Major depressive disorder Flashcards
What is the natural course of Major Depressive Disorder (MDD)?
The progression of MDD varies and may include:
* No further episodes (50% experience full remission)
* Unremitting (15% remain chronically depressed)
* Recurrent (35% experience multiple episodes with increased risk after each episode)
Example: A 30-year-old woman diagnosed with MDD at age 25 experiences a second episode of depression three years later, reflecting recurrence statistics.
What are the risk factors for Major Depressive Disorder (MDD)?
Risk factors include:
* Female gender (2:1 female-to-male ratio)
* Younger age
* Family history of depression
* Prior substance abuse or panic attacks
These factors increase vulnerability to MDD.
What are the primary symptoms required for diagnosing MDD according to DSM-5?
Primary symptoms include:
* Depressed mood most of the day
* Loss of interest or pleasure in almost all activities (anhedonia)
Symptoms must persist for at least two weeks.
What additional symptoms are required for a diagnosis of MDD?
At least three of the following additional symptoms are required:
* Significant weight or appetite change
* Insomnia or hypersomnia
* Psychomotor agitation or retardation
* Fatigue or loss of energy
* Feelings of worthlessness or excessive guilt
* Diminished concentration or decisiveness
* Recurrent thoughts of death or suicidal ideation
These symptoms must cause significant distress or impairment in functioning.
What are the inclusion criteria for diagnosing MDD?
Inclusion criteria include:
* Symptoms cause significant distress or impairment in functioning
* Symptoms not better explained by substance use or a medical condition
This ensures accurate diagnosis.
What are the exclusion criteria for diagnosing MDD?
Exclusion criteria include:
* No history of manic or hypomanic episodes
This is to rule out bipolar disorder.
What are the screening considerations for comorbid conditions in MDD?
Screening for comorbid conditions includes:
* Bipolar Disorder: Assess for episodes of mania or hypomania
* Schizophrenia: Look for auditory hallucinations or delusions
Example: A 28-year-old patient with MDD reports hearing voices daily, indicating the need for further investigation.
What psychological models explain the development of MDD?
Psychological models include:
* Cognitive-behavioral theories (negative thoughts, dysfunctional beliefs)
* Learned helplessness theory (perceived lack of control)
Example: A person internalizes failure as incompetence, perpetuating depressive symptoms.
What neurochemical models are associated with MDD?
Neurochemical changes include:
* Reduced levels of serotonin, norepinephrine, dopamine
* Structural changes in the amygdala and prefrontal cortex
These changes affect emotional regulation and decision-making.
What are the principles of initial treatment for MDD?
Principles of initial treatment include:
* Pharmacological interventions (SSRIs like fluoxetine)
* Psychological interventions (Cognitive Behavioral Therapy)
* Combination therapy for severe cases
Combination therapy shows better outcomes than either approach alone.
What social factors contribute to the risk of depression?
Social factors include:
* Early maternal loss
* Unemployment
* Caring responsibilities
* Lack of confidants
Vulnerability is mediated by low self-esteem and hopelessness.
What is the heritability rate of depression in men and women?
Heritability rates are approximately:
* 40% in men
* 50-60% in women
Twin studies indicate these rates vary by gender.
What is Beck’s Cognitive Model of depression?
Beck’s Cognitive Model includes a cognitive triad:
* Negative view of self
* Negative interpretation of experiences
* Pessimistic view of the future
Example: After losing a job, an individual feels incapable and believes they will remain unemployed.
What is the Revised Learned Helplessness Model?
The Revised Learned Helplessness Model emphasizes:
* Attributional styles (stable, global, internal)
Example: A student failing a test may attribute it to a lack of intelligence, reinforcing helplessness.
What neuroanatomical structures are implicated in mood regulation?
Key structures include:
* Amygdala
* Hippocampus
* Prefronto-striato-thalamic loops
These structures are involved in mood regulation and emotional processing.
