User:Atcovi/Psychopathology/Chapter 7

Depressive and Bipolar Disorders


 * Depression: low, sad state, serious sadness and guilt.
 * Mania: State of horrific, frenzied activity accompanied with a crazy belief.
 * Depressive disorders: Group of disorders marked by "unipolar" depression [depression with no mania], 8% of adults suffer from severe unipolar depression (avg age of onset, 19 years old).
 * Bipolar disorder: Disorder marked by alternating periods of mania and depression.

Depression
Symptoms Types
 * Emotional: sadness, no happiness.
 * Motivation: No motivation, wanna die.
 * Behavioral: Less movement, changes in eating
 * Cognitive: Pessimistic
 * 'Physical: Headaches
 * 1) Major depressive disorder: Disabling depression, caused by drugs/general medical problems
 * 2) Persistent depressive disorder: Chronic form of unipolar depression
 * 3) Premenstrual dysphoric disorder: Disorder with repeated episodes of bad depression relating to menstruation.

Major depressive episode

 * For 2 weeks, person gets mad depression for majority of the day. They also experience at least 4 of the symptoms: daily fatigue, weight change, hypersomnia, reduction in concentration, or concentration in suicide. JUST depressive episodes, no mania.

Persistent depressive disorder

 * Experiences symptoms for at least 2 years (major/mild), not absent for 2+ months at a time. No mania.

Stress and Unipolar Depression
Stress events trigger this, kinds of depression include reactive depression and endogenous depression.

Biological Model
 * Genetic factors (twin/gene studies), molecular biology included.
 * Biochmeical factors: low activity of serotonin and norepinephrine. HPA pathway, as HPA axis is way too reactive in stress (releasing cortisol) within depression people.
 * Brain circuits (see below)

Postpartum Depression

 * Symptoms last for 1+ year(s). Caused by hormonal changes, genetic predisposition, and psycho/social change. Treatment includes self-help groups, medication, and therapy.

Brain Circuit & other ways biology treats unipolar depression

 * Bran circuit involved in unipolar depression includes the subgenual cingulate, which plays a very important part in this. Abnormal activity in terms of flow rate, abnormal neurotransmitter activity, and structural problems play a role.
 * The immune system also bares some consequences, including greater inflammation and slower functioning of lymphocytes.
 * Biological treatments include antidepressant drugs (SSRIs) and brain stimulation (electroconvulsive therapy). Antidepressant drugs, like tricyclic, block the reuptake process, allowing stuff like serotonin to remain in the synapse longer and bind with the recieving neuron.
 * Includes MAO inhibitors and tricyclics. Second-generation antidepressants include SSRIs (increase serotonin), like Fluoxetine, include SNRIs (increase norepinephrine activity), like Strattera, and includes Serotonin-norepinephrine reuptake inhibitors (increase serotonin + norepinephrine), like Effexor.
 * Ketamine-based antidepressants increase glutamate activity in brain, providing a new neural pathway. Alleviates depression fast.
 * Other methods include brain stimulation and other methods (ECT, vagus nerve stimulation, transcranial magnetic stimulation, and deep brain stimulation).

Psychodynamic Model
(old school thought), all depression stems from the sadness of a [real/imagined] loss (Freud and Abraham). More modern-day influences include object relations theorists (depression when people's relationships leave them feeling safe, early-life). Supported ideas include early major losses cause depression or lack of childhood needs were met. But this is a correlation, not causation.

Basic methods include free association and interpretations of client associations/dreams + resistance and transference.

NOTE ABOUT GRIEF: Originally was removed, but now according to DSM-5-TR, if your depression is so bad to a grief reaction (someone died, for example), then this may be given a depression diagnosis.

STRENGTHS AND LIMITATIONS


 * Strengths include general research support, but limitations include inconsistent research findings and overexaggeration in diagnosis.

Cognitive-Behavioral Model
Behavioral dimension (Lewinsohn and others):
 * Depression comes from problematic behaviors and dysfunctional thinking. Perspectives arise from behavioral dimension, negative thinking, and complex CBR interplay.

Learned helplessness: Cognitive-behavioral interplay (Seligman believes that depression is out of the helpless person's hands).
 * More we do, more we are rewarded, the more happy we are. Social rewards and strong relationships play a role.
 * To reactivate the love in life, we'd introduce them to pleasurable events + improve social skills.
 * According to Beck, unipolar depression is caused by automatic thoughts and a pessimistic outlook on life. Beck's cognitive therapy also consists of approach phases, including increasing activities/elevating moods, challenging automatic thoughts, figuring out negative thinking and biases, and changing attitudes.
 * According to Watkins, rumination due to depression are linked to dejection/later life clinical depressions.
 * New-wave theorists: ACT therapy

Attribution-helplessness theory: Modified learned helplessness theory; someone looks at the world and its lack of control, feels helpless, then depression ensues.

Challenges come from problems with animal subjects and attribution feature raises difficult questions.

Unipolar depression influenced by social context and outside stressors, as believed in the family-social perspective & multicultural perspective.

Family-social perspective
Decline in social rewards --> [causes] depression.


 * Depressed people show social deficits, thereby decreasing socialness and amplifying depression

Family-social treatments: IPT (Interpersonal psychotherapy), a brief, attachment-focused psychotherapy that centers on resolving interpersonal problems and recovery. Successful like cognitive-behavioral therapy.

Couples therapy is two people involved in a long-term relationship. Integrative behavior couples therapy combines cognitive-behavioral and sociocultural techniques.

Multicultural perspective
Depression is worldwide, and core symptoms are commonly known (including tension, sadness, and fatigue). Depression is more in the mind vs. in actual situations in the West. Women are more depressed than men, whilst these women are younger and the depression lasts for a while.

Explanations for gender and depression:


 * Artifact theory: women and men are equally likely to fall into depression, but men are less likely to be detected for it.
 * Hormone explanation: hormone changes --> depression in women
 * Life stress theory: women are more stressed out
 * Body dissatisfaction explanation: Females in the west are programmed to certain body standards.
 * Lack-of-control theory: Because women are 'weaker', they will be more depressed.
 * Rumination theory: Thinking over and over again about bad stuff when their mood is horrible, which leads to depression.