ANCC Certification PMHNP Chapter 7
Mood Disorders - Most common psych illnesses
Primary characteristic is persistent disturbance in mood - Major Depressive Disorder
Often occurs without precipitating event - MDD
Object loss theory - Fairbairn, Winnicott & guntrip
Aggression turned inward theory of MDD - Freud
Cognitive Theory - Beck
Learned Helplessness-Hopelessness Theory - Seligman
Genetic predisposition - Strong genetic load for depression for child of depressed parent -
having 3 fold increase in lifetime risk of MDD & 40% chance of depressive episode before
age 18.
Endocrine dysfunction Theory - Probably related to etiology of MDD
Sleep disturbances, appetite disturbances, libido disturbances, lethargy, anhedonia are
neurovegitative symptoms that are related to functions of the - Hypothalamus and pituitary
gland secretions
Endocrine dysfunction and pregnancy - A high incidence of postpartum mood disturbances
is suggested with this
Hypothalamic-pituitary-adrenal axis (HPA) - A theory of MDD, may be a result of an
abnormal stress response related to dysregulation of this system
HPA axis - Controls the physiological response to stress and is composed of interconnective
feedback pathways between the hypothalamus, pituitary gland, and adrenal gland.
Hypothalamus releases - corticotropin-releasing hormone (CRH)
Adrenocorticotropin hormone (ACTH) - Released by pituitary in response to CRH by
hypothalamus
Cortisol - Released by adrenal glands in response to ACTH by pituitary gland
, Hyperactivity of the HPA axis - Demonstrated to be present in individuals with MDD. May
also have elevated cortisol levels
Elevated cortisol levels - Over time damages the CNS by altering neurotransmission and
electrical signal conduction. Cortisol over time can cause changes in size and function of
brain tissue
Dexamethasone suppression test (DST) - Not commonly used in clinical practice for
screening of depression as it is too non specific.
Hypovolemic hippocampus and hypovolemic prefrontal cortex-limbic striatal regions -
Abnormalities demonstrated by neuroimaging in individuals with chronic and severe
depression
Brain damage, including that from stroke and trauma - Depression is a acommon
comorbidity in individuals who have experienced these events
What is the Chronobiological theory of MDD - Desynchronization of the circadian rhythms
produces the symptom constellation collectively called MDD
Circadian rhythms control these biological processes that are frequent problems with
depressed individuals - Sleep-rest cycle disturbances * Increased cortisol secretions *
REM abnormalities Increased emotional reactivity
Frequent waking
More intensified dreaming
Diurnal variations to circadian-related behaviors
Decreased arousal and energy levels
Decreased activity patterns *
Incidence of MDD - 5% of U.S. population ages 18 and older each year. About 9.9 million
Americans
Most common psychiatric illness seen in primary care practices; only 50% of people
receive treatment - MDD
25% women, 12% men - Risk during reproductive years
Risk of MDD is ________ for both genders below puberty and after menopause - equal
MDD is (greater) or (lesser) source of morbidity for women than other illnesses. - Greater
Fifteen percent (15%) - Of people with MDD will commit suicide
People with MDD - Four times greater risk of premature death - Than normal control
population
Mood Disorders - Most common psych illnesses
Primary characteristic is persistent disturbance in mood - Major Depressive Disorder
Often occurs without precipitating event - MDD
Object loss theory - Fairbairn, Winnicott & guntrip
Aggression turned inward theory of MDD - Freud
Cognitive Theory - Beck
Learned Helplessness-Hopelessness Theory - Seligman
Genetic predisposition - Strong genetic load for depression for child of depressed parent -
having 3 fold increase in lifetime risk of MDD & 40% chance of depressive episode before
age 18.
Endocrine dysfunction Theory - Probably related to etiology of MDD
Sleep disturbances, appetite disturbances, libido disturbances, lethargy, anhedonia are
neurovegitative symptoms that are related to functions of the - Hypothalamus and pituitary
gland secretions
Endocrine dysfunction and pregnancy - A high incidence of postpartum mood disturbances
is suggested with this
Hypothalamic-pituitary-adrenal axis (HPA) - A theory of MDD, may be a result of an
abnormal stress response related to dysregulation of this system
HPA axis - Controls the physiological response to stress and is composed of interconnective
feedback pathways between the hypothalamus, pituitary gland, and adrenal gland.
Hypothalamus releases - corticotropin-releasing hormone (CRH)
Adrenocorticotropin hormone (ACTH) - Released by pituitary in response to CRH by
hypothalamus
Cortisol - Released by adrenal glands in response to ACTH by pituitary gland
, Hyperactivity of the HPA axis - Demonstrated to be present in individuals with MDD. May
also have elevated cortisol levels
Elevated cortisol levels - Over time damages the CNS by altering neurotransmission and
electrical signal conduction. Cortisol over time can cause changes in size and function of
brain tissue
Dexamethasone suppression test (DST) - Not commonly used in clinical practice for
screening of depression as it is too non specific.
Hypovolemic hippocampus and hypovolemic prefrontal cortex-limbic striatal regions -
Abnormalities demonstrated by neuroimaging in individuals with chronic and severe
depression
Brain damage, including that from stroke and trauma - Depression is a acommon
comorbidity in individuals who have experienced these events
What is the Chronobiological theory of MDD - Desynchronization of the circadian rhythms
produces the symptom constellation collectively called MDD
Circadian rhythms control these biological processes that are frequent problems with
depressed individuals - Sleep-rest cycle disturbances * Increased cortisol secretions *
REM abnormalities Increased emotional reactivity
Frequent waking
More intensified dreaming
Diurnal variations to circadian-related behaviors
Decreased arousal and energy levels
Decreased activity patterns *
Incidence of MDD - 5% of U.S. population ages 18 and older each year. About 9.9 million
Americans
Most common psychiatric illness seen in primary care practices; only 50% of people
receive treatment - MDD
25% women, 12% men - Risk during reproductive years
Risk of MDD is ________ for both genders below puberty and after menopause - equal
MDD is (greater) or (lesser) source of morbidity for women than other illnesses. - Greater
Fifteen percent (15%) - Of people with MDD will commit suicide
People with MDD - Four times greater risk of premature death - Than normal control
population
