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45 Cards in this Set
- Front
- Back
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Difference (Major Depressive Disorder/Unipolar Disorder) and (Bipolar Disorder) |
Unipolar- only experience depressive episodes
Bipolar- exprience depressive and manic (hyperactivity and positive feelings) mood episodes. |
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Diagnostic Criteria for Major Depressive Disorders (DCM-IV) |
Person must have at least 5 of the following symptoms in the same 2 week period. Change from previous functioning. Symptoms must include either depressed mood or loss of interest/pleasure in all activities. |
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Clinical Characteristics of Depression |
Depressed mood. Loss of interest/pleasure. Weigh gain/loss- more than 5%. Increase/decrease in appetite- failure to make expected weight gain. Insomnia/hypersomnia. Fatigue. Thoughts of death/suicide. Impairment on socialising. Feeling worthless/guilty. |
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Length of Depressive Episodes (Coryell) Suicide Rates (Clarke and Fawcett) National Average
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Coryell-most major depressions dissapear eventually whether treated treated or not. Most recover within 4-6 months. Recurrence and relapse- fairly common. Clarke + Fawcett- 10-15% of those diagnosed commit suicide. 1 in 10 people experience it at 1 point. |
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Define- Relapse and Recurrence |
Relapse- symptoms get worse during period of incomplete or brief recovery.
Recurrence- new episode of depressive symptoms following a period of recovery of more than 2 months. |
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Kraeplin's Ideas |
Some groups of symptoms occur together regularly enough to have an underlying physical cause. All mental disorders are distinct (own cause,symptoms and outcome. Two major groups of mental illness: Dementia praecox (Schizophrenia)-chemical Manic depressive psychosis (bipolar)-metabolism |
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Two Main Diagnostic Manuals Used Today |
Diagnostic and Statistical Manual of Mental Disorders (DCM) 'bible'
International Classification of Diseases (ICD) mental disorders first included in 1948 |
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Issues Surrounding Classification and Diagnosis |
1. Shouldn't be medicalised- everyone has mood levels, not pathology, places labels on individuals. Should only be diagnosed if functioning is impaired. 2. 10% diagnosed with unipolar develop bipolar- people only see the doctors when they are sad. 3. Other medical conditions- drugs for dementia may effect brain, causing symptoms- low validity |
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Issues Surrounding Classification and Diagnosis |
4. GP's- 1/2 people who go to their GP with symptoms are not recognised. 5. Culture- tools not developed in Non-Western cultures, who have more bodily complainants than subjective distress. 6. Gender- men less likely to to admit/remember symptoms. Assumed to have physical complainants.
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Biological Explanations for Depression -Genetics (Diathesis- Stress Model) |
Having a genetic predisposition for depression will make depression more likely in response to environmental stressors.
Incorporates both nature and nurture. |
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Biological Explanations for Depression -Neurotransmitters |
Low levels of noradrenaline and serotonin (associated with reward and punishment). They regulate hypothalamus which controls arousal and some key areas affected by depression - sleep, appetite and sexuality. |
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Evaluation (Strengths and Weaknesses) -Neurotransmitters |
+Antidepressant drugs increasing levels of serotonin and noradrenaline are effective treatment (Low levels= cause) +Reserpine- drug for high blood pressure, causes depression, low levels of noradrenaline. -Antidepressant drugs- increases levels striaght away, but it takes weeks to feel better -Difficult to establish cause and effect |
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Biological Explanations for Depression -Hormones |
High levels of cortisol in depressed people, return to normal when depressed episode finished. Noradrenaline and Serotonin disrupts hypothalamus regulation, and therefore cortisol regulation, producing high levels of the hormone. Post-Natal Depression- ovarian hormones? Difficult to establish cause and effect. (N vs. N) |
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Biological Explanations for Depression -Brain Damage |
Frontal lobes -(block noradrenaline and serotonin pathways to other brain structures, that regulate mood) Lobes used for planning, judgement and plays a role in emotion.
Brain Scans= Frontal lobe abnormality in those with unipolar disorder. (no blame on sufferer) |
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Biological Explanations for Depression -Genetics (Concordance) |
McGuffin et al Maudsley Hospital (UK)- twin register 20% in DZ twins. 46% in MZ twins.
+- genes play a role, higher than national average - - other factors influencing not 50%, 100% - - nurture, twins live in the same environment |
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Biological Explanations for Depression -Genetics (Adoption) |
Disentangling genetic and environmental factors
Wender et al Biological relatives 8x more likely to have depression than adoptive relatives.
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Psychological Explanations for Depression -Behavioural (Learning) Theory (Lewinson and Peterson) |
Lewinson -depression= result of lacking reinforcement eg. losing job, means reduction in positive reinforcement (being around people who like you) Social ineptness-unlikely to bring positive reinforcement from others
Peterson-depressed people experience fewer pleasant experiences Cause and effect? Nurture. Reductionist. |
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Psychological Explanations for Depression -Learned Helplessness (Seligman)
(explains reactive depression- clearly identifiable cause, not endogenous depression- no apparent cause) |
Seligman Dogs restrained with apparatus + given shocks Failed to initiate escape behaviour when restraints removed Exhibited symptoms of depression (lethargy, sluggishness and appetite loss) Gives up trying to influence environment, learned they are helpless, no control over what happens to them. |
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Learned Helplessness Evaluation |
Research based on animals- findings difficult to generalise to humans, weak supporting evidence. However, theory is supported by human studies- given impossible tasks, gave up on possible tasks later on. Ethical Issues- lack of protection from harm Reductionist Determinist Emphasis on Nurture |
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Psychological Explanations for Depression -Cognitive-behavioural Theory/ Hopelessness Theory |
Abramson, depression is caused by faulty cognitions and attributions.
Depressed attribute failure to- internal, stable, global.
Normal attribute failure to external, unstable and specific.
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Hopelessness Theory Methodology Evaluation |
+Seligman found that students who adopted internal, stable and global attribution- more likely to become depressed if they fail an exam. +Questionaires assessing peoples attribution styles- predict future susceptibility to depression - - Gotlib and Colby, people who were never depressed, view negative events with helpless resignation. (Negative thinking= effect not cause of depression) |
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Hopelessness Theory Evaluation |
Cognitive Triad- negative thoughts on self, world, future= depression
Free Will vs. Determinism- deterministic, attributions result in depression. Free will to determine own attributions.
Reductionist- depression caused by attributions |
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Psychological Explanations for Depression -Psychoanalytic Theory (Loss)
Palosaari and Aro- children who have lost a parent susceptible to depression later in life. |
Frued- similarities between the grieving when a loved one dies and symptoms of depression. Depression is a grief response to loss.
Losing job evokes feelings from losing someone person was most dependant on as a child. Explains why depressed people become dependant and regress to childlike state. |
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Psychological Explanations for Depression -Psychoanalytic Theory (Anger) |
Person unconsciously angry towards dead parent (rejection, abandonment). Any kind of loss (job) experienced evoke anger, turned inward, because outward expression is unacceptable to superego. Self directed hostility= motivate depression and potentially suicide. |
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Psychoanalytic Evaluation |
No evidence that depressed people interpret death as desertion Anger turned inward- depressed people display hostility to those that are close to them? Symbolic loss can not be tested- unfalsifiable |
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Biological Therapies for Depression -Drug Therapy (MAOI'S)
(changes what happens at the synapse) |
-block enzyme that deactivates noradrenaline and serotonin -effectiveness: 50% -appropriateness: lethal in OD, have to avoid amine rich foods (cheese), tiredness
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Biological Therapies for Depression -Drug Therapy (Tricyclic) |
-blocking repute of noradrenaline and serotonin by neurones that released them -e: 60-65% -a: lethal in OD, good for mild depression, 50% relapse, tiredness |
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Biological Therapies for Depression -Drug Therapy (SSRI's) |
-blocking reuptake of serotonin -e: 60-65% -a: impaired sexual functioning, increased aggression, virtually impossible to OD |
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Electro- convulsive shock therapy (ECT) -procedure |
Patients given muscle relaxant and sedative Electrodes placed on their temples Electric current 70-150 volts passed through brain for 0.04-1 second Causes convulsion that lasts about a minute Typically 2-3 treatments for 3-4 weeks
(Thought to increase availability of serotonin in the brain) |
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ECT -define bilateral and unilateral
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Bilateral- current passed through both hemispheres
Unilateral- current only passed through one hemisphere |
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ECT -effectiveness |
+ -Fink- ECT effective in over 60% of severe depressives + -Janick, 80% responded to ECT, only 64% responded to drug treatment + -Effect is immediate- effective for someone contemplating suicide. Drugs take weeks to work. -Sackheim, high relapse rate within a year (temporary relief, not cure) |
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ECT -appropriateness |
Not sure how it works, but 3 hypotheses: 1. Seen as punishment- but ECT still unpleasant, so this is wrong, relief must be to do with convulsion 2. Amnesia it causes- however unilateral doesn't cause much memory loss so this is irrelevant, convulsion is important 3. Biochemical changes- increases levels of noradrenaline and serotonin (most likely reason)
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ECT -unpleasant therapy |
-inappropriate to put person through such unpleasant therapy. -less traumatic today due to anaesthetic and muscle relaxant. -people used to break bones when they had a convulsion. -despite improvements ECT still seen as abuse, that patients go to when they are vulnerbable |
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Psychological Therapies for Depression -Psychoanalysis |
Developed by Sigmund Freud. Aims- enable individual to cope better with emotional conflicts, not remove symptoms which makes the situation worse (not treating underlying problem).
Purpose- uncover anxieties and unconscious conflicts experienced in the past. |
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Psychoanalysis -Define catharsis -Why adults are better at dealing with problems? -Cure vagueness/success |
Catharsis: working through problems by examining and dealing with problems safely in a consulting room. Release built up anger and emotion. Adults: can understand conflicting/traumatic childhood experiences. Success: gaining insight. uncovering unconscious reasons for their behaviour |
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Psychoanalysis -Free Association? -Word Association? |
Free- explain with no censorship to psychoanalyst, associations arise- reflect internal conflict. Hesitation= ego stopping them from revealing something.
Word- words are given and the patient says the most instant thing that comes to mind. Ego bypassed |
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Psychoanalysis -Dream interpretation -Transference |
Dream- interpret clients dream. Manifest= actual dream content. Latent= hidden content. Ego relaxed/less vigilant in dreams, but not entirely hence the manifest content.
Transference- Hostile feelings toward therapist unconsciously directed towards a certain person in their life. |
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Psychoanalysis -Projective Test |
What the patient see's around an ink blot/ story around an image, uncover recurrent themes to identify the underlying cause of the depression. |
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Psychoanalysis -Effectiveness |
Eysenck- Patients waiting for therapy- 66% improved. Psychoanalysis patients- 44% improved.
Bergin- people on the waiting list were hospitalised. (different treatments) Criteria assessing improvement , control- 30%, psychoanalysis- 83%.
Svartberg and Stiles- meta analysis, compared psycho. with control- no difference |
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Psychoanalysis -Appropriateness |
-Time consuming and expensive (not for busy/poor) -Not for chronic/suiciders- takes too long -Depressives are fatigued- sessions are demanding -Emotional Harm- traumatic memories uncovered YAVIS- young, articulate, verbal, intelligent and successful
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Cognitive Behavioural Therapy (CBT)
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- identifies the patient's negative, irrational thoughts, so they can be replaced with positive, rational ways of thinking. Includes cognitive and behavioural elements with homework in-between. |
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Rational- Emotive Behavioural Therapy (Ellis)
-cognitions influence emotions and behaviour -negative thoughts= maladaptive behaviour (abc, activating event, belief, consequences)
QUESTION THEMSLEVES |
- recognise and question beliefs -encourage client to ask "who says i have to be perfect" -substitute unrealistic beliefs to realistic possible standards -view failure as unfortunate rather than a disaster |
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Cognitive- Behavioural Therapy (Beck)
DOING ACTIVITES |
-schedule list of activities for client -record negative thoughts- reality tested -identifies thoughts as irrational - leading to behaviour -work together to change maladaptive attitudes -continue with schedule of activities |
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CBT Evaluation -effectiveness -use and effectiveness -clear goals |
-E: Jarrett, CBT and antidepressant drugs= equally effective. Drugs, relapse is common. CBT, effect is maintained beyond end of therapy. -UAE: No harmful side effects. Lower relapse rate. Rapidity- beneficial in both outcome and cost. -CG: therapies are well structured with measurable outcomes |
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CBT Evaluation -Difficulty in evaluating -Elkin -Appropriateness -Appeal of CBT
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-DIE: several different depression scales for measuring improvement. -Elkin: CBT is more effective for someone interested in understanding the aetiology of their depression. -A: Not suitable for those with rigid attitudes, success depends on co-operation and being active - Appeal: CBT empowers the client (client becomes dependant). Psychoanalysis can be found too threatening. |
