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10 25 of women and 5 12 of men lifetime prevalence

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10-25% of women and 5-12% of men lifetime prevalence Average onset in the mid-20s Of those who have one episode, 50-65% will have a second Of those who have two episodes 70% will have a third Psychotic features Hallucinations or delusions Postpartum onset Depression emerging within 4 weeks of giving birth (DSMIV-TR) Seasonal affective disorder (SAD) Winter depression Hypersomnia, increased appetite, weight gain, and irritability Phototherapy Summer depression Late spring Poor appetite, weight loss, less sleep, and psychomotor changes Reduced activity frontal cortex with connections to the amygdala Less able to regulate emotion Connections to pathways of dopamine, serotonin, and norepinephrine Reduced motivated behavior due to reduced frontal, parietal activity Attributional style (for negative events) Internal vs External Stable vs Unstable Global vs specific Depressive attributional style Attributing negative events to internal, global, and stable factors More vulnerable to depression Be familiar with the goals, assumptions, and techniques associated with: Cognitive therapy, Behavioral Activation, and Interpersonal therapy for depression. Behavioral Methods Focus on identifying and changing depressive behaviors Behavioral activation Self-monitoring Scheduling daily activities that lead to pleasure Identifying and decreasing avoidant behaviors Superior to cognitive techniques in treating both moderate and severe depression Self-monitor behaviors, emotions 7pm Watched TV; depressed 7/10 9am Laid in bed; depressed 9/10 11am helped neighbor start car; depressed 2/10 Identify behaviors that worsen mood Notice “avoidance” behaviors (procrastinating, sleeping) that block long-term goals
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Identify alternative behaviors (brainstorm list) Schedule alternative behaviors, try “with an experimental attitude” Cognitive Methods Alter or reduce distorted beliefs, thoughts Thought records to “capture” mood-related thoughts Encouraged to test the accuracy of beliefs CBT is often about as successful as medication Combination of CBT and medication is more effective than medication alone Interpersonal therapy (IPT) Focus on enhancing quality of interpersonal relationships As effective as CBT, antidepressant medication Be familiar with interpersonal and social rhythm therapy for bipolar disorder, and why it is used. Interpersonal and social rhythm therapy (IPSRT) Identifying themes of social stressors Timing of events Increasing overall regularity in daily life Maintain regularity Family therapy and self-help groups are additional treatment options Know the SSRIs for depression and the mood stabilizers used for bipolar disorder.
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