FSU CLP 4143 - Chapter 7: Mood Disorders

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Grief, LossCriteriaBipolar IBipolar IIFatal InjuryUnit 2: Chapters 7,14Chapter 7: Mood DisordersAxis I Mood Disorders1. Unipolar:a. Major Depressionb. Persistent Depression2. Bipolar:a. Bipolar Ib. Bipolar IIc. CyclothymiaThe criteria for mood disorders require the presence (or absence) of Mood Episodes:Major Depressive EpisodeManic Episode: One week or more of irritable mood.Hypomanic Episode: Four +Days of elevated or irritable mood Major Depressive Episode (5 or MORE symptoms needed to diagnose a Major Depressive Disorder):Cognitive symptoms:1. Concentration problems2. Thoughts of death or suicide3. Thoughts of worthlessnessEmotional symptoms (must have at least one of these):1. Depressed mood2. Loss of interest or pleasureBiological symptoms:1.Increase or decrease in appetite/weight2. Sleep disturbances3. Psychomotor changes4. Loss of energyWe all feel sad at times, therefore the duration of sadness is critical when diagnosing someone with MDD.Presence of a major depressive episode (2 weeks)Not better accounted for by another disorderNo history of manic, mixed or hypomanic episodesPersistent Depressive Disorder (Less severe, but more chronic [Eeyore])Cognitive symptoms:1. Concentration problems2. Thoughts of worthlessnessEmotional symptoms (must have at least 2 of these to be diagnosed PDD):1. Depressed mood2. Loss of interest or pleasureBiological symptoms:1.Increase or decrease in appetite/weight2. Sleep disturbances3. Psychomotor changes4. Loss of energyMajor Depression: Major spikes are NOT normal (Hence major depression)Double Depression= Major DepressionBasically long term persistent depression that dips deeper into major depressionDepression facts:16% lifetime prevalence2x more common in women than men.Leading cause in disease burden (productivity loss)Age differences:Rates are lowest in people over 60 bc:Less willing to report symptomsDifficult to make diagnosisDepressed people don’t live past 60 yearsAdaptive coping skillsHigher rates in people 15-29 because Drastic change in hormones, experimentation, transitions, stakesHigh rates in 85+ due to fear of death, boredom, abandonment, loss of loved ones, feeling of uselessness/hopelessness Biological Theories of Depression : Serotonin transporter gene- First degree relatives of people with unipolar depression are two to three times more likely to also have depression than are the first-degree relatives of people without the disorder, serotonin is one of the neurotransmitters implicated in depressiono Gene by environment interactiono S/S=double short alleleso S/L=heterozygous allele o L/L (preferred)=double long allelesDiathesis stress (no maltreatment, probable maltreatment, severe maltreatment)Epigenetics- environment decides which genes are expressedNeurotransmitters- Serotonin (5-ht)/ Norepinephrine are important in regulating our emotions (mood)- Dopamine: rewards system, pleasure, loss experience, disgustProblems in production and regulation of serotonin & norephinephrine  depression- Decreased synthesis- Abnormalities in transport- Increased degradation by synaptic enzymes (enzymes eat neurotransmitter)- Impaired release or reuptake - Abnormalities with receptorBrain abnormalities -Prefrontal cortexo Problem solvingo Decision makingo Concentrationo Motivationso Coping mechanisms-Anterior cingulatedo Fight or flighto Overactive stress responseo Social interactions-Hippocampus o Memory – stronger memories of negative things  stresso Criticism  rumination-Amygdalao Emotions – fear/anger/dangero Identifies the emotional value of your environment – determines threato Overactive amygdala  pay more attention to negative thingsNeuroendocrine factors- Hypothalamic-pituitary-adrenal axis (HPA)o Elevated levels of cortisol in depressed individualso Interacts with amygdala, hippocampus, & cerebral cortex  inhibits neurotransmitter receptorsBiological Treatments for Depression:Drug treatments- MAOI (Monoamine Oxidase Inhibitors)o Prevents degredationo Problems: Fatal interactions with other meds Liver damage, weight gain Fatal in overdose- Tricyclic Antidepressants:o Increases seratonin and norepinephrineo Problems: Numerous side effects Fatal in overdose- SSRI(Selective Serotonin Re-uptake Inhibitors)o Increases the amount of serotonin in the synapseo Most widely used medication: Relief within a couple of weeks Less severe side effects (better tolerated) Not fatal in overdose Better for suicidal patients- SSNRI(Selective Serotonin and Norepinephrine re-uptake Inhibitorso Like SSRI but more stimulant  too impulsive and pumped up- ECT(electroconvulsive therapy)o Only on the right side of the braino Given to patients who DON’T respond to medicationo 6-12 sessionso Relieves depression in 50-60%, but 85% relapseo MEMORY LOSS!- VNS(Vagus Nerve Stimulation:o More serotonin and norepinephrineo 30-40% substantial relief, 30% minimal relief- rTMS(Repetitive Transcranial Magnetic Stimulation):o re-polarize the neurons to increase serotonin and norepinephrine o Few side effectso Patients remain awake (unlike ECT)All treatments increase neurotransmitters within the synapsePsychological Theories of Depression:- Behavioral Theories:o Life stress reduces positive reinforcers, individual withdrawso Learned helplessness: uncontrollable life stressors create a belief that individual has no control- Cognitive Theories of Depression:o Negative Cognitive Triad: Negative thoughts about the Self, World, Future Depressed individuals exhibit errors in thinking, which negatively affects moodo Reformulated learned helplessness theory Causal attribution errors Believe causes of negative events are stable, internal, and global (things will never change, it’s my fault, I suck at everything) (-/+) Thoughts emotions  behaviorso Example: Jenny lost her job after 3 years…. Internal causal attribute:– “It must have been my fault, I didn’t work hard enough on myassigned projects” Stable causal attribute:– “I am not smart enough to do this kind of work and I never will be” Global causal attribute:– “I am never going to be able to maintain a job”- Interpersonal Theories of Depressiono Rejection Sensitivity  Easily perceive rejection from otherso Excessive reassurance seeking Constantly look for reassurance from others.Psychological Treatments for Depression:Goals:1. Cognitive – Change negative thinking2. Behavioral – Increase positive


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FSU CLP 4143 - Chapter 7: Mood Disorders

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