PSYC1002 MHC Lecture 7 2024_depressive disorders CANVAS.pptx

https://www.wearitpurple.org/ https://www.sydney.edu.au/about-us/vision-and-values/diversity/pride-network.html https://www.sydney.edu.au/students/lgbtiq-pride-network/lgbtiq-support.html Wear it Purple Day is: 30-08-24 PSYC1002: Mental Health Conditio...

https://www.wearitpurple.org/ https://www.sydney.edu.au/about-us/vision-and-values/diversity/pride-network.html https://www.sydney.edu.au/students/lgbtiq-pride-network/lgbtiq-support.html Wear it Purple Day is: 30-08-24 PSYC1002: Mental Health Conditions Lesson 7 Depressive disorders Dr Elizabeth Seeley-Wait Credit for slides: Dr Rebekah Laidsaar-Powell (and with changes from Dr Sarah Ratcliffe) Today’s Lesson Major Depressive Disorder Persistent Depressive Disorder Support is available! Student Counselling Service: Phone +61 2 8627 8433 +61 2 7255 1562 [email protected] Psychology Clinic (provisional psychologists supervised by people like me; you are eligible but you will just need to see if it is the right fit for you through an intake): Phone Mood disorders Characterised by a disturbance in mood Continuum : Extremes of normal mood Mood disorders are episodic Avg number of times in a lifetime = 4 Increased risk with each episode (16%) Diagnosis relies on the presence or absence of specific mood episodes Mood disorders DSM-IV Mood Disorders Major Depressive Disorder Dysthymic Disorder Depressive Disorder NOS Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder Bipolar NOS Mood disorder Due to (medical condition/substance abuse/withdrawal) Mood Disorder NOS DSM-5 Depressive Disorders Bipolar and Related Disorders Disruptive Mood Bipolar I Disorder Dysregulation Disorder Bipolar II Disorder Major Depressive Disorder Cyclothymic Disorder Persistent Depressive Substance/Medication- Disorder Induced Bipolar Disorder Premenstrual Dysphoric Bipolar Disorder Due to Disorder Another Medical Condition Substance/Medication- Other Specified Bipolar induced Depressive Disorder Disorder Depressive Disorder due Unspecified Bipolar Disorder to another medical condition Other Specified DSM-5 Depressive Disorders Disruptive Mood Dysregulation Disorder Major Depressive Disorder Persistent Depressive Disorder Common features: presence of sad, empty, irritable mood with Premenstrual Dysphoric somatic and cognitive changes Disorder affecting function. Substance/Medication- induced Depressive Disorder Depressive Disorder due to another medical condition Other Specified Sadness Sadness as a life experience It is milder and temporary and is an almost universal experience Feeling blue, sad, discouraged, apathetic, passive, lacking joy  feelings experienced by many Common after negative experiences – death, illness, relationship breakdown, lost/missed experiences Feelings usually fade, become accustomed to new “normal” Sadness vs Clinical Depression Frequency, intensity, and duration of depressive symptoms out of proportion to person’s life situation  Depressive disorder Responses to significant loss may include feelings of sadness, insomnia, poor appetite: may resemble depressive episode Responses may be understandable or considered appropriate to the loss BUT also don’t want to underdiagnose depression in someone who has faced significant loss. Clinicians need to use clinical judgement based on individuals history, and personal + cultural context Major Depressive Disorder DSM-5 Major Depressive Episode At least 5 or more symptoms during 2 week period (need #1 or # 2) 1. Depressed mood most of the day, nearly every day 2. Markedly diminished pleasure/interest in activities 3. Significant weight loss or weight gain 4. Insomnia or hypersomnia nearly every day 5. Psychomotor agitation or retardation 6. Fatigue or loss of energy nearly every day 7. Feelings of worthlessness and excessive guilt nearly every day 8. Diminished ability to concentrate nearly every day 9. Recurrent thoughts of death, suicide, suicide attempts Clinically significant distress / impairment Not attributed to substance use or other medical condition DSM-5 Major Depressive Episode/Disorder DSM-5 Major Depressive EPISODE 5 or more symptoms during 2-week period Affective symptoms: depressed mood, anhedonia Cognitive symptoms: indecisiveness, lack of concentration Somatic (physical) symptoms: fatigue, sleep or appetite change Motivational symptoms: loss of interest, lack of drive DSM-5 Major Depressive DISORDER Single or recurrent depressive episode (MDE), not accounted for by other disorders (e.g. Bipolar disorder, Schizophrenia, etc.) There has not been a manic, hypomanic or mixed episode Recurrent episodes are common DSM-5 Major Depressive Episode/Disorder Prevalence and course of MDD Prevalence= 5-25% (depending on age, gender) One in seven Australians will experience depression in their lifetime Depression has the third highest burden of all diseases in Australia Depression is the number one cause of non-fatal disability in Australia Onset often after puberty, peaking in 20’s (but can be late in life) Females are twice as likely to have a unipolar mood disorder compared to males Comorbidity with Anxiety and Substance Abuse Course variable – remission from symptoms, number and length of episodes Persistent Depressive Disorder DSM-5 Persistent Depressive Disorder Depressed mood for most of the day, for more days than not, for at least 2 years Presence of two (or more) 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 Individual has never been without these for more than 2 months at a time Criteria for a major depressive disorder (MDD) may be continuously present for 2 years. No manic episodes or a hypomanic episodes Not better explained by other psychotic disorders. The symptoms are not attributable to the physiological effects of a substance or another medical condition (e.g. hypothyroidism). Clinically significant distress and/ or some interference in social, occupational, or other important functioning Prevalence and course of PDD Prevalence= 1-2 % Early onset (childhood, adolescence, early adulthood) Chronic course May be milder than MDD, but still causing distress/dysfunction Lacking symptom free periods Theories & Treatments Depressive Disorders- Biological Biological Theories Genetic vulnerability Heritability: 35-60 percent identical > fraternal > siblings Heredity creates a vulnerability to mood disorders Neurochemistry Low levels of Noradrenalin and/or Serotonin No good evidence for causal mechanism Neuroendocrine System Excess cortisol in response to stress Increased stress is strongly related to mood disorders Vulnerability Stress Models: Biological vulnerability + stress  Depression Depressive Disorders- Biological Biological Treatments Drug treatments: Selective Serotonergic Reuptake Inhibitors (SSRIs) Prozac, Zoloft, Paxil, etc Specifically block reuptake of serotonin Fewer side effects than older drugs Effective in 70-80% Electroconvulsive Therapy (ECT) Involves applying brief electrical current to the brain Uncertain how/why ECT works Can be effective for severe depression (80%+) Relapse is common with biological treatments Therefore likely to be treating the symptoms not the cause Depressive Disorders- Psychological Psychological Theories Diathesis Stress Models Cognitive vulnerability + stress  Depression Schema Theory (Beck, 1976) Schema = Stable memory structures that guide an individual’s information processing style. Pre-existing negative schemas: Developed during childhood; Activated by stress; Result in information processing biases (e.g. attentional biases) Negative thoughts become dominant Distorted view of Self, World, Future Ruminative response styles (Nolen-Hoeksema, 1991) Depressive Disorders- Psychological Vicious cycle of depression Depressive Disorders- Psychological Cognitive Behavioural Therapy Aim: Modify dysfunctional cognitions and related behaviours Psychoeducation Behavioural activation Cognitive restructuring Cognitive Address cognitive errors Aims to develop more realistic view Removing the lens of negative schemas NOT positive thinking Depressive Disorders- Psychological Cognitive-Behavioural Therapy Behavioural Behavioural Experiments Testing beliefs Gathering evidence to: disconfirm negative beliefs support more realistic beliefs/interpretations Behavioural Activation Increase reinforcing/positive events (things to look forward to) Identifying goals and values Building upward spiral of motivation and energy through pleasure /mastery Activity scheduling Outcomes of CBT are comparable to drug therapy Lower relapse rates than biological treatments Depressive Disorders- Psychological Lesson 5: Done