Depression Flashcards
DIAGNOSIS A01:
Define the 2 main types __________________________
Physical _______, behavioural _________, cognitive ____________ and emotional ___________ symptoms
DSM IV (what it is, its definition of depression) __________________
ICD-10 (what it is, its definition of depression) ____________________
Outline/explain the BDI (Beck et al. 1961) _____________________________
Unipolar: persistent low mood, bipolar: episodes of low mood and mania (elevated mood, energy, risk-taking)
Physical: weight loss, energy loss, aches
Behavioural: appetite loss, change in sleep patterns, suicide attempts
Cognitive: negative thoughts, thinking of suicide, guilt, poor memory/concentration
Emotional: sadness, irritability, apathy
The DSM IV is the Diagnostic and Statistic Manual of Mental Disorders which diagnoses depression when symptoms cause stress/social impairment and occur every day for two weeks
The ICD-10 is a different alternative (International Classification of Diseases) which classifies different severity in depression, but is similar to the DSM in symptoms/duration required
The Beck Depression Inventory (1961) is a 21-question self-report to determine depression’s severity by assessing each symptom with a score 0-3.
DIAGNOSIS A02/3:
BDI:
Beck’s study of its test-retest reliability ______________________________
It has high content, concurrent and construct validity - define/explain each ________________________
Design problems: language used ___________ and layout/format ________
DSM:
test-retest and inter-rater reliability _______________________
Explanation of this _____________
Overlap in depression types __________________
GP diagnosis validity (van Weel-Baumgartner et al. 2006) ___________________
Cultural differences in diagnosis __________________________
Relatively good holism in all 3 scales/measures __________________
Beck et al. found with over 20 depressed patients there was high correlation between 2 sessions of therapy - significant reliability
Content validity is how well list items represent actual clinical symptoms commonly found in patients
Concurrent validity is how well it concurs with other scales
Construct validity is the BDI score correlating with other problems e.g. anxiety
Its language is culturally relative, outdated and complex and its layout is confusing and inconsistent, in the scale especially
Both types of reliability for the DSM remained at ‘fair’ because the severity can depend on the difference of 1 symptom between two different assessors/occasions, so it is likely to differ
Subtypes of depression in the DSM (and ICD) overlap in symptoms and treatments, questioning validity
van Weel-Baumgartner et al 2006 found GP diagnoses using the DSM may be subjective or based on prior knowledge
Ethnic minority groups are less likely to seek help for depression, due to cultural differences in how it is defined (less of an individual problem)
All measures consider physical, cognitive, behavioural and emotional symptoms (holism)
BIOLOGICAL EXPLANATIONS A01 Genetics: Family studies (probands and relatives) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Twin studies (identical/fraternal) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Diathesis-stress explanation (Kendler et al. 1995 - genes and life events) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Neurotransmitters: noradrenaline (by-products in urine) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Serotonin (shown by SSRIs) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Cortisol (stress) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Probands are those in the studies who already have depression, and their relatives do have an increased risk of the disorder compared to the general population, showing a genetic link.
There is likewise an increased risk in the twins of probands, in identical more so than fraternal twins.
Kendler et al. (1995) found highest risk of depression in those who had both the diathesis of genes and the stressor of negative life events.
Noradrenaline in studies showing lower by-products of it in the urine of depressed individuals.
Serotonin is lower in depressed patients as confirmed by SSRIs - these block serotonin reuptake and so reduce depression.
Cortisol, the stress hormone, has been shown to be higher in depressed patients, who experience more stressful life events
BIOLOGICAL EXPLANATIONS A02/3
Comorbidity in genetics (reason for low concordance) ___________________
Ruhe et al. (2007) supporting the serotonin-depression link ____________________
Strickland et al. (2002) studying large group of women trying to find cortisol-depression link
____________________
Evolutionary explanation of depression
_____________________
Psych as sci, gender in studies, genes as det
Different mental disorders including anxiety may also be caused by the same genetic vulnerability, meaning related individuals may share a risk for different disorders and so concordance will be higher than it is for just depression.
Ruhe et al. (2007) showed that when drugs were used to lower serotonin levels in previously depressed participants, they briefly suffered relapse
Strickland et al. (2002) found that in a large group of women with depression there was no evidence of increased cortisol
Depression may be adaptive as a signal of genuine need of others’ help.
Support for psych as sci - empirical research with biological basis.
Strickland’s study was gender-biased - using just women could have been a confounding variable.
It is genetic determinism to suggest they will always result in depression, however the diathesis-stress model balances this with the influence of life events.
PSYCHOLOGICAL EXPLANATIONS A01
Psychodynamic:
Freud - loss and mourning ________________
Unconscious negative feelings, who we direct them at ____________________
Cognitive:
Beck’s theory (negative schema, cognitive bias) _________________
Seligman’s learned helplessness (level of control) __________________
Sociocultural factors:
Life events (Kendler et al. 1995 diathesis-stress study) ______________________
Freud argued that after a loss of / separation from a loved one, there is mourning. This returns to normal but in some the mourning is permanent - depression.
We all have unconscious negative feelings toward the loved one in the form of anger, which is turned on ourselves after the loss.
Beck argued depressed individuals develop negative schema about the way the world is, which link to cognitive biases such as overgeneralising.
Seligman argued we learn depression from experiences of trying and failing to control life, which then prevents us controlling situations we can control.
Kendler et al. (1995) showed in his study of depressed women that genetics acted as the diathesis and life events as the stress.
PSYCHOLOGICAL EXPLANATIONS A02/3 Limitation of loss as an explanation \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Cognitive - success/support in therapies \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Restricted research/theories - psych as sci \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Gender differences \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Holism \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Loss can probably only explain a limited number of cases of depression.
The cognitive explanation has led to effective therapy, supporting its strength as an explanation.
These explanations are limited due to the relatively small amount of research conducted.
Women have twice the risk that men have of suffering depression.
The life events/genetics explanation from Kendler is the most holistic of these
BIOLOGICAL THERAPIES A01 Antidepressant drugs: Two main types (old and new) \_\_\_\_\_\_\_\_\_\_\_ How they work \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 3 phases of treatment \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ (ECT): Situations where it is used \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Method of ECT (stages) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Previously, tricyclics, now SSRIs.
SSRIs block reuptake of serotonin into nerve endings, so it can move across the synapse.
Treatting current symptoms, continuing/withdrawing medication, and lastly maintenance - if relapse is considered likely
Electroconvulsive Therapy:
used when psychothrapy and medication are unsuccessful (severe depression)
The patient is given anaesthetic so they remain unconscious and a muscle relaxant to prevent fractured bones in seizure. Seizure is then created in the brain with a small, minute-long current passed through electrodes.
BIOLOGICAL THERAPIES A02/3 Antidepressant drugs: Severity of depression (Kirsch et al. 2008 - effective in most severe, placebo in less severe) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Appropriateness: In children/adolescents \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Suicide attempts (Ferguson et al. 2005) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Ethics of placebo drugs \_\_\_\_\_\_\_\_\_\_\_\_\_\_ ECT: ECT versus fake ECT \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Side effects of ECT \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Ethics of ECT \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Red \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Individual diffs \_\_\_\_\_\_\_\_\_\_\_\_
Kirsch et al. (2008) found SSRIs had an advantage in severe cases of depression, whereas in less severe cases a placebo was more effective.
Antidepressants were shown to be less effective in children/adults due to different biochemistry.
Ferguson et al. (2005) found an increased suicide risk with SSRIs compared to placebos
Such studies with placebos are unethical in that they cause potential psychological harm by using an inferior treatment.
ECT has been shown to be significantly more effective than fake ECT (anaesthetic but no actual treatment)
ECT can cause side effects like impaired memory and headaches.
Both forms of therapy imply biological reductionism, treating only biological causes.
There are individual differences in responses to biological therapies.
PSYCHOLOGICAL THERAPIES A01
__________________ (CBT):
Developed by ____ (1967)
Focusses on ____________ thoughts/beliefs in the _________ part of therapy, then and alter dysfunctional ___________ in the behavioural part.
Thought catching (link between specific events/specific thoughts) _______________
Behavioural activation ________________
Psychodynamic Interpersonal Therapy (PIT):
conversation __________________
shared understanding _______________
difficult feelings _________________
Cognitive Behavioural Therapy (Beck 1967)
Focusses on maladaptive thoughts and beliefs (cognitive), and dysfunctional behaviour (behavioural part)
Thought catching involves how their thoughts link to the way they feel in relation to various events and then learn realistic thoughts to replace these negative cognitions.
Behavioural activation involves becoming active in ways the patient used to before their cognitions became negative.
PIT involves conversation rather than a one-sided relationship with the therapist, and it centres on life relationships the patient has had.
Shared understanding involves the therapist asking and making sure they understand the patient’s experiences/thinking.
The patient may find it difficult to express feelings in the appropriate way or in the right situation - so this should be challenged.
PSYCHOLOGICAL THERAPIES A02/3
CBT:
Effectiveness (Robinson et al. 1990) ________________________
Where it is not appropriate (changes that can’t be made) ________________________
PIT:
Paley et al. (2008) study comparing effectiveness of PIT to CBT _____________________________
red/det ______________
Ethics (not treating some) ______________
Robinson et al. (1990) found CBT was superior to no treatment (a control group)
Some individuals may have dysfunctional beliefs which are resistant to change, and some have actual stressors in their life that the therapist is unable to change.
Paley et al. (2008) compared CBT to PIT and found PIT was equally as effective.
PIT is based on psychodynamic determinism in implying that the same relationship issues will always lead to depression, and psychodynamic reductionism also in not considering alternative factors. CBT is more holistic - considering behaviour and cognitions - but may be deterministic in the same way as PIT.
Some patients were not given treatment in the control groups of the experiments, not protecting participants from psychological harm.
