Problem 6

Question 1

Unipolar depression

Answer 1

Symptoms take over the whole person

–> emotions, bodily functions, behaviors + thoughts

Question 2

Symptoms of depression

Answer 2

1. Anhedonia
   - -> loosing interest in everything in life
2. Changes in appetite, sleep + activity levels
3. Psychomotor retardation vs agitation
   - -> doing things more slowly or faster; either- or
4. Thoughts filled with worthlessness, guilt, suicide
5. Experiencing delusions + hallucinations

Question 3

There are 2 forms of Unipolar Depressive disorders.

Name them.

Answer 3

1. Major depression
2. Dysthymic disorder/Persistent depressive disorder
   - -> less severe but more chronic form

Question 4

What is needed for a person to be diagnosed with major depression ?

Answer 4

Experience of either

a) depressed mood
b) loss of interest in usual activities
- -> must interfere with everyday functioning

+ 4 other symptoms of depression

Question 5

What is the difference between major depression, single episode vs recurrent ?

Answer 5

1. Single episode
   - -> experiencing one depressive episode
2. Recurrent
   - -> experiencing 2 or more ep. separated by at least 2 months without symptoms

Question 6

What is needed for a person to be diagnosed with Dysthymic disorder ?

Answer 6

Experience of depressed mood and 2 other symptoms of depression

–> for at least 2 years, with symptoms occurring 2 month tact, thus more chronic than MD

Question 7

Double depression

Answer 7

Refers to a condition where people experience episodes of both major depression and dysthymic disorder

Question 8

Comorbidity

Answer 8

1. Substance abuse
2. Anxiety disorder (Panic disorder)
3. Eating disorder

Question 9

Major anxiety depression

Answer 9

Refers to the combination of major depression + anxiety

–> requires 3/4 symptoms of MD + 2 or more symptoms of anxiety

Question 10

Name the subtypes of MD.

Answer 10

Depression with

1. Melancholic features
   - -> prominence of physiological symptoms
2. Psychotic features
   - -> experiencing delusions + hallucinations
3. Catatonic features
   - -> strange behavior (catatonia)
4. Atypical features
5. Postpartum onset
6. Seasonal pattern (SAD)
   - -> depressed when daylight h are short + recover when not

=> 5+6 can develop into BpD

(7. Premenstrual dysphoric, distress before menstruation)

Question 11

Catatonia

Answer 11

Ranges from complete lack of movement to excited agitation

–> strange

Question 12

Prevalence of UpD ?

Gender differences ?

Answer 12

1. 18-29 y/o, lowest over 60, but go up over 85
2. Women are 2x more likely to develop it, due to fact that they ruminate about their feelings more
3. One of the most common disorders
4. One is 2-3x more likely to develop it, when a parent has it

Question 13

Bipolar disorder

BpD

Answer 13

Refers to a condition that involves alternations between periods of mania + periods of depression

Question 14

Symptoms of mania

Answer 14

1. Having unrealistically positive + grandiose self-esteem
2. Delusional thoughts + hallucinations
3. Impulsive behaviors

–> have to show for at least 1 week + impair functioning to be diagnosed

Question 15

Bipolar I disorder

Answer 15

Experiencing all the symptoms of mania
–> can be preceded or followed by hypomania or depression

BUT: very rare

Question 16

Bipolar II disorder

Answer 16

Experiencing severe episodes of depression (MD) + hypomania

NO MANIC EPISODES

Question 17

Hypomania

Answer 17

Involves the same symptoms as mania

BUT: these symptoms are not severe enough to interfere with everyday functioning + no hallucinations or delusions

Question 18

Cyclothymic disorder

Form of BpD

Answer 18

Involves alternating between episodes of hypomania + moderate depression

–> less severe but more chronic form of BpD, has to occur over 2y period

Question 19

Why are people diagnosed with cyclothymic disorder at increased risk of developing BpD ?

Answer 19

Because, often periods of depression will interfere with daily function even though they might be less severe than MD periods

Question 20

Temper dysregulation disorder with dysphoria

Form of BpD

Answer 20

Involves acting immature + inappropriate 3-4 times a week on average, with ep. of being sad or angry in-between

–> for youth age 6 or older

Question 21

Prevalence of BpD

Answer 21

Creative people (e.g. artists, composers) have a higher than normal prevalence

a) develops in late adolescence or early adulthood
b) biological factors / inheritance play a bigger role here than in unipolar
c) Men and women are equally likely

–> less common than unipolar depression

Question 22

Is BpD treatable ?

Answer 22

Not really,

1. Only 1/4 recover fully from the symptoms after being hospitalized and are able to live a normal life
2. Often abuse substances which impairs possible treatment

–> medication + high social class are positively correlated

Question 23

Is having BpD an asset or a curse ?

Answer 23

Both,

Many political leaders have suffered form it and have accomplished extraordinary things during periods of hypomania or mania

Question 24

Biological theory of Unipolar depression

Answer 24

Suggests that abnormalities in the serotonin transporter gene leads to a dysfunction in its regulation

–> affects the stability of individuals moods

Question 25

Neurotransmitter theory of Unipolar depression

Answer 25

Suggests that depression is caused by a reduction in the amount of monoamines in the synapse, due to 1. Abnormalities in their synthesis 2. Abnormalities in the serotonin transporter gene which regulates the release process of them 3. Postsynaptic neurons may be less sensitive/malfunctioned

Question 26

What are monoamines ?

Answer 26

Type of neurotransmitter --> in Unipolar depression especially norepinephrine and serotonin are involved

Question 27

Brain abnormalities in UpDs

Answer 27

Depression results from Abnormalities in 1. Left PFC (less active) - -> motivation, goal orientation 2. Anterior cingulate cortex (overactive) - -> stress regulation, social behavior 3. Hippocampus - -> smaller + lower activity 4. Amygdala - -> enlargement + increased activity AND: Reduced metabolic activity + reduction of gray matter volume in PFC

Question 28

Neuroendocrine factors associated with Unipolar depression ?

Answer 28

Hypothalamic-pituitary-adrenal axis (HPA), that is involved in fight-or-flight response is chronically hyperactive --> a biological feedback loop, thus hyperactivity will make one more susceptible to stress

Question 29

Name the steps of the HPA feedback loop that is involved, once we are confronted with a stressor.

Answer 29

1. Hypothalamus releases corticotropin-releasing hormone (CRH) onto receptors of anterior pituitary gland 2. Corticotropin stimulates the adrenal cortex to release cortisol 3. Hypothalamus has cortisol detectors to detect it, then decreases CRH to lower increased levels of cortisol --> thus stress levels are reduced/fought by activating the HPA during stress and calming it when stress is over

Question 30

Hypothalamic-pituitary-adrenal axis | HPA axis

Answer 30

Refer to 3 components of the neuroendocrine system that work together in a biological feedback system that are interconnected with the a) amygdala b) hippocampus c) cortex and are involved in the fight-or-flight response

Question 31

Behavioral theory of Unipolar depression

Answer 31

Suggests that life stress leads to depression because it reduces the positive reinforces in a persons life --> this results in further withdrawal, thus further reduction of reinforcers (Vicious cycle) ex.: having difficulty in marriage will lead to fewer interactions because these are now less positively reinforcing than before

Question 32

Learned helplessness theory | Behavioral theory of unipolar depression

Answer 32

Suggests that the type of stressful event most likely to lead to depression is an uncontrollable negative event --> if the are frequent they will make people feel helpless in any kind of way (Learned helplessness)

Question 33

Negative cognitive triad | Cognitive theory of UpD

Answer 33

Suggests that depressive people have negative views of themselves, world + future and engage in biased thinking that promotes negativity e.g.: Ignoring good events + exaggerating bad ones

Question 34

Reformulated learned helplessness | Cognitive theory of UpD

Answer 34

Suggests that depressive people habitually explain negative events by causes that are internal --> in turn this leads them to recreance longterm learned helplessness deficits, thus expecting to fail again

Question 35

Hopelessness depression | Cognitive theory of UpD

Answer 35

Develops when people make pessimistic attributions for the most important events in their lives + perceive that they have no way to cope with the consequences of these events

Question 36

Ruminative response styles theory | Cognitive theory

Answer 36

Depression results from rumination about the causes of feeling sad or upset, instead of doing sth about it

Question 37

Overgeneral memory

Answer 37

When given a simple word cue, then asked to describe a memory, depressed people will offer memories that are general ex.: angry --> people are mean

Question 38

Interpersonal theories of unipolar depression

Answer 38

Suggest that interpersonal difficulties + losses in relationships are the stressors usually triggering depression

Question 39

Rejection sensitivity vs Excessive reassurance seeking

Answer 39

Having a heightened need for approval + expression of support from others --> often seen in depressed people, who eventually withdraw from social contact altogether as a result

Question 40

Biological theory fo BpD

Answer 40

Suggests that BpD has a greater connection to genetic factors than UpD --> areas most involved are a) amygdala b) PFC c) Striatum thus, showing abnormalities in white-matter tissue (there for communication)

Question 41

Name the Neurotransmitter factors contributing to BpD.

Answer 41

Dysregulation of the dopamine system, which leads to a) excessive reward seeking during the manic phase b) lack of reward seeking in the depressed phase

Question 42

Name the Psychosocial factors contributing to BpD.

Answer 42

1. Higher sensitivity to reward are associated with faster relapse into mania or hypomania 2. Stress 3. Changes in bodily rhythms, eating patterns, etc

Question 43

How do drugs milder Depression ?

Answer 43

Drugs have slow-emerging effects on 1. intracellular processes in the neurotransmitter systems 2. the action of genes that regulate a) neurotransmission b) limbic system c) stress Response --> work better for chronic-severe depression

Question 44

Which drug treatment can be used for UpD ?

Answer 44

1. SSRIs 2. SNRIs - -> slight advantage over SSRI because it affects both Its 3. Bupropion (Norepinphrine-dopamine reuptake inhibitor/NDRI) 4. Tricyclic antidepressants - -> numerous side effects, not used often 5. Monoamine Oxidase inhibitors (MAOIs) - -> breaks down monoamines, very dangerous side effects

Question 45

Mood stabilizers | used for BpD

Answer 45

1. Lithium - -> improves functioning of intracellular processes that are abnormal 2. Anticonvulsant medication - -> reduces convulsions + stabilizes mood 3. Atypical antipsychotic medication - -> quells symptoms of mania

Question 46

Electroconvulsive therapy | ECT

Answer 46

Consists of a series treatments in which a brain seizure is induced by passing electrical current through the brain --> delivered to one side of the brain, to prevent memory loss which occurs from bilateral administration BUT: Usually only used in patients where drugs aren't effective

Question 47

Newer methods of stimulating the brain have been proposed, showing promising results in the treatment of UpDs. Name them.

Answer 47

1. Repetitive transcranial magnetic stimulation (rTMS) --> repeated, high-intensity magnetic pulses, focused on left PFC 2. Vagus nerve stimulation (VNS) - -> increased activity of hypot. + amygdala 3. Deep brain stimulation 4. Light therapy - -> reduces SAD, by resetting circadian rhythm

Question 48

Behavioral therapy for mood disorders

Answer 48

Focuses on increasing positive reinforcers + decreasing aversive experiences in an individuals life --> by helping depressed people to change their patterns of interaction with the environment + other people 1. Functional analysis - -> finding connections between specific circumstances + symptoms 2. Changing aspects of the environment contributing to depression 3. Teaching skills to change these environmental factors

Question 49

CBT

Answer 49

Aims to change the negative, hopeless patterns of thinking , by helping them to develop more adaptive ways of thinking --> proves to be very effective

Question 50

Interpersonal therapy | IPT

Answer 50

Involves identifying + changing the patterns of the patients relationships by looking for 4 types of problems 1. Grieve e. g.: loss of loved ones, breakup 2. Interpersonal role disputes - -> not agreeing on ones role in a relationship 3. Role transitions - -> depressed over role one has to leave behind 4. Deficits in interpersonal skills

Question 51

Name the 2 general categories of mood disorders.

Answer 51

1. Unipolar depression (UpD) | 2. Bipolar disorder (BpD)