PNG 2254 TEST 2 VERIFIED STUDY GUIDE
Depression Epidemiology
Research indicates that the incidence of depressive disorder is higher in women than it
is in men by almost 2 to 1. The gender difference is less pronounced between ages 44
and 65, but after the age of 65, women are again more likely to be depressed than men.
The construction of gender stereotypes, or gender socialization, promotes typical
female characteristics, such as helplessness, passivity, and emotionality, which are
associated with depression. In contrast, some studies have suggested that "masculine"
characteristics are associated with higher self-esteem and less depression.
major depressive disorder
is characterized by depressed mood or loss of interest or pleasure in usual activities.
Evidence will show impaired social and occupational functioning that has existed for at
least 2 weeks, no history of manic behavior, and symptoms that cannot be attributed to
use of substances or a general medical condition. The diagnosis will also identify the
degree of severity of symptoms (mild, moderate, or severe) and whether there is
evidence of psychotic, catatonic, or melancholic features.
Dysthmic Disorder (Depressed Mood DDX)
Characteristics of persistent depressive disorder, or dysthymia, are similar and perhaps
milder than MDD. There is no evidence of psychotic symptoms. The essential feature is
a chronically depressed mood (or possibly an irritable mood in children or adolescents)
for most of the day, more days than not, for at least 2 years (1 year for children and
adolescents). The diagnosis is identified as early onset (occurring before age 21 years)
or late onset (occurring at age 21 years or older).
premenstrual dysphoric disorder
The essential features of premenstrual dysphoric disorder include markedly depressed
mood, excessive anxiety, mood swings, and decreased interest in activities during the
week prior to menses, improving shortly after the onset of menstruation, and becoming
minimal or absent in the week postmenses.
substance induced depressive disorder
The depressed mood is associated with intoxication or withdrawal from substances
such as alcohol, amphetamines, cocaine, hallucinogens, opioids, phencyclidine-like
substances, sedatives, hypnotics, or anxiolytics. The symptoms meet the full criteria for
a relevant depressive disorder. A number of medications have also been known to
evoke mood symptoms including anesthetics, analgesics, anticholinergics,
anticonvulsants, antihypertensives, antiparkinsonian agents, antiulcer agents, cardiac
,medications, oral contraceptives, psychotropic medications, muscle relaxants, steroids,
and sulfonamides.
predisposing factor of depression: biological theories
A genetic link has been suggested in numerous studies of depression, but a definitive
mode of genetic transmission has yet to be proven. Twin studies suggest a strong
genetic factor in the etiology of affective illness including depressive disorders. Family
studies have shown that major depression is more common among first-degree
biological relatives of people with the disorder than among the general population.
Further support for heritability as an etiological influence in depression comes from
studies of the adopted offspring of affectively ill biological parents.
Depressive illness may be related to a deficiency of the neurotransmitters
norepinepherine, serotonin, and dopamine, at functionally important receptor sites in the
brain. More recently, this hypothesis has been expanded to include another
neurotransmitter, acetylcholine. Because cholinergic agents do have profound effects
on mood, electroencephalograms, sleep, and neuroendocrine function, it has been
suggested that the problem in depression and mania may be an imbalance between the
biogenic amines and acetylcholine.
Neurotransmitters
Norepinephrine- key component in ability to deal with stress; Serotonin- regulates
mood, anxiety, irritability, aggression, circadian rhythm; Dopamine- thought to exert
strong force over mood and behavior; Acetycholine- contributes to attention span, REM
sleep
predisposing factors to depression: neuroendocrine disturbances
Neuroendocrine disturbances may play a role in the pathogenesis or persistence of
depressive illness. In clients who are depressed, the normal system of hormonal
inhibition fails, resulting in a hypersecretion of cortisol. Thyrotropin-releasing factor
(TRF) from the hypothalamus stimulates the release of thyroid-stimulating hormone
(TSH) from the anterior pituitary gland. Diminished TSH response to administered TRF
is observed in approximately 25 percent of depressed persons and appears to be
associated with increased risk for relapse despite treatment with antidepressants.
predisposing factors of depression: physiological influences
A number of drugs, either alone or in combination with other medications, can produce
a depressive syndrome. Most common among these drugs are those that have a direct
effect on the central nervous system.
An individual who has suffered a cardiovascular accident (CVA), brain tumors,
particularly in the area of the temporal lobe, Alzheimer's disease, Parkinson's disease,
and Huntington's disease, or multiple sclerosis may display symptoms of
depression.Excessive levels of sodium bicarbonate or calcium can produce symptoms
,of depression, as can deficits in magnesium and sodium. Potassium is also implicated
in the syndrome of depression. Depression is associated with dysfunction of the adrenal
cortex and is commonly observed in both Addison's disease and Cushing's syndrome.
Other endocrine conditions that may result in symptoms of depression include
hypoparathyroidism, hyperparathyroidism, hypothyroidism, and hyperthyroidism. An
imbalance of the hormones estrogen and progesterone has been implicated in the
predisposition to premenstrual dysphoric disorder (PMDD) although the exact etiology is
unknown.
Deficiencies in proteins, carbohydrates, vitamin B1 (thiamine), vitamin B 2 (riboflavin),
vitamin B6 (pyridoxine), B 9 (folate), vitamin B12, iron, zinc, calcium, chromium, iodine,
lithium, selenium, potassium, and omega 3 fatty acids have all been associated with
producing symptoms of depression. Other conditions that have been associated with
secondary depression include collagen disorders, such as systemic lupus
erythematosus (SLE) and polyarteritis nodosa; cardiovascular disease, such as
cardiomyopathy, congestive heart failure, and myocardial infarction; infections, such as
encephalitis, hepatitis, mononucleosis, pneumonia, and syphilis; and metabolic
disorders, such as diabetes mellitus and porphyria.
depression: psychosocial socials
Psychoanalytical theory: A loss is internalized and becomes directed against the ego;
Learning theory: Learned helplessness: The individual who experiences numerous
failures learns to give up trying; Object loss: Experiences loss of significant other during
first 6 months of life, Feelings of helplessness and despair, and Early loss or trauma
may predispose client to lifelong periods of depression; Cognitive theory: Views primary
disturbance in depression as cognitive rather than affective. Three cognitive distortions
that serve as the basis for depression: Negative expectations of the environment,
Negative expectations of the self, and Negative expectations of the future
depression in childhood
It is not uncommon for the symptoms of depression to be manifested differently in
childhood. These symptoms change with age. Up to age 3: Signs may include feeding
problems, tantrums, lack of playfulness and emotional expressiveness, failure to thrive,
or delays in speech and gross motor development. From ages 3 to 5: Common
symptoms may include accident proneness, phobias, aggressiveness, and excessive
self-reproach for minor infractions. The incidence among preschool children is
estimated to be between 0.3 and 0.9 percent.
From ages 6 to 8: There may be vague physical complaints and aggressive behavior.
They may cling to parents and avoid new people and challenges.
They may lag behind their classmates in social skills and academic competence. From
ages 9 to 12: Common symptoms include morbid thoughts and excessive worrying.
They may reason that they are depressed because they have disappointed their parents
in some way. There may be lack of interest in playing with friends. The incidence of
depression among school-age children is estimated to be around 2 to 3 percent. Other
, symptoms of childhood depression may include hyperactivity, delinquency, school
problems, psychosomatic complaints, sleeping and eating disturbances, social isolation,
delusional thinking, and suicidal thoughts or actions. The focus of therapy with
depressed children is to alleviate the child's symptoms and strengthen the child's coping
and adaptive skills, with the hope of possibly preventing future psychological problems.
Parental and family therapy are commonly used to help the younger depressed child.
Recovery is facilitated by emotional support and guidance to family members.
Depression in Adolescence
Depression may be even harder to recognize in an adolescent than in a younger child.
Common symptoms of depression in the adolescent are inappropriately expressed
anger, aggressiveness, running away, delinquency, social withdrawal, sexual acting out,
substance abuse, restlessness, and apathy. Loss of self-esteem, sleeping and eating
disturbances, and psychosomatic complaints are also common.A visible manifestation
of behavioral change that lasts for several weeks is the best clue for a mood disorder.
Examples include the normally outgoing and extroverted adolescent who has become
withdrawn and isolating themselves, the good student who previously received
consistently high marks but is now failing and skipping classes, and the usually self-
confident teenager who is now inappropriately irritable and defensive with
others.Treatment of the depressed adolescent is often conducted on an outpatient
basis. Hospitalization may be required in cases of severe depression or threat of
imminent suicide, when a family situation is such that treatment cannot be carried out in
the home, when the physical condition precludes self-care of biological needs, or when
the adolescent has indicated possible harm to self or others in the family. In addition to
supportive psychosocial intervention, antidepressant therapy may be part of the
treatment of adolescent mood disorders.
depression in senescence
Depression is the most common psychiatric disorder of the elderly, who make up 13.1
percent of the general population of the United States. Symptoms of depression in the
elderly are not very different from those in younger adults. Depressive syndromes in
older adults are often confused by other illnesses associated with the aging process.
Symptoms of depression are often misdiagnosed as neurocognitive disorder (NCD).
The most effective treatment of depression in the elderly individual is thought to be a
combination of psychosocial and biological approaches. Antidepressant medications are
administered with consideration for age-related physiological changes in absorption,
distribution, elimination, and brain receptor sensitivity. Electroconvulsive therapy (ECT)
is an important alternative for treatment of major depression in the elderly, especially
considering the problematic side effects of antidepressants in this population.
postpartum depression
Depression Epidemiology
Research indicates that the incidence of depressive disorder is higher in women than it
is in men by almost 2 to 1. The gender difference is less pronounced between ages 44
and 65, but after the age of 65, women are again more likely to be depressed than men.
The construction of gender stereotypes, or gender socialization, promotes typical
female characteristics, such as helplessness, passivity, and emotionality, which are
associated with depression. In contrast, some studies have suggested that "masculine"
characteristics are associated with higher self-esteem and less depression.
major depressive disorder
is characterized by depressed mood or loss of interest or pleasure in usual activities.
Evidence will show impaired social and occupational functioning that has existed for at
least 2 weeks, no history of manic behavior, and symptoms that cannot be attributed to
use of substances or a general medical condition. The diagnosis will also identify the
degree of severity of symptoms (mild, moderate, or severe) and whether there is
evidence of psychotic, catatonic, or melancholic features.
Dysthmic Disorder (Depressed Mood DDX)
Characteristics of persistent depressive disorder, or dysthymia, are similar and perhaps
milder than MDD. There is no evidence of psychotic symptoms. The essential feature is
a chronically depressed mood (or possibly an irritable mood in children or adolescents)
for most of the day, more days than not, for at least 2 years (1 year for children and
adolescents). The diagnosis is identified as early onset (occurring before age 21 years)
or late onset (occurring at age 21 years or older).
premenstrual dysphoric disorder
The essential features of premenstrual dysphoric disorder include markedly depressed
mood, excessive anxiety, mood swings, and decreased interest in activities during the
week prior to menses, improving shortly after the onset of menstruation, and becoming
minimal or absent in the week postmenses.
substance induced depressive disorder
The depressed mood is associated with intoxication or withdrawal from substances
such as alcohol, amphetamines, cocaine, hallucinogens, opioids, phencyclidine-like
substances, sedatives, hypnotics, or anxiolytics. The symptoms meet the full criteria for
a relevant depressive disorder. A number of medications have also been known to
evoke mood symptoms including anesthetics, analgesics, anticholinergics,
anticonvulsants, antihypertensives, antiparkinsonian agents, antiulcer agents, cardiac
,medications, oral contraceptives, psychotropic medications, muscle relaxants, steroids,
and sulfonamides.
predisposing factor of depression: biological theories
A genetic link has been suggested in numerous studies of depression, but a definitive
mode of genetic transmission has yet to be proven. Twin studies suggest a strong
genetic factor in the etiology of affective illness including depressive disorders. Family
studies have shown that major depression is more common among first-degree
biological relatives of people with the disorder than among the general population.
Further support for heritability as an etiological influence in depression comes from
studies of the adopted offspring of affectively ill biological parents.
Depressive illness may be related to a deficiency of the neurotransmitters
norepinepherine, serotonin, and dopamine, at functionally important receptor sites in the
brain. More recently, this hypothesis has been expanded to include another
neurotransmitter, acetylcholine. Because cholinergic agents do have profound effects
on mood, electroencephalograms, sleep, and neuroendocrine function, it has been
suggested that the problem in depression and mania may be an imbalance between the
biogenic amines and acetylcholine.
Neurotransmitters
Norepinephrine- key component in ability to deal with stress; Serotonin- regulates
mood, anxiety, irritability, aggression, circadian rhythm; Dopamine- thought to exert
strong force over mood and behavior; Acetycholine- contributes to attention span, REM
sleep
predisposing factors to depression: neuroendocrine disturbances
Neuroendocrine disturbances may play a role in the pathogenesis or persistence of
depressive illness. In clients who are depressed, the normal system of hormonal
inhibition fails, resulting in a hypersecretion of cortisol. Thyrotropin-releasing factor
(TRF) from the hypothalamus stimulates the release of thyroid-stimulating hormone
(TSH) from the anterior pituitary gland. Diminished TSH response to administered TRF
is observed in approximately 25 percent of depressed persons and appears to be
associated with increased risk for relapse despite treatment with antidepressants.
predisposing factors of depression: physiological influences
A number of drugs, either alone or in combination with other medications, can produce
a depressive syndrome. Most common among these drugs are those that have a direct
effect on the central nervous system.
An individual who has suffered a cardiovascular accident (CVA), brain tumors,
particularly in the area of the temporal lobe, Alzheimer's disease, Parkinson's disease,
and Huntington's disease, or multiple sclerosis may display symptoms of
depression.Excessive levels of sodium bicarbonate or calcium can produce symptoms
,of depression, as can deficits in magnesium and sodium. Potassium is also implicated
in the syndrome of depression. Depression is associated with dysfunction of the adrenal
cortex and is commonly observed in both Addison's disease and Cushing's syndrome.
Other endocrine conditions that may result in symptoms of depression include
hypoparathyroidism, hyperparathyroidism, hypothyroidism, and hyperthyroidism. An
imbalance of the hormones estrogen and progesterone has been implicated in the
predisposition to premenstrual dysphoric disorder (PMDD) although the exact etiology is
unknown.
Deficiencies in proteins, carbohydrates, vitamin B1 (thiamine), vitamin B 2 (riboflavin),
vitamin B6 (pyridoxine), B 9 (folate), vitamin B12, iron, zinc, calcium, chromium, iodine,
lithium, selenium, potassium, and omega 3 fatty acids have all been associated with
producing symptoms of depression. Other conditions that have been associated with
secondary depression include collagen disorders, such as systemic lupus
erythematosus (SLE) and polyarteritis nodosa; cardiovascular disease, such as
cardiomyopathy, congestive heart failure, and myocardial infarction; infections, such as
encephalitis, hepatitis, mononucleosis, pneumonia, and syphilis; and metabolic
disorders, such as diabetes mellitus and porphyria.
depression: psychosocial socials
Psychoanalytical theory: A loss is internalized and becomes directed against the ego;
Learning theory: Learned helplessness: The individual who experiences numerous
failures learns to give up trying; Object loss: Experiences loss of significant other during
first 6 months of life, Feelings of helplessness and despair, and Early loss or trauma
may predispose client to lifelong periods of depression; Cognitive theory: Views primary
disturbance in depression as cognitive rather than affective. Three cognitive distortions
that serve as the basis for depression: Negative expectations of the environment,
Negative expectations of the self, and Negative expectations of the future
depression in childhood
It is not uncommon for the symptoms of depression to be manifested differently in
childhood. These symptoms change with age. Up to age 3: Signs may include feeding
problems, tantrums, lack of playfulness and emotional expressiveness, failure to thrive,
or delays in speech and gross motor development. From ages 3 to 5: Common
symptoms may include accident proneness, phobias, aggressiveness, and excessive
self-reproach for minor infractions. The incidence among preschool children is
estimated to be between 0.3 and 0.9 percent.
From ages 6 to 8: There may be vague physical complaints and aggressive behavior.
They may cling to parents and avoid new people and challenges.
They may lag behind their classmates in social skills and academic competence. From
ages 9 to 12: Common symptoms include morbid thoughts and excessive worrying.
They may reason that they are depressed because they have disappointed their parents
in some way. There may be lack of interest in playing with friends. The incidence of
depression among school-age children is estimated to be around 2 to 3 percent. Other
, symptoms of childhood depression may include hyperactivity, delinquency, school
problems, psychosomatic complaints, sleeping and eating disturbances, social isolation,
delusional thinking, and suicidal thoughts or actions. The focus of therapy with
depressed children is to alleviate the child's symptoms and strengthen the child's coping
and adaptive skills, with the hope of possibly preventing future psychological problems.
Parental and family therapy are commonly used to help the younger depressed child.
Recovery is facilitated by emotional support and guidance to family members.
Depression in Adolescence
Depression may be even harder to recognize in an adolescent than in a younger child.
Common symptoms of depression in the adolescent are inappropriately expressed
anger, aggressiveness, running away, delinquency, social withdrawal, sexual acting out,
substance abuse, restlessness, and apathy. Loss of self-esteem, sleeping and eating
disturbances, and psychosomatic complaints are also common.A visible manifestation
of behavioral change that lasts for several weeks is the best clue for a mood disorder.
Examples include the normally outgoing and extroverted adolescent who has become
withdrawn and isolating themselves, the good student who previously received
consistently high marks but is now failing and skipping classes, and the usually self-
confident teenager who is now inappropriately irritable and defensive with
others.Treatment of the depressed adolescent is often conducted on an outpatient
basis. Hospitalization may be required in cases of severe depression or threat of
imminent suicide, when a family situation is such that treatment cannot be carried out in
the home, when the physical condition precludes self-care of biological needs, or when
the adolescent has indicated possible harm to self or others in the family. In addition to
supportive psychosocial intervention, antidepressant therapy may be part of the
treatment of adolescent mood disorders.
depression in senescence
Depression is the most common psychiatric disorder of the elderly, who make up 13.1
percent of the general population of the United States. Symptoms of depression in the
elderly are not very different from those in younger adults. Depressive syndromes in
older adults are often confused by other illnesses associated with the aging process.
Symptoms of depression are often misdiagnosed as neurocognitive disorder (NCD).
The most effective treatment of depression in the elderly individual is thought to be a
combination of psychosocial and biological approaches. Antidepressant medications are
administered with consideration for age-related physiological changes in absorption,
distribution, elimination, and brain receptor sensitivity. Electroconvulsive therapy (ECT)
is an important alternative for treatment of major depression in the elderly, especially
considering the problematic side effects of antidepressants in this population.
postpartum depression
