major depressive disorder. mood disorders extremely disabling, second only to heart disease...
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Major Depressive Major Depressive DisorderDisorder
Mood DisordersMood Disorders
Extremely disabling, second only to Extremely disabling, second only to heart diseaseheart disease
Associated with Suicide; 15% w/ MDD Associated with Suicide; 15% w/ MDD complete suicidecomplete suicide
MDD most serous and widely studied MDD most serous and widely studied depressive disorderdepressive disorder
Individuals must have anhedonia or Individuals must have anhedonia or depressed mood for at least two depressed mood for at least two weeks period of timeweeks period of time
EpidemiologyEpidemiology
Lifetime prevalence for any mood Lifetime prevalence for any mood disorder is 20.8%disorder is 20.8%
Lifetime prevalence for MDD is Lifetime prevalence for MDD is 16.6% (Kessler et al., 1994)16.6% (Kessler et al., 1994)
Dysthymia is less common (2.5%-Dysthymia is less common (2.5%-6%)6%)
Depression and etiologyDepression and etiology 20 year old female college student 20 year old female college student
presenting to the clinic. She was just presenting to the clinic. She was just released from an inpatient facility for released from an inpatient facility for attempting suicide. This has not been her attempting suicide. This has not been her first attempt. In addition to her frank suicide first attempt. In addition to her frank suicide attempts she has engaged in a number of attempts she has engaged in a number of nonlethal self harm behaviors. She presents nonlethal self harm behaviors. She presents with major depression, severe and has nearly with major depression, severe and has nearly all of the melancholic features. Her speech is all of the melancholic features. Her speech is labored, her affect is blunted, her movements labored, her affect is blunted, her movements appear slow. Prior to her diagnosis of mdd appear slow. Prior to her diagnosis of mdd she had a diagnosis of dysthymia.she had a diagnosis of dysthymia.
Signs and Symptoms of Signs and Symptoms of MDDMDD
Vegetative: loss of satisfaction, loss Vegetative: loss of satisfaction, loss of interest in sex, early morning of interest in sex, early morning awakening, loss of appetite, loss of awakening, loss of appetite, loss of weight, social withdrawalweight, social withdrawal
Cognitive Signs: Difficulty Cognitive Signs: Difficulty concentrating, indecisiveness, low concentrating, indecisiveness, low self esteem, negative thoughts about self esteem, negative thoughts about the self, world and others, guilt, the self, world and others, guilt, suicidal ideation and in more severe suicidal ideation and in more severe cases psychosiscases psychosis
Signs and Symptoms of Signs and Symptoms of MDDMDD
Mood signs: feeling sad, empty, Mood signs: feeling sad, empty, worried, hopeless and irritableworried, hopeless and irritable
DysthymiaDysthymia
Chronic low level depression lasting 2 Chronic low level depression lasting 2 years or moreyears or more
Symptoms can not be absent more Symptoms can not be absent more than 2 months at a timethan 2 months at a time
Can not have MDD within the first 2 Can not have MDD within the first 2 years of the disorderyears of the disorder
EtiologyEtiology
Twin Studies and Family studiesTwin Studies and Family studiesHeritability and specific environmental Heritability and specific environmental factors such as stress affecting one factors such as stress affecting one twin but not the other appear to be twin but not the other appear to be important. important. --Correlation between MZ twins is .46, --Correlation between MZ twins is .46, compared with DZ twins is .20.compared with DZ twins is .20.
Genetic propensity exists but learning Genetic propensity exists but learning and environmental factors play an and environmental factors play an important roleimportant role
Medical IllnessMedical Illness
Endocrinological DisordersEndocrinological Disorders StrokeStroke Parkinson’s DiseaseParkinson’s Disease Pancreatic CancerPancreatic Cancer Coronary Heart DiseaseCoronary Heart Disease Myocardial InfactionMyocardial Infaction Cerebrovascualr diseaseCerebrovascualr disease
Neuropsychology and Neuropsychology and PsychopharmacologyPsychopharmacology
MRI studies revealed MDD have MRI studies revealed MDD have evidence structural differences evidence structural differences compared with controls:compared with controls:– ventricular enlargements and sulcal ventricular enlargements and sulcal
space compared with control patients. space compared with control patients. Areas of impact include the frontal Areas of impact include the frontal lobes, subcortical white matter and lobes, subcortical white matter and caudate nucleicaudate nuclei
Neurotransmitters, Hormones Neurotransmitters, Hormones and Depressionand Depression
MonoaminesMonoamines NorepinephrineNorepinephrine SerotoninSerotonin DopamineDopamine CortisolCortisol
PersonalityPersonality
Prospective Studies and Prospective Studies and TemperamentTemperament
NeuroticismNeuroticism
StressorsStressors
Prolonged exposure to psychosocial Prolonged exposure to psychosocial stressstress
Most episodes are preceded by a Most episodes are preceded by a severe life event or difficulty in the 6 severe life event or difficulty in the 6 months before the onset of the months before the onset of the episode;episode;
Increased rates of childhood abuseIncreased rates of childhood abuse Themes of lossThemes of loss Maternal loss Maternal loss
Diathesis/Personality/Stress: Diathesis/Personality/Stress: Unipolar DepressionUnipolar Depression
Diathesis
Females more at risk than males
Family history of unipolar depression
Monoamine Deficits
Diminished Norepinephrine
Diminished Serotonin
Diminished Dopamine
Personality
Neuroticism
Behavioral Inhibition
Anxiety
Social reticence
Fearful in presence of strangers
Lower sensation seeking
Stressor
Interpersonal Loss
Threats to economic security
Cummulative Negative Events
Traumatic Events (defined by Criterion A)
Heterogeneity of DepressionHeterogeneity of Depression
Haslam and BeckHaslam and Beck– Examined empirical research for Examined empirical research for
evidence of distinct subtypes of evidence of distinct subtypes of depressiondepression
– SubtypesSubtypes EndogenousEndogenous SociotropicSociotropic AutonomousAutonomous Self-criticalSelf-critical HopelessnessHopelessness
Criteria for AnalysisCriteria for Analysis
Indicators must be dichotomousIndicators must be dichotomous Items were standardizedItems were standardized Was it a taxon?Was it a taxon?
– Do the symptoms hang together?Do the symptoms hang together?– Which elements appear importantWhich elements appear important– Were they discrete or continuous?Were they discrete or continuous?
FindingsFindings
Discrete subtype for endogenous Discrete subtype for endogenous depressiondepression
Heterogeneity of Depression: Heterogeneity of Depression: Male PresentationsMale Presentations
http://www.nimh.nih.gov/health/publihttp://www.nimh.nih.gov/health/publications/real-men-real-depression.shtcations/real-men-real-depression.shtmlml
http://www.nimh.nih.gov/health/http://www.nimh.nih.gov/health/topics/depression/men-and-topics/depression/men-and-depression/depression/
/
The Masculine Depression The Masculine Depression ScaleScale
Depression is twice as common in Depression is twice as common in women as in men;women as in men;
Perhaps men evidence depression Perhaps men evidence depression symptomatology that is differerent symptomatology that is differerent from that of women and that these from that of women and that these differences lead to disparate differences lead to disparate prevalence rates;prevalence rates;
The Masculine Depression The Masculine Depression ScaleScale
Developed a self-report instrument Developed a self-report instrument designed to assess ‘masculine designed to assess ‘masculine depression’depression’
Examined the correlation between Examined the correlation between men who adhere to masculinity men who adhere to masculinity hegemonic norms and masculine hegemonic norms and masculine depressiondepression
Sample itemsSample items
Anger, aggression, irritabilityAnger, aggression, irritability Substance abuseSubstance abuse Withdrawal from family/social Withdrawal from family/social
interactionsinteractions Overfocus on work/schoolOverfocus on work/school Inability or unwillingness to display Inability or unwillingness to display
soft emotionssoft emotions Self-criticism of self/sense of failureSelf-criticism of self/sense of failure
FindingsFindings
Men who adhered to masculine norms Men who adhered to masculine norms were more likely to endorse externalizing were more likely to endorse externalizing symptoms of depression than prototypic symptoms of depression than prototypic symptoms of depressionsymptoms of depression– I’ve yelled at peoplor or thingsI’ve yelled at peoplor or things– I’ve had a short fuseI’ve had a short fuse– I got so angry I smashed or punched somethingI got so angry I smashed or punched something– I don’t get sad I get madI don’t get sad I get mad– I’ve been drinking a lotI’ve been drinking a lot– I’ve been under constant pressureI’ve been under constant pressure– I’ve needed to handle my problems on my ownI’ve needed to handle my problems on my own