Midterm #2 Flashcards
DSM 5 criterion for Major Depressive Disorder?
DSM criterion shown to be consistent across cultures in first, second and third world countries
1) At least two weeks of depressed mood and/or the loss of interest or pleasure in most activities.
Plus 4 additional symptoms from:
Changes in appetite or weight (Increase or decrease in weight, normally due to increase or decrease in appetite), Sleep disturbances (change in normal sleep pattern), agitation, decreased energy, feelings of worthlessness or guilt, difficulty concentrating or making decisions, recurrent thoughts of death, or suicidal ideation.
Most common additional symptoms:
Changes in appetite: Appetite may increase or decrease
Changes in weight: Increase or decrease in weight
Sleep disturbances: Normal pattern changes. May sleep more, or may sleep less. May awake frequently, ie every night at 2am
Agitation: Some people may become jittery and anxious, while others become lethargic and cant get out of bed
Social Phobia
When someone has a marked or persistent fear of social or performance situations in which embarrassment may occur.
*Social phobia is common
It has higher rates in western cultures, primarily North America. Also some Asian countries, but primarily a western phenomenon
Psychoses?
Loss of contact with reality
This is why schizophrenia is considered a psychotic disorder, because they have hallucinations and delusions that prevent them from seeing the world as it actually is
*Depressed people typically see the world more accurately. the opposite of psychoses
Prevalence of Major Depressive Disorder?
2X as common in women
approximately 4.7% of Canadians
2-9% of depressed patients commit suicide
**Only chronic for a minority of people. Depression normally remits within 6 months for most people.
*Highest % in young people and *lowest in older people
Prevalence is increasing steadily year by year. This may be because we are becoming more able/willing to assess/diagnose
**Although depression rates are increasing, suicide rates are not. Suicide rates have not gone up in 20 years. May be because we now have more supports for suicide.
**As rates of depression go up, rates of schizophrenia are going down.
With every episode of depression that you have, your risk of relapse increases. This is the case with all mental health disorders.
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Differences in stated depressive symptoms in western vs nonwestern countries?
DSM 5 criterion are applicable across all cultures
Westerners focus on mental symptoms “depression”
Non-Westerners focus on physiological symptoms, lethargy etc.
What two conditions are highly comorbid in depression?
1) Anxiety
2) Substance abuse
What are the four types of antidepressants?
1) SSRIs
2) Dopamine agonists
3) Epinephrine reuptake inhibitors
4) Reversible MOAI
*All these drugs increase either epinephrine, serotonin, or dopamine in the brain.
What psychiatric condition has the highest rate of mortality?
1) is Anorexia
What four mental disorders have the highest rates of suicide?
1) Depression
2) Schizophrenia
3) Bipolar
4) Substance abuse
Suicide differences between men and women
- Across all cultures *Women have a higher rate of attempting suicide, but *men have a higher rate of successfully committing suicide.
- Men choose more lethal methods, such as guns
- Women tend to choose pills, which are slower, more chance of recue etc.
What mental disorder has the strongest association with suicide?
Depression
marriage and depression?
Marriage is a risk factor for females
Marriage is a protective factor for males
Why do females have twice the rate of depression compared to males?
2: 1 ratio
* This is across all cultures, even present in “progressive” cultures, like Sweden
* rates are the same between career vs housewives
For this class: Women are more likely to continually ruminate on their problems.
Neurobiology of depression
Underactivity of the PFC- not the cause of depression, but it coincides with depression
- Administering drugs that suppress activity of the PFC will result in depression
You can rectify depression by stimulating the PFC:
1) Artificial stimulation: via antidepressants, ECT, TMS (transcranial magnetic stimulation)
2) Psychologically: Use of CBT or insight therapy
* PFC will become more active as you become better
What causes underactivity of the PFC during depression?
*Prolonged Stress, *Stress hormone Cortisol: *biological cause for changes in the depressed brain.
Other reasons: Diet, lack of exercise, hormonal changes etc. *There are many routes that can result in depression.
Sometimes there is a single important factor, but many time it is a combination of factors
Effective treatments for depression?
Psychotherapy: Especially CBT- changing thought processes
Drugs: SSRIs, NRIs, Dopamine Agonists, Reversal MAOI
Hormones: Thyroxin,Testosterone, Estrogen+Progesterone
Underactive thyroid: may cause depression, treated with the hormone “Thyroxin”.
Low testosterone: Testosterone supplemented (indirectly stimulates dopamine), improve mood, energy etc.
Estrogen+ Progesterone: Variations in these hormones are associated with mood. Can be helpful in regulating mood in women
**Antiglucocorticoid: *Upstream approach to stress induced depression: This hormone Decreases cortisol levels. This in turn elevates dopamine, serotonin, and epinephrine.
Sleep deprivation: Temporary mood improvement. Fast effective relief. Only lasts a day or two.
*Everyone with depression has some form of sleep disorder
Exercise: As effective as medication+therapy for minor and moderate depression.
- decreases cortisol
- increases exercise flow to the brain, increases endorphins and keflins
Light
Diet
Problems with lithium
- Only 50% of bipolar patients respond
- Does not treat the depressive phase of depression, it only modulates the manic phase
- Can cause temours and memory problems
- Longterm risk of tardive dyskinesia: permanent uncontrollable tics
- Has a narrow range of safety between therapeutic levels and toxicity
6 Treatments for Bipolar disorder
1) Lithium: Mood stabilizer *Most common for conventional bipolar
2) Carbamazepine(Tegretol): Anticonvulsant
3) Valproic acid: Anticonvulsant
4) Antipsychotics: Given in the the ER to quickly control the manic episode.
5) EMPower
6) ECT
ECT + Bipolar
ECT works for both depressive and manic states
Only used under three conditions:
1) When you don’t respond to medications
2) When you are pregnant and don’t want to damage the fetus
3) When an immediate response is necessary
Mania
Often contains: State of Euphoria
- Grandous delusions
- Excitation
- “Push of speech”- cant interrupt them
- Persistently elevated or irritated mood
What is the most dangerous treatment for bipolar and why?
Lithium, because blood levels must be monitored constantly to avoid toxicity
What environmental manipulations work for bipolar?
Having a strict routine and sleep schedule
What causes bipolar?
Bipolar is mostly a genetic brain disorder, where the brain was built improperly
75% heritable
Similar neurobiological mechanisms to depression
What anticonvulsants are used to treat bipolar?
Valproic Acid
Carbamazepine
How many people have another manic episode after having experienced one?
90%
The frequency increases with every subsequent episode
What are the 6 subtypes of bipolar?
1) Mixed/Rapid cycling- Fast cycling between depression and manic phases
2) Anxious- includes high state of anxiety
3) Psychotic- includes prominent delusions
4) Seasonal- Summer triggers mania (increased light), winter triggers depression (decreased light)
5) Post partum: Fluctuations in hormones causes mood changes
6) Cyclothymia- Chronic. Constains less severe forms of depression, and hypomania instead of mania. May experience clearer thoughts during hypomania, improved cognition etc.
Diet and depression
Depressed people have different dietary profiles, minerals, vitamins etc.
Small levels of lithium can be obtained from foods, and from water
Promising studies for zinc, vitamin D, and folate
Omega 3 fatty acids- low levels are associated with many MH issues.
ECT + Depression
Artificially induced seizure
Last resort
*Most effective treatment for severe depression
80% success vs 2/3 for other therapies
Problem: Causes minor brain damage, can result in memory loss/memory problems
Exercise+Depression
As effective as medication or psychotherapy for minor to moderate depression. Not as effective for severe depression.
Physical action releases build-up of stress hormones, like cortisol
Increases oxygen flow to the brain
Increases endorphins and keflins + increases dopamine indirectly
Transcranial magnetic stimulation TMS
Uses powerful magnets to stimulate PFC
No known side effects
4 Hormone treatments for depression
1) Thyroxin: Stimulates thyroid = more energy
2) Testosterone: Indirectly improves reward/motivation and mood.
3) Estrogen+Progesterone: Associated with mood regulation, , especially in women
4) Antiglucorticoid: Cutting edge hormone that reduces cortisol. Upstream approach
Sleep deprivation
Temporary, fast mood elevation
Not a longterm solution, but can provide effective fast improvement in mood
*All depressed people also have some form of sleep disorder. Maybe insomnia, wierd awakening, too much sleeping etc.
Causes of depression?
50% genetic
Also includes environment and psychological/behaviour patterns
List 7 environmental factors that contribute to depression
1) Stressors: Divorce, loss of a loved one, poverty etc.
2) Traumatic events
3) Lack of social support
4) Psychological coping skills: How you deal with upset and aggression
5) Culture is very achievement oriented, competitive society:
6) Loss of religion as a society: Loss of social support systems, sense of purpose in life
7) Personality: Some people are chronically pessimistic and neurotic
- Permanent optimists are better innoculated against depression
Aboriginals and suicide
Worldwide aboriginal people have higher rates of suicide.
*More trauma and substance abuse in these sections. + disadvantageous social conditions. These result in hopelessness, no sense of a possible future.
Reserves with good economies and living conditions have much lower suicide rates
Frequencies about bipolar
1.5% of the Canadian population
Any age, equally as common in men and women
Peak mania occurs in summer
6-70% of the time mania is preceded or followed by a depression episode
90% relapse rate, interval between episodes decreases with each episode
Rates of suicide are 2-4%
Somatic Symptom Disorder
One or more bodily symptoms causing persistent (>6months) distress
*Excessive thoughts, feelings, and/or behaviours related to these bodily symptoms. (preoccupation, anxiety , excessive time and energy devoted to these symptoms)
- Chronic, but fluctuating
- EXCESSIVE medical consultation and intervention, without effect
- Can and does occur alongside real physical problems
- Inability to realize that your concern is out of proportion
- Resistant to psychological referral
Appraise their symptoms as unduly threatening, despite reassurance
High comorbidity with depression and anxiety
Physical symptoms associated with significant psychological stress or impairment
Generalized Anxiety Disorder
Worried, always nervous about everything
Nonspecific anxiety
self conscious- need excessive reassurance
Psychosomatic complaints: Upset stomach etc.
(Heightened anxiety produces more stress hormones that affect the body)
**Chronic, does not necessarily go away with time or treatment
*Highly genetic