Depressive Disorders and Bipolar Disorders Flashcards
MDD etiology psychodynamic theories
Object Loss Theory
Aggression Turned Inward Theory
Cognitive Theory
Learned Helplessness Hopelessness theory
MDD etiology Object Loss Theory
Early psych development issues as foundation for issues later in life
During development stage, the child experiences traumatic separation (maternal etc), or could be death/illness
Loss causes separation anxiety, grief, mourning, despair
MDD etiology Aggression Turned Inward Theory
Freud
Early psych development issues also highlighting loss (mother etc)
leads to anger and fear of further loss
uses defense mechanisms to deal with conflict. instead of outward anger, it turns inward
anger at oneself and excessive guilt
MDD etiology Cognitive Theory
Beck
development experience sensitize person to respond to stressful life events with depression
people with depression tendency look at world different and are more negative
this promotes low self esteem and belief that they deserve bad things
MDD etiology Learned Helplessness-Hopelessness Theory
Modified cognitive theory
depressed due to perceived lack of control
perceptions learned over time
this leads to not adapting or coping
they become passive/nonreactive
MDD etiology Biological Theories
Genetic
Endocrine
NT function abnormalities
Structural brain changes
Chronobiological theory
MDD etiology Genetic
Clearly there is genetic predisposition
parent is biggest indicator (3x more likely)
earlier age of onset and the more severe sx means that more likely genetic
MDD etiology Endocrine
Neurovegetative sx (sleep, appetite, libido, lethargy) r/t hypothalmus and pituitary hormones
high incidence postpartum is suggestive
dysphoria often triggered by changes in levels of sex steroids during menstrual cycle
deregulation of HPA (stress response)
MDD etiology Abnormal NT function
obviously dysregulation of dopamine, serotonin, norepinephrine
receptor sensitivity
low density of receptor sites
probably more than one NT
MDD etiology Structural Brain Changes
Neuroimaging shows abnormalities:
Hypovolemic hippocampus
Hypovolemic prefrontal cortex
common in those who have experienced brain damage from stroke/trauma
MDD etiology Chronobiological Theory
desynchronization of circadian rhythms
What percent of MDD receive tx ever
50%
MDD age of onset average
Mid 20s
what percent of MDD will die by suicide
15%
Untreated MDD lasts
4+ months usually
What percent of those with 1st episode of MDD have a 2nd episode
60%
Prevention of MDD
At risk family education
community education to reduce stigma and emphasize tx
Screening
Common MDD screening tools
PHQ-9
EPDS
BDI
HAM-D
Diagnostic Criteria for MDD
- Anhedonia or a depressed mood, or both
- Depressed mood most of the day, nearly every day (In children, irritable mood)
- Marked anhedonia in all or almost all ADLs
- 3 or more significant sx during same 2 wk period that are a change in previous functioning
- Significant, unintentional weight loss or gain (5% body weight)
- Hypersomnia or insomnia nearly every day
- Psychomotor agitation or retardation
- Fatigue or loss of energy
- Self-deprecating comments or thoughts
- Feelings of worthlessness or excessive or inappropriate guilt nearly every day
- Decreased concentration and memory
- Recurrent morbid thoughts or suicidal ideation
- Sx onset within 2 months of significant loss and do not persist beyond 2 months are generally considered bereavement and not MDD.
MDD SI risk high for certain sx or hx
presence of psychotic sx
Hx of past attempts
Hx of 1st deg relative who committed suicide
Concurrent SUD
Current serious health problem
Top goal in acute phase of MDD
ensure client safety
Number of episodes of MDD to consider lifetime antidepressant tx
2+
Target sx of antidepressant tx
depressed mood
sleep-rest disturbances
anxiety
irritability
impaired concentration
impaired memory
appetite disturbance
agitation
anhedonia
impaired energy and motivation
antidepressant rebound
common with abrupt cessation
worse with drugs with short half lives