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criteria for OCD
- recurrent, and persisten thoughts/images
- associated behaviors compelled to perform
- insight that it is irrational
- distress, consumes 1+ hour/day
- impairs functioning
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causes of OCD
- thought-action fusion
- tend to be be more depressed
- have exceptionally high standards of conduct
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obsessions vs. compulsions
obsessions - repetitive, unwelcome thoughts
compulsions - repetitive, almost irresistable actions
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Major Depressive Episode
- for (2) weeks, must have:
- depressed mood or anhedonia, and (4):
- appetite or body weight change
- psychomotor agitation or retardation
- feelings of worthlessness or guilt
- thoughts of suicide or death
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manic episode
- 1 week of elevated, expansive or irritable mood and 3+:
- inflated self-esteem
- excessively talkative
- racing thoughts
- less need for sleep
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mixed manic episode
- 1 week duration; meets criteria for MDE and manic episode
- Two types:
- 1) cycle fast; high to low to high, etc.
- 2) acting manic, but feels powerless and depressed abt it at the same time; self-aware they are not behaving normally
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Unipolar Mood Disorder
Major Depressive Episode (single episode)
- rare!
- usually the first of many
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dsythymic disorder
2+ years in a depressed mood; more days than not
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double depression
dysthymic disorder overlaid with a MDE
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bereavement
less than 2 months of grief after death of a loved one
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impacted grief reaction
if loss of a loved one goes beyond an MDE and there is hallucination of loved one or suicidal ideation
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bipolar I disorder
- criteria:
- just a manic episode will suffice to diagnose. assumption is that if you have mania, there will always be depression
manic or mixed manic episode
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bipolar II disorder
hypomanic episode with MDE
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cyclothymic disorder
- 2+ years alternating dysthymia and hypmania
- more dysthymic than hypomanic
- rapid cycling - up to 4 times per year
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biological vulnerabilities for mood disorders
- concordance evidence: twin studies indicate concordance in monozygotic twins
- causes: 40% attributed to genes, 60% attributed to environment
- low levels of serotonin causes a dysregulation of other monamines (dopamine, norepinephrine)
- 60% of non-shared environment (friends, activities, experiences)
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(2) cognitive theories for depression
- 1. learned helplessness
- 2. negative cognitive style (negative outlook)
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1. learned helplessness
2. negative cognitive style
- 1. "i'm a failure"
- 2. errors in logic, cognitive distortions, negative bias
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(theory for depression)
exogenous depression
endogenous depression
"kindling"
- exogenous: external cause and effect (house burns down, become depressed), might have high vulnerabiliy that a small stressor triggers depression
- endogenous: internal cause; not clear stressor
- "kindling effect" - more one has an MDE, the risk of increasing the chance of having another MDE; initial episode is like kindling; brain seems to change and become more vulnerable after first MDE
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antidepressant medications
- SSRI - increases serotonin in synapse
- Tricyclics: MOAR-I's -serotonin, dopamine, norepinephrine and epinephrine reuptake inhibitors; reserved for severe patients not responsive to other meds; deadly side effects
- MAO-Is- can have deadly side effects (tyramine in foods react to cause stroke or heart attacks)
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mood stabilizers
- lithium - very narrow window of therapeutic value; same amt. of value can also cause serious problems (i.e. seizures, kidney dysfunction,death)
- anticonvulsants - reduces excitation; anti-seizure medication
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Electro-convulsive Shock Therapy (ECT)
- if person is actively suicidal or severely depressed and medication is too slow
- induces a seizure (overexcite neurons; kills cells)
- minor amnesia
- lifts patient out of suicidal depression
- every other day for 3 weeks
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transcranial magnetic stimulation (TMS)
- over-excites a brain area
- coil on patient's head; run electricity, create a magnetic field; originally used to inactivate a brain area but is not used to activate a brain area
- is currently approved to treat suicidal depression
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