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PSYC 336: Adv Clinical > depression > Flashcards

depression Flashcards

1
Q

how many ppl suffer globally w depression

A

276 million

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2
Q

depression lifetime prevalence

A
  • 17%
  • women: 20-25%
  • men 9-12%
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3
Q

point prevalence depression

A

6% women, 3% men

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4
Q

social costs of depression

A

14.4 billion dollars in canada

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5
Q

____% suicide can be attributed to depression and depression increases suicide rate ______

A

70%, 4-told

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6
Q

MDD criteria

A
  • depressed mood and loss of interest + pleasure plus at least 3 more of the following:
  • change in appetite/weight, worthlessness/guilt, suicidal ideation/intention/action, fatigue/loss of energy, concentration probs/lack of energy, insomnia/hypersomnia, psychomotor agitation/retardation,
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7
Q

bc DSm criteria for depression is based on wester ideologies, what other parts of the world have other symptoms?

A
  • India: ‘tension’ (headaches)
  • Zimbabwe: Kufungisisa (thinking too much)
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8
Q

episodic accounts for ___ of depressed ppl, and persistant/dysthymia is ___

A

70-80%, 20-30%

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9
Q

SLED

A
  • single lifetime episode depression
  • characterizes lifetime course of half of ppl w episodic depression
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10
Q

early life stress and onset of depression and anxiety

A
  • men: emotional abuse and sexual abuse worse predictors
  • women: emotional abuse, physical abuse, and sexual abuse worse
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11
Q

child maltreatment and depression

A
  • emotional and sexual abuse are strongest predictors
  • ppl w MDD that have history of childhood maltreatment have: younger onset, poorer premorbid functioning, more severe symptoms, more persistent/recurrent course, more treatment resistance, and higher comorbidities
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12
Q

resilience to early life stress

A
  • high risk of drop out youth
  • found violent exposure/family conflict were strong predictors for increasing depression overtime
  • also, mother support buffered the effect and was associated with lowering depression overtim
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13
Q

levels of depressotypic cognition

A
  • automatic thoughts (ie she doesnt like me)
  • intermediary beliefs/assumptions (if someone gets close to me, theyll reject me
  • core beliefs/schemas (im unloveable)
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14
Q

manner in which events are appraised/evaluated determines the ______ of the emotion

A

type, intensity, and persistence

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15
Q

cognitive schemas

A
  • schemas about experiences leading to reactions
  • hypothetical structures containing stored reps of beliefs taken from sensory experiences
  • guides the encoding, storage and retrieval of info
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16
Q

depressotypic schemas

A
  • enduring, rigid, and complex negative beliefs about the self, personal world and future
  • resistant to change despite disconfirming info
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17
Q

Negative cognition and cause of depression

A
  • those at high risk of negative cognitions had more severe depression than low risk
  • not a longer duration/early onset
  • high risk cognition predicted first episode and episodes that followed
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18
Q

neural dysregulation

A
  • ‘gets under the skin’
  • external factors that can effect internal changes (even w/out contact)
  • ie experiences
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19
Q

vulnerability model for depression

A
  • early life stress affects development of HPA axis (hypothalamic-pituitary-adrenal axis)
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20
Q

purpose of HPA axis

A
  • releases cortisol and other neurochemicals to enable fight or flight during life threatening events
21
Q

hippocampus purpose

A
  • holds short term memories and transfers them to long term
  • emotional processing (mediating anxiety and avoidance)
22
Q

role of amygdala

A
  • links emotions to other brain abilities (ie memory, learning and sensations)
  • main hot bed for emotions
23
Q

consequences of cortisol toxicity

A
  • smaller amygdala and hippocampal volume
  • disrupts connection between cortex and hippocampus
  • causes rumination, impairs extinction of painful memories, and emotional dysregulation
24
Q

childhood maltreatment has a negative asoociation with lower connectivity between cortex and ____ or ____ (brain structures)

A
  • amygdala, hippocampus
  • lower functional connectivity sig mediated relation of childhood maltreatment and dev of depression and anxiety
25
Q

ppl with depression are ____x more likely to hve a mjaor life event prior to onset than ppl without depression for a matched time frame

A

3x

26
Q

sensitivity to stress and depression

A
  • ppl with vulnerability factors (diathesis: early life stress and neural dysregulation) are more likely to develop depression in face of stressful life event
  • may need lower levels of stress in order to trigger depression than most
27
Q

____ and _______ increase sensitivity to stressful life events

A

early life stress and neural dysregulation

28
Q

stress generation in depression (depression<->stress)

A
  • ppl w depression more likely to be exposed to future dependent life event than those w out
  • vulnerability factors before onset can contribute to generation of life events
  • stress begets stress
  • humans are architects of our enviro
  • life event generation as result of behaviour/characteristics
29
Q

stress generation (depression)

A
  • ppl with depression are more likely than non depressed ppl to be exposed to future life events
30
Q

____, ______, and ____ make stressful life events more likely to occur

A
  • early life stress, negative cognition, and neural dysregulation
31
Q

emotional and sexual maltreatment and stress generation

A
  • emotional: strong association with emotional deprevation, subjugation, and subjugation and dependent life events
  • sexual: strong association with abandonment, vulnerability to harm, dependent life events, and dependence/incompetence
32
Q

building depression model

A

genetic vulnerability/early life stress /temperament /personality >negative cognition/neural dysregulation> stress later in life > depression

  • can be offset by protective resilience factors (social support, hardiness, community resources, and good habits)
33
Q

_____% of ppl with MDD seek treatment

A

20-25%

34
Q

Treatment options for depression (general names)

A
  • Cognitive behavioural therapy
  • Interpersonal psychotherapy
  • Pharmacotherapy
35
Q

CBT for depression

A
  • teach power of realistic thinking (cognitive): improves mood by challenging dysfunctional cognitions
  • activates behaviour: improves mood by engaging in behaviours that promote sense of pleasure and mastery
36
Q

interpersonal therapy for depression

A
  • focus on identifying and amending lapses in interpersonal functioning that contribute to depression
  • ex interpersonal loss (greif), interpersonal conflict, role transiton, interpersonal deficits
37
Q

pharmacotherapy for depression

A
  • tricyclic antidepressants (TCAs): imipramine (sleep amitryptyline) > more fatal in overdose
  • monoamine oxidase inhibitors (MAOIs): phenelzine (creates reverse vegetative features, effective in countering physical symptoms ie over sleeping/eating)
  • selective serotonin reuptake inhibitors (SSRIs): escitalopram
  • serotonin and norepinephrine reuptake inhibitors (SNRIs): vanlafaxine
38
Q

t or f: people do better on treatment they chose themselves

A

true

39
Q

in a study on different treatment effectiveness, what was found after the sample was stratified into how severely they were depressed at the start of the study

A
  • in least depressed group: no matter what treatment, they were the same and all got better at the end
  • in most depressed group: imipramine and IPT did way better than all other treatments
40
Q

explain E/P>T

A
  • the belief that the cause (E/P, etiology/pathology) of depression should indicate the treatment (T)
  • ie biological cause>bio treatment/drugs, or environmental cause>enviro treatment (therapy)
41
Q

is there evidence for meds being superior to therapy for depression treatment

A
  • no
  • depression involves differences at all levels of analysis and treatments result in different changes at different levels of analysis
  • dif treatments target dif areas that are affected by depression (ie behaviour/cognitive/neural functioning)
42
Q

what percent of people respond to any treatment

A

40-50%

43
Q

hetrogeneity of depression

A
  • 170 dif possible combos
  • rarely will people have same symptoms, treatment, and outcome
44
Q

personalized meds for depression

A
  • w/out: some benefit, some dont
  • with: each patient receives right meds for them (looks at history, biomarkers, etc)
45
Q

clinical management

A
  • patient talks to the nurse about the effects of meds, not anything about how they feel/no therapy
46
Q

maintenance meds

A
  • keep ppl on meds forever
47
Q

anhedonia

A

loss of pleasure/interest

48
Q

examples of markers of different response to pharamcotherapy vs CBT (childhood trauma, stressful live events, anhedonia, and comorbid personality disorder)

A
  • comorbid personality disorder: pharma>CBT
  • anhedonia: behavioural therapy> (doesnt respond to SSRIs)
  • stressful life event: CBT>pharma
  • childhood trauma: trauma focused CBT>reg CBT/pharma
49
Q

who had higher relapse: patients who had imipramine and CBT or those that had placebo and CBT

A

imipramine and CBT

PSYC 336: Adv Clinical (11 decks)

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