Problem 6 Flashcards
Unipolar depression
Symptoms take over the whole person
–> emotions, bodily functions, behaviors + thoughts
Symptoms of depression
- Anhedonia
- -> loosing interest in everything in life - Changes in appetite, sleep + activity levels
- Psychomotor retardation vs agitation
- -> doing things more slowly or faster; either- or - Thoughts filled with worthlessness, guilt, suicide
- Experiencing delusions + hallucinations
There are 2 forms of Unipolar Depressive disorders.
Name them.
- Major depression
- Dysthymic disorder/Persistent depressive disorder
- -> less severe but more chronic form
What is needed for a person to be diagnosed with major depression ?
Experience of either
a) depressed mood
b) loss of interest in usual activities
- -> must interfere with everyday functioning
+ 4 other symptoms of depression
What is the difference between major depression, single episode vs recurrent ?
- Single episode
- -> experiencing one depressive episode - Recurrent
- -> experiencing 2 or more ep. separated by at least 2 months without symptoms
What is needed for a person to be diagnosed with Dysthymic disorder ?
Experience of depressed mood and 2 other symptoms of depression
–> for at least 2 years, with symptoms occurring 2 month tact, thus more chronic than MD
Double depression
Refers to a condition where people experience episodes of both major depression and dysthymic disorder
Comorbidity
- Substance abuse
- Anxiety disorder (Panic disorder)
- Eating disorder
Major anxiety depression
Refers to the combination of major depression + anxiety
–> requires 3/4 symptoms of MD + 2 or more symptoms of anxiety
Name the subtypes of MD.
Depression with
- Melancholic features
- -> prominence of physiological symptoms - Psychotic features
- -> experiencing delusions + hallucinations - Catatonic features
- -> strange behavior (catatonia) - Atypical features
- Postpartum onset
- Seasonal pattern (SAD)
- -> depressed when daylight h are short + recover when not
=> 5+6 can develop into BpD
(7. Premenstrual dysphoric, distress before menstruation)
Catatonia
Ranges from complete lack of movement to excited agitation
–> strange
Prevalence of UpD ?
Gender differences ?
- 18-29 y/o, lowest over 60, but go up over 85
- Women are 2x more likely to develop it, due to fact that they ruminate about their feelings more
- One of the most common disorders
- One is 2-3x more likely to develop it, when a parent has it
Bipolar disorder
BpD
Refers to a condition that involves alternations between periods of mania + periods of depression
Symptoms of mania
- Having unrealistically positive + grandiose self-esteem
- Delusional thoughts + hallucinations
- Impulsive behaviors
–> have to show for at least 1 week + impair functioning to be diagnosed
Bipolar I disorder
Experiencing all the symptoms of mania
–> can be preceded or followed by hypomania or depression
BUT: very rare
Bipolar II disorder
Experiencing severe episodes of depression (MD) + hypomania
NO MANIC EPISODES
Hypomania
Involves the same symptoms as mania
BUT: these symptoms are not severe enough to interfere with everyday functioning + no hallucinations or delusions
Cyclothymic disorder
Form of BpD
Involves alternating between episodes of hypomania + moderate depression
–> less severe but more chronic form of BpD, has to occur over 2y period
Why are people diagnosed with cyclothymic disorder at increased risk of developing BpD ?
Because, often periods of depression will interfere with daily function even though they might be less severe than MD periods
Temper dysregulation disorder with dysphoria
Form of BpD
Involves acting immature + inappropriate 3-4 times a week on average, with ep. of being sad or angry in-between
–> for youth age 6 or older
Prevalence of BpD
Creative people (e.g. artists, composers) have a higher than normal prevalence
a) develops in late adolescence or early adulthood
b) biological factors / inheritance play a bigger role here than in unipolar
c) Men and women are equally likely
–> less common than unipolar depression
Is BpD treatable ?
Not really,
- Only 1/4 recover fully from the symptoms after being hospitalized and are able to live a normal life
- Often abuse substances which impairs possible treatment
–> medication + high social class are positively correlated
Is having BpD an asset or a curse ?
Both,
Many political leaders have suffered form it and have accomplished extraordinary things during periods of hypomania or mania
Biological theory of Unipolar depression
Suggests that abnormalities in the serotonin transporter gene leads to a dysfunction in its regulation
–> affects the stability of individuals moods
Neurotransmitter theory of Unipolar depression
Suggests that depression is caused by a reduction in the amount of monoamines in the synapse, due to
- Abnormalities in their synthesis
- Abnormalities in the serotonin transporter gene which regulates the release process of them
- Postsynaptic neurons may be less sensitive/malfunctioned
What are monoamines ?
Type of neurotransmitter
–> in Unipolar depression especially norepinephrine and serotonin are involved
Brain abnormalities in UpDs
Depression results from Abnormalities in
- Left PFC (less active)
- -> motivation, goal orientation - Anterior cingulate cortex (overactive)
- -> stress regulation, social behavior - Hippocampus
- -> smaller + lower activity - Amygdala
- -> enlargement + increased activity
AND: Reduced metabolic activity + reduction of gray matter volume in PFC
Neuroendocrine factors associated with Unipolar depression ?
Hypothalamic-pituitary-adrenal axis (HPA), that is involved in fight-or-flight response is chronically hyperactive
–> a biological feedback loop, thus hyperactivity will make one more susceptible to stress
Name the steps of the HPA feedback loop that is involved, once we are confronted with a stressor.
- Hypothalamus releases corticotropin-releasing hormone (CRH) onto receptors of anterior pituitary gland
- Corticotropin stimulates the adrenal cortex to release cortisol
- Hypothalamus has cortisol detectors to detect it, then decreases CRH to lower increased levels of cortisol
–> thus stress levels are reduced/fought by activating the HPA during stress and calming it when stress is over
Hypothalamic-pituitary-adrenal axis
HPA axis
Refer to 3 components of the neuroendocrine system that work together in a biological feedback system that are interconnected with the
a) amygdala
b) hippocampus
c) cortex
and are involved in the fight-or-flight response
Behavioral theory of Unipolar depression
Suggests that life stress leads to depression because it reduces the positive reinforces in a persons life
–> this results in further withdrawal, thus further reduction of reinforcers (Vicious cycle)
ex.: having difficulty in marriage will lead to fewer interactions because these are now less positively reinforcing than before
Learned helplessness theory
Behavioral theory of unipolar depression
Suggests that the type of stressful event most likely to lead to depression is an uncontrollable negative event
–> if the are frequent they will make people feel helpless in any kind of way (Learned helplessness)
Negative cognitive triad
Cognitive theory of UpD
Suggests that depressive people have negative views of themselves, world + future and engage in biased thinking that promotes negativity
e.g.: Ignoring good events + exaggerating bad ones
Reformulated learned helplessness
Cognitive theory of UpD
Suggests that depressive people habitually explain negative events by causes that are internal
–> in turn this leads them to recreance longterm learned helplessness deficits, thus expecting to fail again
Hopelessness depression
Cognitive theory of UpD
Develops when people make pessimistic attributions for the most important events in their lives + perceive that they have no way to cope with the consequences of these events
Ruminative response styles theory
Cognitive theory
Depression results from rumination about the causes of feeling sad or upset, instead of doing sth about it
Overgeneral memory
When given a simple word cue, then asked to describe a memory, depressed people will offer memories that are general
ex.: angry –> people are mean
Interpersonal theories of unipolar depression
Suggest that interpersonal difficulties + losses in relationships are the stressors usually triggering depression
Rejection sensitivity vs Excessive reassurance seeking
Having a heightened need for approval + expression of support from others
–> often seen in depressed people, who eventually withdraw from social contact altogether as a result
Biological theory fo BpD
Suggests that BpD has a greater connection to genetic factors than UpD
–> areas most involved are
a) amygdala
b) PFC
c) Striatum
thus, showing abnormalities in white-matter tissue (there for communication)
Name the Neurotransmitter factors contributing to BpD.
Dysregulation of the dopamine system, which leads to
a) excessive reward seeking during the manic phase
b) lack of reward seeking in the depressed phase
Name the Psychosocial factors contributing to BpD.
- Higher sensitivity to reward are associated with faster relapse into mania or hypomania
- Stress
- Changes in bodily rhythms, eating patterns, etc
How do drugs milder Depression ?
Drugs have slow-emerging effects on
- intracellular processes in the neurotransmitter systems
- the action of genes that regulate
a) neurotransmission
b) limbic system
c) stress Response
–> work better for chronic-severe depression
Which drug treatment can be used for UpD ?
- SSRIs
- SNRIs
- -> slight advantage over SSRI because it affects both Its - Bupropion
(Norepinphrine-dopamine reuptake inhibitor/NDRI) - Tricyclic antidepressants
- -> numerous side effects, not used often - Monoamine Oxidase inhibitors (MAOIs)
- -> breaks down monoamines, very dangerous side effects
Mood stabilizers
used for BpD
- Lithium
- -> improves functioning of intracellular processes that are abnormal - Anticonvulsant medication
- -> reduces convulsions + stabilizes mood - Atypical antipsychotic medication
- -> quells symptoms of mania
Electroconvulsive therapy
ECT
Consists of a series treatments in which a brain seizure is induced by passing electrical current through the brain
–> delivered to one side of the brain, to prevent memory loss which occurs from bilateral administration
BUT: Usually only used in patients where drugs aren’t effective
Newer methods of stimulating the brain have been proposed, showing promising results in the treatment of UpDs.
Name them.
- Repetitive transcranial magnetic stimulation
(rTMS)
–> repeated, high-intensity magnetic pulses, focused on left PFC - Vagus nerve stimulation (VNS)
- -> increased activity of hypot. + amygdala - Deep brain stimulation
- Light therapy
- -> reduces SAD, by resetting circadian rhythm
Behavioral therapy for mood disorders
Focuses on increasing positive reinforcers + decreasing aversive experiences in an individuals life
–> by helping depressed people to change their patterns of interaction with the environment + other people
- Functional analysis
- -> finding connections between specific circumstances + symptoms - Changing aspects of the environment contributing to depression
- Teaching skills to change these environmental factors
CBT
Aims to change the negative, hopeless patterns of thinking , by helping them to develop more adaptive ways of thinking
–> proves to be very effective
Interpersonal therapy
IPT
Involves identifying + changing the patterns of the patients relationships by looking for 4 types of problems
- Grieve
e. g.: loss of loved ones, breakup - Interpersonal role disputes
- -> not agreeing on ones role in a relationship - Role transitions
- -> depressed over role one has to leave behind - Deficits in interpersonal skills
Name the 2 general categories of mood disorders.
- Unipolar depression (UpD)
2. Bipolar disorder (BpD)
