Mood Disorder & Depression Ch.8 Psych 300 PDF

Mood disorder & depression: Ch.8 Oct.30 Conceptual definitions: 1. Emotion = effective reaction Physiological Cognitive Behavioral However it is transient (last a short time) 2. Mood = colours your life Prolonge...

Mood disorder & depression: Ch.8 Oct.30 Conceptual definitions: 1. Emotion = effective reaction Physiological Cognitive Behavioral However it is transient (last a short time) 2. Mood = colours your life Prolonged 2 weeks 3. Mood disorder = abnormal mood prolonged DSM 5 changes: Distinguish between depressive and bipolar disorders Depressive disorders- DSM 5: Symptoms are low mood Western culture: “Feeling guilty, life isn’t worth it” – cognitive Other culture: “My heart is closed”, something has taken my soul” Why? Linguistic differences Male depression : irritability, anger and low mood (gender differences) Major depressive disorders: What are the symptoms? Symptoms must last at least for 2-weeks (prolonged) not comes and goes When diagnosed: (5 must be met) 1. Depressed mood 2. Diminished interest or pleasure in almost all activities **Must have one or both first of above 3. Weight changes. (Loss of weight when depression severe at least 10lbs) 4. Insomnia/ hypersomnia (more likely insomnia) 5. Agitation= always walking around Retardation= physical slowing Psychomotor ** 6. Fatigue (less sleep) 7. Guilt and worthlessness (as depression more severe have extreme opinions) 8. Concentrate and indecisiveness inability (ex: I don’t know what I wanna wear) 9. Recurrent thoughts of death (escape from something intolerable) Severe depression – use of passive ideas of death ( I wish I was dead) Very severe depression – use present ideas of death ( I wanna kill myself) Age influence symptoms: Children: in the form of physical complaints and irritability (difficult/act up) Elderly: dementia (look depressed), physical changes, anxiety severity of the symptoms: the severity level indicates the symptoms and continues to slowly change. Sub-syndromal depression (not enough to diagnose) can be painful Severe forms of depression display psychotic symptoms Psychotic features: (highly severe form) Delusions: fixed false beliefs, hopeless 50% severe MDD: 1. Guilt 2. Disease (feeling of decaying) 3. Punishment (feeling that people want to kill me) 4. Nihilistic (feeling that the world is ending) 5. Impoverishment (being poor, no money)  Hallucinations – rare (taste, visual, auditory) Auditory (most common) Suicidal commands Hearing their name Blame Criticism Visual (less common) see dead people Indigenous culture: believe its normal when you are in danger ancestors come to guide you Gustatory- taste Bad taste in mouth (ex: believe someone is poisoning them) Chronic depression: (dysthymia/persistent depressive disorder) Require fewer symptoms to diagnose Symptoms may last short time (mood) Severity low Must last at least 2 years (persistence) Impairment: Less severity but lasts very long treatment ineffective Suicide rate higher Double depression: What: combination of MDD and Dysthymic disorder. How: chronic depressive symptoms with episodes of severe depression. Depressive episodes (at least 2-weeks) + persistent depression At least two years of depression Recurrence of symptoms high Epidemiology:  General: Prevalence high Adult 4-12% experience depression in their life time (affects a lot of people) Children 2.5%. (Some infants can be depressed) How can you tell: offspring does not smile in sonography Girls > boys (why: puberty) Onset: age 12-24 olds more common average age 25 ** onset age decreasing in adolescent girls (younger girls tend to have depression) Triggers: What causes depression? Interpersonal events that cause stress Interpretation of event Ex: separation, death, social exits Other factors: 1. Gender: children no difference Women > men **men show depression differently (anger/numbing/don’t seek help) **men talk to women about their emotions more than to other men 2. Impairment Suicide Occupation Incapacitate (remain in hospital) Clinical course: Could be recurrent Symptoms may remain (some) Remission (when get better) o If untreated last 4-9 months o Most get better by 12 months o Some get better by 3 months Contributors: 1. Biological 2. Neurological 3. Biochemical 4. Social 5. Behavioural Biological: A. Heritability is effective (37%) Severity: people with recurrent depression have greater heritability B. Anxiety shared heritability with depression Neurological: A. Correlation o Pre-frontal cortex: thinness of affect regulation ▪ What: approach behaviour change o Hippocampus: unable to remember details ▪ Smaller hippocampus due to stress o Anterior cingulate cortex: decreased activity ▪ What: connect amygdala and PFC o Amygdala: reactivity increase ▪ What: stress increase dendrite branches o Brodmann’s area 25: overactive MDD treatment resistance B. Neurotransmitter Dysregulation: Monoamines can be dysregulated. (Monoamine = neurotransmitter) 1. Norepinephrine 2. Serotonin 3. Dopamine 4. Secondary messengers (modulate other chemical circuits) Biochemical models: Unknown biochemical processes (broad idea of neurotransmitter imbalance) Monoamine theory: better model o Monoamine=neurotransmitters o Theory suggests an imbalance of neurotransmitters cause mood disorders o Specifically: dopamine, serotonin and norepinephrine Balance of neurotransmitters essential (serotonin lower than dopamine & norepinephrine) The state of mind and body change neurotransmitter levels Neuroendocrine models: Depression is a result of stressful events Stress builds a reactive HPA activation system Dysregulation of glutamate circuits BDNF (brain-derived neurotropic factor) and other biochemicals that maintain hippocampus down regulate Thinning of dendrites to hippocampus (erosion) Worsen memory collection and recall Biological Treatments: (first line treatment) 1. TCAs – antidepressants Problem: many side effects. (Sexual desire low, shakiness, dryness of mouth, drowsiness) **it has positive effects for some but studies don’t know who it is more effective for 2. MAO-inhibitors Problem: overlap with tyramine-aged food (wine, cheese…) which cause blood pressure increase 3. SSRIs (Prozac, Paxil, Effexor) Similar to TCAs with less side effects 4. Ketamine infusion: Increase glutamate, neuronal growth Problem: short-term help, dosage must be low to avoid killing brain cells (excitotoxicity) Exercise: Effective for mild to moderate MDD May enhance impact of medication (strong compound) Overall effectiveness: Reality is that they are not as effective as people believed. 1. Pharmaceutical companies: research Trials are funded by pharmaceutical companies so negative results hidden Publishing of results controlled Antidepressants not the best cure. 2. Placebos and antidepressants have limited differences in effectiveness **low serotonin cause depression and increase suicide EST-electroshock therapy (ECTs) What? Stimulation/ alteration of monamines (how it works is unknown) Under anaesthetics. Side effects: Short term memory loss and confusion. (2-weeks) It prevents deep depression but does not stop episodes of depression (high relapse rate) If after 10 sessions does not work will stop Shorter duration of treatment Safer Why use EST? For non-responsive medication cases this is the best alternative. What are some alternative? Transmagnetic stimulation: What: run magnetic coils to generate electromagnetic pulse to brain areas. Limited side effects Results: Not permanent cure (deep depression but not prevent episodes of depression) EST works better Has some good results (lower in Canada) Social contributions: a) Stressful/ traumatic event occurred within the year (interpersonal) b) Self-generated (choosing problematic romantic partners) c) Inter-generational transmission of depression (behavior of family/caregiver passed on to children not necessarily genetically) Ex: depressed mothers do not care for their offspring by positive emotional expressions or verbally **children of these caregivers have higher chance of divorce Interpersonal psychotherapy (IPT): treatment What: target problems of individuals for interacting with other How: find solutions to improve **more effective than CBT (controversial but data confirms) Ex: marital conflicts, relationship loss, relationship initiation, social skills Cognitive processes: Psychodynamic approach-Beck Believed that depressed individuals have internal aggression towards objects that they care for. Ex: if their loved ones leave them, they show their anger towards oneself and not the person Depressed people: mentality Cognitive content: 1. Self-criticism- believe they should do things better 2. Engage in social comparisons Cognitive processes: 1. Arbitrary inference: assumption of negative criticism Ex: people don’t like me (no evidence) 2. Overgeneralization: Magnify negative things Generalize positive things Selective abstraction (judging whole event by one factor only) 3. Negative schema activation Research: 1. Dysfunctional attitudes 2. Negative memory recall high (biased recall) 3. Mood priming in recovered depressives (ex: recovered depressed people have higher chance of depressive recovery by listening to a sad music) Cognitive treatment: Help person decenter from negative thoughts. Modification of cognitive processes. Behavioral models: Dependent on positive reinforcement. Generate positive social feedback by goal-directed activities. How depression occurs? Usual positive rewards/reinforcement gone or reduced. Research: Less effective social skills Negative verbal behaviour (ex: complaining more than others looking for others to make them feel better but exhausting) Behavioural avoidance (avoid engaging in positive activities) Treatment: Behavioural treatment: 1. Behavioral activation (stepwise process) 2. Pleasant event scheduling **positive events precede mood (scheduling positive events enhance mood) 3. Exercising/being active Study: Behavioral treatments are as effective as cognitive therapy. Summary of treatments: in MDD Medication has high effects and high relapse rates Cognitive therapy- longer but lower relapse rates Combination therapy – a boost to treatment Sequential treatments – 1. Antidepressants 2. Psychotherapy after