PSY240: - L12&13&14

Reading §

1. Describe the symptoms and clinical features of the major unipolar and bipolar mood disorders.
   • Depressive disorders involve a change in mood to depression, and include major depressive disorder (MDD) and dysthymia.
   • Symptoms of MDD include persistent feelings of sadness, loss of interest in activities, loss of appetite or weight loss, insomnia, low energy, feelings of worthlessness or guilt, difficulty concentrating or making decisions, and suicidality. At least five of these symptoms must be present for at least two weeks, although episodes of MDD typically last for several months.
   • Symptoms of persistent depression are chronic feelings of sadness that persist for at least two years, plus at least an additional two depressive symptoms.
   • Bipolar disorders involve alternating periods of depression and mania, and include bipolar I disorder (mania alternating with episodes of major depression), bipolar II disorder (hypomania alternating with episodes of major depression), and cyclothymia (hypomania alternating with minor episodes of depression).
2. Explain how biological, psychological, and environmental factors can work together to cause mood disorders.
   • Mood disorders are caused by the interaction of psychological, environmental, and biological variables.
   • Early psychodynamic views of depression saw it as stemming from an unresolved regression to the oral stage of development following a real or imagined loss. More recent psychodynamic theories have focused on disruptions of early parent–child attachment and the development of pathological adult relationships.
   • Cognitive models stress the role of negative thinking patterns that derive from rigid and tightly connected negative schemas about the self, world, and future.
   • Interpersonal models point to specific maladaptive behaviour patterns that depression-prone individuals engage in, ones that heighten risk for interpersonal conflicts and rejections to trigger depression.
   • Life stress models propose that depression occurs when a stressful event in the environment triggers an underlying biological or psychological diathesis.
   • Biological models of the mood disorders have focused on the role of genetics, neurochemistry, and brain function and structure. Both major depression and bipolar disorder have a strong genetic component, and this may be mediated at least in part by the role of the serotonin transporter gene in heightening sensitivity to stressful life events. Mood disorders are also associated with disruptions in serotonin, norepinephrine, and dopamine neurotransmission. Techniques that look at the function and structure of the brain have found decreased blood flow in certain cortical regions of the brain, as well as increased activity in limbic areas, such as the amygdala, when processing negative information.
3. Identify the major classes of medications used to treat unipolar and bipolar mood disorders.
   • Biological treatments for major depression involve medications (monoamine oxidase inhibitors, tricyclics, and serotonin reuptake inhibitors) that increase the availability of one or more neurotransmitters. Other biological treatments include electroconvulsive therapy (ECT), transmagnetic stimulation (TMS), vagus nerve stimulation (VNS), and deep brain stimulation (DBS). All of these more invasive techniques have shown promise for severely and chronically depressed patients who do not respond to psychotherapy or medication.
   • Biological treatments for bipolar disorder include lithium, anticonvulsant medication, or antipsychotic medication.
4. Define cognitive-behavioural therapy and describe its basic techniques in treating major depressive disorder.
   • Psychological treatments for major depression include cognitive-behavioural therapy (CBT) and interpersonal psychotherapy (IPT). These emphasize the role of negative thinking patterns and improving interpersonal relationships and functioning through structured, collaborative, and time-limited therapy sessions.
5. Compare and contrast the three forms of adjunctive psychotherapies for bipolar disorder.
   • Adjunctive psychological treatments have recently been developed to help improve remission rates and prevent relapse in bipolar disorder. These include family-focused therapy (FFT), interpersonal and social rhythm therapy (IPSRT), and cognitive therapy (CT).
6. Explain how biological, psychological, and social factors can all contribute to suicide
   • Suicide is a devastating problem with huge economic and human costs, and it is now the second-leading cause of death in young people. Men in all age groups are over three times more likely than women to complete suicide, while women are three times more likely than men to attempt suicide. Suicide rates also differ across age categories, with males aged 19 to 24 and over 70 being at greatest risk. Indigenous communities in Canada have suicide rates two to four times greater than in the rest of the country.
   • Suicide is caused by a variety of social, psychological, and biological variables, including genetic predisposition and low serotonin neurotransmission, a sense of detachment from society, and severe stress.
   • Broad primary prevention strategies have not been effective in reducing suicide rates, although strategies that focus on reducing access to lethal means have shown more promise. Treatment of suicide depends on the severity of the behaviour and can range from inpatient hospitalization to outpatient medication and/or psychotherapy.

Lecture §

• Major Depressive Disorder
  • Prevalence
    • $5\%$ of all population
    • Mid-twenties as typical onset age
    • $50\%$ also have Anxiety Disorders
  • What is the basic Diagnostic criteria in DSM
    • $>5/9$ symptom, at least one from 2 of the ★ symptoms within 2-week period
      1. Depressive mood (self-reported or observed or irritation for teen)
      2. Anhedonia
      3. Weight fluctuation
      4. Sleep: insomnia or hypersomnia
      5. Psychomotor agitation or retardation
      6. Fatigue
      7. Feelings of worthlessness & self debt
      8. Concentration problem
      9. Recurrent thought o death
    • Has to cause impairment in daily function
  • One explanation as to why women are more often diagnosed with depression than are men is that?
    • In many cultures women experience role strain.
    • In more equalized cultures, the gender differences are smaller
  • What are the 3 major difference between MDD and Dysthymia?
    1. The length of the symptoms last for at least 2 years in dysthymia
    2. Response to standard depression treatment is poor compared to episodic MDD
    3. Impairment is higher
• Bipolar Disorder
  • Manic episode diagnostic criteria
    • Elevated, expansive, irritable mood and persistently increased goal-directed activity or energy for $>1$ week for most of the day, nearly every day
    • $>3/7$ symptoms or 4 if mood is only irritable
      1. Inflated self-esteem
      2. ★ More talkative than usual
      3. Decreased need for sleep
      4. Racing thoughts and ideas
      5. ★ High distractibility
      6. ★ Increased goal-directed activity
      7. Involvement in activities with high potential for painful consequences
    • Marked impairment
    • Not attributed to other physiological problems or substances
  • Why is people in mania highly distractible?
    • The selective Attention function dysfunctions and filters in inappropriate info
    • Leads to disorganization of thought and behaviour
  • What is the key differences between Bipolar I Disorder and Bipolar II Disorder and Cyclothymic Disorder?
    • Bipolar I: $>1$ manic
    • Bipolar II: $>1$ hypomanic; $>1$ major depressive
    • Rapid cycling specifier: $>4$ episodes in 12 month
    • Cyclothymic: $>2$ years of alternating depression (not major); les severe form
• Etiology for Mood Disorder
  • What are the 3 major sources of factors
    • Heritable
      • Personality
      • Cognitive
    • Pre-existing vulnerability
      • Family
      • Relationships
      • Personality
    • Stressful events
  • What are the 4 psychological schools of thought?
    • Psychodynamic
    • Cognitive Model
      • 3-level
        • Self, future, world
      • Cognitive Distortions
    • Interpersonality model
      • Negative feedback seeking
      • Reassurance seeking
      • Stress generation
    • Life Stress perspective
      • Diathesis Stress Model
  • What are biological factors?
    • Family heritability
      • MDD: first degree are $5\times$ more likely
      • Bipolar: $5-17\times$ more likely
    • Twin study
      • MDD: identical ($40-50\%$); fraternal ($20-30\%$)
      • Bipolar: identical ($75\%$); fraternal ($40\%$)
    • Neurotransmitters (partial explanation)
      • [Norepinephrine]; [Serotonin]; [Dopamine]
    • HPA axis
      1. Hippocampus should help to inhibit HPA axis by negative feedback
      2. Hypersecretion of cortisol due to chronic stress damage Hippocampus and the inhibition
      3. HPA axis becomes more reactive
      • Increased activity in the Amygdala can also lead to negative emotional feelings