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Know the 9 symptoms of Major Depressive Disorder.
1. Depressed mood most of the day nearly every day
2. Diminished Intresttrents/ please in activities
3. Significant weight loss/gain
4. Insomnia/hypersominia
5. Psychomotor agitation (restlessness or retardation observable by others
6. Fatigue or loss of energy nearly daily
7. Feelings of worthlessness or excessive inappropriate guilt
8. Decreased ability to think/concentrate or indecisivness
9. Recurrent thoughts of death or suicidal ideation
At least one of which two symptoms are required for the diagnosis?
1. Depressed mood most of the day nearly every day
2. Diminished Intresttrents/ please in activities
What is the time period during which these symptoms must be present to get this diagnosis?
In the same 2 week period
Can one get the diagnosis of MDD if one is using CNS depressants such as alcohol
or other abused substances?
a diagnosis of Major Depressive Disorder (MDD) can only be given if the depressive symptoms are not solely attributed to the substance abuse
If a patient has had an episode of mania, can they receive a diagnosis of MDD?
No
Describe the symptoms associated with depression. Place each into one of the five
categories of functioning described in class
emotional - tend to lose sense of humor, lose ability to take pleasure in activity’s that they used to take pleasure in words: sad, miserable, empty, anxiety, anger, agitation
motivational- lack of drive, initiative, spontaneity, force themselves to go to work, talk to friends,eat,have sex with a partner
behavioral- Often less active, less productive, May move and/or speak more slowly, often spend more time alone, more time in bed
cognitive- often consider them selves inaduquate, undesirable, inferior, self blame, for events that they had little or nothing to do with them selves, hopelessness and helplessness makes one susceptible to suicidal ideation, depressed intellectual functioning
physical- pain, muscle pain, headaches, bowel issues, constipation diarrhea, problems with appetite increase or decrease and sleep, to much or to little.
Define “anhedonia.”
Inability to experience pleasure
6. What symptoms are especially associated with the risk of suicide?
Cognitive symptoms
7. Point prevalence of MDD. Lifetime risk of MDD.
13%
8. Median age of diagnosis of MDD in the US.
Has this age been increasing or decreasing since the early 1900’s? Steadily increased
9. Are women or men more often diagnosed with MDD?
Women
10. Are boys or girls (before puberty) more likely to be diagnosed with MDD?
neither they are equal
11. Average duration of untreated first episode of MDD
4 months
12. What % of people who experience a first episode of MDD will go on the experience
a second
approximately 50%
How does the severity of the first episode of MDD relate to the likelihood of
persistent of this disorder?
The severtity of inital episode appears to predict persistenence, first episode of MDD often follows a severe psychological stressor (death, divorce.) subsequent episodes are less dependent on stressors
Do subsequent episodes of MDD require the same level of stressor as the first?
No the more one experiences it the easier it is to slip into another one
No the more one experiences it the easier it is to slip into another one
What is the likelihood of MDD in people who have a first degree relative with this
disorder?
20%
What other disorders are other seen in relatives of patients with MDD?
Anxiety,ADHD, ODC,eating disorder, headaches, irritable bowel syndrome.
Why do people with MDD have an increased rate of premature death?
unhealthy lifestyle choices like smoking, poor diet, lack of physical activity, increased risk of suicide, and a higher likelihood of developing chronic physical health conditions like cardiovascular diseases
Describe the sleep disturbances commonly seen with MDD
Sleep EEg abnormalities in 40%-60% of out patients and 90% of in patients, intermittent waking,early morning waking, reduced deep sleep.
Why is it believed that women (after puberty) experience twice the incidence of
depression vs. men?
estrogen and progesterone have been shown to affect brain regions associated with mood
During what part of the menstrual cycle does Premenstrual Dysphoric Disoder
occurs during times of progesterone and estrogen instability - last 7-10 days of menstrual cycle
What is the prevalence of PMDD?
3-9%
What other disorders do we check for in women who present with PMDD?
premenstrual exacerbation of an underlying mood or anxiety disorder.
Prevalence of Post-Partum depression (PPD)?
What causes this disorder? usually begins within 4 weeks of birth. extreme sadness, tearfulness, anxiety, intrusive thoughts, insomnia, feelings of inability
4.4-9% sometimes up to 30%
usually begins within 4 weeks of birth. extreme sadness, tearfulness, anxiety, intrusive thoughts, insomnia, feelings of inability
What women are at highest risk for PPD?
Women with family history of mood disorders
When do we usually (but not always!) see the onset of PPD? Describe the
symptoms of this disorder. What is the likelihood of experiencing a second episode
with a subsequent birth?
Just as with menstrual cycles and pregnancy, most women go through menopause withoutexperiencing depressive symptoms.
However, this is another time of extreme hormonal fluctuations and recent studies have shown an increased risk of depression even in women who have never experienced depressive symptoms prior to menopause. (again, they are more at risk if they have had MDD before)
Do women have an increased risk of MDD during menopause? Why?
Yes Just as with menstrual cycles and pregnancy, most women go through menopause withoutexperiencing depressive symptoms.
However, this is another time of extreme hormonal fluctuations and recent studies have shown an increased risk of depression even in women who have never experienced depressive symptoms prior to menopause. (again, they are more at risk if they have had MDD before)
What neurotransmitters have been linked to MDD? Are these thought to be high or
low in patients with MDD?
Low they are under active
prefrontal cortex, hippocampus, amygdala, Brodmann Area 25 - these areas have abundant 5HT receptors
Name the four areas believed to be involved in the formation of MDD and how each
area is thought to contribute to the disease. What neurotransmitter receptors are in
high concentrations there?
prefrontal cortex, hippocampus, amygdala, Brodmann Area 25 - these areas have abundant 5HT receptors
30. Explain the ‘behavioral view’ of the development of MDD.
MDD results from a change in number of rewards/punishments people receive in their lives. When positive rewards dwindle, people perform fewer and fewer constructive behaviors leading to fewer positive rewards and eventually, depression
31. Describe the “Negative Thinking” cognitive theory of the development of MDD.
Explain Beck’s “Cognitive Triad of Maladaptive Thinking.” What are “Automatic
Thoughts” according to Beck.
Cognitive View - people with MDD view events in negative ways and that such perceptions lead to MDD.
Negative Thinking Maladaptive thinking is key to depression |
•Beck believes that children develop maladaptive attitudes, (e.g., “If I fail, others will feel repelled by me.”) These developed through their experiences. Later in life, upsetting situations trigger extended rounds of negative thinking. This thinking takes 3 forms that Beck calls the: • COGNITIVE TRIAD: They interpret the following in negative ways that make them feel depressed: 1. their experiences 2. themselves |
32. Describe the “Learned Helplessness” cognitive theory of the development of
MDD. Explain the “attribution-helplessness theory”. What do people attribute their
feelings of lacking control in their lives to. (Understand the ideas of internal causes
that are global and stable) If one attributes a difficult situation in ways that are
external and specific how would this effect their thoughts of outcomes in the future?
1. they no longer have control over reinforcements in their lives
2. they themselves are responsible for their helpless state
33. Describe the DSM -V criteria for Dysthymic Disorder. What is the length of time of
having these symptoms required to receive the diagnosis?
1. Depressed mood for most of the day, for more days than not, for at least two years. 2. Presence, while depressed, of at least two of the following: • poor appetite or
overeating • insomnia or hypersomnia • low energy or fatigue • low self-esteem
• poor concentration or difficulty making decisions • feelings of hopelessness. 3. During the two-year period, symptoms not absent for more than two months at
a time.
4. No history of a manic or hypomanic episode.
5. Significant distress or impairment.
. Is treatment of MDD frequently successful?
treatment of Major Depressive Disorder (MDD) can be successful for many people, but it often requires a comprehensive and personalized approach.
35. Explain the psychodynamic approach to the treatment of MDD
the principles of psychoanalysis, developed by Sigmund Freud. This approach focuses on uncovering unconscious conflicts and past experiences that may be contributing to the person’s current symptoms of depression.
36. Explain the behavioral approach to the treatment of MDD. Describe behavioral
activation.
focuses on the idea that depression is, in part, a result of unhelpful behaviors and environmental factors that reinforce and maintain the depressive symptoms. Rather than focusing on past conflicts or unconscious processes, the behavioral approach emphasizes present-day behaviors and how they contribute to the cycle of depression.
37.Explain the cognitive and cognitive behavioral approach to the treatment of MDD.
Describe the four phases of CBT for MDD. Review the cognitive triad and the concept
of automatic thoughts.
Help clients recognize and change their negative cognitive processes and therefore improve their mood. Usually includes behavioral techniques as well.
•** Maladaptive attitudes lead people to view themselves, their worlds, and their futures in negative ways (cognitive triad (Beck) - slide 45)These biased views combine with illogical thinking to produce automatic thoughts - unrelenting negative thoughts that produce depression
•This approach often follows four phases and often requires about 20 sessions
Phase 1- Increasing activities and elevating mood - make a schedule
Phase 2 - Challenging automatic thoughts -educate them about the thoughts.
Recognize and record the thoughts as they occur and bring these lists to each
session. Therapist and client test the reality behind these thoughts
Phase 3. Identify negative thinking and biases - as people begin to recognize the negative automatic thoughts, the therapist begins to discuss how the illogical cognitions contribute to the automatic thoughts.example - all or nothing thought patterns, catastrophic thought patterns.
Phase four - Changing primary attitudes - Therapists help clients change the maladaptive attitudes/thoughts - their viewing of themselves, the world, and their futures in negative ways. Client may be asked to test their attitudes.
How effective is CBT for MDD?
100’s of studies show that Cognitive and CBT therapies significantly help clients with unipolar depression.
•50-60% show a near-total elimination of depressive symptoms
39. Describe Acceptance and Commitment Therapy
Offshoot of CBT - Acceptance and Commitment therapy - Clients are guided to recognize and accept their negative thoughts as streams of cognitions that flow through the mind rather than as guides for behavior and decisions.
•Accepting the negative thoughts for what they are - just thoughts.
40. What were the first meds used for treatment of MDD (tricyclics) . What is a major
problem with this group of drugs
First antidepressants - early 1950’s - huge breakthrough
•primarily Serotonin-NE reuptake inhibitorsBUT interact with MANY other receptors and therefore have MANY side effects (e.g., sleepiness, dry mouth, constipation, cardiac problems...)
•Still used for treatment-resistant depression
41. What is the most common group of drugs used today for the treatment of MDD?
Most commonly used antidepressants
•Examples: Celexa (Citalopram,) Zoloft (Sertraline,) Prozac (Fluoxetine,) Lexaparo (Escitalopram,) Paxil(Paroxetine,)………
•much better tolerated. far more selective therefore far less side effects.
•some help more/less with anxiety.
•some have some weight gain and/or sexual dysfunction (decreased libido) side effects.
42. How do 5HT-NE reuptake inhibitors work?
commonly known as serotonin-norepinephrine reuptake inhibitors (SNRIs), are a class of antidepressant medications that work by increasing the levels of two important neurotransmitters in the brain: serotonin (5-HT) and norepinephrine (NE).
43. How does wellbutrin work?
which is the brand name for the medication bupropion, is an atypical antidepressant that works differently from many other antidepressants, such as SSRIs or SNRIs. It is primarily used to treat major depressive disorder (MDD) and seasonal affective disorder (SAD), and it's also commonly prescribed for smoking cessation (as Zyban).
44.Do antidepressant medications work for everyone? Who has the highest success
rate with these medications?
Antidepressant medications are an effective treatment option for many individuals with Major Depressive Disorder (MDD) and other mood disorders. However, they do not work for everyone, and their effectiveness can vary from person to person. Factors like the type of depression, individual biology, genetics, co-existing conditions, and medication adherence can influence how well antidepressants work.
45.Describe Electroconvulsive Therapy. What is one of the main problems with this
therapy today (memory loss). A patient with what type of MDD disorder is most
likely to be helped. (severe MDD)
Electroconvulsive Therapy (ECT) is a medical treatment used primarily for severe Major Depressive Disorder (MDD)and other psychiatric conditions, particularly when other treatments (e.g., medications, psychotherapy) have not been effective.
47. Describe the symptoms of a manic episode. How long does one need to be
experiencing these symptoms to receive the diagnosis?
A manic episode is a distinct period of abnormally elevated or irritable mood, along with increased energy or activity. Manic episodes are a key feature of Bipolar Disorder, particularly Bipolar I Disorder, but they can also be seen in other mood disorders. Below are the symptoms, diagnostic criteria, and how long these symptoms must persist for a diagnosis.
Symptoms- flight of ideas, increased goal directed, distracabiltiy,more talkitive then usual, decreased need for sleep
46. Describe Transcranial Magnetic Stimulation. Is it thought to be effective?
Transcranial Magnetic Stimulation (TMS) is a non-invasive, FDA-approved treatment for depression, particularly for individuals with treatment-resistant depression (MDD) who have not responded well to medications or psychotherapy.
48. Discuss the “5 areas of functioning” used to describe the symptoms of mania. Give
examples of each.
1. Mood- elevated mood
2. Cognition-flight of ideas
3. behavior- impulsivity
4. Social and occupational functioning - soical disruptions
5. Physical functioning- decreased need for sleep
47.Do people who are experiencing a manic episode retain insight? Why is this
important?
People who are experiencing a manic episode often lack insight into their condition. This means they may not recognize that their behavior, thoughts, or mood are abnormal or problematic. This is a hallmark feature of mania, especially in Bipolar I Disorder, where individuals may feel overly confident, invincible, or excessively energetic, often without realizing the potential negative consequences of their actions.
48.What are the three major diagnostic subtypes of Bipolar Disorder? Describe each.
Bipolar Disorder is a mood disorder characterized by extreme fluctuations in mood, energy, and activity levels.
Bipolar disorder 1- Bipolar I Disorder is defined by the occurrence of at least one manic episode, which may be preceded or followed by episodes of depression. This is the most severe form of Bipolar Disorder and often requires immediate treatment due to the intensity of manic symptoms.
Bipolar disorder 2-Bipolar II Disorder involves a pattern of hypomanic episodes and major depressive episodes. Hypomania is a milder form of mania that does not cause significant impairment in daily functioning, unlike full-blown mania. People with Bipolar II can still experience intense periods of depression, but their manic symptoms are less severe.
Cyclothymic disorder- characterized by chronic fluctuating mood states, with periods of hypomanic symptoms and depressive symptomsthat do not meet the full criteria for a manic or major depressive episode. The mood swings are less severe than those seen in Bipolar I or II but can still interfere with functioning.
51.Lifetime prevalence of Bipolar Disorder? Are women or men more likely to be
diagnosed? What is the most common age of onset?
1-3% prevalence
They are effected the same just different symptoms
Commmon age is 18-25
52.What is the average amount of time between onset of symptoms and actual
diagnosis of Bipolar Disorder?
6-10 years
53. Why is family/friend support so important for patients with Bipolar Disorder?
it can significantly impact the individual's mental health, treatment adherence, and overall well-being.
54. Is there a genetic predisposition in Bipolar Disorder?
Yes
55. Explain the theory regarding how the limbic system and prefrontal cortex become
less connected/disconnected during a manic episode.
The theory surrounding the disconnection between the limbic system and the prefrontal cortex during a manic episode is an important aspect of understanding the neurobiological mechanisms of Bipolar Disorder. This disconnect helps explain several of the characteristic symptoms of mania, such as impulsivity, risk-taking behavior, emotional dysregulation, and grandiosity.
56. How do the mood stabilizers, used in Bipolar Disorder, work?
Mood stabilizers are a critical part of the treatment plan for Bipolar Disorder, as they help manage the extreme mood fluctuations characteristic of the condition — namely, the manic and depressive episodes. The goal of mood stabilizers is to help regulate mood, preventing both the manic highs and the depressive lows that individuals with Bipolar Disorder experience.
57. Risk of relapse of Bipolar Disorder if a patient stops their “mood stabilizer”
medication.
is significantly increased if a patient stops taking their mood stabilizer medication. Mood stabilizers are crucial in managing the episodic nature of Bipolar Disorder, helping prevent both manic and depressive episodes. Discontinuing these medications can lead to a rapid return of symptoms, which often results in a worsening of the disorder.
58. What role does psychotherapy play in the treatment of Bipolar Disorder?
Psychotherapy plays a significant and complementary role in the treatment of Bipolar Disorder alongside medication. While mood stabilizers and other medications are crucial for managing the biological aspects of the disorder, psychotherapy helps individuals manage the emotional, social, and behavioral aspects. It can improve overall functioning and quality of life and assist in preventing relapse.
59. Risk of suicide attempt in patients with Bipolar Disorder?
Significantly higher
