Mood Disorders Study Guide PDF

Study Guide Thursday, June 13, 2024 2:45 AM CHAPTER 8 – Perspectives in Psychopathology by David Dozois, 7th ed. 1. Historical perspective Know the origin of the term manic-depression and how the definition of mood disorders (as used in the DSM-5) was formed. - Exaltation (mania) was cause...

Study Guide Thursday, June 13, 2024 2:45 AM CHAPTER 8 – Perspectives in Psychopathology by David Dozois, 7th ed. 1. Historical perspective Know the origin of the term manic-depression and how the definition of mood disorders (as used in the DSM-5) was formed. - Exaltation (mania) was caused by an excess of warmth and dampness in the brain and melancholia (depression) was caused by an excess of black bile - From the work of Emil Kraepelin, he coined the term manic-depression and described bo depressive and manic forms of the disorder, forming the basis for the definition in the DS 2. Diagnostic issues Distinction between normal mood fluctuations vs clinical mood disorders - Their duration & severity Classification of mood disorders in the DSM-5 - Unipolar & bipolar 3. Major Depressive Disorder (MDD) Definition, characteristics, symptoms - Defined as - Characterized by persistent feelings of sadness, loss of interest or ability to feel pleasure, unexplained weight loss, difficulty sleeping, fatigue, difficulty concentrating, feelings of worthlessness or guilt, suicidal thoughts, and either agitation or slowing down - Symptoms include significant distress or impairment in social, occupational, or other important areas of functioning. The person must not be suffering from other disorders th may present as depression. - Diagnostic criteria: at least 5 out of 9 symptoms Prevalence of MDD o Number of people in Canada affected by MDD: 11.25/over 3 million people o Average age of onset: Early to mid-twenties o Sex differences: More prevalent among women 4. Persistent Depressive Disorder Definition, characteristics, symptoms oth SM-5 , hat o Average age of onset: Early to mid-twenties o Sex differences: More prevalent among women 4. Persistent Depressive Disorder Definition, characteristics, symptoms - Depressed mood for most of the day, more days than not, lasting for a least two years, al with at least three out of a list of six additional symptom - Characterized by appetite disturbance, sleep disturbance, low energy, low self-esteem, p concentration or difficulty making decisions, and hopelessness 5. Bipolar Mood Disorders Define Mania and Hypomania - Mania: A distinct period of elevated, expansive, or irritable mood that lasts at least one w and it accompanied by at least three associated symptoms - Hypomania: Less severe form of mania that involves a similar number of symptoms, but t symptoms need to be present for only four days Symptoms of mania - Increased energy, decreased need for sleep, racing thoughts, pressured speech, and prob with attention and concentration. - Impaired judgement, spending sprees, substance abuse or risky sexual behaviour, aggres - They may also feel that they are special in some way or that they have been "chosen" to a special mission 6. Bipolar I and Bipolar II Define bipolar I and II - Bipolar I: an individual has a history of one or more manic episodes with or without one o more major depressive episodes. ○ A depressive episode is not required for the diagnosis of bipolar I disorder, but mos individuals have both manic and depressive episodes - Bipolar II: a history of one or more hypomanic episodes with one or more major depressi episodes. ○ Can be more difficult to diagnose than bipolar I because hypomanic episodes are no severe as manic episodes - Most effective treatment is medication Understand why it is more difficult to diagnose Bipolar II compared to Bipolar I - Because hypomanic episodes are not as severe as manic episodes Characteristics of hypomanic episodes - Successful high productivity, lasting between two weeks and four months Understand why children and adolescents with Bipolar disorder are under diagnosed long poor week those blems ssion. fulfill or st ive ot as  Characteristics of hypomanic episodes - Successful high productivity, lasting between two weeks and four months Understand why children and adolescents with Bipolar disorder are under diagnosed and undertreated - They often do not meet the strict DSM-5-TR definition, and tend to have a rapid-cycling o mixed-cycling pattern. There is a lack of understanding about pediatric bipolar disorder 7. Mood Disorder with Seasonal Pattern Definition, characteristics - Can occur in both unipolar MDD and bipolar disorder - Characterized by recurrent depressive episodes that are tied to the changing seasons When does it affect patients? (answer: during times of low light, e.g., during winter months) - In northern latitudes, the episodes occur in winter months; In southern latitudes, they oc in our summer months - When nights grow longer and melatonin levels remain high 8. Mood Disorder with Peri- or Postpartum Onset What percentage of new mothers have a major depressive or manic episode. - Approximately 10 to 15% Risk factors for postpartum depression - A history of previous depressive episodes, severely stressful live events concurrent with o immediately following childbirth, a poor marital relationship or low support from their partner, and biological models. 9. Premenstrual Dysphoric Disorder (PMDD) Definition, characteristics, symptoms - Marked affective lability, irrability/anger, depressed mood, and or anxiety, plus the prese of additional symptoms of loss of interest in activities, concentration difficulties, low ener changes in appetite and/or sleep, feelings of loss of control and/or physical symptoms, - Five symptoms must be present to meet the DSM-V criteria and significantly interfere wit daily functioning and must be present for most menstrual cycles in the past year 10. Etiology Etiology of mood disorders - Psychological and environmental casualties factors, biological casualties factors 11. Personality Theories Roles of personality styles as predictors of depression (CANOE!) - High levels of neuroticism, low levels of extroversion and low conscientiousness o The two personality patterns that provide a risk for depression or ccur or ence rgy, th  - Psychological and environmental casualties factors, biological casualties factors 11. Personality Theories Roles of personality styles as predictors of depression (CANOE!) - High levels of neuroticism, low levels of extroversion and low conscientiousness o The two personality patterns that provide a risk for depression - People high on behaviour inhibition system, and are therefore more fearful of novelty an uncertainty, and more sensitive to punishment. - People high on behavioural activation system, as they are more likely to display negative emotional states, and are theorized to be more impulsive and to have more difficulty regulating their emotions and inhibiting their behaviour when faced with rewarding stimu 12. Cognitive theories Beck’s cognitive theory of mood disorders - He proposed that a persons emotional response to a situation is determined by the mann which that situation is appraised or evaluated. o Understand the four examples of common cognitive distortions (i.e., all-or- nothing thinking, overgeneralization, magnification/catastrophizing, and jumping to conclusions). - All-or-nothing thinking: Thinking in black and white, reducing complex outcomes into absolutes - Overgeneralization: Seeing a single negative event as a never-ending pattern of defeat by using words such as always or never when you think about it - Magnification/Catastrophizing: Exaggerating the importance of your errors or problems - Jumping to conclusions: Interpreting things negatively when there are no definite factors support your conclusion o Understand and define schemas and the cognitive triad - Schemas: Hypothetical structures in the mind that contain core beliefs about the self, the world, and the future - Cognitive triad: negative view of self, world, and future Interpersonal Models - A model that individuals who are depressed (or at risk for depression) behave in ways tha bother or alienate others. As a result, depressed individuals are more likely to experience interpersonal rejection and relationship stress, thereby reducing social support and perpetuating their depression o Which social skills people with depression are deficient in - Excessive reassurance seeking o Role of negative feedback seeking in Dr. William Swann’s self-verification theory - the tendency to actively seek out criticism and other negative interpersonal feedback fro others that is consistent with one’s self-schemas nd uli ner in y s to e at e om  perpetuating their depression o Which social skills people with depression are deficient in - Excessive reassurance seeking o Role of negative feedback seeking in Dr. William Swann’s self-verification theory - the tendency to actively seek out criticism and other negative interpersonal feedback fro others that is consistent with one’s self-schemas o Define excessive reassurance seeking - the tendency to repeatedly seek assurance about one’s worth and lovability from others, regardless of whether such assurances have already been provided o Understand Hammen’s stress generation hypothesis - Individuals with a history of depression have higher rates of stressful life events that are a least in part dependent on their own behaviour or characteristics than non-depressed individuals Life Stress Perspective o Role of stress in the development of depression. - individuals with depression are nearly three times more likely than those without depres to have experienced a stressful life event prior to onset o Know that childhood trauma is a strong predictor of depression. 13. Biological Causal Factors Know that biological models have focused on the role of genetics, neurochemistry and brain function and structure. Know that MDD and bipolar disorder have a strong genetic component Know that mood disorders are associated with disruptions in the transmission of certain neurotransmitters Know that techniques used to examine the structures and function of the brain have enabled researchers to discover that there is decreased blood flow in certain brain regions and increased activity in limbic areas, such as the amygdala when processing negative information 14. Treatment According to the evidence, which are the two recommended psychotherapies with the strongest efficacy in the treatment of unipolar major depression - Cognitive-Behavioural Therapy (CBT) and Interpersonal Psychotherapy (IPT) CBT o What is the goal of Cognitive Behaviour Therapy (CBT) - To teach people to become aware of the meanings of and attributions to events in their l and to examine how these cognitions contribute to the emotional reactions that follow o Identify and describe the most common interventions used in CBT - Thought records - Behavioural Experiments - Activity Scheduling Behavioural Experiments o Compare treatment outcomes of CBT vs no treatment - CBT is significantly more effective than minimal or no treatment om , at ssion lives,  - Thought records - Behavioural Experiments - Activity Scheduling Behavioural Experiments o Compare treatment outcomes of CBT vs no treatment - CBT is significantly more effective than minimal or no treatment o Compare treatment outcomes of CBT vs antidepressant medication or the treatment of depression and severe depression - CBT is equally effective as other psychotherapies and antidepressant medication, even fo severe depression - CBT has more enduring effects than antidepressant medication o Purpose of Mindfulness-Based Cognitive Therapy (MBCT) - To promote a non-evaluative awareness of the here and now in an effort to help individu experiencing depression detach from ruminative thinking and cultivate a decentred, deta perspective to depression-related thoughts and feelings o What is Interpersonal Therapy (IPT) and what does it presume? - IPT presumes that depression occurs in an interpersonal context and that addressing curr problems that clients with depression face in the interpersonal realm is key to relieving symptoms Pharmacotherapy for major depression o Know that biological treatments for major depression involve medications that increase the availability of one or more neurotransmitters. o What is the limitation of medications in the treatment of major depression o Note that a study found that antidepressant medication was found to be more effective than a placebo in those with severe depression and that for patients with mild to moderate depression, antidepressants were not found to be more effective than a placebo. Pharmacotherapy for Bipolar Disorder o Identify the major classes of medications used to treat bipolar disorder. - Lithium - Anticonvulsants - Antipsychotics - Antidepressants o How are atypical antipsychotics used to treat acute manic or severe depressive episodes - Used as a short-term treatment, to control psychotic symptoms, as sedatives, for their m stabilizing effect and with patients who do not respond to lithium or anticonvulsants o What is the most effective treatment for bipolar disorder (answer: medication). Why, then, are psychological treatments used in conjunction with medication? o Which were psychological treatments developed for use in conjunction with medication? Phototherapy for seasonal affective disorder o What is phototherapy? - Treatment for SAD that involves exposure to high-intensity full-spectrum lighting or uals ached rent mood- Why, then, are psychological treatments used in conjunction with medication? o Which were psychological treatments developed for use in conjunction with medication? Phototherapy for seasonal affective disorder o What is phototherapy? - Treatment for SAD that involves exposure to high-intensity full-spectrum lighting Neurostimulation and Neurosurgical Treatments o Define treatment-resistant depression and note the percentage of patients with depression who are resistant to treatment - A failure to achieve remission following at least two trials of antidepressant medication a appropriate dose and duration - Approx. 40% of patients remain resistant to treatment o Identify treatments to be considered only when adequate trials of first-line treatments for depression have failed. - Electroconvulsive therapy (ECT) - Transcranial Magnetic Stimulation o How is ECT used in the present day? What are the safeguards in place to ensure patient safety? - Administering patients a general anaesthetic and muscle relaxant, blood pressure cuff aro ankle, wearing mouth guards to protect teeth and tongue from injury o When is ECT indicated as first-line treatment? - Only for treatment-resistant depression or depression with severe, life-threatening symp where an immediate response is desired (e.g., acute suicidal ideation or psychotic feature 15. Suicide Definitions, epidemiology, and risk factors - The intentional taking of one's own life - Nearly a million people die worldwide by suicide annually; estimated 10-20 million attem every year - Suicide is among the 10 leading causes of death in the general population in Canada, occurring at a rate of 11.3 per 100,000 people - The rate of completed suicide among males (17.3 per 100,000) is more than three times rate among females (5.4 per 100,000) o What is the current focus regarding suicide in the Western world? - Suicide prevention and the treatment of mental disorders associated with suicide o Define the behaviours that fall under the general category of suicide. o Identify the strongest risk factor for completed suicide. o Why are the rates of completed suicide different in men and women? Causes of suicide o What is the number one cause of suicide? - Untreated mental disorder o What are the most frequently diagnosed mental disorders in victims of suicide? - After mood disorders, the most frequently diagnosed mental disorder in victims of suicid at an ound ptoms es) mpts the de is o Why are the rates of completed suicide different in men and women? Causes of suicide o What is the number one cause of suicide? - Untreated mental disorder o What are the most frequently diagnosed mental disorders in victims of suicide? - After mood disorders, the most frequently diagnosed mental disorder in victims of suicid alcohol and substance abuse o Briefly, what are the three major factors that cause suicide? - Socio-contextual, biological, and psychological Prevention o What is the aim of primary preventions and secondary/tertiary preventions? o What do primary prevention strategies and secondary/tertiary prevention strategies involve? o Generally, are these strategies effective/successful? Treatment o Identify the pharmacological agent that can be used in emergency situations of acute suicidality to rapidly reduce suicidal ideation Case 5: Major Depressive Disorder 1. What symptoms did Phil present that prompted his primary care doctor to suggest a psychologist? - Mood was down, not feeling enjoyment, not sleeping or eating well, lost weight, hopeles about the future, difficulty concentrating on tasks 2. How does exercise compare to antidepressant medications for mild to moderate depression? - Exercise compares favourably to either psychotherapy or antidepressant medications in m to moderate cases of depression, especially when integrated with either 3. What type of psychotherapy did Rosemary use with Phil? - CBT 4. The process of using CBT strategies for Phil’s depression would include which 4 components? - Psychoeducation - Self-monitoring - Willingness to trust and try new things on his part - An openness to identifying and changing his problematic patterns Case 6: Bipolar Disorder 1. What can antidepressant drugs trigger for some people with bipolar disorder? - A manic episode 2. What was Hannah’s behavioural presentation at the beginning stages of her disorder? - Talkativeness, outbursts, unsure of herself, excessive worry, isolation, paranoia, depressi crying, insomnia 3. Why would Hannah periodically stop taking her medication? - She felt straitjacketed by the drugs; although she was free of the manic episodes, she felt de is ss mild ion, t she  - A manic episode 2. What was Hannah’s behavioural presentation at the beginning stages of her disorder? - Talkativeness, outbursts, unsure of herself, excessive worry, isolation, paranoia, depressi crying, insomnia 3. Why would Hannah periodically stop taking her medication? - She felt straitjacketed by the drugs; although she was free of the manic episodes, she felt had lost her spark, her emotions had dulled, and she had no excitement 4. In her treatment of Hannah’s depression, Dr. Stanley, Hannah’s psychiatrist, started with addressing which issue? How did she go about doing so? - She started by empathizing with Hannah's spotty record of medication compliance - She remarked that the medications used to control manic episodes often had the effect o reducing even a normal sense of high spirits, and as a result, many patients were tempted omit their medications occasionally. 5. What caused Dr. Stanley to finally recommend psychotherapy for Hannah? - She felt that Hannah was not facing up to the reality of her situation and that psychother would help Hannah sort out her feelings and change her behavioural patterns 6. What type of therapy did the psychologist implement and what were the three main components? - Insight-oriented therapy - Hannah's relationship with her parents ion, t she of d to rapy