Diagnosis & Psychopathology 3 Flashcards
Priority 1
What are some risk and course factors associated with Major Depressive Disorder?
- 50%-60% of those who have one major depressive episode will have more
- ~15% of individuals with MDD die by suicide
- relapse is predicted by
- absence of social support
- family hostility, criticism, and overinvolvement
What is the suicide rate associated with Bipolar I Disorder?
10-15%
List some gender differences in prevalence and risk of Major Depressive Disorder.
- MDD about twice as common in adolescents and women than men by age group
- MDD may be underdiagnosed in men
- women may express well-being more extremely (in both directions)
- risk factors in women include passivity, dependency, poverty, having young children
- having multiple roles is a protective factor for women
- marriage is a protective factor, but more for men than women
What are prevalence rates and other factors associated with post-partum depressive symptoms?
- 50%-80% of women experience tearfulness and mood swings in the first few days after giving birth
- within four weeks of giving birth, 10%-20% of women experience Sx meeting criteria for a mood disorder
- Sx typically last 2-8 weeks, can persist for one year
What is “double depression?”
- Dx of both Major Depressive Disorder and Dysthymic Disorder
- associated with lower recovery rates and higher relapse rates than episodic Major Depressive Disoder, greater psychological disturbance, and increased suicide attempts
What is the etiology of Seasonal Affective Disorder?
- believed to be abnormal regulation of pineal melatonin secretion
- can be responsive to light therapy
- phenotype with hypersomnia and carbohydrate craving more responsive
- phenotypes with insomnia and weight loss, chronic depression, incomplete summer remission less responsive but may benefit
What is the role of genetics in the etiology of mood disorders?
- 60%-65% of individuals with a bipolar disorder have a relative with bipolar or unipolar depression
- having either parent with depression increases risk of having depression
What is the role of stress in the etiology of mood disorders?
- appears to be more impactful on early course of uni- and bipolar depression, e.g., critical to first or second episode
- depressed people report 3x as many stressful life events as non-depressed
- day-to-day stressors are also associated with depression, esp. mild forms
What is the catecholamine hypothesis of mood disorders?
- imbalance of catecholamines (incl. e.g., norepinephrine) affect mood
- depletion produces depression
- excess produces mania
- supported by fact that tricyclics and MAOIs increase availability of norepinephrine and lithium decreases norepinephrine and dopamine
What is the permissive theory of mood disorders?
- low serotonin produces mood disorder, then norepinephrine levels determine type:
- depression is due to low norepinephrine and low serotonin
- mania due to high norepinephrine and low serotonin
- supported by SSRI action
What are some sleep cycle irregularities associated with depression?
- unusually rapid REM onset
- reduced slow-wave sleep
- early morning wakening
Name a behavioral intervention for sleep cycle disturbances associated with depression.
Sx can sometimes be reduced with partial sleep deprivation or going to sleep 5-6 hours early
What factors in attributional style are associated with the learned helplessness approach to understanding depression?
- attributing negative events as
- global (vs specific)
- stable (vs transient)
- internal (vs external)
- emphasis on hopelessness
What is the self-control model of depression?
- selective attention focusing on
- negative events
- immediate outcomes
- stringent self-evaluation standards
- dysfunctional attributions
- positive outcomes external
- negative outcome internal
- dysfunctional self-conditioning
- insufficient self-reinforcement
- excessive self-punishment
Rehm’s Self-Control Therapy is based on these findings.
Describe general indications for prescribing tricyclic and SSRI antidepressants.
typically used to treat classic depression Sx
Describe indications for prescribing MAOIs.
usually used for treating atypical depression, e.g., that with anxiety, hypochondria, and obsessive-compulsive Sx
Discuss efficacy and other relevant factors in pharmacological treatment of mood disorders.
- 60% of depressed patients improve (40% do not)
- almost half treated relapse within a year of Rx termination
- up to 50% of patients unilaterally reduce or discontinue medication, in part due to side effects
What two therapies are mentioned as being effective for depression?
- CBT
- IPT (interpersonal therapy)
Describe the three stages of Beck’s CBT for depression.
- ID automatic thoughts producing depression
- understand how thoughts distort reality
- come to see how thoughts are unfounded