Lecture 8 Flashcards

Mood disorders

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1
Q

mood disorders

A

a group of disorders which are categorised as such due to disturbance in mood being the central feature

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2
Q

the world health organisation

A

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

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3
Q

depression

A

a term used to describe symptoms and behaviours, not a diagnostic label

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4
Q

major depressive disorder

A

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

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5
Q

MDD, unipolar

A

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

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6
Q

dysthymia

A

long lasting signs and symptoms that are similar to, not as severe as, those of depression

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7
Q

perinatal or postpartum depression

A

occurs around or following the birth of a child

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8
Q

seasonal affective disorder

A

triggered by the changing of the seasons

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9
Q

bipolar disorder

A

can include both “highs” or manic episodes and the depressive episodes, and generalised anxiety disorder

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10
Q

unipolar vs bipolar

A

depression - recurrent episodes of lows
bipolar - both highs and low episodes outside the normal range

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11
Q

MDD symptoms

A

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

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12
Q

DSM-5 criteria

A

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.

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13
Q

with mixed features

A

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

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14
Q

with anxious distress

A

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

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15
Q

biological explanation

A

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

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16
Q

brain abnormalities

A

cingulate cortex
orbitofrontal cortex
amygdala
hippocampus

17
Q

biological factors

A

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

18
Q

inflammation

A

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

19
Q

psychological explanation

A

life stresses are a precipitating factor
- loss of a loved one
- threats to important close relationships
- threats to occupation, economic loss
- serious health problems

20
Q

elderly

A

bereavement
sleep disturbance
disability
prior depression
female gender
loneliness

21
Q

adolescent

A

female gender
loss of parent
family history of depression/anxiety
bullying
being LGBTQ in a unsupportive environment
low self-esteem
physical disability

22
Q

adverse childhood experience

A

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

23
Q

diathesis stress model

A

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

24
Q

personality factors

A

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

25
Q

cognitive explanation

A

ellis ABC model
- depressed peoples irrational beliefs
- interpretation and beliefs in part determine how we feel about the situation and how we deal with this feeling
beck negative triad
- negative thoughts underlie mental disorders
- errors in logic - depressed people draw illogical conclusions when they evaluate themself
- cognitive triad - there are 3 forms of negative thinking that are typical for those with depression, the world, the self and the future

26
Q

errors in logic

A
  • dichotomous reasoning
  • selective abstraction
  • arbitrary inference
  • personalisation
  • magnification
  • minimisation
  • overgeneralisation
27
Q

learned helplessness theory

A

Seligman
animals given electrical shocks
become passive if they cannot escape
non-contingency is the basis of human depression

28
Q

criticism of the theory

A

did not account for the observation that depressed people blame themself for the bad event

29
Q

reformulated helplessness

A

attribution
a persons causal attributions of the bad event were:
internal
global
stable

30
Q

hopelessness theory

A

Abramson et al
pessimistic attributional style with one or more negative life event not sufficient to produce depression unless hopelessness was experienced first
hopelessness expectancy
- perception that s person has no control over what id going to happen
- s certainty that an important bad outcome will occur or that a highly desired good outcome will not occur

31
Q

longitudinal prospective study

A

following students with pessimistic attributional style and dysfunctional beliefs - high risk
4x more likely than low risk group to develop depression
ruminators - increased risk if in high risk group

32
Q

medication

A

selective serotonin reuptake inhibitors
serotonin and noradrenaline reuptake inhibitors
tricyclic and tricyclic-realted drugs
monoamine oxidase inhibitors

33
Q

however, medications

A

increased suicide risk and worsening of suicidal ideas in vulnerable patients, especially children and adolescents

34
Q

physiological approaches

A

counselling
psychodynamic psychotherapy - long-term, focussed on past
interpersonal psychotherapy - connection between current symptoms and relationship problems
cognitive therapy - CBT, REBT, ACT

35
Q

CBT

A

targets understanding and identifying thoughts
attempts to address underlying cognition driving behaviour
encourages challenging irrational thinking
plans for relapse prevention

guided self help in primary care - cheaper with same effect but low engagement
group work - reduces symptoms but low recovery and not always economically efficient
individual work - highest impact but more costly and time consuming

36
Q

biophycosocial

A

biological influences
- genetic predisposition
- changes in brain chemistry
- brain damage due to stress and other factors

psychological influences
- negative explanatory style
- learned helplessness
- gender differences

social-cultural influences
- traumatic/negative event
- cultural expectations
- depressed-evoked responses

37
Q

outcomes of CBT

A

Gloaguen et al. (1998) conducted a meta-analysis on CBT for depression to date and CBT was found to be superior when compared with waiting list or placebo
controls.
A meta-analyses reported large effect sizes were found for CBT for unipolar depression
BUT, it has been argued that the effectiveness of CBT for depression has been overstated
And underestimated the central importance of the therapeutic relationship as the ‘curative’
component and therapist experience