Mood Disorders - Anx-Dep Overlap, MDD, DD Flashcards
(40 cards)
Describe the overlap between axniety and depression
anxiety and depression share common symptoms
anxiety and depressive symptoms commonly co-occur
child and adult ratings of anxiety sx’s and depressive sx’s demonstrate a high degree of overlap
clinician ratings are typically better at differentiating depression from anxiety in adults as opposed to kids
anxiety disorders are commonly comorbid with depressive disorders
anxiety d/o and depressive d/o are commonly cormobid with other disorders (e.g. personality disorders)
there is a sequential relationship between anixety and depression
differential comorbidity between depression and specific anxiety disorders
pure depression is less common that n pure anixety
which anixety d/o’s are most commonly comorbid with depression
OCD, PTSD, and PDA
which anixety disorder is the least comorbid with depression?
SP
Who do you make sense of the OCD PTSD and PDA rates of comorbidity?
Alloy’s helplessness/hopelessness model
OCD PTSD and PDA perhaps assocaited with certain rather than uncertain helplessness
What are three theories we can turn to to understand the overlap between anxiety and depression?
tripartite model (watson)
helplessness/hopelessness model (alloy et al.)
rumination model (nolen-hoeksema et al.)
describe Clark and Watson’s (1991) Tripartite model (of comobrbidity)
conceptualizes the overlap as being underlain by common and specific generalized vulnerabilities (factors)
the general distress factor (high NA)
- common to anxiety and depression
- accounts for the shared symptoms: anxious/depressed mood, insomnia, poor concentration
low PA factor (anhedonia)
- lack of interest, loss of energy
- specific to depression
the anxious arousal factor
- dry mouth, rapid heart beat, and dizziness
- specific to anxety
What was Alloy et al. (1999) rationale for proposing her Helplessness/hopelessness model of depression?
theory needs to account for:
- the seq relationship between anxiety and depression
- differential comorbidity of depression with specific anxiety disorders
- relative lack of pure depression vs. pure anxiety
describe Alloy et al.’s (1999) Helplessness/Hopelessness model of depression
her theory proposes that depressive/anxiety syndromes are determined by:
- helplessness expectancies
- negative-outcome expectancies
- the certainty of these expectancies
helplessness represents a vulnerability to stressors
failure (or success) to cope with stressors contributes to to the relative certainty-uncertainty of negative-outcomes expectancies
- a pessimistic attributional style contributes to certainty/development of depression
hopelessness represents a subset of helplessness (i.e. certain helplessness) - specific to depression
using Alloy et al’s (1999) model, describe the “equations” that lead to pure anxiety, comorbid anxiety and depression, and hopelessness depression
uncertain helplessness + uncertain negative-outcome expectancies = pure anxiety
certain helplessness + uncertain negative-outcome expectancies = cormorbid anxiety and depression
certain helplessness + certain negative-outcome expectancies = hopelessness depression
Nolen-Hoeksema got interested in talking about __________ b/c it it ________________?
rumination; is common to both depression and anxiety
define rumination (and differentiate from worry)
thinking in a repetitive and passive way about one’s negative emotions focusing on their symptoms of distress AND the meaning of their distress
We read a study by N-H for class; he was studying the relationship between rumination and the onset of depressive episodes: what was his rationale for conducting that study (i.e. what did the previous research say)
rumination predicted depressive episodes
rumination themes often reflect uncertainty about managing/controlling one’s environment
rumination appears to contribute to hopelessness about the future and negative self-evaluations
What were the results of N-H’s study?
Rumination predicted depressive episodes, including the initial onset
rumination predicted anxiety symptoms as well as it predicted depressive symptoms
P’s that had mixed anx-dep were also higher on rumination than P’s with either anxiety or depression alone
Sum up the three models – what do they contribute to your understanding of the relationship between anxiety and depression?
Clark and Watson’s (1991) Tripartite model - contribute to my understanding of general biological vulnerabilities that underlie both (or one) kinds of syndromes)
alloy et al.s (1999) helplessness/hopelessness model - contribute to my understanding of the seq relationship, diff comorbidity, and relative lack of pure depression vs. pure anxiety - helps me understand the transition from anxiety to depression
Rumination (N-H, 2000) - contributes to my knowledge of the specific variables involved in the transition (is common to anx/depression) – rumination is one such specific variable
epidemiology of depression: point prevalence (child, adolescent, adult); lifetime prevalence; ration between men and women; proportion of P’s with MDD who report comorbidity; porportion of P’s with Hx of MDD who report recurrent episodes?
80%
Where does this data come from (Kessler, 2002; a WHO study)
Course of depression: proportion of Px’s w/ MDE that recover in the first year; prop. of Px’s w/ MDE that relapse w/in 1st year; recurrence (new episode) rates 2, 5, and 10 years after MDE
70%
22%
25-40; 60; 75%
Where does this data come from: (Boland & Kessler, 2002)
conseqeunces of depression
According to Kessler, 2002:
WHO study ranked depression as the single most burdensome disease in the world
Estimated cost of depression-related lost productivity in US exceeds $33 billion
Depression can disrupt critical role transitions
People with untreated depression are often heavy users of primary care medical services
What’s the mnemonic for depression symptoms
SIGECAPPS
Sadness (depressed mood) Interest (anhedonia) Guilt (excessive) Energy (loss of) Concentration (diminished/poor) Appetite (loss of, increase -- weight gain/loss?) Psychomotor (agitation/retardation) Sleep (insomina/hypersomina, restless sleep) Suicide
DSM IV criteria for an MDE
5 or more symptoms, in same 2 week period (at least one needs to be depressed mood or anhedonia)
Not part of a Mixed Episode
Cause clinically significant distress/ impairment
Symptoms not due to effects of GMC or substance
Symptoms are not better accounted for by Bereavement
DSM IV criteria for MDD, single episode
Presence of a single Major Depressive Episode
Major Depressive Episode is not better accounted for by a psychotic disorder
There has never been a manic, mixed, or hypomanic episode
DSM IV criteria for MDD, recurrent
Presence of two or more Major Depressive Episodes. Note: To be considered separate episodes, there must be an interval of at least 2 consecutive months in which criteria are not met for a Major Depressive Episode
Major Depressive Episode is not better accounted for by a psychotic disorder
There has never been a manic, mixed, or hypomanic episode
DSM IV criteria for DD
Depressed mood for most of the day, for more days than not, at least 2 years
while depression, experience 2 or more of the following Sx's: CHASES Concentration (diminshed/poor) Hopelessness (feelings of) Appetite (loss of, increase) Sleep (insomnia/hypersomnia) Energy (lack of) Self-esteem (low)
During the 2-year period (1 year for children or adolescents) of the disturbance, the person has never been without the symptoms in Criteria A and B for more than 2 months at a time.
No Major Depressive Episode has been present during the first 2 years of the disturbance (1 year for children and adolescents); i.e., the disturbance is not better accounted for by chronic Major Depressive Disorder, or Major Depressive Disorder, In Partial Remission.
There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode, and criteria have never been met for Cyclothymic Disorder.
The disturbance does not occur exclusively during the course of a chronic Psychotic Disorder, such as Schizophrenia or Delusional Disorder.
not due to substance/GMC
clinically significant distress/impairment
When can DD and MDD co-occur?
Double depression (DD for two years, then onset MDE)
MDD, full remission, at least two months no MDE, then onset DD
Coding MDD
296.xx – Major Depressive Disorder 4th digit - .2 – Single Episode, .3 – Recurrent 5th digit – severity/remission 1 = Mild 2 = Moderate 3 = Severe Without Psychotic Features 4 = Severe With Psychotic Features 5 = In Partial Remission 6 = In Full Remission 0 = Unspecified
