Depression

Question 1

DSM-V

Answer 1

• emotion - depressed most of the time
• motivation - less interest or enjoyment of activities
• physical - insomnia/ excessive sleep e.g. may sleep at strange times of the day, significant weight change
• behavioural - increase/ reduction in physical movement, retardation, substantial fatigue or loss of energy
• cognitive - worthlessness and guilt, lack of concentration, or ability to think and make decisions
• normally more friends and family realise compared to themselves, causes significant impairment in social or occupational functioning, negative feeling of self and future, poor concentration and thinking and decision making, some conditions may mimic or coexist with major depressive disorders

Question 2

WHO

Answer 2

• 2-5% population anual prevalence

- lifetime prevalence between 6-25%

Question 3

Hilt et al (2009)

Answer 3

• 2:1, M:F
• course, 80% reoccuring
• consequences
• comorbid - 59% anziety, 24% substance misuse

Question 4

Heun et al (1992)

Answer 4

• 2-3x more likely is you have first degree relatives with depression BUT may be because of learnt behaviour

Question 5

Gardner et al (2001)

Answer 5

• 30-40% twin concordance rates - BUT not replicated well enough
• say that an allele may develop under stress

Question 6

Monoamine theory

Answer 6

NA, 5HT, DA - low levels of all

- noradrenaline, serotonin, dopamine hypothesis

Question 7

Velulani and Nelopa (2000)

Answer 7

• monoamine oxidase inhibitors - block the degrading enzyme MAO
• tricyclic antidepressants (TCA) block the reuptake
• works … BUT a therapeutic delay
• 30-40% = no effect
• overdose
• Prozac used a lot as there a low risks of overdosing

Question 8

Davidson (2002)

Answer 8

• low activation int eh PFC
• global orientation loss and reduced motivation
• increased amygdala activation
• decreased ACC (anterior cingulate cortex)
• effortful emotional regulation
• hippocampus - no adrenocarticotrophic hormone secreted - aids learning about context
• increased amygdala activation - cannot prioritise emotions and regulate adequately

Question 9

Heuser et al (1994)

Answer 9

• hypothalamic pituitary adrenal cortex network
• 80% of patients have poor HPA network
• cannot regulate cortisol
• smaller hippocampus
• cortisol enlarges adrenal glands

Question 10

Freud

Answer 10

• psychodynamic
• loss of rejection by a parent –> reduced self esteem
• difficulty distinguishing between actual loss and symbolic loss e.g. loss of job, or a loss of affection

Question 11

Beck

Answer 11

+ supports Freud as he says that depression may be caused by a loss of some sort

• • BUT cannot scientifically test the psychodynamic model
• • clinicians overlook the additional aspects of depression

Question 12

Goodman

Answer 12

+ supports psychodynamic

• says that childhood was bad
• retrospective bias

Question 13

Dweck

Answer 13

• humanistic - self actualisation
  1. parents imposing conditions of worth on child
  2. may seen to avoid by disengaging self and projecting image of person that they want to be
  3. adults - undermined by unhappy relationships

Question 14

Lewinsohn (1974)

Answer 14

• behaviourist model
• operant conditioning
• removal of positive reinforcement
• e.g. the loss of a loved one

+ clearly identifiable cause

• • BUT normally no apparent cause
• • does not take into account cognitions
• lack of appropriate reinforcement
• cycle of excessive reassurance seeking behaviour

Question 15

Becks (1967)

Answer 15

• cognitive triad - negative self schemes

- error in logic - developed as a child as a result of adverse childhood experiences

Question 16

Epp et al (2012)

Answer 16

• emotional stroop task

Question 17

Matthews and MacLoed (1994)

Answer 17

• memory test
• better memory for words with negative connotations
• Alloy et al (1997) found supporting evidence

Question 18

Seligman (1974)

Answer 18

• learned helplessness

- a person gives up e.g. a dog who is being shocked eventually lies on the ground

Question 19

Wlaker (2000)

Answer 19

battered woman

- attribution theory

Question 20

Abramson et al (1978)

Answer 20

• learned helplessness theory
• locus and stability
• • does not take into account cognition

Question 21

Hopelessness theory

Answer 21

expectation that positive outcomes will not occur

Question 22

Rumination theory

Answer 22

a tendency to repeatedly dwell on experiences of depression

Question 23

Gitlin (2002)

Answer 23

• prevention of reuptake of neurotransmitter, so more is in the brain e.g. SSRI’s and Prozac
• 60-65% improvement, but there are side effects
• SSRIs are often used over tricyclic drugs, as there are fewer side effects and they are harder to OD on… BUT SSRIs take longer to become effective
• relapse is common - should combine therapies

Question 24

Khan (2012)

Answer 24

• medication is more effective than psychotherapy alone

Question 25

Medda et al (2009)

Answer 25

ECT (electric convulsion therapy)

• could have a role but there is little evidence although normally immediate effects
• hard to assess long term benefits
• • memory loss
• • ethical issues

Question 26

APA of psychoanalytical therapy (1993)

Answer 26

• helps the individual receive an insight into a repressed conflict
• free association or use dream analysis to recall early experiences
• • no long term benefits

Question 27

Lewinsohn and Shaw (1969)

Answer 27

• social skills training

- reinforcement - model, rehearse and role play

Question 28

Thase

Answer 28

1 hour sessions for 12 weeks

• can be done with friends and family
• eye contact, homework, decrease of depressive symptoms at a 6 month follow up

Question 29

Behavioural activation therapy

Answer 29

• increase client access to pleasant events and rewards such as activity and scheduling time management skills
• behavioural goals

Question 30

Cognitive behavioural therapy

Answer 30

• cognitive retraining, helps depressed individuals identify negative beliefs, challenge irrational thoughts, replace negative thought

Question 31

NICE (2005)

Answer 31

• CBTs are as effective as drug therapy - maintenance model
• aim to correct dysfunctional thinking
• matching what you assume people think and what they actually think

Question 32

Kupfer and Frank (2001)

Answer 32

• combination of CBT and drug therapy is superior than just treatment

Question 33

Ma and Teasdale (2004)

Answer 33

• mindfulness based cognitive therapy (MBCT)
• used to combat linkage between depressed periods - make more aware of negative thinking
  + can decrease the chance of future relate from 78%-36%