Week 5 Abnormal Psych

Front 1

What are the 9 symptoms of Major Depressive Disorder.

Back 1

1. Depressed mood most of the day nearly every day. (Children can be irritable mood)

2. Diminished interest/ pleasure in activites

3. Significant weight loss/ gain

4. Insomnia/hypersomnia

5. Psychomotor agitation (restlessness) or retardation observation by others

6. Fatigue or loss of energy nearly daily

7. Feelings of worthless or excessive/inappropriate guilt

8. Decreased ability to think/ concentrate or indecisiveness

9. Recurrent thoughts of death, suicidal ideation

Front 2

At least one of which two symptoms are required for the diagnosed?

Back 2

Either (1) depressed mood or (2) loss of interest or pleasure

Front 3

What is the time period during which these symptoms must be present to get this diagnosis.

Back 3

Same 2-week period

Front 4

Can one get the diagnosis of MDD if one is using CNS depressants such as alcohol or other abused substances?

Back 4

No, can have these symptoms from drinking.

Front 5

If a patient has had an episode of mania, can they receive a diagnosis of MDD.

Back 5

No, once they have episode of mania cannot.

Front 6

Define "anhedonia"

Back 6

Inability to experience pleasure

An- without

Hedon- pleasure seeking

Front 7

What symptoms are especially associated with the risk of suicide?

Back 7

Hopelessness and helplessness makes one susceptible to suicidal ideation.

Front 8

Point prevalence of MDD. Lifetime risk of MDD.

Back 8

Pp= overall 13%

Lt= 20%

Front 9

Median age of diagnosis of MDD in the US. Has this age been increasing or decreasing since the early 1900's.

Back 9

40's decreasing to 26.

Front 10

Are women or men more often diagnosed with MDD.

Back 10

Women:Men (22%:13%)

Hint 10

Children before puberty, boys=girls

Front 11

Are boys or girls (before puberty) more likely to be diagnosed with MDD.

Back 11

Neither after puberty girls double

Front 12

Average duration of untreated first episode of MDD?

Back 12

Untreated average duration = 4 months

Front 13

What % of people who experience a first episode of MDD will go on the experience a second.

Back 13

Approximately 50% will have at least 1 more.

Front 14

Describe the symptoms associated with depression. Place each into one of the five categories of functioning described in class (emotional, motivational, behavioral, cognitive, physical)

Back 14

Emotional- tend to lose sense of humor, lose ability to take pleasure in activities they used to take pleasure in, anxiety, anger, agitation, "sad, miserable, empty"

Motivational- lack of drive, initiative, spontaneity, force themselves to go to work, talk to friends, eat, have sex with partner

Behavioral- often less active, less productive, may move and/or speak more slowly, often spend more time alone, more time in bed.

Cognitive symptoms- often consider themselves inadequate, undesirable, inferior, self-blame for events they had little to nothing to do with, rarely credit themselves for accomplishments, pessimism, helplessness to change their lives, procrastinate. Hopelessness and helplessness makes susceptible to suicide ideation.

Cognitive- depressed intellectual functioning, memory problems, easily distracted, perform poorly on tasks of memory, attention, and reasoning.

Physical- PAIN - muscle pain, headaches, bowel issues (constipation, diarrhea), problems with appetite (increase or decrease,) and sleep (too much, too little)

Front 15

How does severity of first episode of MDD relate to likelihood of persistent of this disorder?

Back 15

The severity of initial episode appears to predict persistence.

Front 16

Do subsequent episodes of MDD require the same level of stressor as the first?

Back 16

First episode of MDD often follows a severe psychological stressor (death,divorce).

The more often one experiences MDD episode the easier to slip into another each time.

Hint 16

Kindling effect

Front 17

What is the likelihood of MDD in people who have a first degree relative with this disorder?

Back 17

1.5 - 3 times more common among first-degree relatives.

22% lifetime risk for women × about 2 with 1st degree relative = 44%

13% life risk for men × about 2 with 1st degree relative = 26%

Front 18

What other disorders are often seen in relatives of patients with MDD?

Back 18

People with MDD have a high probability of relatives with depression as well as anxiety, ADHD, OCD, eating d/o, headaches, irritable bowel syndrome.

Front 19

Why do people with MDD have an increased rate of premature death?

Back 19

Large % with co-morbid medical illness. Increased rate of premature death from medical conditions - lack of self-care.

Front 20

Proband

Back 20

Person who is the focus of a genetic study

Front 21

Do people with MDD have an increased risk of other mental disorders? Name a few.

Back 21

Large % with co-occurring mental disorders - substance abuse, panic d/o, OCD, anorexia, bulimia, borderline PD

Front 22

Describe the sleep disturbances commonly seen with MDD.

Back 22

Intermittent waking, early morning waking, reduced deep sleep.

Hint 22

Evidence that in some patients this may precede the onset of MDD or persist after remission.

Front 23

Diathesis-stress model and related to MDD.

Back 23

Front 24

Why is it believed that women (after puberty) experience twice the incidence of depression vs. Men?

Back 24

Estrogen and progesterone have been shown to affect brain regions associated with mood.

Fluctuations in sex hormones

Front 25

During what part of the menstrual cycle does Premenstrual Dysphoric Disorder occur? What causes this and what are the symptoms? What is the prevalence of PMDD?

Back 25

Occurs during times of progesterone and estrogen instability - last 7-10 days of menstrual cycle.

Symptoms= mood lability, depressed mood, irritability.

Prevalence 3-9%

Front 26

What other disorders do we check for in women who present with PMDD

Back 26

Dysthymia and depression are commonly co-morbid with PDD (about 40%)

Premenstrual exacerbation (make worse) of an underlying mood or anxiety disorder

Front 27

Prevalence of Post-Partum depression (PPD)? What causes this disorder?

Back 27

4.4-9%, Abrupt decrease in estrogen and progesterone may trigger a depressive episode in women at risk.

Front 28

What women are at highest risk for PDD?

Back 28

Highest risk in women with a history of depression pre- or mid-pregnancy.

Increased risk in women with a family history of mood disorders

Front 29

When do we usually (but not always) see the onset of PPD? Describe the symptoms of this disorder. What is the likelihood of experiencing a second episode with a subsequent birth?

Back 29

Usually begins within 4 weeks of birth extreme sadness, tearfulness, anxiety, intrusive thoughts, insomnia, feelings of inability. 25-50% recurrence rate with subsequent births.

Front 30

Do women have increased risk of MDD during menopause? Why?

Back 30

Yes, alot of hormone fluctuation while the ovaries flutter out.

Front 31

What neurotransmitters have been linked to MDD? Are these thought to be high or low in patients with MDD?

Back 31

Low levels of serotonin and/or norepinephrine linked to MDD. Believed now that a complex interaction between 5HT and NE and likely many other neurotransmitters is responsible.

Front 32

Name the four areas believed to be involved in the formation of MDD and how each area is thought to contribute to the disease. What neurotransmitter receptors are in high concentration there?

Back 32

Prefrontal cortex, hippocampus, amygdala, Brodmann Area 25 - these areas have abundant 5HT receptors.

Front 33

Explain the 'behavioral view' of the development of MDD

Back 33

When positive rewards dwindle, people perform fewer and fewer constructive behaviors leading to fewer positive rewards and eventually, depression.

Front 34

Describe the "Negative Thinking" cognitive theory of the development of MDD. Explain Beck's "Cognitive Triad of Maladaptive Thinking." What are "Automatic Thoughts" according to Beck.

Back 34

People with MDD view events in negative ways and that such perceptions lead to MDD.

COGNITIVE TRIAD: they interpret the following in negative ways that make them feel depressed:

1. Their experiences

2. Themselves

3. Their futures

AUTOMATIC THOUGHTS - a steady train of unpleasant thoughts that keep suggesting to them that they are inadequate and their situation is hopeless.

Front 35

Describe the "learned helplessness" cognitive theory of the development of MDD.

Back 35

1. They no longer have control over reinforcements in their lives

2. They themselves are responsible for their helpless state

Front 36

Explain the "attribution-helplessness theory". What do people attribute their feelings of lacking control in their lives to.

Back 36

People attribute their present lack of control to some INTERNAL CAUSE that is GLOBAL and STABLE. Leads to a sense of helplessness.

Front 37

If one attributes a difficult situation in ways that are external and specific how would this effect their thoughts of outcomes in the future?

Back 37

They are less likely to experience depression.

Front 38

Describe the DSM-V criteria for Dysthymic Disorder. What is the length of time having these symptoms required to recieve the diagnosis?

Back 38

1. Depressed mood for most of the day, for more days than not, for at least two years.

2. Presence, while depressed, of at least two of the following; poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, feelings of hopelessness.

3. During the two-year period, symptoms not absent for more than two months at a time.

4. No history of a manic or hypomanic episode.

5. Significant distress or impairment.

Front 39

Is treatment of MDD frequently successful?

Back 39

Most successfully treated

Front 40

Explain the psychodynamic approach to the treatment of MDD.

Back 40

Unconscious grief over real or imagined loss, compounded by excessive dependence on other people, psychodynamic therapists seek to help clients bring these underlying issues to consciousness and work through them.

Front 41

Explain the behavioral approach to the treatment of MDD. Describe behavioral activation.

Back 41

Mood is tied to rewards adding pleasurable activities is called behavioral activation

1. Reintroduce clients to pleasurable activities,

2. Reinforce non-depressed behaviors and do not reinforce depressed behaviors (family members may be asked to help), and

3. Help them improve their social skills

Front 42

Explain the cognitive and cognitive behavioral approach to the treatment of MDD.

Back 42

Help clients recognize and change their negative cognitive processes and therefore improve their mood. Usually includes behavioral techniques as well.

Front 43

Review the cognitive triad and the concept of automatic thoughts.

Back 43

Maladaptive attitudes lead people to view themselves, their worlds, and their futures in negative ways. These biased views combine with illogical thinking to produce automatic thoughts - unrelenting negative thoughts that produce depression.

Front 44

Describe the four phases of CBT for MDD.

Back 44

Phase 1- increasing activities and elevating mood - make a schedule

Phase 2 - challenging automatic thoughts - educate them about the thoughts. Recognize and record the thoughts as they occur and bring these lists to each session. Therapist and client test the reality behind these thoughts.

Phase 3 - identify negative thinking and biases - as people begin to recognize the negative automatic thoughts, the therapist begins to discuss how the illogical cognitions contribute to the automatic thoughts.

Phase 4 - changing primary attitudes- Therapists help clients change the maladaptive attitudes/ thoughts - their viewing of themselves, the world, and their futures in negative ways. Client may be asked to test their attitudes.

Front 45

How effective is CBT for MDD?

Back 45

50-60% show a near-total elimination of depressive symptoms.

Front 46

Describe acceptance and commitment therapy

Back 46

Clients are guided to recognize and accept their negative thoughts as streams of cognitions that flow through the mind rather than as guides for behavior and decisions.

Hint 46

JUST THOUGHTS

Front 47

What were the first meds used for treatment of MDD? What is a major problem with this group of meds.

Back 47

Tricyclic Antidepressants (Serotonin- NE reuptake inhibitors. Interact with MANY other receptors and therefore have MANY side effects.

Front 48

What is the most common group of drugs used today for the treatment of MDD?

Back 48

Selective Serotonin Reuptake Inhibitors SSRI's

Hint 48

Prozac

Front 49

How do 5HT-NE reuptake inhibitors work?

Back 49

Increase both 5-HT and NE in the brain

Hint 49

Venlafaxine

Front 50

How does wellbutrin work?

Back 50

Ne-Da Reuptake inhibitor - antidepressant on it's own but often used in addition to an SSRI. Not associated with weight gain or sexual dysfunction.

Also blocks nicotine receptors and is used as a smoking cessation

Front 51

Do antidepressant medications work for everyone? Who has the highest success rate with these medications?

Back 51

Dont work for everyone. Failure rate likely highest in the mild-moderate depression group.

Front 52

Describe Electroconvulsive Therapy. What is one of the main problems with this therapy today? A patient with what type of MDD disorder is most likely to be helped?

Back 52

Two electrodes are attached to thr patient's head, 65-140 volts are passed through the brain for a half sec or less. Results in a seizure that last 25sec to a few min.

6-12 treatments in 2-4 weeks

Memory loss

Severe MDD

Front 53

Describe Transcranial Magnetic Stimulation. Is it thought to be effective?

Back 53

Electromagnetic coil on or above the patient's head. Sends a current into the prefrontal cortex. TMS increases neuron firing in the area under the magnet (so, prefrontal cortex)

Administered daily for 2-4 weeks.

New studies showing effectiveness comparable to ECT in patients with severe depression without the trauma.

Front 54

Describe the symptoms of a manic episode. How long does one need to be experiencing these symptoms to recieve the diagnosis?

Back 54

They need to be experiencing them for one week patients mood is abnormally and persistently euphoric or irritable.

Symptoms:

1. Grandiosity/exaggerated self-esteem

2. Reduced need for sleep and usually have more energy

3. Pressured/ rapid speech or increased talkativeness

4. Flight of ideas - racing thoughts

5. Easy distractibility

6. Increased goal directed activity - increased psychomotor activity

7. Seriously poor judgement

Front 55

Describe the five areas of functioning used to describe the symptoms of mania. Give examples of each.

Back 55

Emotional - lack of restrictions, lack of fear, lack of awareness of any consequences

Motivational - want constant involvement, excitement, should be at top of their field with no experience

Behavioral - very active, may talk rapidly and loudly. Become very vocal, dangerous activities, lots of spending, increased libido.

Cognitive - poor judgement and planning, dont listen to others, inflated self of others.

Physical - very energetic, typically get little sleep but do not feel tired.

Front 56

Do people who are experiencing a manic episode retain insight? Why is this important?

Back 56

FEW RETAIN INSIGHT, manic episodes often continues until they are hospitalized or jailed.

Front 57

What are the three major diagnostic subtypes of bipolar disorder? Describe each.

Back 57

1. Bipolar I - bouts of depression mixed at least one manic episode. Men = women, cross-cultural

2. Bipolar II - bouts of depression mixed with hypersomnia. Women > men

3. Mixed mania - patient has met criteria for both MDD and Mania nearly everyday for a week or more rage, high degree of suicidal ideation

Front 58

Define rapid cycling bipolar disorder

Back 58

If clients experience four + episodes/ year their disorder is labeled "rapid cycling"

Front 59

Define cyclothymic disorder

Back 59

Basically a mild form of bipolar disorder

Numerous periods of hypomanic and depressive symptoms that do not meet the criteria. For at least 2 years.

Front 60

What is the average amount of time between onset and actual diagnosis of bipolar disorder?

Back 60

Earlier than MDD. Bipolar onset often in late teens but can be as late as mid 40's. On average 12-20 years between onset of symptoms and diagnosis.

Front 61

Lifetime prevalence of bipolar disorder? Women or men more likely to be diagnosed? Most common age of onset?

Back 61

3-5%, men=women, late teens

Front 62

Why is family/friend support so important for patients with bipolar disorder?

Back 62

Because of lack of insight/poor judgement, BP patients tend to go off meds. Helps to have someone who knows what to look for.

Front 63

Is there a genetic predisposition In bipolar disorder?

Back 63

Yes likely a genetic disposition combined with environmental stressors.