CLP4143 Exam 2 Mood Disorders Symptoms of a Major Depressive Episode must have at least five of the nine symptoms and one of the core symptoms Depressed mood occurring most of the time within two weeks Anhedonia loss of interest in things you once enjoyed Appetite or weight changes some experience increased appetite others experience decreased appetite Sleep problems hypersomnia insomnia different from the norm for that person Psychomotor changes psychomotor retardation slowing down movement speech psychomotor agitation speeding of movement fidgety speech Loss of energy Feelings of worthlessness Concentration problems difficulty focusing on one topic Suicidal thoughts Major Depressive Disorder At least one major depressive episode Not better accounted for by another disorder i e postpartum depression No history of manic or hypomanic episode Persistent Depressive Disorder More chronic can be less severe At least two symptoms of Major Depressive Episode for at least two years Prevalence rates MDD about 1 in 6 people PDD about 1 in 20 people MDD is 2x more common in women than in men Increasingly less common MDD cases as age increases Biological theories for Depressive Disorders Neurotransmitters individuals will be low in o Serotonin o Norepinephrine o Dopamine more rarely involved in reward reinforcement anhedonia Genetic factors serotonin transporter gene o long allele more common o short allele still fairly common more frequently associated with MDD higher probability of depression with childhood maltreatment Psychological theories for depressive disorders Behavioral theories of depression o Reduced positive reinforcers behavioral withdrawal Cause each other downward spiral o Learned helplessness situation out of a person s control causes them to emotionally withdraw predictable punisher if bad things happen and there s nothing you can do to avoid those things Accidental punishers people will withdraw o Unpredictable negative events serve as punishers cause behavioral withdrwal Cognitive theories of depression o Negative cognitive triad Beck 1967 Self I m incompetent and undeserving World the world is hostile Future I will always be in emotional pain o Causal Attributions believe causes of negative events are stable internal and global more likely to have depression I got into that car accident because nothing will work out for me global Expands nothing I won t ever be able to change stable It must be my fault internal Drug classes used to treat depression Selective Serotonin Reuptake Inhibitors SSRIs most widely used medication o Relief within a couple of weeks o Less severe side effects better tolerated o Increase amount of serotonin in brain by decreasing uptake Don t start working until about two weeks into treatment Selective Serotonin and Norepinephrine Reuptake Inhibitors SSNRIs o Similar advantages as SSRIs but has more stimulant effects Monoamine Oxidase Inhibitors MAOIs Problems o Fatal interactions with other meds o Can cause liver problems weight gain Tricyclic Antidepressants Problems o Numerous side effects Goals of primary psychological treatments for depressive disorders Cognitive behavioral therapy 1 Cognitive change negative thinking ex Black and white thinking 2 Behavioral increase positive reinforcers behavioral activation 3 Behavioral improve social rhythms and sleep hygiene 4 Both identify triggers and problem solve Interpersonal therapy IPT Goal identify and address 1 of 4 interpersonal sources of depression 12 16 sessions o Grief loss o Role disputes done with one or two other people o Role transitions adjustment situations ex Someone leaving to college OR empty nesters figure out who they want to be in this new stage of their life o Interpersonal skills deficits small conflicts with many people in their lives as opposed to big problems with 1 or 2 people in their lives Key features of a Manic Episode with regard to Mood Distinct period of elevated or irritable mood Time for at least one week Impairment marked impairment dangerous to themselves or others Hypomanic episode Some impairment but not marked Distinct period of elevated mood or irritability for at least four days No psychotic symptoms No hospitalization Bipolar I Disorder more serious Marked impairment OR hospitalization required At least 7 days can be less if hospitalized Bipolar II Disorder hypomanic episodes NO marked impairment hospitalization NOT required At least four days No FULL depressive episode Bipolar disorders Biological theories Genetic factors Brain differences size and activity o Amygdala larger more active o Prefrontal cortex smaller less active o Striatum more active when they are in the presence of a rewarding stimulus o People are more likely to take risks to reach this reward ex Gamble Psychological theories Greater sensitivity to reward Stressful life events o May be trigger for new episodes Changes in social rhythms or usual routines ex When we re stressed we many skip a meal skip a workout skip a couple hours of sleep in order to study Biological treatments Mood stabilizers o Lithium Anticonvulsants Atypical antipsychotics Psychological treatments Treated as chronic condition patients remain on medication throughout life Interpersonal and social rhythm therapy combine interpersonal and behavioral techniques to help maintain routine Cognitive behavioral therapy address problematic cognitions to reduce vulnerability to depression and mania Suicide Suicide vs Self harm Self harm non suicidal self injury no intent to die Suicide attempt intent to die Gender difference with respect to deaths by suicide and suicide attempts Women are 3x more likely than men to attempt suicide Men are 4x more likely to die by suicide Ethnic differences In US most likely that whites will die by suicide Risk factors warning signs Single most potent factor if someone has attempted suicide before Others include Mental disorders Social isolation Family history of suicide suicide attempts Men 4x more likely to die than women Victim or perpetrator of episode of violence Caucasian Trauma history history of aggression Trait impulsivity o More impulsive more difficulty with emotion regulation more likely to take drugs more likely to get into physical fight violence Interpersonal theory of suicide Three factors give rise to death by suicide Thwarted belongingness I don t belong anywhere Perceived burdensomeness believe that other people would be better off if they were dead Death will be worth more than
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