abnormal psych ch 6 test 2

Selective serotonergic reuptake inhibitors

(SSRIs) specifically block the pre-synaptic reuptake of serotonin, thus increasing levels of serotonin at the receptor site. Fluoxetine (Prozac) is the most popular SSRI.

hypomanic

(hypo means below) episode is a less severe version of a manic episode that does not cause marked impairment in social or occupational functioning.

Lithium (lithium carbonate)

1. A common salt found in the natural environment, including drinking water. 2. Lithium is the primary drug of choice in the treatment of bipolar disorder.

In the elderly

1. As many as 18% to 20% of elderly nursing home residents may experience major depressive episodes, which are likely to be chronic. 2. Late-onset depression is associated with marked sleep problems, hypochondriasis, and agitation. 3. It is difficult to diagnose depression in the elderly due to medical illnesses and symptoms of dementia. 4. Generally, the prevalence of major depressive disorder for individuals over age 65 is about half that of the general population. 5. Anxiety disorders often accompany depression in about one third of the elderly population. 6. The gender imbalance in depression disappears after age 65.

Cognitive vulnerability for depression: An integration

1. Considerable evidence suggests that depression is always associated with pessimistic explanatory style and negative cognitions. 2. Evidence also suggests that cognitive vulnerabilities predispose some people to view events negatively and puts them at risk for depression. 3. Research supports that negative cognitive styles do indicate a later vulnerability to depression.

An integrative theory

1. Depression and anxiety may share common biological/genetic vulnerabilities, such as an overactive neurobiological response to stressful life events. 2. The onset of stressful life events may then activate stress hormones that affect certain neurotransmitter systems, including turning on certain genes. Extended stress may also affect circadian rhythms and activate a dormant psychological vulnerability characterized by negative thinking and a sense of helplessness and hopelessness. 3. In addition, psychological vulnerabilities such as feelings of uncontrollability may be triggered. All of this is dependent, however, on mediating environmental factors such as interpersonal relationships.

B. Brain wave activity

1. Different electroencephalogram (EEG) values have been reported in the two hemispheres of brains of depressed persons. Depressed persons show greater right-side anterior activation of the cerebral hemispheres (i.e., left-side activation) than nondepressed persons. This type of brain function may be an indicator of a biological vulnerability for depression.

Bipolar disorders

1. The core identifying feature of bipolar disorders is the tendency of manic episodes to alternate with major depressive episodes. Beyond that, bipolar disorders parallel depressive disorders (e.g., a manic episode can occur once or repeatedly.

Electroconvulsive therapy (ECT)

1. This is the treatment of choice for very severe depression. a. The patient is anesthetized and is given muscle-relaxing drugs to prevent bone breakage from convulsions during seizures and is then administered a brief (less than 1 second) electric shock introduced to the brain. The result is brief convulsions lasting for several minutes. 2. Treatments are usually administered once every other day for a total of 6 to 10 treatments. ECT may increase the level of serotonin. Block stress hormones, and promotes hippocampal neurogenesis.

dysphoric manic or mixed episode.

2. Feeling depression and manic at the same time

rapid eye movement sleep (REM

Depressed persons move into the period of rapid eye movement sleep (REM) more quickly than nondepressed persons and also show diminished slow wave sleep (i.e., the deepest and most restful part of sleep). This REM effect is reduced for persons who have depression related to recent life stress.

depressive cognitive triad

According to Beck, persons with depression make such cognitive errors all the time, as represented in thinking negatively about themselves, their immediate world, and their future

Prevalence of Mood Disorders

Approximately 20% the population experiences some type of mood disorder during their lifetime, 1. Females are twice as likely to have a mood disorder compared to males. The imbalance between males and females is accounted for solely by major depressive disorder and dysthymia. (rates pre-pubertally and post menopausal more equal) a. Bipolar disorders are distributed equally between males and females. 3. Native Americans have a significantly higher prevalence of depression, but this finding may be the results of difficulty in translating the concept of depression to Native American cultures. 4. DON"T See Table 6.1 on page 217 in text for the prevalence of affective disorders. Unipolar: MDD 17% Dysthymia 3%; All BP combined 3% (BP I est ~ 1%, BP II .5-1% Cyclothymia .5- 1%)

examples of cognitive errors

Arbitrary inference Overgeneralization depressive cognitive triad negative schema

mood disorders

Experiences of depression and mania, either singly or together, contribute to disorders characterized by gross deviations in mood called

2. Mood disorders in women

Gender imbalances occur across the mood disorders (with the exception of bipolar disorder) and this is a worldwide phenomenon.

Interpersonal therapy (IPT)

Like cognitive-behavioral approaches, IPT is highly structured and seldom takes longer than 15 to 20 weekly sessions. b. The therapist and client identify life stressors that precipitate depression, and then address interpersonal role disputes, adjustments to losing a relationship, acquisition of new relationships, and identifying and correcting deficits in social skills.

rapid switching or rapid mood switching

May patients cycle between mania and depression without a break this is referred to

3. Neurotransmitter systems

Research indicates low levels of serotonin in the etiology of mood disorders but only in relation to other neurotransmitters, including norepinephrine and dopamine. b. One of the functions of serotonin is to regulate systems involving norepinephrine and dopamine.

D. Across cultures

Somatic symptoms of depression are roughly equivalent across cultures, but it is difficult to compare subjective feelings. a. Societies that are more individualistic tend to produce depressive statements with the "I" pronoun, whereas societies that are more integrated focus on "our" statements. b. Still, the prevalence of depression seems to be similar across subcultures, although more so in economically depressed areas.

Among the creative

Speculation has been made as to whether mood disorders and creativity are related, possibly genetically. The correlation between famous writers and bipolar disorder is one example.

F. The overlap of anxiety and depression

Substantial overlap exists between the emotional states of anxiety and depression. 2. Most persons with depression do display anxiety symptoms, but not all anxious patients are depressed. a. Symptoms of anxiety and panic are similar to symptoms of depression and bipolar disorder. This sometimes called agitated depression. 3. Symptoms common to anxiety and depressive disorders are referred to as negative affect. a. We may need to rethink our diagnostic criteria and combine anxiety and mood disorders into one larger category suggesting that these symptoms are on a continuum with major depression and anxiety disorders.

negative affect.

Symptoms common to anxiety and depressive disorders

agitated depression

Symptoms of anxiety and panic are similar to symptoms of depression and bipolar disorder.

4. The endocrine system

The "stress hypothesis" of the etiology of depression has implicated the endocrine system and the overreactivity in the hypothalamic-pituitary-adrenocortical (HPA) axis, particularly elevated levels of cortisol. b. New research findings indicate that elevated levels of stress hormones in the long term may interfere with the production of new neurons (i.e., neurogenesis), especially in the hippocampus, which may result in disrupted memory processes. c. Successful treatments for depression, including ECT, seem to produce neurogensis in the hippocampus.

Venlaxfaxine

a newer antidepressant, is related to tricyclics but acts in a different manner reducing some of the associated side effects as well as risk of cardiovascular damage.

Cognitive-behavioral therapy

a. Aaron Beck's cognitive therapy involves teaching clients to examine the types of thinking processes they engage in while depressed and recognize cognitive errors when they occur. b. Clients are informed about how these processes lead to depression and faulty thinking patterns are modified. c. Clients also monitor and record their thoughts between therapy sessions and are assigned homework to change their behavior. c. Increased behavioral activity to elicit social reinforcement is also mandated. d. Treatment usually takes 10 to 12 sessions. The textbook illustrates Beck's cognitive therapy with a dialogue between Beck and a patient named Irene. e. Research has shown that increased activities alone can improve self-concept and lift depression. f. Programmed exercise over the course of weeks and months is effective.

In dysthymic disorder if onset is before age 21 it is associated with three characteristics:

a. greater chronicity (lasts longer) b. relatively poor prognosis c. stronger likelihood of disorder running in family

DSM-IV-TR criteria for major depressive episode includes:

a. Extremely depressed mood state lasting at least 2 weeks. b. Cognitive symptoms (e.g., feeling worthless, indecisiveness). c. Disturbed physical functions (e.g., altered sleep patterns, changes in appetite/weight, loss of energy), often referred to as somatic or vegetative symptoms. Such symptoms are central to this disorder. d. Anhedonia, or the loss of interest or pleasure in usual activities. e. Average duration of an untreated major depressive episode is 6 months.

1. Marital relations

a. Marital dissatisfaction and depression are strongly related, and marital disruption often precedes depression. b. This seems particularly true for men. c. In addition, high marital conflict and/or low marital support are important in the etiology and recurrence of depression. d. Conversely, continuing depression may lead to the deterioration of a marital relationship

three stages to a dispute

a. Negotiation stage where both are trying to renegotiate the dispute. b. Impasse stage where the dispute smolders, resentment builds and there is not attempt at resolution. c. Resolution stage where action is taken

3. Social support

a. The number and frequency of social relationships and contact may be related to depression. b. A lack of social support appears to predict the later onset of depressive symptoms, and high expressed emotion or dysfunctional families may predict relapse. c. Conversely, substantial social support is related to rapid recovery from depression.

There are three types of programs to prevent mood disorders in children and adolescents.

a. Universal programs which are applied to everyone b. Selected interventions which target at-risk individuals for depression; e.g., instilling of social and problem-solving skills in children c. Indicated interventions where individuals are already showing mild symptoms of depression

Rapid cycling specifier

applies only to bipolar I and II disorders.

Seasonal pattern specifier

applies to bipolar disorders and recurrent major depression, and is used to indicate whether episodes occur during certain seasons, usually wintertime. Those with winter depression display excessive sleep and weight gain

Sleep disturbances

are a hallmark of most mood disorders.

Longitudinal course specifiers

are used to address whether a person has had a past episode of depression or mania and whether the person recovered fully from past episodes. a. For example, one should determine whether dysthymia preceded a major depressive episode or whether cyclothymic disorder preceded bipolar disorder. Both scenarios tend to decrease chances of recovery and increase length of treatment

Tricyclic antidepressants

are widely used treatments for depression, and include imipramine (Tofranil) and amitriptyline (Elavil). It is not yet clear how these drugs work, but initially at least they block the reuptake of norepinephrine and other neurotransmitters (i.e., down-regulation). This process may take anywhere between 2 to 8 weeks, and patients often feel worse and develop side effects before feeling better.

1. Major depressive disorder, single episode

by the absence of manic or hypomanic episodes before or during the episode. The occurrence of one isolated depressive episode in a lifetime is not typical given that 60 -75% will go on to have at least a second episode

learned helplessness theory of depression

people develop depression and anxiety when they assume they have no control over life stress.

DSM-IV-TR criteria for a manic episode includes:

i. A duration of 1 week; less if the episode is severe enough to require hospitalization. ii. Irritability often accompanies the manic episode toward the end of its duration. iii. Anxiousness and depression are often part of a manic episode. iv. Average duration of an untreated manic episode is 3-6 months.

depressive attributional style

i. First, the attribution is internal in that one believes negative events are one's fault. ii. Second, the attribution is stable in that one believes that future negative events will be one's fault. iii. Third, the attribution is global in that the person believes negative events will influence many life activities.

Several theories have arisen to explain why females display more anxiety and depressive disorders than males:

i. Part of this may be due to perceptions of uncontrollability. Such perceptions are strongly influenced by socialization, where females are expected to be passive and sensitive to others. ii. In addition, females may place more emphasis on intimate relationships and be more disturbed by problems in this area than males. iii. Females may also be self-deprecating in times of stress. iv. Finally, females are subjected to more discrimination, poverty, sexual harassment, and abuse than males.

Family studies

indicate that the rate of mood disorders in relatives of probands (i.e., the person known to have the disorder) with mood disorders is generally two to three times greater than the rate in relatives of normal probands. The most frequent mood disorder in relatives of persons suffering from mood disorders is unipolar depression.

5. Cyclothymic disorder

is a more chronic version of bipolar disorder where manic and major depressive episodes are less severe. a. Such persons tend to remain in either a manic or depressive mood state for several years with very few periods of neutral (or euthymic) mood. b. For the diagnosis, the pattern must last for at least 2 years (1 year for children and adolescents). c. Such persons are also at increased risk for developing Bipolar I or II disorder.

Transcranial magnetic stimulation (TMS)

is a new procedure that is related to ECT, but involves setting up a strong magnetic field around the brain.

3. Bipolar I disorder

is the alternation of full manic episodes and depressive episodes. a. Individual experiences a full manic episode along with a full depressive episode.

Major depressive episode

is the most commonly diagnosed and most severe form of depression. The textbook illustrates clinical depression with the case of Katie

Rapid cycling pattern

is used when a person has at least 4 manic or depressive episodes within a period of 1 year. Rapid cycling is a more severe form of bipolar disorder that does not respond well to treatment, and appears to be associated with higher rates of suicide

bipolar II disorder

major depressive episodes alternate with hypomanic episodes which are less severe.

Seasonal affective disorder

may be related to circadian and seasonal changes in the increased production of melatonin (i.e., a hormone secreted by the pineal gland). Phototherapy is a recommended effective treatment for this condition.

negative schema,

or an automatic and enduring cognitive bias about aspects of life. Substantial empirical evidence supports this theory, although it has been difficult to establish the existence of negative schemas prior to major depressive episodes.

d. Anhedonia

or the loss of interest or pleasure in usual activities.

3. Dysthymic disorder now Persistent Depressive Dx in DSM 5

persistently depressed mood that continues for at least 2 years. During this time, the person cannot be symptom free for more than 2 months at a time. Many eventually experience a major depressive episode at some point.

Mania

refers to abnormally exaggerated elation, joy, or euphoria.

1. Bipolar disorder

refers to alternations between depression and mania.

Double depression

refers to both major depressive episodes and dysthymic disorder.

Arbitrary inference

refers to the tendency of depressed persons to emphasize the negative rather than positive aspects of a situation.

Overgeneralization

refers to the tendency to take one negative consequence of some event and generalize to all related aspects of the situation.

2. Major depressive disorder, recurrent

requires that two or more major depressive episodes occur and are separated by a period of at least 2 months during which the individual is not depressed.

Twin studies

reveal that if one identical twin presents with a mood disorder, the other twin is 3 times more likely than a fraternal twin to have a mood disorder, particularly for bipolar disorder. Severe mood disorders may have a stronger genetic contribution than less severe disorders.

permissive hypothesis

suggests that when serotonin levels are low, other neurotransmitters are permitted to range more widely, become dysregulated, and contribute to mood irregularities.

Monoamine oxidase (MAO) inhibitors

work by blocking an enzyme monoamine oxidase that breaks down serotonin and norepinephrine. MAO inhibitors are slightly more effective than tricyclics and have fewer side effects. However, ingestion of tyramine foods (e.g., cheese, red wine, beer) or cold medications with the drug can lead to severe hypertensive episodes and occasionally death.