Depressive disorders Flashcards
neurovegetative symptoms of depression
somatic complaints
dysphoria
feeling sad/depressed/down
anhedonia
lack of pleasure
paradoxical suicide
committing suicide when symptoms are improving d/t increased energy to carry it out
MDD with psychotic features
delusions/hallucinations
specify if mood-congruent or mood-incongruent
MDD with melancholic features
depression w/ severe anhedonia, early morning awakening, weight loss, profound feelings of guilt
MDD with catatonic features
stupor
blunted affect
extreme withdrawal
negativism
marked psychomotor retardation
objective rating scales for depression
HAM-D (clinician-administered)
Zung (self-administered_
Raskin depression scale (both)
focus of cognitive therapy
identify and test reality of negative cognitions and practice new cognitive and behavioral responses
2 assumptions of interpersonal psychotherapy
- current interpersonal problems originate from previous dysfunctional relationships
- current interpersonal problems precipitate/perpetuate depressive symptoms
the gist of behavioral psychotherapy
by identifying and addressing maladaptive behavior patients can learn to function in a way that gets them positive reinforcement
goal of psychoanalytically oriented psychotherapy
change in personality structure/character for more than just to relieve symptoms
aims of psychoanalytically oriented psychotherapy
-interpersonal trust
-capacity for intamacy
-coping mechanisms
-capacity to grieve
-ability to experience a wide range of emotions
what is another term for dysthymic disorder
persistent depressive disorder
sx of dysthymic disorder in relation to those of MDD
not as severe but often more chronic
what is double depression
when criteria is met for both MDD and dysthymic disrder
which type of medications are best to treat melancholic depressions
those that act dually on serotonin and norepinephrine
what is considered a partial medication response
20-25% reduction in symptoms
what is the effect of depression on the HPA axis
it is overactive leading to increased cortisol levels
thyroid axis activity in depression
20-30% have blunted TSH response on challenge
5-10% have undiagnosed thyroid disorder
what does BDNF stand for
brain-derived neurotrophic factor
what does BDNF do
responsible for ongoing maintenance of neurons in the brain
what happens when there is a disruption of BDNF in the brain
reduction in neuronal number and size
agents that increase BDNF
antidepressants
estrogen
lithium
neurostimulation
amygdala
a waystation for processing stimuli of emotional significance
and coordinating/organizing cortical responses
what is adjacent to the amygdala
and associated with learning and memory
hippocampus
What is L-sided activation of the PFC associated with
goal-directed or appetitive behavior
what is right-sided activation of PFC associated with
avoidance behaviors and inhibition of appetitive pursuits
which region of the brain is involved in attention, motivation, and environmental exploration
anterior cingulate cortex
what structure in the brain regulated the HPA axis by inhibiting its activity
hippocampus
what is the neurogenesis hypothesis of depression
chronic stress increases the activity of the HPA axis which increases glucocorticoid levels. glucocorticoids decrease neurogenesis. the hippocampus then cant regulate the HPA axis so glucocorticoids remain high and fewer neurons are produced leading to depression
what is the neuroplasticity hypothesis of depression
neuronal atrophy causes depression rather than deficient growth. Atrophy is caused by increased glucocorticoid levels, which also decreases BDNF
what are the 4 key points of the psychodynamic theory of depression
-disturbance in infant-mother relationship in the oral stage predisposes to depression vulnerability
-depression can be linked to real/imagined object loss
-unconscious thoughts of object as a defense mechanism to deal with distress connected to its loss
-feelings of anger are directed inward because lost object is associated with mixture of love and hate
what is the cognitive theory of depression
depression results from specific cognitive distortions in someone susceptible to depression
Aaron Beck’s cognitive triad of depression:
-views of self
-views of environment
-views of the future
Triad of depression: views on self
tend to have a negative self-perception
triad of depression: views on environment
tend to experience the world as hostile and demanding
triad of depression: views of the future
tend to have expectations of suffering and failure
