Depression and anxiety Flashcards
1
Q
Diathesis- Stress Model
A
- Inborn predosposition (diathesis) + Environmental stress = psychopathology.
- The idea is that stress may activate someones underlying vulnerability to mental illness
- For people with a low “diathesis” it would take alot of stress to trigger psychopathology. However, for people with a high “diathesis” it would take very little stress to trigger psychopathology. This model helps to explain why when some people experience the same stress, only same will develop mental illness. To further complicate things, the stress and mental illness have a receiprocal relationship where stress exacerbates the disorder and the disorder makes life more stressful.
- Examples of diathesis: genetics, cognition, personality, family history, brain abnormalities, and neurological problems
- Examples of stress: stress can be acute or chronic and can include numerous different things - parental neglect/abuse, death of a family member, relationship problems, traumatic events, etc.
2
Q
Hypothalamic-pituitary adrenal (HPA) axis
A
- HPA axis is an important system in response to stressors. It released cortisol in short-term stress scenarios. Chronically acitvated HPA axis is seen in many people with MDD and anxiety disorders.
- Hypothalamus -(CRH)-> anterior pituitary-(ACTH)-> Adrenal cortex–> cortisol
3
Q
Cortisol Receptors
A
- Two types of receptors bing cortisol - mineralcorticoid type 1 and glucocorticord type 2. Cortisol binds more strongly to the mineralcorticord receptors. This helps maintain low levels of cortisol circulating in blood. it is only when cortisol concentrations are very high (i.e., stress) that is binds to the glucocorticoid receptors - this then provides the negative feedback that terminates the response.
4
Q
Function of cortisol
A
- Cortisol is the main glucocorticoid in humans. It’s primary function is to increase blood glucose levels by inducing production of glocose molecules. Cortisol also modifies fat and protein metbolism to support nutrient requirements of CNS during stress. However, when it binds to glucocorticoid receptors it also effects other wide-ranging effects influencing cardiovascular function, immunologic status (inflammatory reactions), arousal, and learning and memory.
5
Q
Healthy vs. unhealthy stress response
A
- Healthy - characterized by quick rise in cortisol followed by rapid decline with termination of stressful event.
- Unhealthy - when individual faces cumulative stress that cortisol burden increases, exposing individual to catabolic properties of glucocorticoids, stress peptides, and proinflammatory cytokines.
6
Q
Unipolar Depression
A
- Disruptive mood dysregulation disorder
- Major depressive disorder
- Persistent depressive disorder
- Premenstrual dysphoric disorder
- Substance/medications induced depressive disorder
- Depressive disorder due to another medical condition
- Other specified depressive disorder
- Unspecified depressive disorder
7
Q
Disruptive Mood Dysregulation Disorder
A
- Severe recurrent temper outbursts grossly out of proportion to situation, inconsistent with developmental levels, occuring 3+ times a weeks. Mood outside of outburts is persistently irritable or angry. Symptoms have been present for at least 1 year, and are present in at least 2 settings.
- Diagnosis should not be made for first time after 18 or before 6 years.
- Age of onset (by history or observation) is before 10.
- Never met hypomanic or manic episode criteria for more than 1 day.
- Behaviours don’t occur during an epiodes of MDD and are not better explained by another disorder, a sustance, or neurological condition.
- Consequences: Difficulty in peer and family relationships; poor school performances; suicidal ideation or attempts; severe agression; psychiatric hospitalizations
8
Q
Major Depressive Disorder
A
- Need to meet 5/9 criteria for diagnosis. Needs to be present persistently for 2 weeks. Must have either 1 or 2.
- Depressed mood most of the day, nearly every day (children an be irritable instead of sad).
- Markedly decreased interest or pleasure in all, or almost all, activities most of the day, nearly everyday.
- Significant weight loss not due to deleting or weight gain/decrease or increase in appetite nearly everyday
- Insomnia or hypersomia
- Pscyhomtor agitation or retardation
- Fatigue or loss of energy
- Feeling or worthlessness or guilt
- Dimished ability to think or concentrate
- Recurrent thoguhts of death, recurrent suicidial ideations, suicidal attempts.
- Symptoms cause significant distress or impairment
- Symptoms are not better explained by substances or other medical condition
- There has never been a manic or hypomanic episode
9
Q
Disease course MDD
A
- Recovery begins within 3 months for 2/5 people and within 1 year for 4/5 people. Many who are depressed for only a few months will have spontaneous recovery.
- Risk of recurrence - becomes lower as duration or remission increases; its higher in those with more severe episodes and those with multiple episodes; increase risk of relapse when people have residual symptoms during remission
- 1 Episode = 50%
- 2 Episodes = 75%
- 3 Episodes = 90%
10
Q
Risk Factors MDD
A
- Temperament - negative affectivity
- Environmental - Adverse childhood experiences, stressful life events, etc.
- Genetic and physiological - First degress relative
- Presence of other nonmood disorders, especially SUD, anxiety, and BPD
11
Q
Persistent Depressive Disorder
A
- Depressed mood for most of the day, for most days, for at least 2 years (1 year for children).
- Two or more of the following: poor appetite or overeating; insomnia or hypersomnia; low energy or fatigue; low self-esteem; poor concentration or difficulty making decisions; feelings of hopelessness.
- Within 2 year period patient has never been without the above >2 months
- Criteria for MDD may be continuously present for 2 years.
- Never met critieria for manic, hypomania, or cyclothymia
- Not better explained by other disorders, substance, or medical condition
- Symptoms cause clinically significant distress or impairment
12
Q
Premenstrual Dysphoric Disorder
A
- In most menstrual cycles at least 5 symptoms must be present in week before and start to improve a few days after onset and become minimal in the week after.
- One or more of the following - marked affect lability; marked irritability, anger, or increased interpersonal conflicts; marked depressed mood, feelings of hopelessness, or self-depecating thoughts; marked anxiety, tensions, and/or feeling on edge.
- One or more of the following (together with above must add to 5) - decreased interest; difficulty concentrating; lack of energy; changes in appetite; sleep disturbance; sense of being overwhelmed; physical symptoms
- Symptoms associated with clincally significant distress or inteferences in function
- Not just an exacervation of another disorder
- Should confirm by daily rating during at least 2 symptoms cycles.
- Not attributable to physiological effect of substnace
13
Q
Substance/medications-induced depressive disorder
A
- Porminent and persistent depressed mood or reduced interest with evidence that it developed after substance intoxication or withdrawal or after medication exposure. The involved substance has to be capable of producing the symptoms
- Disturbance is not better explained by non-sub-substnace induced causes
- Disturbance is not exclusively during the course of delirium
- Disturbances causes clinically significiant distress or impairment
- Symptoms should have developed within 1 month of using the substance
- Medications: antiviral agents (efavirenze), cardiovascular agents (clonidine, methyldopa), retinoic acid derviates, antidepressants, anticonvulstans, triptans, antipsychotics, hormonal agents, smoking cessation agents, and immunological agents have all been implicated.
14
Q
Depressive disorder due to another medical condition
A
- Prominents and persistent depressed mood or diminished interest with evidence that it is due to another medical condition
- Disturbance is not better explained by another mental disorder
- Disturbance does not occur exclusively during course of delirium
- Disturvance causes clinically signficant distress or impairment
- Medical condition - Stroke, Huntingtons, PD, TBI, Cushings disease, hypothyrodism (this list is not extensive).
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15
Q
- Othe specified depressive disorder
- Unspecified depressive disorder
A
- Applies to peresentation in which symptoms are characteristic of a depressive order that causes clinically significant distress or impairment, but that do not meet full criteria for any depressive disorder diagnostic class. Used in situations where physician chooses to indicated the specific reasons why the presentation does not meet full criteria.
- Applies to peresentation in which symptoms are characteristic of a depressive order that causes clinically significant distress or impairment, but that do not meet full criteria for any depressive disorder diagnostic class. Used in situations where physician chooses not to indicated the specific reasons why the presentation does not meet full criteria.
