- Depression is considered a whole-body disorder that affects many levels of a person's being, including the body, nervous system, thoughts, moods, feelings, and behavior.For this discussion assignment, you are to:a. Pick one depressive disorder from Chapter 8 and discuss the signs and symptoms of the disorder.b. Discuss the important considerations in diagnosing this disorder.
- Use only chapter 8
- No reference require
Basic Statistics for the Behavioral Sciences Chapter Eight Mood Disorders * Assessing Mood Symptoms Disturbances in emotions, thoughts, and behaviors that cause subjective discomfort and hinder a person’s ability to function Differ from temporary emotional reactions: Pervade every aspect of person’s life Persist over extended period of time Occur for no apparent reason Out-of-proportion to life circumstances * Assessing Mood Symptoms (cont’d.) Involve symptoms of depression and/or mania: Depression: Intense sadness, feelings of futility and worthlessness, and withdrawal from others; core feature of many mood disorders Mania: Elevated mood, expansiveness, or irritability resulting in impairment in social or occupational functioning; psychotic symptoms may be present * Assessing Mood Symptoms (cont’d.) * Symptoms of Depression Affective: Depressed mood, with feelings of sadness, dejection, hopelessness, worthlessness, and low self-esteem Limited enthusiasm for things that previously brought joy and pleasure Irritability and feelings of anxiety * Symptoms of Depression (cont’d.) Cognitive: General feeling of futility, emptiness, and hopelessness accompanied by pessimism about the present and future prospects Self-denigration (disparaging or belittling oneself), feelings of incompetence, and thoughts of suicide Rumination: Continually thinking about certain topics or reviewing events that have transpired; often irrational and unjustified * Symptoms of Depression (cont’d.) Behavioral: Fatigue, lethargy, social withdrawal, and reduced work productivity Anhedonia: Loss of the capacity to derive pleasure from normally pleasant experiences Lack of personal cleanliness Slow speech and short responses Some seem agitated and restless * Symptoms of Depression (cont’d.) Physiological: Appetite and weight changes Sleep disturbance Unexplained aches and pain Aversion to sexual activity * Symptoms of Mania Hypomania: A milder form of mania; often includes goal-directed behaviors Increased levels of activity, energy, distractibility Elevated, expansive, or irritable mood Focus on pleasurable activities without concern for consequences Does not involve loss of contact with reality No marked impairment in social or occupational functioning May progress to mania * Symptoms of Mania (cont’d.) Affective: Affective volatility, ranging from extreme elation to intense rage Elevated mood and increased energy Grandiosity An overvaluation of one’s significance or importance Extreme irritability, hostility, and intolerance * Symptoms of Mania (cont’d.) Cognitive: Disorientation, intrusive thoughts, lack of focus and attention Lack of insight regarding inappropriateness of behaviors or verbalizations Speech is rapid, loud, and difficult to interpret Poor judgment without concern for consequences Exhibit frequent changes in topic * Symptoms of Mania (cont’d.) Behavioral: Uninhibited Intolerant of criticism Impulsivity and difficulty delaying gratification Engage in socially-disruptive behaviors Rapid and incoherent speech Psychotic symptoms may be present Paranoia, hallucinations and delusions * Symptoms of Mania (cont’d.) Physiological: Decreased need for sleep High levels or arousal Increased sex drive Weight loss due to high energy expenditure * Diagnostic Considerations with Mood Disorders Specifiers used to describe features: Mild, moderate, or severe symptoms Recent onset or chronic Presence of anxiety and melancholia Substance use patterns Mixed features * Diagnostic Considerations with Mood Disorders Other specifiers used to describe features: Suicide risk severity Postpartum onset Psychotic symptoms Catatonia * Diagnostic Considerations with Mood Disorders (cont’d.) Occur across the lifespan Cause significant distress or impairment in academic, occupational or social functioning Focus on severity and chronicity of symptoms and on presence of symptoms from both poles (depressive and mania) * Diagnostic Considerations with Mood Disorders (cont’d.) Figure 8-1 Mood Disorders Across the Lifespan * Unipolar Depressive Disorders Group of related disorders characterized by depressive symptoms Include: Major depressive disorder Chronic depressive disorder Mixed anxiety-depressive disorder Premenstrual dysphoric disorder Seasonal affective disorder * Unipolar Depressive Disorders (cont’d.) Diagnosis and classification: Diagnosis is made based on severity of and chronicity of depressive symptoms as well as pattern of symptom development Clear hypomanic/manic episodes not present * Unipolar Depressive Disorders (cont’d.) Major depressive disorder: Diagnosis requires that a major depressive episode impair functioning for most of the day, nearly every day for at least two full weeks Major depressive episode Two-week period involving pervasive feelings of sadness or emptiness and/or loss of pleasure and other cognitive, behavioral and physiological changes * Unipolar Depressive Disorders (cont’d.) Chronic depressive disorder: Symptoms are present most of the day for more days than not during a two-year period Ongoing presence of at least two symptoms: Feelings of hopelessness Low self-esteem Poor appetite or overeating Low energy or fatigue Difficulty concentrating or making decisions Sleep difficulties * Unipolar Depressive Disorders (cont’d.) Mixed anxiety-depressive disorder: Distressing symptoms of major depression and accompanied by anxious distress Anxious distress Symptoms of motor tension, difficulty relaxing, pervasive worries or feelings that something catastrophic will occur Neither anxiety nor depression is predominant * Unipolar Depressive Disorders (cont’d.) Seasonal affective disorder: Major depression that occurs with a seasonal pattern associated with decreased light Symptoms typically begin in the fall/winter and remit during spring/summer Two seasonal major depressive episodes are required for diagnosis Symptoms include: Declining energy, lethargy, increased need for sleep, weight gain, and social withdrawal * Unipolar Depressive Disorders (cont’d.) Premenstrual dysphoric disorder: Serious symptoms of depression, irritability and tension that appear the week before menstruation and remit soon after the onset of menses At least five symptoms must be present Symptoms include significant mood swings, anger, irritability, depressed mood, sense of hopelessness, self-deprecation, anxiety, tension Produces significant distress with social and occupational functioning * Epidemiology of Unipolar Depression One of most prevalent psychiatric disorders Leading cause of world-wide disability About $50 billion spent annually in U.S. on health-care services and lost workdays 15 million Americans suffer in a year Associated with other disorders * Epidemiology of Unipolar Depression (cont’d.) Figure 8-2 Twelve-Month and Lifetime Prevalence of Unipolar and Bipolar Disorders I and II Source: Based on Hasin et al. (2005); Kessler et al. (2003); Merikangas et al. (2007). * Epidemiology of Unipolar Depression (cont’d.) Suicide risk is eight times higher for those with depression Increased risk for women, Native American, middle-aged, widowed, separated or divorced, and low SES Recurrence rate high Incomplete remission is common * Etiology of Unipolar Depressive Disorders Figure 8-3 Multipath Model for Unipolar Depression The dimensions interact with one another and combine in different ways to result in unipolar depression. * Biological Dimension Role of heredity: Depression is influenced by genetic factors whose ultimate phenotypic expression is highly dependent on environmental factors Tends to run in families, and same type of disorder found among family members Modest contributions from genetic factors for depression and anxiety disorders Serotonin transporter gene (5-HTT) * Biological Dimension (cont’d.) Circadian disturbances in depression: Melatonin and serotonin disturbances due to light-related changes Sleep disturbances, including increased REM sleep, strongly linked to depression Abnormal cortisol levels: High blood levels of cortisol linked to depression, but influence is unclear Role of early life traumas or stressors * Biological Dimension (cont’d.) Stress circuitry and depression: Effect of cortisol on hippocampus and dysregulation of the stress circuitry Depletion of serotonin due to chronic stress Neurotransmitters and unipolar depressive disorders: Depletion of neurotransmitters Norepinephrine and serotonin * Biological Dimension (cont’d.) Neuroanatomy and depression: HPA axis alterations Smaller hippocampal volume Abnormalities in brain structure and circuitry Decreased activation of prefrontal lobes * Psychological Dimension Behavioral explanations: Depression occurs when insufficient social reinforcement is received Lewinsohn’s model stresses three sets of variables that enhance or hinder access to positive reinforcement: Number of potentially reinforcing events and activities Availability of reinforcements in the environment Individual’s instrumental behavior * Psychological Dimension (cont’d.) Cognitive explanations: The way people think causes depression Depressed individuals have negative thoughts and errors in thinking that result in pessimism, negative self-perception, feelings of hopelessness, and depression * Psychological Dimension (cont’d.) Beck’s cognitive theory: Depression is a disturbance in thinking, not mood. Schemas: Cognitive frameworks that help organize and interpret information Negative schemas can create depression * Psychological Dimension (cont’d.) Beck’s cognitive theory: Depressed individuals have negative self-views, and pessimistic outlooks regarding present experiences and future expectations. Four errors in logic typify negative schemas: Arbitrary inference Selected abstraction Overgeneralization Magnification and minimization * Psychological Dimension (cont’d.) Cognitive explanations: Learned helplessness: Acquired belief that one is helpless and unable to affect outcomes in one’s life Attributional style: People who feel helpless make speculations (causal attributions) about why they are helpless Internal/external, stable/unstable, global/specific Diathesis-stress process: Vulnerability in the presence of stress results in depression * Social Dimension Stress is often linked with depression Interpersonal problems and dependency tend to occur before onset of depressive symptoms Four stress factors leading to depression: Severity Acute more related than chronic Timing of onset Type * Social Dimension (cont’d.) Stress may activate a genetic predisposition for depression Stress and depression are bidirectional Social support and social resources may act as buffer between stress and depression * Sociocultural Dimension Culture, ethnicity, and depression: Cultural differences in symptoms, treatment, doctor-patient interactions, and outcomes Prevalence rates of mood disorders vary considerably among different cultural groups and societies SES, culture, race/ethnicity, and gender have all been related to depression * Sociocultural Dimension (cont’d.) Gender and depressive disorders: Universally, unipolar depression is far more common among women than among men Women may be more likely to seek treatment Women may be more willing to report Diagnostic bias Depression in men may take other forms Environmental, sociocultural, and biological factors interact, influencing gender differences Traditional gender roles * Treatment for Unipolar Depression Biomedical treatments Psychotherapy and behavioral treatments Combining biomedical and psychological treatments * Treatment: Biomedical Medication (antidepressants): Tricyclics, MAOIs, SNRIs: block re-absorption of norepinephrine and serotonin SSRIs: block reuptake of serotonin Symptom-suppressive, not curative Concerns: increases in suicidality, discontinuation syndrome, publication bias, placebo effectiveness * Treatment: Biomedical (cont’d.) Circadian-related treatment: Sleep deprivation followed by sleep recovery Light therapy Brain stimulation therapies: Electroconvulsive therapy (ECT): Used for severe or chronic depression Applies moderate electrical voltage to brain to produce convulsions Vagus nerve stimulation Transcranial magnetic stimulation * Treatment: Psychotherapy and Behavioral Behavioral activation therapy: Focus of treatment is increasing exposure to pleasurable events and activities, improving social skills, and facilitating social interactions via steps: Identifying and rating activities in terms of pleasure and mastery Feeling pleasure or mastery after performing them Identifying problems and using techniques to solve Improving social and assertiveness skills * Treatment: Psychotherapy and Behavioral (cont’d.) Interpersonal psychotherapy: Short-term, psychodynamic-eclectic treatment Depression occurs within interpersonal context, relationship issues are target Focus is on problems and conflicts in grief, role transitions, role disputes, and interpersonal difficulties Geared toward present, not past, relationships * Treatment: Psychotherapy and Behavioral (cont’d.) Cognitive-behavioral therapy: Altering habitually negative or extreme thought patterns associated with depression Clients are taught to: Identify negative, self-critical thoughts, See the connection between negative thoughts and subsequent feelings Examine distorted thoughts and decide if true Replace distorted negative thoughts with realistic interpretations * Treatment: Psychotherapy and Behavioral (cont’d.) Mindfulness-based cognitive therapy: Calm awareness of one’s present experience, thoughts and feelings, and having an attitude of acceptance rather than being judgmental, evaluative, or ruminative Disrupt the cycle of negative thinking by focusing on present * Treatment: Combining Biomedical and Psychological Current treatments often produce symptom remission Antidepressants are effective in severe cases of depression, but temporary Psychotherapies, especially CBT, have longer-lasting