Chapter 5

Depressed: difficulty making decisions, difficulty focusing, slowed thinking, easily distracted. -Guilt and worthlessness(blame themselves for things that have gone wrong, regardless of whether they are in fact responsible. Focus on negative features of themselves, environments, and futures- a comibation known as the "depressive triad) -self destructive ideas, interest in suicide starts gradual and begins with vague sense that life is not worth living. This might come from fatigue and loss of pleasure -feelings of guilt and failure can lead to consider killing themselves. -Preoccupation of being better off dead leads to specific plans and may culminate in a suicide attempt Manic: thoughts are speeded up, ideas flash though their minds, easily distractedm inflated self-esteem and grandiosity

Cognitive symptoms

Based on the assumption that depression will be relieved if these maladaptive schemas are changes, cognitive therapists focus on helping their patients replace self defeating thoughts with more rational self statements

Cognitive therapy for depression

-It will turn normal grief into a form of illness, expanding even farther the boundaries of mental disorders (pro change). The people can show symptoms of depression like sleep problems, loss of interest, trouble concentrating. But some people do develop an episode of depression following a loss and treatment becomes an option for them -BE was developed in order to distinguish between these cases and those for whom symptoms are temporary . Purpose was to minimize the number of false positives (normally grieving people who would have been assigned a diagnosis of depression) - (anti change) It could delay access to much needed treatment. BE is arbitrary and illogical. Why don't all hardships have a 2 month wait?

Controversy of bereavement exclusion

Person must experience several periods of time with hypomanic symptoms and frequent periods of depression during a period of 2 years. No history of major depressive episodes and no clear evidence of a manic episode during first 2 years.

Criteria for cyclothymia

A person must experience at least one major depressive episode in the absence of any history of manic episodes.

Criteria for major depressive disorder

Allow clinicians to describe further the pattern and sequence of episodes as well as the persons adjustment between episodes. ex: the course of bipolar disorder can be specified as rapid cycling if the person experiences at least four episodes of major depression, mania, or hypomania within a 12 month period. Patients are likely to show poor response to treatment and are at greater risk than other types of bipolar patients to attempt suicide

DSM5 course specifiers for mood disorders

Mood disorders

Defined in terms of episodes-discrete periods of time in which the person's behavior is dominated by either a depressed or manic mood. Unfortunately, most people with a mood disorder experience more than one episode

behavioral symptoms

Depression: most obvious symptom is slowed movement. walk and talk in slow motion. Others may become completely immobile and may stop speaking altogether. some pause for extended period before answering questions. Manic: gregarious and energetic. Flirtatious, provocative, can't sit still, everything is interested, easily distracted , full of plans. Excessive pursuit of life goals is frequently associated with the onset of manic episodes.

monoamine oxidase inhibitors

Develop high blood pressure, not as effective as tricuclics.

Duration and severity. The symptoms need to be present for a minimum of only four days to meet the threshold for a hypomanic episode. The mood change in a hypomanic episode must be noticeable to others, but the disturbance must not be severe enough to impair social or occupational functioning or to require hospialization

Difference between manic and hypomanic episodes

distracting style

Divert themselves from their unpleasant mood

"The Noonday Demon" by Andrew Solomon

Documents his own struggle with depresion

People who are grieving will now be exposed to unnecessary treatments including antidepressent medication. Some fear bereavement will be stigmatized BUT most grieving people do not meet diagnostic criteria for major depression.

Elimination of the grief exclusion problems

Severely depressed mood

Feeling is overwhelming, suffocating, or numbing

casual attributions

Following a negative life event, the probability that the person will become depressed is a function of the explanations and importance that the person ascribes to these events

hypothalamic pituitary adrenal axis

Important pathway in the endocrine system that may be closely related to the etiology of mood disorder

1. Lose the feeling of pleasure associated with most activities 2. lose the capacity to feel better when something good happens The person must also exhibit at least three of the following: 1. The depressed mood feels distinctly different from the depression a person would feel after the death of a loved one 2. the depression is most often worst in the morning 3. the person awakens early at least 2 hours before usual 4. marked psychomotor retardation or agitation 5. significant loss of appetite or weight loss 6. excessive or inappropriate guilt

In order to meet the DSM5 criteria for melancholic features, a depressed patient must either:

Compare 2 groups: 1. those who meet criteria for major depression and are not bereaved and 2. those who meet criteria for major depression and are bereaved( who would usually be excluded from diagnosis using BE) No differences found, so depression following the loss of a loved one if not different from other depression, so it is illogical to divide cases on this basis.

Is depression caused by loss of a partner or relative different from other forms of depression?

euphoria

Manic patients experience periods of inexplicable and unbound joy known as ______. Feeling extremely optimistic and cheerful. Period of elated mood tend to alternate with phases of depression

true

Many depressed and manic people are irritable. Even during the manic episode people are easily provoked to anger and become argumentative and abusive. Anxiety is also common among people with mood disorders

Describes a particularly severe type of depression. Represents a subtype of depression that is caused by different factors than those that are responsible for other forms of depression. May also indicate that the person is likely to have a good response to biological forms of treatment, such as antidepressant meds and ECT

Melancholia

selective serotinin reuptake inhibitors

Most used antidepressent. fewer side effects and less dangerous.(sexual dysfunction)

ruminative responses

People who engage in _______ have longer and more severe episodes of depression than do people who engage in distracting responses

in their early thirties, the avg age of onset in 32.

People with depressive mood disorders typically have their first episode __________-

Major depression in terms of both severity and durations. Represents a chronic mild depressive condition that had been present for many years. The person must exhibit a depressed mood for most of the day on more days than not and 2 symptoms that must not be absent for more than 2 months at a time during a 2 year period. If the person met criteria for a major depressive episode, the diagnosis would be major depression instead.

Persistent depressive disorder (dysthymia)

New DSM5 category. Used to be in "disorders provided for further study" category. Women commonly experience premenstrual symptoms that center around emotional and physical complaints but are typically mild. A few experience these symptoms in greater number and greater intensity to the extent that they are associate with obvious social and occupational impairment. Defined in terms of various mood-related symptoms that occur repeatedly during the premenstrual phase of the cycle and are then diminished at the onset or shortly after menses.

Premenstrual dysphoric disorder

Somatic symptoms

Related to basic physiological or bodily functions including fatigue, aches, pains, and serious changes in appetites and sleep patterns Depressed: feel tired, simple tasks require overwhelming effort, not being able to fall asleep, stay asleep, and early morning waking. Feel exhausted when they cant sleep. A less common symptom is for a depressed individual to spend more time sleeping than usual. A change in appetite (most reduce the amount of food they eat and lose weight), lose interest in pleasure activities like sex. Less likely to initiate sex and less likely to enjoy it. Manic: drastic reduction in the need for sleep (one of the earliest signs of onset of an episode), bursting with energy in spite of lack of sleep -Headaches, muscular aches, may develop into a preoccupation with bodily function and fear of disease

ruminative style

Respond to feelings of depression by turning their attention inward, contemplating the causes and implications of their sadness

relapse

Return of active symptoms in a person who has recovered from a previous episode.

somatic symptoms such as overeating, carbohydrate craving, weight gain, fatigue, and sleeping more than usual. Most patients with seasonal affective disorder have a depressive disorder

Seasonal depression is characterized by_______

psychomotor retardation

Several feature of behavior that may accompany the onset of serious depression

Depressogenic attributional style

That pattern that some people tend to explain negative events in terms of internal, stable, global factores.

2 primary types of mood disorders

1. depressive disorders 2. bipolar disorder

interpersonal and social rhythm therapy

(for bipolar) based on the recognition that a repeated episode of either mania or depression is often precipitated by one of the following factore: stressful life events, disruptions in social rhythms, and failure to take medications. Combined with medication. Regulation of sleep and work patterns.

Emotional SymptomsL

-We all experience negative emotions for a few moments that are are useful in our relationships -Depression symptoms: dysphoric -Manic symptoms: euphoria

1. major depressive disorder 2. persistent depressive disorder (dysthymia) 3. premenstrual dysphoric disorder 4. disruptive mood dysregulation disorder added to DSM5 (describes children with chronic, severe irritability)

3 main types of depressive disorders

antidepressant medications

4 categories: selective serotonin reuptake inhibitors, tricuclic antidepressants, monoamin oxidase inhibitors, and others. Improvement evident in 4-6 weeks.

bipolar 2 disorder

A person who has experienced at least one major depressive episode, at least one hypomanic episode, and no full blown manic episodes

bipolar disorder 1

A person who has experienced at least one manic episode

Mood

A pervasive and sustained emotional response that, in in its extreme form, can color the persons perception of the world. 2 specific moods depression and elation

emotion

A state of arousal that is defined by subjective states of feelings, such as sadness, anger, and disgust. Often accompanied by physiological changes, such as changes in heart rate and respiration rate

True

Alcoholism and depression are closely related phonemena. Many who are depressed also drink heavily and many people who are depend on alcohol have experienced major depression at some point. Onset order varies

manic or hypomanic episodes, the mood disturbance must be severe enough to interfere with occupational or social functioning.

All three types of bipolar disorders involve _____

clinical depression

Also called the syndrom of depression. A depressed mood is accompanied by several other symptoms, such as fatigue, loss of energy, difficulty in sleeping, and changes in appetite.

psychotherapy

Although medication is the most important method of treatment for bipolar disorders, _____ can be an effective supplement to biological intervention

Lithium carbonate

An effective form of bipolar treatment in the alleviation of manic episodes and remains first choice for treating bipolar disorders.

hopelessness

A view of cognitive vulnerability of depression that refers to the persons negative expectations about future events and the associated beliefe that these events cannt be controlled

cognitive perspective

According to the _______, pervasive and persistent negative thoughts about the self and pesimistic views of the environment play a central role in the onset and subsequent maintenance of depression after these thoughts are activated by the experience of a negative life event.

True

After recovery from an episode of major depression, the risk of relapse goes down as the period of remission increases

cyclothymia

Chronic but less severe form of bipolar disorder. The bipolar disorder equivelent of persistent depressive disorder.

If someone had at least one episode of major depression and never had a manic episode

Classified as a depressive disorder

1. more specific descriptions of symptoms that were present during the most recent episode of depression (episode specificers) 2. More extensive descriptions of the pattern that the disorder follows over time (course specifers) Studies suggest a patients subtype diagnosis is likely to change over repeated episodes.

DSM includes several additional ways of describing subtypes of mood disorders based on these 2 considerations

clinical syndrome

Depression can refer either to a mood, or to a __________, a combination of emotional, cognitive, and behavioral symptoms

hypomania

Episodes of increased energy that are not sufficiently severe to qualify as full blown mania

1. Emotional 2. cognitive 3. somatic 4. behavioral

Episodes of major depression and mania typically involve all four kinds of symptoms:

analogue studies

Focus on behaviors that resemble mental disorders. or isolated features of mental disorders, that appear in the natural environment

interpersonal therapy

Focused on current relationships, especially those involving family.

Depression

If one measure disability in terms of years lived with severe impairments, major _____ is the leading cause of disability. It accounts for almost 10 percent of all disability

Depressed mood

Include disapointment and dispair

true

Many people with mood disorders suffer from some clinical problems that are not typically considered symptoms of depression. The greatest overlap in comorbidity is anxiety disorders. Amond people who meet the diagnostic criteria for major depression at some point during their lives, 60% also qualify for a diagnosis for at least one anxiety disorder

clinically depressed

People who are ______, note that their thinking is slowed down, that they have trouble concentrating (unable to work and can't make simple decisions, and that they are easily distracted.

dexaketuasone suppression test

Study endocrine dysfunction in patients with mood disorders

maladaptive schemas

The cognitive approach which are general patterns of thought that guide the ways in which people percieve and interpret events in their environment.

bipolar disorder

The person experiences episodes of mania as well as depression.

manic-depressive disorder

Years ago, bipolar disorder was known as ___________. Although this term has been replaced in the official diagnostic manual, some clinicians still prefer to use it because it offers a more direct description of their patients experience.

Dysphoric

depressed, or ______(unpleasant) mood is the most common and obvious symptom of depression. Most people that are depressed feel gloomy, dejected, or despondent

tryclics antidepressants

more side effects. blocks uptake of neurotransmitters from synapse. improvements evident in 2-3 weeks.

Mania

The flip side of depression that involves disturbance in mood that is accompanied by additional symptoms

intermittent. Most patients have more than one episode and bipolar patients tend to have more episodes than depressive patients.

The long term course of bipolar disorders is most often ______

2 weeks, but they can last much longer. Most depressive patients will have at least 2 depressive episodes. The mean lifetime episode is 5 or 6. Length of episodes vary.

The minimum duration of depressive episodes

life events and circumstances

The onset of depression is most often triggered by _______

Affect

The pattern of observable behaviors, such as facial expression, that are associate with these subjective feelings. People also express affect through the pitch of their voices and with their hand and body movements.

depressive disorders

The person experiences only episodes of depression

Sadness

The price that pay for attachments to other people

true

The psychotic features can be either consistent or inconsistent with the patients mood. Depressed patients who exhibit psychotic feature are more likely to require hospitalization and treatment with a combination of antidepressant and antipsychotic medication

That major depressive disorders is frequently a chronic and recurrent condition in which episodes of severe symptoms may alternate with periods of full or partial recovery.

The result of long-term follow up studies of treated patients indicate what

1. Tendency to assign global, personal meaning to experiences of failure. 2. Tendency to overgeneralize conclusions about the self based on negative experiences 3. Drawing arbitrary inferences about the self in the absence of supporting evidence 4. Tendency to recall selectively events with negative consequences and to exaggerate the importance of negative events while simultaneously discounting the significance of positive event

The various types of distortions, errors, and biases are characteristic of the thinking of depressed people

Left to discretion of mental health proffesionals to decide based on own judgement and experience. Treatment remains an option that should be pursued by joint agreement of therapist and patient.

To initiate some form of treatment for a person who qualifies for major depression?

remission

When a persons symptoms are diminished or improved, the disorder is considered to be in _________, or a period of recovery

After a person goes through a negative life event Exception: People who had recently experienced the death of a close friend could not qualify for a diagnosis of depression until 2 months after the loss (bereavement exclusion) Very controversial!

When does depression often begin?

clinical depression

When sadness reaches higher levels of intensity and begins to interfere with a persons ability to function and enjoy life

distracting style

Women are more likely to employ a ruminative style in response to depression, whereas men are more likely to employ a _____

mania

______ often appear after a person has already experienced at least one episode of depression. People who are manic typically have terrible judgment and may get into trouble. The central feature is a persistently elevated or irritable mood that lasts for at least one week

euphoria

also known as elated mood, is the opposite emotional state from a depressed mood. Characterized by an exaggerated feeling of physical and emotional well-being.

behavioral symptoms

constant pacing and fidgeting or extreme inactivity

episodes of depression

defined by the same symptoms, regardless of whether the persons disorder is depressive or bipolar in nature. A small number of patients have only manic episodes with no evidence of depression; they are included in the bipolar category.

stress generation

depressed people create difficult circumstances that increase the level of stress in their lives.

1. Allows the clinician to describe a major depressive episode as having melancholic features 2. Allows the clinician to indicate the presence of psychotic features during the most recent episode of depression or mania 3. Applies to women who become depressed or manic following pregnancy

episode specifiers

severe events

events that are particularly threatening and have long term consequences for the womans adjustment---increase the probability that a woman will become depressed

cognitive symptoms

extreme guilt, feelings of worthlessness, concentration problems, and thoughts of suicide

Manic symptoms that frequently accompany an elated mood

inflated self esteem, decreased need for sleep, distractibility, pressure to keep talking, and the subjective feeling of thoughts racing through the persons head faster than they can be spoken. Mania is a syndrome in the same sense that clinical depression is a syndrome

Consider them as 2 aspects of the same disorder. Both sets of symptoms are frequently seen in the same person.

major depressive disorder vs persistent depressive

Following a seasonal pattern if, over a period of time, there is a regular relationship between the onset of a persons episodes and particular times of the year. The most typical seasonal pattern is one in which the person becomes depressed in the fall or winter, followed by a full recovery in the following spring summer.

mood disorder (either depressive or bipolar)

dexamethason

potent synthetic hormone

anticonvulsant medications

prescribed to bipolar patients who do not respond to lithium

hallucinations or delusions

psychotic features

in which the onset of episodes is regularly associate with changes in seasons as seasonal affective disorder. The episodes most commonly occur in winter, presumably in response to fewer hours of sunlight.

researchers refer to a mood disorder:

most women who experience severe events do not become depressed

severe events increase the probability of depression, but?

mood lability, irritability, dysphoria, and anxiety as well as cognitive (difficulty concentrating, feeling overwhelmed or out of control) and somatic symptoms (lethargy, appetite, sleep, muscle pain, bloating). Must have 5 symptoms including disturbance in mood. Must be present in the past year and they must be associated with clinically significant distress of interference with social or occupational functioning.

symptoms of PMDD

1. Should mood disorders be defined in a broad or narrow fashion? 2. concerns heterogeneity: All depressed patients do not have the same symptoms, same pattern of onset, or same course over time. are different symptoms qualitatively distinct forms of mood disorder or are they different expressions of the same underlying problem? Is the distinction among the different types simply one of severity

two primary issues for diagnosis of mood disorders