Mood Disorders: Depression Flashcards
Definition of Mental Illness (WHO)
Mental illness refers to a diagnosable condition that significantly interferes with an individual’s abilities (cognitive, emotional and social)
Depression
- One of the most common presentations in general practice
- 3.3 out of 100 people (2016)
- Associated with high levels of morbidity and mortality
- Most common disorder contributing to suicide
- Often goes undiagnosed
- Difficulties in recognition
- Patient worries about stigma
Psychosocial Impacts of Depression (4)
Depression causes difficulties with work
Leading to sick days
Sometimes unemployment
Difficulties with relationships
Maladaptive Coping associated with Depression
Self-harm
Attempted Suicide
Suicide
Dysthymia
Persistent or chronic form of mild depression
Similar symptoms but longer lasting
Major Depressive Disorder
At least two weeks:
• Depressed mood
• Loss of interest
• Decreased energy
Categorised as:
• Mild
• Moderate
• Severe
Major Depressive Disorder: Core Symptoms
Low mood
Lack of interest (anhedonia)
Lack of energy
Biological Symptoms of Depression
- Appetite disturbance (overeating and loss of appetite)
* Sleep disturbance
Cognitive Symptoms of Depression
- Difficulties with concentration and attention (and/or memory)
- Worthlessness
- Hopelessness/bleak views of the future
- Guilt
- Suicidal thoughts
Social Symptoms of Depression
Social isolation or withdrawal
Diagnostic criteria for major depressive disorder
Indications of severity:
Mild - at least 2 core symptoms + >=2 of the other symptoms
Moderate – at least 2 core symptoms + >=3 of the other symptoms
Severe – 3 core symptoms + >=4 of other symptoms
Biopsychosocial Model
Bio: Neurotransmitters, Genetics
Psycho: Emotion, Cognition
Social: Social class, Social support
The Three Ps
Predisposing (Increase susceptibility)
Precipitating (Events/experiences/stressors)
Perpetuating (Prolong illness after its onset)
The ‘Common Sense’ Model
Event —-> Emotion
The Cognitive Model
Event —> Cognition (Interpretation) —> Emotion
Types of Cognitions: Schema/Core Belief
Abstract mental element that serves as a guide to action
A structure for interpreting information
Organised frameworks for solving problems
“I am always successful”
Types of Cognitions: Dysfunctional Assumptions
Unhelpful ‘If …then’ thoughts cause distress
• ‘If I am not perfect, then I am useless’”
• “If I ask for help, then I am not good enough”
Types of Cognitions: Negative automatic thought (NAT)
Un-invited schema-congruent thought with negative content
Often taken at face value
• e.g. on hearing about a surprise test: ‘Oh no! I am going to fail!’
Beck’s Cognitive Triad
Negative views about the world
Negative views about oneself
Negative views about the future
Genetics: Twin Studies
Twin studies indicate genes play role, through controlling for the environment
Any differences that emerge should be due to genetics
Serotonin
Is a neurotransmitter
Plays part in regulation of sleep, aggression, eating, sexual behaviour, mood
Serotonin Hypothesis
Reduced tryptophan causes reduced serotonin in blood plasma
Disregulation of the HPA Axis
Chronic hyperactivity of hypothalamus causes increase in cortisol
Chronically elevated cortisol reduces hippocampus volume by affecting neuronal atrophy
Negative feedback loop lost thus even more increase in cortisol
Disregulation of the HPA Axis
Chronic hyperactivity of hypothalamus causes increase in cortisol
Chronically elevated cortisol reduces hippocampus volume by affecting neuronal atrophy
Negative feedback loop lost thus even more increase in cortisol
What does treatment of depression depend on?
Tends to depend on severity and response to treatments
Initial interventions for minimal/mild depression
- Sleep hygiene
- Self-care strategies
- Encouraging exercise
- Stopping smoking
- Cutting down on alcohol/drug use
- Self-help
- Active monitoring
