Abnormal Psyc- Chapter 8

Front 1

Unipolar Mood Disorder

Back 1

Change in mood in direction of depression

Front 2

Bipolar Mood Disorder

Back 2

Periods of depression cycling with periods of mania

Front 3

Major Depressive Disorder (MDD)

Back 3

Leading cause of disability worldwide
- Involves abnormalities in all systems (bio, emotional, cog, behaviour)
- Can impair functioning in all areas of life
- Persistent sad mood and/or lack of pleasure or enjoyment in activities for at least 2 weeks
- Grows steadily and equally in males and females until 10 years old, higher for girls, level off for boys.

Front 4

Depressed Individual with Commorbid Conditions

Back 4

Experience more sever and chronic depression and show slower and less complete response to treatment

Front 5

Dysthymic Disorder

Back 5

Chronic low mood lasting for 2 years.
- Many experience "double depression" recurrent MDD episodes and chronic low mood

Front 6

Major Depression with Poor Inter-episode Recovery

Back 6

Episodes of major depression that fail to remit successfully

Front 7

Chronic Depression

Back 7

High levels of impairment, younger age of onset, high commorbidity and strong family history.

Front 8

Mania

Back 8

Elevated, expansive or irritable mood lasts at least one week

Front 9

Hypomania

Back 9

Less severe, similar number of symptoms present for only 4 days

Front 10

Mixed State

Back 10

Manic/hypomanic and depressive symptoms at same time

Front 11

Bipolar I Disorder

Back 11

One or more manic episodes with or without one or more depressive episodes.

Front 12

Bipolar II Disorder

Back 12

One or more hypomanic episodes with one or more major depressive episodes.
- Hypomanic/manic episode lasts approx 2 weeks to 4 months and depressive episodes last 6-9 months

Front 13

DSM Proposed to require specification of one of the following subtypes of bipolar disorder

Back 13

1. Current or most recent episode hypomanic
2. Current or more recent episode manic
3. Current or more recent episode depressed
4. Current or more recent episode unspecified

Front 14

Cyclothymia

Back 14

Chronic but less severe form of bipolar disorder.
- At least 2 years alternating hypomanic episodes and depression episodes. At risk for developing bipolar disorder

Front 15

Rapid Cycling Bipolar Disorder

Back 15

4 or more manic and/or major depressive episodes in 12 month period
- Episodes must be separated by at least 2 months
- Full or partial remission or switch to opposite mood
- Can be induced or made worse by antidepressants

Front 16

Ultrarapid Rapid Cycling Bipolar Disorder

Back 16

Cycling every few days

Front 17

Ultra-radian Rapid Cycling Bipolar Disorder

Back 17

Cycling daily

Front 18

Seasonal Affective Disorder

Back 18

Can occur in unipolar and bipolar disorder.
- Recurrent depressive episodes tied to changing seasons.
- May need more light to trigger decrease in melatonin secretion.
- As nights grow longer in winter, melatonin remains high and nothing to prompt switch from sleep to wake.

Front 19

Postpartum Depression

Back 19

Risk factors include family history of depression and history or previous depressive episodes, poor marital relationship and low social support and stressful life.
- Progesterone may be involved (rapid withdrawal after delivery).

Front 20

Psychodynamic Theories

Back 20

Relationships between parent and children important in shaping temperament.

Front 21

Dependency

Back 21

Rely excessively on interpersonal relationships for identity. Needy and fearing.

Front 22

Self-Critical

Back 22

Fears of failure, self blame, inferiority and guilt.

Front 23

Cognitive Distortions

Back 23

1. All or nothing thinking
2. Overgeneralization
3. Magnification
4. Jumping to conclusions

Front 24

Schemas

Back 24

Hypothetical structures in the mind, core beliefs about self, world and future (cognitive triad).

Front 25

Diathesis-Stress Model

Back 25

Negative cognitive schemas remain inactive in mind and serve as silent vulnerability that don't express until activated by stressful life event that matches the theme of schema.

Front 26

Interpersonal Relationships

Back 26

Deficient social skills, interactions with others are negative, less eye contact, less animated face.

Front 27

Negative Feedback Seeking

Back 27

Actively seek out criticism and other negative interpersonal feedback from others.

Front 28

Excessive Reassurance Seeking

Back 28

Seek assurance about ones worth and lovability. Doubt sincerity or reassurance.

Front 29

Stress Generation Hypothesis

Back 29

Generate stressful life events in interpersonal domain. Contribute to occurrence in these event due to their maladaptive interpersonal behaviours.

Front 30

Childhood Trauma

Back 30

Early maltreatment internalized by child as negative schemas.

Front 31

Genetics

Back 31

Serotonin transporter gene, greater serotonin and activity of gene if long allele. Show effect in MDD by increased reactivity to stress (if short allele)

Front 32

Neurotransmitters

Back 32

NE and 5-HT responsible for functions disturbed in depression.
- Low NE in bipolar and severe unipolar
- Low 5-HT receptors in depressed
- DA transmission partly depends on level of 5-HT

Front 33

5-HT

Back 33

Serotonin, normal levels inhibit certain behaviors

Front 34

DA

Back 34

Dopamine, regulation of reward processing and motor behaviours.
- Low levels= reduction in capacity to feel pleasure and psychomotor retardation.
- Abnormal levels = hyperactive and psychosis

Front 35

NE

Back 35

Norepinephrine, abnormal levels lead to euphoria and grandiosity

Front 36

Hypothalamic-Pituitary-Adrenal Axis (HPA)

Back 36

When encounter stress, brain releases CRH (cortrophin release hormone) leads to release of adrenocorticotrophic hormone (ACTH) from pituitary and release of cortisol from adrenal gland.

Front 37

Sleep Neurophysiology

Back 37

Loss of slow-wave sleep and early onset of first REM stage and high frequency and amplitude or eye movements in REM. Controlled by 5-HT and NE.

Front 38

PET Scans

Back 38

Showed that bi and uni polar associated with low blood flow and low glucose metabolism in cerebral cortex. Reverse occurs when going from depression to mania.

Front 39

MRI Scans

Back 39

Uncovered neural circuits involved in cognitive emotional deficits of depressed.

Front 40

Multi-site Randomized Control Trial

Back 40

Compared cognitive behavioural therapy, interpersonal therapy, antidepressant and placebo pill.
- No different in efficacy among CBT, IPT and anit depressant, All better than placebo.

Front 41

Cognitive Behaviour Therapy for Depression

Back 41

Become more aware of meanings of attributions to event in their lives. Help make own insights into thought processes.
- Activity scheduling
- Thought records
- Behavioural Experiments

Front 42

Interpersonal Psychotherapy for Depression

Back 42

Loss and disordered attachment as underlying factors in MDD, address current problems. Identify source of dysfunction with relevance to...
- Interpersonal disputes
- Role Transitions
- Grief
- Interpersonal deficits

Front 43

Tricyclic Antidepressants

Back 43

Oldest
- Block reuptake from synapse of NE and/or 5-HT. More of these available.
- Manny side effects
- Highly lethal overdose

Front 44

Monoamine-Oxidase Inhibitors

Back 44

Inhibit enzyme that breaks down neurotransmitters. More monoamines available.
- Dangerous side effects
- Limits intake of foods with amines
- Avoid cold medicines with pseudoephedrine

Front 45

Selective-Serotonin Reuptake Inhibitors

Back 45

First line of treatment for unipolar
- Mild side effects
- Block reuptake of serotonin, more 5-HT

Front 46

Other Antidepressants

Back 46

- Serotonin-NE reuptake inhibitors
- Increase dopamine transmission
- Other misc actions on other neurotransmitters (ex: GABA)

Front 47

Lithium

Back 47

Mood stabilizing, deactivated enzyme (GSK-3B).
- When enzyme active, can't reset brains master clock
- Antagonist of glutamate, general excitatory effect on brain, decreases synthesis and/or release of glutamate accounts for stabilizing effect
- Therapeutic window narrow
- Monitor thyroid and kidney function

Front 48

Anticonvulsants

Back 48

40% of bipolar people don't react to lithium or can't manage the effects.
- Lithium can become ineffective
- Used to treat epilepsy, increases synthesis and release of GABA
- Some decrease synthesis and release of GABA, which give excitatory effect

Front 49

Antipsychotics

Back 49

Short term treatment during acute manic or severe depressive episodes.
- Sedatives, if don't respond to lithium or anticonvulsants
- Antagonists of multiple neurotransmitter receptors (5-HT and DA)

Front 50

Tardive Dyskinesia

Back 50

Irreversible effect of anti-psychotics
- Involuntary, dyskinetic movements.
- Increased risk with duration and cumulative dose

Front 51

Antidepressants (for treatment of bipolar)

Back 51

To treat depressive phase of bipolar.
- Buproprion less likely to trigger manic episode
- All risk triggering mania
- Use in conjunction with mood stabilizer.

Front 52

CBT, IPT and Medication

Back 52

- Non-chronic depression of mild to moderate severity, no advantage.
- For severe depression, CBT and meds work
- Adding CBT to people who don't fully respond to meds increases remission rates and decreases relapse.
- CBT and meds work best in teens

Front 53

Adjunctive Psychotherapy for Bipolar

Back 53

Most effective for treating bipolar is meds.
- Family focused therapy (Mikowitz)
- Interpersonal therapy and Social Rhythm Therapy (Frank)
- Cognitive Therapy (Lam)

Front 54

Family Focused Therapy for Bipolar

Back 54

Communication and problem solving, fewer new onsets. More likely to stay on meds.

Front 55

Interpersonal and Social Rhythm Therapy for Bipolar

Back 55

Disruptions in daily routines and conflicts in interpersonal relationships can cause relapse.
-Teach to regulate routines and cope better with stress.

Front 56

Cognitive Therapy for Bipolar

Back 56

Teach strategies that address unique issues.
- How to regularize sleep and routines
- How to regularly monitor their mood and identify trigger for manic episodes and relapses
- Importance of medication compliance
- Fewer relapses, fewer hospitalizations, higher levels or psychosocial function, less symptoms of depression, less fluctuation in manic symptoms.

Front 57

Phototherapy

Back 57

Stimulate sunlight to regulate melatonin production.
-Remission, should be on mood stabilizer if bipolar SAD

Front 58

Treatment Resistant Depression

Back 58

Failure to achieve remission following at least 2 trials or antidepressant meds at appropriate dose and duration.

Front 59

ECT

Back 59

First line of treatment only for treatment of resistant depression or depression with severe life threatening symptoms where immediate response in desired.

Front 60

Transcranial Magnetic Stimulation

Back 60

Electric current created magnetic pulse, non-invasive and painless.

Front 61

Vagus Nerve Stimulation

Back 61

Pulse generator sends electrical signals through wire to nerve then brain. Permanent implant. Increase release of Ne and 5-HT and increases blood flow.

Front 62

Deep Brain Stimulation

Back 62

Implant wires into brain, deliver dose of electrical current to brain

Front 63

Suicidal Ideation

Back 63

Thoughts of death and plans of suicide.

Front 64

Suicidal Gestures

Back 64

"Parasuicide"
- Suicide attempts, clearly not life threatening to alter other of their suffering.

Front 65

Suicide Attempt

Back 65

Carrying out of suicide plan which is unsuccessful, but clear intent to die.

Front 66

Self-harm

Back 66

Private way of coping with extreme emotional distress. Often follows trauma. Feel dissociation during self-harm.

Front 67

Number One Cause of Suicide

Back 67

Untreated mental disorder

Front 68

Anomie

Back 68

Feeling rootless and lacks sense of belonging.
- Emil Durkheim
- Sociological

Front 69

Psychache

Back 69

Shneidman
- Feel unendurable psychological pain and frustration

Front 70

Primary Preventions

Back 70

Broad public education programs or restricting access to suicidal means

Front 71

Secondary/Tertiary Prevention Strategies

Back 71

Preventions centres and telephone hotlines

Front 72

CBT and Suicide

Back 72

Identify and modify thoughts, images and core beliefs.