diagnostic criteria depressive disorders
MDD Criterion A says that 5+ symptoms have to be present for the same 2 week period. The 2 most important symptoms are:
1. depressed mood or
2. loss of interest or pleasure (anhedonia)
What is mania?
Try to think of not only what it is characterized by, but how long, and how often
A distinct period of abnormally and persistently
elevated, expansive, or irritable mood and
abnormally and persistently increased activity or
energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if
hospitalization is necessary)
Hypomania vs Mania vs Cyclothymic Disorder
2 specific points for each, but just a broad overview is fine
Hypomania = less severe form of mania; DSM criterions A-F;
at least 4 consecutive days
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Mania = characterized by presence of psychotic symptoms; DSM criterions "A-D"
at least 1 week, present most of the day, nearly every day, or any duration if there is hospitalization)
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Cyclothymic disorder = A chronic but less severe form of bipolar disorder; at least 2 years of alternating numerous periods of hypomanic and depressive symptoms that do not meet full criteria for a hypomanic or depressive episode
Symptoms present for at least half the time
Doesn't remit for longer than 2 months
general factors/perspectives in implicated in etiologies (7 mentioned)
genetics,
neurotransmitters, HPA axis,
corticolimbic brain activity,
personality, cognitive
theories, life stressors
Types of medications for MDD
(3 mentioned in slides)
antidepressants
selective serotonin reuptake inhibitors
serotonin and norepinephrine reuptake inhibitors
Name some symptoms of MDD (9 in total), and try to be more specific if you can, ex. "insomnia" is better than "trouble sleeping"
1. Depressed mood
2. Markedly diminished interest or pleasure (anhedonia)
3. Significant weight loss when not dieting or
weight gain, or decrease or increase in
appetite
4. Insomnia or hypersomnia
5. Psychomotor agitation or retardation
6. Fatigue or loss of energy
7. Feelings of worthlessness or excessive or
inappropriate guilt (which may be delusional)
8. Diminished ability to think or concentrate,
or indecisiveness
9. Recurrent thoughts of death; recurrent
suicidal ideation without a specific plan; a
specific suicide plan; or a suicide attempt
Criterion B for mania states:
B. During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behaviour:
Name at least a couple of the symptoms for this part
1. Inflated self-esteem or grandiosity
2. More talkative than usual or pressure to keep talking
3. Decreased need for sleep
4. Flight of ideas or subjective experience that thoughts are racing
5. Distractibility
6. Increase in goal-directed activity or psychomotor agitation
7. Excessive involvement in activities that have a high potential for painful consequences
"Direction" of how mood changes in depression VS bipolar:
In depressive disorders, mood changes with... meanwhile, in bipolar disorders, mood changes according to.....
depressive = unipolar ("change in mood in the direction of depression")
bipolar = cycling through periods of mania and depression
3 things that interact in etiology of mood disorders
- heritability
- life stressors
- vulnerabilities (family history, poor relationships w/ caregivers, personality patterns)
neurostimulation can be used for "treatment-resistant depression" in both MDD and Bipolar. What are their names?
electroconvulsive therapy
transcranial magnetic stimulation
Criterion A for Persistent Depressive Disorder:
PDD is a [ ] depressed mood, for at least X amount of time (differs from MDD in its definition)
chronic
2 years
criterion C for mania:
C. The mood disturbance is sufficiently severe to cause in [ ] in social or occupational functioning or to necessitate [ ] to prevent harm to self or others, or there [are/aren't] psychotic features
marked impairment
hospitalization
there are psychotic features
Fill in the blanks on the type of behaviours associated w/ each type:
Depression associated with higher scores on the behavioural inhibition system (BIS) --> regulates [ ] behaviours
Bipolar associated with higher scores on the behavioural activation system (BAS)--> regulates [ ] behaviours
Depression associated with higher scores on the behavioural inhibition system (BIS) --> regulates AVOIDANCE behaviours
Bipolar associated with higher scores on the behavioural activation system (BAS)--> regulates APPROACH behaviours
explain Beck's cognitive model for the explanation of depression and how cognitive distortions factor in
cognitive negative triad --> negative beliefs/schemas --> when a stressful life event happens, the depression is primed/activated --> more likely that stressful events will lead to depression if the event matches their initial negative belief/schema
cognitive distortions arise from this relationship between triad, automatic thoughts/schemas and life events
2 classes of medications for Bipolar
mood-stabilizing (ex. lithium, anticonvulsant, antipsychotic)
also antidepressants, but they must be used in combination with mood-stabilizers because antidepressants by itself worsen mania symptoms
Impairment is higher in MDD or PDD? In which one is there a lower response rate to treatment?
Criterion D for mania has to do with differential diagnosis. Fill the blanks:
Criterion D. The episode is not attributable to the
physiological effects of a [ ] or to another [ ].
substance (drugs or medication)
mental condition
Distinguish the 5 common cognitive distortions
1. All-or-nothing thinking
2. Overgeneralization (single negative event will occur in other situations, even if it's unlikely)
3. Magnification (certain aspects of a situation is magnified or downplayed)
4. Catastrophizing (imagining worst possible outcome)
5. Jumping to conclusions (specifically, without sufficient evidence for the conclusion)
low norepinephrine is seen in MDD, bipolar, or both?
in both bipolar + severe depression
Match the psychotherapies involved in each type of disorder (and explain what they do, if you can remember)
- Family-focused therapy (FFT), interpersonal and social rhythm therapy (IPSRT), cognitive therapy (CT) are psychotherapies for [MDD or Bipolar]
- Cognitive behaviour therapy (CBT), and Interpersonal psychotherapy (IPT) are psychotherapies for [Bipolar or MDD]
first one is for bipolar --> ex. family-focused educates family members so the patient can get support; cognitive therapy focuses on issues specific to bipolar
second is for MDD --> ex. interpersonal therapy explores how transitioning roles influences depression
PDD criterion B says 2+ of the following 6 symptoms have to be present while depressed. Name the symptoms
hint: most of it is similar/same as MDD
B. Presence, while depressed, of two (or more) of the following:
1. Poor appetite or overeating
2. Insomnia or hypersomnia
3. Low energy or fatigue
4. Low self-esteem
5. Poor concentration or difficulty making decisions
6. Feelings of hopelessness
(probably the hardest question)
what is the "rapid cycling" specifier criteria(s) for bipolar I and II?
For bipolar I: Presence of four or more manic, hypomanic, or major depressive episodes in a 12-month period
For bipolar II, only hypomanic or depressive episode
2 main differences in Bipolar I vs II
I = at least 1 manic episode
major depressive episode or hypomanic episode not required for diagnosis
II = at least 1 hypomanic (and it never reaches the level of manic)
at least 1 major depressive episode
3 neurotransmitters implicated in these disorders and list some ways in which these NTs affect the disorders (range of possibilities)
no need to be 100% correct
Low NE: bipolar disorder + severe major depression
- Few 5-HT receptors in major depression
- DA neurotransmission partly depends on the level of 5-HT
- DA linked to regulation of reward processing (experience of pleasure) and motor behaviour
(psychomotor retardation)
- Depression: anticipation and extending effort to obtain reward--> reduced DA
- Bipolar (mania): anticipation and consuming reward --> higher activity in DA-receptor-rich areas
Difference btwn Melatonin vs Phototherapy
Used in treating which disorder?
melatonin has been found to not work
seasonal affective disorder (SAD) or "seasonal pattern"