Lecture 9

Question 1

Which of the following must be present as part of meeting DSM-V diagnostic criteria for schizophrenia?

A) Negative symptoms
B) Avolition
C) Catatonic behaviour
D) Delusions

Answer 1

D

Question 2

Recent estimates by the World Health Organization indicate that _________ is the number one cause of disability globally.

A) Anxiety
B) Depression
C) Cancer
D) Heart Disease

Answer 2

B

Question 3

What are the 3 major categories of mood disorders

Answer 3

• Depressive Disorders
• Disruptive Mood Dysregulation Disorder
• Bipolar Disorder

Question 4

What are the symptoms that must be present in MDD (major depressive disorder)?

Answer 4

• Severely low mood AND/OR
• Characterised by anhedonia

Question 5

What are the adjunctive symptoms of MDD?

Answer 5

• Sense of worthlessness or guilt
• Changes in appetite or unintentional weight change
• Sleep disturbance (e.g., insomnia/hypersomnia)
• Low energy
• Slow movement
• Poor concentration
• Thoughts of death

Criteria
Symptoms must last at least two weeks
* Prevalence and incidence of MDD is increasing globally for all age groups

Question 6

Give the stats for MDD

Answer 6

• 2017: over 300 million people globally experienced clinical depression
• 2005-2015: 18% increase in prevalence
• WHO estimates it is the #1 cause of disability globally

Question 7

What is Persistent Depressive Disorder?

Answer 7

(previously dysthymia)
* Symptoms include MDD characteristics, but diagnosis requires the presence of
fewer symptoms

• Symptoms must last at least two years (persistent)
• feeling low, limited/excess appetite, sleep disruptions, lethargy, general sense of failure, lack of hope/faith in self/future
• less intense than MDD but longer term

Question 8

What is Premenstrual Dysphoric Disorder? (PMDD)

Answer 8

• New to DSM-V
• Changing mood, irritability, appetite change during the luteal phase (period between ovulation and menstruation) of the menstrual cycle
• Distinguished from Premenstrual Syndrome by the severity of symptoms and increased impact on daily functioning

Question 9

What is the controversy around PMDD?

Answer 9

Some critics note that the addition of this “disorder” is overly medicalizing a natural biological process and stigmatizing female bodies/minds

Further controversy: creation of this diagnosis coincides with the extension of a patent for an existing medication for new use intended to treat PMDD (what medication was renamed?) (SSRI???? IDK)

Question 10

What is Disruptive Mood Dysregulation Disorder (DMDD)

Answer 10

• Long-standing debate: does mental illness present differently in children and youth?
• New to DSM-V
• Diagnosis applied to children between the ages of 6-18
• Children with DMDD frequently exhibit extreme anger or irritability that seems disproportional to the triggering situation (described as “unwarranted”)

Question 11

What is the controversy behind DMDD?

Answer 11

Controversy exists about this category. Some critics argue:
* It medicalizes what may be normal phases of emotional development among children and youth

• Majority diagnosed with DMDD also match symptoms of oppositional defiant disorder
• Children diagnosed with DMDD likely to be treated with antipsychotic medication
• Labelling children with mental illness affects how they see the world and their interactions with others

Question 12

What is bipolar disorder?

Answer 12

• Bipolar disorder involves a person who experiences episodes of mania (high energy/excitement) and episodes of depression (melancholy), previously termed “manic depression”

Question 13

What is hypomania

Answer 13

refers to milder forms of mania – elevated mood with lesser degrees of functional impairment
◦ E.g., Less need for sleep, higher energy and self-confidence, overly optimistic attitude

◦ Difference with mania: mania is more severe, may involve psychosis, more likely to lead to incarceration of hospitalization, treatment may differ

Question 14

What are the 3 subtypes of bipolar disorder?

Answer 14

Bipolar I

Bipolar II

Cyclothymic disorder

Question 15

explain Bipolar I

Answer 15

mania and depression (depression not necessary for diagnosis)

Question 16

explain Bipolar II

Answer 16

hypomania and more severe depression (stronger depressive symptoms, less intense mania)

Question 17

explain Cyclothymic disorder

Answer 17

The most mild form, with swings between mild depression and hypomania

Question 18

explain Eithymia

Answer 18

periods without mania and depression (APA, 2023)

Question 19

What are the different interventions that can be used to treat and manage mood disorders?

Answer 19

• Psychotherapy, most commonly cognitive behavioural therapy
• Psychopharmaceuticals (e.g., tricyclic antidepressants, SSRIs, and Lithium)
• Electroconvulsive therapy (ECT) used when other treatments fail

Question 20

As described in the textbook, patient surveys have found that approximately __% prefer psychotherapy to antidepressant medication.

Answer 20

75%

Question 21

What are some of the reasons people living with depression are more likely to be prescribed antidepressants, rather than receive psychotherapy?

Answer 21

• faster
• fee-for-service
• physicians don’t have much training in therapy than counsellors
• cheaper and affordability
• easier to change brain chemistry than behaviour
• convenient
• marketing strategies
• not covered by insurance
• lack of staff

Question 22

According to the meta-analysis conducted by Kirsch and Sapirstein (1998) that was described in the textbook, what percentage of the response to antidepressant medication was due to the placebo effect?

Answer 22

50%

Question 23

how many americans take antidepressant medications

Answer 23

1 in 10 americans

Question 24

give stats (percentages) for case study 1 about antidepressants and the placebo effect

Answer 24

• 25% of the response to the drugs was duplicated in nontreatment control groups
• 50% of the response to the drugs was due to the placebo effect
• 25% of the response to the drugs was a true effect of medication

Question 25

review case study 1

Answer 25

* Analysis of published trials of SSRIs suggest a significant benefit of medication over placebo * Analysis of all available data (published and unpublished) suggests that the placebo effect accounts for 80% of patient response to the medication * The authors point to the practice of drug manufacturers of only publishing research that supports claims of drug effectiveness, partially “burying” negative findings, which is compounded further by citation bias (smth gets cited more than the other) * They conclude that the evidence in favour of prescribing SSRIs is “insufficient” and recommend that psychotherapy, exercise, and acupuncture provide the same benefit, with lower risk of side effects

Question 26

case study 2: is cognitive therapy enduring or are antidepressants iatrogenic

Answer 26

* Depression is a disorder that will often usually spontaneously remit – this means that even without treatment, it may go away on its own * Using antidepressant medications reduces the amount of time that patients experience depressive symptoms, compared to receiving no treatment * The period of time between when the medications would be effective and the depressive episode would have resolved on its own is called the continuation phase: better to stay on medications (analogy with antibiotics, symptoms are only gone because of medication)

Question 27

What happened in case study 2?

Answer 27

In this study, patients with severe depression were randomly assigned to one of three treatment groups: * Pill placebo * Antidepressant medication * Cognitive Behavioural Therapy At the end of 8 weeks, antidepressant medications were significantly more effective than placebo and slightly more effective than cognitive behavioural therapy * At the end of 16 weeks, cognitive behavioral therapy was slightly more effective than antidepressant medications * At the 16 week point, patients who had done well on antidepressant medications were randomized into either a group being withdrawn from medication to placebo, or were kept on medication * Patients taking placebo were much for likely to relapse * Patients who had done well with CBT were withdrawn from treatment and did much better than patients withdrawn from medication, but not significantly better than patients who continued on medication * After treatment ended, patients who did well on CBT were considerably less likely to relapse than those who did well on ADM

Question 28

What was the conclusion with case study 2

Answer 28

* Concluded that Cognitive Behavioural Therapy has more enduring positive results and a reduced risk of relapse, compared to antidepressant medication * They also found that the use of medication reduces the enduring effectiveness of CBT