von: Lynn Rehm

Hogrefe Publishing, 2010

ISBN: 9781616763268

Sprache: Englisch

92 Seiten, Download: 723 KB

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Hyde, Mezulis, and Abramson (2008) present an ABC model that links affective, biological, and cognitive vulnerabilities with life stress. The model incorporates most of the factors cited above and adds a few additional risks for depression to which women are exposed. The affective factors they cite include personality style, dependency and affiliative needs (cf. sociotropy), and temperament, such as negative emotionality. Biological factors include familial risk, specific genetic mechanisms, and pubertal hormones. Cognitive factors include negative cognitive style (helpless attributions), rumination, and body-image dissatisfaction. Beginning in adolescence, all of these interact with stressors such as broadly construed sexual abuse, negative interpersonal events, and pressure to conform to gender roles. The model nicely incorporates factors from theoretical models that have empirical support.

1.3.3 Summary

Depression is a widespread disorder that has a major impact on society. Research suggests that both Major Depression and Bipolar Disorder are on the rise around the world, although the reasons for this are unclear. Children score equally on depression measures, but by adolescence depression is more common among women by about 1.5:1 to 2.0:1. This is true around the world. A number of factors have been proposed to account for these differences and many of them have empirical support.

1.4 Course and Prognosis

The description of mood disorders in the latest version of the DSM addressed the course of the disorder in great detail. Course descriptors were written in for the subtypes and specifiers. Single Episode and Recurrent are subtypes. Recurrence is also a significant feature for prognosis. Among people who have a first episode of MDD, 50% experience a second episode, and of those with a second episode, about 70% experience a third episode. People who experience three episodes have a 90% chance of having a fourth and more (American Psychiatric Association, 2000). The course of Recurrent MDD is further described by course specifiers: With, and Without Full Interepisode Recovery; Seasonal Pattern; and Rapid Cycling. Without Full Interepisode Recovery implies that depression can be almost continuous with a waxing and waning course. Because of the probability of recurrence and lack of full recovery between episodes, many experts believe depression should be considered a chronic disorder and treated as such. The typical age of onset for a first episode of depression is the mid-twenties. As discussed earlier, however, onset is earlier for people born in more recent decades. Depression is being diagnosed more frequently in children as well. Diagnosing children with depression has led to some controversy. The syndrome is less coherent in children and hence the reliability of diagnosis is low. Many children are treated with antidepressant medications even though evidence for the effectiveness of antidepressants in children is sparse. Concern that some selective serotonin reuptake inhibitors (SSRIs) may lead to increased rates of suicide in children and adolescents has led to warning labels on these medications, even though the evidence is controversial.

Seasonal Pattern is clearly related to exposure to light and the length of days. Less light leads to the onset of depression. This type of depression is more common closer to the poles and less common closer to the equator, where there is less variability in annual daylight. The DSM requires that this occurs for at least 2 years in a row with seasonal episodes far outnumbering nonseasonal ones. Interestingly, research suggests that, even in individuals who do not show a regular seasonal pattern, there is a higher probability of depressive episode onsets in the fall and remissions in the spring than in other seasons. Seasonal Pattern has only been recognized in recent decades in the DSM; however, it is a long-known phenomenon in Scandinavian countries, where it is referred to with terms like “Spring Disease,” and where the traditional treatment is to recommend use of sun lamps. Bright light as a treatment for depression will be covered in a later chapter.

Postpartum Onset has its own set of complexities. In earlier DSMs, postpartum depression was an independent diagnosis. Now it is treated as a specifier. In part this recognizes that postpartum depressions are like any other depression, although whether there is a specific hormonal contribution is still debated. Three types of depression with postpartum onset can be distinguished. “Postpartum blues” are a common experience of women following the birth of a child. This is a mild form of depression that most likely results from the various stresses involved in having a child. Postpartum Onset depression is diagnosed when DSM criteria are met. These episodes are similar to other forms of depression and are likely to be the target of one form of treatment or another. Psychotic Depression with Postpartum Onset is the most severe form. Danger of harm to self and children is a concern in such cases, and although these incidents are rare, they often make the news. It is critical for these individuals to receive treatment. Michael O’Hara found factors such as being single, having a lack of social support, and already having some symptoms of depression were predictors of Postpartum Onset depression (O’Hara, Rehm, & Campbell, 1982, 1983). Other factors that have been identified as being associated with postpartum onset depression include tobacco use during the last 3 months of pregnancy, physical abuse before or during pregnancy, stress related to partner, trauma, or finances during pregnancy, and delivering a low-birth-weight infant (Centers for Disease Control and Prevention, 2008).

Rapid Cycling (four or more bipolar episodes in a year) occurs in 10% to 20% of cases and is more frequent in women. In rare cases, Rapid Cycling may involve episodes that alternate within days or even hours. Rapid Cycling is associated with a poor prognosis. Poor prognosis in unipolar and bipolar mood disorders is associated with earlier onset, more severe episodes, and incomplete recovery from an initial episode.

1.5 Differential Diagnosis

Within the mood diagnoses themselves, differential diagnosis can be a problem. A first episode of depression may be the prelude to later depression in its unipolar form, or it could be the first episode of a bipolar disorder. Likewise, a Manic Episode with irritable mood or a Mixed Episode may be difficult to differentiate from a MDE. In either case, inquiring into family history may help to make a determination. A lengthy period of depression (greater than 2 years) that does not remit may fit criteria for Dysthymia, but if it began with a full MDE then it is MDD in Partial Remission. Dysthymia can only be diagnosed in a person who has had MDD if it can be established that the person had Dysthymia first or if the MDD had fully remitted for at least a 2-month period before the Dysthymia began. If the Dysthymia occurs first and the person develops a MDE, then both Dysthymia and MDD diagnoses apply, a condition sometimes referred to as Double Depression. Dysthymia is distinguished from Adjustment Disorder with Depressed Mood by duration and by the fact that the latter is preceded by a clear stressor. Bereavement is not considered an instance of MDD unless it is persistent (greater than 2 months) or the person is functionally impaired. It should also be remembered that severity and duration criteria are important in differentiating MDD from normal periods of sadness.

Mood disorders may also be difficult to differentiate from anxiety disorders. In general, anxiety and depression are overlapping emotions and disorders of anxiety and mood have overlapping symptoms. The fact that the DSMIV contains criteria for a diagnosis of Mixed Anxiety-Depressive Disorder in the appendix for possible disorders needing further study for inclusion in the DSM reflects this overlap. Both MDD and Generalized Anxiety Disorder (GAD) may involve excessive worrying




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