Exam 3 Flashcards
5 domains of depression symptoms
- emotional (sadness, guilt, irritability)
- motivational (dec interest, drive)
- behavioral (less productive, isolate self)
- cognitive (negative views, dec conc)
- physical (sleep issues, ailments)
major depressive disorder
- unipolar depression
-5+ symptoms for 2+ weeks
-depressed mood or loss of interest/pleasure (required)
-4+ extra symptoms (fatigue, sleep, weight, guilt, psychomotor, death thoughts)
-distress or impairment
persistent depressive disorder
-unipolar depression
-depression symptoms for most days for 2+ years (no mania)
Bipolar 1
-Prescence of manic episodes
- 1+ weeks, most of day
-inflated mood and energy, high self esteem, talkative
-depressive episodes are common but not required
Bipolar 2
depressive episode
hypomanic episode
5 domains of manic symptoms
- emotional (intense emotions, euphoria)
- motivational (inc drive, action)
- behavioral (high activity, risky?, fast talk)
- cognitive (poor judgement, grandeur)
- physical (high energy, dec sleep need)
depressive disorder diagnosis
-distress/impairment required
-NOT due to substance use or medical condition
- differential diagnoses: bipolar, “normal” grief, schizophrenia condition
possible features of depression
seasonal pattern
peripartum onset
melancholic (loss of pleasure)
psychotic features (delusions)
catatonia (extreme motor activity
premenstrual dysphoric disorder
depressive symptoms week before period
is this a physical condition or a psychological one??
disruptive mood dysregulation disorder
depression + severe outbursts
diagnosed in childhood
MDD etiology
equifinality vs multifinality
multiple risk factors
impact of factors depend on timing, interaction, and whether or not there are protective factors
prenatal risk factors for MDD
genetic factors
over-reactive HPA axis, depression brain circuitry, and abnormal serotonin, NE, or glutamate can be inherited
depression-related brain cicuitry
overlap with PTSD circuitry
structure and activity differences in hippocampus (smaller), amygdala (active), and anterior cingulate cortex
low NE and S
early childhood risk factors for drepression
adverse child experiences (parent loss, trauma)
inadequate parenting (absence, depression)
parenting impact on depression
psychodynamic- real or symbolic loss causes introjection (anger or sadness directed at one self)
biological- inadequate parenting triggers HPA pathway, trauma may cause dysfunction in depression brain circuit
middle childhood depression risk factors
biological risk may create patterns of feeling and thinking which increase depression risk
maladaptive attitudes, cognitive triad, automatic negative thoughts
maladaptive attitudes
evaluative beliefs about self, very often negative
cognitive triad
negative views about themselves, experiences in the world, and future
adolescence risk factors for depression
stress and the immune system- inevitable stressors activate HPA axis and dysregulate immune system
social factors- protective constructive behavioral engagement and risk social withdrawal
gender risk factors- 2:1 difference for women:men
constructive behavioral engagement
protective factor
Ex: going to school, parties, work, etc.
more opportunities for rewards and less depression risk
learned helplessness
no control over life’s events and reinforcers
leads to feeling helpless
risk factors in adulthood for depression
learned helplessness
attributions (explanations for events) that are internal, stable, or global/”always”
new stressors (college, work, family)
overview of depression treatment
50% of people seek treatment
50-60% show significant improvement with cognitive-behavioral therapy, interpersonal psychotherapy, meds, brain stimulation
behavioral activation (Lewinsohn)
cognitive-behavioral therapy
increase constructive activity and change consequences to reward non-depressive behavior
Beck’s Cognitive Therapy
cognitive-behavioral therapy
increase constructive activities
educate client on cognitive triad
cognitive restructuring to identify, challenge, and replace depression-linked thoughts
acceptance and commitment therapy
cognitive-behavioral therapy
do not NEED to eliminate negative cognitions, but instead use mindfulness and related techniques to help client
accept things as they are, not as negative or positive
sociocultural barriers to depression treatment
address barriers to treatment: stigma, family beliefs, no community resources, costs, language barriers, lack of culturally sensitive care, discrimination
interpersonal psychotherapy
core idea: social factors influence mood and vice versa
depression linked to interpersonal loss, role disputes, role transitions, deficits
goals: cope with interpersonal events, improve social support, improve mood and social functioning
couples therapy
sociocultural approach for couples with relationship distress and 1 member with depression
goals: improve communication, problem-solving skills, caring and acceptance
as effective as CBT
monoamine oxidase inhibitors
MAO enzyme breaks down S and NE
MAO inhibitors stops this
MAOI allows tyramine to accumulate which increases risk for high blood pressure
tricyclics
blocks reuptake of S and NE
dry mouth, blurred vision, relapse if stopped taking too soon
second generation antidepressants
acts on reuptake mechanisms
includes SSRIs
fewer side effects, no diet restrictions, lower risk of overdose
ketamine antidepressants
increases activity of glutamate in brain, might promote new neural pathway development
pros: quickly reduces depression, helps those who don’t respond to other meds
cons: short term impact, very addictive
effectiveness of antidepressant drugs
50-60% of people feel better
many responders still have many symptoms
10-30% do not respond to any antidepressant
maintenance drug therapy often needed
electroconvulsive therapy (ECT)
electrical current applied to cause a seizure
controversial history because of injury, major memory loss, but is safer today
use of ECT for depression
treatment-resistant severe depression
6-12 sessions over 2-4 weeks
muscle relaxants and anesthetics given
mild memory loss may occur
60-80% of treatment resistant patients improve
vagus nerve stimulation
10th cranial nerve
communicates between brain and major organs
parasympathetic fibers
pulse generator in chest sends electrical signals to vagus nerve for stimulation
transcranial magnetic stimulation
electromagnetic coil placed above patient’s head sends current into brain
deep brain stimulation
electrodes implanted in subgebual cingulate
not FDA approved because evidence is inconsistent
psychodynamic therapy for depression
therapists use free association and interpretation to work through loss, bring out unconscious grief into consciousness, and reduce dependence
most effective for moderate depression or working through loss
biological vs psychotherapy effectiveness
drugs decrease symptoms faster but relapse risk is lower for psychotherapy
more helpful to do both than either one alone
common features of schizophrenia
psychotic symptoms (not in contact with reality
loss of functioning
enormous costs (self, friends, family, money)
prevalence of schizophrenia
1 in 100 worldwide
equal in men and women
more common in lower SES (poverty stress triggers disorder or disorder leads to dysfunction that leads to poverty)
schizophrenia course and prognosis
avg onset is late teens-early 30s
stages of disorder
chronic condition for most people
better outcomes with good premorbid functioning, sudden onset/stress trigger, early treatment
phases of schizophrenia
- prodromal- deterioration begins, mild
- active- symptoms acute
- residual- return to prodromal levels
psychomotor symptoms of schizophrenia
movement abnormalities- odd movements, repeated grimaces
catatonia is a severe motor disturbance
these things are less common today because of advanced meds
negative symptoms of schizophrenia
deficits- traits that are lacking
avolition- lack of motivation
social withdrawal
Alogia- poverty of speech
restricted emotion
positive symptoms of schizophrenia
hallucinations
delusions
disordered speech and thought
inappropriate affect
hallucinations
sensory perceptions that occur in the absence of external stimuli
auditory is most common but can be visual, tactile, somatic
delusions
strongly held false beliefs, not cultural
Ex. delusions of grandeur, persecution, reference, somatic delusions
disordered speech and thought
loose association (derailment)
neologisms (made-up words)
perseveration (repetition)
clang (rhyme)
inappropriate affect
emotions unsuited to the situation
Ex. inappropriate laughter
person’s affect may not match their felt experience
diagnosing schizophrenia
- loss of contact with reality in 2+ areas:
-delusions, hallucinations, disorganized speech, catatonic behavior, negative symptoms - marked decrease in functioning in 1+ area:
-occupational, social, or personal care - symptoms last 6+ months
- exclusion diagnoses is symptoms due to depression, substance abuse, medical condition
related psychotic disorders
SEE PAPER SLIDES SHEET
genetic explanations for schizophrenia
multiple chromosomes are affected
a polygenic disorder
heritability estimates up to 80%
viral explanations for schizophrenia
prenatal viral exposure has been linked to higher winter births and maternal influenza
virus triggers brain abnormalities
biochemical explanations for schizophrenia
excess dopamine
antipsychotic meds dec DA
amphetamines inc dopamine and can trigger psychosis
Parkinson’s meds inc DA and can lead to psychotic symptoms
challenge: new meds affect serotonin
brain circuitry explanations for schizophrenia
evidence of structural abnormalities (enlarged ventricle, small frontal lobe), dysfunction of multiple structures, abnormal interconnectivity
psychological explanations of schizophrenia
psychodynamic- historical view, not supported
behavioral- operant conditioning view where person reinforced for bizarre behavior, not supported as cause but maybe shape expression
cognitive- person misinterprets symptoms (person has hallucination -> family doesn’t believe them -> develops paranoia)
sociocultural explanations for schizophrenia
better recovery in developing nations?
social labeling theory might reinforce
high levels of stigma and discrimination can impact functioning
negative expressed emotions (EE) in families may play a role
diathesis stress explanation for schizophrenia
diathesis- bio factors place person at risk
stressors- bio, psych, social trigger the disorder and influence course
treatment needs to address biological, psychological, and sociocultural factors
community mental health act (1963)
deinstitutionalization, treatment in community settings, a range of mental health services
assertive community treatment model for schizophrenia
decreased symptoms, increased quality of life
comprehensive treatments plans include meds, relapse plan, employment support, family support, psychotherapy, supports for daily living with the person in the middle of it all
antipsychotics for schizophrenia
more effective than any other single approach
70% show symptom reduction
typically needed but not sufficient
conventional- neuroleptics, dec pos symptoms, Parkinson’s like effects (extrapyramidal), tardive dyskinesia
second gen- atypical, dec pos and neg symptoms, can have weight gain or dizziness
supervised residences
paraprofessional staff
help person avoid rehospitalization
milieu Therapy approach- respect and openness, promote individual responsibility, productive activity, and community engagement
CBT therapy for those with schizophrenia
cognitive remediation- computer tasks to improve social awareness and problem solving
hallucination reinterpretation- educated about bio cause and challenge hallucination’s power
new wave CBT- accept problematic thought
relapse plan for schizophrenia
chronic condition for 75%
medication reassessment, 24-hour supervised living, short term hospitalization, and day programs
