PSYC 451 Ch. 7

Lithium carbonate

A common salt that is often effective at preventing and treating manic episodes. This salt is considered a mood stabilizer because it treats depressive and manic symptoms. However it is toxic in large amounts and only effective for 50% of patients. Its mechanism of action remains unclear.

Interpersonal psychotherapy

A depression therapy, IPT, which focuses on resolving problems in existing relationships and learning to form important new interpersonal relationships. After identifying life stressors, the therapist and patient work collaboratively on the patient's current interpersonal problems which typically include issues such as dealing with interpersonal role disputes, adjusting to the loss of a relationship, acquiring new relationships, and identifying and correcting deficits in social skills.

Bipolar mood disorder

A mood disorder in which both depressed and elevated moods are experienced.

Unipolar mood disorder

A mood disorder in which only one extreme of mood is experienced, e.g. only depression or only mania. Depression alone is much more common than mania alone.

Suicide neurobiology

A variety of evidence suggests that low levels of serotonin may be associated with suicide and with violent suicide attempts. Low levels of 5HT are associated with impulsivity, instability, and the tendency to overreact to situations.

Bipolar disorder statistics

Bipolar disorders affect men and women approximately equally. Women are more likely to experience rapid cycling and to be in a depressive period. Bipolar disorder has a similar incidence in children, adults, and adolescents.

Mood disorders in children

Children as young as 3 months can show depressive symptoms, although bipolar or manic symptoms are rare. In children, many mood disorders may be misdiagnosed as or comorbid with ADHD as well as conduct disorder. There is an increasing number of children being diagnosed with bipolar disorder.

Suicide prevention

Clinicians often do risk assessments of individuals considering suicide (ideation, intent, means, plans, etc.) and work to develop safety plans (who to call, strategies for coping with suicidal thoughts). In some cases, therapists have patients sign no-suicide contracts. Preventative programs such as CBT can reduce suicide risk in at-risk groups. Another important component is removing access to lethal methods

Depression CBT

Cognitive-behavioral treatment for depression addresses cognitive errors in thinking and also includes behavioral components including behavioral activation (scheduling valued activities).

Negative cognitive styles

Depressed persons tend to engage in cognitive errors that cause them to interpret everyday events in a negative way.

Mood disorder integrative theory

Depression and anxiety may often share a common, genetically determined biological vulnerability that can be described as an overactive neurobiological response to stressful life events. In addition, people who develop mood disorders also posses a psychological vulnerability experienced as feelings of inadequacy for coping with the difficulties confronting them as well as depressive cognitive styles.

Onset and duration of depressive disorders

Depressive disorders are rare in childhood, but risk increases in adolescence and young childhood. The mean age of onset for depressive disorders is 30. If depressive disorders leave residual symptoms, they are more likely to reoccur and end with another incomplete recovery. Early onset is associated with greater chronicity, poor prognosis, and stronger familial incidence.

Acute grief

Grief or mourning that occurs immediately after a loss. Experienced by most people.

Suicide family history

If a family member committed suicide, there is an increased risk that someone else in the family will too. This is both due to witnessing family members committing suicide and due to inherited traits such as impulsivity.

Catatonic features specifier

Individual with this specifier have major depressive episodes (rarely manic episodes) and consists of extremely rare muscular symptoms such as remaining in a still stupor, "waxy" limbs that remain in place when manipulated, and repetitive or purposeless movement.

Peripartum onset specifier

Individuals with this specifier have depression occurring around the time of giving birth. Higher incidence postpartum rather than during pregnancy. Fathers can also have increased depressive symptoms

Seasonal pattern specifier

Individuals with this specifier have depression occurring primarily in certain seasons, usually winter. These episodes must have occurred for at least two years. This specifier may be related to levels of melatonin produced by the pineal gland. May be treated with light exposure

Mixed features specifier

Individuals with this specifier have predominantly depressive episodes that have at least three symptoms of mania. This applies both to individuals with major depressive disorder and individuals with persistent depressive disorders

Major depressive disorder statistics

Lifetime prevalence of MDD is 16%. 6% of people have experienced MDD in the last year. Females are twice as likely to have major depression. The overall prevalence of MDD in adults over 65 is about half that of the general population.

Suicide gender differences

Males complete more suicides than females, although females attempt suicide more often than males. This disparity is due to males using more lethal methods than females. In China, suicide is more common among women, possibly due to differences in cultural acceptability. In China, suicide is seen as an honorable solution to some problems.

Mood disorder social causes

Marital dissatisfaction is strongly related to depression, a relationship that is particularly strong in males. Likewise, depression or bipolar disorder may lead to marital problems. Lack of social support predicts late onset depression. Substantial social support predicts recovery from depression.

Bipolar disorder treatment

Medication, usually lithium, is still the first line of defense for bipolar disorder. Psychotherapy can be helpful in managing the interpersonal and occupational problems that accompany bipolar disorder. Family therapy to alleviate tension may also be helpful.

Mood disorder statistics

Mood disorders are less common in prepubescent children than in adults but rises rapidly during adolescence. As many as 20-50% of children experience some depressive symptoms, but not with enough frequency or severity or diagnosis. In children, the sex ratio is 1:1, but during adolescence, the sex ratio skews towards females.

Mood disorder endocrine causes

Mood disorders are related to elevated cortisol and overactivation of the HPA axis, which decreases neurogenesis in the hippocampus (which keeps stress hormones in check) and makes individuals less able to make new neurons.

Mood disorder neurobiological causes

Mood disorders are related to low levels of serotonin, but only in relation to other neurotransmitter. According to the permissive hypothesis, low serotonin levels "permit" other neurotransmitters to vary more widely, increasing vulnerability to depression. Particular focus on the role of dopamine in manic episodes, atypical depression, or depression with psychotic features.

Mood disorders across cultures

Mood disorders are similar in prevalence across U.S. subcultures, but experience of symptoms can vary. Some cultures are more likely to express depression as a somatic concern. Higher prevalence among Native Americans: 4x the rate of the general population.

Suicide preexisting disorders

More than 80% of those who commit suicide suffer from a psychological disorder, usually mood, substance abuse, or impulse control disorders.

Onset and duration of bipolar disorders

Onset for bipolar I and II disorder are in adolescence and early adulthood, respectively. They have an acute onset and a chronic course. Suicide is common in individuals with bipolar disorders. Cyclothymia also has a chronic course.

PDD with pure dysthymic symptoms

PDD in which an individual has mild depressive symptoms without any major depressive episodes.

PDD with persistent major depressive episode

PDD with a major depressive episode lasting two or more years.

Double depression

PDD with mild depressive symptoms and major depressive episodes occurring intermittently.

Stress and bipolar disorder

Positive, yet stressful, life events can trigger mania. These include getting accepted to graduate school, obtaining a new job or promotion, or other kinds of success.

Depression prevention

Prevention of mood disorders focuses around universal programs. selected interventions, and indicated interventions. By identifying these groups and using prevention methods, incidence of depressive episodes can be reduced.

Grief

Previously, depression could not be diagnosed during periods of mourning, but it is now recognized that major depression may occur as part of the grieving process.

Preventing relapse

Research on relapse prevention is less common than research on treatments. Both psychosocial and pharmacological treatments are used. Pharmacological treatments can be effective for rapid action, while psychosocial protection can prevent relapse over the long term.

Depression medications

SSRIs, tricyclic antidepressants, monoamine oxidase inhibitors, and mixed reuptake inhibitors (e.g. serotonin/norepi) are all approximately equallyeffective, with 50% benefitting and 25% achieving normal functioning. SSRIs may pose risks for teen suicide because they give depressed individuals enough energy to carry out ideations. Tricyclic antidepressants cause weight gain, and thus discontinuation is common. Mixed reuptake inhibitors are effective and have fewer side effects than SSRIs. MAOI's are effective but have dietary restrictions.

Hallucinations

Seeing or hearing things that aren't there.

Mood disorder sleep causes

Sleep disturbance is a hallmark of most mood disorders. In people who are depressed, there is a significantly shorter period after falling asleep before REM sleep begins. Sleep deprivation may temporarily improve depressive symptoms in bipolar patients.

Gene-environment correlation model

Some individuals may have genetically based personality characteristics that may lead them to depression. Individuals may put themselves in high-risk, stressful environments where bad outcomes are common.

Suicide contagion

Some research indicates that a person is more likely to commit suicide after hearing about someone else committing suicide. Media accounts may worsen the problem by sensationalizing/romanticizing suicide and describing lethal methods of committing suicide.

Mood disorder psychological causes

Stressful life events are strongly related to mood disorders, leading to a poorer response to treatment (especially when occurring during the course of depression) and longer time before remission. The context of life events matter; something that is stressful for one individual is a relief for another. There is a particularly strong relationship between stress and bipolar disorder. However, most people who experience stressful events do not develop mood disorders

Suicide stress

Stressful, humiliating, life events are perhaps the most important risk factor for suicide.

Delusions

Strongly held but inaccurate beliefs.

Suicide risk factors

Suicide in the family, low serotonin levels, preexisting psychological disorders, alcohol use and abuse, stressful life events, past suicidal behavior, and plans and access to lethal methods are all suicide risk factors.

Suicide statistics

Suicide is 11th leading cause of death in the USA, most common among whites and Native Americans, particularly in young adults, where it is the third leading cause of death in teenagers. 12% of college students consider suicide in a given year.

Suicidal attempts

Suicides that are unsuccessful.

Cognitive triad

The combination of making cognitive errors in thinking negatively about oneself, one's immediate world, and one's future.

Integrated grief

The eventual coming to terms with the meaning of a loss, in which the finality of death and its consequences are acknowledged and the individual adjusts to the loss.

Suicidal plans

The formulation of a specific method of killing oneself.

Mood disorders in elderly

The prevalence of depression in the elderly is between 14% and 42% and is often comorbid with anxiety disorders or alcohol abuse. There is less gender imbalance after 65 years of age.

Psychological autopsy

The process by which the psychological profile of the person who committed suicide is reconstructed through extensive interviews with friends and family members who are likely to know what the individual was thinking and doing in the period before death.

Mixed features

The term for a mood episode with some elements reflecting the opposite valence of mood, e.g. a depressive episode with some manic features or a manic episode with some depressed/anxious features. Individuals with these symptoms are more severely impaired than individuals with only one set of symptoms.

Mood disorders

These disorders are characterized by gross deviations in mood and are composed of periods of depressed or elevated moods (mania) lasting days or weeks.

Bipolar disorders

These disorders are characterized by the tendency of manic episodes to alternate with major depressive episodes. A manic episode might occur only once or repeatedly.

Psychotic features specifier

These individuals with major depressive (or manic) episode may experience psychotic symptoms such as hallucinations, delusions that are either mood congruent (related to disorder) or mood incongruent (do not seem consistent with disorder).

Suicidal ideation

Thinking seriously about suicide

Depressive style

This "style" consists of internal attributions (negative outcomes are one's own fault), stable attributions (future negative outcomes will be one's own fault), and global attribution (believing negative events will disrupt many life activities), all of which contribute to a sense of learned helplessness.

Overgeneralization

This cognitive error occurs when individuals believe that one negative event applies to all situations.

Arbitrary inference

This cognitive error occurs when individuals overemphasize the negative aspects of a mixed situation.

Cyclothymic disorder

This disorder is characterized by a chronic alteration of mild hypomania symptoms and mild depressive symptoms that does not reach the severity of manic or major depressive episodes. There are relatively few periods of neutral, or euthymic, mood. Must persist for 2 years or one year for adolescents and children.

Persistent depressive disorder

This disorder is characterized by at least two years of depressed mood with depressed mood most of the day on more than 50% of days and no more than 2 months symptom free. As few as 2 symptoms are needed to diagnose. Symptoms can persist for more than 20 years without changing but may include periods of more severe major depressive symptoms, either intermittently or for the majority of the time. High comorbidity with other mental disorders and less responsive to treatment.

Bipolar I disorder

This disorder is characterized by full manic episodes alternating with major depressive disorders. For manic episodes to be considered separate, there must be a symptom-free period of at least 2 months between them. Individuals must have at least one manic episode.

Bipolar II disorder

This disorder is characterized by major depressive episodes alternating with hypomanic episodes.

Major depressive disorder

This disorder is characterized by one or more major depressive episodes separated by periods of remission. A single episode is highly unusual; most individuals have recurrent episodes.

Disruptive mood dysregulation disorder

This disorder is characterized by severe temper outbursts occurring frequently, against a backdrop of angry or irritable mood, but without the criteria for manic/hypomanic episodes are not being met. This diagnosis exists in part to combat the overdiagnosis of bipolar disorder in children ages 6 to 18.

Premenstrual dysphoric disorder

This disorder is characterized by significant depressive symptoms occurring prior to menses during the majority of cycles, leading to distress or impairment. This diagnosis legitimizes the difficulties some women face, but runs the risk of pathologizing an experience many consider to be normal.

Hypomanic episode

This mood episode is a shorter, less severe version of a manic episode that lasts at least 4 days. It has fewer and milder symptoms than mania and is associated with less impairment than a manic episode. This may not be problematic in and of itself, but it usually occurs in the context of a more problematic mood disorder.

Major depressive episode

This mood episode is characterized by an extremely depressed mood state and/or anhedonia for at least two weeks and includes at least 4 additional cognitive or physical symptoms such as feelings of worthlessness and indecisiveness; altered sleep patterns; significant changes in appetite and weight; or a notable loss of energy.

Manic episode

This mood episode is characterized by elevated, expansive mood for at least one week and includes inflated self-esteem; decreased need for sleep, excessive talkativeness; flight of ideas or sense that thoughts are racing; easy distractibility; increase in goal-directed activity; psychomotor agitation; and excessive involvement in pleasurable but risky behaviors. Must cause impairment in normal functioning.

Melancholic features specifier

This specifier applies only to individuals with the full criteria for a major depressive episode. This specifier includes severe somatic symptoms such as early morning awakenings; weight loss; loss of libido; excessive or inappropriate guilt; and anhedonia.

Atypical features specifier

This specifier applies to both depressive episodes and consists of presence of several symptoms less common in depression such as oversleeping, overeating. These individuals do not have complete anhedonia. Early age of onset and found in women.

Anxious distress specifier

This specifier is the presence and severity of accompanying anxiety, whether in the form of comorbid anxiety disorders or anxiety symptoms that do not meet all the criteria for disorders. For all depressive and bipolar disorders, the presence of anxiety indicates a more severe condition, makes suicidal thoughts and completed suicide more likely, and predicts a poorer outcome from treatment.

Rapid cycling specifier

This specifier of bipolar I and II disorders describes moving quickly in and out of mania and depression. These individuals experience at least four manic or depressive episodes within a year and occurs in 20-50% of cases. This specifier is associated with greater severity.

Learned helplessness theory of depression

This theory of depression holds that a lack of perceived control leads to decreased attempts to improve one's own situation. People become anxious and depressed when they decide they have no control over their lives.

Transcranial magnetic stimulation

This treatment for depression uses magnets to generate a precise localized electromagnetic pulse. It has few side effects other than occasional headaches, and while less effective than ETC, can be combined with medication.

Electroconvulsive therapy

This treatment for mood disorder is the brief application of an electrical current to the brain, resulting in temporary seizures. Although this treatment has the side effect of short- and long-term memory loss, 50% of patients not responding to medication will benefit. continued psychotherapy is needed as relapse rates are ~60%. The mechanism of action is not clear.

Maintenence treatment

Treatment to prevent relapse or recurrence over the long term.

Mood disorder genetic causes

Twin studies have shown that concordance rates are high in identical twins. An identical twin is 2-3 times more likely to present with mood disorders than a fraternal twin of depressed co-twin. Severe mood disorders are shown to have strong genetic contributions, but heritability overall is higher for females than for males. Some genetic factors seem to confer risk for both anxiety and depression. The genetic contribution for depression is 40% in women and 20% in men. The genetic contribution for bipolar is somewhat higher. Finally, relatives of bipolar probands are more likely to have unipolar depression.

Mood disorders in women

Women account for 7 out of 10 cases of MDD and dysthymia. This gender imbalance is constant across cultures. This may have to do with gender roles and "uncontrollability." In addition, parenting styles make girls less independent. Further, women may be more sensitive to relationship disruptions such as breakups or tension in friendships and engage in rumination more often than men.