Lecture 8 Flashcards
Mood disorders
mood disorders
a group of disorders which are categorised as such due to disturbance in mood being the central feature
the world health organisation
ranks major depressive disorder and bipolar disorder as the first and fifth leading cause of years lived with a disability, yet very little is certain about there pathogenesis
depression
a term used to describe symptoms and behaviours, not a diagnostic label
major depressive disorder
a mood disorder characterised by one or more major depressive episode without a history of manic, mixed, or hypomanic episodes, and not due to a medical condition, medication or substance
MDD, unipolar
common
lifetime prevalence 10-20%
marriage/cohabiting and good socio-economic positions are associated with a lower risk of depression in both genders
less common in children and presents differently
dysthymia
long lasting signs and symptoms that are similar to, not as severe as, those of depression
perinatal or postpartum depression
occurs around or following the birth of a child
seasonal affective disorder
triggered by the changing of the seasons
bipolar disorder
can include both “highs” or manic episodes and the depressive episodes, and generalised anxiety disorder
unipolar vs bipolar
depression - recurrent episodes of lows
bipolar - both highs and low episodes outside the normal range
MDD symptoms
mood changes
- a long period of feeling worried or empty
- loss of interest in activities once enjoyed
behavioural changes
- feeling tired or slowed down
- having problems concentrating, remembering, and making decisions
- being restless and irritable
- changing to eating, sleeping or other habits
- thinking of death or suicide, or attempting suicide
DSM-5 criteria
The DSM-5 outlines the following criterion to make a diagnosis of depression. The individual must be experiencing five or
more symptoms during the same 2-week period and at least one of the symptoms should be either (1) depressed mood or
(2) loss of interest or pleasure.
1. Depressed mood most of the day, nearly every day.
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
3. Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.
4. A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective
feelings of restlessness or being slowed down).
5. Fatigue or loss of energy nearly every day.
6. Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
7. Diminished ability to think or concentrate, or indecisiveness, nearly every day.
8. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan
for committing suicide.
To receive a diagnosis of depression, these symptoms must cause the individual clinically significant distress or impairment
in social, occupational, or other important areas of functioning. The symptoms must also not be a result of substance abuse
or another medical condition.
with mixed features
this specifier allows for the presence of manic symptoms as part of the depression diagnosis in patients who do not meet the full criteria for manic episodes
with anxious distress
the presence of anxiety in patients may affect prognosis, treatment options, and the patients response to them
clinicians will need to assess whether or not the individual experiencing depression also presents with anxious distress
biological explanation
heritability based o twin studios is 40 to 50%
but depression doesn’t have a clear pattern of inheritance in families
people who have a first degree relative with depression appear tp be art a 2-3 times greater risk of developing the condition
serotonin transporter gene and short alleles linked to depression
brain abnormalities
cingulate cortex
orbitofrontal cortex
amygdala
hippocampus
biological factors
stress hypothesis
- depression results from exposure to chronic mild stressors
- causes over activity on the hypothalamic-pituitary-andrenocortical axis
-too much cortisol causes long term damage to some brain areas
inflammation
a longitudinal study in the UK on 5000 subjects showed that those with signs of increased inflammation in their blood at age 9 predicted depressive symptoms 9 years later
psychological explanation
life stresses are a precipitating factor
- loss of a loved one
- threats to important close relationships
- threats to occupation, economic loss
- serious health problems
elderly
bereavement
sleep disturbance
disability
prior depression
female gender
loneliness
adolescent
female gender
loss of parent
family history of depression/anxiety
bullying
being LGBTQ in a unsupportive environment
low self-esteem
physical disability
adverse childhood experience
Brown and Harris
3 times higher risk of depression in women who lost their mothers before 11 years old
not parental loss per se but aftercare
- instability
- poor parental care
diathesis stress model
diathesis - a predisposition or vulnerability
stress - an environmental stressor
leads to development of the disorder - the stronger the diathesis then the less stress needed to produce the disorder
personality factors
neuroticism
- higher risk of experiencing stressful life events
- heritable traits
- higher levels of neuroticism and lower levels of extroversion noted as risk factors
- social network, together with neuroticism, also strong associations with severity, independently from current depressive state
introversion
- unenthusiastic unenergetic, flat, bored
- vulnerable personality
