Task 6 - Depression Flashcards
DSM 5 - major depression
A) 5 or more symptoms during same 2 week period (at least one symptom is depressed mood or loss of interest/pleasure)
- depressed mood
- diminished interest/pleasure
- weight loss, decreased/increased appetite
- insomnia/hypersomnia
- psychomotor agitation
- fatigue/loss of energy
- worthlessness/guilt
- problems concentrating/thinking
- thoughts about death/suicide
E) never been a manic or hypomanic episode
Prevalence depression
- 16p in America
- 3p in Japan
- lowest in people over age 60
- 2.5 of children
- 8.3 of adolescents
- 24 of youth will experience major depression before age 20
- women: 2x more likely
- people with major depression had spent an average of 16 weeks during previous years with symptoms
- relapse: 75p
explanations why depression is lowest over age 60
- less willing to report symptoms
- often occurs in context of serious medical illness -> can interfere with diagnosis
- more likely to have mild-severe cognitive impairment
- depressive people are more likely to die before old age
- more adapted coping skills -> psychological healthier
- historical changes to vulnerability to depression
Genetic Factors depression
- first degree relatives: 2/3 x more likely
- depression begins early in life -> stronger genetic base
- unclear if there are different genes in women/men responsible for depression
- probably multiple genetic abnormalities contribute
- example: seretonin transporter gene
Neurotransmitter theories depression
- monoamines: norepinephrine, seretonin, dopamine
- found in limbic system (sleep, appetite, emotional processes)
- seretonin and norepinephrine are synthesized in neurons from tryptophan and tyrosine -> abnormalities in synthesis process
- release process, which is regulated by seretonin transporter gene -> may be abnormal
- receptors for seretonin and norepinephrine on post-synaptic neurons may be less sensitive
PFC abnormalities - depression
- reduced metabolic activity
- reduction in volume of gray matter, particularly left side
- lower brain-wave activity left side
- left PFC: motivation, goal orientation
Anterior cingulate - depression
- subregion PFC
- response to stress, emotional expression, social behavior
- altered activity -> problems with attention and planning of response, coping
Hippocampus - depression
- smaller volume
- lower metabolic activity
- many cortisol receptors
- depressed people: high levels of cortisol -> kill/inhibit development of new neurons in Hippocampus
Amygdala - depression
- increased activity
- direct attention to stimuli that are emotionally salient and have major significance for the individual
Neuroendocrine factors - depression
- regulates hormones -> sleep, appetite, sexual drive, ability to experience pleasure
- hormones also help to respond to environmental stressors
- HPA axis -> active during stress, calms system down whens stress is over
- > elevated levels of cortisol and coticotrophin-releasing hormone (CRH)
- > hyperactivity of HPA axis
- changes in ovarian hormones (estrogen, progesterone) -> affect seretonin and norepinephtine system
- > could affect mood
Behavioral theories - depression
-life stress -> reduces positive reinforcers -> withdraw -> further reduction in reinforcers -> more withdrawal -> depression
-learned- helplessness theory:
uncontrollable negative event -> believe they are helpless to control -> lose motivation, reduce actions
Cognitive theories - depression , negative triad
-depressed people look through a negative triad: negative views about themselves, the world, the future -> ignore good events
cognitive theories depression - reformulated learned helplessness theory
- role of causal attribution
- > explain events by causes that are internal, stable, global, blame themselves
- > experience long term learned helplessness deficits
cognitive theories- hopelessness depression
-making pessimistic attributions for most important events in their lives
cognitive theories depression - ruminative response styles theory
- focus on process of thinking
- focus intently on how they feel and identify many causes
- > engage in rumination about their depression
cognitive theories depression - overgeneral memory
- depressed people store memories in more general way (people are mean instead of jane was rude last friday)
- > to cope with traumatic events
interpersonal theory depression
- interpersonal difficulties, losses -> triggering depression
- rejection sensitivity
- excessive reassurance seeking -> family and friends can become weary, frustrated, hostile
sociocultural theory depression - cohort effects
- historical changes put generations at higher risk
- rapid changes in social values in 60s, disintegration of family unit
- unrealistic high expectations for themselves
sociocultural theory depression - gender differences
-men: turn to alcohol to cope, develop alcohol abuse
- women:
- ruminate about feelings, problems
- more interpersonally oriented -> bad things happen to others or problems in relationships -> more depressive
- base self-worth on health of their relationships
- have less status and power -> more prejudice, discrimination, and violence
sociocultural theory depression -ethnicity/ race differences
- in US:
- hispanics have higher prevalence -> might be due to higher rates of poverty, unemployment, discrimination
- african americans: lower prevalance, but more anxiety disorders
sociocultural theory depression - cross cultural differences
-lower levels in less industrialized and less modern countries
in modern countries:
-> fast-paced lifestyle, lack of stable social support and community values
-people in less modern cultures -> manifest depression through physical complaints rather than psychological symptoms
Bipolar 1 DSM 5
- necessary to meet criteria for manic episode (at least one)
- major depressive episodes and hypomanic episodes possible but not necessary
DSM 5 manic episode
A) -abnormally, persistent, elevated, expansive or irritable mood
and
-abnormally and persistent increased goal-directed activity or energy
B) during this, 3 or more are present: (4 or more if mood is only irritable)
1-inflated self-esteem/grandiosity
2-decreased need for sleep
3-more talkative, keep talking
4-flight of ideas/subjective experience that thoughts are racing
5-distractibility
6-increase in goal-directed activity or psychomotor agitation
7-excessive involvement in activities that have high potential for painful consequences
- > must show this at least for 1 week
- disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
Bipolar 2 - DSM 5
-necessary to meet criteria for current or past hypomanic episode
AND
current or past major depressive episode
-mania CANNOT be present for diagnosis
