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Psych Abnormal Mine > Depressive Disorders > Flashcards

Depressive Disorders Flashcards

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1
Q

The DSM-IV combined which disorders in one chapter (which are now separated)? Why were they combined and why are they now separated?

A

Depressive disorders and bipolar disorders - they were known to be “extremes” in normal mood (extremely deflated mood and extremely elevated mood).

Now they know that bipolar and depression are not as closely related as once thought.

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2
Q

In the DSM-5, what changes have been made to MDD?

A

Grief exclusion - normal response to loss (to job, spouse, etc). Clinician must decide whether it is a normal response to loss. Does it fit the cultural norms of the person? What about previous patient history?

DSM-IV previously allowed grief for 2 months.

DSM-5 states that, for grief, the sadness is more specifically focused on the death (and comes in waves). Depression is more a pervasive/general sadness to many thing

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3
Q

What are the two symptoms in MDD that are necessary for a diagnosis? (Meeting criteria for MDD involves having EITHER or BOTH of these)

A
  1. Low mood most of the day, nearly every day

2. Lack of interest/pleasure in most/all activities

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4
Q

In MDD the symptoms need to represent a ______ from normal functioning

A

change

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5
Q

What are the other 7 possible symptoms for MDD? How many do you have to have for diagnosis?

A

5 or more, 2 week period

  1. Weight loss or weight gain
  2. Insomnia or hypersomnia
  3. fatigue or loss of energy
  4. feelings of worthlessness or inappropriate guilt
  5. Diminished ability to think, concentrate or make decisions
  6. Psychomotor agitation
  7. Recurrent thoughts of death
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6
Q

What are some of the subtypes of MDD? And what are the other disorders people are not meeting criteria for that makes them meet criteria for MDD + subtype?

A
  • anxious distress - don’t meet criteria for GAD
  • mixed features - don’t meet criteria for manic/hypomanic episode
  • melancholic features - Parker studies!
  • atypical features - eat more, sleep more, highly sensitive to rejection
  • psychotic features
  • catatonia - psycho-motor immobility, numbness
  • peripartum onset
  • seasonal pattern
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7
Q

Persistent Depressive Disorder (Dysthymia), what is the compulsory criterion?

A

Depressed mood for most of the day, most days than not, for a least 2 years

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8
Q

Persistent Depressive Disorder (Dysthymia), what are the elective criteria? How many do you need?

A

2 or more

  1. poor appetite/overeating
  2. insomnia or hypersomnia
  3. low energy/fatigue
  4. Low self-esteem
  5. Poor concentration
  6. Feelings of hopelessness
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9
Q

In Persistent Depressive Disorder (Dysthymia), the patient has the symptoms for ______, and is not without the symptoms for more than a _______ period in these 2 years. If major depressive episodes are present in this 2 year period, the diagnosis is ______. However, it is possible to have ______ and ______ (if there was a two year period without major depressive episodes.

A

2 years
2 month
MDD
MDD and PDD

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10
Q

Disruptive Mood Dysregulation disorder is a ______ disorder characterised by recurrent ________ _______ that are grossly ____ ____ ______ in _______ or duration to the provocation. And, the mood between outbursts is persistently ________ or ____.

A 
child
temper outbursts
out of proportion 
intensity
irritable, angry
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11
Q

MDD is an _______ disorder (dips in functioning). Once you have an episode, your chance of having another one _______. And the more you have, the _____ the risk of having another one. Hence, it increases ________. Finally, this is important in treatment, as we need to consider how to prevent subsequent episodes.

A

episodic, increases, higher, cumulatively

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12
Q

Gordon Parker at the Blackburn institute has suggested what changes to subtyping?

A

He has suggested melancholic, psychotic and non-melancholic subtyping

Argues that these subtypes have different causes, symptoms and treatment.

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13
Q

What are the characteristics of Parker’s melancholic depression?

A

Lack of reactivity - total loss of pleasure
Distinct quality of mood
Early morning awaking
Mood worse in the mornings
Marked psychomotor features (very agitated or not able to move)
Excessive guilt
Weight loss/appetite loss

biological/endogenous in nature
less likely to respond to placebo and anti-depressants
no clear trigger
more likely with in-patients

hence, treat with anti-depressants

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14
Q

What are the criticisms of Parker’s subtyping?

A

That this can also be explained in terms of severity, not biological/endogenous causes.
E.g - if it is severe - less likely to respond to treatment, and lower trigger needed to trigger another episode

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15
Q

The lifetime prevalence of MDD is…? And in Australia the one-year prevalence is…?

A

16%, 3-5%

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16
Q

What has caused the increase in prevalence in MDD, and contributed to the earlier age of onset, since 1950s?

A
  • lifestyle changes?
  • decreased social support?
  • more acceptable? So not a real difference
  • over-diagnosed? Criteria has changed
17
Q

Is MDD more common in women than men

A

TWICE as many women than men, but could be reporting differences

18
Q

Name and expand on biological influences (causation and maintenance) for MDD

A
  1. genetic - higher in identical twins than fraternal twins - especially in severe depression (0.59) and bipolar (0.8). BUT data is mixed from adoption studies. Genetic loading means an increased vulnerability.
  2. neurochemistry - low levels of NA, DA, SE (but no evidence of causation)
  3. neuroendocrine - hormones? Overactivity in HPA axis, excess cortisol
  4. brain structures - amygdala, hippocampus,

A combination between these and negative life events determines your risk

19
Q

What has been found about gene-environment interactions in the causation/maintenance of MDD?

A

Increased negative life events means only a lower genetic component is needed for increased risk

Decreased negative life events means you need a higher genetic component for increased risk

OR, the higher your genetic vulnerability, the few negative life events you need to trigger depression.

The genetic vulnerability is not expressed without the occurrence of negative life events.

20
Q

Name the 6 psychological theories in the causation/maintenance of depression

A
  1. Learned helplessness theory
  2. Hopelessness theory
  3. Attribution theory
  4. Schema therapy
  5. Response style Theory
  6. Interpersonal approaches
21
Q

Learned helplessness is when people believe they have a ______ ___ ______ over life events. This is not based on the ______ of negative life events that occur, but rather your ________ of ________ over these events.

A

lack of control
amount
interpretation
controlability

22
Q

Attribution theory is grounded in the idea that an individual has a _____ ______ to a ______ ______ style, or a ________ triad. Negative life events interact with these attribution styles to cause/maintain depression.

These are:

  1. _____ vs ______
  2. _____ vs ______
  3. _____ vs ______

Give an example of this

A

cognitive vulnerability
depresogenic cognitive
triad

internal vs external
stable vs unstable
global vs specific

e.g: failed the exam –> because I’m not smart enough. Intelligence is often stable, and will affect things globally (will still be present in future events). ALSO often attribute positive events to external, unstable, specific things :O

SO there is an interaction between these attribution styles and negative life events.

23
Q

Attribution Theory was further extended upon to create ________ theory. Describe this theory.

A

hopelessness

Helplessness
Expectancy + Negative Outcome
Expectancy
= Hopelessness
(I will not be able to (negative events
control -ve events) will happen)

24
Q

Schema Theory is…? How does this relate to the causation/maintenance of depression?

A

People have characteristic ways of seeing the world
- beliefs about the world, self, future
(people are nice and kind, the world is nice, I am a nice person) OR (I’m unlovable, the world is scary and people are terrible)

These schema stay dormant and are then activated by stress/negative life event and become more dominant in the consciousness to interpret events.

Following this, these schemas are dominant during ambiguous situations (e.g: a friend walking past you on the street), it generalises to other situations and is amplified.

Negative thoughts about the world + self + future = DEPRESSIVE COGNITIVE TRIAD.

Soon a smaller and smaller trigger is needed for these schemas, and we even look for confirmation of these schemas in everyday life - so the schema becomes more and more entrenched.

Related to attachment theory AND genetic vulnerability (already have this risk and then the parents parent you in a way which increases risk as well)

25
Q

Response Style theory describes that people vulnerable to depression have a _______ response style, instead of using strategies like ______ or problem _______. This not really helpful. Rumination is about the _____, and interferes with _____ _____. Worry is about the _______.

A 
ruminative
distraction, solving
past
problem solving
future
26
Q

Interpersonal relations are _______ affected as a result of depression. This is because depressed people interact in a way that will elicit _______.

A

negatively
rejection
social skills

27
Q

Interpersonal approaches describe a few ways people with depression will act compared to others. Name these and how this maintains/exacerbates depression.

A
  • display limited social skills
  • speak slowly,
  • seek reassurance
  • don’t respond as well to friends
  • fewer positive facial expressions
  • disclose more negative information about themselves.

So people spend less time with them, reject them, and the people who are depressed have many of their beliefs confirmed from these situations.

28
Q

What is the stress-generation hypothesis?

A

A theory on the CAUSATION of negative life events and stress. The other approaches speak of stress as something which just happens to you, which interacts with your biological and/or psychological vulnerabilities.

BUT depressed people have a tendency to generate negative life events.

Negative life events can be independent (e.g earthquake) or dependent (e.g achievement failures, interpersonal relations) of the person.

So in dependent negative life events, if someone has a depresogenic style (helplessness, hopelessness, lack self-confidence, expect negative things, etc) this can contribute to negative life events.

So this stress-generation hypothesis explains, partly, the first occurrence of depression, and definitely explains the recurrence.

So there is a reciprocal relationship between stress and depression. Interact with each other in maintaining and exacerbating depression

29
Q

ECT is a brief ____ _____ in the brain. It is still used today in people not ______ to other ______. But _____ is common and we are still _______ how it works

A

electrical current, responsive, treatments, relapse, unsure

30
Q

Describe the three drug treatments of depression and their side effects. How do they compare in effectiveness?

A
  1. Monoamine Oxidase Inhibitors
    - block breakdown of SE, NA
    - hypertension and stroke unless they are on strict diet
    - oldest type - still used if others don’t work
  2. Tricyclic Medications
    - gold standard
    - block reuptake of SE, NA
    - serious side effects - blurred vision, dry mouth, so lack of compliance - including increased risk of suicide! And they are cardiotoxic - so you have the means to kill yourself :O
  3. Selective Serotonin Reuptake Inhibitors
    - present drug of choice
    - fewer side effects compared to the others - insomnia, agitation, nausea, etc. More specific than the other drugs

ALL ARE SIMILAR IN EFFECTIVENESS but (3) has reduced side effects, hence increased compliance

31
Q

Problems with drug treatments

  1. It is important that we do not _______ from treatment to describe the ______ of depression.
  2. drugs also work on ____-_____ people
  3. _____-______ of treatment effectiveness
  4. The _____ of action not in-sync with the effects - see increase in serotonin in a few days. But effectiveness seen after 2-3 weeks.
  5. The drugs are effective, but often ______ is needed long-term to change cogitations
A 
extrapolate, causation, 
non-depressed
non-specificity (used in other disorders)
timing 
psychotherapy
32
Q

The effectiveness of drugs vs CBT is ______ but relapse is less common with ______ as you are taught to become a less depresogenic person. It addresses your specific cognitive _____, and includes ______ components

A

similar
CBT
biases
behavioural

33
Q

Interpersonal therapy is also _______ to CBT in effectiveness. It is used at the _____ or to prevent _______ of the episode. It focuses on _______ and social skills. It can also target changes of _____ circumstances, such as loses of a marriage/job, illness onset

A 
comparable
onset
exacerbation
communication
life
34
Q

Drugs are still recommended as the _____ line of treatment, but there is _____ evidence for this. Potentially we have to think about the ______ person and what will help them. Is it more an _______/______ depression? Will the client be _______ in CBT? (abstract thinker, flexible, conscientious)

A

first
limited
endogenous/biological
successful

Psych Abnormal Mine (18 decks)

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