depressive disorders Flashcards
DSM-5 major depressive disorder diagnostic criteria
5 or more of the following symptoms present during the same 2-week period:
- depressed mood
- loss of interest/pleasure
- reduced energy
- appetite/weight change
- psychomotor agitation/retardation
- feelings of worthlessness/guilt
- reduced concentration or indecision
- suicidal ideation
ISD-11 major depressive disorder diagnostic criteria
same as for DSM-5 but with additional symptoms of disturbed sleep & reduced self-esteem/confidence
negative & positive factors in relation to depression
depression is hallmarked not only by negative factors but also an absence/decrease of positive factors
individual differences in MDD with regard to diagnostic criteria
(1) may experience some symptoms very severely but still do not meet all criteria (2) combination of symptoms varies widely for different people (3) highly variable duration of symptoms, number of episodes, & time between episodes (4) comorbidity: over half of people w/ depression also meet criteria for another condition
disorders within DSM-5 depressive disorders category
major depressive disorder, disruptive mood dysregulation disorder, premenstrual dysphoric disorder, persistent depressive disorder (dysthymia), substance/medication-induced depressive disorder, unspecified depressive disorder
person-centered view
clinical perspective that a comprehensive assessment of depression should not rely on symptom count but (1) the degree of functional impairment &/or disability & (2) situational/contextual factors
lifetime risk for depression in men & women
men = 7-13%, women = 20-25%
typical onset of depression
adolescence & early adulthood
possible explanation for sex differences in depression
under-reporting in males or social factors
atypical information processing model of depression
on the basis that interpretations & thinking inform one’s experience at all times, the model associates depression w/ a shift in information processing leading to systematic negative thinking biases that affect views of oneself, the world, & future
causes given for atypical information processing model of depression
critical incidents can ‘prove’ negative core beliefs, which are maintained w/ perpetuation factors: unhelpful/maladaptive beliefs, avoidance, social isolation – avoidance of potential opportunities to disprove negative biases
ruminative thinking
a maladaptive thinking pattern describing a cycle of thoughts/behaviours focused on symptoms w/o action to relieve them
Beck model of depression
(1) depression is not causal; negative views/thoughts lead to the development of depression
(2) 3 levels of cognition used to construct model of the world (core beliefs, dysfunctional assumptions, negative automatic thoughts)
types of negative core beliefs (Beck model)
absolute beliefs, polarised, dichotomous black/white thinking; selective abstraction (focusing on failures & ignoring successes), overgeneralisation
1/3 cognitive levels used to construct model of the world
dysfunctional assumptions (Beck model)
often occurring as non-explicit/non-obvious stream of thoughts that must be inferred from behaviour (ex: social withdrawal due to assumption of negative evaluation)
negative automatic thoughts (Beck model)
negative thoughts that are unintentional, habitual (so often not focus of attention), plausible & often interpreted as objectively true, even if they are not likely to be true; they may be suppressed / attended away from
cognitive restructuring (CBT)
a CBT method that challenges thoughts/beliefs, identifies thinking errors, & considers alternative views
behavioural activation (CBT)
behaviour focused CBT method to increase engagement w/ valued activities, improve mood, reduce rumination, improve social networks, & increase self-esteem & sense of control, on the basis that behaviour can directly influence thoughts/emotions
heritability of depression (3)
(1) depression is not 100% heritable but heritability has been determined through twin & molecular genetic studies
(2) hundreds of genes related to depression exist; different combinations of genes can cumulatively increase susceptibility to depression
(3) there seems to be more heritability among women than men
serotonin hypothesis + limitations (2)
people w/ depression thought to have lower serotonergic brain activity due to reduced serotonin bioavailability in the brain, fewer serotonin receptors, or insufficient binding action to produce an action potential – BUT (1) evidence is mixed (2) serotonergic activity is not necessary / sufficient to explain development of depression
monoamine hypothesis
other monoamines besides serotonin have been implicated in depression, including norepinephrine, dopamine, & glutamate
neural atypicality in connectivity in depression
there may be atypical connectivity between, rather than in, particular brain regions
neural atypicality in brain regions in depression
there have been mixed results to demonstrate neural atypicality in depressed individuals’ brain regions incl. prefrontal & orbitofrontal cortex (planning, problem solving, decisions making), anterior cingulate cortex (emotion & interoception), limbic system (emotion, reinforcement, memory), basal ganglia / brain stem (reward, motivation)
neural atypicality in hippocampus in depression
volume of the hippocampus may be decreased in those w/ depression
HPA: hypothalamic-pituitary-adrenal axis
stress activates the hypothalamus, triggering CRF (corticotrophin-releasing-factor) release & causing pituitary gland to release adrenocorticotropic hormone, which causes adrenal gland to secrete GCs (glucocorticoids); GCs bind to GC receptors in hippocampus, then suppressing CRF secretion & creating negative feedback of HPA axis
pro (1) & con (1) of standardised psychometric measures as a clinical assessment
self-report questionnaires are useful for quantifying/screening, but reduce level of detail & specificity of patient’s individual circumstances
clinical assessment: clinical interview
in-depth w/ detailed client info, usually w/ client themselves but sometimes w/ family or partner; considers background / demographic info, environmental triggers, risk assessment, etc.
clinical assessment: case formulation
focuses on person as individual, not requiring them to be in a specific diagnostic category
clinical assessment: simple diagnosis
diagnosis based on predetermined criteria, following a checklist format & assuming there is an underlying disorder
clinical assessment difficulties (3)
(1) common comorbidities, incl. substance misuse, anxiety or eating disorder, or OCD can make it difficult to determine which symptoms are explained by which disorder
(2) symptoms can interact (ex: w/ depression & ED comorbidity, more depressed mood can mean more severely disordered eating & vice versa)
(3) many simple questionnaires & screening tools are not specific or in depth enough to determine which disorder is responsible for which symptom / item score
bereavement exclusion clause
a clause of EARLIER DSM editions stating that one cannot be diagnosed w/ depression if recently bereaved; current inclusion of bereavement in DSM-5 is controversial
reasons for controversy of inclusion of bereavement in DSM-5 (3)
(1) worry for ‘false positive’ diagnosis
(2) worry of pathologising a normal human experience (grief)
(3) invisibility to researchers; researchers may be unaware of depressed individuals making up a sample who are experiencing depression as a result of grief
