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30 Cards in this Set
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Clinical characteristics for depression > diagnosing Major depressive disorder (MDD) |
Five symptoms: 1. Emotional:depressed mood, sadness,feeling low 2. Physical: disturbed sleep, insomnia, decrease in appetite, shifts in weight 3. Motivational/Behavioural: social withdrawal, restlessness, agitation, Apathy and loss of drive 4. Cognitive: feeling guilt, worthless, lack of concentration, indecisiveness + (possible thoughts of death/suicide) To diagnose someone with MDD the 5 symptoms must be present: - every day for 2 weeks - contributes to an impairment in general functioning - not caused by other medical conditions or bereavement Core symptoms: 1. constantly depressed mood and feelings of sadness 2. diminished interest or pleasure in activities |
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issues surrounding the classification and diagnosis of depression: Reliability A01: outlining the issues raised |
Reliability: refers to consistency + how a classification system produces the same diagnosis for a particular set of symptoms
Keller et al interviewed 524 depressed individuals using DSM + 6 months later: inter-rater reliability: fair to good Test retest: fair to poor |
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issues surrounding the classification and diagnosis of depression
A02 reliability |
Evaluation of Reliability Why IRR is low: On DSM 9/5 symptoms must show, disagreement between GP's on a single symptom can determine MDD or DD Cultural bias diagnostic tools: DSM created in West, in English so reflect culture of Europeans/doesn't reliably assess other cultures > Karasz: described depressive symptoms to whites/ south Asians, only whites found problematic × keller's study: 6 month period could mean they improve in condition |
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issues surrounding the classification and diagnosis of depression: Validity
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Validity: whether a classification system is measuring what it is supposed to be measuring > subjective: to GPs experience, knowledge interpretations of symptoms Zanarini: IRR for MDD was 0.8 but a TRT showed this dropped to 0.61 a week later > Retrospective recall: correct recall exaggeration, honesty? > co-morbidity: disorders in the DSM overlap and so pts are diagnosed with co-morbid disorders instead > McCullough: compared 681 outpatients with types of depression - found considerable overlap in symptoms and responses to treatment so is hard to justify different sub-types of depressive illness > issues: separating disorders, ignorant on differences, what to treat first |
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issues surrounding the classification and diagnosis of depression
> A02 validity |
Evaluation of Validity little predictive validity: some don't respond well to wrong treatments. Reductionist tools: for identification, unclear on individual differences in symptoms nonobjective diagnosis: Gp's look at history rather than symptoms. + Stirling et al: psychiatrists spend 1 hour while Gps spend 8 minutes. (increase in consultation time with GPs increased reliability) |
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A02 issues surrounding the classification and diagnosis of depression > Gender bias and reliability and validity |
Gender: rates are twice as high in women than men across all cultures × Men less likely to report/ seek help for depression due to socialisation (suicide rates higher for men)
× High rate due to pre-natal depression, premenstrual-dysphoric disorder, higherbiological pre-disposition × Winter: GPs likely to be white mc males, bias against diagnosing males |
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A02 issues surrounding the classification and diagnosis of depression
> ethical issues |
> stigmatization: - labelling someone with depression may lead to SFP - targeted due to label and treated differently (social isolation, distress and employment prospects) × unable to diagnose someone may lead to greater harm/ suicide/ opportunities missed for treatment |
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Biological explanations for depression: Genetics |
> family studies: 1st degree relative also have depression + Harrington et al: 20% of all 1st degree relatives to depressed individuals also had depression vs 10% gen pop > Twin studies: if genes play a prevalent role in depression concordance rates would be high + McGuffin et al: 177 depression sufferers compared to either their MZ or DZ twin (MZ 46% and DZ 20% concordant rates) >Adoption studies: distinguish between nature v nurture + Wender et al: biological relatives 8x more likely to have depression than adoptive relatives > physical changes: sleep patterns, appetite, weight, fatigue suggests biological cause |
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Biological explanations for depression: Evaluation for genetics |
× Family studies: share similar environments, due to nurture
× Twin studies: in McGuffins study 50% did not suffer of Mz twins didn't suffer from depression, incomplete explanation + Genetic stress diathesis: genetic pre-dispositions triggered by environmental factors > Co-morbidity: explains low concordance rates - ppl inherit a vulnerability for a wider range of disorders (depending on environment different disorders are developed - depression or anxiety) +Kendler: higher concordance rate among twins for depression AND general anxiety disorders |
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Biological explanations for depression: Biochemistry |
NEUROTRANSMITTERS > low levels of monoamines which regulate emotion/appetite (serotonin, noradrenaline, dopamine) found in depressed + Teuting: low amounts of byproduct of noradrenaline found in urine of depressed + postmortem studies: increased densities of noradrenaline receptors in brain- overcompensation/ upregulation + McNeal et al: Reduced amounts of serotonin byproduct found in cerebrospinal fluid found in depressed + suicidal patients
+ Delgado: diet that reduced serotonin levels given to patients taking anti-depressants, depressive symptoms worsened then disappeared once off diet |
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Biological explanations for depression: Evaluation for Biochemistry |
+ Neurotransmitters: linked to mood arousal × Isolationist: This link is too simple +Applications: reductionist approach to neurotransmitters allows for development of research + Kraft et al: 96 patience with MDD given SNRI, patients showed positve response than placebo group × Claridge: non depressed given drugs that reduced serotonin and neurotransmitters and didn't express symptoms >> Reductionist × Not C&E: Teuting + most studies based on correlation so levels of neurotransmitters/hormones may be an symptom not cause >> lack internal validity × postmortem: no control group to compare |
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Biological explanations for depression: Hormones |
HORMONES
> Empirical evidence: High levels of cortisol due to stressful life events reduce levels of serotonin and triggers depression > Dexamethasone suppression test - temporarily suppresses cortisol secretion in typical people - in depressed it doesn’t keep up cortisol suppression for as long -depressed have over active HPAs which maintain depression + hormones: women are more hormonal and 3x more likely to suffer from depression × Gender bias: women socialised to be expressive, willing to seek help |
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Biological therapies for depression: drug therapies >> MAOIs |
MAOIs: stop the break down of serotonin and neurotransmitters so increases the availability in the NS × Side effects: associated with strokes × impractical: reacts badly with certain food groups, special diet needed × Jarret: effective for MDD mostly + Julien: new version as skin patch has slow continual release which produces less dangerous food interactions |
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Biological therapies: drug therapies >> TCAs |
TCAs: blocks transporter mechanism that reabsorbs serotonin and noradrenaline into the presynaptic cell after is has fired - more neurotransmitters left insynapse, prolonging activity × slower acting: mild-takes up to 10 days × Side effects: associated with heart problems & lethal in overdose + fewer adverse effects × efficiency: 50% relapse if stop taking drugs too early |
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Biological therapies: drug therapies >> SSRIs |
SSRIs: block the re-uptake of serotonin which increases the availability to activate neighboring brain cells
e.g. prozac, more recent develop × has links to suicide and violence × Kirsch: only effective for MDD + most frequently prescribed: Safer and fewer side effects Overall A02 + practical: quicker and cheaper × 30-40% don't respond to drugs, 30% respond to placebo × ethical issues: informed consent × treats the symptoms not the cause
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Biological therapies: ECT |
ECT: restores the chemical imbalance in the brain by electrically inducing a seizure, treatment continue 2-4weeks for 6 months and only given as a last resort
× side effects: memory loss and bone fractures × ethical issues: consent, history of abuse × not efficient LT: only effective for 4 weeks + quicker and cheaper than some treatments + Janicak: 80% of severely depressed patients responded well to ECT v 64% drug therapy |
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Psychological explanations: Cognitive theories |
BECK Cognitive triad: negative view of self, world & future maintained by negative self schemas and cognitive distortions
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Psychological explanations: Cognitive theories continued.. |
2. Cognitive distortions
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Psychological explanations: evaluation of cognitive theory |
+ Real world applications: development for cognitive based therapies which tackle root/environmental causes + Beck and Butler: reviewed 14 metanalyses found becks CBT more effective than control drug therapy × Correlational data: negative cognitions cause depression or a symptom × Genetic stress diathesis: genetic pre-disposition + childhood loss/bereavement = negative thinking/depression × Psycho social: stressful life events act as avulnerability to developing depression |
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Behavioural explanations for depression:
>> Lewinsohn: positive and negative reinforcement |
> depression occurs due to a reduction in positive reinforcement e.g. due to job loss, relationship breakdown > less positive reinforcement = depression and social withdrawal > depressed state maintained through positive reinforcement from attention/sympathy (reinforces depressive behaviour as secondary gain) × can't explain why behaviour continues even after attention has stopped + real world applications: theory suggests therapies can be created to unlearn behaviour - possibility for change in hands of client
× reductionist: simplifies to environmental stressors, ignores biological pre-disposition + drug therapies work therefore not solely behavioural
× deterministic: ignores free will, reduces humans to stimulus response machines responding to environmental stimuli, disregards complex human thoughts |
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Behavioural explanations for depression:
>> Seligman: learned helplessness |
> if uncontrollable, unpleasant experiences occur too often, individual comes to learn they have no control over them
> leads to chronic lack of motivation/passivity as they view events as uncontrollable = learned helplessness = depressive state
+ explains reactive depression (stimulated my unfortunate life events) + demonstrated in human studies + Hiroto and seligman: college students exposed to uncontrollable aversive events more likely to fail on cognitive tasks × reliability: few research studies findings have been replicated × isolationist: ignores cognitive processes × individual differences: ignores personality factors, people who don't fall into depression/helplessness despite life events |
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Behavioural explanations for depression:
>> Abramson: hopelessness |
- Pessimistic expectations of the future where people develop negative attribution style - Bad event: causal explanation: attributions/expectations: symptoms - e.g. bad exam result: internal/stable/global: 'i'm stupid, will never succeed: hopelessness/depression
× C&E: hopelessness are a cause or effect of depression × how can you measure attribution style in reliable/valid way ? |
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psycho-dynamic explanations for depression |
>Freud: depression occurs when the normal grieving process following the death of a loved one doesn't diminish with time - depressed cannot accept loss so merges own personality with deceased - introjection: depressed direct feelings of deceased inwards on themselves (anger/sadness) - those who haven't experienced loss of another have experienced symbolic loss e.g. job loss, break up
× difficult to test: no empirical evidence to prove subconscious motivations/symbolic loss/introjection × subjective research; evidence based on depressed's memory × significance of findings: fewer than 10% react to major loss with depression (Bonanno) × correlational: job loss or parental loss may create financial hardships which are the cause of depression |
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Cognitive therapies for depression > CBT |
Cognitive element: Thought catching - taught to see link between the way they think and the way they feel - for HW record emotional events, automatic negative thoughts + realistic thoughts that challenge them Behavioural element: Behavioural activiation - assumes being active can lead to rewards which act as antidote to depression - many depressed don't participate in activities they used to enjoy - therapist and client identify activities + anticipate/plan ways to deal with obstacles to them |
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Cognitive therapies for depression > CBT evaluation |
+ Babyak: 156 volunteers with MDD randomly assigned to 4M course of aerobic exercise/drug treatment/both 6 months +: aerobic group had significantly lower relapse rate especially if exercise kept up + no side effects: more appropriate for those suffering with health conditions + treats underlying cause: psychological symptoms are addressed so longterm and lower relapse rates × time consuming and costly: requires multiple sessions, drug therapies cheaper/practical × unsuitable: client has to share intimate feelings, overwhelming/counterproductive for severely withdrawn, × subjective: effectiveness is due to therapist's skill, enthusiasm, & collaborative effort Kuyken: as much as 15% variance in outcome due to competence > Whitefield and Williams: effective but costly for those on budget + real life applications: usage of self help versions e.g. SPIRIT course teaches core cognitive behavioural skills through self help material |
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Behavioural therapies > Behavioural activation therapy > social skills training |
> Behavioural activation therapy: -patients given activities to take part in to create normal/satisfying lives (deliver feelings of joy and mastery) > social skills training: - depressed struggle with social skills/building relationships - leads to isolation and encourages depression - SST improves client's social skills and self esteem to increase sociability - purpose is to change behaviour patterns to help client function in everyday situations |
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Behavioural therapies evaluation |
+ Houghton: self report of 42 patients found treatment effective, tolerable, low dropout rate ×reductionist: focuses on observable aspects of depression and ignores cognitive processes × superficial: replacing depressive behaviours with more socially acceptable behaviours only treats symptoms + not effective long-term > combined approach: behavioural therapies not effective alone, e.g. CBT combines cognitive side |
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psycho-dynamic therapies > psycho-analysis |
Techniques that facilitate catharsis: 1. free association: client allowed the free flow of thoughts, feeling, images + expresses them in words 2. word association: client responds to word with whatever comes to mind 3. dream analysis: client recounts dream and analyst interprets hidden meaning 4. transference: client redirects feelings (e.g. hostility) on to therapist that are unconsciously directed at another 5. projective tests: ink blot test- client asked what they see in an inkblot |
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psycho-dynamic therapies: > psychoanalysis evaluation |
× time consuming: therapy takes many sessions, years to complete therefore costly × suitability: not appropriate for depression, many are too passive, withdrawn, fatigued for demanding therapy + likely to drop out before benefiting × effectiveness: Eysenk completed 19 meta-analysis between psychoanalysis v none and found no difference in outcome after 1 year × ethical issues: dealing with unstable clients + sensitive issues, possibility of bringing up subconscious conflicts causing more distress & fully informed consent? × inconclusive: theory the therapy is based on is hard to prove and test empirically due to unknown nature of subconscious |
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psycho-social therapies > interpersonal psycho-therapy (IPT) * see word notes for more detail* |
× Weismann et al: treatment is as effective as CBTi.e. the symptoms disappear 50-60% of clients × Inappropriate: not suitable for all depressed,mainly those linked to social conflict × Subjective: to the skill of the therapists andability to create strong bond |
