Mood / Personality Disorders Flashcards
Major Depressive Disorder Symptoms
Depressed mood or diminished interest/pleasure for Symptoms: weight gain/loss, sleep issues, psychomotor agitation/retardation, fatigue, feelings of worthlessness or excessive guilt, loss of concentration recurrently morbid thoughts/plans.
Diagnosis of MDD
5 of 9 symptoms for 2 week episodic period, as well as a noticeable change from previous function. Codes as mild/moderate/severe, with/without psychotic symptoms, with/without postpartum onset, and with/without seasonal patterns.
Persistent Depressive Disorder (Dysthymic Disorder)
Mild or severely depressed throughout most of the day most days for >2 years. No manic episodes unlike MDD, and generally milder symptoms than MDD. Onset: often follows major depression in early adulthood (75% within five years of MDD). High rates of self-medicating substance abuse.
MDD Prevalence and Onset
2F:M. 3x risk factor to poor, though unrelated to race or education. Onset: 1st episode often in early 20s, and at least 60% of those with 1st episode have a second (70% to have third, 90% have fourth)
MDD Specifiers
Anxious mood concurrent with insomnia, concentration issues. Psychotic features. Seasonal patterns (Seasonal Affect Disorder, maybe linked to circadian rhythm). Post-/Peri-Partum Onset (3-6% of women. Often anxious with panic attacks due to hormonal changes and sleep deprivation).
Premenstrual Dysphoric Disorder
Depressive symptoms the week before menstruation that recede afterwards. Total 5 symptoms from two lists of 4 and 7 respectively, including mood swings, irritability, depression, anxiety, lethargy, appetite changes, overwhelmed, etc. 1.8-5.8% of menstruating women. Controversial in that it medicalizes normal moods in menstruating women.
Culture and Depression
In some non-western civilizations, depression is expressed as a somatic issue rather than an emotional one, characterized by fatigue, sleep loss, headaches, etc. In Africa, it is the 2nd leading cause of disability, and is more common in Zimbabwe than US, despite the closest translation for a word for depression being “thinking too much” or “heavy heart”
Depression in Children and Adolescents
m.
<20% of teens may have depressive episode of one point. Children present symptoms as irritability, aggression.
Disruptive Mood Dysregulation Disorder
Severe pattern of irritability or rage with outburts 3x a week for >1 yr in more than one setting ******
Freud’s Psychodynamic Theory of Depression
Early or imagined loss -> early needs not met -> early trauma -> hypersensitivity to loss.
Klerman’s Interpersonal Approach (Psychodynamic) to Depression
Past and present relationships associate with depression. People are most vulnerable to depression when bonds are disrupted or there is a threat of loss. Based on Bowlby’s Attachment Theory
Psychodynamic Research in Depression
Death of a parent can lead to depression. Variables of severity include quality of parenting before/after loss, and psychopathology. If it is a parent of the same sex, it is more intense.
Learning and Behavioral Theory of Depression
Reduction in number and frequency of social reinforcers. Backed up by evidence of a positive correlation between social rewards and depression
Learned Helplessness (Learning/Behavioral) + Seligman’s Dogs
Three groups of dogs who were shocked on the paws. 1st could escape, 2nd could not, 3rd was control. When given the opportunity to escape, 1 and 3 did so, but 2 was slow to learn to escape and had human depressive symptoms. In humans: external locus of control.
Negative Cognitive Set (Cognitive Theory)
Theory of Beck. Thinking patterns associated with depression are known as a negative cognitive set, and change in thoughts leads to change in mood. Contains the “negative triad”: Negative thoughts about self, world, and future.
Distressed Patterns of Thinking (Cognitive)
Overgeneralization, Selective Abstraction (occupation with minor negatives despite major positives), Arbitrary Inferences (conclusion based on no evidence), Magnification/Minimization (magnify mistakes, minimize achievements)
Factors Related to Depression (Research)
Stress, marital dissatisfaction, interpersonal problems with family (high EE -> relapse), social support, intimacy, if a caretaker to children, unemployed.
Stress and Depression
High relation with depression. A strong indicator of initial depression rather than later relapses. Reciprocal pattern: depressed individual purposefully places themselves in stressful environments
Employment/Marriage/Gender and Depression
Highest rates: unemployed, divorced women. Lowest rates: employed, married men. No difference in widows
Genetics and Depression
Twin studies: 37% heritability, higher in inpatients and women. Thus, a moderate to minor role in depression. Gene: 5HTT on Chrom 17
Biogenic Amines
Catecholamines (DA, NE) and Indole Amines (5HT)
Early NT Theories of Depression
1) Low levels of NE -> depression, high levels -> mania
2) Low levels of 5HT -> Depression.
Theories were based on antidepressant actions, but debunked as the action of the drugs would take over a week to work despite the neurotransmitters improving immediately.
Anti-Depressants
Tricyclics: Raise NE and 5HT by blocking reuptake.
MAOIs: Raise NE and 5HT by preventing breakdown.
Reserpine: Causes depression by reducing levels of all biogenic amines
Revised NT Theories of Depression
Focus on post-synaptic receptor sensitivity as well as the insides of neurons. Focus on deficiencies in Brain Derived Neurotrophic Factor which is a growth factor for neurons, possibly helped by exercise.
Hormonal Imbalance and Depression
Malfunction of hyptothalamus (4 F Drives), high cortisol levels can affect depression. The hypothalamus pituitary axis (HPA Axis) can also affect MDD and PTSD if it is disregulated by childhood stress or maltreatment.
Sleep Disturbance and Depression
Common to have hyper or hyposomnia, also abnormalities in sleep stages, known as “shortened REM latency” when it takes longer to enter REM sleep.
Bipolar Affective Disorder
Includes manic episodes, hypomanic episodes, depressive episodes, and normals states with varied cycle times.
Manic Episode
Elevated, expansive, irritiable mood for < 1 week.
Diagnosis: 3+ of list (4 if irritable): increased self esteem, less sleep, more talkativeness, scattered thoughts, distractability, increased activity or agitation, excessive pleasurable activities with high risks, marked impairment in function, and possibly psychotic features.
