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PSY240 > PSY240 4. Depression > Flashcards

PSY240 4. Depression Flashcards

1
Q

Cognitive Symptoms of Depression

A
  • Poor concentration and attention
  • Indecisiveness
  • Poor self-esteem
  • Hopelessness
  • Suicidal ideation
  • Delusions and hallucinations
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2
Q

Cognitive Symptoms of Depression

A

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3
Q

Cognitive Symptoms of Depression

A

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4
Q

Cognitive Symptoms of Depression

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5
Q

Cognitive Symptoms of Depression

A

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6
Q

Cognitive Symptoms of Depression

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7
Q

Physiological and Behavioural Symptoms of Depression

A
  • Sleep disturbances
  • Appetite disturbances
  • Psychomotor retardation/agitation
  • Catatonia
  • Fatigue
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8
Q

Physiological and Behavioural Symptoms of Depression

A

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9
Q

Physiological and Behavioural Symptoms of Depression

A

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10
Q

Physiological and Behavioural Symptoms of Depression

A

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11
Q

Physiological and Behavioural Symptoms of Depression

A

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12
Q

Emotional Symptoms of Depression

A
  • Depressed mood
  • Anhedonia
  • Irritability*
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13
Q

Emotional Symptoms of Depression

A

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14
Q

Emotional Symptoms of Depression

A

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15
Q

Emotional Symptoms of Depression

A

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16
Q

Major Depressive Episode

A 
Not a disorder
• 5+ symptoms for 2 weeks
1. Depressed Mood*
2. Anhedonia
3. Decreased / increased appetite / weight
4. Insomnia / Hypersomnia
5. Psychomotor agitation / retardation
6. Fatigue
7. Worthlessness / inappropriate guilt
8. Diminished ability to concentrate / indecisiveness
9. Suicidal ideation / behaviour
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17
Q

Major Depressive Episode

A

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18
Q

Major Depressive Episode

A

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19
Q

Major Depressive Episode

A

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20
Q

Major Depressive Episode

A

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21
Q

Major Depressive Disorder

A 
1+ MDE (Single episode vs. Recurrent)
• Not accounted for by psychotic disorder
• No hypo/manic, or mixed episodes
• Not better accounted for by:
– A General Medical Condition
– The effects of a substance
– Bereavement (
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22
Q

Major Depressive Disorder

A

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23
Q

Major Depressive Disorder

A

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24
Q

Major Depressive Disorder

A

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25
Q

Major Depressive Disorder

A

-

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26
Q

Bereavement Exclusion (DSM-IV)

A

An “expectable response” to the death of a loved one
• A “culturally sanctioned response” to the event
• Certain symptoms are less common

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27
Q

Bereavement Exclusion (DSM-IV)

A

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28
Q

Bereavement Exclusion (DSM-IV)

A

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29
Q

Bereavement Exclusion (DSM-IV)

A

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30
Q

Bereavement Exclusion (DSM-IV)

A

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31
Q

Bereavement Exclusion (DSM-5)

A

Omitted from DSM-5, because:

– Removes implication that bereavement lasts

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32
Q

Bereavement Exclusion (DSM-5)

A

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33
Q

Bereavement Exclusion (DSM-5)

A

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34
Q

Bereavement Exclusion (DSM-5)

A

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35
Q

Bereavement Exclusion (DSM-5)

A

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36
Q

Bereavement Exclusion

A

Removal in DSM-5 is Controversial!
– Associated with lower risk of subsequent MDEs
– Less associated with treatment-seeking
– Less associated with substantial functional impairment
– Associated with lower Neuroticism and guilt

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37
Q

Bereavement Exclusion

A

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38
Q

Bereavement Exclusion

A

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39
Q

Bereavement Exclusion

A

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40
Q

Bereavement Exclusion

A

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41
Q

Prevalence and Prognosis

A
  • 8.2 – 12.2% lifetime prevalence (Canada)
  • 15 – 24 yrs old most likely to have a current MDE
  • More common in females (2:1)
  • > 50% have a comorbid condition
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42
Q

Prevalence and Prognosis

A

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43
Q

Prevalence and Prognosis

A

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44
Q

Prevalence and Prognosis

A

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45
Q

Prevalence and Prognosis

A

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46
Q

Depression in Youth

A

• Children

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47
Q

Depression in Youth

A

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48
Q

Depression in Youth

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49
Q

Depression in Youth

A

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50
Q

New to DSM-5

A 
DSM-IV Mood Disorders Chapter 
– DSM-5 Depressive Disorders Chapter
– DSM-5 Bipolar and Related Disorders Chapter
• Added:
– Premenstrual dysphoric disorder added
– Persistent depressive disorder added
– Disruptive mood dysregulation disorder
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51
Q

New to DSM-5

A

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52
Q

New to DSM-5

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53
Q

New to DSM-5

A

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54
Q

New to DSM-5

A

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55
Q

Premenstrual Dysphoric Disorder

A

5+ symptoms in the final week before the onset of
menses, that improve within a few days of onset
• Affective Symptoms
– Marked affective lability
– Marked irritability or anger
– Marked depressed mood
– Marked anxiety
• At least one Cognitive/Physical symptom

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56
Q

Premenstrual Dysphoric Disorder

A

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57
Q

Premenstrual Dysphoric Disorder

A

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58
Q

Premenstrual Dysphoric Disorder

A

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59
Q

Premenstrual Dysphoric Disorder

A

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60
Q

Persistent Depressive Disorder

A

Includes
– DSM-IV Dysthymic disorder (3+symptoms, 2+ years)
– Chronic major depressive disorder (5+symptoms)
• Symptoms for 2+ years
– No periods >2 month without symptoms

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61
Q

Persistent Depressive Disorder

A

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62
Q

Persistent Depressive Disorder

A

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63
Q

Persistent Depressive Disorder

A

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64
Q

Disruptive Mood Dysregulation

A 
Severe temper outbursts
– Out of proportion
– Inconsistent with developmental level
– 2-3 times/week
• Mood is otherwise irritable/angry
• 12+ months
• Diagnosed between 6 – 18 yrs
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65
Q

Disruptive Mood Dysregulation

A

-

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66
Q

Disruptive Mood Dysregulation

67
Q

Disruptive Mood Dysregulation

68
Q

Disruptive Mood Dysregulation

69
Q

Biological Theories

Structural

A 
Amygdala:
• Associated with emotions
• Activated in recall of emotional memories
• Higher activity among depressed
Thalamus:
• Relay center for sensory information
• Sensory input (pleasant & unpleasant feelings)
Hippocampus:
• Processing long term memory
• Smaller in depressed people
• Stress hormones may impair its growth
70
Q

Biological Theories

Structural

71
Q

Biological Theories

Structural

72
Q

Biological Theories

Structural

73
Q

Biological Theories

Structural

74
Q

Biological Theories

Structural

75
Q

Biological Theories

Neuroendocrine

A

Hypothalamic-pituitary-adrenal (HPA) axis
• Governs hormonal activities
Cortisol:
• Steroid hormone
• Indexes HPA activation
• Involved in stress responses
Response to stress:
• Hypothalamus releases corticotropin-releasing hormone (CRH)
• Anterior pituitary releases adrenocorticotropic hormone (ACTH)
• Adrenal cortex releases cortisol

76
Q

Biological Theories

Neuroendocrine

77
Q

Biological Theories

Neuroendocrine

78
Q

Biological Theories

Neuroendocrine

79
Q

Biological Theories

Neuroendocrine

80
Q

Biological Theories

Neuroendocrine

81
Q

Biological Theories

Neurotransmission

A 
Acetylcholine (ACh)
• Memory, learning
Serotonin (5-HT)
• Sleep, appetite, mood
Norepinephrine (NE)
• Activity, motivation/reward
Dopamine (DA)
• Movement, motivation/reward
Gamma-aminobutyric acid (GABA)
• Inhibitory
82
Q

Biological Theories

Neurotransmission

83
Q

Biological Theories

Neurotransmission

84
Q

Biological Theories

Neurotransmission

85
Q

Biological Theories

Neurotransmission

86
Q

Biological Theories

Neurotransmission

87
Q

Biological Theories

Genetics

A 
Twin & Family Studies
• Estimated heritability at 37%
• 1st degree relatives at increased risk for depression
– Early onset
– Higher recurrence
88
Q

Biological Theories

Genetics

89
Q

Biological Theories

Genetics

90
Q

Biological Theories

Genetics

91
Q

Biological Theories

Genetics

92
Q

Biological Theories

Genetics

A

Candidate Gene Studies
• Serotonergic genes (e.g., SLC6A4; 5HTT)
• Brain-derived neurotrophic factor (BDNF) gene

93
Q

Biological Theories

Genetics

94
Q

Biological Theories

Genetics

95
Q

Psychological Theories

A 
Stressful life events
– Often precede onset of depression
– Diathesis-stress model
• Learned helplessness
– Belief of having no control over stress  depression
– Depressive attributional style
• Internal, Stable, Global
96
Q

Psychological Theories

97
Q

Psychological Theories

98
Q

Psychological Theories

99
Q

Aaron T. Beck’s Cognitive Model of Depression

A 
Cognitive triad of depression:
Self, World, & Future
Early Experience
Dysfunctional Beliefs
Critical Incident(s)
Beliefs Activated
Negative Automatic
Thoughts
Symptoms of
Depression
100
Q

Aaron T. Beck’s Cognitive Model of Depression

101
Q

Aaron T. Beck’s Cognitive Model of Depression

102
Q

Aaron T. Beck’s Cognitive Model of Depression

103
Q

Aaron T. Beck’s Cognitive Model of Depression

104
Q

Social & Cultural Theories

A
  • Marital relations
  • Gender imbalances
  • Social support
105
Q

Social & Cultural Theories

106
Q

Social & Cultural Theories

107
Q

Social & Cultural Theories

108
Q

Biological Treatments

A 
Drug therapy / Antidepressants (ADM)
– Tricyclics
– Monoamine oxidase inhibitors
– Selective serotonin reuptake inhibitors
– “Atypicals” (e.g., Wellbutrin)
• Electroconvulsive therapy (ECT)
• Repetitive Transcranial Magnetic Stimulation (rTMS)
• Light therapy
109
Q

Biological Treatments

110
Q

Biological Treatments

111
Q

Biological Treatments

112
Q

Psychological Treatments

A 
• Behavioural Therapy (BT)
– Increase positive reinforcers and decrease aversive events
– Teach new coping skills
• Cognitive-behavioural Therapy (CBT)
– Challenge distorted thinking
– Teach more adaptive ways of thinking
– Teach new behavioural skills
113
Q

Psychological Treatments

114
Q

Psychological Treatments

115
Q

Psychological Treatments

116
Q

Psychological Treatments

A

Interpersonal Therapy (IPT)
– Focuses upon actual grief or loss
– Interpersonal role disputes, role transitions
– Interpersonal skills deficits
• Psychodynamic Therapy (PT)
– Gain insight on hostility and fears of abandonment
– Facilitate change in self-concept and behaviours

117
Q

Psychological Treatments

118
Q

Psychological Treatments

119
Q

Psychological Treatments

120
Q

Psychological Treatments

121
Q

Psychological Treatments

A

Mindfulness meditation
• Mindfulness-based cognitive therapy (Segal et al., 2002)
– Group therapy
– Increase awareness of thoughts and feelings
– Thoughts and feelings are mental events, not reality
– Reduces relapse in patients with recurrent depression

122
Q

Psychological Treatments

123
Q

Psychological Treatments

124
Q

Psychological Treatments

125
Q

Psychological Treatments

126
Q

What Works?

A

• IPT, CBT, and drug therapies seem to work well
• ADM + psychotherapy for chronic depression
• Emphasis on prevention, early interventions
– Advantages of MBCT

127
Q

What Works?

128
Q

What Works?

129
Q

What Works?

130
Q

Bipolar Disorder

A
  • Mania and depressive symptoms
  • 0.6 - 4.4% of the population
  • Average age of onset is in the 20s
  • Males = Females
131
Q

Bipolar Disorder

132
Q

Bipolar Disorder

133
Q

Bipolar Disorder

134
Q

Mania

A

Elevated or irritable mood and increased activity
level (DSM-5) +3 symptoms (4 if irritable mood)
– ↑ activity level (work, socially, or sexually)
– Talkative/rapid speech
– Flight of ideas/racing thoughts
– Less need for sleep
– Inflated self-esteem
– Distractibility
– Excessive involvement in pleasurable activities

135
Q

Mania

136
Q

Mania

137
Q

Mania

138
Q

Mania

139
Q

Bipolar Disorder

A 
Mania
• Symptoms last >1 week
OR
• Hospitalization required
– Psychotic features
 Bipolar I
140
Q

Bipolar Disorder

141
Q

Bipolar Disorder

A 
Hypomania
• Symptoms last > 4 days
• No hospitalization
• No psychotic features
• Lesser severity
 Bipolar II
142
Q

Bipolar Disorder

143
Q

Bipolar Disorder

144
Q

Cyclothymic Disorder

A
  • Hypomania
  • Depressive symptoms, but no MDE
  • Symptoms 2+ years
145
Q

Cyclothymic Disorder

146
Q

Cyclothymic Disorder

147
Q

Cyclothymic Disorder

148
Q

Bipolar Spectrum

149
Q

Bipolar Spectrum

150
Q

Bipolar Spectrum

151
Q

Bipolar Spectrum

152
Q

Theories

A

Biological
• Genetic diathesis (85% concordance rate)
– 8-10% first degree relatives (vs. 1% in population)
• Low 5-HT or NE (in depressed phase)
• High NE & DA (in manic phase)

Psychological ??

153
Q

Theories

154
Q

Theories

155
Q

Theories

156
Q

Theories

A

Biological
• Genetic diathesis (85% concordance rate)
– 8-10% first degree relatives (vs. 1% in population)
• Low 5-HT or NE (in depressed phase)
• High NE & DA (in manic phase)

Psychological ??

157
Q

Theories

158
Q

Theories

159
Q

Theories

160
Q

Treatments

A

Pharmacotherapy: lithium, anticonvulsants,
antipsychotics
– May be used in combination with other drugs
– Side effects
• Psychological: Family-focused, psychoeducation,
interpersonal therapy, CBT

161
Q

Treatments

162
Q

Treatments

163
Q

Treatments

164
Q

Treatments

PSY240 (5 decks)

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