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215 Cards in this Set
- Front
- Back
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What are the two braod types of Mood Disorder
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Unipolar and Bipolar
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What are the cardinal symptoms of depression?
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Profound sadness and/or an inability to experience pleasure
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What are the three new depressive disorders proposed in the DSM-5?
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mixed anxiety/depressive disorder, premenstrual disorder, and disruptive mood regulation disorder
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What are the 5 depressive disorders in the DSM-5?
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1. Major Depressive Disorder;
2. Dysthmia; 3. Mixed anxiety/depressive disorder; 4. Premenstrual dysphoric disorder; 5. Disruptive mood dysregulation disorder |
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What are the three bipolar disorders?
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1. Bipolar I;
2. Bipolar II disorder; and 3. Cyclothymia |
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What are 5 physical symptoms commonly found in people with depressive disorder?
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fatigue, sleeping problems, decrease sexual interest, psychomotor retardation, and psychomotor agitation
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What are 6 common psychological symptoms of depressive disorders?
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self-recrimination, difficulty paying attention, physical symptoms, reduced initiative, social withdrawal, and neglect of appearance
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How many symptoms and for how long must they be present to be diagnised with MDD?
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5 symptoms for 2 weeks
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Symptoms of MDD must include depressed mood or what?
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loss of interest or pleasure
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Why is MDD regarded as an episodic disorder?
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because symptoms tend to be present for a period of time and then disappear
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What are the 7 symptoms, of which 5 must be present, in the DSM-5 criteria for MDD?
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1. sleeping too much or too little;
2. psychomotor retardation or agitation; 3. weight loss or change in appetite; 4. loss of energy; 5. feelings of worthlessness or excessive guilt; 6. difficutly concentrating, thinking or making decisions; 7. recurrent thoughts of death or suicide |
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What proportion of people who have suffered a Major depressive episode are likely to have a second episode?
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two thirds
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What is the average number of MDD episodes?
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4
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Each episode of MDD increases the risk of another episode by what percent?
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16%
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Chronic depression is known as what?
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dysthmia
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How many symptoms and for how long must they be present to be diagnised with dysthmia?
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2 symptoms for 2 years
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In dysthmia what proportion of the time do people need to experience a depressed mood to meet the criteria?
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more than half the time
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What percentage of people with dysthmia develop MDD over a 10 year period?
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95%
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The criteria for dysthmia requires that symptoms do not clear for what period of time over the 2 years?
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2 months
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What is the most prevalent psychiatric disorder?
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MDD
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Prevalence of MDD over the lifetime?
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16%
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Prevalence of dythmia?
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2.50%
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What is the Female Male ratio of MDD?
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2 :1 ratio
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How many times more common is MDD in low SES individuals?
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three times
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Is MDD or dysthmia more rare?
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dysthmia
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What is the prevalence of MDD in Taiwan and Lebanon?
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1.5 Taiwan and 19% in Lebanon
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Do symptoms of MDD vary across cultures?
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yes
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What symptoms of MDD are common is Latino cultures and Asian cultures?
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nerves & headaches in latino, and fatigue and weakness in asians
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What might symptoms of MDD show cross-cultural variation?
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due to cultural standards regarding acceptable expressions of emotional distress
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What changes in the rates of MDD and dysthmia are found in countries with high fish consumption?
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lower rates of both
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In most countries did the prevalence of MDD increase or decrease steadily until the late 20th century?
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increased
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Has the age of MDD onset become older or younger over time?
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younger
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What percentage of people in their 60's report an experience an episode MDD by age 20?
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5%
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What percentage of people in aged 18 to 29 report an experience an episode MDD by age 20?
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10%
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What is the median age of onset for MDD?
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late teens , early 20's
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What social change may explain the increase in rates of MDD and the lower age of onset?
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reduced social support structures
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What percentage of people who meet the criteria for MDD during their lifetime will also meet the criteria for an anxiety disorder at some point?
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60%
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What disorders are commonly comorbid with MDD?
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anxiety, substance abuse, sexual dysfunctions, and personality disorders
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What is the worlds leading cause of diability?
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MDD
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The further a person's distance from the equator the more they are at risk for developing which disorder?
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MDD
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There is strong evidence that depression is related to the onset and severity of which physical disease?
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cardiovascular disease
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IS MDD acute or chronic?
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Acute
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Is dysthmia acute or chronic?
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chronic
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Does dysthmia require more or less symptoms for a diagnosis than MDD?
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less
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What is the average duration of dysthmic symptoms?
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more than 5 years
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What differences in MDD symptomology are found in children vs older adults?
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children often display somatic complaints, where older adults display distractibility and memory loss
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Episodes of mood disorders that occur during certain seasons is known as what?
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seasonal affective disorders
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How does seasonal effective disorder affect depression and bipolar disorder?
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in depression it typically worsens on late autumn to early spring, and for bipolar people are typically depressed in winter and manic in summer
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What changes in sleep and appetite in SAD?
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excessive sleep and decreased appetite
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What hormone is implicated in SAD?
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melatonin
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What is the defining feature of bipolar?
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mania
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What differentiates each of the three bipolar disorders?
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the severity and length of the mania
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Which types of bipolar require the presence of depression and which don't?
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diagnosis of depression is not required for bipolar I, but is required for bipolar II, and cyclothmic disorder
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What are the three subtypes of MDD in the dSM-IV-TR?
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single epsiode, recurrent, chronic substype
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What 7 criteria of which 3 are required, or 4 if the mood is irritable, for a manic or hypomanic episode?
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1. increased goal-directed activity or psychomotor agitiation;
2. unusual talkativeness/rapid speech; 3. flight of ideas or subjective impression that thoughts are racing; 4. decreased need for sleep; 5. increases self esteen/belief that one has special talents, powers, or abilities; 6. distractibitiity; 7. excessive involvement in acitivities that are likely to have undesireable consequences, such as reckless spending, sexual behaviour, or driving |
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Aside from the list of symptoms, what are criteria are required for a manic episode?
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1. distincly elelvated or irritible mood for most of the day;
2. (DSM-5) abnormally increased actvity and energy; 3. symptoms later one week or require hisoitalisation; 4. symptoms cause significant ditress or impairment |
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What is the difference of criteria between a manic and a hypomanic episode?
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Manic- required symptoms for be present for one week or require hisoptialisation, and symptoms cause significant distress or impair funcitoning; and
Hypomanic - symptoms last for 4 days, clear changes in functioning observable to others but impairment is not marked, and no psychotic symptoms are present |
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What is it known as when a person shifts rapidly from topic to topic?
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flight of ideas
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What are the two chronic mood disorders?
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dysthmia and cyclothymic disorder
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Which form of bipolar requires only a single manic eopisode over the lifetime?
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Bipolar 1
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Which form of bipolar is considered a milder form?
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bipolar II
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What are the two criteria for bipolar II?
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a person must have experienced at least one major depressive episode, and at least one episode of hypomania
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How long must mild syptoms of depression alternating with mild symptoms of mania be present for to meet the criteria for cyclothmic disorder?
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2 years
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How long must symptoms be present in children to diagnose cyclothmic disorder?
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1 year
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In the criteria for cyclothmic disorder symptoms must not clear for more than what period of time for a diagnosis?
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2 months
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Prevalence of bipolar I?
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0.06%
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Prevalence of bipolar II
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.4 to 2%
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prevalence of cyclomythmic disorder?
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4%
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What proprtion of people diagnosed with a bipolar spectrum disorders report onset before age 25?
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half
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Bipolar occurs equally in men and woman but what symptoms occur more often in women?
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depression
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What proportion of people with bipolar disorder meet diagnostic criteria for a comorbid anxiety disorder?
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two-thirds
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What proportion if people with bipolar disorders meet diagnostic criteria for a comorbid substance abuse?
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more than one third
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What two disorders are commonly comorbid with bipolar disorder?
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anxiety and substance abuse
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Which type of bipolar is seen as one of the most severe forms of mental illness?
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bipolar I
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What percentage of the time is it estimated that people with bipolar unable to work?
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25%
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What proprtion of people remain unemployed for a year after hospitalisation?
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one third
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One in 4 persons with bipolar 1, and one in five with bipolar II report a history of what?
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suicide attempts
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People with bipolar disorders are at high risk of developing what four medical conditions?
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cardiovascular disease, diabetes , obesity, and thyroid disease
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rapid cycling is only diagnosed for which condition?
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bipolar
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Are the symptoms of mood disorders homogenous or heterogenous?
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heterogeneous
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People with cyclothymic disorder are at a high risk of developing what?
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episodes of mania and depression
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How many episodes must be present each year for rapid cycling?
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4
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A person who moves in and out of depression or manic episodes describes what mood disorder subtype?
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rapid cycling
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Which subtype of mood disorders tends to be resistent to treatment?
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rapid cycling
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Which mood disorder subtype is described as having delusion or hallucinations with themes that are consistent with mood state?
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mood-congruent psychotic features
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Which mood disorder subtype is described as having delusions or hallucinations with themes that do not match the valence of the depressive or manic episode?
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mood-incongruent psychotic features
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Which mood disorder subtype involves extreme physical immobility or excessive perculiar movements?
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Catatonic
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Which mood disorder subtype involves loss of pleasure in any acitivty, an inability to gain relief from positive events, and depressive symptoms are worse in the morning?
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melancholic
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Which mood disorder subtype symptoms that are unusual for depressive or manic episodes that are present, such as oversleeping and overeating can gain pleasure form acitivties?
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Atypical
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Which mood disorder subtype has an onset withint 4 weeks of giving birth?
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postpartum
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The heritability of mood disorders is what?
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36%
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The poly morphisms of what type of transporter gene is thought is implicated in mood disorders?
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serotonin
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How does mania present in children?
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modd swings and irritability not as marked as in adults
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Depression is fundamentally similar across the lifespan however what must clinicians look for when assessing for the presence of a mood disorders?
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changes in behaviour
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What comorbidity differences are found in children and adults with a mood disorder?
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Adults typically comorbid with anxiety, whereas children are typically comorbid with AdHD and CD
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What percentage of children with a mood disorders meet criteria for ADHD?
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90%
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MDD is common in people with polymrphism of which dopamine gene?
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DRD4.2
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Is it more likely to one gene or a set of genes is involved with mood disorders?
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a set of genes
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Which three neurotransmitters are implicated in mood disorders?
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noreponephrine, dopamine, and serotonin
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What is the primary function of serotonin?
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regulate emotional reactions
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Which of the three neurotransmitters implicated in mood disorders is thought to impact more than the others?
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serotonin
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Are serotonin low or high in mood disorders?
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low
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Is it the balance of the neurotransmitters or absolute levels of neurotransmitters that is important in mood disorders?
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balance of the neurotransmitters
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Dopamine plays a role in the sensitivity of which system?
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reward system
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What is the name of the brain system which is believed to guide pleasure, motivation, and energy in the context of opportunities to obtain rewards?
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reward system
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Among people with bipolar, drugs that increase dopamine have been found to trigger what?
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a manic episode
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In support of the reward system, diminished dopamine functioning in people with MDD can cause what type of deficits?
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pleasure, motivation and energy
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People with depression are less responsive than other people to drugs that increase what?
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dopamine levels
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What differences in dopamine sensitivity are found among those with depression and those with bipolar?
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people with depression are less sensitive to dopamine, and people with bipolar are more sensitive to dopamine
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A person who has insensitive serotonin receptors is expected to experience what symptoms as levels drop?
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depression
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What difference in serotonin sensitivity is found among those with depression and those with bipolar?
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both conditions show a diminished sensitivitiy of the serotonin receptors
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What are the four primary brain structures involved with depression?
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amygdala, prefrontal cortex, sub-genual anterior cingulate, and hippocampus
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What brain structure helps a person assess how emotionally important a stimulus is?
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amygdala
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Is hyperactivity of the amygdala in people with MDD a predisposing factor or a resulting factor of MDD?
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both
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Functional brain activation studies show elevated levels of acitivity in the amygdala among people with which disorder?
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MDD
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Of the four brain structures implicated in MDD and bipolar 1 disorder which 2 are hyperreactive and which two have diminshed reactivity in people with MDD and bipolar?
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the amygdala and sub-genual anterior cingulate show hyperreactivity, and the prefrontal cortex and hippocampus show diminshed reactivity
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Brain patterns shown during mania are similar to the patterns shown during what?
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depression
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Which other brain structure linked to the reward system is overly active in people with mania but not in people with depression?
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striatum
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People with MDD have increases reaction to emotions but a decreased ability to do what?
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plan
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People with bipolar disorder often have deficits in the membranes of what which influences how readily they can be activated?
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neurons
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Which type of protein is abnormally high among people with mania?
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protein kinase C
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Which axis is involved in MDD?
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HPA
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Too much cortisol resutls in what sort of symptoms?
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depressive symptoms
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Is high or low levels of cortisol linked to depression?
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high
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What does dexamethasone do?
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suppresses cortisol secretion
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Dexamethasone does not adequeately suppress cortisol secretion in people with MDD and particularly in those showing what type of symptoms?
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psychotic
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At times of stress and increased activity of the immune system what hormone is secreted to help the body prepare for threats
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cortisol
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Dexamethasone suppresses cortisol over the course of what?
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the night
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The lack of cortisol suppression is seen as poor regulation of what in people ith MDD?
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HPA axis
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Long-term excesses of cortisol have been linked to damage and shrinkage of what brain structure?
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hippocampus
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The HPA axis manages rectivity to what?
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stress
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The HPA axis receives signals from what brain structure causing it to acitivate?
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amygdala
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Do life events typically happen before or after a depressive episode?
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before
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What percentage of people report a serious life event before the onset of depression?
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42 to 67%
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What are two types of life events that appear to trigger depressive episodes?
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loss & humiliation
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Do life events tend to trigger initial episodes of depression or subsequent episodes?
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initial episodes
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In what way do adequate social support networks protect against mood disorders?
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adequate social support help a persons handle stressful life events
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What term describes a family member's critical or hostile comments toward or emotional involvement with the person with depression?
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expressed emotions (EE)
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What does high EE predict?
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a relapse in depression
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What percentage of patients in families with high EE relapsed within one year? and with low EE?
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69.5% high EE compared to 30.5% low EE
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Depressive symptoms seem to eleicit what kind of reactions from others?
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negative
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Interpersonal problems are a risk factor for what?
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depression
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What impact can seeking reassurance from others have on a person with depression?
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elicit a negative response from others which may contribute to the onset of a depressive episode
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Those with anxiety and depression generally have what sort of affect?
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negative
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What is the primary difference in affect between people with depression and people with anxiety?
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People with depression experience a lack of positive affect while people with anxiety do not
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Which personality factor tends to predict the onset of depression?
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neuroticism
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Why does neuroticism predispose people to depression?
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because high neurotocism is the tendency to react to events with greater negative affect
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Which cogntive theory is most influential in the aetiology of depression?
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Beck's Theory
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What are the three main cognitive theories implicated in the aetiology of depression?
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Beck's Theory, Hopelessness Theory, and Rumination Theory
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Which cognitive theory emphasises the negative triad?
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Beck's Theory
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What is the negative triad?
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negative views of self, the world, and the future
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According to Beck' Theory what do people acquire during childhood through experiences such as loss of a parent, the social rejection of peers, or the depressive attitude of a parent?
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negative schema
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What are schemas?
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underlying sets of beliefs that operate outside of the persons awarenes to shape the way a person makes sense of his or her experiences
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When is a negative schema activated?
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when the person encounters situations similar to those that originally caused the schema to form
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The tendency to process information in certain negative ways is known as what?
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negative bias
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Once activated negative schemas are believed to cause what?
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cognitive bias
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According to Beck's Theory people who are depressed make certain cognitive errors to arrive at what?
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biased conclusions
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What widely used self report instrument has been used in stidies of Beck's Theory?
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DAS - Dysfunctional Attitudes Scale
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People with depression have a tendency to focus on what once it is noticed?
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negative information
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People with depression tend to have a negative bias toward what information processing functions?
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what information they attend to and retain
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According to which theory the most important trigger of depression is hopelessness?
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Hopelessness Theory
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An expectations that desirable outcomes witll not occur and that the person has no responses available to change the situation is known as what?
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hopelessness
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Stable and global attribution about the event and it's meaning for the future or self leads to what?
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hopelessness
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What are the two key dimensions of attribution implicated in the hopelessness theory?
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stable vs unstable and global vs specific causes
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How does low self esteem promote hopelessness?
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it undermines the confidence that a person can cope with life challenges
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How does rumination contribute to the onset of a depressive episode?
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it t interferes with problem solving and increases negative mood
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What type types of factors have been found to predict increases in manic symptoms over time?
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reward sensitivity and sleep deprivation
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Being highly reward sensitive has been shown to predict what?
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the onset of bipolar disorder and a more severe course of mania after onset
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What type of life events seem to precipitate the onset of bipolar or a manic episode?
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life events that involve attaining goals
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Excessive goal pursuit may trigger what in people with bipolar disorder?
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manic symptoms
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Mania is intricately tied to disruptions in what?
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sleep and circadian rhythms
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Sleep deprivation can precede the onset of what in people with bipolar disorder?
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manic episode
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Protection of what daily function can help reduce symptoms of bipolar disorder?
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sleep
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Depression and anxiety share what?
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a genetic vulnerabitilty
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Interpersonal relationship can act as what for depression?
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protective or risk factor
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What are the four psychological treatments for depression?
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Interpersonal psychotherapy, Cognitive Therapy, Behavioural Activation Therapy, and Behavioural Couples Therapy
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What does IPT stand for?
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Interpersonal Therapy
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What idea does IPT build on?
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the idea that depression is closely tied to interpersonal problems
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What is the core of IPT?
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to examine major interpersonal problems, such as role transitions, interpersonal conflicts, bereavement, and interpersonal isolation
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What is the typical number of sessions for IPT?
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16
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What are the 5 techniques used in IPT?
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1. disucssing interpersonal problems;
2. exploring negative feelings and encouraging their expression; 3. improving both verbal and nonverbal communications; 4. problem solving; 5. suggesting new and more satisfying modes of behaviour |
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What are the 3 goals of IPT?
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helping the person identify his or her feelings about the issues, make important decisions, and make changes to resolve problems related to these issues.
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Cognitive therapy is aimed at altering what?
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maladaptive thought patterns
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An adaption of CT called mindfulness-based cognitive therapy (MBCT) focuses on what?
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relapse prevention after successful treatment for recurrent episodes of MDD
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Behavioural Activation Therapy is based on what idea?
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that many of the risk factors for depression can result in low levels of positive reinforcement and that increasing engagement in rewarding acitvities will alleviate depression through increased positive reinforcement
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What is the purpose of behavioural couples therapy?
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improve communicate and relationship satisfaction and therefore alleviating depression
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What is a necessary part of treatment for bipolar disorder?
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medication
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What is an inherent problem with medicating people with bipolar disorder?
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high rates non adherence
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What are three psychological treatments that are effective for treating bipolar disorder?
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Psychoeducation, CBT and FFT
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What is the aim of family focussed treatment in people with bipolar disorder?
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to educate the family about the illness, enhance family communication, and develop problem solving skills
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What are the two main biological treatment for MDD?
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ECT and medication
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What are the three types of medication used to treatment depressive disorders?
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SSRI's, Mao inhibitors, and Tri-cyclic antidepressants
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Which type of antidepressant is more effective in the treatment of depressive disorders?
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all equally effective
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Combining psychotherapy with antidepressant drugs in the treatment of depressive disorders increases the effectiveness by what perentage?
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20%
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What percentage of people with depression show major improvement after taking AD medication?
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50 to 70%
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What is the most commonly prescribed AD medication?
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SSRI's
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What are some side effects of SSRI's?
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physical agitation, sexual dysfunction, insomnia, gastrointestinal upset
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What does MAO stand for?
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Mono-amine oxidase inhibitor
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What can sometimes be a serious temporary side effect of SSRI's particualrly found in adolescents?
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increases thoughts of suicide
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MAO's inhibitor block which enzyme?
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Mono-amine oxidase
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What are the two potential serious side effects of MOA inhibitors?
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consuming anything containing tyramine can lead to hypertension, and everyday medication interactions are dangerous
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What does MOA breakdown?
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noreponephrine, dopamine, and serotonin
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What common food and drink is tyramine found in?
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wine, cheese, and beer
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Which AD medication is lethal if taken in high doses?
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tricyclic AD's
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What are the disruptive side effects of tricyclic AD's?
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blurred vision, dry mouth, drowsiness, and weight gain
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Medications that reduce manic symptoms are known as what?
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mood stabilisers
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What is the common drug used to treat bipolar disorder?
|
lithium
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What percentage of people receive some benefit from taking lithium?
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80%
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What percentage of people who take lithium relapse within 5 years?
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70%
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What are some serious side effects of lithium?
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coma, and even death
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What other two medications are used when lithium doesn't work?
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anticonvulsives and antipsychotics
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What is the main reason a person with bipolar will cease taking lithium?
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because it flattens affect
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When is ECT used to treat MDD?
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when all other treatments and medications fail
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What are the main side effects for ECT?
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short-term memory loss and cognitive decline for up to 6 months
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What voltage current is used in ECT?
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70 to 130 volts
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