Depressive Disorders

Question 1

Orientation

Answer 1

=unipolar - major depression
= bipolar - elevated mood (mania) and depression
=caveats
-unipolar mania: does it exist? it can, but it is very rare
-never had a depressive episode - still get a bipolar diagnosis
=cannot have both, if you have ever had a hypomanic or manic mood means you have bipolar not depression

Question 2

Defining Feature of Depression and bipolar

Answer 2

=textbook says it is disrupted mood for both
=depression: could just be loss of interest in pleasurable activity
=bipolar: could be high increase in goal directed behavior, not grandiose thought

Question 3

DSM depression

Answer 3

=see textbook
=loss of interest
=psychomotor retardation - speaking and moving more slowly
=psychomotor agitation - keyed up, restlessness

Question 4

Depression: heterogenous presentation

Answer 4

=Person 1
-sadness, weight gain, psychomotor retardation, hypersomnia, fatigue, excessive guilt, suicidal ideation

=Person 2
-loss of interest, weight loss, psychomotor agitation, insomnia, can’t concentrate

Question 5

Course Specifiers

Answer 5

=Table 7-1 in textbook 
=with melancholic features 
=with psychotic features 
=with atypical features 
=with catatonic features 
=with seasonal patterns

Question 6

1. with melancholic features

2. with psychotic features

Answer 6

1. black void, nothingness, no feelings
2. depressed delusions or hallucinations
   - psychotic symptoms occur only when someone is in a mood episode

Question 7

1. with atypical features
2. with catatonic features
3. with seasonal patterns

Answer 7

1 - 3. see table 7-1 in textbook

Question 8

Etiology of Depression

Answer 8

early experience –> formation of dysfunctional beliefs
critical incidents –> beliefs activated –> negative automatic thoughts –> symptoms of depression = behavioral, motivational, affective, cognitive, somatic

“if I’m not the best, I’m nothing” - easier to become depressed when proved right

Question 9

Negative Cognitive Triad

Answer 9

=negative cognitions about world, self, future

=errors in thinking and logic that maintain depression

Question 10

Errors in Thinking and Logic

Answer 10

=overgeneralization 
=selective abstraction 
=excessive responsibility 
=catastrophizing 
=should statements - perfectionism

Question 11

Cognitive Behavioral Therapy

Answer 11

Make a chart with: 
=situation 
=mood 
=automatic thought 
=evidence supports the thought
=evidence that does not support the thought 
=alternative thoughts 
=mood now

Question 12

Acceptance and Commitment Therapy

Answer 12

=change your relationship to your thoughts and moods
=trying to change a thought or feeling can you to muse on it
=choose valued action, even if you feel down

Question 13

Reformulated Helplessness Theory

Answer 13

=based on Seligman’s experiments with animal models
-learned helplessness
=addition of a cognitive component - attributing thought
-internal/external
-stable/unstable
-global/specific

Question 14

Attributing Thoughts of someone depressed

Answer 14

=Depressed

• negative events: internal, stable, global
• positive events: external, unstable, specific

Question 15

Hopelessness

Answer 15

=a real certain belief that bad things are going to happen and not good things
=a real problem for treating depression, makes it harder for patients to see solutions

Question 16

Coping Styles

Answer 16

=ruminate on problems --> depression 
-women more than men 
-problem focused 
-emotion focused 
=distraction --> protective 
-men more than women 
-ex working out, running

Question 17

Interpersonal Aspects

Answer 17

=lack of social support
-friends get tired of dealing with depressed person and she gets more depressed
=social skills deficit
=marital distress
=depression’s negative effects on others
=for children, having a depressed mother
-much worse than depressed father

Question 18

Interpersonal Psychotherapy

Answer 18

=depression arises i the context of interpersonal relationships
=focus on skill building, asking for support, role-playing, reenactments

Question 19

Behavioral Activation

Answer 19

=decrease avoidance behaviors

=fill out activity diary in therapy

Question 20

Pharmacological Treatments for Depression

Answer 20

=MAOIs
-have to follow a strict diet
-atypical features
=TriCyclics
-no dietary restrictions, but toxic in high doses
-easy to overdose - not good for a suicidal population
-side effects
=SSRIs
-less toxic, fewer side effects
-placebo effect - only work in people with very severe depression

Question 21

Other Biological Treatments

Answer 21

=ECT - in very severe, last resort, but effective
- 6-12 treatments
-induce seizures
=TMS - transcranial magnetic stimulation
=DBS - surgical procedure
-thing attached to head with wires and a stimulator
=bright light therapy - seasonal

Question 22

Psychotherapy

Answer 22

=on par with medication for treatment
=people tend to try meds before psychotherapy because of HMOs
=long term
-withdraw meds –> recurrence
-withdraw cbt -> still have skills –> less recurrence

Question 23

Could depressive symptoms ever be adaptive

Answer 23

=guide your actions
=tell you if this is not the right place to be
=can’t eliminate all symptoms because sometimes they are adaptive

Question 24

prevalence of MDD (major depressive disorder)

Answer 24

=lifetime in us: 17%
-ratio of women: men is 2:1
=12 month prevalence: 7%
=white people are most likely to have depression
=where there is greater income, depression rates are lower
=the us has one of the highest rates of depression

Question 25

MDD is typically persistent

Answer 25

=average duration of untreated episode: 6-9 months
-for 10-20% of people, takes >2years
=financial difficulties, severely stressful life events and high genetic risk –> longer time to remission

Question 26

MDD is often recurrent

Answer 26

=recurs in 40-50% of cases
=kindling hypothesis
-with each new episode the likelihood of another episode increases
=residual symptoms are common, especialy when reccurrent
-these are symptoms that dont’ meet criteria for depression

Question 27

onset of mdd

Answer 27

=typically late adolescence to middle age
-boys as likely as girls in children
=significantly lower in >65 years old
=sharp rise in teens

Question 28

comorbidities are common

Answer 28

=personality disorders
=alcohol abuse/dependence
=anxiety

Question 29

Tripartite Model

Answer 29

=anxious arousal + negative affect –> anxiety symptoms

=negative affect + low positive affect –> depressive symptoms

Question 30

Persistent Depressive Disorder

Answer 30

=milder intensity, more chronic
=worse outcomes, equal impairment
=lifetime prevalence between 2.5 - 6% in us
=average duration of 4-5 years

Question 31

What causes depressive disorders: nature

Answer 31

• genes: moderate heritability
• neurotransmitters: DA, 5HT, NE
• hormones: cortisol, HPA axis, hypothyroidism, immune system dysregulation
• brian influences: figure 7.2
• biological rhythms: sleep, circadian cycle, seasons

Question 32

What causes depressive disorders: nurture

Answer 32

• stress

- psychological factors

Question 33

Stress and depression

Answer 33

=severe life stress sometimes plays a role
-20-50%
=life stress implicated less over time
=dependent life stress more problematic than independent
=women experience more and are more sensitive to stress
=interaction with genetics