Mood Disorders - Depressive Disorders Flashcards
depressive disorders types
- disruptive mood dysregulation disorder
- major depressive disorder (MDD)
- persistent depressive disorder - dysthymia (PDD)
- premenstrual dysphoric disorder
- substance/medication-induced depressive disorder
- depressive disorder due to another medical condition
bipolar and related disorders types
- bipolar 1disorder
- bipolar 2 disorder
-cyclothymic disorder - substance/medication-induced bipolar and related disorder
- bipolar and related disorder due to another medical condition
emotion continuum distinguishing
- duration
- impaired ability to function
- often occurs for no apparent reason
- involves extreme reactions not easily explained by what is happening in person’s life
- cluster of additional signs and symptoms
types of symptoms of depression
- behavioural
- cognitive
- emotional
- physiological
DSM5 criteria for MDD
A
- at least one major depressive episode
- never experienced a hypomanic or manic episode
- symptoms last for at least 2 weeks (for the majority of the time)
- change from baseline
- symptoms are not substance/medically-induced
DSM criteria for MDD episode
B
at least 1 of these:
1. depressed mood
2. anhedonia
at least 4 of these:
1. significant change in weight/appetite
2. insomnia or hypersomnia
3. psychomotor agitation/retardation
4. fatigue, loss of energy
5. feelings of worthlessness or inappropriate guilt
6. difficulty thinking and concentrating
7. recurrent thoughts of death, suicidal ideation (with or without plan), suicide attempt
DSM criteria for MDD with seasonal pattern
A
- at least 2 weeks
B
- same symptoms as the MDD episode
- associated with changes in daily as seasons change
- occurs more often in Northern latitudes
- previously termed seasonal affective disorder
recurrence of depressive episodes
- each major depressive episode increases risk of subsequent episode
- 1 episode = 50-60% will have another
- 2 episodes = 70% will have another
- 3 episodes = 90% will have another - with each subsequent episode, the length of time to recurrence is shortened
DSM5 criteria for PDD
A
- at least 2 years
B
-at least 2 of these:
1. poor appetite or overeating
2. insomnia or hypersomnia
3. low energy and fatigue
4. low self-esteem
5. poor concentration or difficulty making decisions
6. feelings of helplessness
at least 1 of these:
1. depressed mood
2. anhedonia
depressive reactions to grief
- important to distinguish from from normal grief-related reactions
grief
-often involves feelings of emptiness associated with the loss
- may last several years
- need to be carefully consider cultural, religious and age-appropriate norms
- frequency and intensity diminish over time
persistent complex bereavement disorder
condition undergoing study as a diagnostic category in DSM5
burden of depressive disorders - MDD
- lifetime prevalence 11.3% in Canada (2012)
- typical onset = late 20s
- 72% of individuals with MDD has comorbidity
1. anxiety disorder = 59%
2. substance use disorder = 24%
3. impulse control disorder = 30%
burden of depressive disorders - PDD
- lifetime prevalence 3-6% in Canada
- typical onset late childhood and adolescence
culture and depression prevalence
- individualistic cultures more likely to be diagnosed with depression than collectivist cultures
- why?
etiology of depressive disorders
- biological dimension
- psychological dimension
- social dimension
- sociocultural dimension
etiology - biological
- low levels of neurotransmitters
- heritability
- neuroendocrine systems(cortisol, stress, depression)
- anatomical and functional brain differences
- circadian rhythm disturbances
neurotransmitter dysfunction
- low levels of norepinephrine, dopamine, serotonin
- refer to functions of neurotransmitters in chapter 2 “perspectives”
- antidepressants medications
antidepressant medications in relation to neurotransmitter dysfunction
- increase the availability of neurotransmitters
- actual mechanism of how this works is not concrete
heritability
- genetic component with depression
- same types of disorders in families
- concordance rate of MDD (DZ=10%, MZ=40%)
- 35% variability in risk of developing MDD due to heritability (moderate genetic influence)
neuroendocrine dysregulation
- dyregulation and overactivity of HPA axis
- overpopulation of stress-related hormones (depressed people have higher levels of cortisol in their blood)
- influences mood, energy, appetite
- directionality is not concrete (no causal explanation)
brain changes with depression - have decreased brain activity and other brain changes
- decrease in neuroplasticity and neurogenesis in the hippocampus
- structural differences in hippocampus
- functional differences…
decrease of neuroplasticity and neurogenesis
reduced amount of neuro production
brain changes with depression - functional differences
- less activation in the prefrontal cortex
- more reactivity in amygdala
- increase for negative stimuli, decrease for positive stimuli
circadian rhythm disturbance
- internal biological rhythms maintained by melatonin
- sleep disturbances strongly linked with depression
- depression linked to disruptions (w/ and w/out seasonal patterns)
- irregularities in rapid eye movement
etiology: psychological
- behavioural
- cognitive
behavioural: Lewinson’s theory
depression occurs when people receive insufficient social reinforcements
behavioural: risk of depression increase when ______
- person participates infew activities that are possibly reinforcing
- there arefew reinforcements available in the environment
- person’s B and social skills result in limited reinforcement
behavioural activation model
types:
1. life circumstance
2. how doyou feel
3. what do you do
4. negative consequences
these interact between each other
etiology: cognitive (Beck)
- depression is a disturbance in thinking rather than disturbance in mood
- negative thinking patterns and faulty thinking
- refer to Beck’s theory
Beck’s theory
- self - negative self-schema
- world
- future
Beck’s types of faulty thinking
- arbitrary inference
- personalization
- overgeneralization
- magnification and exaggeration
- polarized thinking
- selective abstraction
Beck’s types of faulty thinking: arbitrary inference
- drawing conclusions about oneself/world without sufficient and relevant info
- “man not hired by potential employer concludes that he is ‘totally worthless’ and that will never find a job”
Beck’s types of faulty thinking: personalization
- relating external events to one another when there is no objective basis for such a connection
- “man who doesn’t receive a response to an email he sent to his supervisor concludes that the supervisor must dislike him”
Beck’s types of faulty thinking: overgeneralization
- holding extreme beliefs on the basis of a single incident and applying these inaccurate beliefs to other situations
- “woman who doesn’t get along with her father believes she will fail in all relationships with men”
Beck’s types of faulty thinking: magnification and exaggeration
- the overestimating significance of negative events
- “woman misses an important social event at work an concludes that all her coworkers are criticizing her for not attending”
Beck’s types of faulty thinking: polarized thinking
- “all or nothing” approach at viewing world
- “woman feels that she needs to be perfect in all she does at work - she makes a mistake, she considers herself totally incompetent”
Beck’s types of faulty thinking: selective abstraction
- drawing conclusions from very isolated details and events without considering the larger context
- “student who receives a C on an exam stops attending classes and considers dropping out of school despite having As and Bs in all other courses”
response style theory: Nolen-Hoeksema
- way a person responds to negative mood can impact severity/duration of the mood
- rumination
rumination
focused attention on negative emotional state, thinking repeatedly about causes and consequences
- depressed people tend to ruminate more than non-depressed people when in a negative mood
co-rumination
- constantly talk about negative experiences with others
- increase of depression risk, especially in females
etiology - attributional style
attributional style
- charcateristic way of explaining why a +/- event occurred
negative attributional style
- focus on internal, stable, global causes
positive attributional style
- focus on external, unstable, specific causes
learned helplessness
learned belief that one is helpless and unable to affect outcomes
learned helplessness and attribution style
refer to table and diagram in notebook
etiology - social
- maltreatment
- parental depression
- stressful life events influence/influenced by depression
- low social support
social etiology - maltreatment
- if occurs in early childhood, increased likelihood with later depression
- appears to modify expression of genes associated with HPA axis
- affects emotional reactivity
social etiology - parental depression
- influences the intergenerational transmission of depression
- decrease in parent-child interactions
- children more likely to dev. a variety of mental issues (SUD, anxiety disorders, depression, etc)
social etiology - stressful life events influence/influenced by depression
depression may increase social stress
social etiology - low social support
- excessive reassurance seeking may elicit negative reactions from others
1. tendency to seek positive feedback
2. dos not trust feedback
3. continues to seek more feedback - can arise from deficits in social skills, communication
- less social support decreases ability to cope with depression
sociocultural etiology - race/ethnicity
- African American and Latina women report depression through somatic symptoms
- triggers for depression differ among cultural groups
- acculturation conflicts associated with depressive symptoms
- perceived discrimination based on this is strongly associated with depression
- ethnic based bullying can increase risk of depression
sociocultural etiology - LGBTQ+
LGBTQ+ experience higher rates of depression and suicide
- due to discrimination, lack of family acceptance, bullying, societal rejection
- fear of rejection + social isolation around decision to share sexual orientation or gender identity
- silence about gender/orientation can result in personal distress
sociocultural etiology - sex and gender
- women may be more willing to acknowledge and seek help for depression
- hormonal differences
- women are more likey to have experienced childhood trauma and other stressors associated with depression
- gender role expectations/limited occupational opportunities
- cognitive styles that increase depression (more common in women)
sociocultural etiology - poverty
- difficult to be hopeful about future when lack of housing and food security
- limit opportunities, including employment
- increased day to day stressors
evidence-based treatments
- medications
- brain stimulation treatments (*promising)
- behavioural activation
- cognitive-behavioural therapy
- mindfulness-based cognitive therapy
- interpersonal therapy
antidepressant medications goal
- increase availability of neurotransmitters
- 1/3 - 1/2 discontinue meds due to side effects
antidepressant medications
- block reabsorption of norepinephrine and serotonin
- block reabsorption of serotonin
- affect other neurotransmitters - atypical antidepressants (dopamine)
medications for block reabsorption of norepinephrine and serotonin
- tricyclics
- monoamine oxidase inhibitors (MAOIs)
- serotonin-norepinephrine reuptake inhibitors (SNRIs)
medications for block reabsorption of serotonin
- selective serotonin reuptake inhibitors (SSRIs)
- most commonly used
brain stimulation treatment
- for severe depression or treatment-resistant depression
- promising, but based on research with small samples
- electroconvulsive therapy, vagus nerve stimulation, transcranial magnetic stimulation
brain stimulation treatment: electroconvulsive therapy
inducing seizures in the brain
brain stimulation treatment: vagus nerve stimulation
delivers frequent electric impulses from vagus nerve to brain
brain stimulation treatment: transcranial magnetic stimulation
- TMS
- non-invasive brain stimulation
- brief magnetic pulses to the brain
behavioural activation
- helps patients increase participation in enjoyable activities and social interactions
1. identifying and rating pleasurable activities
2. performing some activities (increase pleasure and mastery)
3. improving social and assertiveness skills
interpersonal psychotherapy
- presumes depression occurs within interpersonal context
- therapy focuses on current relationship issues (oriented towards present)
interpersonal psychotherapy: goal
to develop more staisfying relationships and increased social support
- improves communiction
- identifies roles conflicts
- increases social skills
cognitive behavioural therapy
- focuses on altering negtaive though patterns and distorted thinking
- identify negative self-critical thinking
- examine connection between negative thoughts and feelings
- examine accuracy of thoughts/beliefs
- learn to replace inaccurate beliefs with realistic interpretations
relapse rate: CBT vs medications
those treated with CBT less likely to relapse than those being treated with antidepressants
mindfulness-based CBT
- calm awareness of one’s presence, thoughts, feelings
- attitude acceptance (instead of judgmental, evaluative, ruminative)
- mindfulness helps disrupt the cycle of negative thinking
