question

About ___ of the people with unipolar depression receive treatment (In the US).

answer

1/2

question

Which races tend to be more likely to receive treatment?

answer

White, followed by black and hispanic

question

Many people in therapy for unipolar depression experience depressed feelings as a part of

answer

another disorder.

question

___ is used very often to treat unipolar depression although it has not been proven entirely effective through research.

answer

Psychodynamic therapy

question

Behavioral therapy is practiced ___ and is primarily used for ___

answer

less often today mild or moderate depression

question

Most popular approach for treating unipolar depression is...

answer

cognitive and cognitive-behavioral

question

Psychodynamic therapy

answer

believing that unipolar depression results from unconscious grief over real or imagined losses, compounded by excessive dependence on other people...psychodynamic therapists seek to help clients bring underlying issues to consciousness and work them through. They encourage free association, use dream interpretation, and observe any signs of resistance or transference.

question

Psychodynamic therapists expect that in the end...

answer

after the course of treatment depressed clients will gain awareness of the losses in their lives, become less dependent on others, cope with losses more efficiently and make corresponding changed in their functioning.

question

Cases show that psychodynamic therapy is only ___ helpful in cases of unipolar depression.

answer

occasionally

question

What limits the effectiveness of long-term psychodynamic therapy?

answer

-depressed clients may be too passive and feel too weary to join into therapy discussions -they may become discourages and end treatment too early when this long-term approach is unable to provide the quick relief they seek.

question

Psychodynamic therapy seems to help most often when cases of depression result from

answer

history of childhood loss or trauma, long-standing sense of emptiness, feelings of perfectionism, extreme self-criticism.

question

____ term psychodynamic therapies have performed better than ___ term

answer

short long

question

Most behavioral treatments for unipolar depression are modeled after the intervention proposed by

answer

Peter Lewinsohn, the behavioral theorist

question

In a typical behavioral approach to unipolar depression...

answer

therapists -reintroduce depressed clients to pleasurable events and activities -appropriately reward nondepressive behaviors and withhold rewards for depressive behaviors -help clients improve their social skills

question

Behavioral activation

answer

adding positive activities into a person's life which can lead to a better mood

question

A depressed person's negative behaviors, such as crying, are said to

answer

keep others at a distance, reducing chances for rewarding experiences and interactions. SO therapists encourage patients to monitor these behaviors and instead try new and more positive ones

question

Contingency management approach

answer

systematically ignoring a client's depressive behaviors while praising or otherwise rewarding constructive statements and behavior such as going to work. Sometimes family and friends are recruited to help with this.

question

Behavioral therapists also train clients in

answer

effective social skills. in group therapy programs, for example, members may work together to improve eye contact, facial expression, posture, etc. that contribute to social messages

question

Behavioral techniques seem to be ______ when only one is applied

answer

of little help

question

Behavioral treatment appears to be successful in treating depression symptoms when

answer

two or more behavioral approaches are applied.

question

Maladaptive attitudes...

answer

lead people to view everything negatively.

question

cognitive triad

answer

when people with maladaptive thoughts view themselves, their world and their future negatively

question

automatic thoughts

answer

maladaptive attitudes combined with illogical thinking... unrelenting thoughts that flood the mind and produce the symptoms of depression

question

cognitive therapy

answer

developed by Beck its primary purpose is to help clients recognize and change their negative cognitive processes and this improve their mood. The approach also uses a number of behavioral techniques (by encouraging them to try out new behaviors, for example) so many people actually consider this the cognitive-behavioral therapy

question

cognitive-behavioral therapy

answer

what the cognitive therapy is really considered to be called to some.

question

Beck's cognitive-behavioral therapy is similar to that of Alber Ellis'

answer

rational-emotive therapy

question

Phases of cognitive therapy

answer

1. increasing activities and elevating mood 2. challenging automatic thoughts 3. identifying negative thinking and biases 4. changing primary attitudes

question

phase 1

answer

increasing activities and elevating mood encourage clients to become more active and confident. Clients often prepare detailed schedules of hourly activities for them in the coming week and as their more active from week to week their mood is expected to improve

question

phase 2

answer

challenging automatic thoughts clients are instructed to recognize and record automatic thoughts as they occur and to bring their lists to each session. then together, therapist and client test the reality behind these thoughts and often conclude that they are groundless.

question

phase 3

answer

identifying negative thinking and biases therapists show them how illogical thinking processes are contributing to these thoughts. also assist clients in recognizing that almost all their interpretations of events have a negative bias and change that style of interpretation

question

phase 4

answer

changing primary attitudes change maladaptive attitudes that set the stage for their depression in the first place encourage clients to test their attitiudes

question

Beck's therapy has been proven to

answer

help depression

question

Around __% - ___% of people who receive cognitive behavioral therapy will show a near total ellimination of their symptoms.

answer

50-60

question

Although the behavioral-cognitive approach is very widely used, many clinicians do not believe

answer

Beck's proposition that individuals must fully discard their negative cognitions in order to overcome depression. "new-wave" cognitive therapists instead guide clients to recognize and accept their negative cognitions simply as streams if thinking that flow through their minds rather than as valuable guides for behaviors and decisions. As clients increasingly accept their negative thoughts for what they are, they can better work around the thoughts as they navigate their way through life. These therapists practice "acceptance and commitment therapy" or ACT.

question

Sociocultural approaches trace the causes of unipolar depression to

answer

broader social structure in which people live and the roles they are required to play

question

two groups of sociocultural approaches

answer

family social approaches and multicultural approaches

question

Culture sensative approaches

answer

are increasingly being combined with traditional forms of psychotherapy to help minority clients overcome their disorders. minority groups are more likely to overcome their depression when culture-sensitive approaches are used

question

Many medication needs of depressed patients are

answer

not properly met because of their lack of money

question

Most effective family-social treatments

answer

interpersonal psychotherapy and couple therapy

question

Interpersonal Psychotherapy

answer

Developed by Gerald Klerman and Myrna Weissman, IPT holds that any of four interpersonal problem areas may lead to depression and must be addressed: interpersonal loss, interpersonal role dispute, interpersonal role transition, and interpersonal deficits, over the course of about 16 sessions.

question

Interpersonal Loss

answer

have grief reactions over an important interpersonal loss (the loss of a loved one), here, therapists encourage clients to explore their relationship with the lost person and express feelings of anger...this helps them develop new ways of remembering the person.

question

Interpersonal role dispute

answer

people may find themselves in the midst of an interpersonal role disputes, role disputes occur when two people have different expectations of their relationship and of the role each should play. therapists help clients examine whatever role disputes they may be involved in and then develop ways of resolving them.

question

Interpersonal deficits

answer

extreme shyness or social awkwardness prevents people from having intimate relationships. IPT therapists may help such clients recognize their deficits and teach them social skills and assertiveness in order to improve their social effectiveness.

question

studies suggest that IPT and related interpersonal treatments for depression have a similar success rate to

answer

cognitive-behavioral therapies

question

symptoms almost entirely disappear in % - % of IPT patients

answer

50-60

question

Couple Therapy

answer

depression can result from marital discord and recovery from depression is slower for people who don't receive support from their spouse. As many as half of depressed patients may be in failing relationships. therapists work with two people who share a long-term relationship.

question

integrative behavioral couples therapy

answer

teach specific communication and problem-solving skills to couples and further guide them to be more accepting of each other. This could be as effective as individual cognitive therapies in cases of relationships filled with conflict but couple therapy often leads to a more satisfied client with the status and state of their relationship.

question

Biological Approaches

answer

drugs, electroconvulsive therapy, brain stimulation

question

ECT - Electroconvulsive therapy

answer

one of the most controversial forms of treatment for depression is electroconvulsive therapy clinicians and patients alike very greatly in their opinions of this procedure. Some consider it a safe biological approach with minimal risks. others believe it to be an extreme measure that can cause troublesome memory loss and even neurological damage but it is often used because it is fast-acting

question

treatment procedure of ECT.

answer

two electrodes are attached to the patient's head, 65 to 240 volts of electricity are passed through the brain for half a second or less. thsi results in a brain seizure that lasts from 25 seconds to a few minutes. after 6 to 12 of these treatments, spaced out over 2-4 weeks, most patients feel less depressed.

question

bilateral ECT

answer

one electrode is applied to each side of the forehead and a current passes through both sides of the brain

question

unilateral ECT

answer

electrodes are places so that they current passes through only one side

question

Origins of ECT

answer

discovery made by accident 1930s clinical researchers accidentally came to believe that brain seizure or convulsions that accompany a seizure could cure schizophrenia and other psychotic disorders they observed that people with psychosis rarely suffered from epilepsy and that people with epilepsy were rarely ever psychotic and so concluded that brain seizure or convulsions somehow prevented psychosis. We now know that the observed correlation between seizures and lack of psychotic symptoms doesnt necessarily imply that one causes the other. Nevertheless, clinicians in the 1930s searched for ways to induce seizures as a treatment for patients with psychosis

question

Joseph von Meduna andManfred Sakel

answer

gave the drug Metrazol to patients suffering from psychosis gave large doses of insulin (insulin coma therapy) to induce brain seizures BUT these procedures were dangerous and sometimes even caused death.

question

Ugo Cerletti

answer

discovered basis for ECT but much controversy accompanied this discovery

question

NOW ECT has been ruled out as treatment for ___ disorders and is used for ___

answer

Psychotic disorders depression

question

Today when ECT is used...

answer

practitioners give patients strong muscle relaxants to minimize convulsions and eliminate the danger of fractures and dislocations. They also use anesthetics to put patients to sleep during the procedure, reducing their terror. ECT us medically more complex than it used to be but it is now less harmful as well.

question

effectiveness of ECT

answer

effective in treating unipolar depression, between 60-80% of ECT patients improve its most effective when patients follow up the initial cluster of sessions with continuation therapy

question

continuation therapy

answer

ongoing antidepressant meds or periodic ECT sessions

question

ECT in the brain

answer

delivers a broad insult to the brain that activates a number of brain areas, causes neurons all over the brain to fire and leads to the release of all kinds of neurotransmitters and affects many other systems throughout the body as well

question

Use of ECT has ___ since the 1950s why?

answer

declined memory loss in ECT patients and frightening nature of the procedure also the emergence of effective antidepressant drugs, a much less threatening concept

question

three types of antidepressant drugs

answer

monoamine oxidase inhibitors and tricyclics and second-generation antidepressants

question

MAO inhibitors

answer

discovered accidently doctors noticed a TB drug made people happier and followed its makeup to see that MAO inhibitors could help with depression they slow the body's production of the enzyme monoamine oxidase (MAO) MAO breaks down and degrades the neurotransmitter, norepinephrine, MAO inhibitors block MAO from carrying our this activity and stop the destruction of norepinephrine (often lacking in depressed patients) the result is a rise in norepinephrine activity and in turn a reduction of depressive symptoms. MAO inhibitors help about half of the patients that take them.

question

danger of MAO

answer

when people who take MAO inhibitors eat foods containing the chemical tyramine including cheese and bananas, their BP rises dangerously. people on these drugs must stick to a rigid diet MAO inhibitor skin patches have recently become available and it allows for slow and continuous absorption into the body. and because it is slow the reactions to foods are less common

question

Tricyclics

answer

discovered in the 1950s on accident researchers were looking for a new drug to combat schizophrenia and ran tests on a drug called imipramine they discovered that imipramine was of no help in schizophrenia but did relieve unipolar depression in many people this new drug that became named tofranil and related ones become known as tricyclic antidepressants because they all share a three-ring molecular structure.

question

if depressed people stop taking tricyclics immediately after obtaining relief

answer

they run a high risk of relapsing within a year. if however they continue taking the drug for five months or more after being free of depressive symptoms " continuation therapy their chances of relapse decrease considerably.

question

maintenence therapy

answer

continuing to take the drug 3-4 years after relief and drug use becomes indefinite

question

Tricyclics reduce depression by

answer

acting on neurotransmitter "reuptake" mechanisms.

question

reuptake

answer

a pump like mechanism in the neuron's ending immediately starts to reabsorb it in a process called reuptake purpose is to control how long the neurotransmitters remain in the synaptic space and prevent it from overstimulating the receiving neuron unfortunately reuptake doesn't always progress properly. reuptake mechanism may be too efficient in some people -- cutting off norepinephrine or serotonin activity too soon, preventing messages from reaching the receiving neurons and producing clinical depression tricyclics block this reuptake process allowing neurotransmitters to remain in the synapse longer and increasing their stimulation of receiving neurons

question

symptoms continue for __ days after drug begins

answer

10 or more because initially they slow down the activity of the neurons that use norepinephrine and serotonin neuron respond to change of more efficient transmission if neurotransmitter (caused by reuptake mechanisms) by releasing smaller amounts of neurotransmitters fixed after 1-2 weeks.

question

tricyclics are prescribed _____ than MAO

answer

more often bc no dietary restrictions and higher improvement rates. BUT each patient is individual and responds differently to each

question

Second generation antidepressants

answer

a third group of effective antidepressant drugs called selective serotonin reuptake inhibitors (SSRIs) they increase serotonin activity specifically without affecting norepinephrine or other neurotransmiters.

question

SSRIs include

answer

Prozac (fluoxetine), Zoloft (sertaline) and Lexapro (escitalopram)

question

selective norepinephrine reuptake inhibitors

answer

atomoxetine or strattera increase norepinephrine activity only

question

serotonin-norepinephrine reuptake inhibitors

answer

venlafacine (effexor) increase both serotonin and norephonephrine activity

question

Second generation antidepressants are about as effective as

answer

Tricyclics but are often preferred because it's harder to OD on them and they don't pose dietary problems and have less side effects but they do have side effects of their own such as weight gain or reduced sex drive.

question

what can also determine prescription of meds for certain people

answer

insurance and financial means

question

Antidepressants do not...

answer

work for everyone

question

Even the most successful antidepressants fail to help

answer

35% of clients

question

Brain stimulation

answer

three additional biological approaches have been developed for the treatment of depressive disorders that fall under this category... vagus nerve stimulation transcranial magnetic stimulation deep brain stimulation

question

vagus nerve

answer

vagus nerve is the longest nerve in the human body, it runs from the brain stem through the neck down the chest and on to the abdomen serving as a primary channel of communication between the brain and major organs such as the heart, lungs, and intestines.

question

Vagus nerve stimulation

answer

created with hopes of stimulating the brain by electrically stimulating the vagus nerve. in hopes of mimicking the positive effects of ECT without the undesirable effects or trauma. in this procedure, a surgeon implants a small device called a pulse generator under the skin of the chest. The surgeon then guides a wire which extends from the pulse generator up to the neck and attaches it to the vagus nerve. Electrical signals travel from the pulse generator through the wire to the vagus nerve generator which runs on battery power and is typically programmed to stimulate the nerve every five minutes for a period of 30 seconds, approved by the FDA in 2005 for depression that has not improved after the implementation of at least 4 different other treatments. shown to bring significant relief. as many as 40% improve significantly.

question

As with ECT, researchers do not yet know exactly why vagus nerve stimulation

answer

reduces depression

question

Transcranial magnetic stimulation

answer

another technique that is being used to try to simulate the brain without subjecting depressed patients to the undesired effects of ECT. in this procedure, developed in 1985, the clinician places an electromagnetic coil on or above the patient's head. the coil sends a current into the prefrontal cortex ( an inactive brain portion in many depressed patients) When administered daily for two to four weeks, it showed improvement in depression patients. When administered to severely depressed patients, it may be as helpful as ECT. FDA approved in 2008 for depression

question

Deep brain stimulation

answer

depression is linked to high activity in the Brodmann area 25, it may be a kind of "depression switch." modeled after deep brain stimulation that had been used for brain seizure disorders and Parkinson's disease. Mayberg team drilled two tiny holes into the patient's skill and implanted electrodes in area 25. electrodes were connected to a battery or pacemaker that was implanted in the patient's chest for men and stomach for women. the pacemaker powered the electrodes, sending a steady stream of low voltage electricity to area 25. the expectation was that repeated stimulation would reduce area 25 activity to a normal level and recalibrate and regulate the depression brain circuit.

question

in the initial study of DBS

answer

four of the six severely depressed patients became almost depression free within a matter of months. subsequent research with other severely depressed individuals has also yielded promising findings. in addition to significant mood improvements, patients reported improvements in short-term memory and quality of life.

question

research on DBS is still

answer

in its earliest stages

question

Unipolar depression is one of the most

answer

Treatable of all abnormal patterns it responds to seceral approaches and all approaches seems to have equal success rates

question

depression assesment

answer

Hamilton Rating Scale for Depression

question

study comparing therapies found that

answer

drug therapy reduced depressive symptoms more quickly than the cognitive and interpersonal therapies did but these psychotherapies have matched the drugs in effectiveness by the final 4 weeks of treatment. more recent studies suggest that behavioral-cognitive therapies may be more effective in preventing recurrences of depression except when drug therapy is continued for an extended time.

question

recently there has been an increase in

answer

prescriptions written for depression

question

as many as 30% of depressed patients who initially respond to these approaches may

answer

relapse within a few years after the completion of treatment.

question

in an effort to ward off relapse,

answer

many therapists offer continued treatment.

question

people who recover from depression are less likely to relapse if

answer

they recieive continuation or maintenance therapy in either drug or psychotherapy form, regardless of what was originally prescribed/performed.

question

when people with depression have marital issues

answer

couples therapy can be just as effective as other individual methods

question

behavioral therapy alone

answer

is not very successful but better than nothing

question

most studies suggest traditional long term psychotherapy is not

answer

as effective as these other approaches

question

combinations of ___ help most

answer

drug therapy and another therapy

question

some treatments are ____ and wont carry over and help

answer

age-based, children

question

ECT appears to be more effective than

answer

other drug therapies and works much faster. BUT it must be followed up by drug or other therapy in order to prevent a relapse.

question

ECT is only prescribed if

answer

its a severe enough case (maybe suicidal)

question

ECT is helpful % _% of the time

answer

50-80

question

treatments for bipolar disorders

answer

FDA approves use of lithium in 1970

question

lithium

answer

a silvery white element found in various simple mineral salts throughout the natural world

question

Discovery of lithium was

answer

accidental in 1949, Australian psychiatrist john cade hypothesized that manic behavior is caused by a toxic level of uric acid in the body. he set out to test this theory by injecting guinea pigs with uric acid but he first combined it with lithium to increase solubility. the guinea pigs became not manic but quite lethargic after injevtions

question

lithium ____ is very important

answer

dosage

question

lithium is a mood

answer

stabilizer drug

question

other mood stabilizers..

answer

carmabazepine and valproate or tegretol and depakote

question

more than __ % of patients improve when given

answer

60 mood stabilizer drugs

question

prophylactic drugs

answer

prevent symptoms from developing

question

mood stabilizers like other drugs are most effective when

answer

continuously administered

question

mood stabilizers help with both but are more effective in curing

answer

manic episodes

question

many clinicians use a combo of __ for bipolar patients

answer

mood stabilizers and antidepressants

question

operation of mood stabilzers

answer

change synaptic activity in neurons in a way different fro that of antidepressant drugs.

question

second messages

answer

relaying the original message from the receptor site to the firing mechanism of the neuron

question

first message

answer

neurotransmitter itself

question

systems of second messages

answer

phosphoinositides produced once neurotransmitters are received they suggest that lithium and other mood stabilizers affect this particular, messenger system

question

lithium and other mood stabilizing drugs also increase the

answer

production of neuroprotective proteins - key proteins within certain neurons whose job is to prevent cell death the drugs may increase health and functioning of those cells and this reduce bipolar symptoms

question

alternatively it may be that mood stabilizers correct bipolar funtioning by

answer

directly changing sodium and potassium ion activity in neurons

question

abjunct psychotherapy

answer

using other therapy in tandem with drug therapy to treat bipolar disorders

question

abjunctive therapy

answer

helps patients to solve the family school and occupational problems caused by their disorder and helps prevent patients from attempting suicide, also educated patients and families about bipolar disorders

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