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215 Cards in this Set

  • Front
  • Back
What are the two braod types of Mood Disorder
Unipolar and Bipolar
What are the cardinal symptoms of depression?
Profound sadness and/or an inability to experience pleasure
What are the three new depressive disorders proposed in the DSM-5?
mixed anxiety/depressive disorder, premenstrual disorder, and disruptive mood regulation disorder
What are the 5 depressive disorders in the DSM-5?
1. Major Depressive Disorder;
2. Dysthmia;
3. Mixed anxiety/depressive disorder;
4. Premenstrual dysphoric disorder;
5. Disruptive mood dysregulation disorder
What are the three bipolar disorders?
1. Bipolar I;
2. Bipolar II disorder; and
3. Cyclothymia
What are 5 physical symptoms commonly found in people with depressive disorder?
fatigue, sleeping problems, decrease sexual interest, psychomotor retardation, and psychomotor agitation
What are 6 common psychological symptoms of depressive disorders?
self-recrimination, difficulty paying attention, physical symptoms, reduced initiative, social withdrawal, and neglect of appearance
How many symptoms and for how long must they be present to be diagnised with MDD?
5 symptoms for 2 weeks
Symptoms of MDD must include depressed mood or what?
loss of interest or pleasure
Why is MDD regarded as an episodic disorder?
because symptoms tend to be present for a period of time and then disappear
What are the 7 symptoms, of which 5 must be present, in the DSM-5 criteria for MDD?
1. sleeping too much or too little;
2. psychomotor retardation or agitation;
3. weight loss or change in appetite;
4. loss of energy;
5. feelings of worthlessness or excessive guilt;
6. difficutly concentrating, thinking or making decisions;
7. recurrent thoughts of death or suicide
What proportion of people who have suffered a Major depressive episode are likely to have a second episode?
two thirds
What is the average number of MDD episodes?
Each episode of MDD increases the risk of another episode by what percent?
Chronic depression is known as what?
How many symptoms and for how long must they be present to be diagnised with dysthmia?
2 symptoms for 2 years
In dysthmia what proportion of the time do people need to experience a depressed mood to meet the criteria?
more than half the time
What percentage of people with dysthmia develop MDD over a 10 year period?
The criteria for dysthmia requires that symptoms do not clear for what period of time over the 2 years?
2 months
What is the most prevalent psychiatric disorder?
Prevalence of MDD over the lifetime?
Prevalence of dythmia?
What is the Female Male ratio of MDD?
2 :1 ratio
How many times more common is MDD in low SES individuals?
three times
Is MDD or dysthmia more rare?
What is the prevalence of MDD in Taiwan and Lebanon?
1.5 Taiwan and 19% in Lebanon
Do symptoms of MDD vary across cultures?
What symptoms of MDD are common is Latino cultures and Asian cultures?
nerves & headaches in latino, and fatigue and weakness in asians
What might symptoms of MDD show cross-cultural variation?
due to cultural standards regarding acceptable expressions of emotional distress
What changes in the rates of MDD and dysthmia are found in countries with high fish consumption?
lower rates of both
In most countries did the prevalence of MDD increase or decrease steadily until the late 20th century?
Has the age of MDD onset become older or younger over time?
What percentage of people in their 60's report an experience an episode MDD by age 20?
What percentage of people in aged 18 to 29 report an experience an episode MDD by age 20?
What is the median age of onset for MDD?
late teens , early 20's
What social change may explain the increase in rates of MDD and the lower age of onset?
reduced social support structures
What percentage of people who meet the criteria for MDD during their lifetime will also meet the criteria for an anxiety disorder at some point?
What disorders are commonly comorbid with MDD?
anxiety, substance abuse, sexual dysfunctions, and personality disorders
What is the worlds leading cause of diability?
The further a person's distance from the equator the more they are at risk for developing which disorder?
There is strong evidence that depression is related to the onset and severity of which physical disease?
cardiovascular disease
IS MDD acute or chronic?
Is dysthmia acute or chronic?
Does dysthmia require more or less symptoms for a diagnosis than MDD?
What is the average duration of dysthmic symptoms?
more than 5 years
What differences in MDD symptomology are found in children vs older adults?
children often display somatic complaints, where older adults display distractibility and memory loss
Episodes of mood disorders that occur during certain seasons is known as what?
seasonal affective disorders
How does seasonal effective disorder affect depression and bipolar disorder?
in depression it typically worsens on late autumn to early spring, and for bipolar people are typically depressed in winter and manic in summer
What changes in sleep and appetite in SAD?
excessive sleep and decreased appetite
What hormone is implicated in SAD?
What is the defining feature of bipolar?
What differentiates each of the three bipolar disorders?
the severity and length of the mania
Which types of bipolar require the presence of depression and which don't?
diagnosis of depression is not required for bipolar I, but is required for bipolar II, and cyclothmic disorder
What are the three subtypes of MDD in the dSM-IV-TR?
single epsiode, recurrent, chronic substype
What 7 criteria of which 3 are required, or 4 if the mood is irritable, for a manic or hypomanic episode?
1. increased goal-directed activity or psychomotor agitiation;
2. unusual talkativeness/rapid speech;
3. flight of ideas or subjective impression that thoughts are racing;
4. decreased need for sleep; 5. increases self esteen/belief that one has special talents, powers, or abilities;
6. distractibitiity;
7. excessive involvement in acitivities that are likely to have undesireable consequences, such as reckless spending, sexual behaviour, or driving
Aside from the list of symptoms, what are criteria are required for a manic episode?
1. distincly elelvated or irritible mood for most of the day;
2. (DSM-5) abnormally increased actvity and energy;
3. symptoms later one week or require hisoitalisation;
4. symptoms cause significant ditress or impairment
What is the difference of criteria between a manic and a hypomanic episode?
Manic- required symptoms for be present for one week or require hisoptialisation, and symptoms cause significant distress or impair funcitoning; and
Hypomanic - symptoms last for 4 days, clear changes in functioning observable to others but impairment is not marked, and no psychotic symptoms are present
What is it known as when a person shifts rapidly from topic to topic?
flight of ideas
What are the two chronic mood disorders?
dysthmia and cyclothymic disorder
Which form of bipolar requires only a single manic eopisode over the lifetime?
Bipolar 1
Which form of bipolar is considered a milder form?
bipolar II
What are the two criteria for bipolar II?
a person must have experienced at least one major depressive episode, and at least one episode of hypomania
How long must mild syptoms of depression alternating with mild symptoms of mania be present for to meet the criteria for cyclothmic disorder?
2 years
How long must symptoms be present in children to diagnose cyclothmic disorder?
1 year
In the criteria for cyclothmic disorder symptoms must not clear for more than what period of time for a diagnosis?
2 months
Prevalence of bipolar I?
Prevalence of bipolar II
.4 to 2%
prevalence of cyclomythmic disorder?
What proprtion of people diagnosed with a bipolar spectrum disorders report onset before age 25?
Bipolar occurs equally in men and woman but what symptoms occur more often in women?
What proportion of people with bipolar disorder meet diagnostic criteria for a comorbid anxiety disorder?
What proportion if people with bipolar disorders meet diagnostic criteria for a comorbid substance abuse?
more than one third
What two disorders are commonly comorbid with bipolar disorder?
anxiety and substance abuse
Which type of bipolar is seen as one of the most severe forms of mental illness?
bipolar I
What percentage of the time is it estimated that people with bipolar unable to work?
What proprtion of people remain unemployed for a year after hospitalisation?
one third
One in 4 persons with bipolar 1, and one in five with bipolar II report a history of what?
suicide attempts
People with bipolar disorders are at high risk of developing what four medical conditions?
cardiovascular disease, diabetes , obesity, and thyroid disease
rapid cycling is only diagnosed for which condition?
Are the symptoms of mood disorders homogenous or heterogenous?
People with cyclothymic disorder are at a high risk of developing what?
episodes of mania and depression
How many episodes must be present each year for rapid cycling?
A person who moves in and out of depression or manic episodes describes what mood disorder subtype?
rapid cycling
Which subtype of mood disorders tends to be resistent to treatment?
rapid cycling
Which mood disorder subtype is described as having delusion or hallucinations with themes that are consistent with mood state?
mood-congruent psychotic features
Which mood disorder subtype is described as having delusions or hallucinations with themes that do not match the valence of the depressive or manic episode?
mood-incongruent psychotic features
Which mood disorder subtype involves extreme physical immobility or excessive perculiar movements?
Which mood disorder subtype involves loss of pleasure in any acitivty, an inability to gain relief from positive events, and depressive symptoms are worse in the morning?
Which mood disorder subtype symptoms that are unusual for depressive or manic episodes that are present, such as oversleeping and overeating can gain pleasure form acitivties?
Which mood disorder subtype has an onset withint 4 weeks of giving birth?
The heritability of mood disorders is what?
The poly morphisms of what type of transporter gene is thought is implicated in mood disorders?
How does mania present in children?
modd swings and irritability not as marked as in adults
Depression is fundamentally similar across the lifespan however what must clinicians look for when assessing for the presence of a mood disorders?
changes in behaviour
What comorbidity differences are found in children and adults with a mood disorder?
Adults typically comorbid with anxiety, whereas children are typically comorbid with AdHD and CD
What percentage of children with a mood disorders meet criteria for ADHD?
MDD is common in people with polymrphism of which dopamine gene?
Is it more likely to one gene or a set of genes is involved with mood disorders?
a set of genes
Which three neurotransmitters are implicated in mood disorders?
noreponephrine, dopamine, and serotonin
What is the primary function of serotonin?
regulate emotional reactions
Which of the three neurotransmitters implicated in mood disorders is thought to impact more than the others?
Are serotonin low or high in mood disorders?
Is it the balance of the neurotransmitters or absolute levels of neurotransmitters that is important in mood disorders?
balance of the neurotransmitters
Dopamine plays a role in the sensitivity of which system?
reward system
What is the name of the brain system which is believed to guide pleasure, motivation, and energy in the context of opportunities to obtain rewards?
reward system
Among people with bipolar, drugs that increase dopamine have been found to trigger what?
a manic episode
In support of the reward system, diminished dopamine functioning in people with MDD can cause what type of deficits?
pleasure, motivation and energy
People with depression are less responsive than other people to drugs that increase what?
dopamine levels
What differences in dopamine sensitivity are found among those with depression and those with bipolar?
people with depression are less sensitive to dopamine, and people with bipolar are more sensitive to dopamine
A person who has insensitive serotonin receptors is expected to experience what symptoms as levels drop?
What difference in serotonin sensitivity is found among those with depression and those with bipolar?
both conditions show a diminished sensitivitiy of the serotonin receptors
What are the four primary brain structures involved with depression?
amygdala, prefrontal cortex, sub-genual anterior cingulate, and hippocampus
What brain structure helps a person assess how emotionally important a stimulus is?
Is hyperactivity of the amygdala in people with MDD a predisposing factor or a resulting factor of MDD?
Functional brain activation studies show elevated levels of acitivity in the amygdala among people with which disorder?
Of the four brain structures implicated in MDD and bipolar 1 disorder which 2 are hyperreactive and which two have diminshed reactivity in people with MDD and bipolar?
the amygdala and sub-genual anterior cingulate show hyperreactivity, and the prefrontal cortex and hippocampus show diminshed reactivity
Brain patterns shown during mania are similar to the patterns shown during what?
Which other brain structure linked to the reward system is overly active in people with mania but not in people with depression?
People with MDD have increases reaction to emotions but a decreased ability to do what?
People with bipolar disorder often have deficits in the membranes of what which influences how readily they can be activated?
Which type of protein is abnormally high among people with mania?
protein kinase C
Which axis is involved in MDD?
Too much cortisol resutls in what sort of symptoms?
depressive symptoms
Is high or low levels of cortisol linked to depression?
What does dexamethasone do?
suppresses cortisol secretion
Dexamethasone does not adequeately suppress cortisol secretion in people with MDD and particularly in those showing what type of symptoms?
At times of stress and increased activity of the immune system what hormone is secreted to help the body prepare for threats
Dexamethasone suppresses cortisol over the course of what?
the night
The lack of cortisol suppression is seen as poor regulation of what in people ith MDD?
HPA axis
Long-term excesses of cortisol have been linked to damage and shrinkage of what brain structure?
The HPA axis manages rectivity to what?
The HPA axis receives signals from what brain structure causing it to acitivate?
Do life events typically happen before or after a depressive episode?
What percentage of people report a serious life event before the onset of depression?
42 to 67%
What are two types of life events that appear to trigger depressive episodes?
loss & humiliation
Do life events tend to trigger initial episodes of depression or subsequent episodes?
initial episodes
In what way do adequate social support networks protect against mood disorders?
adequate social support help a persons handle stressful life events
What term describes a family member's critical or hostile comments toward or emotional involvement with the person with depression?
expressed emotions (EE)
What does high EE predict?
a relapse in depression
What percentage of patients in families with high EE relapsed within one year? and with low EE?
69.5% high EE compared to 30.5% low EE
Depressive symptoms seem to eleicit what kind of reactions from others?
Interpersonal problems are a risk factor for what?
What impact can seeking reassurance from others have on a person with depression?
elicit a negative response from others which may contribute to the onset of a depressive episode
Those with anxiety and depression generally have what sort of affect?
What is the primary difference in affect between people with depression and people with anxiety?
People with depression experience a lack of positive affect while people with anxiety do not
Which personality factor tends to predict the onset of depression?
Why does neuroticism predispose people to depression?
because high neurotocism is the tendency to react to events with greater negative affect
Which cogntive theory is most influential in the aetiology of depression?
Beck's Theory
What are the three main cognitive theories implicated in the aetiology of depression?
Beck's Theory, Hopelessness Theory, and Rumination Theory
Which cognitive theory emphasises the negative triad?
Beck's Theory
What is the negative triad?
negative views of self, the world, and the future
According to Beck' Theory what do people acquire during childhood through experiences such as loss of a parent, the social rejection of peers, or the depressive attitude of a parent?
negative schema
What are schemas?
underlying sets of beliefs that operate outside of the persons awarenes to shape the way a person makes sense of his or her experiences
When is a negative schema activated?
when the person encounters situations similar to those that originally caused the schema to form
The tendency to process information in certain negative ways is known as what?
negative bias
Once activated negative schemas are believed to cause what?
cognitive bias
According to Beck's Theory people who are depressed make certain cognitive errors to arrive at what?
biased conclusions
What widely used self report instrument has been used in stidies of Beck's Theory?
DAS - Dysfunctional Attitudes Scale
People with depression have a tendency to focus on what once it is noticed?
negative information
People with depression tend to have a negative bias toward what information processing functions?
what information they attend to and retain
According to which theory the most important trigger of depression is hopelessness?
Hopelessness Theory
An expectations that desirable outcomes witll not occur and that the person has no responses available to change the situation is known as what?
Stable and global attribution about the event and it's meaning for the future or self leads to what?
What are the two key dimensions of attribution implicated in the hopelessness theory?
stable vs unstable and global vs specific causes
How does low self esteem promote hopelessness?
it undermines the confidence that a person can cope with life challenges
How does rumination contribute to the onset of a depressive episode?
it t interferes with problem solving and increases negative mood
What type types of factors have been found to predict increases in manic symptoms over time?
reward sensitivity and sleep deprivation
Being highly reward sensitive has been shown to predict what?
the onset of bipolar disorder and a more severe course of mania after onset
What type of life events seem to precipitate the onset of bipolar or a manic episode?
life events that involve attaining goals
Excessive goal pursuit may trigger what in people with bipolar disorder?
manic symptoms
Mania is intricately tied to disruptions in what?
sleep and circadian rhythms
Sleep deprivation can precede the onset of what in people with bipolar disorder?
manic episode
Protection of what daily function can help reduce symptoms of bipolar disorder?
Depression and anxiety share what?
a genetic vulnerabitilty
Interpersonal relationship can act as what for depression?
protective or risk factor
What are the four psychological treatments for depression?
Interpersonal psychotherapy, Cognitive Therapy, Behavioural Activation Therapy, and Behavioural Couples Therapy
What does IPT stand for?
Interpersonal Therapy
What idea does IPT build on?
the idea that depression is closely tied to interpersonal problems
What is the core of IPT?
to examine major interpersonal problems, such as role transitions, interpersonal conflicts, bereavement, and interpersonal isolation
What is the typical number of sessions for IPT?
What are the 5 techniques used in IPT?
1. disucssing interpersonal problems;
2. exploring negative feelings and encouraging their expression;
3. improving both verbal and nonverbal communications;
4. problem solving;
5. suggesting new and more satisfying modes of behaviour
What are the 3 goals of IPT?
helping the person identify his or her feelings about the issues, make important decisions, and make changes to resolve problems related to these issues.
Cognitive therapy is aimed at altering what?
maladaptive thought patterns
An adaption of CT called mindfulness-based cognitive therapy (MBCT) focuses on what?
relapse prevention after successful treatment for recurrent episodes of MDD
Behavioural Activation Therapy is based on what idea?
that many of the risk factors for depression can result in low levels of positive reinforcement and that increasing engagement in rewarding acitvities will alleviate depression through increased positive reinforcement
What is the purpose of behavioural couples therapy?
improve communicate and relationship satisfaction and therefore alleviating depression
What is a necessary part of treatment for bipolar disorder?
What is an inherent problem with medicating people with bipolar disorder?
high rates non adherence
What are three psychological treatments that are effective for treating bipolar disorder?
Psychoeducation, CBT and FFT
What is the aim of family focussed treatment in people with bipolar disorder?
to educate the family about the illness, enhance family communication, and develop problem solving skills
What are the two main biological treatment for MDD?
ECT and medication
What are the three types of medication used to treatment depressive disorders?
SSRI's, Mao inhibitors, and Tri-cyclic antidepressants
Which type of antidepressant is more effective in the treatment of depressive disorders?
all equally effective
Combining psychotherapy with antidepressant drugs in the treatment of depressive disorders increases the effectiveness by what perentage?
What percentage of people with depression show major improvement after taking AD medication?
50 to 70%
What is the most commonly prescribed AD medication?
What are some side effects of SSRI's?
physical agitation, sexual dysfunction, insomnia, gastrointestinal upset
What does MAO stand for?
Mono-amine oxidase inhibitor
What can sometimes be a serious temporary side effect of SSRI's particualrly found in adolescents?
increases thoughts of suicide
MAO's inhibitor block which enzyme?
Mono-amine oxidase
What are the two potential serious side effects of MOA inhibitors?
consuming anything containing tyramine can lead to hypertension, and everyday medication interactions are dangerous
What does MOA breakdown?
noreponephrine, dopamine, and serotonin
What common food and drink is tyramine found in?
wine, cheese, and beer
Which AD medication is lethal if taken in high doses?
tricyclic AD's
What are the disruptive side effects of tricyclic AD's?
blurred vision, dry mouth, drowsiness, and weight gain
Medications that reduce manic symptoms are known as what?
mood stabilisers
What is the common drug used to treat bipolar disorder?
What percentage of people receive some benefit from taking lithium?
What percentage of people who take lithium relapse within 5 years?
What are some serious side effects of lithium?
coma, and even death
What other two medications are used when lithium doesn't work?
anticonvulsives and antipsychotics
What is the main reason a person with bipolar will cease taking lithium?
because it flattens affect
When is ECT used to treat MDD?
when all other treatments and medications fail
What are the main side effects for ECT?
short-term memory loss and cognitive decline for up to 6 months
What voltage current is used in ECT?
70 to 130 volts