Psychopathology (Final) Depressive and Bipolar Disorders

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1

Features of Major Depressive Episode

  1. Depressed mood (most common) = sadness (mild melancholy to complete helplessness)
  2. Anhedonia (most common)= loss of pleasure or interest in usual activities
  3. Disturbance of appetite= appetite changes and/or weight change
  4. Sleep disturbances= insomnia or hypersomnolence
  5. Psychomotor retardation/ agitation= slow and deliberate movements/ incessant activity
  6. Loss of energy= reduced energy, exhaustion
2

Features of a Manic Episode

  1. Elevated, expansive, or irritable mood
  2. Inflated self esteem
  3. Sleeplessness
  4. Hyperactivity
  5. reckless behavior
3

Features of a hypomanic episodes

  • More brief and less severe than manic episode
  • Doesn’t require impairment but has similar symptoms as a manic ep
  • Requires change in functioning and must be observable by others
4

Mixed episode

  • When a person meets criteria for major depression and manic/ hypomanic episodes simultaneously
5

Bipolar I

  • Manic episode is experienced
  • May or not experience at least one major depressive episode as well
6

Bipolar II

  • Hypomanic episode is experienced
  • Individual has at least one major depressive episode
  • Never met criteria for a manic episode
7

Rapid cycling

  • Less common form of bipolar
  • Person (usually a woman) switches back and forth between depressive and manic/ hypomanic episodes (with at least 4 mood episodes per year), with little or no “normal” functioning between mood eps
8

How are bipolar and unipolar depression different?

  • Bipolar= much less common; occurs in each sex with about equal frequency; more common in high SES; likely to have history of hyperactivity of ADHD; mood episodes are generally more brief and more frequent; depressive episodes in bipolar include excess sleep and weight/ appetite increase; associated with greater occupational and social functioning; has higher risk for suicide; has worse long-term outcomes; has a stronger genetic predisposition and more likely to run in families
  • Married people less likely to experience major depression but no decreased risk for bipolar dx
  • Major depression= likely to have histories of low self esteem, dependency, obsessive thinking;
9

Dimensions of a Mood disorder

  1. psychotic vs no psychotic
  2. early vs late onset
10

Psychotic vs non-psychotic mood disorders

  • Some individual who have eps of major depression or mania may experiences symptoms of psychosis
  • Episodes of mania with psychotic features are more prevalent than depressive episodes with psychotic features
11

Early vs late onset mood disorders

  • People with earlier onset have poorer outcomes
  • Earlier onset of depression associated with higher risk for suicide
12

Suicide Risk factors

  • Age of onset (earlier onset= higher risk of suicide)
  • Gender (women more likely to have attempts but men are more successful at completing suicide)
  • Race/ ethnicity (American Indian/ Alaskan natives have highest rates; lowest rates among Hispanic and African Americans)
  • Sexual orientation (LGB more likely to attempt and commit suicide)
  • Biology/ genetics (relative of suicide victims are 2-6x more timely to complete suicide themselves)
  • Mental disorders (attempts and completed suicide very rare in absence of major mental dx)
13

CBT treatment with depression

  • Behavioral assignment, modification of dysfunctional thinking, attempts to change schemata
  • IDs, challenges, and modifies negative schemata to generate less (-) info processing
  • Changing thoughts protects again future depression
  • Aim= symptom reduction
14

ACT treatment of depression

  • Acceptance and Commitment Therapy (ACT)
  • Combines cognitive and behavioral components
  • But based on relational frame theory (theory of language and cognition)
  • 6 components: acceptance, defusion, contact with present moment, self as context, values, committed action
  • Aim= increased psychological flexibility
15

Acute treatment of manic episodes in bipolar

  • Medications control mood swings, manage recurrences, and reduce risk of suicide
    • Lithium
    • Valproate
16

Acute treatment of depressive episode in a bipolar context

  • Can be controversial= antidepressants can send person into manic episodes; antidepressants may cause rapid cycling
  • Mood stabilizers are often used (lithium or valproate) in combination with antidepressants. The dosage of the antidepressant might be titrated down once the symptoms start to resolve (and will eventually be discontinued(
  • Antipsychotic meds may be used if there are psychotic symptoms present
17

Phobic behavior

  • Vary widely in object, severity, generality
  • Great variation in the number, kinds, and patterning of individuals’ phobias
  • Can be accompanied by sad mood, panic attacks, somatic concerns, and many others
18

Compulsive behavior

  • Carried out one or more action far beyond reason and with a feeling of being compelled to do so
  • Include cleaning, hand washing, repeating, checking, counting, arranging, hoarding
  • Can involve elaborate time-consuming rituals that have a symbolic function (Rather than practical effect)
  • Accompanied by obsessions, feelings of fear/ discomfort that declines with the behavior, idea that compulsions prevent harm, recognitions that behavior is unreasonable
19

What are troubling thoughts and how do they fit in with anxiety disorders?

  • Aversive, intrusive thoughts that are difficult to control
  • Excessive worries, obsessive preoccupations
  • Slow elements of both worries and obsessions
  • Some people engage in compulsions in response to troubling thoughts
  • And some people are phobic of situations that may cause these troubling thoughts and thus might require compulsions
  • The compulsion or neutralizing rituals might actually increase the thought’s frequency