Psychology: Depressive disorders

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  1. Define mood
    a prolonged emotional state that represents the prevailing and dominant emotional tone
  2. What are the four adaptive functions of emotions
    • social communication
    • physiological arousal
    • subjective awareness (how am I doing?)
    • psychodynamic defense (ego defense)
  3. Define affect
    The observable external expression of mood; more transient (short-lived) than mood
  4. Characteristics of a depressive sign
    objective, observable
  5. Characteristics of a depressive symptom
    subjective, self-reported
  6. Characteristics of a depressive emotional state
  7. Characteristics of a depressive reaction
    "caused by"
  8. Characteristics of a depressive disease
    disorder, illness
  9. Characteristics of a depressive clinical entity
    characteristic cluster of signs/symptoms
  10. What is MDD?
    Major Depressive Disorder
  11. What is MDE
    Major Depressive Episode
  12. What is dysthymia?
    • Persistent Depressive Disorder
    • "milder" but chronic form of depression with a significant impact on functioning and QOL
    • Risk factor for MDD
  13. Define anhedonia
    Lack of pleasure in activities
  14. 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
  15. 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
  16. 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
  17. 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
  18. Who are the main providers of mental health services?
    Primary care providers
  19. What is the leading cause of disability in the US and worldwide?
  20. What form of depression is most common?
    • Recurrent
    • Can be well-managed (compared to asthma)
  21. 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)
  22. Endogenous causes of depression
    • genetic predisposition
    • biochemical (neurotransmitter dysregulation)
    • neuroendocrine
    • inflammatory processes (cytokines)
  23. Exogenous causes of depression
    • cognitive, behavioral, learned helplessness
    • stressors (particularly in early life)
  24. What is the diathesis-stress pathway?
    stressors -> neurophysical/neurochemical changes -> neuronal loss/dysfunction -> vulnerability to subsequent stressors
  25. Define bereavement
    • the process of grieving the death of a loved on or other types of significant loss (e.g. job).
    • NOT the same as MDD.
    • Resolves.
  26. Non-pharmacological interventions for mild depression and anxiety
    • exercis
    • stress reductio
    • engagement in positive pleasurable activities
    • changing negative thinking patterns
  27. 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
  28. 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.
  29. Types/Classes of antidepressants
    • SSRIs
    • Atypical antidepressants
    • Cyclic antidepressants (TCA)
    • MAOIs
  30. 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
  31. Drawbacks of SSRIs
    • GI - nausea/vomitting
    • CNS - HA, dizziness, tremors (usually short term)
    • Sexual dysfunction
    • Some restlessness, insomnia (take in morning)
    • weight gain
  32. 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
  33. Atypical antidepressants
    • used at much lower dosages for pain, sleep management
    • commonly used
  34. Cyclic antidepressants
    • mostly TCAs
    • side effects can be harder to handle - anticholinergic, cardiotoxic, cognitive effects
    • usually used for pain management at lower dosages
  35. MAOIs
    • monoamine oxidase inhibitors
    • usually last tried
    • intense dietary restrictions - interactions with tyramine, which causes hypertensive crisis
    • use very low dosages.
  36. Electroconvulsive Therapy is best option for these types of people
    • older adults
    • people who cannot tolerate medications
    • co-morbidities
  37. Define TMS
    • transcranial magnetic stimulation
    • use of MRI-strength magnetic pulses to stimulate focal areas of the cerebral cortex
  38. Define VNS
    • Vagus nerve stimulation
    • pacemaker implant to electrically stimulate teh vagus nerve to increase NTs
  39. Define DBS
    • Deep brain stimulation
    • electrodes implanted in brain to electrically stimulate focal areas of the brain
  40. Light therapy
    • first-line treatment for SAD
    • suppresses nocturnal melatonin secretion
    • can be as effective as medication
  41. St. John's Wort
    • mild to moderate depression
    • equivalent results to antidepressant medications
    • inconsistent evidence
    • not regulated by FDA
  42. Best random trial evidence states that this is as effective as medication n mild to moderate depression
  43. Behavioral techniques for depression
    • activity scheduling
    • problem-solving
    • stress management
  44. Define cognitive restructuring (reframing)
    • CBT
    • focuses on testing hypotheses about thinking to change how stressors are perceived
    • Thinking -> Feelings -> Behaviors
  45. 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
  46. Psychosocial Resources
    • Social support
    • optimism
    • mastery
    • self-esteem
    • coping resources
  47. Psychological distress
    • depressive symptoms
    • anxiety
    • neuroticism
Card Set
Psychology: Depressive disorders
Mood disorders, cognitive restructuring, depression
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