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72 Cards in this Set
- Front
- Back
Unipolar Mood Disorder
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Change in mood in direction of depression
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Bipolar Mood Disorder
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Periods of depression cycling with periods of mania
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Major Depressive Disorder (MDD)
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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. |
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Depressed Individual with Commorbid Conditions
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Experience more sever and chronic depression and show slower and less complete response to treatment
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Dysthymic Disorder
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Chronic low mood lasting for 2 years.
- Many experience "double depression" recurrent MDD episodes and chronic low mood |
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Major Depression with Poor Inter-episode Recovery
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Episodes of major depression that fail to remit successfully
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Chronic Depression
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High levels of impairment, younger age of onset, high commorbidity and strong family history.
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Mania
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Elevated, expansive or irritable mood lasts at least one week
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Hypomania
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Less severe, similar number of symptoms present for only 4 days
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Mixed State
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Manic/hypomanic and depressive symptoms at same time
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Bipolar I Disorder
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One or more manic episodes with or without one or more depressive episodes.
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Bipolar II Disorder
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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 |
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DSM Proposed to require specification of one of the following subtypes of bipolar disorder
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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 |
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Cyclothymia
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Chronic but less severe form of bipolar disorder.
- At least 2 years alternating hypomanic episodes and depression episodes. At risk for developing bipolar disorder |
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Rapid Cycling Bipolar Disorder
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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 |
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Ultrarapid Rapid Cycling Bipolar Disorder
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Cycling every few days
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Ultra-radian Rapid Cycling Bipolar Disorder
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Cycling daily
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Seasonal Affective Disorder
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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. |
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Postpartum Depression
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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). |
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Psychodynamic Theories
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Relationships between parent and children important in shaping temperament.
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Dependency
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Rely excessively on interpersonal relationships for identity. Needy and fearing.
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Self-Critical
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Fears of failure, self blame, inferiority and guilt.
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Cognitive Distortions
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1. All or nothing thinking
2. Overgeneralization 3. Magnification 4. Jumping to conclusions |
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Schemas
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Hypothetical structures in the mind, core beliefs about self, world and future (cognitive triad).
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Diathesis-Stress Model
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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.
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Interpersonal Relationships
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Deficient social skills, interactions with others are negative, less eye contact, less animated face.
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Negative Feedback Seeking
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Actively seek out criticism and other negative interpersonal feedback from others.
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Excessive Reassurance Seeking
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Seek assurance about ones worth and lovability. Doubt sincerity or reassurance.
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Stress Generation Hypothesis
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Generate stressful life events in interpersonal domain. Contribute to occurrence in these event due to their maladaptive interpersonal behaviours.
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Childhood Trauma
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Early maltreatment internalized by child as negative schemas.
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Genetics
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Serotonin transporter gene, greater serotonin and activity of gene if long allele. Show effect in MDD by increased reactivity to stress (if short allele)
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Neurotransmitters
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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 |
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5-HT
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Serotonin, normal levels inhibit certain behaviors
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DA
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Dopamine, regulation of reward processing and motor behaviours.
- Low levels= reduction in capacity to feel pleasure and psychomotor retardation. - Abnormal levels = hyperactive and psychosis |
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NE
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Norepinephrine, abnormal levels lead to euphoria and grandiosity
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Hypothalamic-Pituitary-Adrenal Axis (HPA)
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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.
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Sleep Neurophysiology
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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.
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PET Scans
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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.
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MRI Scans
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Uncovered neural circuits involved in cognitive emotional deficits of depressed.
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Multi-site Randomized Control Trial
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Compared cognitive behavioural therapy, interpersonal therapy, antidepressant and placebo pill.
- No different in efficacy among CBT, IPT and anit depressant, All better than placebo. |
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Cognitive Behaviour Therapy for Depression
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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 |
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Interpersonal Psychotherapy for Depression
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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 |
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Tricyclic Antidepressants
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Oldest
- Block reuptake from synapse of NE and/or 5-HT. More of these available. - Manny side effects - Highly lethal overdose |
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Monoamine-Oxidase Inhibitors
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Inhibit enzyme that breaks down neurotransmitters. More monoamines available.
- Dangerous side effects - Limits intake of foods with amines - Avoid cold medicines with pseudoephedrine |
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Selective-Serotonin Reuptake Inhibitors
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First line of treatment for unipolar
- Mild side effects - Block reuptake of serotonin, more 5-HT |
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Other Antidepressants
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- Serotonin-NE reuptake inhibitors
- Increase dopamine transmission - Other misc actions on other neurotransmitters (ex: GABA) |
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Lithium
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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 |
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Anticonvulsants
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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 |
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Antipsychotics
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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) |
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Tardive Dyskinesia
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Irreversible effect of anti-psychotics
- Involuntary, dyskinetic movements. - Increased risk with duration and cumulative dose |
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Antidepressants (for treatment of bipolar)
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To treat depressive phase of bipolar.
- Buproprion less likely to trigger manic episode - All risk triggering mania - Use in conjunction with mood stabilizer. |
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CBT, IPT and Medication
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- 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 |
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Adjunctive Psychotherapy for Bipolar
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Most effective for treating bipolar is meds.
- Family focused therapy (Mikowitz) - Interpersonal therapy and Social Rhythm Therapy (Frank) - Cognitive Therapy (Lam) |
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Family Focused Therapy for Bipolar
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Communication and problem solving, fewer new onsets. More likely to stay on meds.
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Interpersonal and Social Rhythm Therapy for Bipolar
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Disruptions in daily routines and conflicts in interpersonal relationships can cause relapse.
-Teach to regulate routines and cope better with stress. |
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Cognitive Therapy for Bipolar
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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. |
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Phototherapy
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Stimulate sunlight to regulate melatonin production.
-Remission, should be on mood stabilizer if bipolar SAD |
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Treatment Resistant Depression
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Failure to achieve remission following at least 2 trials or antidepressant meds at appropriate dose and duration.
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ECT
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First line of treatment only for treatment of resistant depression or depression with severe life threatening symptoms where immediate response in desired.
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Transcranial Magnetic Stimulation
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Electric current created magnetic pulse, non-invasive and painless.
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Vagus Nerve Stimulation
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Pulse generator sends electrical signals through wire to nerve then brain. Permanent implant. Increase release of Ne and 5-HT and increases blood flow.
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Deep Brain Stimulation
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Implant wires into brain, deliver dose of electrical current to brain
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Suicidal Ideation
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Thoughts of death and plans of suicide.
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Suicidal Gestures
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"Parasuicide"
- Suicide attempts, clearly not life threatening to alter other of their suffering. |
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Suicide Attempt
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Carrying out of suicide plan which is unsuccessful, but clear intent to die.
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Self-harm
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Private way of coping with extreme emotional distress. Often follows trauma. Feel dissociation during self-harm.
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Number One Cause of Suicide
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Untreated mental disorder
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Anomie
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Feeling rootless and lacks sense of belonging.
- Emil Durkheim - Sociological |
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Psychache
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Shneidman
- Feel unendurable psychological pain and frustration |
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Primary Preventions
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Broad public education programs or restricting access to suicidal means
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Secondary/Tertiary Prevention Strategies
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Preventions centres and telephone hotlines
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CBT and Suicide
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Identify and modify thoughts, images and core beliefs.
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