Unit 2 Chapters 7 14 Chapter 7 Mood Disorders Axis I Mood Disorders 1 Unipolar a Major Depression b Persistent Depression 2 Bipolar a Bipolar I b Bipolar II c Cyclothymia The criteria for mood disorders require the presence or absence of Mood Episodes Major Depressive Episode Manic Episode One week or more of irritable mood Hypomanic Episode Four Days of elevated or irritable mood Major Depressive Episode 5 or MORE symptoms needed to diagnose a Major Depressive Disorder Cognitive symptoms 1 Concentration problems 2 Thoughts of death or suicide 3 Thoughts of worthlessness Emotional symptoms must have at least one of these 1 Depressed mood 2 Loss of interest or pleasure Biological symptoms 1 Increase or decrease in appetite weight 2 Sleep disturbances 3 Psychomotor changes 4 Loss of energy We all feel sad at times therefore the duration of sadness is critical when diagnosing someone with MDD Presence of a major depressive episode 2 weeks Not better accounted for by another disorder No history of manic mixed or hypomanic episodes Persistent Depressive Disorder Less severe but more chronic Eeyore Cognitive symptoms 1 Concentration problems 2 Thoughts of worthlessness Emotional symptoms must have at least 2 of these to be diagnosed PDD 1 Depressed mood 2 Loss of interest or pleasure Biological symptoms 1 Increase or decrease in appetite weight 2 Sleep disturbances 3 Psychomotor changes 4 Loss of energy Major Depression Major spikes are NOT normal Hence major depression Double Depression Major Depression Basically long term persistent depression that dips deeper into major depression Depression facts 16 lifetime prevalence 2x more common in women than men Leading cause in disease burden productivity loss Age differences Rates are lowest in people over 60 bc Less willing to report symptoms Difficult to make diagnosis Depressed people don t live past 60 years Adaptive coping skills Higher rates in people 15 29 because Drastic change in hormones experimentation transitions stakes High rates in 85 due to fear of death boredom abandonment loss of loved ones feeling of uselessness hopelessness Biological Theories of Depression Serotonin transporter gene First degree relatives of people with unipolar depression are two to three times more likely to also have depression than are the first degree relatives of people without the disorder serotonin is one of the neurotransmitters implicated in depression o Gene by environment interaction o S S double short alleles o S L heterozygous allele o L L preferred double long alleles Diathesis stress no maltreatment probable maltreatment severe maltreatment Epigenetics environment decides which genes are expressed Neurotransmitters Serotonin 5 ht Norepinephrine are important in regulating our emotions mood Dopamine rewards system pleasure loss experience disgust Problems in production and regulation of serotonin norephinephrine depression Decreased synthesis Abnormalities in transport Abnormalities with receptor Increased degradation by synaptic enzymes enzymes eat neurotransmitter Impaired release or reuptake Brain abnormalities Prefrontal cortex o Problem solving o Decision making o Concentration o Motivations o Coping mechanisms Anterior cingulated o Fight or flight o Overactive stress response o Social interactions Hippocampus o Criticism rumination Amygdala o Emotions fear anger danger o Memory stronger memories of negative things stress o Identifies the emotional value of your environment determines threat o Overactive amygdala pay more attention to negative things Neuroendocrine factors Hypothalamic pituitary adrenal axis HPA o Elevated levels of cortisol in depressed individuals o Interacts with amygdala hippocampus cerebral cortex inhibits neurotransmitter receptors Biological Treatments for Depression Drug treatments MAOI Monoamine Oxidase Inhibitors o Prevents degredation o Problems Fatal interactions with other meds Liver damage weight gain Fatal in overdose Tricyclic Antidepressants o Increases seratonin and norepinephrine o Problems Numerous side effects Fatal in overdose SSRI Selective Serotonin Re uptake Inhibitors o Increases the amount of serotonin in the synapse o Most widely used medication Relief within a couple of weeks Less severe side effects better tolerated Not fatal in overdose Better for suicidal patients SSNRI Selective Serotonin and Norepinephrine re uptake Inhibitors o Like SSRI but more stimulant too impulsive and pumped up ECT electroconvulsive therapy o Only on the right side of the brain o Given to patients who DON T respond to medication o 6 12 sessions o Relieves depression in 50 60 but 85 relapse o MEMORY LOSS VNS Vagus Nerve Stimulation o More serotonin and norepinephrine o 30 40 substantial relief 30 minimal relief rTMS Repetitive Transcranial Magnetic Stimulation o re polarize the neurons to increase serotonin and norepinephrine o Few side effects o Patients remain awake unlike ECT All treatments increase neurotransmitters within the synapse Psychological Theories of Depression Behavioral Theories o Life stress reduces positive reinforcers individual withdraws o Learned helplessness uncontrollable life stressors create a belief that individual has no control Cognitive Theories of Depression o Negative Cognitive Triad Negative thoughts about the Self World Future Depressed individuals exhibit errors in thinking which negatively affects mood o Reformulated learned helplessness theory Causal attribution errors Believe causes of negative events are stable internal and global things will never change it s my fault I suck at everything Thoughts emotions behaviors o Example Jenny lost her job after 3 years Internal causal attribute It must have been my fault I didn t work hard enough on my assigned projects Stable causal attribute I am not smart enough to do this kind of work and I never will be Global causal attribute I am never going to be able to maintain a job Interpersonal Theories of Depression o Rejection Sensitivity Easily perceive rejection from others o Excessive reassurance seeking Constantly look for reassurance from others Psychological Treatments for Depression Goals 1 Cognitive Change negative thinking 2 Behavioral Increase positive reinforcers and decrease aversive experiences solve problems develop skills How Individual short term therapy sessions identifying precipitants teaching skills Specific techniques Functional Analysis Behavioral Activation Social Rhythms Interpersonal Therapy IPT Goal Identify
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