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Assessment, Personality and Psychopathology > Depression > Flashcards

Depression Flashcards

1
Q

DSM Definition of MDD

A

A. Five or more within a two-week period, and presenting a change from previous functioning, at least one of the symptoms is

  1. Depressed mood most of the day, nearly every day
  2. Markedly decreased interest or pleasure in all, or almost all activities (anhedonia)
  3. Significant weight or appetite changes
  4. Insomnia or hypersomnia
  5. Fatigue or loss of energy in absence of physical exertion
  6. Psychomotor agitation
  7. Worthlessness or inappropriate guilt
  8. Diminished ability to think or concentrate
  9. Suicidality
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2
Q

Prevalence of MDD

A
  • 12 month prevalence in US 10%
  • 23% and 15% lifetime prevalence, female male
  • Women twice as likely to report MDD
  • Less prevalence in 60+ age group
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3
Q

Onset of MDD

A
  • Mean age of first episode is 26, but onset is decreasing
  • Early onset associated with greater frequency of depressive episodes
  • Major life events strong predictor of initial depressive episodes, but this relationship diminishes with subsequent episodes
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4
Q

Course of Depression

A
  • Variable course - some rarely experience remission, while others have years between episodes
  • Early age of onset associated with more lifetime episodes, greater severity and greater suicidality
  • Recovery typically begins within one year of onset
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5
Q

Relapsing Course of Depression

A
  • Majority of cases experience complete remission from MDE
  • 20-30% remain in partial remission (subclinical symptoms not MDE)
  • Approx 80% with MDE will have at least one more episode

Incomplete inter-episodic recovery

  • Increased likelihood of subsequent episodes
  • Remission periods longer in early course of MD
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6
Q

PDD (Dysthymia)

A

A. Most of the day for more days than not for at least 2 years

B. Presence while depressed, 2+ of

  1. Poor appetite or overeating
  2. Insomnia or hypersomnia
  3. Low energy or fatigue
  4. Low self-esteem
  5. Poor concentration
  6. Feelings of hopelessness
  • more unrelenting, chronic, less severe
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7
Q

DSM History of PDD

A

PDD first introduced in DSM-3 after they found more chronic circumstances

  • DSM-4 had specificies but little differences observed in course
  • DSM-5 simplified
  • Can have diagnosis of both
  • Prevalence is 0.5% of half year
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8
Q

Onset of PDD

A
  • Early and insidious (childhood to early adulthood), higher likelihood of childhood maltreatment
  • Higher rates of mood disorders in first degree relatives
  • 10 to 25 more likely to have comorbid personality disorders and substance abuse
  • If onset of PDD precedes MDD → greater likelihood of more frequent subsequent episodes
  • 79% of people with PDD also experience an MDE at some point
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9
Q

Other Depressive Disorders

A
  • All have in common sad, empty or irritable mood, and somatic and cognitive changes that affect functioning

Differ in duration, timing and presumed etiology

  • Premenstrual dysphoric disorder
  • Substance induced depressive disorder
  • Disruptive mood dysregulation disorder

Specifiers include

  • Seasonal patterns
  • Peripartum onset
  • Psychotic features
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10
Q

Family and Twin Studies Finding Biological Influences in Depression

A

Family Studies

  • Relatives of patients with mood disorder show lower age of onset and more likely to have recurrent depressive episodes

Twin studies

  • If genetic contribution, disorder more likely in identical than fraternal twins
  • Higher severity and recurrence of MDD associated with higher rates of MDD in relatives and twins
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11
Q

Estimates of Heritability in Depression

A
  • Higher in women (36-44%) than men (18-24%)
  • Small positive association between 5-HTTLPR (serotonin transporter linked polymorphism) and suicidal behaviour and depressive traits
  • Carriers of 5HTTLPPR short variant reported more depression symptoms, cases of diagnosed depression and suicidality as a function of stressful life events - gene x environment interaction
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12
Q

Neurotransmitter Systems and Depression

A
  • Lower serotonin implicated in etiology of mood disorders but only in relation to other neurotransmitters (norepinephrine and adrenaline)
  • Permissive hypothesis - when serotonin is low, other neurotransmitters permitted to range more widely - become dysregulated → mood disturbance
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13
Q

Learned Helplessness

A

Animal Studies

  • Dogs who received inescapable shock subsequently didn’t try to escape

Human Studies

  • Similar patterns
  • Propose that when humans learn they have no control over reinforcements in life
  • Theory modified - attribution helplessness theory - depressed individuals attributed lack of control to internal, global and stable cause
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14
Q

Response Style Theory of Depression

A
  • Duration, severity and course are consequence of symptom appraisal
  • Ruminative response style – focusing on causes, meanings, and consequences
  • Increases likelihood of developing depression and impair remission
  • Predicts depression onset and duration
  • Predicted depressive symptom 7 weeks post-earthquake
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15
Q

Cognitive Model of Depression

A
  • Depression results from tendency to negatively interpret events

Types of thoughts implication in depression

  • Negative schemas, beliefs, automatic thoughts

Cognitive triad

  • Negative interpretations of self, world, future

Cognitive errors

  • Overgeneralisation
  • Black or white thinking
  • Filtering
  • Emotional reasoning
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16
Q

Responsiveness to Treatment of Depression

A
  • 54% recover within 6 months, 70% in 12 months
  • 12-25% don’t recover and develop unremitting chronic illness
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17
Q

Therapies for the highest Efficacy for Depression

A
  • CBT
  • IPT
  • Behavioural activation
  • Problem solving therapy
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18
Q

Antidepressants in the 50s

A

Monoamine oxidase inhibitors - stop the breakdown of NT’s serotonin and norepinephrine, leads to rise in activity

  • High blood pressure side effects
  • Rarely used

Tricyclics - block reuptake of NT’s serotonin & norepinephrine

  • Side effects in overdose are cardiotoxic and potentially fatal
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19
Q

Antidepressants in the 90s

A

SSRIs

  • Inhibit serotonin reuptake so it sit in the synaptic cleft for longer
  • Fewer side effects

Effective

  • Although 40-50% do not respond
  • Lots engage in polytherapy (a combination)
20
Q

Efficacy of CBT for mild to moderate Depression

A

CBT as effective as antidepressants for mild to moderate depression

  • In severe depression pharmacology is superior
21
Q

Behavioural Activation

A
  • Doing non pleasurable things results in feeling worse
  • Leads to lethargy that might initiate depression
  • Focus on increasing pleasure, problem solving
22
Q

Difference Between Psychoanalytic Therapy and CBT for Depression

A
  • Psychoanalytic → very client led, therapist sits back but takes an expert stance and lets them get there themselves
  • CBT → collaborative empiricism, therapist active, transparent with what they are doing
23
Q

Different Eras of Therapies reflecting the assumptions of psychopathology:

A
  • Psychoanalytic (unconscious conflict)
  • Humanistic (conditions of worth)
  • Behavioural (learned response stimuli)
  • Cognitive (thinking influences emotions and behaviour)
24
Q

Psychoanalysis

A

→ mental disorders arise as a result of unresolved unconscious conflicts, revolutionary, took it from external forces and made it more internal

Conflicts between

  • Id - pleasure, immediate gratification
  • Ego - rational
    decision
  • Super ego - morals
  • Ego moderates the two, copes by means of neuroses and dreams which fulfil Id’s suppressed desires
  • Defence mechanisms such as repression and denial are an outlet for this conflict
  • These cause mental illness
25
Q

Types of Defence Mechanisms

A
  1. Denial → not accepting reality
  2. Dissociation → removing self from reality
  3. Projection → attributing unacceptable unconscious impulses to others
  4. Reaction formation → take opposite behaviour from unacceptable impulses

AIM: reduce defences and gain insight into hidden intrapsychic conflicts

  • Free association
  • Dream analysis
26
Q

Transference/Counter-Transference

A
  • Client plays out relationships in their life with the therapist, so that the therapist can have insight into their unconscious conflicts
  • Or, the therapist plays out the clients relationship so that have insight into how this might be affecting them in the real world
27
Q

Issue with Psychoanalysis

A

Treatment is long and expensive

  • 3-5 times a week
  • Indefinite
  • Some types of shorter and more focussed
28
Q

Criticism by Karl Popper

A
  • Theories based primarily on case-studies, rather than quantitative and experimental studies
  • Theory is reductionist and simplistic
  • Theory is unscientific as claims were unfalsifiable
  • Therapist may take an expert stance over the client, and so they have complete control of the situation, which might have been exploited for results today
29
Q

State of the Evidence Concerning Psychoanalysis

A
  • 1st review found it to not be successful form of treatment
  • 2nd review had a completely contradicting stance
  • 2nd review was fine picked, and people found that it was a sponsored by a psychodynamic firm and had some very significant methodological flaws
  • Shows that it is very hard to test
30
Q

Basics of Behaviour Therapy

A

→ challenge overt, observable maladaptive behaviour

  • Rationale transparently explained to client, who is an active participant
  • Emphasis on evaluation of outcome
  • Time-limited
  • Therapist-client relationship not sufficient
  • Behaviour modification
  • Exposure therapy
31
Q

Behaviour Modification Technique

A
  • Based on principles of operant conditioning

Example

  • Contingency management with children
  • Reward behaviour you want to see more of
  • Time-out in response to unwanted behaviour

Token economies (used to be popular in mental institutions)

  • Received tokens for behaviour they wanted to encourage
32
Q

Exposure Therapies

A
  • In vivo = in person
  • Imaginal exposure = when it is harder to interact with it in person, relieve experiences with therapist

Doses

  • Flooding → all at once
  • Graded exposure → slowly, over time exposure to feared stimuli
  • Spaced (over multiple sessions), massed (over time of one session)
33
Q

Basics of Cognitive Therapy

A

→ Beck
→ psychological problems due to maladaptive thought patterns

  • Trained as psychoanalyst so he was denied admission to american psychoanalytic institute for being incorrectly analysed
  • Systematically tested assumptions underlying psychoanalysis & found did not match patients’ experience
  • Emotional distress arise from patients’ beliefs and thoughts
  • Correcting the biases in the way individuals think leads to reduce psychological symptoms
  • Activating Event → belief or (emotional consequence) → emotional consequence
  • Need to change people’s interpretation of reality rather than reality itself
34
Q

Cognitive Therapy in Practice

A

→ reduce distress by helping patients think in away that is more realistic and helpful

  • Present-focused, time-limited, specific and directive

Using,

  • Collaborative empiricism - make plan together on how it will be tested
  • Socratic questioning - therapist asks logical questions to help the client discover the flaws in their thinking
  • Cognitive restructuring - pose a more realistic thought that they can amplify

Substantial support for effectiveness

35
Q

Basics of CBT

A

→ behaviourists often use ‘cognitive’ explanations and vice versa

  • Based on recognition that cognitive change is often best achieved by experience/action rather than by talking
  • Combines strengths of both approaches
  • Most widely used and well-validated treatment techniques to data
36
Q

CBT Techniques integrating Cognitive and Behavioural Strategies

A

Imaginal exposure

  • Behavioural (habituation of arousal and fear extinction)
  • Cognitive (contextualising fear memory, introducing corrective information into the narrative to realise that the event is not actually happening

Behavioural experiments

  • In vivo exposure exercises designed to test out catastrophic conditions
  • Exposure to social situation, then person realises that there is no one noticing their fear in the situation (also known as cognitive restructuring)
37
Q

Humanistic Therapy

A

→ Carl Rogers in reaction to psychoanalysis

Humans have an inherent drive to self-actualisation (realise full potential)

  • Humans are inherently good and greater than the sum of their parts
  • Principles of this therapy focus on creativity and free will

Person-centred

Necessary conditions in therapy include

  • Empathic understanding
  • Unconditional positive regard
  • Congruence: the willingness to transparently relate to clients without hiding behind professional facade

Difficult to research/operationalise

  • Used in a lot of RCT’s because it provides a client therapist interaction with no strategy to the session
38
Q

Scientist Practitioner Model

A

Scientific research ←→ theoretical models ←→ psychological treatment

  • Profession of clinical psychology based on intersection between research and practice

Clinical psychologists are conceptualised as scientists, using science to inform and test their own practice

  • Rigorous training in scientific methods, often conducting own research project
  • Stay informed regarding scientific evidence for treatments
  • Conduct own research or apply scientific principles to working out whether treatment is working
  • Deliver treatment in accordance with treatment protocols
39
Q

Evidence-Based Treatment

A

Premises

  • Patient care can be enhanced by up-to-date empirical knowledge
  • Opinion based on clinical experience is an insufficient basis for practice
  • If clinicians don’t keep up to date, their performance will deteriorate
  • Clinicians need to be critical consumers of research evidence
  • Clinicians need summaries of evidence provided by expert reviews
40
Q

What makes a good treatment study ?

A
  1. Use an appropriate comparison condition
  2. Random Allocation
  3. Manualised Treatments
  4. Blind Designs
41
Q
  1. Use an appropriate comparison condition (making a good treatment study)
A
  • Need a control group to compare results of the treatment to
  • RCT, wait-list control can show receiving the treatment is better than getting nothing, but it doesn’t show whether the treatment itself was making it effective and the factors that may have influenced the outcome
  • RCT, placebo comparison can show whether the intervention actually displayed the greater improvement, it doesn’t show who received greater improvement than those who received another intervention
  • Use all groups to compare
42
Q
  1. Random Allocation (making a good treatment study)
A

Why is this important in order to obtain the most accurate comparison

  • Client differences
  • Therapist preferences
43
Q

Synthesis through Meta-analysis

A
  • Data derived from all controlled clinical trials investigating a particular treatment with a psychiatric disorder
  • Effect of intervention is converted to a standardised measure of the effect of the intervention expressed as effect size, both statistically and clinically significant reduction in symptoms
44
Q

Efficacy Research

A
  • Aimed at determining whether patient outcomes result from a specific, often experimental intervention
  • Studies estimate an intervention’s effects under conditions of optimal control and standardisation
45
Q

Effectiveness Research

A
  • Establishing external validity of a treatment or generalisability of empirical evidence
  • Real-world contexts

Assessment, Personality and Psychopathology (18 decks)

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