Depression Flashcards
DSM-V
- 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
WHO
- 2-5% population anual prevalence
- lifetime prevalence between 6-25%
Hilt et al (2009)
- 2:1, M:F
- course, 80% reoccuring
- consequences
- comorbid - 59% anziety, 24% substance misuse
Heun et al (1992)
- 2-3x more likely is you have first degree relatives with depression BUT may be because of learnt behaviour
Gardner et al (2001)
- 30-40% twin concordance rates - BUT not replicated well enough
- say that an allele may develop under stress
Monoamine theory
NA, 5HT, DA - low levels of all
- noradrenaline, serotonin, dopamine hypothesis
Velulani and Nelopa (2000)
- 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
Davidson (2002)
- 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
Heuser et al (1994)
- hypothalamic pituitary adrenal cortex network
- 80% of patients have poor HPA network
- cannot regulate cortisol
- smaller hippocampus
- cortisol enlarges adrenal glands
Freud
- 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
Beck
+ 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
Goodman
+ supports psychodynamic
- says that childhood was bad
- retrospective bias
Dweck
- 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
Lewinsohn (1974)
- 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
Becks (1967)
- cognitive triad - negative self schemes
- error in logic - developed as a child as a result of adverse childhood experiences
Epp et al (2012)
- emotional stroop task
Matthews and MacLoed (1994)
- memory test
- better memory for words with negative connotations
- Alloy et al (1997) found supporting evidence
Seligman (1974)
- learned helplessness
- a person gives up e.g. a dog who is being shocked eventually lies on the ground
Wlaker (2000)
battered woman
- attribution theory
Abramson et al (1978)
- learned helplessness theory
- locus and stability
- does not take into account cognition
Hopelessness theory
expectation that positive outcomes will not occur
Rumination theory
a tendency to repeatedly dwell on experiences of depression
Gitlin (2002)
- 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
Khan (2012)
- medication is more effective than psychotherapy alone
Medda et al (2009)
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
APA of psychoanalytical therapy (1993)
- helps the individual receive an insight into a repressed conflict
- free association or use dream analysis to recall early experiences
- no long term benefits
Lewinsohn and Shaw (1969)
- social skills training
- reinforcement - model, rehearse and role play
Thase
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
Behavioural activation therapy
- increase client access to pleasant events and rewards such as activity and scheduling time management skills
- behavioural goals
Cognitive behavioural therapy
- cognitive retraining, helps depressed individuals identify negative beliefs, challenge irrational thoughts, replace negative thought
NICE (2005)
- 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
Kupfer and Frank (2001)
- combination of CBT and drug therapy is superior than just treatment
Ma and Teasdale (2004)
- 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%
