CLP4143 Exam 3 Study Guide Chapter 7 Major Depressive Episode At least 5 of the following symptoms 1 Depressed Mood 2 Anhedonia 3 Appetite or Weight Changes 4 Sleep problems 5 Psychomotor Changes 6 Loss of Energy 7 Feelings of Worthlessness or Inappropriate Guilt 8 Concentration Problems 9 Suicidality Major Depressive Disorder 1 Presence of a major depressive episode 2 Not better accounted for by another disorder 3 No history of a manic mixed or hypomanic episode Dysthymia Less severe but more chronic At least 2 of the following for at least 2 years 1 Appetite problems 2 Sleep problems 3 Low Energy 4 Low self esteem 5 Poor concentration 6 Feelings of hopelessness Double Depression A condition in people who experience long term mild to moderate depression dysthymia and eventually progress to having episodes of major depression superimposed on the dysthymia Almost always experiencing depressed mood these individuals cycle between the mild to moderate lows of dysthymia and the deep lows of major depression To be diagnosed as having double depression a person must have experienced at least two years of mild to moderate depression Prevalence and Course of Depression 16 lifetime prevalence Long lasting recurrent Leading cause of disease burden 37 billion year in lost productivity 2X more common in women than men Biological Theories for Depressive Disorders Genetic Factors Serotonin Transporter Gene Neurotransmitters Serotonin 5 ht Norepinephrine Dopamine Problems in production and regulation of serotonin norephinephrine depression Decreased synthesis Abnormalities in transport Increased degradation by synaptic enzymes Impaired release or reuptake Abnormalities with receptor Brain abnormalities Prefrontal cortex reduced volume reduced metabolic activity Anterior Cingulate altered activity in either direction Hippocampus reduced volume reduced metabolic activity Memory Amygdala bigger enlarged volume overactive Overactive to stimuli Neuroendocrine factors Hypothalamic pituitary adrenal axis HPA Psychological Theories for Depressive Disorders Behavioral Theories Life stress reduces positive reinforcers individual withdraws learned helplessness uncontrollable life stressors create belief that individual has no control Cognitive Theories Negative Cognitive Triad Self World Future Depressed individuals exhibit errors in thinking that negatively affect mood Reformulated learned helplessness theory Causal attribution errors Believe causes of negative events are stable internal and global Cognitive Model of Depression Casual Attributions Global Nothing will work out for me Stable I won t ever be able to change Internal Things haven t been working out for me It must be my fault Interpersonal Theories Rejection sensitivity Easily perceive rejection from others Excessive reassurance seeking Constantly looks for reassurance from others that they are accepted and loved Interacts with negative events to predict depression Biological Treatments for Depressive Disorders Monoamine Oxidase Inhibitors MAOIs Problems Fatal interactions with other medications Can cause liver damage weight gain Fatal in overdose Tricyclic antidepressants Problems Numerous side effects Fatal in overdose Selective Serotonin Reuptake Inhibitors SSRIs Most widely used medication Relief within a couple of weeks Less severe side effects better tolerated No fatal overdoses Go to drugs for depression Hard to overdose on Can t overdose on the drugs alone Selective Serotonin and Norepinephrine Reuptake Inhibitors SSNRIs Similar advantages as SSRIs but has more stimulant effects Very helpful in treating depression have a more stimulant effect Electroconvulsive Therapy ECT Given to patients who do not respond to medication 6 12 sessions Relieves depression in 50 60 but 85 relapse Vagus Nerve Stimulation VNS 40 30 substantial relief 30 minimal relief Repetitive Transcranial Magnetic Stimulation rTMS Few side effects Patients remain awake unlike ECT Psychological Treatments for Depressive Disorders Cognitive Behavioral Therapy Change negative thinking Increase positive reinforcers decrease aversive experiences Solve problems develop skills Individual short term therapy sessions Identifying precipitants Teaching skills Specific Techniques Functional Analysis Behavioral Activation Social Rhythms Interpersonal Therapy IPT Identify and address 1 of 4 interpersonal sources of depression Manic Episode Distinct period of elevated or irritable mood Plus at least 3 of the following 1 Inflated self esteem or grandiosity 2 Decreased need for sleep 3 More talkative 4 Flight of ideas 5 Distractibility 6 Increase in goal directed activity or psychomotor agitation 7 Excessive involvement in pleasurable activities Can qualify if it has not been a week but they have to be hospitalized because of the severity Hypomanic Episode Distinct period of elevated mood or irritability for at least 4 days At least 3 of the following 1 Inflated self esteem 2 Decreased need for sleep 3 More talkative 4 Flight of ideas 5 Distractibility 6 Psychomotor agitation 7 Excessive involvement in pleasurable activities Between 4 6 days Good self esteem but not quite the grandiosity not feeling untouchable or impervious to danger No need to be hospitalized only full manic episodes are hospitalized Not as extreme symptoms as manic episode Basically a less severe manic episode Bipolar I vs Bipolar II Men and women are equally as likely to have these disorders Race does not matter either Develops 18 24 age ranges Can occur in children but hard to diagnose Main treatment is STRONG medication and do not want children on that while developing Chronic course Best predictors of good prognosis Medication adherence Higher social class Bipolar I Needs to experience a full manic episode lasts 7 days or hospitalization very severe Most of the people with this disorder experience depressive episodes Lifetime prevalence is 0 4 1 6 Bipolar II Little or no impairment no hospitalization 4 day manic episode but not full blown manic but you MUST have a major depressive episode Lifetime prevalence is 0 5 Cyclothymic Disorder Feeling lower than normal for 2 years Less severe more chronic form of bipolar disorder Never full blown mania never full blown major depressive Do not feel normal and content Hypomanic or moderately depressed Biological Theories for Bipolar Disorders Genetic Factors Identical twins 45 65 more likely to develop than the gen population Brain Abnormalities Amygdala larger more
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