Ch. 6 Quiz

Understanding & Defining Mood Disorders

(PG 201)......................................................................................... The fundamental experiences of depression and mania contribute, either signly or together, to all the mood disorders. - Mood Disorders: major depressive episode: One of a group of disorders involving severe and enduring disturbances in emotionality ranging from elation to severe depression.

Depressive Disorders

(pg 204)..............................

Hypomanic Episode

- A less severe version of a manic episode that does not cause marked impairment in social or occupational functioning and need only last 4 days rather than a full week. (Hypo means "below") - not super problematic if have one, but usually means there are several diff mood disorders present. - hypomanic episode Less severe and less disruptive version of a manic episode that is one of the criteria for several mood disorders.

Double Depression (205)

- Individuals have both major depressive episodes and dysthymic disorder. Typically, dysthymic disorder develops first, perhaps at an early age, and then one or more major depressive episodes occur later (Boland & Keller, 2009; Klein et al., 2006). Identifying this particular pattern is important because it is associated with severe psychopathology and a problematic future course (Boland & Keller, 2009; Klein et al., 2006). - For example, Keller, Lavori, Endicott, Coryell, and Klerman (1983) found that 61% of patients with double depression had not recovered from the underlying dysthymic disorder 2 years after follow-up. The investigators also found that patients who had recovered from the superimposed major depressive episode experienced high rates of relapse and occurence. --double depression: Severe mood disorder typified by major depressive episodes superimposed over a background of dysthymic disorder.

Prevalence in Children, Adolescents, and Older Adults

- The general conclusion is that depressive disorders occur less often in prepubertal children than in adults but rise dramatically in adoles- cence (Brent & Birmaher, 2009; Costelloello, Foley, & Angold, 2006; Garber & Carter, 2006; Garber et al., 2009; Rudolph, 2009). - children the sex ratio is 50:50 - adolescent sex ratio is largely female as well as adults - Sex imbalance is not evident for more mild depression -prevalance of disorder older than age 65 is about half that of the general population.(not as much) - polar disorder seems to occur at about the same rate (1%) in childhood and adolescence as in adults (Brent & Birmaher, 2009; Merikangas & Pato, 2009). However, the rates of diagnosis of bipolar disorder in clinics has in- creased substantially as a result of greater interest and a controversial tendency to broaden the diagnostic criteria in children to acc

Major Depressive Disorder, recurrent

- if two or more major depressive episodes occurred and were separated by at least 2 months of no depression. - 35-85% likely to experience it twice if have it once. - first year 20% changce have again - 40% in second year -unipolar depression is often chronic, waxes and wanes but never dissapears. -4:7 in large sample, 25% six more episodes -median durration of recurrent major depressive episodes is 4 ot 5 months. - If onset is earlier, will see these three characteristics: (1) greater chronicity (it lasts longer), (2) relatively poor prog- nosis (response to treatment), and (3) stronger likelihood of the disorder running in the family of the affected indi- vidual. These findings have been replicated (Akiskal & Cas- sano, 1997).

Bipolar Disorders (207)

- key identifying feature of bipolar disorders is the tendency of manic episodes to alternate with major depressive episodes in an unending roller-coaster ride from the peaks of elation to the depths of despair. - bipolar disorders are parallel in many ways to depressive disorders. Example, a manic episode might occur only once or repeatedly. - 1/3 cases of bipolar begin in adolescense, onset is minor mood swings ( PG 209)(onset and duration) - rare to develop after age 40 (210) -suicide attemps 12-48% 20X higher with this disorder -Example of Jane, mom with OCD son. - Bipolar II Disorder: major depressive episodes alternate with hypomanic episodes rather than full manic episodes. As we noted earlier, hypomanic episodes are less severe. Although she was noticeably "up," Jane functioned pretty well while in this mood state. CRITERIA: Bipolar II Disorder ❯ Presence (or history) of one or more major depressive episodes ❯ Presence (or history) of at least one hypomanic episode ❯ No history of a full manic episode or a mixed episode ❯ Mood symptoms are not better accounted for by schizoaffec- tive disorder or superimposed on another disorder such as schizophrenia ❯ Clinically significant distress or impairment of functioning -Average age of onset 15-18 - Bipolar I disorder are the same, except the individual experiences a full manic episode. As in the criteria set for depressive disorder, for the manic episodes to be considered separate, there must be a symptom- free period of at least 2 months between them. Otherwise, one episode is seen as a continuation of the last. -Average age of onset 19-22

Cyclothymic disorder

- milder but more chronic version of bipolar disorder. Similar in many ways to dysthymic disorder (Akiskal, 2009). Like dysthymic disorder, cyclothymic disorder is a chronic alternation of mood elevation and depression that does not reach the severity of manic or major depressive episodes. Individuals with cyclothymic disorder tend to be in one mood state or the other for years with relatively few periods of neutral (or euthymic) mood. - Pattern must last for at least 2 years to meet disorder criteria (1 for kids, youth) - Should be treated so dont develop bioplar I or II - CRITERIA: ❯ For at least 2 years, numerous periods with hypomanic symp- toms and numerous periods with depressive symptoms that do not meet the criteria for a major depressive episode ❯ Since onset, the person has not been without the symptoms for more than 2 months at a time ❯ No major depressive episode, manic episode, or mixed epi- sode has been present during the first 2 years of the disturbance ❯ Mood symptoms are not better accounted for by schizoaffec- tive disorder or superimposed on another disorder such as schizophrenia ❯ The symptoms are not caused by the physiological effects of a substance or a general medical condition ❯ Clinically significant distress or impairment of functioning -12-14 age of onset, female (210)

Life Span Developmental Influences on Mood Disorders (pg 212)

- no mood disorder really have a set developmental stage as mood disorders are similar in adults and children. - look of depression changes with age - Often conduct disorder and de- pression co-occur in bipolar disorder. In patients with bi- polar disorder, between 60% and 90% of children and ado- lescents also meet criteria for ADHD (Biederman et al., 2000; Singh, DelBello, Kowatch, & Strakowski, 2006; Youngstrom, 2009). Age-Based Influences on Older Aduldts - studies estimate that 14% to 42% of nursing home residents may experience major depressive episodes. - Late-onset depressions are associated with marked sleep difficulties, hypochondriasis (anxiety focused on possibly being sick or in- jured in some way), and agitation (Baldwin, 2009). - As many as 50% of patients with Alzheimer's disease suffer from comorbid depression. (213, more facts about old people) - depression doubles the risk of death in elderly pations who have suffered a heart at- tack or stroke (Schulz, Drayer, & Rollman, 2002). - Bruce (2002) confirmed that death of a spouse, caregiving burden for an ill spouse, and loss of independence because of medical illness are among the strongest risk factors for depression in this age group. cycle is deadly because suicide rates are higher in older adults than in any other age group (Conwell, Duberstein, & Caine, 2002), although rates have been decreasing lately (Blazer & Hybels, 2009). - childhood boys more depressed, youth girls, old age even Across Cultures: - feelings of weakness or tiredness characterize depression in some cultures - Hopi Native Americans cal it "heartbroken" - The lifetime prevalence for any mood dis- order was 19.4% in men, 36.7% in women, and 28% over- all, approximately 4 times higher than in the general popu- lation. Examined by disorder, almost all the increase is accounted for by greatly elevated rates of major depression.

Combinaion is called a dysphoric manic episode or a mixed manic episode.

- usually depression and manic are often relatively independent. - An individual can experience manic symptoms but feel depressed or anxious at the same time. - The patient usually experiences the symptoms of mania as being out of control or dangerous and becomes anxious or depressed about this uncontrollability. Research suggests that manic episodes are characterized by dysphoric (anxious or depressive) features more commonly than was thought - mixed manic episode or dysphoric manic episode Condition in which the individual experiences both elation and depression or anxiety at the same time. Also known as dysphoric manic episode

Major Depressive Disorder, Single Episode(204)

-defined by absence of manic & hypomainic episodes during the disorder. - one isolated depressive episode in a lifetime rare. --depressive disorder, single or recurrent episode Mood disorder involving one major depressive episode; mood disorder involv- ing multiple (separated by at least 2 months without depression) major depressive episodes. -Onset teens, mean age 30s (206) - most people get this after a loved one dies, not considered disorder unless lasts more than 6 months

Dysthymic Disorder (204-5)

-shares symptoms of major depressive disorder. - differs in course - milder ymptoms and unchanging symptoms over long periods of time (doesnt go away) - persistently depressed, continues at least 2 years. cant be sympotm free for more than 2 months at a time - 22% eventually experience major depressive episode - CRITERIA: ❯ Depressed mood for most of the day, on most days, for at least 2 years (or at least 1 year in children and adolescents) ❯ The presence, while depressed, of at least two of the follow- ing: poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, feelings of hopelessness ❯ During the 2 years or more of disturbance, the person has not been without the symptoms for more than 2 months at a time ❯ No major depressive episode has been present during this period ❯ No manic episode has occurred, and criteria have not been met for cyclothymic disorder ❯ The symptoms are not caused by the direct physiological ef- fects of a substance or a medical condition ❯ Clinically significant distress or impairment of functioning --dysthymic disorder Mood disorder involving persistently depressed mood, with low self-esteem, withdrawal, pessimism, or despair, present for at least 2 years, with no absence of symptoms for more than 2 months. - typical onset age before 21 -last 20-30, mean = 5 yrs adults, 4=children - more llikely to commit suicide than depressvie dis.

Causes of Mood Disorders ( PG 215)

BIOLOGICAL: - Family Genetics: look at the proband (imidiate family) if you have it 2 to 3 times family has it too. -Best eveidenc comes from twin studies. - 2 to 3 times more likely to have it if fraternal twin does - environmental roles plays bigger role in men than women. - if family member has bipolar disorder doesnt mean youll be bipolar but likely to inherit some mood disorder. -individuals with bipolar disorder are genetically suceptable to depression and mania. - genetic contributions for depression are about 40% for women and 20% for men. seem to be higher for biopolar. - 60-80% environmental influences. -Close relationship between depression, anxiety, and panic disorder. (pg 216) -Low levels of serotonin causes of mood disorders, but only in relation to other neurotransmitters, including norepinephrine and dopamine The Endocrine System: - HPA axis produces stress hormones. - diseases that effect this system usually end up w/depression - hypothalamus releases neurohormones - cortisol is a stress hormone 5 Biological sources can contribute to modd disorders: enetics, neurotransmitter system abnormalities, endocrine system, cir- cadian or sleep rhythms, neurohormones PSYCHOLOGICAL DIMENSIONS--(pg 218) -stress and trauma most striking and unique contributions to the etiology of all psychological disorders. - evident in the wide adoption of the diathesis-stress model of psychopathology: describes possible genetic and psychological vulnerabilities. -George W Browns way of studying life events - current moods distort memories - Scientists have confirmed that humiliation, loss, and social rejection are the most potent stressful life events likely to lead to depression (Monroe et al., 2009). - We referred to this as the reciprocal gene-environment model (219) - think that typically negative stressful life events trigger depression, but a somewhat different more positive set of stressful life events seems to trigger mania (Johnson et al., 2008). Experience associated with striving to achieve important goals, such as getting accepted into graduate school, obtaining a new job or pro- motion, or getting married, trigger mania in vulnerable individuals. - 20-50% of individuals that experience stressful life events develop mood disorders. -(pg220) Learned Helplessness Theory of Depression: Anxiety is the first response to a stressful situation. (1) internal, in that the individual attributes negative events to personal failings ("it is all my fault"); (2) stable, in that, even after a particular negative event passes, the attribu- tion that "additional bad things will always be my fault" remains; and (3) global, in that the attributions extend across a variety of issues. Martin Seligman -correlated with depression not a cause(220) - Arbitrary Inference and OVergeneralization. arbitrary inference:evident when depressed individual emphasizes the negative rather than the positive aspects of a situation. -Overgeneralization: example: when your professor makes one critical remark on your paper, you then assume you will fail the class despite a long string of positive comments and good grades on other papers. You are overgeneralizing from one small remark. -the depressive cognitive triad: According to Beck, people who are depressed think like this all the time. They make cognitive errors in thinking negatively about themselves, their immediate world, and their future, three areas that together are called the depressive cognitive triad -also explain everything negatively Psychological sources that have an impact on mood disorders: stressful life events, learned helplessness, depressive cognitive triad, a sense of uncontrollability SOCIAL and CULTURAL Factors that Contribute: -Marital Relations, -mood disorders in women: almost 70% are women that have major depressive and dysthymia -parenting styles (pg 223) -Social Support (pg 224) Also effect mood disorders: marital satisfaction, gender, social support

Treatment of Mood Disorders

MEDICATIONS: Antidepressants: - These come in three main types (tricyclics, MAO inhibitors, and SSRIs) and are often prescribed but have numerous side effects. Lithium - Mood stabilizing drug: A medication used in the treatment of mood disorders, particularly bipolar disorder, that is effective in preventing and treating pathological shifts in mood. (pg 229) This antidepressant must be carefully regulated to avoid illness but has the advantage of affecting manic episodes. Electroconvulsive Therapy and Transcranial Magnetic Stimulation (ECT) - When someone does not respond to medication (or in an extremely severe case), clinicians may consider a more dramatic treatment, electroconvulsive therapy (ECT), the most controversial treatment for psychological disorders after psychosurgery. Biological treatment for severe, chronic depression involving the application of electrical impulses through the brain to produce seizures. the reasons for its effectiveness are unknown. (pg 230) Psychological Treatments: - Cognitive Behavioral Therapy (CBT) (cognitive therapy) Treatment approach that involves identifying and altering negative thinking styles related to psychological disorders such as depresson and anxiety and replacing them with more positive beliefs and attitues- and ultimately, more adaptive behavior and coping styles. (231) This teaches clients to carefully examine their thought process and recognize "depressive" styles in thinking. - Interpersonal Psychotherapy (IPT) Brief treatment approach that emphasizes resolution of interpersonal problems and stressors, such as role disputes in marital conflict, forming relationships in marriage, or a new job. It has demonstrated effectiveness for such problems as depression. (pg 232) This therapy focuses on resolving problems in ex- isting relationships and learning to form new in- terpersonal relationships. - Prevention: COMBINED TREATMENTS: - (pg 233) PREVENTING RELAPSE: - Maintenance Treatment: Combination of continued psychosocial treatment, medication, or both designed to prevent relapse following therapy. (pg 233) This is an effort to prevent relapse or recurrence over the long run. Psychologica Treatments for Bipolar Disorders: (pg234)

Major Depressive Episode

Major Depressive Episode: most severe depression & commonly diagnosed. Depression Disorder Criteria: ❯ Depressed mood for most of the day (or irritable mood in chil- dren or adolescents) ❯ Markedly diminished interest or pleasure in most daily activities ❯ Significant weight loss when not dieting or weight gain, or sig- nificant decrease or increase in appetite ❯ Ongoing insomnia or hypersomnia ❯ Psychomotor agitation or retardation ❯ Fatigue or loss of energy ❯ Feelings of worthlessness or excessive guilt ❯ Diminished ability to think or concentrate ❯ Recurrent thoughts of death, suicide ideation, or suicide attempt ❯ Clinically significant distress or impairment ❯ Not associated with bereavement ❯ Persistence for longer than 2 months -lack of energy and inability to engage in pleasurable activities or have any "fun", is more characteristic of these severe episodes of depression than are, for example, reports of sadness or distress or the tendency to cry, which occurs equally in depressed and nondepressed indi- viduals (mostly women in both cases) - major depressive episode Most common and severe experience of depression, including feelings of worthlessness, disturbances in bodily activities such as sleep, loss of interest, and inability to experience plea- sure, persisting at least 2 weeks.

pathological or impacted grief reaction (207)

Many of the psychological and social factors related to mood disorders in general, including a history of past depressive episodes (Horowitz et al., 1997; Jacobs et al., 1989), also predict the development of a typical grief response into a pathological or impacted grief reaction, although this reaction can develop without a preexisting depressed state (Bonanno, Wortman, & Nesse, 2004). In children and young adults, the sudden loss of a parent makes them particularly vulnerable to severe depression beyond the normal time for grieving, suggesting the need for immediate intervention (Brent, Melhem, Donohoe, & Walker, 2009). Particularly prominent symptoms include intrusive memories and distressingly strong yearnings for the loved one and avoiding people or places that are reminders of the loved one (Horowitz et al., 1997; Lichtenthal, Cruess, & Prigerson, 2004; Shear, 2006). -Although a recent analysis suggests that the similarities to major depression outweigh the differ- ences (Kendler et al., 2008), brain-imaging studies show certain parts of brain active in this diagnosis -therapy for em is reliving it and incorporating positivte thoughts and helping them realize they can get through the pain and life.

Prevalence of Mood Disorders

Pg 211................................................................................................................

Suicide

STATISTICS: - 11th leading cause of death in the US, could be higher - males 4X more likely to commut suicide than females - mostly white people - Suicidal ideation Serious thoughts about committing suicide. - Suicidal plans: The formulation of a specific method of killing oneself. - Suicidal attempts Effort made to kill oneself. CAUSES: (pg 238) - formalized suicides: approved of, such as ancient custom of harakiri. refered to as altruistic suicide. Ex: woman in africa, traditional, she kills herself for mistakes - loss of social supports egoistic suicide. woman in nursing home all family eventually stops seeing her and her friends die. - fatalistic suidices result from a loss of control over ones own destiny. ex: mass suicide, prisoner of war -anomic: a conflict with the new station owners, he was re- cently fired. If Ralph kills himself, his suicide is anomic. RISK FACTORS: - Psychological Autopsy Postmortem psychological profile of a suicide victim constructed from interviews with people who knew the person before death - Family History: if family members have done it your are more likely too - Neurobiology: low levels of serotonin may be associated with suicide and with violoent suicide attempts. impulsivity, instability, tendency to overreact to situations. - Psychological Disorders and Other Psychological Risk Factors: - 60% suicides associated with mood disorder - addiction contributes - Stressful Life Events - evidence confirsms that the likligood of suicide increases with stress and disruptino of natural disasters IS SUICIDE CONTAGIOUS - suicide is romanticised TREATMENT: - limit access to leathal weapons - hotline - screenings

Mania

Second fundamental state in mood disorders is abnormally exaggerated elation, joy, or euphoria. Find extreme pleasure in every activity; some patients compare their daily experience of mania to a con- tinuous sexual orgasm. They become extraordinarily active (hyperactive), require little sleep, and may develop grandiose plans with the belief that they can accomplish anything they desire. -flight of ideas :when manians try to express too many exciting things at once - mania Period of abnormally excessive elation or euphoria associated with some mood disorders. - Manic Episode Cirteria: ❯ A distinct period of abnormally and persistently elevated, ex- pansive, or irritable mood lasting at least 1 week ❯ Significant degree of at least three of the following: inflated self-esteem, decreased need for sleep, excessive talkative- ness, flight of ideas or sense that thoughts are racing, easy distractibility, increase in goal-directed activity or psychomotor agitation, excessive involvement in pleasurable but risky behaviors ❯ Mood disturbance is severe enough to cause impairment in normal functioning or requires hospitalization, or there are psychotic features ❯ Symptoms are not caused by the direct physiological effects of a substance or a general medical condition