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Depression (Beck's cognitive model of depression (Rumination (Effects?…

- - - - activated by internal or external environement
      - affect how information is processed
        
        lead to impairment in attention, memory, and interpretation
  - - - When depressive patients process negative stimuli
        
        Amygdala response
        
        more intense and long-lasting response, even it's followed with a non-emotional task
        
        increase reponse
        
        faster processing of negative stimuli
        
        decrease psychological well-being
        
        Untreated patients
        
        More likely to attend to negative stimuli
        
        stronger and longer lasting neural response
        
        identifying emotional expressive
        
        have difficulties in idetifying positive emotions, and identify low-intensity sad emotion more easily
        
        Resource-allocation hypothesis (Ellis, 1988)
        
        resources are used by task irrelevant emotional processing
        
        have difficulties in remembering and processing other effortful cognitive processes
        
        What parts of the brain is related?
        
        increase amygdala reactivity
        
        left DLPFC hypoactivity
        
        Right DLPFC hyperactivity
  - - - depressive individuals do not direct their attention more frequently than control, but has difficulties in disengaging it once it capture their attention
        
        Rinck (2005)
        
        Did not show enhanced detection of depression-related words in the visual search task, but were more easily distracted by them
  - - - Internalising negative stimuli
    - - altered emotional and memory processing
      - increase self-referential schema
      - decrease top-down inhibition
    - - hyperactive amygdala, hippocampus, mPFC
      - amygdala activation
        
        weakly associated with the severity of depression, but strongly associated with rumination
    - - Elimating the opportunity to ruminate = elimating the impairment in memory task
  - - - greater in depressed patients
    - - correlate positively with functional connectivity of subgenual cingulate
- - - - Hypothalamic-pituitary-adrenal axis (HPA axis)
        
        what is HPA axis?
        
        a major endocrine system to control reactions to stress
        
        Corticotrophin- releasing hormone (CRH)
        
        important reaction to acute stress
        
        too much: dysfunctional of stress system
        
        Glucocorticoids
        
        restore balance during stress
  - - - Due to neuroendocrine dysregulation
        
        Due to high level of stress hormone cortisol
        
        Consequence?
        
        impairment in neuroplasticity
        
        Neuroplasticity plays an important role in depression
        
        Antidepressant and Electroconvlsive shock treatment
        
        1 more item...
        
        Impairment in cellular resistance
- - - - lower depression level: smaller differences in placebo and antidepressant
      - Moderate to severe depression: Antidepressant have superiority
    - - increase the serotonin in the synaptic cleft available to blind to the post-synaptic receptor
  - - - Purpose
        
        aims to undermine patients' latent schema
        
        fewer negative stimuli elicit bottom-up reactivity
        
        the burden of cognitive control system to regulate subcorticol regions will be migrated
        
        based on inaccurate beliefs and maladaptive information processing
      - therapists helps patient to...
        
        validate their beliefs (any evidence?)
        
        Distance themslves from the belief
        
        identify the themes
      - Effect
        
        DeRubeis (2005)
        
        after 8 weeks: Antidepressant mediation slightly better than CT
        
        After 16 weeks: almost identical
      - Effectiveness?
        
        CT lower relapse rate than ADM
        
        Depends on the expertise of therapist
        
        Cuijper (2010)
        
        Publication bias: effect size: 0.67 decrease to 0.42
    - - focus on interpersonal relationship and unconscious belief and thoughts
      - short in duration
      - small but significant effect size
    - - paying full attention to the present moment with an accepting and non-judgmental attitude
      - Mindfulnes-based cognitive therapy
        
        increase meta-awareness
        
        reduces overgeneral autobiographical memry
        
        reduced cognitive reactivity
        
        decrease rumination
        
        increase mindfulness and self- compassion
        
        a 8- session group- based intervention
        
        Effect?
        
        may prevent relapse but need replication
  - - - use magnetic fields to stimulate nerve cells
      - repetitive stimulation
    - - only for severe depression
    - - use constant, low current of neurostimualation to the brain area of interest small electrodes
      - Effect
        
        increase cognitive perfromance depending on the brain area being stimulated
    - - treatment- resistant depression
        
        decrease 50% depression rating scale score
- - - - complicated with co-morbid diagonsis and medication
- - - - polymorphism in the gene of serotonin transporter promoter region: small positive relationship with BD, depression- related personality, suicidal behavioural, BUT NOT WITH MDD
    - - A functional polymorphism in the gene 5HT- T: associated with both UD and BD
        
        One or two copies of short allele: more depressive symptoms than homozygous long allele
  - - - Low Serotonin level can induce acute symptomatic relapse
- - - - Task 1: active regulation; Task 2: passive viewing
    - - Patients
        
        able to down- regulate negative emotional, corresponding to amygdala activation
        
        decrease ability with increasing severity of symptoms
        
        less communication between amygala and PFC
        
        less inhibition
        
        failure in down-regulating these emotional states
      - Controls
        
        able to sustained regulation effect after the delay
  - - - Role of PFC: emotional regulation
    - - heightened emotionality in adolescents
        
        diminshed the ability to down regulate aversive stimuli