Depressive Disorders Flashcards
What are the DSM criteria for Major Depressive Disorder?
Major Depressive Disorder:
◦ A Single or Recurrent depressive episode
Major Depressive Episode (5+ in 2 weeks) of:
◦ Depressed mood most of the day, nearly every day
◦ Markedly diminished pleasure/interest in activities
◦ Significant weight loss or gain
◦ Insomnia or hypersomnia nearly every day
◦ Psychomotor agitation or retardation nearly every day
◦ Fatigue/loss of energy nearly every day
◦ Feelings of worthlessness, excessive guilt
◦ Diminished ability to concentrate nearly every day
◦ Recurrent thoughts of death, suicide, suicide attempts
There has never been a manic episode or a hypomanic episode.
What are the DSM criteria for Persistant Depressive Disorder (DSMIV dysthymia)?
Depressed mood most of the day, more days than not. While depressed, of 2+ 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
No more than 2 months ‘normal’ mood in 2-years, No manic features. Symptoms can persist unchanged over long periods (e.g., 20 years or more)
Symptoms are milder than major depression, May also develop Major Depressive episodes
What are the DSM criteria for Disruptive Mood Dysregulation Disorder
A. Severe recurrent temper outbursts (verbal rages, physical aggression) that are grossly out of proportion in intensity or duration to the situation or provocation.
B. The mood between temper outbursts is
persistently irritable or angry, and is observable
by others (e.g., parents, teachers, peers).
C. The diagnosis should not be made for the first
time before age 6 years or after age 18 years.
What are the DSM criteria for Premenstrual Dysphoria Disorder?
In the majority of menstrual cycles, 5+ symptoms in final week before menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week postmenses.
1+ of the following symptoms must be present:
- Marked affective lability
- Marked irritability or anger or increased conflicts.
- Marked depressed mood or self-deprecating thoughts.
- Marked anxiety, tension, and/or feelings of being on edge.
1+ of the following symptoms must additionally be present, to reach a total of five symptoms
- Decreased interest in usual activities
- Subjective difficulty in concentration.
- Lethargy or marked lack of energy.
- Marked change in appetite
- Hypersomnia or insomnia.
- A sense of being overwhelmed or out of control.
- Physical symptoms such as breast tenderness
What were the main changes in mood disorders between DSM IV & V?
- ‘Depressive disorders’ vs ‘Bipolar and Related Disorders’
- Changed Dysthymia to ‘Persistent Depressive Disorder’
- Removed Grief exclusion from diagnosis of MDD
- Added ‘Disruptive Mood Dysregulation Disorder’
- Added ‘Premenstrual Dysphoric Disorder’
What are the subtypes of MDD?
- anxious distress
- seasonal pattern (Seasonal Affective Disorder)
- peripartum onset (Postnatal Depression)
- atypical features (weight, rejection sensitivity etc)
- psychotic features (more biological, increased severity)
- melancholic features (more biological, increased severity)
What is the epidemiology of MDD?
16.4% lifetime prevalence, 3-5 % one-year prevalence in Australia. There has been a steady increase in numbers and decrease in age of onset (reasons uncertain)
More common in women during youth, evens out later.
What biological factors contribute to MDD?
Genetic: high rate of relatives
Neurochemical: Noradrenalin, serotonin, dopamine
Brain structures: amygdala, hippocampus, etc
Neuroendocrine (hormone) system: increased levels of cortisol
epigenetics: interaction between genetic vulnerability and negative life events
What are the learned helplessness, attribution and hopelessness theories of depression?
Learned Helplessness Theory
- Lack of control over traumatic life events leads to belief that a person has no control over their life at all
- depression is driven by a sense of futility
Attribution Theory
- how a person explains and understands what happens to them
- Individuals who tend to view the causes of negative events as internal, global, and stable are said to have a pessimistic attributional style.
Hopelessness Theory (combination)
- helplessness expectancy plus
- negative outcome expectancy
What are the schema theory and response style theory of depression?
Schema theory; Pre-existing negative schema
- Developed during childhood (esp if vulnerable)
- Activated by stress
- Results in cognitive biases (memory, attention,
interpretation)
- Depressive Cognitive Triad : negative thoughts about the self, the world, the future become dominant in consciousness
Response style:
- similar to schema, depression is caused by your responses to events (rumination vs distraction, problem solving)
What are the interpersonal approaches to depression?
- Interpersonal relations are negatively altered as a result of depression. Depressed people have limited social support networks, seek excessive reassurance from others, have / display limited social skills, elicit rejection from others, can maintain or exacerbate depression.
- Stress-generation hypothesis; Depressogenic cognitions and behaviours generate negative life
events. Self-generated negative life events may partly explain depression recurrence
What are the biological treatments for Depression?
ECT: First used in 1938, only effective treatment prior to 1950s. Still used for non-responsive cases
- highly effective (85%) but causes seizures
Drugs
- MAOIs (monoamine oxidase inhibitors) have major side effects (strokes possible) interact with food
- Tricyclics: block serotonin & noradrenalin reuptake but have serious side effects (tremors, cardiotoxicity)
- SSRIs: specifically block seratonin reuptake, side effects less serious, but can increase suicidality in early stages in adolescents
- Drugs have high relapse when they are stopped
What are the psychological treatments for Depression?
CBT: addresses cognitive errors, includes behavioural components
- outcomes are comparable to drug therapy, better if combined
IPT: focus on interpersonal/role disputes, life transitions (eg new relationships, jobs), interpersonal deficits (social skills training)
- outcomes comparable to CBT
What is the epidemiology of MDD in children and adolescents?
2-3% in school-age children, Similar rates in both genders
15-30% in adolescence (age 14-18), 2:1 women (reason unknown but thought to relate to body image, increased stress and objectification, stress, sexual aggression and more negative cognitive styles)
What are the major theories explaining adolescent Depression?
Cognitive diathesis-stress models
- Beck: negative schema
- Seligman: helplessness, negative attributions
- Cognitive style + Negative events => Depression
Mid adolescence: critical time for MD
- Negative cognitive styles consolidated
- Increased stress during adolescence
In younger children:
- role of negative parental figure (learned depression)
- abuse or neglect
What are possible preventative measures for adolescent depression?
- Uses CBT techniques
- universal prevention: given to all students
- indicated prevention: aimed at children or adolescents with high scores on symptom scales
- selective prevention: target ‘high risk’ groups
- young children/toddlers: aimed at parents
