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Flashcards in Abnormality / Intro General Psychopathology / MDD Deck (39):


Statistical deviation away from the norm

A behavior cannot be deemed abnormal outside of a context

Elements of abnormality
*May include suffering and maladaptation

In reality, multiple elements are needed to properly diagnosis

Focus on qualitative descriptions of the symptoms, not quantity

*If the behavior leads one to harm him or herself

*If the behavior leads to suffering or pain


DSM-V + ICD-X Features




Cases and Risk Factors

Necessary Factors

Sufficient Factors

Contributory Factors

Distal vs. Proximal Causal Factors


Diathesis-Stress Model

Diathesis + stress = disorder

o Relatively distal necessary or contributory causal factors
• Not sufficient factors

o Response of taxing demand


Mood Disorders, General

Refers to difficulties associated with unproductive mood states
(vs. euthymia = an even, productive, mood state)

Includes the following abnormalities related to
1. mood/emotion
2. physical aspects
3. cognitive symptoms
4. behavioral factors


Mood Disorders Symptomotology

Sleep disturbances
o Early morning awakening = most common sleep disturbance

Eating disturbances
Including weight gain and loss

Fatigue or a change in energy

o A specifier in DSM-V

Change in concentration ability

Psychomotor agitation or retardation

Suicidal behavior/thoughts

Anhedonia (physical and social settings)

Feelings of gloom, hopelessness, or guilt


Depression, Prevalence

Unipolar depression is one of the most common disorders in western culture
o affects individuals across SES, race, and genders

Lifetime prevalence = 19%
• (As a comparison, in Taiwan = 1.5%)


MDD vs. Depression

Mild, brief, depression is normal and adaptive

MDD = chronic, maladaptive, depression, accompanied by additional features

1/5 of US population experiences single episode of depression
• Psychologists focus on reoccurring episodes


Depressive Psychosis and MDD

Whenever present, even if it is a single episode, depression is automatically classified as MDD


Psychotic depression, approaches to dx

It is important to recognize what comes first – the depression or psychosis

Mood-congruent delusions/hallucinations
• Consider psychotic depression

Mood-incongruent = unrelated to depressed mood
• Consider a dominant psychosis-related disorder


Grieving and Attachment Sequence of Emotional Responding (according to Bowlby)

1. Numbing

2. Searching and yearning for the lost individual

3. Disorganization and despair when one begins to come to terms with loss

4. Reorganization



Bereavement exclusion was included in DSM-IV
• Prevented the immediate diagnosis of depression after the death of a loved-one

Was removed in DSM-V
• Has been argued that loss of a loved one is too similar to the loss of anything else
o 7% chance of experiencing a second episode of depression after a loss


Seasonal Affective Disorder (SAD)

Requires a pattern year after year
• Includes hibernating-like behaviors: excessive sleep and eating

More common in women

First proposed in 1984


Persistent Depressive Disorder (PDD), general

This disorder is a combination of chronic depression and dysthymia of the DSM-IV

Can be diagnosed with both PDD and MDD

Symptoms include
• Too much or little of an appetite
• Insomnia or hypsomnia
• Hopelessness
• Low energy
• Low self-esteem

*Patients often do not recognize PDD because it is so chronic
o Having children is a risk factor


Depression and Age

Was previously believed that depression was as middle-age problem
o It is now recognized it occurs in children

In fact, there is as general trend that depression is occurring at an earlier age
o Research by Plorman
• In contrast to expectations, found an increase in depression within the younger population

There is an increased rate of depression in those who were born later

Lifetime prevalence has increased for younger generations
o Younger generations are experiencing an earlier onset


Postpartum Depression

25% of all deliveries

Believed to be caused by a rapid decrease in hormone levels

Specifically estrogen and progesterone
*but since all women experience hormonal decrease, other factors must be operating


Postpartum Psychosis

Very rare: 1 or 2 in 1,000 cases

An acute reaction that starts before leaving the hospital after delivering

Typically, an earlier psychotic episode must have occurred prior to this

Includes homicidal delusions directed at her child


Early (Child) Onset Depression or
PDD (Pediatric Depressive Disorder)

Increased chance of relapse and severity of symptoms

Decreased recovery rate

The longer one is symptom free, the further the chance of a relapse


Causal Factors, Physiological: Amygdala

Enlarged amygdala and increased activation
*specifically in bipolar

Normally regulates attention directed at emotional stimuli

May be key in creating biased-attention


Causal Factors: Genes

MZ studies: genes play a significant role, but the environment is more significant

Genes account for ~25% of risk factors


Causal Factors: Circadian Rhythm

Hormones and brain activity typically vary throughout the day

Depression may be a deregulation of these bodily rhythms

Reduced REM
• Delay onset of stage 4, if they can even enter it
• CBT ineffective with increased REM disturbances
• Bidirectional relation: negative mood and sleep disturbances

*Partial sleep-deprivation offers a temporary reduction of elevated mood


Causal Factors: Hormones
HPT Axis

Hypothalamic-Pituitary-Thyroid Axis
(*more specifically the thyroid)

Always need to check the thyroid before treating depression

Grave’s disease = hyperthyroidism often made apparent by bulging eyes


Causal Factors: Hormones
HPA Axis

Hypothalamic-Pituitary-Adrenal Axis

Deregulation of the hypothalamus

Overproduction of cortisol which common occurs to prepare the body for stress

An increase in cortisol is supposed to shut down the corticotropin-releasing hormone (CRH) in the hypothalamus

In depression, this feedback system doesn’t function properly
• Continued cortisol production: neural death in the hippocampus


Beck’s Cognitive Model of Depression

Core of depression = negative thinking
(*DSM-V only recognizes negative thinking as one aspect of depression)

Depression stems from negative automatic thoughts about one’s self, future, and world

Individuals with depression experience a futile attempt to alter their behaviors
*negative thinking


Learned Helplessness Theory

Behavior typical of an organism (human or animal) that has endured repeated painful or otherwise aversive stimuli which it was unable to escape or avoid

After such experience, the organism often fails to learn escape or avoidance in new situations where such behavior would be effective

In other words, the organism seems to have learned that it is helpless in aversive situations, that it has lost control, and so it gives up trying

Clinical depression and related mental illnesses may result from real or perceived absence of control over the outcome of a situation

*Seligman and his dog electric-shock experiment

Theory: individuals who consistently experience negative stimuli become helpless and then depressed

Negative attributions were added to this theory over time
• (Attributions = personal explanations)
• i.e. internal, stable, global = depression
o theory was further developed in the 1990s


MDD DSM-5 Criteria

5 out of 9 symptoms for 2 week period

At least 1 symptom is either
1. depressed mood
2.loss of interest or pleasure

No history of manic or hypomanic episode


Mood Range





Dysthymia (Persisent Depressive Disorder)

Major Depressive Disorder


MDD DSM-5 Symptoms (9)

Depressed mood
*most of the day, nearly every day

Loss of interest or pleasure in all or almost all activities
*most of the day nearly every day
*can manifest as Irritable mood in adolescents

Significant Weight Loss or Gain (change of 5% body weight in a month)

Insomnia or hypersomnia nearly every day

Psychomotor agitation or retardation nearly every day

Fatigue or loss of energy

Feelings of worthlessness or excessive / inappropriate guilt
*not just self-reproach about being sick

Diminished ability to think or concentrate, indecisiveness

Recurrent thoughts of death; recurrent suicidal ideation without plan; suicide attempt or specific plan
*not just fear of dying


Persistent Depressive Disorder (PDD)
DSM-5 Criteria

Depressed mood for most of the day, for more days than not, for at least 2 years

* In children and adolescents, mood can be irritable and duration must be at least 1 year

Presence, while depressed, of 2 or more of the following:

1. Poor appetite or overeating

2. Insomnia or hypersomnia

3. Low-energy or fatigue

4. Low self-esteem

5. Poor concentration were difficulty making decisions

6. Feelings of hopelessness

*Individual has never been without symptoms in A and B for more than 2 months at a time

*Criteria for MDD may be continuously present for two years

*No history of a manic or hypomanic episode, and criteria for cyclothymic disorder have never been met


Arguments against Diathesis-Stress Model

Without diathesis, even if one is under high stress, no disorder will arise

(Though some argue if the stress is high enough, even without the diathesis, one will experience a disorder)


Diathesis-Stress: Factors influencing development and course

Resilience factors

Active features

Protective factors

Passive features
• i.e. IQ, prenatal care, social support


Depression: Race

Increased rate of depression for Native Americans

Decreased rate of depression for African-Americans


Depression: SES

Inverse relation of SES and depression


Depression: Gender

Depression is 2x more likely for females

Equal chance between genders for bipolar


Mood Disorders: Comorbidity

High comorbidity

Typically co-occurs with anxiety, substance abuse, and stress-related disorders (i.e. PTSD)


Possible Reasons younger onset of depression

Increased competition

social comparison (coupled with less social) support


financial pressures

Less opportunity for growth

Overscheduling of free-time


Causal Factors: Hippocampus

Reduced hippocampus due to increased cortisol

Normally regulates memory and learning behaviors, especially fear

Increased cortisol disrupts neurogenesis in this area

Possible connection with depression and increased chance of Alzheimer’s later in life

Increased activation of error detection areas


Causal Factors: PFC and ACC

o Approach/goal-related behaviors

Anterior cingulate
o Regulates social behaviors and cognitive control
o Area begins to demonstrate increased activation as people respond to treatment


Predictive Factors: Genetics: Alleles

Serotonin transporting alleles help predict diagnosis

In an individualistic society
o 2 short = greatest risk factor
o 1 and 1 = average
o 2 long = greatest protective factor

Reversed in an collectivistic society if an enriched environment is provided
o 2 short = greatest protection
• But these rates all increase if exposed to prolonged stress


Corticotrophin-releasing hormone (CRH)

Causes release of adrenocorticotropic hormone from the pituitary gland

Adrenocorticotropic hormone in turn travels in the bloodstream to the adrenal glands where it causes the secretion of the stress hormone cortisol.

Also acts on many other areas within the brain where it:

suppresses appetite

increases anxiety

improves memory and selective attention

Together, these effects co-ordinate behaviour to develop and fine tune the body’s response to a stressful experience