Moods and Disorder Pt 2

Specifiers for MDD – Psychotic Features

 With Melancholic Features:  

– Early morning awakening, depression worse in the morning, psychomotor changes, loss of appetite/weight, excessive guilt.  

Specifiers for MDD – Psychotic Features

  With Psychotic Features:  

– Presence of delusions or hallucinations (usually mood-congruent).  

Specifiers for MDD – Psychotic Features 

With Atypical Features: 

– Mood reactivity (mood brightens in response to positive events) plus two or more symptoms (e.g., weight gain, hypersomnia, leaden paralysis, sensitivity to rejection).  

Specifiers for MDD – Psychotic Features 

With Catatonic Features:  

– Motoric immobility, including mutism and rigidity.  

Specifiers for MDD – Psychotic Features

With Seasonal Pattern:  

– Recurrent depressive episodes occurring at the same time each year with full remission in other seasons.

Symptoms of Persistent Depressive Disorder (Dysthymia)

 At least two of the following: poor appetite/overeating, insomnia/hypersomnia, low energy, low self-esteem, poor concentration, feelings of hopelessness.  

Key Characteristic of Persistent Depressive Disorder

 Intermittent periods of normal mood (lasting a few days to a few weeks, but never more than 2 months).  

Clinical note of Persistent Depressive Disorder

 intermittent normal moods, the chronic nature of persistent depressive disorder often results in outcomes as impaired as those seen in MDD.

Studies (e.g., Caspi et al., 2003) found that

individuals with s/s alleles who experienced four or more stressful life events were twice as likely to develop a major depressive episode compared to l/l individuals.  

Endocrine Dysregulation- The HPA Axis and Elevated cortisol is observed

in 20–40% of outpatients and 60–80% of hospitalized patients with depression.  

What percent of patients with serious depression, dexamethasone fails to suppress cortisol levels

45%

Prolonged cortisol elevations can lead to

to memory impairments, cognitive difficulties, and cell death in the hippocampus.

What is the relationship between hypothyroidism and depression?

Hypothyroidism is often associated with depression.

What percentage of depressed patients with normal thyroid levels show dysregulation of the hypothalamic–pituitary–thyroid axis?

Approximately 20–30% of depressed patients.

How can thyrotropin-releasing hormone impact treatment-resistant depression?

Administration of thyrotropin-releasing hormone can improve symptoms in some treatment-resistant cases.

How is depression linked to immune system dysregulation?

Depression is associated with activation of the inflammatory response system and increased production of proinflammatory cytokines.

What are examples of proinflammatory cytokines linked to depression?

Interleukin and interferon.

What does EEG research reveal about prefrontal cortex activity in depressed individuals?

Depressed individuals show lower left-hemisphere activity and higher right-hemisphere activity.

What structural abnormalities in the prefrontal cortex are found in depressed individuals?

Decreased volume in the orbital and dorsolateral prefrontal cortex.

How does prolonged cortisol exposure affect the brain in depression?

It may contribute to reduced hippocampal volume.

What abnormalities in the anterior cingulate cortex and amygdala are observed in depression?

The anterior cingulate cortex shows abnormalities, and the amygdala exhibits increased activation, possibly contributing to biased attention toward negative stimuli.

What are the normal sleep involves five stages

Five Stages 1–4 of non-REM and REM sleep

Example of a stressful life event

 loss of a loved one, major economic or health crises

Example of Independent life event

natural diasters

Example of dependent Life event

those partly generated by the person’s behavior

Dependent life event is stronger than independent in that

 life events may play a stronger role in triggering depression.  

Chronic Stress

ongoing for several months and is associated with increased risk for the onset, maintenance, and recurrence of depression.

Example of Chronic Stress

poverty and marital discord

Neuroticism

is a major psychological vulnerability for depression, as it is associated with a tendency to experience negative emotions like anxiety, sadness, and emotional instability.