Anxiety and mood disorders

What are the symptoms of MDD

• Persistent sad mood (has to be one of the symptoms)

• Lack of pleasure aka. Anhedonia (has to be one of the symptoms)

• Weight gain or loss

• Sleep gain or loss (insomnia vs. Hypersomnia)

• Fatigue

• Suicidal thoughts

• Agitation or 'retardation' - restless or slow

• Recurrent thoughts of guilt /worthlessness

• Diminished ability concentrate

What are the 8 depressive disorders in the DSM-5?

1. Disruptive mood regulation disorder

2. Major depressive disorder

3. Persistent depressive disorder (dysthymia)

4. Premenstrual dysphoric disorder

5. Substance / medication induced depressive disorder

6. Depressive disorder due to another medical condition

7. Other specified depressive disorder

8. Unspecified depressive disorder

What are the symptoms of dysthymia (persistent depressive disorder)?

• Poor appetite / overeating

• Insomnia/ hypersomnia

• Fatigue

• Low self-esteem

• Poor concentration indecisiveness

• Sense of hopelessness

What is the course of MDD??

• Can begin at any age, but onset increases significantly with puberty

• Peak onset is 20's

• People can go 2 or more months with no symptoms or years without experiencing an episode

• Most people experience spontaneous recovery (recover without intervention) -for 4 of 5 people, this will happen within 12 months

What are factors associated with lower rates of recovery for MDD?

• Symptom severity

• Personality disorders

• Psychotic features

What are factors associated with an increased risk of an episode of MDD?

• Severity of previous episode

• Being younger at onset

• More prior episodes

What is the course of persistent depressive disorder (dysthymia)?

• Early and chronic onset

• Some people rarely experience remission

• Symptoms will return at a lower level

What is the prevalence of depressive disorders?

• prevalence in adults is 6-7% (Aus and US)

• 12 month prevalence rate for dysthymia is 0.5%

What are the implications in the aetiology of depressive disorders?

• Disruption in neurotransmitter functioning

• Genetic risk

• Childhood trauma,abuse or neglect

• Incidence of negative life events

What is the cognitive behavioural model of depression?

Made up of 2 components:

1. Behavioural component - suggest that depression is maintained by a lack of positive reinforcement - feeds into a sense of learned helplessness in relation to external environment

2. Cognitive component - suggests that depression is about cognitive thoughts relating to the self, the world and the future -pessimism

What is used to treat depressive disorders?

• Ants depressant medications

• SSRI's ( selective serotonin reuptake inhibitors) -most prescribed class of anti-depressants

• ECT ( electroconvulsive therapy)

• Biological treatment used as a last resort

• Psychological interventions - CBT (cognitive behavioural therapy) and IPT ( interpersonal therapy)

What are the key strategies in CBT for depression?

Behavioural activation aka pleasant events scheduling - targets symptom of anhedonia (loss of pleasure/ interest)

Engage in previously enjoyed activities - positive reinforcement

Cognitive restructuring

Help clients identify negative thoughts relating to sadness and hopelessness -evaluate evidence for and against these thoughts

What are the 10 anxiety disorders in the DSM-5?

1. Separation anxiety disorder

2. Selective mutism

3. Specific phobia

4. Social anxiety disorder (social phobia)

5. Panic disorder

6. Agoraphobia

7. Generalised anxiety disorder

8. Substance/ medication induced anxiety disorder

9. Anxiety disorder due to another medical condition

10. Other specified anxiety disorder

What are the 3 systems of anxiety?

1. Cognitive - what people think during anxiety -provoking situations

2. Behavioural- action taken when feeling anxious

3. Psychological - bodily responses to anxiety

What are the symptoms of specific phobia?

• Extreme fear: fear that is disproportionate to the actual threat -specifically related to the identified object or situation

• Avoidance behaviour

• duration and impact:

  • Persist for 6 months or longer

  • Causes significant stress / interference in daily functioning

  • Symptoms cannot be better explained by another condition

Diagnostic criteria for generalised anxiety disorder (GAD)

• 6 months

• Worry is difficult to control

• At least 3 of 6 physiological symptoms present (muscle tension, restlessness, fatigue, difficulty concentrating, irritability and sleep disturbances

• Distress and impairment

• Exclusion criteria

• Individuals with GAD also often exhibit hyper-vigilance

What are the symptoms of panic disorder?

• Palpitations, pounding heart, accelerated heart rate

• Sweating

• Trembling or shaking

• Shortness of breath

• Feelings of choking

• Chest pain/discomfort

• Nausea or abdominal pain

• Dizziness, lightheadedness

• Chills or heat sensations

• Derealisation

• Depersonalisation

• Numbness or tingling

• fear of loosing control / going crazy

• Fear of dying

Comorbidity

Simultaneous presence of more than one diagnose in an individual

Implications in the aetiology of anxiety disorders

• Stressful life events

• Genetic influence

• Temperament

• Exposure to traumatic events

• Parenting behaviours

• Interaction between biological and environmental factors

Stanley Rackmann's Pathways to Fear Development

• Direct experience: personal negative experiences - conditioning

• Instructional learning: warnings from others, particularly caregivers

• Vicarious learning: observing significant others behaving fearfully

Interventions for anxiety disorders

• psychoeducation about anxiety -use of a cognitive behavioural model

• cognitive restructuring - ABC model

• Behavioural strategies - exposure hierarchy