PS280 Study Guide - Final Guide: Major Depressive Episode, Bipolar Disorder, Pressure Of Speech

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14 Aug 2019
Bipolar disorder (formerly manic-depression):
-cycling b/w periods of elevated mood/expansive/irritable mood and depressed mood
-mania = symptoms present for 1+ week, hypomania = less severe, only 4+ days
-mixed state: experiencing both manic/hypomanic and depressive symptoms at same time
-mania: increased energy, decreased need for sleep, racing thoughts, pressured speech, problems
w attention, impaired judgement, may feel chosen
-mania may first be experienced as enjoyable (leads to delayed treatment) but symptoms may
become more severe and disturbing, may lead to psychosis
-Bipolar I: manic episodes with or without depressive episodes (most have both)
-Bipolar II: hypomanic episodes w major depressive episodes, harder to diagnose
-hypo/manic episodes typically last 2 weeks-4 months, depression lasts 6-9 months
-rates of suicide 10-15%; no gender differences; onset = 20 years but more and more children
-Cyclothymia: chronic (2+ years), less severe BD, at risk for developing fullblown BD
-Rapid cycling: 4+ manic/major depressive episodes in 12 months, higher disability, worse
response to treatment (ultrarapid = every few days, ultradian = cycling occurs daily)
-antidepressants can trigger manic episodes in vulnerable patients
-heritability estimate: 0.75%
Major depression:
-common cold of mental disorders bc prevalent/chronic (leading cause of disability worldwide)
-5+ symptoms present during same 2 week period (depressed mood, anhedonia, weight change,
insomnia, psychomotor issues, fatigue, feelings of worthlessness/guilt, inability to think,
recurrent suicidal thoughts)
-episodes last 6-9 months but can last years, average onset mid-20s
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-women 2x more likely to develop it (sex difference begins in early adolescence, stabilizes by
late adolescence), esp those w 2+ children at home
-men are no less willing to disclose symptoms of depression
-Cicero was first to suggest psychotherapy for depression; said it results from neglect of reason
-over 50% comorbid w anxiety (= more severe depression + slower treatment response)
-heritability estimate: 0.36%
-anhedonia = lack of responsiveness to reward, unable to extend effort to obtain it
-stress/activation of HPA axis = release of pro-inflammatory cytokines (part of immune
response), prolonged exposure = sickness behaviours (anhedonia, withdrawal)
-key feature of depression may be inability to disengage from negative info (rumination)
Seasonal affective disorder:
-can occur in unipolar MDD and bipolar disorder; depression tired to winter months
-need more light to trigger decreased melatonin secretion, feel drowsy when awake
-phase-delayed circadian rhythms; need to reset circadian clock (phototherapy)
-serotonin transporter gene (HTT) located on chromosome 17 / regulates function of serotonin
-HTT can heighten stress reactivity, leading to depression (short allele of HTT = higher rates)
-norepinephrine, dopamine, and 5-HT are all monoamine neurotransmitters
-depressed people have fewer 5-HT receptors (leading to decreased dopamine)
-whereas those in manic phase have elevated dopamine in reward pathways
-5-HT and NE control sleep abnormalities in depressed people (loss of slow-wave sleep time,
early onset of first REM stage, more eye movements during REM)
-sleep deprivation triggers onset of mania in approx 77% of BD patients
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