Psychology: Depressive disorders
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a prolonged emotional state that represents the prevailing and dominant emotional tone
What are the four adaptive functions of emotions
- social communication
- physiological arousal
- subjective awareness (how am I doing?)
- psychodynamic defense (ego defense)
The observable external expression of mood; more transient (short-lived) than mood
Characteristics of a depressive sign
Characteristics of a depressive symptom
Characteristics of a depressive emotional state
Characteristics of a depressive reaction
Characteristics of a depressive disease
Characteristics of a depressive clinical entity
characteristic cluster of signs/symptoms
What is MDD?
Major Depressive Disorder
What is MDE
Major Depressive Episode
What is dysthymia?
- Persistent Depressive Disorder
- "milder" but chronic form of depression with a significant impact on functioning and QOL
- Risk factor for MDD
Lack of pleasure in activities
Diagnostic requirement for MDD
- Two weeks or more of either depressed mood and/or anhedonia with symptoms occurring nearly every day for a 2-week consecutive time period.
- Represents a change from previous functioning
- Most specific symptoms are: feelings of worthlessness, excessive or inappropriate guilt, recurrent thoughts of death or suicidal ideation
Diagnostic requirements for Persistent Depressive Disorder (Dysthymia)
- Depressed mood for most of the day, for more days than not, for at least 2 years
- Has at least two symptoms on the list. The most associated are low self-esteem and feelings of hopelessness
What types of depression are most likely to be seen in primary care? Why?
- Depressive disorder due to another medical condition
- minor/subsyndromal depressive disorder (depressive symptoms of clinical concern).
- Widespread in population
Depressive disorders are commonly seen with these co-morbidities
- substance abuse/addiction
- anxiety disorders (>50%)
- neurocognitive disorders
- Schizophrenia, Schizoaffective disorder
- personality disorders
- chronic medical conditions
Who are the main providers of mental health services?
Primary care providers
What is the leading cause of disability in the US and worldwide?
What form of depression is most common?
- Can be well-managed (compared to asthma)
Factors that are relatively strong risk predictors for depression
- prior episodes of depression (especially if severe)
- family history of depression
- prior suicide attempts (MDD is risk factor)
Endogenous causes of depression
- genetic predisposition
- biochemical (neurotransmitter dysregulation)
- inflammatory processes (cytokines)
Exogenous causes of depression
- cognitive, behavioral, learned helplessness
- stressors (particularly in early life)
What is the diathesis-stress pathway?
stressors -> neurophysical/neurochemical changes -> neuronal loss/dysfunction -> vulnerability to subsequent stressors
- the process of grieving the death of a loved on or other types of significant loss (e.g. job).
- NOT the same as MDD.
Non-pharmacological interventions for mild depression and anxiety
- stress reductio
- engagement in positive pleasurable activities
- changing negative thinking patterns
Treatment for MDE
- Based on severity and health history, including response to txs tried previously
- combination of medication & psychotherapy (EBP)
- Refractory depression: ECT, transcranial magnetic stimulation
What is the relaively most dangerous time during treatment for MDD?
During lag time between an increase in physical energy and mood improvement. Pts can suddenly have ability to act on suicidal thoughts.
Types/Classes of antidepressants
- Atypical antidepressants
- Cyclic antidepressants (TCA)
Benefits of SSRIs
- inhibit reuptake of serotonin
- have long half-life; can take once a day
- first line of treatment
- anxiolytic action
- few anticholinergic, antihistaminic or adrenergic side effects
- few cardiovascular effects
Drawbacks of SSRIs
- GI - nausea/vomitting
- CNS - HA, dizziness, tremors (usually short term)
- Sexual dysfunction
- Some restlessness, insomnia (take in morning)
- weight gain
Serotonin (Toxicity) Syndrome
- Danger with SSRIs
- Serotonergic hyperstimulation
- may occur quickly
- can be caused by interactions with MAOIs, tryptophan, and St. John's Wort
- Tachycardia, restlessness, seizures, confusion, malaise, mania, hyperthermia, profuse diaphoresis, respiratory and CV collapse, death
- used at much lower dosages for pain, sleep management
- commonly used
- mostly TCAs
- side effects can be harder to handle - anticholinergic, cardiotoxic, cognitive effects
- usually used for pain management at lower dosages
- monoamine oxidase inhibitors
- usually last tried
- intense dietary restrictions - interactions with tyramine, which causes hypertensive crisis
- use very low dosages.
Electroconvulsive Therapy is best option for these types of people
- older adults
- people who cannot tolerate medications
- transcranial magnetic stimulation
- use of MRI-strength magnetic pulses to stimulate focal areas of the cerebral cortex
- Vagus nerve stimulation
- pacemaker implant to electrically stimulate teh vagus nerve to increase NTs
- Deep brain stimulation
- electrodes implanted in brain to electrically stimulate focal areas of the brain
- first-line treatment for SAD
- suppresses nocturnal melatonin secretion
- can be as effective as medication
St. John's Wort
- mild to moderate depression
- equivalent results to antidepressant medications
- inconsistent evidence
- not regulated by FDA
Best random trial evidence states that this is as effective as medication n mild to moderate depression
Behavioral techniques for depression
- activity scheduling
- stress management
Define cognitive restructuring (reframing)
- focuses on testing hypotheses about thinking to change how stressors are perceived
- Thinking -> Feelings -> Behaviors
What is the cognitive triad of depression?
- negative, self-deprecating view of self
- Pessimistic view of the world
- Believe that the negative will continue in the future
- Social support
- coping resources
- depressive symptoms
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