KHA713 Lecture Notes - Lecture 3: Statistical Hypothesis Testing, Back Pain, Weight Loss
25 Jun 2018
School
Department
Course
Professor
Adult Psychopathology
Week 3
Unipolar Depression
Depressive disorders according to the WHO:
- Projected to be the number one health concern in 2030
oIn developed and non-developed level
But more people in developed world seek treatment
o9% of US population
- Prevalence and severity make it a large concern
oSuch a high prevalence disorder
oHigh risk associated with it
Suicide
Suggestion that we should screen everyone for it
2 item screening for flagging of issue
o8% of female population 16-54 age range
oMales
Have a peek of prevalence
35-44 age group peak
- Antidepressant use
o11% of US population are on this medication
oAs you age, ability to metabolize medications differ
oPolypharmacy interactions
oTreatment is a really critical thing that psychologists do
- Differences between genders most pronounced in females for depressive
episode
oBipolar and dysthymia there isn’t much gender difference
- Global burden of disease study
oCauses a large degree of loss of quality of life
oParticularly during middle age to adult age range
oFemales more so than males
Diagnoses: DSM- 5:
- DSM-4 had non-diagnosis building blocks
oE.g. episodes
oStill there only in mania diagnosis
- DSM-5: MDD
oSingle or recurrent episode
- Dysthymia: persistent depressive disorder
oChanged between DSM-4 AND 5
4: less severe but chronic form of MDD
5: Chronic form of MDD
- Premenstrual dysphoric disorder
- Depressive disorder due to another medical condition
oBrain systems not working in the way that they should do
oDepression a secondary consequence to other medical conditions
oCBT may help them cope, but wont help the severity of the symptoms
- Other specified depressive disorder:
oRecurrent but brief
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oShort duration of episode
oDepressive episode with insufficient symptoms
- Unspecified depressive disorder
oDon’t have the time or the skills to assess whether depressive disorder
is present
oDon’t use this
oSubclinical but you cant explain why
MDD:
- Criteria A
o5 or more of the following, but you need to have one of the first two
oThis is important:
You don’t need to have sadness per say to meet MDD
You can just have flatness- anhedonia
Different underlying neurochemistry (increased negative
affect… serotonin) and decrease in positive affect
(norepinephrine based)
oWeight loss or change in appetite:
Meaningful weight loss
Not associated with dieting
Associated with lack of interest or motivation to eat
oInsomnia or hypersomnia
Changes in sleep
Very typical
Hypothesis testing
Make sure its related to mood and not secondary factors
Hypersomnia: feel un refreshed from normal amount of sleep
oPsychomotor agitation or retardation
Not usually both
Weird that you have symptoms that work in both directions
Looks like negative symptoms in schizophrenia
Moving and talking is effortful
Agitation:
Looks like an anxiety
Keyed up and on edge
Pacing around
oFatigue or loss of energy
Don’t use the same piece of evidence for multiple symptoms
Needs to be more than/unrelated to the insomnia or
hypersomnia diagnosis
oDiminished concentration, indecisiveness, nearly every day
Also related to fatigue and sleepiness
Irritating when there are multiple distractions
Might come up if reading, TV shows (useful questions to tease
out these)
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Job and demands at work, following conversations, making
decisions when shopping
Overwhelming decisions
oWorthlessness or excessive or inappropriate guilt
Mood congruent
They are being punished for something abd they have done
Everyone is better without them/burden
oSuicidal thoughts
Depressed without suicidal thoughts do exist
Risk assessment
- Criteria B:
oIMPACT ON functioning
oNeed to think broadly: when people don’t work or don’t have family
etc.
oSignificant distress
oOther areas:
There is no point trying to get into the course or apply for the
job
Under-functioning from where they want to be or could be
oProbing for this- they want to change
- Criteria C:
oNot attributable to the physiological effects of
Substance
Other medical condition
This was included in DSM-4: Not bereavement or significant
loss
CONTROVERSIAL
Normal response
No longer in DSM-5:
Can still be diagnosed with a depressive episode, but it
needs to be ‘more than you would expect’ from normal
General approach from Allan Francis
- Criteria D:
oExclude more pervasive disorders:
Schizophrenia spectrum
- Criteria E:
oAs soon as there is the presence of one episode of mania, they can
never get an MDD diagnosis
oImportant because you cant give them anti-depressive disorders
-Specifiers:
oMelancholic features
Clear indication that it is not secondary
oPsychotic
oAnxious-distressed
oMixed features
oAtypical features
oCatatonia
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Projected to be the number one health concern in 2030: in developed and non-developed level. But more people in developed world seek treatment: 9% of us population. Prevalence and severity make it a large concern: such a high prevalence disorder, high risk associated with it. Suggestion that we should screen everyone for it. 2 item screening for flagging of issue: 8% of female population 16-54 age range, males. Antidepressant use: 11% of us population are on this medication, as you age, ability to metabolize medications differ, polypharmacy interactions, treatment is a really critical thing that psychologists do. Differences between genders most pronounced in females for depressive episode: bipolar and dysthymia there isn"t much gender difference. Global burden of disease study: causes a large degree of loss of quality of life, particularly during middle age to adult age range, females more so than males. Dsm-4 had non-diagnosis building blocks: e. g. episodes, still there only in mania diagnosis.
