Combination Drug Cocktails

• Synergistic Effects: Enhancing therapeutic outcomes by targeting multiple

  neurotransmitter systems.

• Comprehensive Management: Addressing both manic and depressive symptoms

  simultaneously.

• Reducing Relapse Rates: Combining medications can help stabilize mood more

  effectively.

  C. Major Depressive Disorder (MDD) 1. Diagnostic Criteria

• Symptoms: At least five of the following during the same 2-week period, representing a change from previous functioning:

o Depressed mood
o Anhedonia
o Significant weight loss or gain
o Insomnia or hypersomnia
o Psychomotor agitation or retardation
o Fatigue or loss of energy
o Feelings of worthlessness or excessive guilt o Diminished ability to think or concentrate
o Recurrent thoughts of death or suicide

2. Differences Between MDD and Persistent Depressive Disorder (PDD)

• MDD: Characterized by discrete episodes of major depression.

• PDD (Formerly Dysthymic Disorder): Chronic depressive mood lasting for at

  least two years, with symptoms that are less severe than MDD but more enduring.

  3. Double Depression

Psy 341 – Exam 2 Study Guide – Dr. Mori Page 4

• Definition: The occurrence of a major depressive episode on top of a persistent depressive disorder.

4. Associated Features

• Prevalence: Twice as common in women as in men.

• Socioeconomic Status: Higher prevalence in lower socioeconomic classes.

• Genetics: Runs in families, but with lower genetic transmission rates compared to

  bipolar disorders.

  5. Etiological Models

• Biological Factors: Neurotransmitter imbalances, hormonal changes, genetic

  predisposition.

• Psychological Factors: Cognitive distortions, learned helplessness.

• Environmental Factors: Stressful life events, trauma, social support deficits.

  6. Biological Aspects

• Brain Circuit Dysfunction: Involves areas such as the prefrontal cortex,

  amygdala, hippocampus.

• Neurotransmitter Abnormalities: Imbalances in serotonin, norepinephrine,

  dopamine.

• Ion Transmission Dysfunction: Altered ion channel functioning affecting neuronal

  activity.

  7. Cognitive Behavioral Theories

• Beck's Cognitive Triad: Negative views about the self, the world, and the future.

• Learned Helplessness (Seligman): Belief that one has no control over outcomes,

  leading to passive behavior.

• Negative Attributions: Internal, stable, and global attributions for negative events.

• Cognitive Distortions: Systematic errors in thinking that reinforce negative beliefs.

  8. Positive Psychology (Seligman)

• Focus: Enhancing well-being and positive emotions to combat depression.

9. Course, Prognosis, Treatment

• Course: Can be chronic or recurrent; varies based on individual and treatment

  adherence.

• Prognosis: Generally favorable with appropriate treatment, though some cases

  can be resistant.

• Treatment: Combination of medication, psychotherapy, and lifestyle changes.

  D. Major Research Findings

• Genetic Studies: High heritability rates for mood disorders.

• Neuroimaging: Structural and functional abnormalities in specific brain regions.

• Longitudinal Studies: Patterns of onset, recurrence, and chronicity.

• Treatment Efficacy: Comparative studies on the effectiveness of various

  treatments.

  E. Theories of Depression
  1. Biological/Biochemical Theories

• Neurotransmitter Imbalance: Deficits in serotonin, norepinephrine, dopamine.

• Brain Circuit Dysfunction: Altered activity in the limbic system, prefrontal cortex.

• Genetic Vulnerability: Heritable factors contributing to risk.

Psy 341 – Exam 2 Study Guide – Dr. Mori Page 5

2. Cognitive Theories

• Beck's Cognitive Triad: Negative thoughts about self, world, and future.

• Negative Schemas: Deeply held negative beliefs influencing perception and

  behavior.

• Cognitive Distortions: Errors in thinking patterns (e.g., all-or-nothing thinking,

  overgeneralization).

• Systematic Errors of Logic: Flawed reasoning processes contributing to

  depressive thoughts.

  3. Seligman’s Learned Helplessness

• Concept: Depression results from a perceived lack of control over outcomes.

• Attributes: Global, stable, and internal attributions for negative events.

• Reinforcement: Lack of reinforcement leads to passive behavior and depression.

  4. Interpersonal Models of Depression

• Social Support: Lack of support can increase risk of depression.

• Stressful Life Events: Significant stressors can trigger depressive episodes.

• Marital Discord: Conflict in relationships can contribute to depression.

• Multicultural Factors: Cultural context influences the expression and treatment of

  depression.

  F. Treatment
  1. Drug Therapy (Medication)

  • Antidepressants:

o Tricyclics: e.g., Amitriptyline
o MAOIs: e.g., Phenelzine
o SSRIs/SNRIs: e.g., Fluoxetine, Sertraline, Venlafaxine o Esketamine: A fast-acting antidepressant.
o Auvelity: A novel antidepressant.

• Antipsychotics:
o Examples: Quetiapine (Seroquel), Olanzapine (Zyprexa), Aripiprazole

(Abilify), Haloperidol (Haldol)

2. Electroconvulsive Therapy (ECT)

• Uses: Severe depression, treatment-resistant depression, acute suicidal ideation.

• Effectiveness: Highly effective for certain cases; rapid symptom relief.

• Side Effects: Memory loss, confusion, physical side effects like headaches or

  muscle aches.

• Other Brain Stimulation Treatments:

o Vagus Nerve Stimulation (VNS): Implanted device that stimulates the

vagus nerve.
o Deep Brain Stimulation (DBS): Implanted electrodes in specific brain

regions.
o Transcranial Magnetic Stimulation (TMS): Non-invasive magnetic

stimulation of the brain.
o Light Therapy: Primarily used for Seasonal Affective Disorder (SAD).

3. Psychosurgeries

• Definition: Surgical interventions for severe, treatment-resistant depression.

• Types: Anterior cingulotomy, subcaudate tractotomy.

Psy 341 – Exam 2 Study Guide – Dr. Mori Page 6

• Considerations: Rarely used due to invasiveness and ethical concerns. 4. Psychotherapy

• Cognitive Behavioral Therapy (CBT):
o Behavioral Activation: Increasing engagement in positive activities.
o Beck’s Cognitive Therapy: Addressing and restructuring negative thought

patterns.
o Acceptance and Commitment Therapy (ACT): Focusing on acceptance

and commitment to personal values.
o Dialectical Behavior Therapy (DBT): Combining CBT with mindfulness and

emotional regulation.

• Interpersonal Therapy (IPT): Focusing on improving interpersonal relationships

  and social functioning.

• Culture-Sensitive CBT: Tailoring CBT to align with cultural contexts and values.

• Couple Therapy: Addressing relationship issues contributing to depression.

• Other Talk Therapies: Including psychodynamic therapy, supportive therapy.

  5. Empirically Supported Treatments (ESTs) for Depressive Disorders

• Medications: SSRIs, SNRIs, MAOIs, tricyclics.

• Psychotherapies: CBT, IPT, behavioral activation.

• Combination Treatments: Medication plus psychotherapy for enhanced

  outcomes.

  G. Suicide
  1. Associated Features and Statistics

• Prevalence: 60-70% of all suicides are committed by individuals with depression.

• Primary Reason: Desire to end psychological pain and suffering, seeking

  surcease.

• Risk Factors: Mental disorders (especially depression and bipolar disorder),

  substance abuse, previous suicide attempts, family history, access to means,

  stressful life events.

  2. Shneidman's Suicide Characteristics and 4 Types • Characteristics:

o Psychache: Intense psychological pain.
o Thwarted Belongingness: Lack of meaningful connections.
o Perceived Burdensomeness: Belief that one is a burden to others. o Hopelessness: Belief that circumstances cannot improve.

• 4 Types of Suicide (Shneidman):
o Anomic Suicide: Resulting from social or economic upheaval.
o Fatalistic Suicide: Caused by oppressive circumstances.
o Altruistic Suicide: Driven by self-sacrifice for a perceived greater good. o Communal Suicide: Carried out by a group.

H. Other Depressive Disorders
1. Persistent Depressive Disorder (PDD; Formerly Dysthymic Disorder)

• Characteristics: Chronic depressive mood lasting at least two years with less severe symptoms than MDD.

• Possible Causes: Genetic factors, chronic stress, personality traits.

Psy 341 – Exam 2 Study Guide – Dr. Mori Page 7

• Best Treatments: Psychotherapy (CBT, IPT), antidepressant medications. 2. Premenstrual Dysphoric Disorder (PMDD)

• Characteristics: Severe depressive symptoms occurring in the luteal phase of the menstrual cycle.

• Possible Causes: Hormonal fluctuations affecting neurotransmitter systems.

• Best Treatments: SSRIs, hormone therapy, lifestyle modifications. 3. Disruptive Mood Dysregulation Disorder (DMDD)

• Characteristics: Severe and chronic irritability and frequent temper outbursts in children and adolescents.

• Possible Causes: Genetic predisposition, environmental stressors, family dynamics.

• Best Treatments: Psychotherapy (CBT), parent training, medication (antidepressants, stimulants).

  4. Specifiers for Major Depressive Disorder

• With o

  o

  o

• With o

  o o

Seasonal Pattern (Formerly SAD):
Features: Depressive episodes linked to seasonal changes, typically winter. Possible Causes: Reduced sunlight exposure affecting circadian rhythms and serotonin levels.
Best Treatments: Light therapy, SSRIs, psychotherapy.

Peripartum Onset (Postpartum Depression):
Features: Depression occurring during pregnancy or within four weeks postpartum.
Possible Causes: Hormonal changes, sleep deprivation, psychosocial stressors.
Best Treatments: Psychotherapy, antidepressant medications (considering breastfeeding), support groups.