Transcript MDD 6B - Reagan Humanities

Amber Gerdman,
Jared Costillo,
Brianna Hoskins,
Melissa Grady,
and Paula
Criteria
from
the
DSM-IV
TR
1.) Presence of two or more Major Depressive Episodes which are:
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 Depressed mood most of the day, nearly every day
 Markedly diminished interest or pleasure in all, or almost all,
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activities most of the day
Significant weight loss when not dieting or weight gain
Insomnia or hypersomnia nearly every day
Psychomotor agitation or retardation nearly ever day
Fatigue or loss of energy nearly every day
Feeling or worthlessness or excessive or inappropriate guilt nearly
every day
Diminished ability to think or concentrate, or indecisiveness, early
every day
Recurrent thoughts of death, suicidal ideation without a specific
plan, or suicide attempt.
DSM-IV-TR (cont)
 2.) There has never been a Manic Episode, a Mixed
Episode, or a Hypomanic Episode.
Discuss the interaction of
biological, cognitive, and
sociocultural factors in abnormal
behaviors
Factors
 There are cognitive, biological, and sociocultural factors to
abnormal behavior, recently, is looked at from an
integrationist perspective. This means that psychologists
focus on how a combination of these factors can be
involved in abnormal behavior, unlike in the past when
many times a single factor would be the focus.
 Biological factors look at the role of genetics and heredity
in abnormal behavior, cognitive looks at the role of thought
patterns and schema and such, and sociocultural factors
look at the role of enviornment and culture.
Analyze etiologies of one disorder
from two of the following groups:
anxiety disorders, affective
disorders, and eating disorders
Etiologies of MDD
 Biological causes- It has been shown that genetics
may play a role in the MDD, however the main
biological involvement with MDD has to do with
neurotransmitters. Many times part of the cause of
MDD has to do with chemical imbalances.
 When certain neurotransmitters are inhibited it can
result in feelings of depression. The neurotransmitters
known to be associated with MDD are serotonin,
norepineprhrine, and dopamine.
MDD Etiology Cont.
 Cognitive factor can involve a persons schema and
“outlook”.
 People who tend to continually have sad thoughts or
have a negative outlook are at higher risk for
depression because there is a higher chance those
thoughts will continue (think of the brain’s
neuroplasticity and how use or disuse of
neurotransmitters can cause a more or less prevalent
connection).
Describe symptoms and prevalence
of one disorder from two of the
following groups: anxiety disorders,
affective disorders, and eating
disorders
MDD
 -Can be diagnosed when someone experiences 2 weeks of either
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a depressed mood or loss of interest and pleasure.
-Also requires a person to have at least 4 of these
symptoms: insomnia, appetite disturbances, loss of energy,
feelings of wothlessness, thoughts of suicide, or difficulty
concentrating.
-Prevalence Rates:
-2 to 3 more times common in women than in men.
-Levav (1997) found prevalence rate to be above average in
Jewish males and no difference between male and female
prevalance rates among the Jewish population.
-Major Depressive Disorder is a recurrent disorder with 80%
having subsequent episodes.
-Average # of episodes is 4. Lasting about 3 to 4 months.
Etiology
 Symptoms are caused by a trigger in an adverse
social/environmental change.
 Biological origin=primary cause of depression.
 Also triggered by negative events . Ex: ) Divorce,
death, fired from job, or serious accident.
 *Depression is NOT caused by a single factor, but a
combination of factors such as, genetic vulnerability,
neureotransmitter malfunctioning, psychological
problems, life events or lifestyle factors, like alcohol or
drugs.
Cont.
 Sociocultural factors of MDD can either be something
that causes the disorder over time (such as a person
who has been abused or in a stressful situation for
many years).
 However it can also be triggered by a single traumatic
and extremely saddening event during a person’s life,
such as the death of a loved. It is also important to
remember that the cause can be any combination of
these three causes.
Etiology and Therapeutic Approach
 Etiology of a person suffering from MDD and the
approach to that person’s treatment are inextricably
linked for obvious reasons. In order for a person to be
treated the cause (etiology) of their symptoms must be
known.
 The cause of MDD may not be the same for each
patient, therefore any combination of medical
treatment and individual therapy and so on may be
needed depending on the what the type of cause is.
Discuss the use of eclectic
approaches to treatment
Eclectic approach
 Research evaluating treatment has demonstrated there is a
postitive effect if people take action to cope or change a
behavior.
 Taking drugs, participating in group sessions in a support
group, and taking part in a number of therapy sessions may
all positively contribute to increase mental health.
 Eclectic therapy recognizes the strengths and limitations of
various therapies.
 Rush et al (1977) suggests a higher relapse rates because
patients in cognitive therapy learn skills to cope with
depressions that the patients with drugs do not.
Evaluate the use of biomedical,
individual, and group approaches
to the treatment of one disorder
Biomedical approach
 Is based on the assumption that if the problem is based on
biological malfunctioning, drugs should be used to restore
the biological system.
 Example: depression involves imbalance in
neurotransmission, drugs restore appropriate chemical
balance.
 Since 1950’s there has become a widespread, and
psychoactive drug account.
 The drugs typically operate by affecting transmission in the
nervous system of neurotransmitters such as dopamine,
serotonin, noradrenalin, or GABA.
 The outcome is to increase or decrease the levels of available
neurotransmitters in the synaptic gap.
Biomedical approach (cont)
 Antidepressant drugs are used to elevate the mood of
people suffering from depression.
 The most common group of drugs used today is selective
serotonin re-uptake inhibitors, which increase the level of
available serotonin by preventing its re-uptake in the
synaptic gap
 Examples: Prozac (fluxetine)
 Side effects: vomiting, nausea, insomnia, sexual
dysfunction, or headaches.
Individual approaches
 Aaron Beck developed the idea of congitive
restructuring. The principles are:
 Identify negative, self-critical thoughts that occur
automatically
 Note the connection between negative thought and
depression
 Examine each negative thought and decide whether it
can be supported
 Replace distorted negative thoughts with realistic
interpretations of each situation.
Cognitive-behavioral therapy (CBT)
 CBT is a brief form of psychotherapy with around 12-20
weekly sessions, with practice exercises.
 First aim: identify and correct faulty cognitions and
unhealthy behavior
 Client finds out thoughts identified with depressed
feelings
 Second aim: encourage people to increase gradually any
activities that could be rewarding
Group approaches
 Most group therapy is “couple therapy” because of the
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strong link with depression and marital problems.
Marital therapies focus of teaching the couple to
communicate and problem solve.
Toseland and Siporin reviewed 74 studies comparing
individual and group treatment.
75% was found to be just as effective as individual
treatment
25% was found to be more effective as individual treatment
Explain cultural and gender
variations in disorders
Gender variations
 Brown and Harris(1978) discovered that 29 out of 32 women who
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become depressed had experienced a severe life event, but 78
percent of women that did experience a severe life event did not
become depressed.
One out of five women said that they became depressed from:
1.Lacking employment away from home.
2.absence of social support.
3.having several young children at home.
4.loss of mother at an early age.
5.history of childhood abuse.
-Women are two to three more times more likely to become
depressed than men. Also more likely to go through more
episodes of depression as well.
Cultural variations
 World Health Organization (1983) looked at depression
from a cultural perspective and they found that in Iran,
Japan, Canada, and Switzerland all had common symptoms
of depression. Which were sad affect, loss of enjoyment,
anxiety, tension, lack of energy, loss of interest inability to
concentrate, and ideas of sufficiency, inadequacy, and
worthlessness.
 Marsella(1979) found that sadness, loneliness, and
isolation are typical symptoms of depression in
individualistic cultures. Cultures that are more collectivists.
 Ex- have larger and more stable social networks to support
the individual, and where one’s identity is more linked to
the group.
Evaluate psych research relevant to
the study of abnormal behavior
Research and theories
 Department of Health (1990):
 depression accounted for about one quarter of all psychiatric
hospitals in UK
 two or three times more common in women
 occurs frequently among members of lower socio-economic
groups, and young adults
 Levav (1997):
 prevalence rate above average in Jewish males
 no difference in prevalence btw Jewish men and women
 suggest some groups are more vulnerable to depression
 Can be hard for a clinician to diagnose depression because it
could just be a case of “the blue”
Research and theories cont.
 Nurnberger and Gershon (1982):
 reviewed the results of seven twin studies
 found that the concordance rate for major depressive disorder was consistently
higher for MZ twins then for DZ twins
 Average concordance rates
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MZ= 65%
DZ=14%
 The evidence from twin studies does not contradict the view that
environmental events and psychological characteristics play a role
 long term stress may result in depression b/c people who have a predisposition
are more vulnerable and more likely to develop depression
 Duenwald (2003)
 a short variant of the 5-HTT gene may be associated with a higher risk of
depression
 The gene plays a role in the serotonin pathways which are thought to control
moods, emotions, aggression, sleep, and anxiety
Dunewald
Research and theories cont.
 Catecholamine hypothesis (1965)
 this theory says depression is associated with low levels of noradrenalin.
 Serotonin is the neurotransmitter responsible.
 Delgado and Moreno (2000) found abnormal levels of noradrenalin and
serotonin in patients suffering from major depression.
 abnormal levels of neurotransmitters might not cause depression but indicate
that depression influences production o neurotransmitters.
 Rampello et al. (2000)
 Found patients with depressive disorder have an imbalance of several
neurotransmitters---adrenaline, serotonin, noradrenalin, dopamine
 Burns (2003) says there is no evidence that depression results from a deficiency
of brain serotonin.
 Lacasee and Leo (2005) argue that contemporary neuroscience research has
failed to provide evidence that depression is cause by a simple
neurotransmitter deficiency. They believe the brain is complex and poorly
understood.
Catecholamine hypothesis
Examine biomedical, individual,
and group treatment approaches
Biomedical
 Drugs:
 Drugs decrease level of
noradrenalin tends to
produce depression-like
symptoms.
 Jankowsy (1972) participants
were given a drug called
physostigimine
 They became very depressed
and experienced feelings of
hate and suicide within
minutes of taking drug.
 Image: effect of
physostigimine on the brain