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PSYC3018 Abnormal Psychology > Depression > Flashcards

Flashcards in Depression Deck (28)
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What changed in the Mood Disorder chapter from DSM-IV to DSM-V?

DSM-IV: All extremes in normal mood
- MDD and Dysthymia
- 3 Bipolars
- No more Bipolar (has its own chapter)
- Disruptive Mood Dysregulation Disorder
- Dysthymia: Persistent Depressive Disorder
- Premenstrual Dysphoric Disorder


Describe the symptoms of a Major Depressive Episode (within MDD).

Has to have 1) or 2), followed by >5 of other symptoms in 2 week period
(Never been a hypo/manic episode)

1) Depressed mood most of the day, nearly every day
2) Markedly diminished pleasure/interest in activities
- Sig weight loss/gain
- In/hypersomnia nearly every day
- Psychomotor agitation/retardation nearly every day
- Fatigue/loss of energy nearly every day
- Feelings of worthlessness, excessive guilt nearly every day
- Dim ability to concentrate nearly every day
- Recurrent thoughts of death, suicide, suicide attempts


What changed between DSM-IV and DSM-V for the Mood Disorder chapter?

- DSM-IV "Mood disorders" --> DSM-V "Depressive disorders" + "Bipolar and Related Disorders"
- IV: Dysthymia --> V: Persistent Depressive Disorder
- Removal of bereavement/grief clause from diagnosis of MDD (persisting >2 months)
V: Added "Disruptive Mood Dysregulation Disorder" and "Premenstrual Dysphoric Disorder"


Persistent Depressive Disorder (= Dysthymia) symptom description

Depressed mood most of the day, more days than not
Presence, while depressed, of two (or more) of the following:
- Poor appetite or overeating
- In/hypersomnia
- Low energy/fatigue
- Low self-esteem
- Poor concentration or difficulty making decisions
- Feelings of hopelessness

- No more than 2 months "normal" mood in 2 years
- No manic features
- Symptoms milder than MDD
- May also develop MD episodes
- Symptoms can persist unchanged over long periods (e.g. >20 years)


Disruptive Mood Dysregulation disorder symptom description

- Severe recurrent temper outbursts (verbal rages, physical aggression) that are grossly out of proportion in intensity/duration to provocation
- Mood between temper outbursts is persistently irritable or angry, and is observable by others (e.g. parents, teachers, peers)
- Diagnosis should not be made for the first time before age 6 years or after 18 years.

Prevents kids from being diagnosed as bipolar


Premenstrual Dysphoric Disorder

Majority of Menstrual cycles, >5 symptoms must be present in the final week before menses onset, start to improve within a few days after menses onset, and become minimal/absent in postmenses week.

One (ore more) of the following symptoms must be present:
- Marked affective liability (e.g. mood swings)
- Marked irritability/anger/increased interpersonal conflicts
- Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts
- Marked anxiety, tension, and/or feelings of being keyed up/on edge
One (or more) of the following symptoms much additionally be present, to reach a total of 5 symptoms when combined with symptoms from Criterion B above.
- Decreased interest in usual activities
- Subjective difficulty in concentration
- Lethargy, easy fatigability, or marked lack of energy
- Marked change in appetite; overeating; or specific food cravings
- Hyper/insomnia
- A sense of being overwhelmed or out of control
- Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of "bloating", or weight gain


What are the subtypes/specifiers of MDD?

MD with...
- Anxious distress
- Seasonal pattern (Seasonal Affective Disorder)
- Peripartum onset (Postnatal depression)
- Atypical features (weight gain, oversleep, rejection sensitivity)
- Psychotic features
- Melancholic features: does not respond to positive events. Loss of pleasure + lack of reaction. They experience a distinct quality of depressed mood


What is an alternative way of subtyping MDD, as proposed by Parker (2000)?

Melancholic, psychotic, non-melacholic subtypes
- Assumes different symptoms, causation, and treatment
Melancholic depression:
- Lack of reactivity/total loss of pleasure
- Distinct quality of mood
- Mood worse in morning
- Early morning awakening
- Weight/appetite loss
- Marked psychomotor agitation or retardation

Melancholic and psychotic subtypes are seen as "endogenous depression" (biological)
- Best treated with bio treatments
Non-melancholic: more environmental factors
Evidence: Differences in severity of depression, rather than in cause
- Placebo: Melancholic more responsive than non-melancholic


Epidemiology of MDD: Prevalence

16% Lifetime prev
3-5% one year prev in Aus
- Steady increase in prevalence since 1950s
- Steady decrease in age of onset

Gender imbalance: 2F:1M
- Emerges during adolescence, evens out after 65


Why has there been an increase in prevalence and a decrease in onset age of MDD?

- Increased speed of change/stress
- Decreased social support/family
(loneliness has increased sig.; Assoc with depression)
- More acceptable to report symptoms (perhaps not necessarily more ppl with symptoms)
- Overdiagnosis


Biological influences on Depression - Genetic

Family studies: higher rate in relatives of MDD patients
Twin studies: Concordance rates higher in identical twins than in fraternal twins
- The more severe the depression, the more genetically related the depression is
Adoption studies: Mixed findings

Perhaps no one gene passed down
Neuroticism factor: perfectionistic society/envr encourages neuroticism --> depression
(But never just nature or nurture - always both)


Biological influences on MDD - Neurochemistry

Low levels of NA, dopamine and serotonin.
- No good evidence for mechanisms
- absolute levels unlikely to be cause
- Most studies correlational - unsure of causality direction


Biological influences on MDD - Brain structures

Amygdala, Hippocampus, prefrontal cortex, anterior Cingulate Cortex
- Difference between people with current/history of depression vs no depression
- Causation?


Biological influences on MDD - Neuroendocrine System

Overactivity in the Hypothalamic-pituitary-adrenocortical (HPA) Axis: Regulates response to stress
- Excess cortisol (stress hormone) --> damage hippocampus? --> damage of serotonin receptors?
- Implicates role of early stress in depression

Genetic vulnerability x negative life events
- Magnitude of response to stress depends on number of life stress events previously experienced


Psychological Influences on MDD - Learned Helplessness Theory (Seligman, 1975)

Lack of control over life events
Based on the experiments with the dogs pushing on the plate to stop aversive events (electric shocks) from occurring
New situation --> Dog gives up, and did not even try to change the aversive events
- Learnt that they have no control over their negative life events


Psychological Influences on MDD - Attribution Theory (Abramson, Seligman, & Teasdale, 1978)

3 main aspects of cog in trying to figure out cause of events:
- Internal vs External attributions
- Stable vs unstable attributions - predictability
- Global vs specific attributions
Interaction between cognitive style and life event.
Depressed cog style: Negative events = Internal, stable, global. Opposite for positive events
- Decrease ability to take credit for hard work
- expect negative things to happen --> hard to commit to events


Psychological Influences on MDD - Hopelessness Theory (Abramson, Metalsky, & Alloy, 1989)

Helplessness (negative attrib) expectancy + Negative outcome expectancy = Depression


Psychological Influences on MDD - Schema theory (Beck, 1976)

People have pre-existing negative schemas (knowledge structures in LTM) - causes us to look for evidence that are consistent with schemas, and evidence strengthens schemas (bad if schemas are negative and inconsistent with evidence)
- Problematic schemas developed during childhood (esp if vulnerable)
- Activated by stressful life event --> Cog biases --> Overgeneralisation, magnification
- Depressive Cog triad: Negative thoughts about self world and future become dominant in consciousness


Response Style Theory of Depression

Bad event --> Rumination (F) vs Distraction (M)
- This interferes with problem solving


Interpersonal Approaches to Depression

Interpersonal relations are negatively altered as a result of depression
Depressed people:
• Have limited social networks
• Seek excessive reassurance from others
• Have/display limited social skills (e.g. limited eye contact, show less interest in others, etc.)
• Elicit rejection from others  Can maintain/exacerbate depression
• Stress-generation hypothesis: Depressogenic cog and behaviours  negative life events
o Self-generated negative life events may partly explain depression reoccurrence


Treatments: ECT

• Applying brief electrical current to brain  Temporary seizures
• Effective for severe depression (85%+)
• Still used in people not responsive to other treatment
• Relapse common (within 2 years)
• Few side effects
• Uncertain why/how ECT works


Treaments: Drugs: MAOs

• Takes 14-21 days to take effect
• MAOs break down monoamines, esp serotonin/NA
• MAO inhibitors block MAO
• Serious side effect: Can cause hypertension  Stroke if not on strict diet
o Must avoid Tyramine (beer, red wine, cheeses)
o Ideally MAO1 should inhibit MAO-A only
o Still used: Parnate, Nardil


Depression Drug treatment: Tricyclic medications

• Blocks presynaptic reuptake of Serotonin and NA
• 14-21 days to take effect
• Still widely used (Tofranil, Tryptanol)
• Vegetative symptoms often lift first: more energetic, but still feel bad
o Increased suicide risk between 10-14th day
• Negative side effects common:
o Anti-cholinergic: dry mouth, blurred vision, etc.
o Cardiotoxicity – can overdose


Depression Drug treatment: SSRIs

• Specifically block reuptake of Serotonin
• Drug of choice
• Negative side effects are fewer and less serious
o Insomnia, agitation, nausea, sexual dysfunction
• But possible risk of suicide, esp in child/adolescents
o Now have warning labels


Psychological treatments: CBT

• Addresses cog errors in thinking (not positive thinking!)
• Includes behavioural components:
o Behavioural activation: Intentionally doing things they like
o Behavioural experiments: “Find something nice about nice things”
• Outcomes comparable to drug therapy
o Lower relapse rates vs drug treatment alone (29 vs 60% for drugs)


Psych treatments: IPT

Beginning/exacerbation of depression:
• Interpersonal/role disputes: Communication analysis, role expectations
• Role transitions:
o Loss of relationships, marriage, job change, illness
o Forming new relationships, expanding old ones
• Interpersonal deficits:
o Limited social support network
o Social skills training
• Outcomes comparable to CBT – not specific to depression, but still effective


Psych treatments: Mindfulness-based

• Prevention from relapse
• Person’s relationship with thinking changes in these
• Looking at thought from outsider perspective – not taken personally
• Tends to reduce depressive rumination, which is the mechanism of change in depression


Which treatment to choose?

Depends on client
• Recommendation: Drug as first choice (but no research-based evidence)
• Drugs for “endogenous/organic/biological” (melancholic) depression
• Psychotherapy for reactive (non-melancholic) depression
o No good evidence
• Client characteristics for CBT success: Introspective, abstract thinker, less rigid, more organised, conscientious