Mood Disorders: Depressive Disorders (ppt slides) Flashcards
Depressive Disorders: Fact
Among the most common disorders in youth and adults
Depressive Disorders are Characterized by?
- sadness
- lack of interest in usual hobbies (anhedonia),
- sleep and appetite disturbances
- feelings of worthlessness, and
- thoughts of death and dying
- Somatic complaints are also common
- Associated with increased suicide risk
Depressive Disorders: Diagnosis
Whats Common among ALL depressive disorders?
-Mood symptoms (e.g., feeling sad, empty, worried, or irritable)
-Vegetative symptoms (e.g., fatigue, social withdrawal, and agitation)
Sleep and appetite disturbance
-Cognitive symptoms (e.g., low self-esteem, guilt, or suicidal ideation)
Diagnosis: Major Depressive Disorder
Depressed Mood/Anhedonia + 4
2 weeks, nearly everyday
Major Depressive Disorder (D+4, 2 weeks)
-Depressed mood or anhedonia (with at least four other symptoms) present for at least 2 weeks, most of the day, nearly every day
Diagnosis: Persistent Depressive Disorder
Depressed Mood
2 years
Specify…
Persistent depressive disorder (D, 2 years)
-Depressed mood, lasting at least 2 years, for most of the day, for more days than not
Specify whether major depressive episodes occur during a 2-year period as a qualifier
Diagnosis: Premenstrual dysphoric disorder (Added)
Mood disorder thought to be caused by hormonal fluctuations in the female menstrual cycle
Depression that may not be a depressive disorder
- Depression following a significant life stressor (adjustment disorder)
- Depression following a manic episode (bipolar disorder)
- Medical conditions (hyperthyroidism)
- “Normal” sadness
Commonalities
Each depressive disorder varies from the others, but they do share commonalities:
- Negativistic thinking (i.e., pessimistic and critical)
- Somatic symptoms
- Difficulty engaging in and enjoying formerly pleasurable activities
- Passive coping skills
- Loss of productivity
Diagnostic Considerations: Medical/psychological illness
Depression is often comorbid with other mental disorders (e.g., anxiety disorders)
Diagnostic Considerations: Medical/psychological illness
Endocrinological disorders (hypo- and hyperthyroidism) can produce symptoms of depression
Diagnostic Considerations: Medical/psychological illness
Acute medical illnesses
Diagnostic Considerations
- Drug and alcohol abuse
- Strongly associated with depressive symptoms - Grief and bereavement
- Some disagreement in field with respect to whether bereavement is a form of clinical depression
- Depression due to other psychiatric disorders
- Individuals with personality disorders, particularly those with borderline, avoidant, or obsessive-compulsive personality disorders
Late-life depression
NOT a natural consequence of aging, although it is common among older adults
- Commonly report memory problems and somatic complaints
- Associated with increased mortality and health service usage
Lifetime Prevalence: Mood Disorder
20.8%
Lifetime Prevalence: Episode of Major Depression
- 6% (5.8 to 12%)
12month: 6.6%
What percentage of the general population has had a period of Persistent Depressive Disorder? (PDD)
2.5% to 6% of the general population has had a period of persistent depressive disorder
Epidemiology: Ethnic Minority Samples
- Rates among African Americans are similar to Caucasians, whereas Asian Americans have the lowest rates
- Among Hispanics, rate depends on immigration status
Etiological Considerations: Research focused mainly on?
Most research has focused on MDD
Etiological Considerations: Familial and genetic factors
Evidence from twin and family studies indicates that genetic factors contribute to development of depression
Etiological Considerations
Some twin and familial rates are not compelling
Etiological Considerations: Familial (Heritability)
Overall rate of heritability ranges from 31% to 42%
Etiological Considerations: heritability
Recurrent, early-onset MDD seems most heritable
Etiological Considerations: genetic factors
Genetic factors increase the propensity to develop the disorder, but no strong connections have been identified yet
Brain areas associated with depression:
AODA
AODA Amygdala Orbitofrontal cortex Dorsolateral prefrontal cortex Anterior cingulate cortex
Etiological Considerations cont
Dysregulation of norepinephrine and serotonin
Antidepressants increase availability of receptor sites for these neurotransmitters
Racial/ethnic
Unclear why rates differ across ethnic groups
Low SES and exposure to violence in minority groups
Sex
More commonly reported by women
May be related to biological difference, differences in cognitive and behavioral patterns of mood control, or social influences
Men are reluctant to express depressed feelings
Women are more willing to seek treatment
Course
Early onset (before 20 years old) of MDD has a more severe course than late onset (during 30s)
Course
Average depressive episode lasts 6 months, though episodes are recurrent
Patients who have one episode have a 36.7% chance of having another
Each additional episode increases the chances of another by about 15%
Mean Length of Persistent Depressive Disorder
30 years (based on data from dysthymic disorder)
1/2 develop MDD as wellDepressive Disorders: Mood EPISODES
- Major Depressive Episode (2 weeks)
- Manic Episode: (1 week)
- Hypomanic Episode: briefer and less severe
The Depressive DISORDERS Are:
-MDD
-Persistent depressive disorder (dysthymia)
-Disruptive Mood Dysregulation Disorder
-Premenstrual Dysphoric Disorder
-Depressive Disorder due to another medical condition
-Substance/medication-induced depressive disorder
Other specified, or unspecified, depressive disorder
