Exemplar : Depressive Disorders EXAM I Flashcards
an umbrella term for a variety of disorders that range from mild, moderate to severely disabling. ____ is known as a syndrome rather than a disease. while a disease is a specific condition characterized by a common underlying cause and consistent physical traits, a syndrome is a collection of signs and symptoms known to frequently appear together, but without a single known cause.
Depression
women are ___% more likely than men to experience depression during their lifetime.
70
typically accompanies other psychiatric disorders such as anxiety, PTSD, schizophrenia, substance use disorders, eating disorders, etc. People with anxiety disorders, personality disorders, adjustment disorders, and brief depressive reactions commonly present with depression. People with chronic medical problems are are at a higher risk of depression as well. Often depression may be the first sign of a medical condition. Comorbidity has been shown to result in a higher rate of suicide, greater severity of depression, and greater impairment in social and occupational functioning as well as including more coexisting illnesses, both medical and psychiatric.
Depressive Syndrome
____ are often under diagnosed but can be diagnosed with depression as young as 3 years old. May present with irritability rather than depressed mood. May not show typical signs of depression but rather feeling unwell, refusing to go to school, complaining of vague physical complaints, aggression and clingy.
Children
typically present with depression by sulking, being negative/grouchy, getting into trouble, feeling misunderstood, withdrawing from others, or running away from home. Major depression among ____ is often associated with substance use disorder and antisocial behavior. Early treatment with medication and cognitive behavioral therapy (CBT) in the first 12 weeks can help achieve remission. Children and ________ with MDD have a high rate of future recurrence.
Adolescents
Depression among older adults has been declining but it is highest among ______ _____, and is undiagnosed in 50% of this specific population. Often time associated with chronic illness and does increase the cost of health care.
elderly men.
Research suggests that the use of antidepressants in those __ and older can be risky. Studies indicate that antidepressants in older adults can lead to falls, strokes, seizures, and other adverse outcomes. SSRI’s have more negative outcomes than older adults taking TCA’s therefore SSRI’s are less likely to be given to older adults.
65
The overall basis theory is that there are changes in receptor neurotransmitter relationships in the following areas of the brain:
LIMBIC SYSTEM (which is associated with memory impairments)
PREFRONTAL CORTEX (associated with decreased mood and problems concentrating)
HIPPOCAMPUS (which is associated with memory impairments, feelings of worthlessness, hopelessness, and guilt)
AMYGDALA (anxiety and reduced motivation)
Theory of Depression
What are the primary neurotransmitters involved with depression ?
serotonin * norepinephrine * dopamine * GABA and acetylocholine
It is commonly accepted that genetic disposition to the illness combined with childhood ____ may lead to significant changes in the CNS.
Stress
Monozygotic twins (same genetic constitution) are 50% more likely that both twins will be affected by depression. Dizygotic twins are 20% more likely. B/c the mono twins concordance rates aren’t 100% it appears that other factors must be involved.
Twin Studies of Genetic Factors involved in Depression
risk for development in depression in children born to parents with a depressive illness is the same when these children are adopted by a non-depressive family
Adoptive Studies of Genetic Factors involved in Depression
supportive of a genetic link, concluding that mood disorders are heritable for some people. People with a first-degree family member with depression are two to four times more likely to become depressed.
Family studies of genetic factors involved in depression
two major neurotransmitters involved with depression that are believed to be involved in perceptions of pain.
serotonin (5-HT) and norepinephrine (NE)
regulator of sleep, appetite, and libido. Dysfunction in _____ can result in poor impulse control, low sex drive, decreased appetite, disturbed regulation of body temp, irritability.
Serotonin
may account for anergia (reduction in or lack of energy), anhedonia (inability to find meaning or pleasure), decreased concentration and diminished libido in depression.
norephinephrine
believed to be involved in major depressive episode. Dopamine neurons in the mesolimbic systems are thought to play a role in the reward and incentive behavior processes, emotional expression, and learning processes that are disrupted in depression.
GABA
when a patient presents with severe pain (commonly back pain, abdominal or pelvic pain) and deny feelings of sadness although they may suffer from other symptoms of depression. There can often times be an overlap of major depression and chronic pain.
Masked Depression
backaches or headaches may be due to MDD rather than chronic pain, and in some cases these conditions may present as the only sign of depression.
Chronic Painful Physical Conditions (CPPCs)
explains depression form an environmental, interpersonal, and life events perspective combined with biological vulnerability or predisposition (diathesis). Early life trauma may result in long-term hyerpactivity of the corticotropin-releasing factor (CRF) and norepinephrine systems of the CNS with a consequent neurotoxic effect on the hippocampus that leads to neuronal loss. Treated with CBT, Interpersonal therapy, behavior therapy, milieu therapy.
Stress Diathesis Model of Depression
proposed that people acquire a psychological predisposition to depression through early life experiences. These experiences contribute to negative, illogical and irrational thought processes that may remain dormant until they are activated during times of stress. Cognitively an individual has a very negative view of self, pessimistic view of the world, and a belief that negative reinforcement will continue. Treated with intrapersonal therapy, CBT, behavioral therapy, milieu therapy.
Cognitive Theory (Aaron Beck)
although anxiety is the initial response to a stressful situation, anxiety is replaced by depression if the person feels no control over the outcome of the situation. The rationale is that it’s the patient’s fault and nothing can be done to change it. treated with interpersonal social relationships.
Learned helplessness (Seligman)
- mood of sadness, despair, emptiness
- negative pessimistic thinking
- loss of ability to experience pleasure in life (anhedonia)
- low self-esteem
- apathy, low motivation, social withdrawal
- excessive emotional sensitivity
- irritability and low frustration tolerance
- insomnia and or hypersomnia
- disruption (mild to severe) in concentration or ability to make decisions
- SI
- excessive guilt
- indecisiveness
DSM-5 symptoms that are most prevalent in ALL types of depression
These people experience substantial pain and suffering, as well as psychological, social, and occupational disability. Patient presents with an episode of one of more major depressive episodes and no history of maniac or hypomaniac episodes. Many people who are diagnosed with ____ will later be diagnosed with bipolar disorder. Some cases include psychotic features of delusions or hallucinations. Mood congruence delusion can occur which is when patients tend to remember information that is consistent with their particular mood. For instance, “I am a bad person; therefore I am being punished”. It often remits within 3 months of 20% of patients, and 1 year for 80% of patients. Occurrence of future episodes tends to be longer and more severe and portends the risk for a continued cyclic occurrence.
Major Depressive Disorder
five or more of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either 1) depressed mood or 2) loss of interest or pleasure.
- depressed mood most of the day, or nearly every day
- markedly diminished interest or pleasure in all, or almost all activities
- significant weight loss when not dieting or weight gain, or decrease/increase in appetite
- insomnia or hypersomnia
- psychomotor agitation (pacing, biting nails, smoke, tap fingers, etc) or psychomotor retardation (Slowed movements to complete inactivity or incontinence) every day
- fatigue or loss of energy (anergia)
- feelings of worthlessness or excessive inappropriate guilt
- diminished ability to think or concentrate
- recurrent thoughts of death
DSM-5 Diagnostic Criteria for major depressive disorder
5 or more of these symptoms in a 2-week period. One of which must be depressed mood or interest loss S - sleep changes I - interest loss G - guilt or worthlessness E - energy loss C - cognition A - appetite changes, more or less food P - psychomotor agitation S -suicidal ideation
memory trick to remember DSM-5 diagnosis criteria for major depressive disorder
commonly known as dysthymia or chronic depression. This form of depression is notably severe and is characterized by depressive symptoms that are present for at least 2 years. Because _____ is usually chronic in nature, it cannot be distinguished from the persons usual pattern of functioning. Although they experience social and occupational distress, it typically doesn’t warrant hospitalization unless the patient becomes suicidal. Simultaneous presentation of ____ and MDD is referred to as “double depression” The major differences between MDD and ____ is the level of severity, duration, and persistence
persistent depressive disorder
- daytime fatigue
- frequently but not always to function at work or in social situation to optimum level.
- chronic depressed/irritable mood
- eating too much/little
- difficulty sleeping, PDD often has a hard time getting to sleep, but when they do they excessively sleep (hypersomnia), and MDD it is more common to have early morning awakenings
- loss of energy for simple tasks
- Irritability
- pessimistic thoughts
- low self esteem
Notable Symptoms of PDD
