Mood Disorders (Chapter 5, Kring)

striatum

brain region implicated in reactions to reward which is overly active during mania

Mood-incongruent psychotic features

Delusions or hallucinations with themes that do not match the valence of the depressive or manic episode

nonsuicidal self-injury (NSSI)

Behaviors that are meant to cause immediate bodily harm but are not intended to cause death.

Structural studies

focus on whether a brain region is smaller or larger among people with a disorder compared to control participants

Functional activation studies

focus on whether there is a change in the activity of a brain region

neuroticism

The tendency to react to events with greater- than-average negative affect; a strong predictor of onset of anxiety disorders and depression.

dexamethasone suppression test

(dex/CRH) is an even more sensitive test of the HPA system in which researchers administer both dexamethasone and corticotropin-releasing hormone (which increases cortisol levels)

dexamethasone

suppresses cortisol secretion over the course of the night for people who do not have a mood disorder

suicide ideation

thoughts of killing oneself

Aaron Beck

argued that depression is associated with a negative triad: negative views of the self, the world, and the future

bipolar II disorder

A form of bipolar disorder, diagnosed in those who have experienced at least one major depressive episode and at least one episode of hypomania.

1. bipolar I disorder 2. bipolar II disorder 3. cyclothymic disorder.

3 bipolar disorders

monoamine oxidase inhibitors (MAOIs)

A group of antidepressant drugs that prevent the enzyme monoamine oxidase from deactivating catecholamines and indolamines.

tricyclic antidepressants

A group of antidepressants with molecular structures characterized by three fused rings; interfere with the reuptake of norepinephrine and serotonin.

1. major depressive disorder 2. persistent depressive disorder 3. premenstrual dysphoric disorder 4. disruptive mood dysregulation disorder.

4 depressive disorders

persistent depressive disorder (dysthymia)

A DSM-5 disorder defined by depressive symptoms that last for at least two years.

premenstrual dysphoric disorder

A DSM-5 disorder defined by mood and physical symptoms that consistently emerge in the week before menses and clear within a week after menses.

episodic disorder

A condition, such as major depressive disorder, whose symptoms dissipate but that tends to recur.

bipolar I disorder

A diagnosis defined on the basis of at least one lifetime episode of mania. Most people with this disorder also experience episodes of major depression.

major depressive disorder (MDD)

A disorder of indi- viduals who have experienced episodes of depression but not of mania. Depression episodes are marked by sadness or loss of pleasure, accompanied by symptoms such as feelings of worthlessness and guilt; withdrawal from others; loss of sleep, appetite, or sexual desire; and either lethargy or agitation.

major depressive disorder (MDD)

A disorder of indi- viduals who have experienced episodes of depression but not of mania. Depression episodes are marked by sadness or loss of pleasure, accompanied by symptoms such as feelings of worthlessness and guilt; withdrawal from others; loss of sleep, appetite, or sexual desire; and either lethargy or agitation.

lithium

A drug useful in treating both mania and depression in bipolar disorder.

unilateral ECT

A form of ECT in which the current passes only through the nondominant (typically the right) cerebral hemisphere, is often used because side effects are less pronounced

bilateral ECT.

A form of ECT where electrodes were placed on each side of the forehead

cyclothymic disorder

A form of bipolar disorder characterized by swings between elation and depression over at least a 2-year period, but with moods not so severe as manic or major depressive episodes.

subgenual anterior cingulate

A region in the anterior cortex that is part of a network of structures involved in emotion processing; believed to be overly active in major depressive disorder.

dorsolateral prefrontal cortex

A region of the prefrontal cortex involved in working memory, motor planning, organization, and regulation that is implicated in many psychopathologies.

selective serotonin reuptake inhibitors (SSRIs)

A spe- cific form of serotonin reuptake inhibitors (SRIs) with less effect on dopamine and norepinephrine levels; SSRIs inhibit the reuptake of serotonin into the presynaptic neuron, so that serotonin levels in the cleft are sustained for a longer period of time.

seasonal affective disorder

A subtype of mood disorders in which episodes consistently occur at the same time of year; in the most common form, major depressive episodes consistently occur in the winter.

psychomotor agitation

A symptom characterized by pacing, restlessness, and inability to sit still.

psychomotor retardation

A symptom commonly observed in major depressive disorder in which the person moves his or her limbs and body slowly.

flight of ideas

A symptom of mania that involves a rapid shift in conversation from one subject to another with only superficial associative connections.

tryptophan

Amino acid that is the major precursor of serotonin; experimental depletion has found that a lowered serotonin level causes temporary depressive symptoms in people with a personal or family history of depression.

Cushing's syndrome

An endocrine disorder usually affecting young women, produced by oversecretion of cortisone and marked by mood swings, irritability, agitation, and physical disfigurement.

hypomania

An extremely happy or irritable mood accompanied by symptoms like increased energy and decreased need for sleep, but without the significant functional impairment associated with mania.

antidepressant

Any drug that alleviates depression; also widely used to treat anxiety disorders.

With anxious distress

At least 2 symptoms of anxiety are present

Mixed features

At least three manic symptoms are present during a depressive episode, or at least three depressive symptoms are present during a manic episode

behavioral couples therapy

Clinical approach to depression in which a couple works to improve communication and satisfaction; more likely to relieve relationship distress than individual cognitive therapy.

hopelessness theory

Cognitive theory of depression that began with learned helplessness theory, was modified to incorporate attributions, and has been modified again to emphasize hopelessness—an expectation that desirable outcomes will not occur and that no available responses can change the situation.

disruptive mood dysregulation disorder

DSM-5 disorder defined by severe temper outbursts and observably irritable mood between outbursts in youth older than age 6.

Mood-congruent psychotic features

Delusions or hallucinations with themes that are consistent with the mood state (e.g. guilt, disease, or death themes accompanying depression)

Seasonal pattern

Episodes happen regularly at a particular time of the year

psychoeducational approaches

Especially with bipolar disorder and schizophrenia, the component of treatment that helps people learn about symptoms, expected time course, triggers for symptoms, and treatment strategies.

Catatonia

Extreme physical immobility or excessive peculiar physical movement

G-proteins

Guanine nucleotide-binding proteins that serve to modulate activity within the postsynaptic cell, are implicated in mania and depression, and are possibly the intracellular target of lithium. High levels have been found in patients with mania and low levels in patients with depression.

Melancholic features

Lack of pleasure in any activity, inability to gain relief from positive events, and at least three other symptoms of depression, such as a distinct quality of mood, depressive symptoms that are worse in the morning, waking at least 2 hours too early, loss of appetite/weight, psychomotor retardation or agitation, or guilt

expressed emotion (EE)

Hostility, criticism, and emotional overinvolvement directed from other people toward the patient, usually within a family.

negative triad

In Beck's theory of depression, a person's negative views of the self, the world, and the future, in a reciprocal causal relationship with pessimistic assumptions (schemas) and cognitive biases such as selective abstraction.

mania

Intense elation or irritability, accompanied by symptoms such as excessive talkativeness, rapid thoughts, distractibility, grandiose plans, heightened activity, and insensitivity to the negative consequences of actions.

Reasons for Living Inventory

Items on this inventory tap into what is important to the person, such as responsibility to family and concerns about children

elevated

Levels of Activity among People with Mood Disorders as Shown in Functional Activation Studies of the amygdala

diminished during emotion regulation

Levels of Activity among People with Mood Disorders as Shown in Functional Activation Studies of the dorsolateral prefrontal cortex

diminished

Levels of Activity among People with Mood Disorders as Shown in Functional Activation Studies of the hippocampus

elevated

Levels of Activity among People with Mood Disorders as Shown in Functional Activation Studies of the subgenual anterior cingulate

mood-stabilizing medications

Medications that reduce manic symptoms

Peripartum onset

Onset during pregnancy or within 4 weeks postpartum

peripartum onset

Onset during pregnancy or within 4 weeks postpartum, characterizing a subtype of episodes of major depressive disorder or mania.

stable and global

People whose attributional style leads them to believe that negative life events are due to ______ and _____ causes are likely to become hopeless, and this hopelessness will set the stage for depression.

mindfulness-based cognitive therapy (MBCT)

Recent adaptation of cognitive therapy/restructuring that focuses on relapse prevention after successful treatment for recurrent episodes of major depression; aims to "decenter" the person's perspective in order to break the cycle between sadness and thinking patterns.

rumination

Repetitive thought about why a person is experiencing a negative mood.

suicide prevention centers

Staffed primarily by paraprofessionals who are trained to be empathic and to encourage suicidal callers—assumed to be ambivalent—to consider nondestructive ways of dealing with what is bothering them.

melancholic

Subtype of major depressive disorder in which the individual is unable to feel better even momentarily when something good happens, regularly feels worse in the morning and awakens early, and suffers a deepening of other symptoms of depression.

Suicide risk severity

Suicidal ideation, plans, or other risk indicators are present

Atypical features

Symptoms that are unusual for depressive or manic episodes are present

reward system

System of brain structures involved in the motivation to pursue rewards. Believed to be involved in depression, mania, schizophrenia, and substance use disorders.

cognitive biases

Tendencies to perceive events in a negative manner, for example, by attending to or remembering negative information more than positive information; hypothesized to be driven by underlying negative schemas.

rapid cycling

Term applied to bipolar disorders if the person has experienced at least four episodes within the past year.

Interpersonal Psychotherapy

The core of the therapy is to examine major interpersonal problems, such as role transitions, interpersonal conflicts, bereavement, and interpersonal isolation.

attribution

The explanation a person has for why an event or behavior has occurred.

suicide

The intentional taking of one's own life.

norepinephrine, dopamine, and serotonin

Three neurotransmitters that have been studied the most in terms of their possible role in mood disorders

reward sensitivity and sleep disruption

Two predictors of mania

Cognitive Therapy

aimed at altering maladaptive thought patterns

HPA axis (hypothalamic- pituitary-adrenocortical axis)

biological system that manages reactivity to stress, triggers the release of cortisol

Electroconvulsive Therapy (ECT)

entails deliberately inducing a momentary seizure and unconscious- ness by passing a 70- to 130-volt current through the patient's brain.

Dysfunctional Attitudes Scale (DAS)

self-report scale which includes items concerning whether people would consider themselves worthwhile or lovable

- amygdala - subgenual anterior cingulate - hippocampus - dorsolateral prefrontal cortex

four primary brain structures that have been most studied in depression

37 percent

heritability for MDD

Suicide attempts

involve behaviors that are intended to cause death but do not result in death

diathesis-stress models

models that consider both preexisting vulnerabilities (diatheses) and stressors

69.5 percent

percent of patients in families with high EE who relapsed within 1 year, compared to 30.5 percent of patient in families with low EE

protein kinase C

protein that has a major role in the function of receptors and cell membranes of neurons throughout the brain; its activity appears to be abnormally high among people with mania

behavioral activation

technique where people are encouraged to engage in pleasant activities that might bolster positive thoughts about one's self and life

Behavioral Activation (BA) Therapy

the goal of this therapy is to increase participation in positively reinforcing activities so as to disrupt the spiral of depression, withdrawal, and avoidance

cortisol

the main stress hormone, increases activity of the immune system to prepare for threats

Attributional Style Questionnaire (ASQ)

tool used in the first test of hopelessness theory

STAR-D (Sequenced Treatment Alternatives to Relieve Depression)

trial that examined antidepressant response among 3,671 patients across 41 sites, including 18 primary care facilities