MHP-1

MENTAL HEALTH AND PSYCHOPATHOLOGY

Assignment: 01

NOORAIN CHANNA
05-171211-122
SECTION: V-D
DATE OF SUBMISSION: 11th June 2023

Institute of Professional Psychology

Bahria University Karachi Campus

1
 MHP-1

Q) Write a detailed note on the Etiology, Prevalence, and Prognostic Factors of spectrum of
“Depressive Disorders” as outlined in DSM-5-TR.
ETIOLOGY
More than one factor can be the cause of depression. It includes biological factors as genetic,
neurological, hormonal, immunological, and neuroendocrinological mechanisms appear to be
involved in the development of major depression, many of which are related to responses to
stressors and processing of emotional information. Secondly, talking about environmental
and personal vulnerabilities, Etiological models for depression are largely diathesis-stress
models in which stressful experiences trigger depression in those who may be vulnerable due
to biological and psychosocial characteristics and circumstances. Environmental stressors
associated with depression include acute life events, chronic stress, and childhood exposure
to adversity. Individuals vulnerabilities associated with depression include cognitive,
interpersonal and personal factors. A combination of biological, environmental, and personal
vulnerabilities contributes to the development of depression and can be affected in a two-way
process by depressive states. The majority of women experience depression during and after
pregnancy due to the hormonal changes in the body along with social pressure and low
support from family and society. Genetic vulnerability is also a cause of depression, people
are prone to major depression if it runs in the family.

1. DISRUPTIVE MOOD DYSREGULATION DISORDER

 Prevalence
DMDD is more common in children presenting to pediatric mental health clinics. A
population-based cohort study on Brazilian 11 years old children showed that the prevalence
of DMDD was 2.5%. Although clinical sample shows male majority, consistent gender
difference cannot be seen in population sample. To support this up to 80% population of
children presenting to clinic in Turkey, showing features of DMDD were boys. Finally, data
suggest that it is more common in children (e.g., 8.2% in a community sample of 6-year-olds
in the United States)
 Prognostic Factor
i. Temperamental:
Children with chronic hypersensitivity usually have a complex psychiatric history. Such
children often have relatively long-lasting chronic sensitivities, which typically manifest
themselves as symptoms. Before all criteria for the syndrome were met. Such pre-diagnostic
presentations may have qualified for a diagnosis of oppositional defiant 180 disorder. Many
children with DMDD also exhibit symptoms that meet criteria for attention deficit
hyperactivity disorder (ADHD) and anxiety disorders, and such diagnoses are commonly
present at a relatively early age. Some children also meet criteria for major depressive
disorder.
ii. Environmental:
Factors associated with disrupted family life, such as psychological abuse or neglect, parental
psychiatric disorder, limited parental education, single-parent household, early trauma, death
of a parent, parental grief, divorce, and malnutrition (e.g., vitamin deficiency), are associated
with the core behaviors of disruptive mood dysregulation disorder

2
 MHP-1

iii. Genetic and Physiological:

Data suggest that a family history of depression may be a risk factor for disruptive mood
dysregulation disorder. Consistent with this, twin data suggest that the association between
early irritability and later unipolar depression and anxiety may be, in part, genetically
mediated. On the other hand children, with pediatric bipolar disorder show both
commonalities and differences in information-processing deficits.

2. MAJOR DEPRESSIVE DISORDER

 Prevalence
The 12-month prevalence of major depressive disorder in the United States is approximately
7%, with marked age differences, with a prevalence of 18-29-year olds, three times the
prevalence over the individuals age 60 or older. The most reproducible findings in the
epidemiology of major depressive disorder were higher-grade findings of female prevalence.
This effect peaks at puberty and stabilizes thereafter. In females, it occurs about twice as
often in men, especially during menarche and menopause. Women reported more atypical
depressive symptoms, which are characterized by, Hypersomnia, increased appetite, and lead
paralysis compared to men.
 Prognostic Feature
i. Temperamental:
Negative affectivity (neuroticism) is a well-established risk factor for the onset of major
depressive disorder, and high levels appear to render individuals more likely to develop
depressive episodes in response to stressful life events.
ii. Environmental:
Adverse childhood experiences, particularly when they are multiple and of diverse types,
constitute a set of potential risk factors for major depressive disorder. Women may be
disproportionately at risk for adverse childhood experiences, including sexual abuse that may
contribute to the increased prevalence of depression in this group. Other social determinants
of mental health, such as low income, limited formal education, racism, and other forms of
discrimination, are associated with a higher risk of major depressive disorder. Stressful life
events are well recognized as precipitants of major depressive episodes, but the presence or
absence of adverse life events near the onset of episodes does not appear to provide a useful
guide to prognosis or treatment selection. Etiologically, women are disproportionately
affected by major risk factors for depression across the lifespan, including interpersonal
trauma.
iii. Genetic and Physiological:
First-degree family members of individuals with major depressive disorder have a risk for
major depressive disorder two- to fourfold higher than that of the general population. Relative
risks appear to be higher for early-onset and recurrent forms. Heritability is approximately
40%, and the personality trait neuroticism accounts for a substantial portion of this genetic

3
 MHP-1

liability. Women may also be at risk for depressive disorders during specific reproductive life
stages, including in the premenstrual period, postpartum, and perimenopause.
iv. Course modifiers:
All mood disorders including, anxiety, substance use, trauma and obsessive compulsive play
a role in developing depression.
3. PERSISTENT DEPRESSIVE DISORDER
 Prevalence
The 12-month prevalence of dysthymia in the United States is approximately 0.5%.
Chronic major depressive disorder is 1.5%, and female prevalence is approximately 1.5 and 2
times higher than male prevalence for each of these diagnoses, respectively. The lifetime
prevalence of persistent depressive disorders in the United States is estimated at
approximately 2.5%.
 Prognostic Features
i. Temperamental
Factors that predict poor long-term outcome include higher levels of negative affect
(neuroticism), more severe symptoms, lower systemic functioning, and the presence of
anxiety or behavioral disturbances.
ii. Environmental:
Early childhood risk factors include the death or separation of parents and childhood
adversity.
iii. Genetic and physiological:
There are no clear differences in disease onset, disease course, or family history between
DSMIV dysthymia disorder and chronic major depressive disorder. Therefore, early findings
on both disorders should also apply to persistent depressive disorders. Therefore, individuals
with ongoing major depressive disorder may have a higher proportion of first-degree relatives
with ongoing major depressive disorder than those with non-chronic major depression and
other depressive disorders in general Some brain regions (e.g. prefrontal cortex, anterior
cingulate cortex, amygdala, hippocampus) have been implicated in persistent depressive
disorder. Possibility of polysomnography abnormalities too.

4. PREMENSTRUAL DYSMORPHIC DISORDER

 Prevalence
The 12-month prevalence of premenstrual dysphoric disorder in the community has been
estimated at 5.8% based on a large study from Germany. Another study that looked at
prevalence over two menstrual cycles found 1.3% of menstruating women with the disorder
in the United States
 Prognostic Features
i. Environmental:

4
 MHP-1

Environmental factors associated with the development of premenstrual dysphoric disorder

include stress, a history of interpersonal trauma, seasonal changes, and sociocultural aspects
of female sexual behavior in general and female gender roles in particular.
ii. Genetic and physiological:
No studies have specifically examined the heritability of premenstrual dysphoric disorder.
The heritability of premenstrual dysphoric symptoms has been estimated between 30% and
80%, and it remains unclear whether the symptoms themselves are hereditary or simply
associated with other genetic factors and traits.

5. SUBSTANCE/MEDICATION INDUCED DEPRESSIVE DISORDER

 Prevalence
Lifetime rates of alcohol- and stimulant-induced depressive episodes have been reported to be
greater than 40% in subjects with associated substance use disorders. However, in a
nationally representative US adult population, the lifetime prevalence of substance/drug-
induced depressive disorder with no lifetime history of non-substance-induced depressive
disorder was only 0.26%.
 Prognostic Feature
Risk factors for this disorder include a history of antisocial personality disorder,
schizophrenia, and bipolar disorder. History of stressful events, drug-induced depression, or
family drug use within the last 12 months. Neurochemical changes associated with alcohol
and other substance abuse often contribute to depressive and anxiety symptoms during
withdrawal and subsequently affect sustained drug use and remission of substance use
disorders. less likely. The course of substance-induced depressive disorder can be
exacerbated by socio-structural adversity related to poverty, racism, and marginalization.
6. DEPRESSIVE DUSORDER DUE TO ANOTHER MEDICAL CONDITION
 Prevalence
Sex differences in prevalence depend somewhat on the sex difference associated with the
medical condition (e.g., systemic lupus erythematosus is more common in women; stroke is
somewhat more common in middle-aged men compared with women)
 Prognostic Features
Risk of acute onset of major depressive disorder is strongly correlated with lesion location.
With strokes on left frontal, least risk is related to stroke on right frontal side.