Chapter 7 Mood Disorders and Suicide Mood Disorders Unipolar Only go down MDD Persistence depressive dis Bipolar both higher and lower than normal Bipolar 1 2 clyclothymia Criteria sets for mood disorders require an episode Mood episodes make up mood disorders Both unipolar and bipolar major depressive episode Manic and hypomanic episode are only bipolar 1 What are the symptoms of a Major Depressive Episode Major Depressive Episode MDE Need to demonstrate at least 5 of the following symptoms for at least 2 weeks 1 Depressed mood sadness and feeling down crying more often than usual 2 Anhedonia loss of interest or pleasure of things you once enjoyed Core symptoms of depression need one of these two to be depressed 3 Appetite or weight changes can go either way 4 Sleep Problems also either way hypersomnia more than usual or insomnia 2 hrs different 5 Psychomotor changes speeding up or slowing down in the way you move or talk agitation speeding up talking moving fidgeting or retardation slow down in movement or speech other people notice or say something 6 Loss of energy can interplay with sleep problems try to look at separately 7 Feelings of worthlessness or inappropriate guilt class prez but not proud feeling extra or not guilty 8 Concentration problems difficulty focusing on one thing or staying on task 9 Suicidal thoughts least common most dangerous 2 What distinguishes a Major Depressive Episode from Major Depressive Disorder Major Depressive Disorder MDD At least one major depressive episode Not better accounted for by another disorder grieving after death or postpartum depression No history of a manic or hypomanic episode would probably be in the bipolar spectrum 3 How is Persistent Depressive Disorder PDD similar to and different from Major Depressive Disorder What is PDD s relationship to Major Depressive Episodes CLASS More chronic can be less severe Meeting criteria for at least 2 symptoms of MDE for at least 2 years 4 What is the prevalence rate for Major Depressive Disorder Persistent Depressive Disorder What are the gender and age differences in MDD s prevalence MDD about 1 in 6 people lifetime prevalence rate these people will experience it at some point in their lives 1 year prevalence rate percentage that will experience this disorder in a given year much less 1 in 10 or 12 PDD about one in 20 recurrent if untreated MDD 1 in 5 in their lifetime PDD 1 in 20 The leading cause of disease burden people miss work loss in productivity higher than any other disease period 2X more common in women than in men Age differences in depression Why rates lowest in people over 60 Less willing to report symptoms stigma surrounding depression in older group difficult to make diagnosis because of comorbidity they re more likely to be dead learned adaptive coping skills age 85 sharp increase loss of independence everyone they know is dead 5 Describe biological theories for Depressive Disorders a What gene has been associated with MDD and how do environmental factors influence its expression Serotonin transporter gene levels of serotonin in the brain 2 main types of alleles that encode for this transporter Long allele more common and short allele Environment can turn on short allele through maltreatment b What neurotransmitters are lower on average in people who are depressed Serotonin 5HT mood regulating eating and sleep and prolonged states of anxiety Norepinephrine fight or flight system More rarely dopamine motivation drug and sex pathways pleasure instant reinforcement c What brain regions have been shown to act differently in people with MDD For each region is it over or under active Prefrontal cortex DOWN ARROW overall decrease in volume activity and connectivity Anterior cingulate UP ARROW alteration though increased activity Hippocampus DOWN ARROW memory decreased functionality and blood flow in depressive episodes decreased volume in MDD more episodes more chronic the more differences likely to see Amygdala UP ARROW associated with fear active when in presence of emotionally relevant info love desire for food depression amygdala hyperactivity or increased response Neuroendocrine factors HPA axis UP ARROW increased response hyperactive in depression 6 Describe psychological theories for depressive disorders a What do behavioral theories say about the development of depression What behaviors are or aren t reinforced in depressed individuals How does this contribute to the syndrome Behavioral withdrawal and reduced positive reinforces social connectedness exercise food sex entertainment are a big part of what causes depression Learned helplessness came from translational research was in animals originally but has been translated into human research when ppl or animals experience unpredictable punishers it causes them to reduce all of their behaviors Unpredictable negative life events serve as negative punishers cause behavioral withdrawal b What do cognitive theories say about depression What maladaptive cognitions have been shown to be present more often in individuals who are depressed All about thought patterns and cognitions Negative cognitive triad negative thoughts about the self the world and the future all reinforce each other Beck 1967 Causal attributions believe causes of negative events are stable internal and global related to negative triad only distinction between these 2 causal attribution fits into negative cognitive triad 7 Compare and contrast major drug classes are used to treat depression 1 SSRI s most common type of biological depression treatment mental illness period described by general practitioners Inhibiting or decreasing the amount of uptake that occurs increasing the available serotonin in the brain by decreasing reuptake Less severe side effects better tolerated withdrawal effects and digestive probs 2 SSNRI s selective serotonin and norepinephrine reuptake inhibitors Increase serotonin in brain by decreasing reuptake and increase norepinephrine More stimulant effects 3 MAOI s monoamine oxidase inhibitors increase the availability of all NT s by inhibiting enzyme that breaks them down often last step fatal interactions with other meds weird diet restrictions can cause liver damage weight gain 4 Tricyclic antidepressants people who have tried other routes didn t work for them Numerous cardiac side effects 8 Describe the general goals of two primary psychological treatments for depressive disorders Cognitive Behavioral Therapy 1 Cognitive treatments
View Full Document
Unlocking...