Ch.7, Mood Disorders

Question 1

Two key moods involved in mood disorders/ mixed episode cases

Answer 1

depression, feelings of extraordinary sadness and dejection
mania, intense and unrealistic feelings of excitement and euphoria
Normal moods can occur between both types of episodes
Mixed episode cases: individual may have symptoms of mania and depression during the same time period. In these mixed-episode cases, the person experiences rapidly alternating moods such as sadness, euphoria, and irritability, all within the same episode of illness.

Question 2

Why might manic and depressive episodes not be polar opposites?

Answer 2

sometimes an individual may have symptoms of mania and depression during the same time period.

Question 3

Unipolar depressive disorders

Answer 3

in which a person experiences only depressive episodes,

Question 4

bipolar disorders

Answer 4

person experiences depressive and manic episodes

Question 5

Two primary kinds of mood episodes and their duration

Answer 5

-he most COMMON form of mood disturbance involves a depressive episode, in which a person is markedly depressed or loses interest in formerly pleasurable activities (or both) for at least 2 weeks, as well as other symptoms such as changes in sleep or appetite, or feelings of worthlessness.
manic: person shows a markedly elevated, euphoric, or expansive mood, often interrupted by occasional outbursts of intense irritability or even violence—particularly when others refuse to go along with the manic person’s wishes and schemes; PERSIST FOR ONE WEEK

Question 6

Three additional symptoms needed alongside manic and depressive episodes for diagnosis

Answer 6

1. behavioral symptoms (such as a notable increase in goal-directed activity)
2. mental symptoms where self-esteem becomes grossly inflated and mental activity may speed up (such as a “flight of ideas” or “racing thoughts”),
3. physical symptoms (such as a decreased need for sleep or psychomotor agitation)

Question 7

Hypomanic episode

Answer 7

person experiences abnormally elevated, expansive, or irritable mood for at least 4 days.
-person must have at least three other symptoms similar to those involved in mania but to a lesser degree (inflated self-esteem, decreased need for sleep, flights of ideas, pressured speech, etc.
- much less impairment in social and occupational functioning in hypomania, and hospitalization is not required.

Question 8

Prevalence of mood disorders stats

Answer 8

-15 to 20 times more frequently occuring than schizophrenia
-15 to 20 times more frequently than schizophrenia
- lifetime prevalence rates of unipolar major depression at nearly 17 percent
-Worldwide, mood disorders are the second most prevalent type of disorder (following anxiety disorders), with a 12-month prevalence ranging from 1 to 10 percent across different countries

Question 9

Most serious of the two types of serious mood disorders/ gender difference

Answer 9

major depressive disorder (MDD; also known as “major depression” or “unipolar depression”), in which only major depressive episodes occur, is the most common, and its occurrence has apparently increased in recent decades
WOMEN MORE LIKELY TO BE AFFECTED; 2:1 RATIO ( the disparity starts in adolescence and continues until about age 65, when it seems to disappear.)

Question 10

Prevalence and sex differences in bipolar disorder

Answer 10

risk of developing the classic form of this disorder is about 1 percent; and there is no discernible difference in the prevalence rates between the sexes.

Question 11

Ethnic rates for mood disorders; difference in bipolar

Answer 11

-mood disorders occur less frequently among African Americans than among European white Americans and Hispanics, whose rates are comparable
-Native Americans, by contrast, have significantly elevated rates compared to white American
*****There are no significant differences among such groups for bipolar disorder.

Question 12

Unipolar depression and SES/ bipolar and SES

Answer 12

inversly related; lower SES, higher unipolar
This may be because low SES leads to adversity and life stress
Bipolar: used to think it was related to higher SES, but no controlled studies show this now

Question 13

Mood disorders and artistic individuals; hypothesis explaining this

Answer 13

-elevated rates of mood disorders consists of individuals who have high levels of accomplishments in the arts; that both unipolar and bipolar disorder, but especially bipolar disorder, occur with alarming frequency in poets, writers, composers, and artists
HYPOTHESIS: One possible hypothesis to explain this relationship is that mania or hypomania actually facilitates the creative process. However, it is also possible that the intense negative emotional experiences of depression also can provide material for creative activity.

Question 14

Emily Dickinson and panic disorder and depression

Answer 14

evidence supports the idea that Dickinson’s painful experiences with panic disorder and depression provided ideas for her especially high-quality work during those times. However, a detailed analysis of her hypomanic periods suggests that her hypomanic symptoms increased her motivation and output but not her creativity per se

Question 15

MDD and absence of manic episodes/ duration

Answer 15

The diagnostic criteria for major depressive disorder (see the DSM-5 criteria box) require that a person must be in a major depressive episode and never have had a manic, hypomanic, or mixed episode.
must be during two week p[period and represent change from previous functioning

Question 16

Depression and anxiety

Answer 16

-few, if any depressions—including milder ones—occur in the absence of significant anxiety
-high degree of overlap between measures of depressive and anxious symptoms in self-reports and in clinician ratings

Question 17

Single vs recurrent episode MDD

Answer 17

When a diagnosis of MDD is made, it is usually also specified whether this is a first, and therefore single (initial), episode or a recurrent episode (preceded by one or more previous episodes
-Depressive episodes typically last about 6 to 9 months if untreated. In approximately 10 to 20 percent of people with MDD, the symptoms do not remit for over 2 years, in which case persistent depressive disorder is diagnosed

Question 18

Chronic major depression and childhood factors

Answer 18

associated with serious childhood family problems and an anxious personality in childhood

Question 19

Relapse vs recurrence when they tend happen

Answer 19

Relapse refers to the return of symptoms within a fairly short period of time, a situation that probably reflects the fact that the underlying episode of depression has not yet run its course: relapse may commonly occur when pharmacotherapy is terminated prematurely—after symptoms have remitted but before the underlying episode is really over
-Recurrence, which refers to the onset of a new episode of depression, occurs in approximately 40 to 50 percent of people who experience a depressive episode :The probability of recurrence increases with the number of prior episodes and also when the person has comorbid disorders.

Question 20

Residual symptoms, depression and recurrence

Answer 20

people with some residual symptoms, or with significant psychosocial impairment, following an initial depressive episode are more likely to have recurrences than those whose symptoms remit completely

Question 21

Onset of unipolar depressive disorders , adults vs children recurrence rates

Answer 21

most often occurs during late adolescence up to middle adulthood, such reactions may begin at any time from early childhood to old age
recurrence rates are higher in children

Question 22

Depression and individuals over 65

Answer 22

Although the prevalence of major depression is significantly lower in people over age 65 than in younger adults, MDD in older adults is still considered a major public health problem

Question 23

Depression and risk of death in ollder adults who have a heart attack/stroke; difficulty diagnosing depression later in life

Answer 23

depression in later life has many adverse consequences for a person’s health, including doubling the risk of death in people who have had a heart attack or stroke
depression in later life can be difficult to diagnose because many of the symptoms overlap with those of several medical illnesses and neurocognitive disorders

Question 24

Specifiers

Answer 24

additional patterns of symptoms or features that are important to note when making a diagnosis because these patterns have implications for understanding more about the course of the disorder and its most effective treatment

Question 25

Major depressive episode with melancholic features

Answer 25

SPECIFIER
This designation is applied when, in addition to meeting the criteria for a major depressive episode, a patient either has lost interest or pleasure in almost all activities or does not react to usually pleasurable stimuli or desired events. This subtype of depression is more heritable than most other forms of depression and is more often associated with a history of childhood trauma

Question 26

mdd episodes with melancholic features vs mdd episodes with psychotic features

Answer 26

Three of the following: early morning awakening, depression worse in the morning, marked psychomotor agitation or retardation, loss of appetite or weight, excessive guilt, qualitatively different depressed mood
psychotic: Delusions or hallucinations (usually mood congruent); feelings of guilt and worthlessness common

Question 27

mdd episodes with atypical features (why this is an important specifier) nvs catatonic features

Answer 27

atypical
: Mood reactivity—brightens to positive events; two of the four following symptoms: weight gain or increase in appetite, hypersomnia, leaden paralysis (arms and legs feel as heavy as lead), being acutely sensitive to interpersonal rejection; atypical depression is linked to a mild form of bipolar disorder that is associated with hypomanic rather than manic episodes
IMPORTNT SPECIFIER BC: important specifier because there are indications that individuals with atypical features may preferentially respond to a different class of antidepressants—the monoamine oxidase inhibitors—than do most other individuals with depression.
catatonic: A range of psychomotor symptoms from motoric immobility to extensive psychomotor activity, as well as mutism and rigidity

Question 28

Seasonal pattern/ MDD episodes

Answer 28

At least two or more episodes in past 2 years that have occurred at the same time (usually fall or winter), and full remission at the same time (usually spring). No other nonseasonal episodes in the same 2-year period

Question 29

severe major depressive episode with psychotic features/ long term prognosis/ treatment

Answer 29

Psychotic symptoms, characterized by loss of contact with reality and delusions (false beliefs) or hallucinations (false sensory perceptions), may sometimes accompany other symptoms of major depression.
Individuals who are psychotically depressed are likely to have longer episodes, more cognitive impairment, and a poorer long-term prognosis than those suffering from depression without psychotic features
-Treatment generally involves an antipsychotic medication as well as an antidepressant

Question 30

Mood congruent delusions

Answer 30

delusions that seem in some sense appropriate to serious depression because the content is negative in tone, such as themes of personal inadequacy, guilt, deserved punishment, death, or disease.

Question 31

Catatonia and catalepsy

Answer 31

catalepsy—a stuporous state): mdd with catatonic features
catatonia: usually known as a subtype of schizophrenia, but more frequently associated with certain forms of depression/mania than with schizophrenia

Question 32

Seasonal affective disoreder

Answer 32

, recurrent major depressive episode with a seasonal pattern, also commonly known as seasonal affective disorder. To meet DSM-5 criteria for this specifier, the person must have had at least two episodes of depression in the past 2 years occurring at the same time of the year (most commonly fall or winter), and full remission must also have occurred at the same time of the year (most commonly spring).
-winter seasonal affective disorder is more common in people living at higher latitudes (northern climates) and in younger people.

Question 33

Persistent depressive disorder (formerly called dysthymic disorder or dysthymia) /difference from MDD/ OUTCOMES COMPARED TO MDD

Answer 33

disorder characterized by persistently depressed mood most of the day, for more days than not, for at least 2 years (1 year for children and adolescents).
-Periods of normal mood may occur briefly, but they usually last for only a few days to a few weeks (and for a maximum of 2 months)
-These intermittently normal moods are one of the most important characteristics distinguishing persistent depressive disorder from MDD. Nevertheless, in spite of the intermittently normal moods, people with persistent depressive disorder, because of its chronic course, show poorer outcomes and as much impairment as those with MDD

Question 34

Double depression

Answer 34

Form of persistent depressive disorder
Although persistent depressive disorder is distinct from MDD, the two disorders sometimes co-occur in the same person
- People with double depression are moderately depressed on a chronic basis (meeting symptom criteria for persistent depressive disorder) but undergo increased problems from time to time, during which they also meet criteria for a major depressive episode.
Although nearly all individuals with double depression appear to recover from their major depressive episodes (though usually just to their previous level of dysthymia), recurrence often occurs

Question 35

Precursor to depression

Answer 35

Depression is nearly always precipitated by stressful life events. Some of the most stressful events possible are those involving the loss of life, as well as the creation of new life. Indeed, these dramatic events often can push a person into a depressive episode, and psychologists have struggled with how to appropriately diagnose (or not) a person’s response to them.

Question 36

Bowlby’;s four phases of normal response to loss of someone close

Answer 36

1) numbing and disbelief, (2) yearning and searching for the dead person, (3) disorganization and despair that sets in when the person accepts the loss as permanent, and (4) some reorganization as the person gradually begins to rebuild his or her life.

Question 37

Bereavement and DSM5

Answer 37

The normal nature of exhibiting a certain number of grief symptoms led DSM-IV-TR to suggest that a major depressive disorder usually should not be diagnosed for the first 2 months following the loss, even if all the symptom criteria are met. However, in a controversial move, this 2-month bereavement exclusion was dropped in DSM-5
-This criterion was designed to distinguish true disorder from normal sadness, thus reducing diagnostic false-positives, unnecessary treatment, potential stigmatization, and inflated prevalence rates
-bereavement-triggered depression and depression triggered by other forms of loss were very similar on eight of nine symptoms of depression (the exception being that bereaved individuals, not surprisingly, thought about death more). There was therefore no evidence to support granting bereavement special status.

Question 38

Dropping bereavement exclusion in DSM 5

Answer 38

-Dropping the bereavement exclusion may now create the risk that a normal grief reaction becomes misdiagnosed as a major depressive episode leading to unnecessary treatment, stigmatization, or other negative consequences.
-however, the assumption that any depressive response to the loss of a love one is “normal” could lead to delays in receiving needed treatment.

Question 39

Premenstrual Dysphoric Disorder

Answer 39

-This disorder is diagnosed if a woman has had a certain set of symptoms in the majority of her menstrual cycles for the past year
-she must have at least one of the following four symptoms in the final week before the onset of menses; these symptoms must start to improve within a few days after the onset of menses, and become minimal or absent in the week post-menses.
- (1) marked affective lability such as mood swings; (2) marked irritability or anger or increased interpersonal conflicts; (3) marked depressed mood, or feelings of hopelessness or self-deprecating thoughts; or (4) marked anxiety, tension, or feelings of being “keyed up” or “on edge.”

Question 40

“Postpartum blues” vs depression

Answer 40

-symptoms of postpartum blues typically include changeable mood, crying easily, sadness, and irritability, often liberally intermixed with happy feelings

Question 41

MDD and postpartum mothers

Answer 41

• the once firmly held notion that women are at especially high risk for major depression in the postpartum period has not been upheld. There is, however, a greater likelihood of developing major depression after the postpartum blues—especially if they are severe
  It appears that major depression in women occurs no more frequently in the postpartum period than would be expected in women of the same age and socioeconomic status who have not just given birth

Question 42

NT systems postpartum depression

Answer 42

hormonal readjustments (Miller, 2002) and alterations in serotonergic and noradrenergic functioning (Doornbos et al., 2008) may play a role in postpartum blues and depression, although the evidence on this issue is mixed.

Question 43

Prevalence of mood disorders in family

Answer 43

Family studies have shown that the prevalence of mood disorders is approximately two to three times higher among blood relatives of persons with clinically diagnosed unipolar depression than it is in the population at large
-Monozygotic co-twins of a twin with MDD are about twice as likely to develop the disorder as are dizygotic co-twins, with about 31 to 42 percent of the variance in liability due to genetic influences
-Taken together, the results from family and twin studies make a strong case for a moderate genetic contribution to the causal patterns of MDD, although not as large a genetic contribution as for bipolar disorder, discussed later

Question 44

s/s on the 5HTTLPR and mood disorders

Answer 44

individuals who possessed the genotype with the s/s alleles were twice as likely to develop a major depressive episode following four or more stressful life events in the past 5 years as those who possessed the genotype with the l/l alleles and had experienced four or more stressful events (those with the s/l alleles were intermediate).
-those who had the s/s alleles and had experienced severe maltreatment as children were also twice as likely to develop a major depressive episode as those with the l/l alleles who had had severe maltreatment and also as compared to those with the s/s alleles who had not been maltreated as children.
=Life events predicted a diagnosis of major depression among carriers of the s allele (s/s or s/l), but not among carriers of two l alleles (l/l).

Question 45

monoamine theory of depression and inaccuracy

Answer 45

depression was at least sometimes due to an absolute or relative depletion of one or both of these neurotransmitters at important receptor sites in the brain
- no such straightforward mechanisms could possibly be responsible for causing depression
-some studies have found exactly the opposite of what is predicted by the monoamine hypothesis—that is, net increases in norepinephrine activity in patients with depression—especially in those with severe or melancholic depression
-only a minority of patients with depression has lowered serotonin activity, and these tend to be patients with high levels of suicidal ideation and behavior.
-even though the immediate, short-term effects of antidepressant drugs are to increase the availability of norepinephrine and serotonin, the long-term clinical effects of these drugs do not emerge until 2 to 4 weeks later, when neurotransmitter levels may have normalized.

Question 46

Dopaminergic activity and depression

Answer 46

dopamine dysfunction (especially reduced dopaminergic activity) plays a significant role in at least some forms of depression, including depression with atypical features and bipolar depression

Question 47

dexamethasone and depression

Answer 47

evidence that implicates the failure of feedback mechanisms in some patients with depression comes from robust findings that in about 45 percent of patients with serious depression, dexamethasone, a potent suppressor of plasma cortisol in normal individuals, either fails entirely to suppress cortisol or fails to sustain its suppression= This means that the HPA axis is not operating properly in these “dexamethasone nonsuppressors.”

Question 48

Dexamethasone and nonsupresion as a nonspecific indicator of generalized mental distress

Answer 48

However, subsequent research has shown that several other groups of psychiatric patients, such as those with panic disorder, also exhibit high rates of nonsuppression, suggesting that nonsuppression may merely be a nonspecific indicator of generalized mental distress.

Question 49

hypothalamic-pituitary-thyroid axis

Answer 49

People with low thyroid levels (hypothyroidism) often become depressed, and approximately 20 to 30 percent of patients with depression who have normal thyroid levels nevertheless show dysregulation of this axis. Moreover, some patients who do not respond to traditional antidepressant treatments show improvement when administered thyrotropin-releasing hormone, which leads to increased thyroid hormone levels

Question 50

Patients with depression and elevated cortisol

Answer 50

Research also has revealed that patients having depression with elevated cortisol tend to show memory impairments and problems with abstract thinking and complex problem solving = due to cell death in the HPC from cortisol

Question 51

Depression and immune system dysregulation

Answer 51

depression is associated with activation of the inflammatory response system as evidenced by increased production of proinflammatory cytokines such as interleukin and interferon

Question 52

anterior prefrontal cortex damage and depression

Answer 52

damage to LEFT anterior pfc = often leads to depression
This led to the idea that depression in people without brain damage may nonetheless be linked to lowered levels of brain activity in this same region
Studies measuring the electroencephalographic (EEG) activity of both cerebral hemispheres in people who are depressed reveal an asymmetry or imbalance in the EEG activity of the two sides of the prefrontal regions of the brain. People with depression show lower activity in the left hemisphere in these regions and higher activity in the right hemisphere

Question 53

Left frontal asymmetry and prediction of depression

Answer 53

recent study found that left frontal asymmetry in never-depressed individuals predicted onset of major and minor depressive episodes over a 3-year period

Question 54

why is activity lower in left pfc than in right in people with depression based on their symptoms?

Answer 54

ower activity on the left side of the prefrontal cortex in depression is thought to be related to symptoms of reduced positive affect and approach behaviors to rewarding stimuli, and increased right-side activity is thought to underlie increased anxiety symptoms and increased negative affect associated with increased vigilance for threatening information

Question 55

OFC volume and depression

Answer 55

rbital prefrontal cortex, which is involved in responsivity to reward show decreased volume in individuals with recurrent depression relative to normal controls

Question 56

DLPFC ACTIVITY and depression

Answer 56

Lower levels of activity in the dorsolateral prefrontal cortex, which are associated with decreased cognitive control, have also been observed in individuals with depression compared to controls

Question 57

HPC volume and depression

Answer 57

prolonged depression can lead to decreased hippocampal volume, which could be due to cell atrophy or cell death
evidence of decreased hippocampal volume in never-depressed individuals who are at high (versus low) risk for depression suggests that reductions in hippocampal volume may precede the onset of depression

Question 58

anterior cingulate cortex, VOLUME AND ACTIVITY in depression

Answer 58

shows both decreased volume and abnormally low levels of activation in patients with depression
-This area is involved in selective attention, which is important in prioritizing the most important information available, and therefore in self-regulation and adaptability—all significant processes that are disrupted in depression.

Question 59

amygdala activity and depression

Answer 59

• tends to show increased activation in individuals with depression (and anxiety disorders), which may be related to their biased attention to negative emotional information

Question 60

REM sleep (rapid eye movement sleep) and hypothalamus regulation

Answer 60

characterized by rapid eye movements and dreaming as well as other bodily changes; the first REM period does not usually begin until near the end of the first sleep cycle, about 75 to 80 minutes into sleep. This normal sleep–wake cycle is thought to be regulated by the suprachiasmatic nucleus of the hypothalamus

Question 61

Sleep problems and depression

Answer 61

People who are depressed often show one or more of a variety of sleep problems, ranging from difficulty falling asleep, to periodic awakening during the night (poor sleep maintenance), to early morning awakening. Such changes occur in about 80 percent of hospitalized patients with depression and in about 50 percent of outpatients with depression, and are particularly pronounced in patients with melancholic features.

Question 62

REM and depression

Answer 62

enter REM sooner, after only 60 minutes or less of sleep (15 to 20 minutes sooner than nondepressed patients), show greater amounts of REM sleep during the early cycles, and have more intense and frequent rapid eye movements

Question 63

Reduced latency to enter REM nd decreased amount of sleep as vulnerability markers

Answer 63

. Both the reduced latency to enter REM sleep and the decreased amount of deep sleep often precede the onset of depression and persist following recovery, which suggests that they may be vulnerability markers for certain forms of major depression

Question 64

Most effective treatment for SAD

Answer 64

Although antidepressant medications can also be useful, the use of light therapy is more cost efficient in the long term

Question 65

Hormonal changes in women and depression

Answer 65

t seems that for the majority of women, hormonal changes occurring at various points (e.g., at the onset of puberty, before menstruation, in the postpartum period, and at menopause) do not play a significant role in causing depression. However, it remains possible that there is a causal association that has not yet been discovered because of real methodological difficulties in conducting conclusive research on this topic
=for a small minority of women who are already at high risk (for example, by being at high genetic risk), hormonal fluctuations may trigger depressive episodes, possibly by causing changes in the normal processes that regulate neurotransmitter systems

Question 66

Young adult females and stressful life events/depression

Answer 66

Many studies have shown that severely stressful life events often serve as precipitating factors for unipolar depression: This is especially true for young female adults for whom stressful life events are more likely to show a stronger stress–depression relationship than is the case for men

Question 67

Caregiving stress and onset of depression/anxiety

Answer 67

The stress of being the caregiver to a spouse with a debilitating disease such as Alzheimer’s is also known to be associated with the onset of both major depression and generalized anxiety disorder in the caregiver

Question 68

Independent and dependent life events as precursors

Answer 68

An important distinction has been made between stressful life events that are independent of the person’s behavior and personality (independent life events, such as losing a job because one’s company is shutting down or having one’s house hit by a hurricane) and events that may have been at least partly generated by the depressed person’s behavior or personality (dependent life events)
= Evidence to date suggests that dependent life events play an even stronger role in the onset of major depression than do independent life events

Question 69

Depression and negative view of self / why it makes it dsiiffdicult to study stress and onset of depression

Answer 69

That is, their pessimistic outlook may lead them to evaluate events as stressful that other nondepressed people would not. Therefore, researchers have developed more sophisticated interview-based measures of life stress that do not rely on the depressed person’s self-report of how stressful an event is and that take into account the biographical context of a person’s life.
SOLUTION= Trained independent raters evaluate what the impact of a particular event would be expected to be for an average person who has experienced this event in these particular life circumstances; the person’s subjective evaluations of stress are not recorded or taken into account in the rating of impac

Question 70

Severely stressful life events and causal role in depression

Answer 70

Several recent reviews of studies that employed these sophisticated measurements of life stress suggest that severely stressful episodic life events play a causal role (most often within a month or so after the event) in about 20 to 50 percent of cases—. It has been estimated that about 70 percent of people with a first onset of depression have had a recent major stressful life event, whereas only about 40 percent of people with a recurrent episode have had a recent major life event

Question 71

Minor stressors and depression vs chronic stress and depression

Answer 71

An interesting hypothesis has been raised that minor events may play more of a role in the onset of recurrent episodes than in the initial episode
-=chronic stress is associated with increased risk for the onset, maintenance, and recurrence of major depression

Question 72

Primary personality variablew as a vulnerability factor for depression

Answer 72

neuroticism is associated with a worse prognosis for complete recovery from depression. Finally, some researchers attribute sex differences in depression to sex differences in neuroticism

Question 73

Introversion and depression

Answer 73

igh levels of introversion (or low positive affectivity) may also serve as vulnerability factors for depression, either alone or when combined with neuroticism
people low on this disposition tend to feel unenthusiastic, unenergetic, dull, flat, and bored. It is therefore not surprising that this might make them more prone to developing clinical depression, although the evidence for this is very mixed.

Question 74

Attrubition of negative events and depression

Answer 74

people who attribute negative events to internal, stable, and global causes may be more prone to becoming depressed than are people who attribute the same events to external, unstable, and specific cause

Question 75

Early adversities in environment that can create vulnerabilities to depression short term and long term

Answer 75

A range of adversities in the early environment (such as family turmoil, parental psychopathology, physical or sexual abuse, and other forms of intrusive, harsh, and coercive parenting)
Such factors operate, at least in part, by increasing an individual’s sensitivity to stressful life events in adulthood, with similar findings having been observed in animals

Question 76

Psycodanimic perspective of depression

Answer 76

-In his classic paper “Mourning and Melancholia” (1917), Freud noted the important similarity between the symptoms of clinical depression and the symptoms seen in people mourning the loss of a loved one
-Freud and his colleague Karl Abraham (1927) both hypothesized that when a loved one dies the mourner regresses to the oral stage of development (when the infant cannot distinguish self from others) and introjects or incorporates the lost person, feeling all the same feelings toward the self as toward the lost person..
-. These feelings were thought to include anger and hostility because Freud believed that we unconsciously hold negative feelings toward those we love, in part because of their power over us
=led to the psychodynamic idea that depression is anger turned inward. Freud hypothesized that depression could also occur in response to imagined or symbolic losses. For example, a student who fails in school or who fails at a romantic relationship may experience this symbolically as a loss of his or her parents’ love.

Question 77

most important contribution of the psychodynamic approaches to depression

Answer 77

has been their noting the importance of loss (both real and symbolic or imagined) to the onset of depression and noting the striking similarities between the symptoms of mourning and the symptoms of depression.

Question 78

behavourism and depression

Answer 78

-several theorists in the behavioral tradition developed behavioral theories of depression, proposing that people become depressed either when their responses no longer produce positive reinforcement or when their rate of negative experiences increases
-consistent with research showing that people with depression do indeed receive fewer positive verbal and social reinforcements from their families and friends than do people who are not depressed and also experience more negative events
-they have lower activity levels, and their moods seem to vary with both their positive and their negative experiences rates
-some of the primary symptoms of depression, such as pessimism and low levels of energy, cause the person with depression to experience lower rates of reinforcement, which in turn may help maintain the depression.

Question 79

Beck’s cognitive theory

Answer 79

• one of the most influential theories of depression
  -diathesis stress theory
• Beck hypothesized that the cognitive symptoms of depression often precede and cause the affective or mood symptoms rather than vice versa
  -certain kinds of early experiences can lead to the formation of dysfunctional assumptions that leave a person vulnerable to depression later in life if certain critical incidents (stressors) activate those assumptions. Once activated, these dysfunctional assumptions trigger automatic thoughts that in turn produce depressive symptoms, which further fuel the depressive automatic thoughts.

Question 80

Beck, depressogenic schemas and negative automatic thoughts

Answer 80

dysfunctional beliefs, known as depressogenic schemas, which are rigid, extreme, and counterproductive
-hese depression-producing beliefs or schemas are thought to develop during childhood and adolescence as a function of negative experiences with parents and significant others, and they are thought to serve as the underlying diathesis, or vulnerability, to developing depression
when dysfunctional beliefs are activated by current stressors or depressed mood, they tend to fuel the current thinking pattern, creating a pattern of negative automatic thoughts—thoughts that often occur just below the surface of awareness and involve unpleasant, pessimistic predictions

Question 81

Beck, negative cognitive triad

Answer 81

which include negative thoughts about (1) self (“I’m worthless”); (2) world (“No one loves me”); and (3) future (“It’s hopeless because things will always be this way”

Question 82

Beck; dichotomouse/all or nothing reasoning, selective abstraction,m arbitrary inference MAINTENCE OF THE COGNITIVE TRIAD

Answer 82

• negative cognitive triad tends to be maintained by a variety of negative cognitive biases or errors. Each of these involves biased processing of negative self-relevant information.
  Dichotomous or all-or-none reasoning, which involves a tendency to think in extremes. For example, someone might discount a less-than-perfect performance by saying, “If I can’t get it 100 percent right, there’s no point in doing it at all.”

Selective abstraction, which involves a tendency to focus on one negative detail of a situation while ignoring other elements of the situation. Someone might say, “I didn’t have a moment of pleasure or fun today” not because this is true but because he or she selectively remembers only the negative things that happened.

Arbitrary inference, which involves jumping to a conclusion based on minimal or no evidence

Question 83

Beck and cognitive therapy/ value of his theory

Answer 83

-theories generated cognitive therapy
- been well supported as a descriptive theory that explains many prominent characteristics of depression
-Beck’s theory originally proposed that stressors are necessary to activate depressogenic schemas or dysfunctional beliefs that lie dormant between episodes, but more recent research has shown that stressors are not necessary to activate the latent depressive schemas between episodes. Indeed, simply inducing a depressed mood (e.g., through listening to sad music or recalling sad memories) in an individual who was previously depressed (that is, at risk) is generally sufficient to activate latent depressogenic schemas

Question 84

cognitive biases for negative self-relevant information in depression/ vicious cycle of depression.

Answer 84

• people with depression show better or biased recall of negative information and negative autobiographical memories, whereas people who are not depressed tend to show biased recall of positive emotional information and positive autobiographical memories
  “vicious cycle of depression.”: if one is already depressed, remembering primarily the bad things that have happened is likely to maintain or exacerbate the depression

Question 85

Causal factors In beck’s theory and accuracy of these claims

Answer 85

CLAIMED THAT: that dysfunctional beliefs or attitudes at Time 1, in interaction with stressful life events, predict depression at Time 2.
only some studies have shown this ***: many studies don’t show the diathesis-stress reaction, they only show the vulnerability = which then produces the depression

Question 86

Learned helplessness, seligmen

Answer 86

noted that laboratory dogs who were first exposed to uncontrollable shocks later acted in a passive and helpless manner when they were in a situation where they could control the shocks. In contrast, animals first exposed to equal amounts of controllable shocks had no trouble learning to control the shocks.
CLAIMED THAT: It states that when animals or humans find that they have no control over aversive events (such as shock), they may learn that they are helpless, which makes them unmotivated to try to respond in the future. Instead they exhibit passivity and even depressive symptoms. They are also slow to learn that any response they do make is effective, which may parallel the negative cognitive set in human depression.

Question 87

The Reformulated Helplessness Theory/ Abramson and attribution

Answer 87

when people (probably unlike animals) are exposed to uncontrollable negative events, they ask themselves why, and the kinds of attributions that people make are, in turn, central to whether they become depressed.
- three critical dimensions on which attributions are made: (1) internal/external, (2) global/specific, and (3) stable/unstable.
-They proposed that a depressogenic or pessimistic attribution for a negative event is an internal, stable, and global one.
- proposed that people who have a relatively stable and consistent pessimistic attributional style have a vulnerability or diathesis for depression when faced with uncontrollable negative life events. This kind of cognitive style seems to develop, at least in part, through social learning

Question 88

Helplessness theory and sex differences in depression

Answer 88

This theory proposes that by virtue of their roles in society, women are more prone to experiencing a sense of lack of control over negative life events. These feelings of helplessness might stem from poverty, discrimination in the workplace, high rates of sexual and physical abuse against women (either currently or in childhood), role overload (e.g., being a working wife and mother), and less perceived control over traits that men value when choosing a long-term mate
=There is at least some evidence that each of these conditions is associated with higher-than-expected rates of depression, although whether the effects involve a sense of helplessness has not yet been established
=Given that women have higher levels of neuroticism and experience more uncontrollable stress, the increased prevalence of depression in women becomes less surprising.

Question 89

hopelessness theory of depression

Answer 89

• proposed that having a pessimistic attributional style in conjunction with one or more negative life events was not sufficient to produce depression unless one first experienced a state of hopelessness
• A hopelessness expectancy was defined by the perception that one had no control over what was going to happen and by the absolute certainty that an important bad outcome was going to occur or that a highly desired good outcome was not going to occur.
• depression-prone individuals not only tend to make global and stable attributions for negative events but also tend to make negative inferences about other likely negative consequences of the event (e.g., that this means more bad things will also happen) and negative inferences about the implications of the event for the self-concept (e.g., that one is unworthy or deficient;

Question 90

hopelessness with motivational theory of depression

Answer 90

posits that depression is associated with decreased approach behavior, which refers to the tendency to approach or engage a stimulus appearing in the person’s environment
-t cognitively vulnerable individuals are at risk for decreased approach-related behavior as a result of increased hopelessness under stress, thereby contributing to depression.

Question 91

Nolen-Hoeksema’s ruminative response style cognitive theory of depression

Answer 91

-focuses on different kinds of responses that people have when they experience feelings and symptoms of sadness and distress, and how their differing response styles affect the course of their depression
-rumination: rumination, which involves a pattern of repetitive and relatively passive mental activity
-people who ruminate a great deal tend to have more lengthy periods of depressive symptoms. They are also more likely to develop full-blown episodes of major depressive disorder
-women are more likely than men to ruminate when they become depressed
-when gender differences in rumination are statistically controlled, gender differences in depression are no longer significant

Question 92

Sex differences unipolar depression adolescence

Answer 92

-revealed this sex difference in depression emerges at age 12, peaks during middle-adolescence, and then declines but remains stable into adulthood
-indicating that children and adolescents, like adults, are prone to experiencing increases in depressive symptoms if they have a pessimistic attributional style and experience stressful life events
-during early adolescence, gender differences in attributional style, in rumination, and in stressful life events emerge such that girls tend to have a more pessimistic attributional style, to show more rumination, and to experience more negative life events

Question 93

Where does the overlap between measures of depression and anxiety occur?

Answer 93

The overlap between measures of depression and anxiety occurs at all levels of analysis: patient self-report, clinician ratings, diagnosis, and family and genetic factors
-=Just over half of the patients who receive a diagnosis of a mood disorder also receive a diagnosis of an anxiety disorder at some point in their lives, and vice versa

Question 94

Shared genetic trait for anxiety and depressive disorders

Answer 94

The shared genetically based factor among these disorders seems to be at least in part the personality trait of neuroticism—a major risk factor for all of these disorders

Question 95

Differences in positive affect between anxiety and depression

Answer 95

-Although depressed and anxious individuals cannot be differentiated on the basis of their high level of negative affect, they do differ in their reports of positive affect, which includes affective states such as excitement, delight, interest, and pride.
-Depressed persons tend to be characterized by low levels of positive affect, but anxious individuals usually are not (with the exception of people with social phobia

Question 96

Tripartite model of anxiety and depression

Answer 96

explains what features anxiety and depression share (high negative affect) and what features they differ on (low positive affect for depression and anxious hyperarousal for panic

Question 97

Depression and lack of social support

Answer 97

reported that women without a close, confiding relationship were more likely than those with at least one close confidant to become depressed if they experienced a severely stressful event: some people with depression have social-skills deficits. For example, they seem to speak more slowly and monotonously and to maintain less eye contact; they are also less skilled than people without depression at solving interpersonal problems

Question 98

when is social rejection especially likely for someone with depression

Answer 98

Social rejection may be especially likely if the person with depression engages in excessive reassurance seeking

Question 99

Marital dissatisfaction and depression

Answer 99

That is, a person whose depression clears up is likely to relapse if he or she has an unsatisfying marriage, especially one characterized by high levels of critical and hostile comments from the spouse

Question 100

Link of criticism to relapse

Answer 100

criticism perturbs some of the neural circuitry that underlies depression. Moreover, even after full recovery, criticism may still be a powerful trigger for those who are vulnerable to depression
mother criticism study: When they heard criticism from their mothers, the recovered-depressed participants showed less brain activation in the dorsolateral prefrontal cortex and anterior cingulate cortex than the never-depressed controls did. In contrast, during criticism, brain activity in the amygdala was much higher in the recovered-depressed participants than it was in the controls. What was especially interesting was that all of this occurred without the recovered-depressed subjects being aware that they were responding differently to the criticisms.

Question 101

mothers with depression and effects on parenting

Answer 101

mothers with depression show more friction and have fewer playful, mutually rewarding interactions with their children (Goodman & Gotlib, 1999). They are also less sensitively attuned to their infants and less affirming of their infants’ experiences (Goodman & Brand, 2009). Furthermore, their young children are given multiple opportunities for observational learning of negative cognitions, depressive behavior, and depressed affect. T