Lecture 6 Depression Diagnosis & Causation Flashcards
DSM-IV mood disorders
Depressive (Unipolar) Disorders
- Major depressive disorder
- Dysthymic disorder
Bipolar Disorders
- Bipolar I disorder,
- Bipolar II disorder,
- Cyclothymic disorder
Extremes in normal mood
DSM-V depressive disorders
Disruptive Mood Dysregulation Disorder
Major Depressive Disorder
Persistent Depressive Disorder (Dysthymia)
Premenstrual Dysphoric Disorder
DSM-V disruptive mood dysregulation disorder
- Severe recurrent temper outbursts that are grossly out of proportion in intensity or duration to the situation or provocation.
- mood between temper outbursts persistently irritable or angry, and is observable by others
- diagnosis should not be made for the first time before 6 or after 18
DSM-V premenstrual dysphoric disorder
- in most menstrual cycles, at least 5 symptoms must be present
- in the week before, improve within a few days, minimal the week after
Core symptom of PMDD (1+ of 4)
Marked affective lability (e.g., mood swings; feeling suddenly sad or tearful)
Marked irritability or anger or increased interpersonal conflicts.
Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts.
Marked anxiety, tension, and/or feelings of being keyed up or on edge
Additional symptoms of PMD (1+ of 7)
- Decreased interest in usual activities
- Subjective difficulty in concentration.
- Lethargy, easy fatigability, or marked lack of energy.
- Marked change in appetite; overeating; or specific food cravings.
- Hypersomnia or insomnia.
- A sense of being overwhelmed or out of control.
-Physical symptoms such as breast tenderness or swelling, joint or muscle pain,
“bloating,” or weight gain
DSM-V Major depressive disorder
- a single or recurrent depressive episode
- never manic or hypomanic episode
- different from DSM-IV: removed bereavement exclusion
Major depressive episode (9)
5+ including 1 or 2 in a 2-week period
- Depressed mood most of the day, nearly every day
- Markedly diminished pleasure/interest in activities
- Significant weight loss or gain
- Insomnia or hypersomnia nearly every day
- Psychomotor agitation or retardation nearly every day
- Fatigue/loss of energy nearly every day
- Feelings of worthlessness, excessive guilt nearly every day
- Diminished ability to concentrate nearly every day
- Recurrent thoughts of death, suicide, suicide attempts
DSM-V persistent depressive disorder (DSM-IV dysthymia)
A. Depressed mood most of the day, more days than not
B. Presence, while depressed, of 2+:
- Poor appetite or overeating
- Insomnia or hypersomnia
- Low energy or fatigue
- Low self-esteem
- Poor concentration or difficulty making decisions
- Feelings of hopelessness
C. No more than 2 months ‘normal’ mood in 2-years
D. No manic features
Difference between MDD and PDD
- symptom milder in PDD
- PDD may develop major depressive episodes
- PDD symptoms can persist unchanged over long periods
Change in DSM-V
Changed Mood Disorders to ‘Depressive disorders’ vs ‘Bipolar and Related Disorders’
Added ‘Disruptive Mood Dysregulation Disorder’
Added ‘Premenstrual Dysphoric Disorder’
Removed Grief exclusion from diagnosis of Major Depressive Disorder
ChangedDysthymia to ‘Persistent Depressive Disorder’
Major depression subtypes (8)
- anxious distress
- mixed features
- melancholic features
-atypical features
eg Weight gain, oversleep, rejection sensitivity
- psychotic features
- catatonia
- peripartum onset (Postnatal Depression)
- seasonal pattern (Seasonal Affective Disorder)
Prevalence of MDD
16.4% lifetime
3-5% one-year in Aus
steady increase in prevalence, decrease in age of onset
Gender difference
2:1 female:male
emerges during adolescence, evens out after 65
Biological influences of MDD (4)
Genetics
- high rate in family studies
- concordance rates higher in identical twins
- mixed data in adoption studies
Neurochemistry
- low levels of noradrenalin, dopamine, serotonin
- no good evidence for mechanism
- absolute level unlikely be the cause
Brain structures
- amygdala, hippocampus, prefrontal cortex, anterior cingulate
- problem with direction of causation
Neuroendocrine system
- overactivity in HPA axis
- response to stress, excess cortisol
=>interaction between genetic vulnerability and negative life events
Psychological influences (6)
Learned helplessness
-lack of control over life events
Attribution
- internal vs external
- stable vs unstable
- global vs specific
Hopelessness
-helplessness expectancy + negative outcome expectancy
Schema
Response style
-rumination vs distraction, problem solving
Interpersonal approach
Schema theory
Pre-existing negative schema
Developed during childhood (esp if vulnerable)
Activated by stress
-Results in cognitive biases, process information in terms of the schema (memory, attention, interpretation)
- arbitrary Inference, overgeneralization, magnification
e. g. active no one loves me schema,
inference: my friend doesn’t say hi because he hates me overgeneralization: he’ll never talk to me again magnification: i’ll never have friends, i’ll die alone
-Depressive Cognitive Triad :
negative thoughts about the self, the world, the future become dominant in consciousness
each time schema activated, more evidence collected in support of pre-existing schema, easier to recall all those negative/ambiguous events that happened
self-exacerbating nature of depression, responsible for episodic depression (each episode increases likelihood of another episode)
Interpersonal approach
Interpersonal relations are negatively altered as a result
of depression
Depressed people -have limited social support networks -seek excessive reassurance from others -have / display limited social skills eg poor eye contact, wrapped up in own's depression -elicit rejection from others =>maintain or exacerbate depression
Stress-generation hypothesis
- way of interpreting the world changes when depressed
- Depressogenic cognitions and behaviours generate negative life events, person-dependent
- Self-generated negative life events may partly explain depression recurrence
response style theory
how i think about stressful events: ruminative response style, over-thinking about event but not solve problem, distract
“why is this happening to me, etc…”
increased risk of depression
