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
