Abnormality / Intro General Psychopathology / MDD Flashcards
Abnormality
Statistical deviation away from the norm
A behavior cannot be deemed abnormal outside of a context
Elements of abnormality
*May include suffering and maladaptation
In reality, multiple elements are needed to properly diagnosis
Focus on qualitative descriptions of the symptoms, not quantity
- If the behavior leads one to harm him or herself
- If the behavior leads to suffering or pain
DSM-V + ICD-X Features
Diagnosis
Prevalence
Incidence
Cases and Risk Factors
Necessary Factors
Sufficient Factors
Contributory Factors
Distal vs. Proximal Causal Factors
Diathesis-Stress Model
Diathesis + stress = disorder
Diathesis
o Relatively distal necessary or contributory causal factors
• Not sufficient factors
Stress
o Response of taxing demand
Mood Disorders, General
Refers to difficulties associated with unproductive mood states
(vs. euthymia = an even, productive, mood state)
Includes the following abnormalities related to
- mood/emotion
- physical aspects
- cognitive symptoms
- behavioral factors
Mood Disorders Symptomotology
Sleep disturbances
o Early morning awakening = most common sleep disturbance
Eating disturbances
Including weight gain and loss
Fatigue or a change in energy
Irritability
o A specifier in DSM-V
Change in concentration ability
Psychomotor agitation or retardation
Suicidal behavior/thoughts
Anhedonia (physical and social settings)
Feelings of gloom, hopelessness, or guilt
Depression, Prevalence
Unipolar depression is one of the most common disorders in western culture
o affects individuals across SES, race, and genders
Lifetime prevalence = 19%
• (As a comparison, in Taiwan = 1.5%)
MDD vs. Depression
Mild, brief, depression is normal and adaptive
MDD = chronic, maladaptive, depression, accompanied by additional features
1/5 of US population experiences single episode of depression
• Psychologists focus on reoccurring episodes
Depressive Psychosis and MDD
Whenever present, even if it is a single episode, depression is automatically classified as MDD
Psychotic depression, approaches to dx
It is important to recognize what comes first – the depression or psychosis
Mood-congruent delusions/hallucinations
• Consider psychotic depression
Mood-incongruent = unrelated to depressed mood
• Consider a dominant psychosis-related disorder
Grieving and Attachment Sequence of Emotional Responding (according to Bowlby)
- Numbing
- Searching and yearning for the lost individual
- Disorganization and despair when one begins to come to terms with loss
- Reorganization
Bereavement
DSM-IV vs DSM-5
Bereavement exclusion was included in DSM-IV
• Prevented the immediate diagnosis of depression after the death of a loved-one
Was removed in DSM-V
• Has been argued that loss of a loved one is too similar to the loss of anything else
o 7% chance of experiencing a second episode of depression after a loss
Seasonal Affective Disorder (SAD)
Requires a pattern year after year
• Includes hibernating-like behaviors: excessive sleep and eating
More common in women
First proposed in 1984
Persistent Depressive Disorder (PDD), general
This disorder is a combination of chronic depression and dysthymia of the DSM-IV
Can be diagnosed with both PDD and MDD
Symptoms include • Too much or little of an appetite • Insomnia or hypsomnia • Hopelessness • Low energy • Low self-esteem
*Patients often do not recognize PDD because it is so chronic
o Having children is a risk factor
Depression and Age
Was previously believed that depression was as middle-age problem
o It is now recognized it occurs in children
In fact, there is as general trend that depression is occurring at an earlier age
o Research by Plorman
• In contrast to expectations, found an increase in depression within the younger population
There is an increased rate of depression in those who were born later
Lifetime prevalence has increased for younger generations
o Younger generations are experiencing an earlier onset
Postpartum Depression
25% of all deliveries
Believed to be caused by a rapid decrease in hormone levels
Specifically estrogen and progesterone
*but since all women experience hormonal decrease, other factors must be operating
Postpartum Psychosis
Very rare: 1 or 2 in 1,000 cases
An acute reaction that starts before leaving the hospital after delivering
Typically, an earlier psychotic episode must have occurred prior to this
Includes homicidal delusions directed at her child
Early (Child) Onset Depression or
PDD (Pediatric Depressive Disorder)
Increased chance of relapse and severity of symptoms
Decreased recovery rate
The longer one is symptom free, the further the chance of a relapse
Causal Factors, Physiological: Amygdala
Enlarged amygdala and increased activation
*specifically in bipolar
Normally regulates attention directed at emotional stimuli
May be key in creating biased-attention
Causal Factors: Genes
MZ studies: genes play a significant role, but the environment is more significant
Genes account for ~25% of risk factors
Causal Factors: Circadian Rhythm
Hormones and brain activity typically vary throughout the day
Depression may be a deregulation of these bodily rhythms
Reduced REM
• Delay onset of stage 4, if they can even enter it
• CBT ineffective with increased REM disturbances
• Bidirectional relation: negative mood and sleep disturbances
*Partial sleep-deprivation offers a temporary reduction of elevated mood
Causal Factors: Hormones
HPT Axis
Hypothalamic-Pituitary-Thyroid Axis
(*more specifically the thyroid)
Always need to check the thyroid before treating depression
Grave’s disease = hyperthyroidism often made apparent by bulging eyes
Causal Factors: Hormones
HPA Axis
Hypothalamic-Pituitary-Adrenal Axis
Deregulation of the hypothalamus
Overproduction of cortisol which common occurs to prepare the body for stress
An increase in cortisol is supposed to shut down the corticotropin-releasing hormone (CRH) in the hypothalamus
In depression, this feedback system doesn’t function properly
• Continued cortisol production: neural death in the hippocampus
Beck’s Cognitive Model of Depression
Core of depression = negative thinking
(*DSM-V only recognizes negative thinking as one aspect of depression)
Depression stems from negative automatic thoughts about one’s self, future, and world
Individuals with depression experience a futile attempt to alter their behaviors
- negative thinking
- rumination
Learned Helplessness Theory
Behavior typical of an organism (human or animal) that has endured repeated painful or otherwise aversive stimuli which it was unable to escape or avoid
After such experience, the organism often fails to learn escape or avoidance in new situations where such behavior would be effective
In other words, the organism seems to have learned that it is helpless in aversive situations, that it has lost control, and so it gives up trying
Clinical depression and related mental illnesses may result from real or perceived absence of control over the outcome of a situation
*Seligman and his dog electric-shock experiment
Theory: individuals who consistently experience negative stimuli become helpless and then depressed
Negative attributions were added to this theory over time
• (Attributions = personal explanations)
• i.e. internal, stable, global = depression
o theory was further developed in the 1990s
MDD DSM-5 Criteria
5 out of 9 symptoms for 2 week period
At least 1 symptom is either
1. depressed mood
or
2.loss of interest or pleasure
No history of manic or hypomanic episode
Mood Range
Mania
Hypomania
Hyperthymia
Euthymia
Dysthymia (Persisent Depressive Disorder)
Major Depressive Disorder
MDD DSM-5 Symptoms (9)
Depressed mood
*most of the day, nearly every day
Loss of interest or pleasure in all or almost all activities
- most of the day nearly every day
- can manifest as Irritable mood in adolescents
Significant Weight Loss or Gain (change of 5% body weight in a month)
Insomnia or hypersomnia nearly every day
Psychomotor agitation or retardation nearly every day
Fatigue or loss of energy
Feelings of worthlessness or excessive / inappropriate guilt
*not just self-reproach about being sick
Diminished ability to think or concentrate, indecisiveness
Recurrent thoughts of death; recurrent suicidal ideation without plan; suicide attempt or specific plan
*not just fear of dying
Persistent Depressive Disorder (PDD)
DSM-5 Criteria
A:
Depressed mood for most of the day, for more days than not, for at least 2 years
- In children and adolescents, mood can be irritable and duration must be at least 1 year
B:
Presence, while depressed, of 2 or more of the following:
- Poor appetite or overeating
- Insomnia or hypersomnia
- Low-energy or fatigue
- Low self-esteem
- Poor concentration were difficulty making decisions
- Feelings of hopelessness
* Individual has never been without symptoms in A and B for more than 2 months at a time
* Criteria for MDD may be continuously present for two years
* No history of a manic or hypomanic episode, and criteria for cyclothymic disorder have never been met
Arguments against Diathesis-Stress Model
Without diathesis, even if one is under high stress, no disorder will arise
(Though some argue if the stress is high enough, even without the diathesis, one will experience a disorder)
Diathesis-Stress: Factors influencing development and course
Resilience factors
Active features
Protective factors
Passive features
• i.e. IQ, prenatal care, social support
Depression: Race
Increased rate of depression for Native Americans
Decreased rate of depression for African-Americans
Depression: SES
Inverse relation of SES and depression
Depression: Gender
Depression is 2x more likely for females
Equal chance between genders for bipolar
Mood Disorders: Comorbidity
High comorbidity
Typically co-occurs with anxiety, substance abuse, and stress-related disorders (i.e. PTSD)
Possible Reasons younger onset of depression
Increased competition
social comparison (coupled with less social) support
materialistic-view
financial pressures
Less opportunity for growth
Overscheduling of free-time
Causal Factors: Hippocampus
Reduced hippocampus due to increased cortisol
Normally regulates memory and learning behaviors, especially fear
Increased cortisol disrupts neurogenesis in this area
Possible connection with depression and increased chance of Alzheimer’s later in life
Increased activation of error detection areas
Causal Factors: PFC and ACC
Prefrontal
o Approach/goal-related behaviors
Anterior cingulate
o Regulates social behaviors and cognitive control
o Area begins to demonstrate increased activation as people respond to treatment
Predictive Factors: Genetics: Alleles
Serotonin transporting alleles help predict diagnosis
In an individualistic society
o 2 short = greatest risk factor
o 1 and 1 = average
o 2 long = greatest protective factor
Reversed in an collectivistic society if an enriched environment is provided
o 2 short = greatest protection
• But these rates all increase if exposed to prolonged stress
Corticotrophin-releasing hormone (CRH)
Causes release of adrenocorticotropic hormone from the pituitary gland
Adrenocorticotropic hormone in turn travels in the bloodstream to the adrenal glands where it causes the secretion of the stress hormone cortisol.
Also acts on many other areas within the brain where it:
suppresses appetite
increases anxiety
improves memory and selective attention
Together, these effects co-ordinate behaviour to develop and fine tune the body’s response to a stressful experience
