Ch. 16: Depressive Disorders

Question 1

Depression intro

Answer 1

Transient symptoms are normal, healthy responses to everyday disappointments in life.

Question 2

Pathological depression occurs when adaptation is…

Answer 2

• Ineffective
• Mood is also called affect (observable)
• Depression is an alteration in mood that is expressed by feelings of sadness, despair, and pessimism.
• There is also psychomotor retardation. Everything slows down. Usually at hospital for this.

Question 3

Epidemiology

Answer 3

• During their lifetime, about 21% of women and 13% of men will become clinically depressed
• Major depresive disorder (MDD) is one of the leading causes of disability in the U.S.
• Depression is ranked by the World Health Organization as the single largest contributor to global disability and major contributor to suicide deaths, which is 800,000 per year worldwide.

Question 4

More epidemiology

Answer 4

• Gender: depression is more prevalent in women than in men by about 2 to 1
• Age: Depression is more prevalent in young women than in young men. Less pronounced gap between 44 and 65

Question 5

Race and culture

Answer 5

• Depression is more prevalent in white Americans than black Americans, but when diagnosed, is more severe and disabling in blacks.
• Blacks are less likely to receive treatment than are whites.

Question 6

Marital status

Answer 6

Single and divorced people are more likely to experience depression than are married persons or persons with a close interpersonal relationship (differences occur in various age groups)

Question 7

Seasonality

Answer 7

• Affective disorders are more prevalent in the spring and in the fall
• Seasonal affective disorder (SAD) is not considered as a separate disorder. It is a type of depression displaying a recurring seasonal pattern. To be diagnosed with SAD, people must meet full criteria for major depression coinciding with specific seasons for at least 2 years.

Question 8

major depressive disorder

Answer 8

• Symptoms present for at least 2 weeks
• No history of manic behavior
• Cannot be attributed to use of substances or another medical condition

Question 9

Dysthymic disorder

Answer 9

• Sad or “down in the dumps”
• No evidence of psychotic symptoms
• Essential feature is a chronically depressed mood for:
• Most of the day
• More days than not
• At least 2 years

Question 10

Premenstrual dysphoric disorder

Answer 10

• Depressed mood, anxiety, mood swings, decreased interest in activities
• Symptoms begin during week prior to menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week postmenses.

Question 11

Substance induced depressive disorder

Answer 11

• Considered to be the direct result of physiological effects of a substance

Question 12

Depressive disorder associated with another medical condition

Answer 12

Attributable to the direct physiological effects of a general medical condition

Question 13

Biological theories

Answer 13

• Genetics may be involved
• Deficiency or norepinephrine, serotonin, and dopamine has been implicated
• Excessive cholinergic transmission may also be a factor

Question 14

Neuroendocrine disturbances

Answer 14

• Possible failure within the hypothalamic-pituatary adrenocorticol axis results in hypersecretion of cortisol.
• Possible diminished release of TSH…treat with hormone replacement instead of antidepressants

Question 15

Physiological influences of depression

Answer 15

• medication side effects
• neurological disorders
• Electrolyte disturbances
• Hormonal disorders
• Nutritional deficiencies
• Other physiological conditions

Question 16

Psychoanalytic theory (Freud)

Answer 16

A loss is internalized and becomes directed against the ego. Freud believed melancholia occured after the loss of a loved object and the individual then turns rage inward, which reduces self-esteem and makes one vulnerable to depression.

Question 17

Psychosocial theories: Learning theory

Answer 17

Learned helplessness: the individual who experiences numerous failures learns to give up trying

Question 18

Pt: Object loss

Answer 18

• Experiences loss of significant other during first 6 months of life
• feelings of helplessness and despair
• Early loss or trauma may predispose client to lifelong periods of depression

Question 19

PT: Cognitive theory

Answer 19

• Views primary disturbance in depression as cognitive rather than affective
• Three cognitive distortions that serve as the basis for depression —>
  1. Negative expectations of the environment
  2. Negative expectations of the self.
  3. and of the future

Question 20

Childhood depression

Answer 20

• Symptoms:
• Under age 3: Feeding problems, tantrums, lack of playfullness and emotional expressiveness
• Ages 3 - 5: accident proneness, phobias, excessive self-reproach
• Ages 6 - 8: physical complaints, aggressive behavior, clinging behavior
• Ages 9 - 12: Morbid thoughts and excessive worrying

Question 21

Childhood depression (Cont’d)

Answer 21

• Precipitated by a loss
• Focus of therapy: alleviate symptoms and strengthen coping skills
• Parental and family therapy

Question 22

Adolescence

Answer 22

• Symptoms may include anger, social withdrawal, and apathy or even substance abuse.
• Best clue that differentiates normal adolescent behavior from depression is a visible manifestation of behavioral change that lasts for several weeks.
• Most common precipitant for adolescent suicide –>
• Perception of abandonment by parents or close peer relationship

Question 23

Treatment of adolescent depression

Answer 23

• Supportive psychosocial intervention (most are outpatient but hospitalization for severe cases)
• Antidepressant medication
• All antidepressants carry a black box warning for increased risk of suicidality in children and adolescents

Question 24

Senescence and depression

Answer 24

• Bereavement overload
• High percentage of suicides among elderly
• Symptoms of depression often confused with symptoms of neurocognitive disorder (pseudodementia)
• TX: antidepressants, ECT, therapies

Question 25

Postpartum depression

Answer 25

• May last for a few weeks to several months
• Associated with hormonal changes, tryptophan metabolism, or cell alterations
• TX: Antidepressants and psychosocial therapies
• Symptoms: fatigue, irritability, loss of appetite, sleep disturbances, loss of libido, concern about inability to care for infant

Question 26

Screening tools for depression

Answer 26

• Hamilton depression scale (HAM-D)
• Patient health Questionnaire (PHQ-9) very commonly used for depression assessment
• Depends on what provider wants
• HAM-D is more specialized.
• More tool examples on slide

Question 27

Meds

Answer 27

• life saving in severe depression
• In milder depression, other treatments are useful too

Question 28

4 general classifications of depression

Answer 28

• Transient depression = life’s everyday disappointments
• Mild depression = Normal grief response
• Moderate depression = Dysthymia
• Severe depression = Major depressive disorder

Question 29

Transient depression

Answer 29

• Symptoms at this level of the continuum are not necessarily dysfunctional
• affective: “the blues”
• Behavioral: Some crying
• Cognitive: Some difficulty getting mind off of one’s disappointment
• Physiological: feeling tired and listless

Question 30

Mild depression

Answer 30

• Symptoms of mild depression are identified by clinicians as those associated with normal grieving
• Affective: anger, anxiety
• behavioral: tearful, regression
• Cognitive: Preoccupied with loss
• Physiological: Anorexia, insomnia

Question 31

Moderate depression

Answer 31

• Symptoms associated with dysthymic disorder
• Affective: Helpless, powerless
• Behavioral: slowed physical movements, slumped posture, limited verbalization
• Cognitive: Retarded thinking processes, difficulty with concentration
• Physiological: anorexia or overeating, sleep disturbance, headaches

Question 32

Severe depression

Answer 32

• Includes symptoms of major depressive disorder and bipolar depression
• Affective: feelings of total despair, worthlessness, flat affect
• Behavioral: psychomotor retardation, curled-up position, absence of communication
• Cognitive: Prevalent delusional thinking, with delusions of persecution and somatic delusions; confusion; suicidal thoughts
• Physiological: A general slow-down of the entire body

Question 33

A DX we forget to assess for: Spiritual distress related to

Answer 33

Complicated grieving process over loss of valued object evidenced by anger toward God, questioning meaning of own existence, inability to participate in usual religious practices

Question 34

Electroconvulsive therapy

Answer 34

• Mechanism of action: thought to increase levels of biogenic amines
• Side effects: Temporary memory loss and confusion
• Risks: Mortality; permanent memory loss; brain damage
• Medications: Pretreatment medication; muscle relaxant; short acting anesthetic

Question 35

Other treatment modalities

Answer 35

• transcranial magnetic stimulation (TMS)
• Vagal nerve stimulation (VNS)
• Deep brain stimulation (DBS)
• Light therapy