depressive disorders

Question 1

DSM-5 major depressive disorder diagnostic criteria

Answer 1

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

Question 2

ISD-11 major depressive disorder diagnostic criteria

Answer 2

same as for DSM-5 but with additional symptoms of disturbed sleep & reduced self-esteem/confidence

Question 3

negative & positive factors in relation to depression

Answer 3

depression is hallmarked not only by negative factors but also an absence/decrease of positive factors

Question 4

individual differences in MDD with regard to diagnostic criteria

Answer 4

(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

Question 5

disorders within DSM-5 depressive disorders category

Answer 5

major depressive disorder, disruptive mood dysregulation disorder, premenstrual dysphoric disorder, persistent depressive disorder (dysthymia), substance/medication-induced depressive disorder, unspecified depressive disorder

Question 6

person-centered view

Answer 6

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

Question 7

lifetime risk for depression in men & women

Answer 7

men = 7-13%, women = 20-25%

Question 8

typical onset of depression

Answer 8

adolescence & early adulthood

Question 9

possible explanation for sex differences in depression

Answer 9

under-reporting in males or social factors

Question 10

atypical information processing model of depression

Answer 10

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

Question 11

causes given for atypical information processing model of depression

Answer 11

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

Question 12

ruminative thinking

Answer 12

a maladaptive thinking pattern describing a cycle of thoughts/behaviours focused on symptoms w/o action to relieve them

Question 13

Beck model of depression

Answer 13

(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)

Question 14

types of negative core beliefs (Beck model)

Answer 14

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

Question 15

dysfunctional assumptions (Beck model)

Answer 15

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)

Question 16

negative automatic thoughts (Beck model)

Answer 16

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

Question 17

cognitive restructuring (CBT)

Answer 17

a CBT method that challenges thoughts/beliefs, identifies thinking errors, & considers alternative views

Question 18

behavioural activation (CBT)

Answer 18

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

Question 19

heritability of depression (3)

Answer 19

(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

Question 20

serotonin hypothesis + limitations (2)

Answer 20

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

Question 21

monoamine hypothesis

Answer 21

other monoamines besides serotonin have been implicated in depression, including norepinephrine, dopamine, & glutamate

Question 22

neural atypicality in connectivity in depression

Answer 22

there may be atypical connectivity between, rather than in, particular brain regions

Question 23

neural atypicality in brain regions in depression

Answer 23

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)

Question 24

neural atypicality in hippocampus in depression

Answer 24

volume of the hippocampus may be decreased in those w/ depression

Question 25

HPA: hypothalamic-pituitary-adrenal axis

Answer 25

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

Question 26

pro (1) & con (1) of standardised psychometric measures as a clinical assessment

Answer 26

self-report questionnaires are useful for quantifying/screening, but reduce level of detail & specificity of patient’s individual circumstances

Question 27

clinical assessment: clinical interview

Answer 27

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.

Question 28

clinical assessment: case formulation

Answer 28

focuses on person as individual, not requiring them to be in a specific diagnostic category

Question 29

clinical assessment: simple diagnosis

Answer 29

diagnosis based on predetermined criteria, following a checklist format & assuming there is an underlying disorder

Question 30

clinical assessment difficulties (3)

Answer 30

(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

Question 31

bereavement exclusion clause

Answer 31

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

Question 32

reasons for controversy of inclusion of bereavement in DSM-5 (3)

Answer 32

(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