Depressive Disorders Flashcards
1
Q
history of depression
A
- recognised as a condition for over 2000 years
- known as melancholia since 1600s
- Emil Kraepelin (late 1800s): the classification of disorders, differentiated between schizo and manic dep, talked about depressive states, recognised the dif between endogenous (internally caused) and exogenous depression
2
Q
history of depression in DSM
A
1: depressive reaction (associated with guilt, The degree of reaction depends upon the intensity of the patient’s feeling towards the loss and the realistic circumstances of the loss)
2: depressive neurosis (excessive reaction of depression due to an internal conflict or to an identifiable event such as the loss of a love object or cherished possession)
3and4: MDD, diagnostic criteria based on patterns of symptoms, no aetiology incl, EXCLUDED bereavement (2 month period)
3
Q
Epidemiology of Depression
A
- MDD has the highest lifetime prevalence of any psychiatric disorder
- Lifetime prevalence varies widely, from 3% in Japan to 17% in the US
- Prevalence rates of up to 50% in some groups (e.g. female adolescents and the elderly)
- Twice as many women affected as men
- Leading cause of years lost owing to disability
4
Q
Epidemiology of Depression in SA
A
- Lifetime prevalence = 9.7%;
- 12-month prevalence = 4.9%
- Lifetime prevalence was 1.75 times higher among females than males and the 12-month prevalence was 2.17 times higher among females than males
- The prevalence was higher among those with a lower level of education
- Over 90% of the respondents with major depression reported global role impairment
5
Q
is there a depression epidemic?
A
- use of antidepressants tripled from 1988-2000
- research on depression has become a major industry
- spending on antidepressants increased dramatically
- increased media attention
- 16% of USA populations have had MDD at some point
6
Q
Critique of DSM’s diagnostic criteria
A
- Is the DSM’s definition of major depressive disorder too broad?
- Should the bereavement exclusion have been expanded or eliminated?
- Is normal sadness being pathologised?
- Do the symptoms of Major Depression really distinguish ‘ill’ people from the rest of the population?
- Alternative definitions?
- Why five symptoms?
- Why two weeks?
- Why a 2-month cut-off for ‘normal bereavement’ (DSM-IV)
- “markedly” diminished interest or pleasure in activities
- “excessive or inappropriate” guilt
7
Q
Normal sadness vs Depression
A
- context specific (bereavement, loss of valued relationships, loss of power, status or resources, failure to achieve goals, chronic social stressors, a combo of stress)
- Proportionate response (Accurate cognitive perception of the negative circumstance, Intensity of emotional response is consistent with the seriousness of the situation)
- recedes once the situation changes
8
Q
Rethinking Depression (Holtzheimer & Mayberg, 2010)
A
- The current construction of depression is too broad
- Depression is better defined as “the inability to disengage from a negative mood state and the tendency to re-enter this state inappropriately” (p.1)
- In people with MDD, the pressure to enter the down state is relatively high (even in the absence of a stressor) and, as the down state becomes more established, the person may experience greater difficulty returning to the normal state without external intervention
9
Q
Disruptive Mood Dysregulation Disorder
A
- severe recurrent temper outbursts verbally or behaviourally that are out of proportion in intensity or duration to the situation or provocation
- inconsistent with developmental level
- occur 3 or more times a week
- mood is irritable/angry most of the days and is observable by others
- symptoms present for 12 or more months with no more than 3 months without
- 2 of three setting the symptoms are present
- 6-18 yrs
10
Q
Rationale for including DMDD in the DSM-5
A
- To decrease the number of children diagnosed with bipolar disorder
- Children experiencing persistent irritability and anger outbursts were diagnosed with bipolar disorder even though they had never experienced a manic episode
- The same diagnostic criteria are used for both adults and children
- Children were being treated with strong medication (antipsychotics and mood stabilisers) that have serious side-effects, including increased risk for diabetes
- Concern about the stigma associated with being diagnosed with a chronic, severe mental illness
11
Q
A critique of the DMDD diagnosis
A
- Only a limited amount of research exists in relation to DMDD. Thus, it is not well established as a distinct disorder
- Very little is known about the prevalence of DMDD, whether it can be distinguished from normal temper tantrums and it’s relation to other disorders that present with irritability or anger outbursts e.g. depression, ADHD, conduct disorder
- Substance use in adolescents may result in an irritable mood
- No current treatment protocols exist
- It is likely that this diagnosis will lead to another epidemic and that children will be over-medicated
- Temper tantrums shouldn’t be given the status of a separate official diagnosis
- Tantrums may represent a developmental stage or be part of a person’s temperament
- Tantrums may be a way to communicate anger and distress. They may be a response to stress or family conflict. It is possible that the child will be diagnosed as disordered while these factors are ignored
- Most children outgrow developmental or situational temper problems as they gradually acquire self-control and ways of getting their needs met
12
Q
Cultural factors that may influence depression
A
- Emotion “display rules”
- Limits of tolerance for specific emotions
- Interpretation of symptoms
- Lay theories and strategies for managing distress
- Help-seeking behaviours
- Interaction with the clinician
- Symptomatology
13
Q
Haitian somatisation
A
references to the heart and the head; constricted heart; loaded head; spinning head; thinking too much; feeling like you are ‘going down’; lost the taste for doing anything; difficulty sleeping; low energy
14
Q
Chinese somatisation
A
headache; heart palpitations; pressure in the chest; numbness in the limbs; bodily aches and pains; feeling sad; loss of self-confidence; hard to enjoy things
15
Q
Why somatisation?
A
- the somatic expression of symptoms of depression occurs worldwide
- More socially acceptable to express symptoms somatically and a non-stigmatized reason to seek help
- Somatization versus Psychologization
- USA - people speak openly about conflict, about feelings. They share explicit details of their lives and relationships on talk-shows
- Compare: cultures where non-confrontation and social harmony are valued
