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What causes Depression?
Neurochemical changes + Negative thinking and attributional style
Unipolar Depression stats on: % adults in US with severe for. % mild form. % adults exp an episode at least once. Who is more likely to suffer.
- 9% suffer from severe depression.
- 5% suffer from mild depression.
- 18% suffer from severe unipolar depression some point in living.
- More likely: Poor, 40 YO, Woman 2x more likely than standard.
inability to experience any pleasure. A symptom of depression
% of people who suffer severe depression commit suicide?
What's a major depressive episode?
- period of 2 or more weeks with at least 5 symptoms of:
- Depression, loss of pleasure, sad mood, and in extreme cases, delusions or hallucinations.
What is Major Depressive Disorder?
- Patient's gone through a MDE with no history of Mania.
- Seasonal, Catatonic, peripartum, melancholic. If the patient gets a manic episode later on after the diagnosis, it can be changed to BIPOLAR DISORDER.
What is Persistant Depressive Disorder?
chronic unipolar depression, repeated MDE's- PDD with MDD. If less severe, PDD w/ Dysthymic syndrome
Premenstrual dysphoric disorder
woman who have clinically significant depressive and related symptoms during the week before menstruation
Is all Major Depression Disorders Endogenic? T/F
FALSE! Not all MDDs originate from the body. Most cases yes, but not all
genetic causes of unipolar depression
- Proband- person in a family with UD.
- Probands family has 30% higher rate of depression than general pop @ 10%.
- TWINS: identical twins- other twin has 46% chance of UD.
- Fraternal- 20%
Due to abnormality in serotonin gene- low serotonin activity=depression dude.
biochem causes of unipolar depression
Low activity of NE and/or Serotonin. Overall imbalance of those mentioned and dopamine and acetylcholine.
Why is Serotonin more important to the causes of unipolar depression?
It's a neuromodulator, primary function is to increase or decrease activity of other neurotrans. if decrease, depression.
Endocrine system affect on unipolar depression?
High levels of cortisol from the adrenal glands during stress. Also, Melatonin "dracula hormone", released only in the dark.
Brain anatomy relation to Unipolar depression?
- Prefrontal cortex: functions with mood, attention, immune sys. lower blood flow here in depressed ppl.
- Hippocampus: neurogeneis- produces new neurons. depression decreases this. if treated w/ drugs, neurogenesis is restored.
- Amygdala: 50% more bloodflow here in depressed ppl. involved in expression of negative emotions + memories
- Brodmann Area 25: smaller in depressed ppl, but more active, may be a "depression switch".
Psychodynamic view on unipolar depression
- Freud + Abraham developed explanation for depression through:
- Symbolic/Imagined Loss- loss of a valued object thats unconciously interpreted as the loss of a loved one.
This is abandoned, but Object relations theorists play off it and say parents that pushed ppl to excessive dependance or selfreliance are more likely to become depressed when faced with relationship issues
What's anaclitic depression?
Aka reactive depression. Result of a major loss.
Behavioral view on Unipolar depression
results from number of rewards + punishments received during life.
Cognitive view on Unipolar depression
- Aaron Beck believed:
- depressed ppl persist with negative views on events.
- Theory of negative thinking: maladaptive attitudes, cognitive triad, errors in thinking, automatic thoughts.
- Learned Helplessness: developed by Seligman in 1975,
- depression brought on by feelings of loss of control and blaming of self on helplessness.
What's the cognitive triad in the cognitive view of unipolar depression?
Individuals repeatedly interpret 3 things in their life in negative ways. Experiences, Themselves, Futures.
Sociocultural view on unipolar depression
- triggered exogenically.
- Family-social perspective:depressed ppl have bad social skills, cycle of socially failing + gettting more depressed.
- Multiculti Perspective: 2 relationships- Gender and depression-- Women 2x more likely for depression, but artifact theory says men + women are equal in development, but due to social norms, less detectable in men. hormone explanation says hormonse changes trigger it in women. Life stress theory women more subject to stress than men. Same w/ Body dissatisfaction theory. Lack of control theory says women are more prone b/ they feel less in control of their lives than men.
- Rumination theory says if you focus on your feels when depressed, you get turned in a cycle of depression
Cultural BG: every culture shares depressive symptoms. but in US, hispanics + africans more 50% more likely to experience depression.
When is someone considered to be in a Full Manic Episode?
at least one week of display of abnormally high or irritable mood, increased activity and 3 other symptoms of mania, like overblown self esteem, reduced sleep, less inhibitions. May include psychotic features or delusions and hallucination.
What is Bipolar I disorder?
Full manic + depressive episodes. Most experience an alternation of these, for ex: weeks of mania followed by a period of wellness, then an episode of depression. Some have mixed features though, with mania + depression at the same episode.
What's Bipolar II disorder?
- hypomanic episodes alternate with MDE's. Some people with this can accomplish tons of work during the hypomanic periods.
- w/o treatment, the mood episodes recur.
What is rapid cycling?
If someone with Bipolar disorder has 4 or more episodes within a year.
Which side of bipolar disorder is experienced more, and which disorder is more common? % adults suffering from bipolar disorder. % lifetime prevalence. Age of onset?
- More common for depressive side, 3x more likely than manic eps. and they last longer. women experience more depressive eps with more rapid cycling. but overall its equal in prevalence for men and women.
- % adults suffering: 1-2.6
- % lifetime prevalence: 4
- Age of onset is 15-44, most untreated cases the episodes subside, but recur eventually later on, and those with it get more medical complications.
What is Cyclothymic disorder?
numerous periods of hypomaic symptoms and mild depressive symptoms. Symptoms last 2 or more years with normal moods interrupting for a few days or a few weeks.
Cyclothymic age of onset? Gender prevalence? % pop prevalence?
Same age of onset at Bipolar I and II, in adolenscence or early adulthood. Equal in men and women. .4% of pop develops it. Eventually blossoms into Bipolar I or II.
Old views on Causes of Bipolar disorder?
psychodynamic theorists such as Lewin said mania and/or depression can emerge from the loss of a love object. introjection @ lost object=depression. deny loss=mania.
Neurotransmitter cause of Bipolar disorder?
Similar to depression, but low serotonin with high NE. May also be tied to abnormal activity of neurotransmitters such as GABA
Ion Activity cause on Bipolar disorder?
- Na and K ions
- neurons firing too easily- mania
- neurons firing not as easily- depression
Brain structure cause on bipolar disorder?
- Basal ganglia and cerebellum are smaller
- low volumes of gray matter
- amygdala, hippocamp, prefrontal cortex, dorsal raphne structurally abnormal.
- Serotonin produced in dorsal raphne
Genetic factor of bipolar disorder?
- Identical twins- 40% more likely to develop.
- frat twins, siblings + close relatives- 5-10% likely.
- Linked to X chromosomes
Psychodynamic view of causes for SUicide
- Results from depression + anger directed to oneself- Wilhelm Stekel
- "No neurotic harbors thoughs of suicide which he has not turned back upon himself from murderous impulses against others"- Freud.
- "Murder in 180th Degree"- Menninger.
- Introjection of lost person.
- Suicide is the extreme experession of self hatred and self punishment.
- Relationship between childhood losses = later suicidal behaviors:
- Early parental loss- more common cause of suicide 48%
- parental rejection or neglection leads to more than common too.
- Thanatos- death instinct believed by Freud- everyone aims it towards others. ex- suicide rates drop during war. self-destruction aimed at enemy.
Durkheim's sociocultural view on Suicide causation
- broad + influential theory supported even today.
- Probability determined by attachment of famiily, religion and community.
Durkheim's categories of suicide causation
- Egoistic Suicides: society has no control over committer. person not concerned with societal norms nor integrated/belonging. Alienation
- Altruistic Suicides: Person well integrated in society, intentional sacrifice for society well being- seppuku.
- Anomic Suicides: societal environment not stable, without law, unable to gain sense of belonging.
Biological stance on Suicide Causation
- Identical twins- 21% likely other twin committs
- Frat/sibs/close relatives- no correlation
- Low serotonin- predictor of suicidal acts- 10x more likely to make a repeat attempt
- Fewer receptor sites on neurons for serotonin, abnormal activity in prefrontal cortex, orbitofrontal cortex, cingulate cortex
- Low serotinin- promote aggression and impulsive behaviors. Must be comined with other psychocoial factors to be seen as a strong predictor
general Suicide prevalence in and Age groups
- Suicide rates increase with age up to middle age then decreases and increases at 85.
- 1/100,000 under 15 yo commits suicide.
- 11/100,000 15-24
- 19/100,000 45-64
- 15/100,000 65-84
- 18/100,000 85 n up
- infrequent among children, but has been on the rise. more than 6% of 10-14 yo deaths are caused by suicie. Boys outnumber girls 5 to 1 in this.
- 1/100 child harms self a year
- Preceded by running away, acting out, temper tantrums, self critique, lonelynesss, sleep probs
- As well as loss of lvoed one, abuse.
6-33% of children have thought of suicide!!!
Adolesence/Teen Suicide Stats
- more common after 13. 7/100,000 13-18
- 12% of teens think about suicide persistently 4% attempt.
- 3rd leading cause of death.
- High stress, development and imitation are factors.
- 93% of teens who attempted suicide knew someone who did the same.
Why are teens more disposed to attempt suicide than complete?
- 4 to 1 ratio of teens unable to complete suicide. High rate! Half may try again. 14% eventually die from it.
- Societal factors:
- Number and proportion of teens has risen, so inc. competition for jobs, and college- leads to increasingy shattered dreams. Also weaking of familial ties and availability of alcohol.
- Mass media coverage of suicide contibrutes too. serves as models unexpectedly.
- ex- NJ, 1987- highly publicized suicides led to more suicides, about 7% rise in NYC.
- Also, pro-suicide chatrooms + forums.
Multicultural factors on teen suicide
- 8/100,000 white
- 5/100,000 black
- 5/100,000 hispanic
- The gap is closing though, as more blacks and hispanics go to college, they face same stress as whites.
- also related to unemployment and innercity life.
- 4.5/100,000 asian
- Highest- Natives- 15/100,000
What demographic experiences cluster suicides?
- commit 19% of all suicides in the US! outweighs their 14% hold over population
- More old people die by suicide than live in the US.
- Linked to illness, loss of relatives, control, status.
- More determined, therefore more successful in completion.
- if treated for depression, it lowers their risk, duh.
- Minority Elders:
- low in native pop. due to high status.
- still pretty low in black pop.
- .5 mil ppl in US admitted to hospital/year for injuries from failed suicide.
- Left w/ severe injuries
- Many fail to receive follow up care though.
- 1/3 adolescents did not get care after.
- 8% of teens get care, 18% of them dont want it.
- Various therapies: pharmotherapy, other therapies, but doesnt help much
- 30% retry if havetn received treatment
- 16% who do get treated still try again.
- Cognitive-behavioral: helpful, focuses on painful thoughts, hopelessness, coping, problem-solving. Use of Beck's cognitive therapy.
- Mindfulness based cognitive therapy.
- Suicide prevention programs: found in LA in 1955. first in england called Samaritans in 1953.
- Hundreds in the US and england along with suicide hotlines manned by paraprofessionals.
- Crisis intervention: try to help suicidal people see situations more accurately and make better decisions to overcome crises.
- LgBtQ ex- Trevor lifeline
Tasks a counselor of a Suicide Prevention center
- Est. Positive Relationship
- Understand + problem
- Assess suicide potential
- Asses and mobilize caller's resources
- Formulate a plan- get a no-suicide contract from suicidee
Means reducing SUicide
- prevention of suicide by removing public access from common means of suicide
- ex- britain had 12/100,000 doing coal gas suicide, but as soon as it was replaced by natty gas, that shit went down to ZERO.
- Suicide rates dropped especially with older people.
- Less access to firearms= less suicide, but 2nd amendment, bro. dont you tread on me
- Firearms + PTSD for soldiers= :(
- More soldiers killed themselves during OIF than died in combat. Very sad.
Do suicide prevention Programs work?????
- No concrete evidence.
- Only a small percentage contact prevention centers.
- Usually young, african american, female.
- Most suicides are by white old men
- 2% of 8000 callers for LASPC committed suiide!
- Many say we need better public education= emergence of suicide education programs.
Which anxiety disorder had the worst prognosis of all anxiety disorders?
Currently, OCD is a main category in the DSM 5. How was it presented in the DSM 4?
OCD was a subcategory in DSM 4
What else did Patterson warn about for the exam??
- Dont worry about exogenous depression, only endogenous depression.
- If asked T/F if all major depression endogenous? Say F because most, but not all.