Chapter 7: Mood Disorders

Question 1

Symptoms of depression

Answer 1

• Feelings of sadness, hopelessness, passivity, sleep and eating disturbances lasting for two weeks or more.
• Experiences five or more emotional, cognitive, motivational and somatic symptoms and one of the symptoms must be depressed mood or loss of interest or pleasure.

Question 2

Define “Episodic Depression”

Answer 2

Lasts for less than two years and has a clear beginning, which distinguishes it from previously nondepressed functioning.

Question 3

Define “Chronic depression”

Answer 3

A.k.a., Dysthymia, is less severe than major depression. With dysthymia, the depression symptoms can linger for a long period of time, often two years or longer. Those who suffer from dysthymia can also experience periods of major depression

Question 4

Symptoms of melancholia

Answer 4

Severity in…

• Loss of pleasure from all activities
• Numbing
• General lack of reaction to pleasurable events
• Worse in the morning
• Early morning awakening
• Lethargia
• Weight loss
• Guilt
• Slow speech
• Slow movement
• Lack of reaction to environmental change during episode
• Somatic symptoms

Question 5

Who is most susceptible to depression?

Answer 5

• Those born after 1970, live in a prosperous nation and are female.
• Women twice as likely as men to get depression

Question 6

Mood symptoms of depression

Answer 6

Comorbid with anxiety disorders
Loss of interest in bigger things (job or child-rearing), progressing to smaller things (food, sex).
64% lose enjoyment of other people

Question 7

What percentage of Americans are depressed?

Answer 7

1/20

Question 8

Cognitive Symptoms of depression

Answer 8

-Thinks of self in a very negative light
-Believes they are cause of own failures
Pessimistic about future

Question 9

Motivational Symptoms of depression

Answer 9

• Ambivalence

- Trouble getting up in the morning or getting started

Question 10

Physical symptoms of depression

Answer 10

• Loss of sex drive, appetite, weight
• Somatic symptoms
• Higher rate of physical illness
• Especially true of melancholia
• Depression is often symptom of cancer, heart disease and infectious illness

Question 11

What are the theories behind the sex differences of depression?

Answer 11

• Women more likely to admit depression than men in Western society
• Women: Passivity and crying
• Men: Anger or indifference
• Women experience premenstrual dysphoric disorder: spontaneous sadness, anger, tensity, depression, apathy, overwhelmed, difficulty concentrating, appetite changes, sensitivity to rejection, sleep changes
• Women carrying depressive gene are more likely to become depressed whereas men are more likely to become alcoholics
• Differences of dealing with adversity: men inclined to more action and less thought and women ruminate more

Question 12

What women are least likely to get depressed?

Answer 12

Those with…

• Intimate relationship with significant other
• Part or full time job
• Fewer than three children
• Religious commitment

Question 13

Why do those who are depressed more prone to getting sick?

Answer 13

Hypothalamic-pituitary-adrenal axis: Greatly increased levels of cortisol in blood and cerebrospinal fluid.

• Cortisol increases delivery of glucose to the bloodstream to enable defensive action against a stressor.
• However, it also shuts down wound-healing and the deactivation of germs by the immune system

Question 14

Which brain regions are suspected to cause depression?

Answer 14

Right-Frontal Lobe

Question 15

Explain the Psychodynamic Approach of Depression

Answer 15

-Anger against the self, dependence on others for self esteem and helplessness at achieving one’s goals causes depression

Question 16

Biological: Drug Treatment for Depression

Answer 16

Tricyclic antidepressants
-Monoamine oxidase inhibitors:
inhibit monoamine oxidase, thereby increasing norepinephrine
-Selective serotonin reuptake inhibitors:
inhibit the reuptake of serotonin
60-70% success rate in patients with mild depression
Reduces the chances of relapse

Question 17

Biological: Electroconvulsive Shock Therapy for Depression

Answer 17

Electro-convulsive shock therapy
Discovered in 1938
80% improvement
Side-effects are high and many
Amnesia, high recurrence, motivational changes, cognitive deficits on learning and memory
Inexpensive
No known reasons as to why it works.

Question 18

Psychological Treatment for Therapy: Cognitive Therapy

Answer 18

• Changes the way the depressed patient thinks
• This is not to create an inflated sense of optimism but rather get the patient into thinking the way normal people do by…
• Detecting automatic thoughts, reality-testing said thoughts, reattribution training and changing depressogenic (depression-causing) assumptions

Question 19

What are some hormonal explanations in regards to depression?

Answer 19

-Hypothyroidism
-Low levels of testosteron
-HPA Axis:
Greatly increased levels of cortisol in blood and cerebrospinal fluid

Question 20

What is the “Theory of Learned Helplessness” in regards to treating depression

Answer 20

Change “internal, stable, global” to “external, unstable and specific.”

Question 21

What is the etiology of depression?

Answer 21

• .6-1.1% experience bipolarity at some point in their life.
• Appears between ages of 20 and 30
• First attack occurs before the age of 50 mostly.
• Episode can last several days to several months
• Frequency and intensity of episodes tends to worsen
• Not many episodes appear twenty years after first onset

Question 22

Explain “flexible optimism” in its treatment of depression. Name the pros, cons and considerations.

Answer 22

Pros

• People with optimism tend to do better than pessimists.
• Teaches people to curtail catastrophic thinking.

Cons

• However, pessimism can keep people from seeing things as they really are.
• Might help enable them from taking responsibility and blaming it on others.
• Sometimes better not to dispute such thoughts

Considerations

• Therefore, should only choose optimism when it will lead to less depression, more achievement or better health.
• If the cost of failure is high, optimism is the wrong strategy.

Question 23

Prevalence of Bipolar Depression

Answer 23

.6-1.1% at some point in everyone’s life.

Question 24

Drug treatment of bipolar disorder and its side-effects

Answer 24

Lithium Carbonate
-Makes people with mania lethargic
-Ended severe manic attacks
-Discovered by John Cade in 1949
effective treatment for both the mania and depression of bipolarity.
-80% of patients who take it will show full or partial alleviation in symptoms when administered.
-Lots of side effects on the heart and kidney
-Physically damaging if overdose
-Especially risky for bipolar patients who need to take it and are already unreliable at taking drugs consistently

Anticonvulsant Drugs: benzodiazepines, GABA analogs

Question 25

Cycling of Bipolarity

Answer 25

Cycling: - Lots of self-medicating with alcohol - The more severe the mania, the more frequent the alcohol - Between 20-50% of people with it experience social and occupational impairment - In most cases, hospitalization is required - Suicide is a constant threat - Rate of success of suicide tends to be higher in people with bipolarity than people with just unipolar depression - 15% with bipolarity tend to end their life.

Question 26

Cognitive theories of bipolarity

Answer 26

- Mania and depression coexist to cancel each other out when one becomes too overwhelming - Some believe mania to be a mask for depression

Question 27

Egoistic Suicide

Answer 27

Reflects a prolonged sense of not belonging, of not being integrated in a community, an experience, of not having a tether, an absence that can give rise to meaninglessness, apathy, melancholy, and depression. -The result of a weakening of the bonds that normally integrate individuals into the collectivity

Question 28

Cultural Differences with Suicide

Answer 28

1.Religion has no influence over those who commit or attempt suicide. 2. More common in industrialized countries a. Russia and Hungary have the highest suicide rates in the world i. Triple that of the U.S. ii. USSR Russia had double what it has today 3. Communities with strong religious foundations have low rates a. Mexico and Egypt have the lowest suicide rates 4. In past thirty-five years, suicide rate in college students has more than tripled a. 28 per 100,000 compared to 12 per 100,000 in general population 5.Raises considerably in men between middle and old age

Question 29

Anomic Suicide

Answer 29

Precipitated by a shattering break in an individual’s relationship to his society; the loss of a job, economic depression and even sudden wealth

Question 30

Altruistic suicide

Answer 30

For the sake of the group or society

Question 31

Surcease Suicide

Answer 31

To give up

Question 32

Prevention of Suicide

Answer 32

a. To have the final word in an argument b. Revenge on a rejecting lover c. To ruin the life of another

Question 33

Biological Explanations of Depression

Answer 33

1) Biological: genes, brain development, neurotransmitters (serotonin, norepinephrine, dopamine deficiences)

Question 34

Hormonal Explanations of Depression

Answer 34

2) Hormonal: estrogen, hypothyroidism, low testosterone levels, hypothalamic-pituitary-adrenal axis creating a surplus of cortisol

Question 35

Neurological Explanations of Depression

Answer 35

3) Neurodevelopment: less activity in the right and frontal lobe and smaller hippocampi (especially true in women)

Question 36

Psychodynamic Explanations of Depression

Answer 36

4) Psychodynamic: Anger against the self, dependence on others for self esteem and helplessness at achieving one’s goals causes depression

Question 37

Beck's Cognitive Theories of Depression: The Cognitive Triad

Answer 37

The Cognitive Triad -Negative thoughts about the self -Patient thinks they are worthless, defective and inadequate -Unpleasant experiences = personal worthlessness -Belief that they will never attain happiness -Ongoing experience -Small obstacles seen as impassable barriers -Drawn to negative interpretations of experiences the future -Negative things are happening now, thus will continue to happen

Question 38

Beck's Cognitive Theories of Depression: Errors in Logic

Answer 38

Errors in Logic -Arbitrary Interference: Refers to drawing a conclusion when there is little to no evidence to support it -Selective abstraction: Draws wrong conclusions from an event. -Overgeneralization: Drawing global conclusions about worth, ability, or performance on the basis of a single fact. -Magnification and minimization: Small events are magnified and large good events are minimized. -Personalization: Incorrectly taking responsibility for bad events in the world.

Question 39

Beck's Cognitive Theories of Depression: Helplessness

Answer 39

Learned helplessness, hopelessness.

Question 40

How many people a year commit/attempt suicide, how many people are alive that have attempted it and how many who have attempted it will succeed in doing so later on?

Answer 40

- 25,000 people kill themselves every year - 30,000 attempted and completed suicides in 1996 - As many as ten times attempted suicides than completed ones. - 5 million people in the U.S. who have survived suicide - 10% of those who have attempted will succeed in the next ten years.

Question 41

What % of suicides are committed by people with depression, and how much more likely are they to do it over the normal population?

Answer 41

- 80% of suicidal patients are depressed | - 25 times more likely to commit suicide than general population

Question 42

What are other comorbidities with suicide?

Answer 42

-20% are comprised of alcoholics, schizophrenics and homicidal individuals.

Question 43

How do men and women compare in suicide statistics?

Answer 43

- Women most at risk. - Three times more likely than men to try and commit suicide. - However, men are more successful - Men are more likely to use definitive ways of killing themselves than women. - Guns, jumping off a building for men - Slitting wrists, overdosing for women - Men are more likely to kill themselves because of failure at work - Women are likely to kill themselves over depression or failure in interpersonal relationships.