chapter 7 Vocab
Epidemiology for Persistent depressive disorder
Globally dysthymia occurs in about 105 million people a year (1.5% of the population). It is 38% more common in women (1.8% of women) than in men (1.3% of men). The lifetime prevalence rate of dysthymia in community settings appears to range from 3 to 6% in the United States. However, in primary care settings, the rate is higher ranging from 5%-15%. United States prevalence rates tend to be somewhat higher than rates in other countries.
Biological Theories on Mood Disorders
Mood disorders have been shown to have a strong genetic and biological basis. Relatives of those with major depressive disorder have double the risk of developing major depressive disorder, whereas relatives of patients with bipolar disorder have over nine times the risk People with mood disorders often have imbalances in certain neurotransmitters, particularly norepinephrine and serotonin. Specific neurotransmitters are important regulators of the bodily functions that are disrupted in mood disorders, including appetite, sex drive, sleep, arousal, and mood. Medications that are used to treat major depressive disorder typically boost serotonin and norepinephrine activity, whereas lithium—used in the treatment of bipolar disorder—blocks norepinephrine activity at the synapses
Treatment for PMDD
Selective serotonin reuptake inhibitors (SSRIs) are the first-line medication used to treat PMDD, although contraceptives are also used.
Epidemiology for Cyclothymia
Some studies estimate that between 5 %-8% are affected at some point in their life whereas other studies suggest a rate ranging from 0.4%-2.5%. Males appear to be affected equally often, though women are more likely to receive treatment. Cyclothymia is diagnosed in around fifty percent of people with depression who are evaluated in psychiatric outpatient settings.
Etiology for Cyclothymia
The causes of cyclothymia are unknown. Risk factors include a family history of bipolar disorder.
hopelessness theory.
a cognitive theory of depression postulates that a particular style of negative thinking leads to a sense of hopelessness, which then leads to depression (Abramson, Metalsky, & Alloy, 1989). According to this theory, hopelessness is an expectation that unpleasant outcomes will occur or that desired outcomes will not occur, and there is nothing one can do to prevent such outcomes. A key assumption of this theory is that hopelessness stems from a tendency to perceive negative life events as having stable ("It's never going to change"), global ("It's going to affect my whole life") causes, in contrast to unstable ("It's fixable"), and specific ("It applies only to this particular situation") causes, especially if these negative life events occur in important life realms, such as relationships, academic achievement, and the like.
major depressive disorder
a mood disorder in which a person feels sad and hopeless for weeks or months aka depression or major depression characterized by sadness or loss of pleasure in usual activites and other symptoms
atypical features
a person dealing with depression may also experience elevated moods for certain periods of time or around particular people, show weight gain or increased appetite, or excessive sleep
melancholic features
a person experiences lack of interest or pleasure in activities
mixed features
a person experiences some manic symptoms alongside depression, such as elevated moods, increased energy, or talkativeness
mood-congruent psychotic features
a person may also experience delusions or hallucinations
catatonia
a person may show catatonic symptoms, such as staying still or immobilized for long periods of time
Treatment DMDD is treated with a combination of medications that target the child's symptom presentation. For youths with DMDD alone, _____ medication is sometimes used to treat underlying problems with irritability or sadness. For youths with unusually strong temper outbursts, an atypical antipsychotic medication, such as risperdone, may be warranted.
antidepressant
Existential psychotherapies
application of humanistic psychology, apply existential philosophy, which emphasizes the idea that humans have the freedom to make sense of their lives. They are free to define themselves and do whatever it is they want to do. This is a type of humanistic therapy that forces the client to explore the meaning of their life, as well as its purpose. There is a conflict between having freedoms and having limitations. Examples of limitations include genetics, culture, and many other factors. Existential therapy involves trying to resolve this conflict.
diathesis-stress model
depression results when a preexisting vulnerability, or diathesis, is activated by stressful life events. The pre-existing vulnerability can be either genetic, implying an interaction between nature and nurture, or schematic, resulting from views of the world learned in childhood.
persistent depressive disorder
depressive disorder characterized by chronically sad and melancholy mood
A third cognitive theory of depression
focuses on how people's thoughts about their distressed moods—depressed symptoms in particular—can increase the risk and duration of depression focuses on rumination
depressive disorders
general category of mood disorders in which people show extreme and persistent sadness, despair, and loss of interest in life's usual activities. one of a group of mood disoders in which depression is the defining feature
Etiology The etiology of PDD is unknown, although there are some _____ predispositions and links with other factors such as stress, social isolation, and lack of social support.
genetic
Etiology The causes of bipolar disorder likely vary between individuals and the exact mechanism underlying the disorder remains unclear. _____ influences are believed to account for 73%-93% of the risk of developing the disorder indicating a strong hereditary component. The overall heritability of the bipolar spectrum has been estimated at 0.71.
gentic/biological
bipolar and related disorders
group of mood disorders in which mania is the defining feature
Etiology The etiology of PMDD is an active area of investigation. Potential biological contributors include central nervous system (CNS) sensitivity to reproductive ______, genetic factors, and psychosocial factors such as stress. The timing of symptom onset and offset in PMDD suggests that hormonal fluctuation is a key component in PMDD's pathogenesis.
hormones
Treatment Cognitive behavioral therapy (CBT) is considered potentially effective for people diagnosed with cyclothymia. _____ stabilizers such as lithium are sometimes prescribed, and shown to be more effective than antidepressants. Antidepressants are a concern due to the possibility of inducing hypomanic switches or rapid cycling.
mood
bipolar disorder
mood disorder characterized by mood states that vacillate between depression and mania
premenstrual dysphoric disorder (PMDD)
more serious from of PMS marked by severe irritability, depression, or anxiety in the week or two before your period starts
Chronic anxiety:
not a symptom chronic anxiety is more common with anxiety disorders not a primary symptom of depression
Flashbacks of distressing events:
not a symptom flashbacks are a primary symptom of PTSD, not depression
Improved memory:
not a symptom many people with depression experience cognative difficulties not improvements
Increased energy:
not a symptom many people with depression experience fatigue or lack of energy
mood disorder
one of a group of disorders characterized by severe disturbances in mood and emotions categories of mood disorders listed in DSM-5 are bipolar and related disorders and depressive disorders
manic episode
period in which an individual experiences mania, characterized by extremely cheerful and euphoric mood, excessive talkativeness, irritability, increased activity levels, and other symptoms
anxious distress
person experiences anxiety in the form of tenseness, restlessness, lack of focuse, fear, or losing control
Bipolar I
previously know as manic-depression characterized by a single or recurrent manic episode
Bipolar II
single (or recurrent) hypomanic episodes and depressive episodes manic episodes are less sever than in Bipolar I more mild to moderate in their impulsive behavior
mania
state of extreme elation and agitation
peripartum onset
subset of depression applies to women who experienece an episode of major depression either during pregnancy or in the first four weeks following childbirth
seasonal pattern
subtype of depression person experiences the symptoms of major depressive disorder only during a particular time of year
Inability to concentrate:
symptom
Irritability
symptom
Lack of interest in activities:
symptom aka anhedonia common symptom of depression
Insomnia
symptom many people with depression experince insomnia
For each of the following, determine whether or not it is a symptom of depression. To help you, you may want to think about a time when you were down or sad, and think of the behaviors you exhibited at the time. Clinical depression is an extreme version of normal sadness. Sad mood:
symptom sad mood is one of the hallmark symptoms of depression
flight of ideas
symptom of mania abruptly swiching in conversation from one topic to another
DSM-5 Criteria Disruptive mood dysregulation disorder (DMDD) is characterized by irritability or ____ moods most of the day, combined with severe temper outbursts averaging ____ or more times a week. Outbursts must be present for at least ____ and occur in at least two settings (e.g. home and school), and it must be severe in at least one setting. Symptoms usually appear before the age of 10, and diagnosis must be made between ages 6 and 18.
1 year
Epidemiology for premenstrual dysphoric disorder
A majority of menstruating women have feelings of premenstrual symptoms to some degree, with 20%-30% feeling enough symptoms to qualify for diagnosis of PMS and 3%-8% of that group qualifying for the diagnosis of PMDD
hopelessness theory
A theory of depression that people are more likely to become depressed if they make global, internal, and stable attributions about negative life events. cognaitive theory of depression style of thinking that perceives negative life events as having stable and global causes leads to a a sense of hoplessness and then depression
The Behavioral Perspective
Behavioral theories of depression emphasize the role maladaptive actions play in the onset and maintenance of depression. These theories stem from work concerning the principles of learning and conditioning from the early to mid-1900s. Ivan Pavlov and B. F. Skinner are often credited with the establishment of behavioral psychology with their research on classical conditioning and operant conditioning, respectively. their research established that certain behaviors could be learned or unlearned, and these theories have been applied in a variety of contexts, including abnormal psychology.
Epidemiology
Bipolar disorder is the sixth leading cause of disability worldwide and has a lifetime prevalence of about 1%-3% in the general population.
Etiology for DMDD
Causes of disruptive mood dysregulation disorder are unknown, but there is a possible connection with the amygdala or sociocultural factors.
Epidemiology for Disruptive mood dysregulation disorder (DMDD)
Estimates for DMDD range from 0.8%-3.3% of the population.
biopsychosocial model
terdisciplinary model that looks at the interconnection between biological, psychological, and social-environmental factors. The model specifically examines how these aspects play a role in topics ranging from health and disease models to human development. Childhood abuse, whether physical, sexual, or psychological, are all risk factors for depression, among other psychiatric issues that co-occur such as anxiety and drug abuse. Childhood trauma also correlates with the severity of depression, lack of response to treatment, and length of illness. However, some are more susceptible to developing mental illness such as depression after trauma, and various genes have been suggested to control susceptibility.
Treatment _____ and antidepressants are often effective in treating dysthymia. Different modalities have been shown to be beneficial. Empirically-based treatments, such as cognitive-behavioral therapy, have been researched to show that through the proper course of treatment, symptoms can dissipate over time.
therapy
cognitive behavioral therapy
therapy focused on challenging and changing unhelpful cognative distortions and behaviors, improving emotional regulation, and developing personal coping strategies that target solving current problems
dialectical behavior therapy
therapy focused on teaching a patient skills to regulate emotions and improve r/s with others
suicidal ideation
thoughts of death by suicide, thinking about or planning suicide, or making a suicide attempt
DSM-5 Criteria Persistent depressive disorder is diagnosed if an invididual reports a depressed mood or appears depressed to others for a majority of days for ____ or more years. When depressed, the patient has two or more of the following symptoms: decreased or increased ______ , decreased or increased sleep (insomnia or hypersomnia), fatigue or low energy, reduced self-esteem, decreased concentration or problems making decisions, and feelings of hopelessness or pessimism. During a two-year period, the above symptoms are never absent longer than _____ consecutive months, and the patient may have had a perpetual major depressive episode but not have any manic, hypomanic, or mixed episodes and has never fulfilled criteria for cyclothymic disorder. The depression does not exist only as part of a chronic psychosis (such as schizophrenia or delusional disorder). The symptoms may cause significant problems or distress in social, work, academic, or other major areas of life functioning.
two; appetite two
cognitive therapy for suicide prevention
type of CBT for patients following a suicide attempt tought new ways of thinking during suicidal episodes
brief cognitive behavior therapy
midified CBT program 12 sessions designed to help patients after a suicide attempt they develop skills and self-management techiques
Diathesis-Stress Model and Major Depressive Disorders
believed that stressful life events can trigger depression, and research has consistently supported this conclusion. individuals who are exposed to traumatic stress during childhood—such as separation from a parent, family turmoil, and maltreatment are at a heightened risk of developing depression at any point in their lives Of course, not everyone who experiences stressful life events or childhood adversities succumbs to depression—indeed, most do not. Clearly, a diathesis-stress interpretation of major depressive disorder, in which certain predispositions or vulnerability factors influence one's reaction to stress, would seem logical. suggested that an alteration in a specific gene that regulates serotonin (the 5-HTTLPR gene) might be one culprit. found that people who experienced several stressful life events were significantly more likely to experience episodes of major depression if they carried one or two short versions of this gene than if they carried two long versions. Individuals who carried one or two short versions of the 5-HTTLPR gene were unlikely to experience an episode, however, if they had experienced few or no stressful life events. These diathesis-stress models propose that depression is triggered by a "cognitive vulnerability" (negative and maladaptive thinking) and by precipitating stressful life events
Cyclothymia is classified as a sub-type _______ of disorder characterized by periods of elevated mood and depressive symptoms for at least half the time during the last two years for adults and one year for children and teenagers. Periods of stable moods last only month(s) at most, interfere with daily life, and the symptoms do not meet the criteria for bipolar disorder, major depression, or another mental disorder.
bipolar; 2
disruptive mood dysregulation disorder (DMDD)
childhood condition marked by extrene irritability; anger; and frequent, intense temper outbursts
rumination
compulsive fretting; overthinking about our problems and their causes in depression, tendency to repetitcely and passively dweel on on one's depressed sysptom, their meaning and their consequnces
The Sociocultural Perspective
cultural differences on the expectations of individuals based on gender varied across cultures and that resulted in different levels of depression across individuals. Changes in gender roles across countries and cultures in this study served to explain varying levels of stress and responsibility that changed on the basis of gender. These ever-changing expectations and these additional responsibilities on the basis of gender increased levels of depression. The differences in gender roles within a community also impact one's level of depression. The way one is socialized to deal with their negative emotions will vary across cultures and may lead to different outcomes.
suicide
death caused by intentional, self-directed injurious behavior
The Psychodynamic Perspective
depression is caused by unresolved unconscious conflict or repressed anger towards others. A person may be so plagued with inner conflict, anxiety, and guilt that they are unable to perceive reality clearly or meet the ordinary demands of the environment in which they live
The Humanistic Perspective
includes several approaches to counseling and therapy. Among the earliest approaches, we find the developmental theory of Abraham Maslow, emphasizing a hierarchy of needs and motivations; the existential psychology of Rollo May acknowledging human choice and the tragic aspects of human existence; and the person-centered or client-centered therapy of Carl Rogers, which is centered on the client's capacity for self-direction and understanding of his or her own development. Client-centered therapy is non-directive; the therapist listens to the client without judgment, allowing the client to come to insights by themselves. The therapist should ensure that all of the client's feelings are being considered and that the therapist has a firm grasp on the concerns of the client while ensuring that there is an air of acceptance and warmth. A client-centered therapist engages in active listening during therapy sessions.
When cortisol is released, the body
initiates a fight-or-flight response in reaction to a threat or danger. Many people with depression show elevated cortisol levels
DSM-5 Criteria According to DSM-5, there are two main depressive symptoms—a depressed mood and loss of ____ in activities (anhedonia). At least one of these symptoms and five total symptoms must frequently occur for more than ____ week(s) (to the extent in which it impairs functioning) for the diagnosis. Other criteria include weight and appetite changes, sleep issues, psychomotor changes, fatigue or loss of energy, feelings of worthlessness or guilt, difficulty concentrating and indecisiveness, and suicidal ideation.
interest; two
Symptoms of PMDD include the following:
lasting irritability or anger that may affect other people feelings of sadness or despair, or even thoughts of suicide feelings of tension or anxiety panic attacks mood swings or crying often lack of interest in daily activities and relationships trouble thinking or focusing tiredness or low energy food cravings or binge eating trouble sleeping feeling out of control physical symptoms, such as cramps, bloating, breast tenderness, headaches, and joint or muscle pain
Treatment Treatment includes a combination of psychotherapy and medication, oftentimes mood-stabilizers such as in ______ conjunction with CBT are used.
lithium
Epidemiology In most countries, the number of people who have depression during their lives falls within an 8%-18% range. In North America, the probability of having a major depressive episode within a year-long period is 3%-5% for ____ and 8%-10% for _____. Around 6.6% of the U.S. population experiences major depressive disorder each year; 16.9% will experience the disorder during their lifetime
males; females
DSM-5 Criteria Bipolar I disorder is diagnosed if there has been at least one ____ episode, with or without depressive episodes. Bipolar II is diagnosed if there has been at least one ______ episode (but no full manic episodes) and one ____ major episode.
manic hypomanic;depressive
DSM-5 Criteria There are three different criterion of symptoms to be met for a diagnosis of premenstrual dysphoric disorder, of which at least six symptoms must be present. Symtoms must occur in the final week before the onset of ______ and start to improve within a few days after the onset of menses, and become minimal or absent in the week post-menses. At least some of the symptoms must include marked _____ swings, irritability, depressed mood, or anxiety. Other criteria include decreased interested in usual activities, difficulty concentrating, lethargy, appetite changes, hypersomnia or insomnia, feeling overwhelmed or out of control, and physical symptoms (e.g., breast tenderness or swelling, joint or muscle pain, a sensation of bloating and weight gain).
menses; mood
cyclothymic disorder
mental disorder considered less extreme form of bipolar disorder characterized by numerous periods of symptoms of depression and periods of symptoms of hypomania
Cognitive Theories of Depression
view that depression is triggered by negative thoughts, interpretations, self-evaluations, and expectations Beck theorized that depression-prone people possess depressive schemas, or mental predispositions to think about most things in a negative way Depressive schemas contain themes of loss, failure, rejection, worthlessness, and inadequacy, and may develop early in childhood in response to adverse experiences, then remain dormant until they are activated by stressful or negative life events. Depressive schemas prompt dysfunctional and pessimistic thoughts about the self, the world, and the future. Beck believed that this dysfunctional style of thinking is maintained by cognitive biases, or errors in how we process information about ourselves, which lead us to focus on negative aspects of experiences, interpret things negatively, and block positive memories Longitudinal studies have supported Beck's theory, in showing that a pre-existing tendency to engage in this negative, self-defeating style of thinking—when combined with life stress—over time predicts the onset of depression Cognitive therapies for depression, aimed at changing a depressed person's negative thinking, were developed as an expansion of this theory
