Test 3 Study Guide Ch 7 11 Depression 1 Major Depression a Episodes Include five or more of the following during a two week period i ii iii iv v vi vii viii ix Depressed mood for most of the day nearly everyday Either feeling sad or empty Anhedonia diminished interest or pleasure in all activities Significant weight loss gain or change in appetite Insomnia or hypersomnia Psychomotor agitation or retardation Fatigue or loss of energy Feeling of worthlessness or excessive inappropriate guilt Diminished ability to think or concentrate or indecisiveness Recurrent thoughts of death suicidal ideation attempted suicide or suicide plan b Major depressive episodes are a change in a person s normal mood social occupational educational and other important functioning The person is negatively impaired It causes significant social academic and occupational impairment It can impair judgement c Features i Affective ii Behavioral 1 Depression 2 Anxiety 3 Guilt 4 Anger hostility and irritability 1 Agitation 2 Facial Expression 3 Psychomotor retardation 4 Retardation of speech and thought 5 Crying iii Attitude Toward Self 1 Self reproach 2 Low self esteem 3 Feelings of helplessness and pessimism 4 Hopelessness iv v i ii iii iv i ii iii 5 Thoughts of death suicide attempt Cognitive Impairment 1 Decreased ability to think or concentrate Physiological Changes 1 Loss of appetite 2 Sleep disturbance 3 Loss of energy 4 Decreased libido 5 Inability to experience pleasure d Core Features Physical Functions Fatigue sleeping eating and sexual problems issues with overall health Social Functions Problems with family and friends dependant behavior Negative Emotion Depressed mood anxiety anger guilt Intellectual Functioning Distractibility apathy forgetfulness impaired executive functioning personal neglect slow psychomotor functioning The presence of major depressive episodes Symptoms are not better accounted for by another disease There have never been manic or hypomanic episodes other than substance related one s e Diagnostic Criteria f Specifiers i Severity 1 Mild 2 3 symptoms are present the patient is distressed but should be able to continue with activities 2 Moderate 4 or more symptoms are present and the person has difficulty continuing with everyday activities 3 Severe Several symptoms are present and distressing Need for institutional care phobias panic attacks alcohol and or drug abuse may be present Suicidal actions are common Anxious Distress Restlessness tension worry ii iii Mixed Features Manic Hypomanic features iv Melancholic Features Severe anhedonia or physical features v vi Psychotic Features Delusions and hallucinations Catatonic Features Lack of movement disturbance in speech not reacting to environment Atypical Features Assortment of odd symptoms that are not typical to major depressive disorder vii viii ix x Peripartum Onset Occurs during pregnancy or within 4 weeks of pregnancy Seasonal Patterns Recurrent pattern during certain times of the year SAD 15 commit suicide 60 of those over 55 commit suicide g Course Generally starts in mid 20 s Once you have a first episode there is a 60 chance of a second episode The more episodes the more likely you are to have another episode h Treatments Pharmacotherapy i ii iii Psychotherapy 1 About 60 respond to SSRI s but only 45 55 recover Electrocompulsive Therapy 1 55 go into remission but relapse rates are very high 1 20 25 go into remission the relapse rate is also high 2 Persistent Depressive Disorder Dysthymia a Diagnostic Criteria Depressed mood for most of the day for 2 years 1 year for children i ii More than 2 of the following 1 Poor appetite or overeating 2 Insomnia or hypersomnia 3 Low energy or fatigue 4 Low self esteem 5 Poor concentration or difficulty decision making 6 Feelings of hopelessness iii iv v vi vii viii Never without A or B for more than a two month period within the two years Criteria for major depressive disorder may be present for 2 years No manic or hypomanic episodes Does not occur exclusively during other disorders Not related to substance abuse or other medical disorders Causes Impairment 3 Double Depression 4 Prevalence of Mood Disorders a Major Depressive Disorder 16 6 b Bipolar 3 9 c Dysthymia 2 5 d Any Mood disorder 20 8 i Recent studies claim up to 41 4 of people have experienced depression 5 Demographic Trends a Women are 2x as likely to experience mild and severe depression than men i ii Differences appear during puberty Could be because of higher rate of sexual abuse in women self concept coping styles socio cultural strains and differences in functioning of the HPA axis b Rate of depression in elderly is less than half of the general population c Depression rates have increased across generations d Rates are lower among blacks e Enviormental factors i ii of depressed people have experienced a negative event before the depression started Only 1 in 5 people that experience a negative event develop depression a Low self esteem b Low social support c Ruminative response style d Physical Emotional illness e Previous episodes of depression f Heredity g People are more likely to recall negative events and attend to negative information 6 Risk Factors a Disturbances in people s roles in their close relationships are the main causes of once a sad mood has been induced 7 Interpersonal Therapy depression b Maladaptive if then rules c Excessive Reassurance seeking d Interpersonal Sources of Depression i ii iii iv Grief Loss Help the client accept feelings and evaluate the relationship with the lost person Help the client develop new relationships Interpersonal Role Disputes Help client compromise and communicate Role Transitions Help client be more realistic about roles that are lost and embrace new roles Interpersonal Skills Deficit Help client review past relationships understand how they affect current relationships and teach social skills 8 Learned Helplessness If a negative event is uncontrollable we become depressed a b Seligman s experiment with shocking dogs c The type of event that most commonly leads to depression d Depression results from frequent chronic uncontrollable events e Believing in helplessness leads to reduced motivation reduced actions in controlling environment inability to learn how to control situations that are controllable 9 Cognitive Therapy Individual short term client centered therapy session a b Cognitive Theory People who are depressed have negative thoughts which lead them to
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