Chapter 5 Depressive Disorders PDF

8/18/2024 Copyright Notice Do not remove this notice. 1 CHAPTER 5 DEPRESSIVE DISORDERS Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd...

8/18/2024 Copyright Notice Do not remove this notice. 1 CHAPTER 5 DEPRESSIVE DISORDERS Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-2 2 1  8/18/2024 LEARNING OBJECTIVES 5.1 Describe the diagnostic criteria for depressive disorders 5.2 Understand the prevalence of depression in various groups and its associated features 5.3 Understand the current biological, psychological and social theories of the causes of major depressive disorders 5.4 Understand the effective treatments for depressive disorders and approaches to reducing relapse and preventing the onset of depression Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-3 3 Depressive and Bipolar Disorders Mania Depression Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-4 4 2  8/18/2024 Depressive and Bipolar Disorders Mania Depression Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-5 5 DSM-5 Changes In DSM-IV, “Mood Disorders” included both Depressive (Unipolar) Disorders and Bipolar Disorders. In the DSM-5 (and also the DSM-5-TR), there are now separate chapters of “Depressive Disorders” and “Bipolar and Related Disorders”. There is now no longer a category called “Mood Disorders” in the DSM, although it is still commonly used. Sometimes the term Affective Disorders is used. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-6 6 3  8/18/2024 DSM-5 Changes The DSM-5 also includes three new changes to the depressive disorders: – Bereavement no longer excluded from a diagnosis of major depression – In the DSM-5-TR, they have added Prolonged Grief Disorder, but in the Trauma- and Stressor-Related Disorders section. – Dysthymic disorder renamed “persistent depressive disorder”, but still can be referred to as dysthymia – The addition of “disruptive mood dysregulation disorder” Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-7 7 Terminology Unipolar Disorder Either Depression or Mania? Actually just depression (aka depressive disorders) Bipolar Disorder Always alternating? Actually, could just be mania (unipolar mania) but more typically alternates Depression and mania are constructs but not diagnoses Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-8 8 4  8/18/2024 DSM-5 Depressive Disorders Disruptive Mood Dysregulation Disorder Major Depressive Disorder Persistent Depressive Disorder (Dysthymia) Premenstrual Dysphoric Disorder Substance/Medication Induced Depressive Disorder Depressive Disorder Due to Another Medical Condition Other Specified Depressive Disorder Unspecified Depressive Disorder Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-9 9 DSM-5 Depressive Disorders Disruptive Mood Dysregulation Disorder Major Depressive Disorder Persistent Depressive Disorder (Dysthymia) Premenstrual Dysphoric Disorder Substance/Medication Induced Depressive Disorder Depressive Disorder Due to Another Medical Condition Other Specified Depressive Disorder Unspecified Depressive Disorder Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-10 10 5  8/18/2024 Historical Approaches In Ancient Greece, “melancholia” was a mental condition characterised by fear and depression – now used to refer to a sub-type of major depressive disorder Emil Kraepelin (1896) identified “manic depressive insanity” as a major category of mental illness Distinction between unipolar depression and bipolar disorder made by Karl Leonhard (1957) Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-11 11 Depressive Disorders With various disorders, I will try to cover: – General Description (diagnostic criteria, etc.) – Epidemiology – Aetiology (causes) – Treatment Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-12 12 6  8/18/2024 DSM Defined [Mood] Episodes Primary depressive (and bipolar) disorders are based on the presence or absence of various types of Episodes: – Major Depressive – Manic – Hypomanic Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-13 13 DSM-5 Diagnostic Criteria for Major Depressive Episode A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure 1) Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood. 2) Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation). 3) Significant weight loss when not dieting or weight gain (e.g., a change of more that 5% of body weight in month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains. 4) Insomnia or hypersomnia nearly every day. 5) Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down). 6) Fatigue or loss of energy nearly every day. 7) Feelings of worthlessness of excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick). 8) Diminished ability to think or concentrate, or indecisiveness, nearly every day (ether by subjective account or as observed by others). 9) recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide. Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-14 14 7  8/18/2024 DSM-5 Diagnostic Criteria for Major Depressive Episode B. The symptoms cause clinically significant or impairment in social, occupational, or other important areas of functioning. C. The episode is not attributable to the physiological effects of a substance or to another medical condition. Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-15 15 Major Depressive Episode 2 Weeks or More Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-16 16 8  8/18/2024 Now, from Episodes to Disorders First Depressive Disorders Then Bipolar Disorders (next week) Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-17 17 DSM-5 Depressive Disorders Disruptive Mood Dysregulation Disorder Major Depressive Disorder Persistent Depressive Disorder (Dysthymia) Premenstrual Dysphoric Disorder Substance/Medication Induced Depressive Disorder Depressive Disorder Due to Another Medical Condition Other Specified Depressive Disorder Unspecified Depressive Disorder Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-18 18 9  8/18/2024 DSM-5 Diagnostic Criteria for Major Depressive Disorder A. One or more major depressive episodes. B. The occurrence of the major depressive episode is not better explained by another mental disorder. C. There has NEVER been a manic episode or hypomanic episode. Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-19 19 Depressive Disorders: Major Depression – Single Episode 2 Weeks or More Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-20 20 10  8/18/2024 Depressive Disorders: Major Depression – Recurrent Depressive Episodes 2 weeks or more each Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-21 21 Depressive Disorders: Major Depressive Disorder DSM-5 includes “specifiers” in the clinical diagnosis. These are extensions to the diagnosis to clarify such variability as: – severity of depression (mild, moderate or severe) – number of episodes of depression (single, recurrent) – degree of recovery between episodes (full or partial) – depression with …. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-22 22 11  8/18/2024 Subtypes of Depressive Disorders With… – Anxious distress – Melancholic features  Inability to experience pleasure (anhedonia) – Psychotic features  Delusions or hallucinations – Catatonia  Extreme physical immobility or excessive peculiar physical movement – Peripartum onset  During pregnancy or within 4 weeks of giving birth – Seasonal pattern Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-23 23 DSM-5 Depressive Disorders Disruptive Mood Dysregulation Disorder Major Depressive Disorder Persistent Depressive Disorder (Dysthymia) Premenstrual Dysphoric Disorder Substance/Medication Induced Depressive Disorder Depressive Disorder Due to Another Medical Condition Other Specified Depressive Disorder Unspecified Depressive Disorder Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-24 24 12  8/18/2024 DSM-5 Diagnostic Criteria for Persistent Depressive Disorder (Dysthymia) A. Depressed mood for most of the day, for more days than not, as indicated either by subjective account or observation by others, for at least 2 years. Note: In children and adolescents, mood can be irritable and duration must be at least 1 year. B. Presence, while depressed, of two (or more) 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 making decisions 6) Feelings of hopelessness C. During the 2-year period (1 year for children or adolescents) of the disturbance, the person has never been without the symptoms in Criteria A and B for more than 2 months at a time. Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-25 25 DSM-5 Diagnostic Criteria for Persistent Depressive Disorder (Dysthymia) D. Criteria for major depressive disorder may be continuously present for 2 years. E. There has NEVER been a manic episode or hypomanic episode, and criteria have never been met for cyclothymic disorder. F. The disturbance is not better explained by another disorder. G. The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hypothyroidism). H. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Copyright © 2022 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-26 26 13  8/18/2024 Depressive Disorders: Persistent Depressive Disorder (Dysthymia) 2 Years or More Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-27 27 Depressive Disorders: Persistent Depressive Disorder (Dysthymia) 2 Weeks or More Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-28 28 14  8/18/2024 Depressive Disorders With various disorders, I will try to cover: – General Description (diagnostic criteria, etc.) – Epidemiology – Aetiology (causes) – Treatment Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-29 29 The Epidemiology of Depressive Disorders Prevalence in Australia is around 3.1 per cent in men and 5.1 per cent in women over a one-year period Women are twice as likely to experience depression as men High levels of anxiety and substance abuse are associated with an increased risk of developing depression in young people Other risk factors include a history of depression, ongoing family conflict, a history of sexual or physical abuse, residing in a rural area, being of Aboriginal or Torres Strait Islander descent, and having a parent with a psychological disorder Median age at onset is approximately 30 years Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-30 30 15  8/18/2024 Prevalence Data - Australia Data from: Teesson, Mitchell, Deady, Memedovic, Slade, & Baillie. (2011). Affective and anxiety disorders and their relationship with chronic physical conditions in Australia: findings of the 2007 National Survey of Mental Health and Wellbeing. Australian and New Zealand Journal of Psychiatry, 45, 939-946 Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-31 31 The Epidemiology of Depressive Disorders Fifty percent of those with a depressive disorder will recover within six months following treatment. Many who recover from a first episode will have another episode within five years. Earlier age of onset, continued experience of some symptoms, multiple prior depressive episodes, ongoing life stressors and history of depression in family members increases the risk of relapse. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-32 32 16  8/18/2024 Additional Problems Associated with Depressive Disorders Increased risk of suicide attempts and death by suicide – Rate of suicide in the community from depressive disorders is approximately 3.5 per cent – Higher rate for male suicides (6.9 per cent), than female suicides (1.1 per cent) Impaired social and occupational functioning Co-morbid anxiety disorders Increased physical health problems Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-33 33 Symptom Variation and Depressive Disorders Symptom variation across cultures – Latino cultures  Complaints of nerves and headaches – Asian cultures  Complaints of weakness, fatigue, & poor concentration Symptom variation across life span – Children  Stomach & headaches – Older adults  Distractibility and forgetfulness Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-34 34 17  8/18/2024 More on Gender Differences in Depressive Disorders Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-35 35 More on Gender Differences in Depressive Disorders MDD and DD more common in women than men – Similar discrepancy occurs in many countries Differences emerge in adolescence Some biological and psychological factors may factors: – Measurement bias – Hormones – Girls twice as likely to experience sexual abuse – Women more likely to experience chronic stressors – Girls and women more likely to worry about body image – Women may react more intensely to interpersonal loss – Women spend more time ruminating; men tend to distract Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-36 36 18  8/18/2024 Depressive Disorders With various disorders, I will try to cover: – General Description (diagnostic criteria, etc.) – Epidemiology – Aetiology (causes) – Treatment Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-37 37 Aetiology of Depressive Disorders Biological factors: – Genetic component—a family history increases the risk of depression by two to three times – Polymorphism on the 5-HTTLPT gene is associated with an increased risk of depression in combination with aversive life events – Neurotransmitter activity is implicated in depression – Hyperactivity in the hypothalamic-pituitary-adrenal (HPA) axis – Potential structural or functional abnormalities in the pre-frontal cortex, hippocampus, anterior cingulate cortex and the amygdala – Inflammation-related theories Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-38 38 19  8/18/2024 Aetiology of Depressive Disorders Environmental factors: – Stressful life events (acute: financial disaster; chronic: living with an abusive partner) can act as causal triggers – Growing up in a hostile, disruptive and violent family environment increases the risk – Environmental risks usually interact with biological and learnt psychological vulnerabilities to trigger depression – It is possible to reduce the impact of stressful life experiences by increasing social support Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-39 39 Aetiology of Depressive Disorders Social factors: – Interpersonal difficulties  High expressed emotion (relationships involving hostility, high levels of criticism, and over- involvement) have been linked to depression – Lack of intimate relationships  Particularly a risk factor for women Protective factors: – Good interpersonal skills – High levels of family cohesion – Being connected with one’s community – Achievement in a valued pursuit – Optimism and low anxiety – Openness to experience – Effective coping skills Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-40 40 20  8/18/2024 Aetiology of Depressive Disorders Psychological factors including cognitive theories, behavioural theories, and psychoanalytic theories – Cognitive theories:  Depressive attributional style – seeing negative events as due to internal, global, and stable factors  Beck’s negative cognitive triad – depressed people hold a negative view of the self, the world and the future, and this view is maintained by cognitive distortions – Behavioural theories:  Focus on contingencies associated with depressed and non-depressed behaviours  Highlight the role of poor coping skills – Psychoanalytic theories:  Depression is a form of pathological grief Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-41 41 Aetiology of Depressive Disorders: Psychological Factors Cognitive theories – Beck’s theory – Negative triad  Negative view of: Self World Future – Negative schemata  Underlying tendency to see the world negatively – Negative schemata cause cognitive biases  Tendency to process information in negative ways Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-42 42 21  8/18/2024 Several Depressogenic Cognitive Distortions Overgeneralisation: one experience applies to all situations Selective abstraction (mental filter): only measuring oneself via failure Personalisation: assuming oneself is responsible for all failures Emotional Reasoning: you feel it; therefore, it must be so Dichotomous thinking: everything is either one extreme or the other Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-43 43 Beck’s (1976) Cognitive Model Regarding The Development of Depressive Episodes Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-44 44 22  8/18/2024 Three Helplessness/Hopelessness Theories of Depression Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-45 45 Depressive Disorders With various disorders, I will try to cover: – General Description (diagnostic criteria, etc.) – Epidemiology – Aetiology (causes) – Treatment Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-46 46 23  8/18/2024 Treatment of Depressive Disorders Pharmacological and physical approaches: – Medication – Repetitive transcranial magnetic stimulation – Vagus nerve stimulation – Bright light therapy for seasonal affective disorder – Electroconvulsive therapy (for severe depression) Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-47 47 Medications for Treating Depressive Disorders Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-48 48 24  8/18/2024 Medications for Treating Depressive Disorders Published studies may overestimate the effectiveness of medication (Turner et al., 2008. Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy). Compared Food and Drug Administration (FDA) versus published versions of efficacy of medications. According to the published literature, it appeared that 94% of the trials conducted were positive. By contrast, the FDA analysis showed that 51% were positive. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-49 49 Psychological Treatment of Depressive Disorders Interpersonal Psychotherapy (IPT) – Short term psychodynamic therapy – Focus on current relationships Behavioural Therapy – Behavioural activation Cognitive Therapy – Monitor and identify automatic thoughts  Challenge negative thoughts replace with more neutral or positive thoughts – Includes behavioural components too Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-50 50 25  8/18/2024 Cognitive Therapy Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-51 51 Basic Questions of Cognitive Restructuring 1. What’s the evidence? 2. What are alternative explanations? 3. What are the realistic implications? So what? Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-52 52 26  8/18/2024 Cognitive Therapy Judith Beck PhD talks about Cognitive Therapy – You might need to turn up the volume In my opinion, “talk therapy” is a very bad term. Notice that it is directive and didactic (client takes notes and has homework). Notice the references to challenging one’s thoughts (e.g., what’s the evidence). There are also references to relapse prevention. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-53 53 Self-Help Approaches Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-54 54 27  8/18/2024 Relapse Prevention Most common method is antidepressant medication Continue active phase of psychological treatment, e.g., CBT and IPT – Plan how to cope with future triggers to depressed mood – Develop a plan for how to respond if symptoms re-emerge Treatments specifically for relapse: – Well-being therapy – Preventive cognitive therapy – Mindfulness-based cognitive therapy Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-55 55 The Prevention of Depression Most preventive interventions have CBT or interpersonal focus – Teach cognitive, interpersonal and coping skills – Most effective when the target group has some risk of developing depression due to family history, pre-existing symptoms, or adverse environmental fact Some programs aimed at all members of a population, regardless of pre-existing risk level – Inconsistent effects – Require substantial resources to reach large numbers Internet delivery of treatment and prevention programs may be promising Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-56 56 28  8/18/2024 Any Questions? If so, post them online Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 5-57 57 29