Abnormal Psych Exam 2 Mood

Biological Causal Factors for bipolar disorder

-There is a greater genetic contribution to bipolar disorder than to unipolar disorder -Norepinephrine, serotonin, and dopamine all appear to be involved in regulating our mood states -Disturbances in hormonal regulatory systems -Neurophysiologic and Neuroanatomical Influences -Disturbances in Biological Rhythms **Cyclical Nature perhaps related to Circadian Rhythms Sleep Difficulties, core feature during and between manic/depressive episodes.

Bipolar 1 and II

"Bipolar" replaces the term "manic-depressive" -If a person only shows Manic Symptoms, it is nevertheless assumed that Bipolar Disorder exists -Bipolar I disorder includes at least one manic or mixed episode -Even if periods of depression do not reach threshold for a major depressive episode, diagnosis of Bipolar I still given. -Bipolar II disorder does not include full-blown manic or mixed episodes, but does include hypomanic episodes -Symptoms are the same for manic and hypomanic episodes, but less impairment in hypomania, and hospitalization is generally not required. -Patient experiences depressed mood that meet the criteria for major depression.

Major Depressive Disorder + experiencing loss DSM-5

***"Responses to a significant loss (e.g., bereavement, financial ruin, losses from a natural disaster, a serious medical illness or disability) may include the feelings of intense sadness, rumination about the loss, insomnia, poor appetite, and weight loss noted in Criterion A, which may resemble a depressive episode. ***Although such symptoms may be understandable or considered appropriate to the loss, the presence of a major depressive episode in addition to the normal response to a significant loss should also be carefully considered. ***This decision inevitably requires the exercise of clinical judgment based on the individual's history and the cultural norms of the expression of distress in the context of loss.

Development and Course for Major Depressive Disorder

**MDD may first appear at any age, but the risk of onset increases markedly with puberty. In the US, incidence appears to peak in the 20s; however, first onset in late is not uncommon. **The course of MDD is variable, some individuals rarely experience remission, others may have years of remission **Recovery typically begins within 3 months of onset for 2/5 individuals and within 1 year for 4/5 individuals **Individuals may recover from MDD spontaneously *Duration, psychotic features, prominent anxiety, personality disorders and symptom severity impact prognosis *Most MDE will remit, the average duration is 9 months; however in some individuals the MDE will occur at some point

Biological Causal Factors of Suicide

*Genetic factors may play a role in risk for suicide *Reduced serotonergic activity appears to be associated with increased risk

Adolescent Suicide

*Rates of suicides for people 15-24 tripled between the mid-1950s and mid-1980s' *Suicide is now the 3rd leading cause of death in the US for 15-19 year olds, after accidents and homicide *Risk factors for adolescent suicide include mood disorders, conduct disorder, and substance abuse *Very slight increase in suicidal ideation in children and adolescents with anti-depressants

Overview of Bipolar and related disorders

-Bipolar disorders are distinguished from unipolar disorders by the presence of manic or hypomanic symptoms

Cyclothymic Disorder

-Cyclical mood swings less severe than those of bipolar disorder -Symptoms similar to Dysthymia and Hypomania -Symptoms must be present for at least 2 year duration -Lacking the severe symptoms and psychotic features of Bipolar Disorder -There may be significant periods between episodes in which the person with Cyclothymia functions in a relatively adaptive manner.

Persistent Depressive Disorder (Dysthymia) Description 1) overview/ the length 2)normal moods? 3)onset

-Essential feature is a depressed mood that occurs for most of the day, for more days than not, for at least 2 years, or at least 1 year for children and adolescents. *Patients describe mood as "Sad or down in the dumps" -Individuals whose symptoms meet major depressive disorder criteria for 2 years should be given a diagnosis of persistent depressive disorder as well as major depressive disorder. -Chronicity is the hallmark of this disorder. *Patients may report, "I've always been this way." -Intermittent normal moods occur briefly (no longer than 2 months) -Average duration 4-5 years, but it can persist for 20 years or more. -Often begins in adolescence-50% onset before 21

Biological Causal Factors for unipolar mood disorders (depressive disorders)

-Family studies and twin studies suggest a moderate genetic contribution -Altered neurotransmitter activity in several systems is associated with major depression -Stress Hormones -Depression may be linked to low activity in the left anterior or prefrontal cortex -A specific gene that might be implicated in major depressive disorder is the serotonin-transporter gene -Disruptions of the following may also play a role: Sleep Circadian rhythms Exposure to sunlight (seasonal) Biological Explanations for Sex Differences (hormones)

Lithium Carbonate Therapy

-Historically the drug of choice for Bipolar Disorder -1-2 weeks of Lithium use eliminates or reduces symptoms in 60-80% of manic episodes without causing depression. -Less effective in treating depression, may be administered with an anti-depressant. -Reduces the occurrence of future episodes of mania and depression -Serotonin key neurotransmitter -Side Effects-Lethargy, cognitive slowing, weight gain, decreased motor coordination, GI upset. -Specific mechanism not well understood Hypothesis-Modifies second messenger systems. -Treatment with mood stabilizers may be a lifelong necessity for some patients.

Persistent Depressive Disorder and Major Depressive Disorder

-Major depression may precede persistent depressive disorder, and major depressive episodes may occur during persistent depressive disorder. -Major difference b/t major depressive disorder and persistent depressive disorder: persistent depressive disorder may have periods of normal mood occur briefly (a few days to a few weeks, max 2 months) - w/ MDD the person can have multiple episodes but those are different cycles of depression

The Adaptive Significance of Depression

-Mild, brief depression can be normal and adaptive -Sadness, hopelessness, and pessimism are common human experiences -Mild Depression allows us to be still and reflect.

Suicide Notes

-Only 15-25% of completed suicides left notes -Some notes include statement of love and concern; others include very hostile content -Many short and straightforward, "I could not bear it any longer."

Communication of Suicidal Intent

-People who threaten to take their lives often do so -Interviews with family and friends indicate that 40% of people who committed suicide specifically indicated suicidal intent -Another 30% had talked about death or dying in preceding weeks or months -Communication is most often to a friends and family members. -50% of people who die from suicide have never seen a mental health professional, and only 20% under the care of a mental health professional at the time of their death

Psychological Causal Factors for depression

-Stressful life events are linked to depression Independent Life Events vs. Dependent Life Events (Stronger Impact) -Diathesis-stress models propose that some people have vulnerability factors that may increase the risk for depression -Genetics, Gender -Neuroticism or negative affectivity may lead to vulnerability Neuroticism-sensitivity to negative stimuli; Introversion; Negative thinking -Early adversity or parental loss, parent psychopathology

DSM-5 List of Bipolar and Related Disorders

1) Bipolar I 2) Bipolar II 3) Cyclothymic Disorder 4) Substance/Medication-Induced Bipolar and Related Disorder 5) Bipolar and Related Disorder due to another medical condition 6) Other specified Bipolar and Related Disorders 7) Unspecified Bipolar and Related Disorder

DSM-5 List of Depressive Disorders

1) Disruptive Mood Dysregulation Disorder Chronic, severe persistent irritability marked by temper outbursts and persistent irritable or angry mood between outbursts for children up to 12 years of age 2) Major Depressive Disorder 3) Persistent Depressive Disorder (Dysthymia) 4) Premenstrual Dysphoric Disorder Symptoms present in the final week before the onset of menses, start to improve within a few days after the onset of menses and become minimal or absent in the week post menses 5) Substance/Medication-Induced Depressive Disorder 6) Depressive Disorder Due to Another Medical Condition

The general types of mood disorders

1) In unipolar depressive disorders the person experiences only depressive episodes 2) In bipolar disorders the person experiences both manic and depressive episodes

Other forms of depression (that don't fit into the depressive disorders)

1) Loss and the grieving process - Bereavement exclusion removed in DSM-5 2) Postpartum "blues" - Postpartum blues are more common than postpartum depression. Symptoms include emotional lability, crying easily, and irritability intermixed with happy feelings. - Major depression in women occurs no more frequently in the postpartum period than would be expected in women of the same age and socioeconomic status who have not just given birth. - DSM-Allows a "Peri-partum Onset" Specifier if onset of symptoms occur during pregnancy or within 4 weeks of postpartum.

Mood Disorders 1) other name 2) definition

1) Mood disorders are also known as affective disorders -Extremes of emotion—or affect—are common to all mood disorders 2) Deep depression or soaring elation Other symptoms or co-occurring disorders may also be present, but abnormal mood is the defining feature

Beck's negative cognitive triad

3 themes = looking at self, the world, the future

Major Depressive Disorder DSM-5

A-C = major depressive A. Five or more of following symptoms in same 2 week period; at least one must be depressed mood or loss of interest/pleasure 1) depressed mood; 2) loss of interest, pleasure; 3)weight loss; 4)insomnia; 5)psychomotor agitation or retardation; 6)failure/ loss of energy 7)feeling worthless or inappropriate guilt 8)can't think or concentrate 9)thoughts of death/ suicide w/ or w/o a plan B. symptoms cause distress or impaired functioning (social, occupational) C. Episode not due to physiological effects of substance or medication D. no other disorder that better explains it E. NO MANIA!!

DSM-5 Manic Episode (also hypomania to a lesser extent)

A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary). B. During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior 1. Inflated self-esteem or grandiosity 2. Decreased need for sleep (feels rested after only 3 hours of sleep) 3. More talkative than usual or pressure to keep talking 4. Flight of ideas or subjective experience that thoughts are racing. 5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed. 6. Increase in goal-directed activity 7. Excessive involvement in activities that have a high potential for painful consequences (e.g. engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments). C. The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features. D. The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment) or to another medical condition. Note: A full manic episode that emerges during antidepressant treatment but persists at a fully syndromal level beyond the physiological effect of that treatment is sufficient evidence for a manic episode and bipolar I diagnosis.

Persistent Depressive Disorder DSM-5

A. Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years. B. Presence, while depressed, 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. C. During the 2 year period (1 year in children or adolescents) of the disturbance, the individual has never been without symptoms in Criteria A and B for more than 2 MONTHS at a time. D. Criteria for a major depressive disorder may be continuously present for 2 years. E. There has never been a manic or hypomanic episode. F. Disturbance not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and psychotic disorders. G. Symptoms are not due to physiological effects of a substance. H. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Full DSM-5 Major Depressive Disorder

A. FIVE (or more) of the following symptoms have been present during the same 2-WEEK period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood, or (2) loss of interest or pleasure. (1) Depressed most of the day, nearly every day, as indicated by either subjective report or observation made by others. Note: In children and adolescents, can be irritable mood. (2) Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation) (3) Significant weight loss (when not dieting) or weight gain (e.g. change of more than 5% of body weight in a month), or decease or increase in appetite nearly every day. Note: in children, consider failure to make expected weight gain. (4) Insomnia or hypersomnia nearly every day. (5) Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down). (6) Fatigue or loss of energy nearly every day. (7) Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick). (8) Diminished ability to think or concentrate, or indecisiveness, nearly every day. (9) Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a plan, or a specific plan for committing suicide. B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. C. The episode is not attributable to the physiological effects of a substance or another medical condition. (A-C = describing a major depressive episode) D. The occurrence of the major depressive episode is not better explained by schizoaffecive disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders. E. There has never been a manic episode or hypomanic episode. This exclusion does not apply if all of the manic-like or hypomanic-like episodes are substance-induced or are attributable to the physiological effects of another medical condition

Treating the Acute and Chronically Suicidal Suicide Assessment

Acutely suicidal - person may come in and say that they do not want to live then Chronically suicidal - at various moments in time they are suicide; think about it all the time; may not have a suicide attempt Suicide Assessment-Look into Increased risk: family hx, previous attempts, alcohol and other drug use, lack of protective factors-what stops you?, access to realistic method

Major Depressive Disorder Diagnostic Recording: Additional Specifiers

Additional Specifiers With anxious distress, with mixed features, with melancholic features, with atypical features, with mood-congruent psychotic features, with catatonia, with peri-partum onset, with seasonal pattern.

Independent vs. Dependence Life Events

Dependent life events stronger role in onset of MDD Independent life events: independent of a person's behavior and personality; you had nothing to do with it ex) company has merger and everyone is laid off Dependent life events: dependent on a person's behavior or personality; you played a role in some way ex) a bad grade on a test

Time spent in either depression or mania

Approximately three times as many days are depressed as manic/hypomanic Some experience Rapid Cycling (at least four episodes (either manic or depressive) every year.

Impact on the Therapist/Patient Dynamic

Assessment with Uncertainty Restoring Trust Processing Loss Individually and Systemically Hospitalization (therapist's decision whether it's safe for the person to go home)

Cognitive Theories of Depression

Beck proposed a cognitive model of depression -hypothesized that the cognitive symptoms of depression often precede and cause the affective or mood symptoms rather than vice versa ex) thoughts that you are a failure and are ugly lead to depressed mood Book: -its a diathesis-stress theory where negative cognitions are central -depression producing beliefs or schemas are thought to develop during childhood and adolescence as a function of negative experiences w/ parents and significant others and serve as underlying diathesis or vulnerability -lay dormant until activated by current stressor or depressed mood

Behavioral theory of depression

Behavioral Theories: People become depressed when: 1) Responses no longer lead to positive reinforcement 2) Rate of negative experiences increases These are not proven to be causes though -Rewards of the state of depression? Checklist - anger, loss, gain; depression allows you to escape from life, we like what we know - healing depression opens up a lot of opportunities which can be scary ex. Why wont you go out? A: my depression wont allow me to go out (hate job A: my depression causes me to miss work);

Depressive Disorders: Bipolar vs Unipolar

Bipolar -More Mood lability, Psychotic Features, Psychomotor Retardation, Substance Abuse -On average more severe than Unipolar Unipolar -More Anxiety, Agitation, Insomnia, Physical Complaints, Weight Loss

Comorbidity for Bipolar 1

Bipolar I: Anxiety Disorders including Panic Disorder, Social Anxiety Disorder, Specific Phobia occur in approximately 75% of individuals. More than half of individuals whose symptoms meet criteria have an Alcohol Use Disorder and those with both disorders are at greater risk for suicide attempts.

Comorbidity for Bipolar II

Bipolar II: Approximately 60% of individuals with Bipolar II disorder have three or more co-occurring mental disorders: 75% have an Anxiety Disorder and 37% have a substance use disorder. Approximately 14% of individuals with Bipolar II Disorder have at least one lifetime Eating Disorder, with BED being the most common. Anxiety and Eating Disorders tend to associate most with depressive symptoms, and substance use disorders are moderately associated with manic symptoms.

Takeaways from Beck's Sample Session

CBT - challenge your thought in the moment Sample session is somewhat confrontational b/c they are challenging your thought You don't get into law school = you can never be happy = black and white thinking CBT = back and forth need to build trust and safe space, need to understand their thoughts in order to challenge them (this sample is not the first session)

Bipolar I and II distinct disorders?

In 5-15 percent of cases, Bipolar II evolves into Bipolar I Disorder,

DSM-5 Depressive Disorders Overview

In DSM-5, "Depressive Disorders" are separated from the "Bipolar and Related Disorders." Previously these disorders fell under the broad heading of "Mood Disorders." Features of the Depressive Disorders: - Sad, Empty, or Irritable Mood - Somatic and Cognitive Changes that significantly affect the individual's capacity to function. - They differ across issues of duration, timing, or presumed etiology

Specifications for different Persistent Depressive Disorder and Major Depressive Disorder Comorbidity

In addition to MDD specifiers, specify (for most recent 2 years of persistent depressive disorder): 1) With pure dysthymic syndrome (just persistent) 2) With persistent major depressive episode-MDD met throughout 2 years (fit the criteria of MDD the whole period of time) 3) With intermittent major depressive episodes, with current episode-MDD currently met but periods of at least 8 weeks with symptoms below threshold for full MDD - MDD sometimes, currently having Major depressive episode 4) With intermittent major depressive episodes, without current episode-MDD not currently met, but one or more MDE in the preceding 2 years. - MDD sometimes, not in a major depressive episode

Major Depressive Disorder Diagnostic Recording Procedure

In recording the name of the diagnosis, terms should be listed in the following order: Major Depressive Disorder, Single/Recurrent, Severity/ Psychotic/Remission Specifiers, Additional Specifiers Example: Major depressive disorder, recurrent, moderate, with melancholic features

Treating the Survivors of Suicide (the loved ones)

Loss of a loved one through suicide is "one of the greatest burdens individual and families may endure" (Dunne, 1992, p. 222) -Guilt, Anger, Loss, Yearning to know why

Manic episode

Manic Episode-markedly elevated, euphoric, and expansive mood, often interrupted by occasional outbursts of intense irritability or violence. hypomania = milder version of the same symptoms

Dimensional Conceptualization of Severity: Mild

Mild-Few if any symptoms in excess of those required to make the diagnosis are present, the intensity of the symptoms is distressing but manageable, the symptoms result in minor impairment in social or occupational functioning.

Mixed episode

Mixed episode includes both depressive and manic symptoms for at least one week

Dimensional Conceptualization of Severity: Moderate

Moderate-The number of symptoms, intensity of symptoms, and/or functional impairment are between those specified "mild" and "severe."

Neurochemistry of depression

Monoamine Theory of Depression: Original theory, depression due to the depletion of norepinephrine and most recently serotonin In contrast: not all individuals respond to antidepressants, the time for alleviating symptoms is a question and not all depressed individuals show decreased levels of monoamines SSRIs = Selective Serotonin Reuptake Inhibitors Celexa (citalopram) Lexapro (escitalopram oxalate) Luvox (fluvoxamine) Paxil (paroxetine) Prozac (fluoxetine) Zoloft (sertraline) MAOIs = Monoamine oxidase inhibitors An enzyme called monoamine oxidase is involved in removing the neurotransmitters norepinephrine, serotonin and dopamine from the brain

Major Depressive Episodes vs. Major Depressive Disorder

Mood Episodes do not have their own diagnostic codes and cannot be diagnosed as separate entities Episodes serve as building blocks for the Disorder diagnoses: 1) Major Depressive Disorder, Single Episode Presence of a single Major Depressive Episode 2) Major Depressive Disorder, Recurrent Presence of two or more Major Depressive Episodes

Bipolar 1 and II gender differences and onset?

Occur equally in males and females Usually start in adolescence or young adulthood. Average age of onset is 22 years

Suicidal Ambivalence = the different groups

Of those who have made an suicide attempt 7 to 10 percent will eventually die by suicide. Distinct Groups: 1) Those who do not really wish to die but instead want to communicate a dramatic message concerning their distress Nonlethal methods Arrange their action so that intervention by others is likely 2) Those Intent on dying Little or no warning of intent Rely on certain means 3) Those Ambivalent about dying Methods are often dangerous but moderately slow acting, such as drug ingestion. "If I die, the conflict is settled, but if I am rescued that is what was meant to be."

Why do patients discontinue lithium?

Patients may discontinue use for many reasons Side Effects Failure to experience normal mood changes, diminishing the richness of life Loss of manic phase which may be perceived as a period of heightened creativity and productiveness.

Psychological Causal Factors for Bipolar Disorder

Precipitating Stressful life events Hypothesis=Destabilization due to stress; stressful life events precipitate a shift in mood Personality variables (such as neuroticism and high levels of achievement striving) Low social support Pessimistic attributional style

Psychoanalytic theory for depression

Psychodynamic/Psychoanalytic Theories: Freud "Mourning and Melancholia"-Mourning and Depression = = when someone is mourning, the symptoms very similar to depression - Book: when loved one dies, person regresses to the oral stage (infant can't distinguish self from others) and feels the feelings towards self that you feel for the lost person "Anger turned inward" = if you are depressed, there is some anger that is misdirected towards yourself (instead of the person you are angry with) - Freud = holding anger and hostility towards loved ones b/c of their power over us "Real or Imagined Loss" = you are depressed because you are experiencing the loss of the life you should have had or the life you had ex) girl feels real loss for a parent that was there but always leaving ex) failure on test/ relationship = symbolic loss of parent's love

Cognitive Behavioral Therapy for depression

See it as all interconnected: situation<->thoughts thoughts (negative thoughts) , mood/feelings (negative affect), behavior (stop going out), physical reactions (Feeling sick) all interconnect with each other CBT Thought record - write down evidence that does and does not support the thought as well as alternative thoughts CBT Core Beliefs automatic thoughts ("I shouldn't even try", "I'm going to mess it up") flow from core negative belief (ex. I'm a failure) Beck = negative automatic thoughts (the negative triad) = thoughts that occur just below the surface of awareness and cause unpleasant, pessimistic predictions CBT Case Conceptualization diagram - look at core beliefs, childhood data, situations

Stress and depression

Severe stressful life events often serve as precipitating factors for unipolar depression. **Most often involve-loss of a loved one, serious threats to close relationships or occupation, severe economic or health problems. Minor Stressful Events and Chronic Stress **Minor Stressful Events-Generally not associated with MDD **Chronic Stress-Increased risk for the onset, maintenance, and recurrence of MDD

Dimensional Conceptualization of Severity: Severe

Severe-The number of symptoms is substantially in excess of that required to make the diagnosis, the intensity of the symptoms is seriously distressing and unmanageable, and the symptoms markedly interfere with social and occupational functioning.

Dimensional Conceptualization of Severity

Severity is based on the number of criterion symptoms, the severity of those symptoms, and the degree of functional disability.

Suicide Attempts and fatalities

Suicide attempts are most common in people between 18 and 24 years old Highest rate of completed suicides are most common in the elderly (65 and older) In the U.S., women are more likely to attempt suicide, but men are more likely to complete suicide In 2011, in the U.S., suicide was the seventh leading cause of death for men and the 15th leading cause of death for women. Method may be a factor Exception in Bipolar patients., as many or more women as men complete suicide. Elevated rates also in fairly severe and recurrent mood disorders, schizophrenia, ETOH dependence, BPD, History of Conduct Disorder, Isolated individuals, highly creative or successful scientists, health professionals, business people, composers, writers, artists.

Major Depressive Disorder Diagnostic Recording: The Diagnostic Code How long does the recording last?

The diagnostic code for MDD is based on whether this is a single or recurrent episode, current severity, presence of psychotic features and remission status. Mild, Moderate, Severe, With psychotic features, In partial remission, In full remission -Current Severity and Psychotic features are only indicated if full criteria are currently met in a MDE. -Remission specifiers are only indicated if the full criteria are not currently met for a MDE 2 months duration

The 2 key moods involved in mood disorders

The two key moods involved are mania and depression

How to work to prevent suicide

Three main thrusts to preventive efforts: 1) Treatment of the person's current mental disorder(s) 2) Crisis intervention Coping with an immediate life crisis Do you want to die, or escape? Maintain support and contact Recognize acute distress Instill hope, distress will not be endless 3) Working with high-risk groups Ex. Groups for older men and adolescents

Beck's Negative Cognitive Biases

maintains the negative cognitive triad 1) Dichotomous or all-or-none reasoning-tendency to think in extremes ex) If I don't get 100%, I'm a failure 2) Selective Abstraction-a tendency to focus on one negative detail ex) "Today was terrible" b/c only remembering the bad 3) Arbitrary Inference-jumping to a conclusion with minimal evidence ex) after one assignment, "I could never do this"

Overview Major Depressive Disorder

require that a person be in a major depressive episode and never had a manic, hypomanic or mixed episode

single or recurrent episode

single = this is the first episode, initial episode (Depressive episodes typically last 6-9 months if untreated) (if symptoms do not remit after 2 years = persistent depressive disorder) Recurrent- most depressive disorders remit (symptoms gone for at least 2 months) - the depressive episodes return after a certain point 1) relapse = return of symptoms in short period of time (prob showing that the depression has not run its course) 2) recurrence = the onset of a new episode of depression - occurs in 40 - 50% of people with depression episodes