33 Depression Flashcards
LIFETIME prevalence of depression in NZ
~20%
Gender dimorphisms for depression prevalence?
Women 2x more likely than men
Depression is more common in what TYPES of countries?
Industrialised > developing countries
List the DSM5 criteria for depression
5 or more symptoms, present for >2 weeks
- depressed mood
- dec INTEREST in activities
- changes to WEIGHT and APPETITE
- FATIGUE
- INSOMNIA/HYPER somnia
- Feelings of WORTHLESSNESS and GUILTb
- dec concentration
- recurrent thoughts of death + SUICIDE
Diagnostic criteria for these symptoms being CAUSATIVE of depression?
- Cause clinically significant DISTRESS
- Impairment in functioning (social, occupational, etc)
- Not attributable to a substance or another disorder
Explain possible OVER-diagnosing of depression
- People are INCLINED to label symptoms as depression if presented out of CONTEXT
- Drug companies reap MONETARY gain
Perhaps the issue is not with the individual, but with _____ (in which case we need ______)
Perhaps the issue is not with the individual, but with SOCIETY (in which case we need a REVOLUTION, not therapy!)
Name the dominant BIOLOGICAL hypotheses for depression
- Serotonin depletion (limited evidence)
* NeuroSTRUCTURAL differences
Explain the Nature vs Nurture debate in terms of depression?
Physical differences in brain due to GENETICS (nature) or TRAUMA/events (nurture)?
Evidence AGAINST biological explanations?
Stressful EVENTS ALONE can predict likelihood of depression
List the 4 psychological explanations of depression, and what they think causes it
Psychoanalysis - EARLY experiences evoked by a later loss
Behaviorism - “Learned Helplessness” due to repeatedly feeling lack of CONTROL
Humanism - Incongruence (discrepancy between ACTUAL and IDEAL self)
Sociocultural - POVERTY strongly associated with depression
What is the COGNITIVE model’s explanation of depression
Neg THOUGHTS cause depression
Explain Beck’s Cognitive Triad
CORE BELIEFS developed in youth (uncounscious)
Activation of NEG core beliefs by neg life EVENTS
= depression
Self “I am a bad person”
World “The world is a hopeless place”
Future “The future is hopeless”
What is the “BEST” model to explain depression
COMBO
Bio-Psycho-Social model
Genetic vulnerabilities + psychosocial vulnerabilities + social STRESS = depression
what GUIDELINES are used for treatment?
Explain these guidelines
NICE guidelines = STEPPED care
Early intervention beneficial
Mild-moderate = TALKING therapies best Moderate-severe = DRUGS + Tx
What is ECT
Electroconvulsive Tx
= epileptic seizures induced in people (found that epileptics suffered less depression)
= comas induced using insulin
Is ECT actively prescribed?
What type of patient would it be used for?
LAST RESORT for life-threatening depression
Used for NON-responders to medication
What is the RELAPSE rate of ECT?
60% relapse
How is ECT applied in modern psychiatry?
More GENTLE, done with general anaesthetic, with MINIMAL electricity
What is psychosurgery
Lobotomies, common in 40-50s
Explain how CBT works for depression
Must change the way you THINK
- identify cognitive DISTORTIONS and REPLACE these with more ADAPTIVE thoughts
NZ suicide rates in youth?
HIGHEST male youth suicide
THIRD highest female youth suicide
What is the GENDER paradox in suicide rates
Women more likely to ATTEMPT
Men more likely to COMPLETE
Common reasons cited for suicide attempts?
- pressure to conform/perform
- financial worries
- abuse/neglect
- alcohol/drugs
List some WARNING SIGNS of suicide
- Depression
- Threats/warnings
- Hopelessness
- Risk-taking behavior
- Personality changes
- Giving away PRIZED possessions
- Lack of interest in future
3 factors that AFFECT suicide prevalence
Describe each effect
Age - high in YOUTH, MIDDLE-aged, and ELDERLY
Gender - women attempt, men complete
Ethnicity - Maori in NZ (colonisation, poverty)
