Chapter 8: depression and mood disorders

true or false: depression is the most disabling condition

false: it’s associated with high levels of disability

what are the DSM5 diagnostic criteria for major depressive disorder? (9, how many you need to be diagnosed)

1. depressed mood most of the day

2. diminished interest or pleasure in all or almost all activities

3. significant weight loss of gain

4. insomnia or hypersomnia

5. psychomotor agitation or retardation

6. fatigue or loss of energy

7. feelings of worthlessness or excessive guilt

8. diminished ability to think, concentrate or indecision

9. recurrent thoughts of death, suicide

• need at least 5, one of them has to be #1 or #2

define “mood disorders”

severe deviations in mood

define “major depressive episode”

extremely depressed mood state that lasts for at least two weeks, includes cognitive symptoms and disturbed physical functions

define “specifier”

• symptoms that may (or may not) accompany a depressive disorder, but help us determine the treatment or course

• you have the symptoms, but not enough to get diagnosed with that disordern

what are the specifiers for major depressive disorder?

1. anxious mood: being tense, restless

2. mixed features: mania, hypomania

3. melancholia: loss of pleasure in most actives

4. atypical features: mood reactivity (better mood in response to s positive event)

5. psychotic features: delusions, hallucinations

6. catatonia: catatonic behaviour (motor immobility or excessive motor activity)

7. peripartum onset: during or 4 weeks postpartum

8. seasonal pattern: worse during winter, improve during spring and summer

define “major depressive disorder with anxious mood”

experiencing symptoms of anxiety along with depression (ex: tense, restless, not concentrating)

define “major depressive disorder with mixed features”

depressive symptoms with some mania or hypomania

define “major depressive disorder with melancholia”

• loss of pleasure in most activities, lack of reaction to pleasurable stimuli

• + at least 3 of: early morning awakening, significant weight loss, excessive guilt, psychomotor retardation or agitation

which specifier of major depressive disorder would technically work well with antidepressants?

melancholia as it’s a “biological” depression

define “major depressive disorder with atypical features”

• mood brightens in response to certain activities, but gets bad again when the activity is over

• + at least 2: weight gain/increased appetite, hypersomnia, leaden paralysis, interpersonal rejection sensitivity

define “major depressive disorder with psychotic features”

delusions or hallucinations that are congruent or incongruent with the mood

define “major depressive disorder with catatonia”

depressive symptoms are accompanied by catatonic behaviour: motor immobility, excessive motor activity, extreme negativism, mutism or peculiar voluntary movements

define “major depressive disorder with peripartum onset”

depressive episode occurs during pregnancy or within four weeks postpartum

define “major depressive disorder with seasonal pattern”

depressive episodes occur in a seasonal pattern, usually worsening in the winter and improving in the spring or summer

define “relapse”

return of depressive symptoms when you thought you were getting better

define “recurrence”

being free of depressive symptoms for at least 2 months (recovered), but getting them again

what’s the difference between relapse and recurrence?

• relapse: you were starting to get better, but suddenly got worse again

• recurrence: you technically recovered, but then got it again

true or false: most people only have depression once in their life

false: it’s something recurrent, if you had it once then you will most likely have it again

how many depressive episodes do people have in a lifetime and for how long to they last?n

• 4-7

• 4-5 months

define “persistent depressive disorder”

depressive symptoms that don’t meet the criteria for major depressive disorder, but still have a chronic onset

what’s the duration for persistent depressive disorder?

depressive mood for most days for at least two years

what are the symptoms for persistent depressive disorder? (6, how many do you need)

1. poor appetite or overeating

2. insomnia or hypersomnia

3. low energy or fatigue

4. low self-esteem

5. poor concentration or difficulty making decisions

6. feelings of hopelessness

how long can persistent depressive disorder last?

20-30 years

define “treatment-resistance depression”

depressive symptoms that last more than 1 year, but that give poor response to two adequate antidepressants

how can you assess depression? (3)

• clinical interview

• structure diagnostic interview

• self-report measures

why is there a slow presentation in people in depression? (act, talk slowly)

it reflects their slow cognitive process

when and why would you use structured diagnostic interview?

• when: for research

• why: you want to make sure that everyone has the same specifier of depression

explain how the BDI-II was used and why it’s not popular today

• self-report measure: you would answer questions about different levels of depression

• problem: asker questions that weren’t relevant to depression (ex: past failure, self-criticism)

explain how the PHQ9 is used

self-report measure that asks questions based on the 9 diagnostic criteria for depression

why can’t you use the PHQ9 to diagnose depression?

it’s a self-report measure: you could score high only because you’re going through a tough time

what’s the difference between incidence and prevalence?

• incidence: new cases

• prevalence: look at everyone

true or false: you get false positives and false negatives when using the PHQ9

true:

• false positive: someone goes through a tough time, but PHQ9 says that they have depression

• false negative: person doesn’t understand the questions or doesn’t answer truthfully, but they actually have depression

→ this is why you don’t use PHQ9 to diagnose

what are the mental disorders that comorbid with depression? (4)

• anxiety disorders: anxiety, panic, social anxiety, phobia, OCD

• substance abuse disorder

• personality disorder

• PTSD

why do we say that depression is disabling?

because it affects how you feel and what you do

what are the sec difference found in depression? (8)

1. women express more distress or vulnerability

2. rumination: women worry more

3. lack of control: women have less control

4. lower status: women have lower status than men even of they work more

5. greater role burden: women usually have more home tasks

6. greater life stresses

7. higher rates of trauma: violence, discrimination

8. hormonal factor

what are the risk factors for depression? (6)

• facility history of depression

• adverse childhood experiences

• exposure to traumatic events

• major life changes

• socioeconomic status

• social isolation

explain the hypothesis and the method used for the experiment on “relation between perceived injustice and symptom severity”

• hypothesis: changes in perceived injustice would predict changes in symptom severity

• method:

  • participants: patients with major depressive disorder

  • measure: depressive symptom severity, perceived injustice, catastrophic thinking

• → reduce perceived injustice will predict a reduction in depression (because we sometimes use a language as if what they live is unfair)

  • but reduced symptom doesn’t predict reduced perception of injustice

true or false: pain catastrophizing doesn’t have an depressive symptoms

false: it does

what’s the value of transdiagnostic variables? (3)

• prevent adverse outcomes

• prevent co-morbidity

• manage diver conditions: different techniques for different things

what are the psychological risk factors for depression? (6)

• helplessness

• dependency

• self-criticism

• low self-esteem

• perfectionism

• neuroticism

how can social support help someone with mood disorders?

it’s a buffer: if you through a tough time, but you feel supported by friends or family, then your symptoms will be less worse

how can the effects of depression of others affect you?

when you struggle to maintain your own mood, you don’t want to interact with someone’s who’s depressed because it will bring your mood down

true or false: marriage and family life can gave an impact on depression

true: especially in conflicts. your walls aren’t as up and criticisms will have an important impact on you

what was Harry Stack Sullivan’s theory on social relationships and depression?

• social relationships and interpersonal experiences shape mental health

• depression can be influenced by disruptions or difficulties in social relationships (loneliness, social rejection, conflict)