major depressive disorder

Question 1

affective

symptoms of MDD

Answer 1

sadness, helplessness, loneliness, anxiousness, numbness

Question 2

cognitive

symptoms of MDD

Answer 2

• low self-esteem
• pre-occupation with failure
  and self-blame

Question 3

motivational

symptoms of MDD

Answer 3

• difficulties with task initiation
• impaired performance
• difficulty with making decisions

Question 4

physiological

symptoms of MDD

Answer 4

loss of appetite

• weight and sleep instability
• fatigue
• loss of libido
• pre-occupation with personal health problems

Question 5

APMS (2014)Adult Psychiatric Morbidity Survey [England]:

Answer 5

• One in six (17%) met the criteria for a common mental disorder (CMD)
• One in five women (19%) reported CMD symptoms, compared with one in eight men (12%). 10% of women reported severe symptoms compared to 6% of men
• The trend has been upward for some time

Question 6

• CIS-R (Clinical Interview Schedule):

- Scoring:

Answer 6

> 12: Symptoms warrant clinical recognition

>18: Symptoms severe, require intervention

Question 7

genetic vulnerability of MDD

Answer 7

i. 1.5-5 times greater occurrence among 1st degree relatives than in general population
ii. Twin Studies: 48% MZ, 42% DZ concordance

Question 8

biochemical vulnerability of MDD

Answer 8

iii. Higher vulnerability of women, different hormone cycle

iv. Gene-carrier effect (female prone to depression, male prone to alcoholism)

Question 9

serotonin on norepinephrine and dopamine systems

Answer 9

serotonin system regulates norepinephrine and dopamine systems, and low levels of serotonin leads to mood deregulation

• Serotonin system as a mood regulator
• Regulates norepinephrine and dopamine activity
• Depletion of serotonin results in deregulation of norepinephrine and larger mood fluctuation

Question 10

how to MAO inhibitors work at the synapse

Answer 10

(e.g., Nardil)
• Inhibit the breakdown on monoamine neurotransmitters (norepinephrine and serotonin) in the synaptic cleft
• Side effects: blood pressure, drowsiness/headache, fatigue, anxiety, mood shift, weight gain, sexual dysfunction, drug and food interactions (cheese, yoghurt, beer, etc.)

Question 11

how to Tricycles inhibitors work at the synapse

Answer 11

e.g, Tofranil [imipramine]
• Block reuptake of monoamines into presynaptic cell
• Side effects: dry mouth, sweating, constipation, blurry vision

Question 12

how to SSRIs inhibitors work at the synapse

Answer 12

• Specifically block serotonin reuptake

* Side effects: anxiety/agitation, digestive problems, dizziness, dry mouth, sweating, low libido

Question 13

the link between stress and depression

Answer 13

• Early childhood adversity or abuse can lead to lasting difficulty in combating the effects of stress
• In animals, lasting elevation in stress response has been shown following temporary early-life trauma
• High levels of stress can damage the hippocampus
• Impairs down regulation of stress response
• Impairs memory

Question 14

support of the role of stress regulation in depression

Answer 14

• Brain imaging studies are showing negative effects on the hippocampus of people with depression

Cole et al. (2010)

Question 15

the implications of the finding that early life stress in animal models can lead to permanent changes in stress levels

Answer 15

In animals, lasting elevation in stress response has been shown following temporary early-life trauma

Question 16

serotonin depletion

Answer 16

Serotonin levels can be reduced artificially by introducing an agent that depletes tryptophan (which is used in serotonin synthesis). When this is done with people who are in remission from depression, they can experience a relapse in their symptoms. This suggests that lower serotonin levels can be a causal agent in the onset of depression. However, the story is more complicated than this.

When the experiment is done with people with no personal or family history of depression, no mood changes are found due to serotonin depletion. So, lower serotonin levels won’t bring about depressive symptoms in everyone.

Question 17

Anxiety-Alcohol-Depression vicious cycle

Answer 17

red, green and blue routes

Question 18

red route

Answer 18

shows anxiety as the entry point. An easily available way to reduce anxiety is to numb oneself with alcohol. Large quantities of alcohol have a depressive effect on the nervous system. This impacts motivation and productivity, which end up increasing anxiety. Meanwhile the body develops tolerance for alcohol, so more alcohol is necessary to get the same numbing effect

Question 19

green route

Answer 19

shows perhaps the most insidious route into this vicious cycle. Frequent intake of large quantities of alcohol, perhaps as a social ritual, starts to depress the nervous system (where there was no dysfunction to begin with). Once depression kicks, the person starts to become anxious as well. This increases the need and attachment to heavy drinking as a means of dampening anxiety.

Question 20

blue route

Answer 20

shows the cycle that can begin with, say, stress-induced depression. The state of depression brings with it personal non-coping and under-performance, which in turn elevates anxiety levels. At this point, if alcohol is chosen as self-medication, then it succeeds in deepening depression.

Question 21

learned helplessness

Answer 21

• Responding to improve things is ineffective
• Formed through specific inescapably negative experiences
• Become all-encompassing through stimulus generalization
• Experimental results:
• Escapability and helplessness
• Explanatory style

Question 22

Seligman’s shock experiment

Answer 22

Escapability & helplessness
• Escapable shock => Escapable shock : Tries to escape
• No shock => Escapable shock: Tries to escape
• Inescapable shock => Escapable shock : Doesn’t escape

Question 23

internal attributions

Answer 23

blame the self, external ones find causes outside the self.

Question 24

stable explanations

Answer 24

imply that the reason for the outcome are persistent as opposed to transient (unstable).

Question 25

global causes

Answer 25

are broad reasons for negative outcomes whereas specific causes refer only the current event or event type.

Question 26

internal-stable-global explanation

Answer 26

places the highest, most resilient level of blame on the self. The external-unstable-specific explanatory style has the least impact on how the self is viewed. The other combinations fall in between.

Question 27

what is BECK triad?

Answer 27

• Assume personal defectiveness
• Negatively interpret events
• No hope for the future
• DEPRESSIVE REASONING:
• Arbitrary inference leading to unsupported conclusions
• “My work is not valued”
• “Nobody likes me”

Question 28

arbitrary inference

Answer 28

Drawing a negative conclusion without a tight argument.

Question 29

selective abstraction

Answer 29

Picking up something negative and then broadening it into a more general principle.

Question 30

over generalisation

Answer 30

Again, going from negative instances to broad negative views.

Question 31

magnification of negatives, minimisation or positives

Answer 31

Highlighting or over-estimating the importance of the negative aspects of experience

Question 32

personalisation

Answer 32

Unwarranted levels of holding the self responsible for negative things.