Depression

Question 1

Genetic Vulnerability for Depression: effect sizes

Answer 1

Small effect sizes for multiple genes research

Question 2

Genetic Vulnerability for Depression: Influencing genes

Answer 2

1. Serotonin Transporter promoter polymorphism (5HTTLPR) 2. Short alleles = more likely for depression

Question 3

Neuroendocrinology

Answer 3

1. dysregulation of hypothalamic-pituitary-adrenal (HPA) axis (stimulates cortisol) 2. abnormalities in cortisol - diurnal patterns and delayed return to baseline levels 3. abnormalities = do not predict depression but do portend poorer prognosis and high likelihood of relapse

Question 4

Neurotransmitters

Answer 4

serotonin and norepinephrine

Question 5

functional and structural brain changes in depression

Answer 5

• brain lesions (strokes, degenerative diseases) - volume reduction in frontal region - relatively left frontal hypoactivation - prefrontal cortex, hippocampus and amygdala - reduction hippocampal volume (learning and memory)

Question 6

Female hormones

Answer 6

• pubertal development, premenstrual, postpartum and menopause and perimenopause

Question 7

Ruminative response style

Answer 7

tendency to repeatedly replay negative self-referential thoughts leading to exacerbation of sad moods and risk for depressive episodes (especially in females)

Question 8

Stressful life events

Answer 8

70-95% of people who developed depression had a prior severe life event

Question 9

Interpersonal approaches to depression vulnerability

Answer 9

• debilitating social consequences e.g. depression on marital relations and child’s development - traditional psychodynamic perspectives (attachment theory) and social learning perspectives - more evidence of insecure attachment and more maladaptive perceptions - parent-child relationships: negative affect and harsher control - dependency and reassurance seeking - sociotropy - high levels of investment in interpersonal relationships and concern with others - low social support

Question 10

Treatment of depression

Answer 10

• Antidepressants (only good for severely depressed, generally used for acute episodes, chronic depression and relapse prevention) - psychotherapies (CBT for severely depressed, better for relapse prevention, comparable for acute)

Question 11

Assessment of Depression

Answer 11

• Gold standard: Structured clinical interview - SCID-5 (semi-structured interview guide DSM-5)

Question 12

outlines for unstructured clinical interviews

Answer 12

1. Identify information 2. presenting problem/chief complaint 3. History of presenting problem 4. Family history 5. Relationship history 6. Developmental history 7. Educational History 8. Work history 9. Medical history 10. Substance Abuse (CAGE questionnaire - Cut, annoyed, guilty, eye opener) 11. Legal history 12. Previous counselling 13. Mental Status Exam Can incorporate performance based or self report personality testing

Question 13

Why use performance based or self report personality testing?

Answer 13

Can facilitate diagnostic understanding of client’s symptoms which may in itself help to alleviate some of the client’s presenting symptoms. Build rapport

Question 14

Grief or depression?

Answer 14

Question 15

Psychometric assessment of depression

Answer 15

• Hamilton Rating Scale
  
  • 17 items
  • antidepressant trials with focus on insomnia and suicidal ideation
  • not suitable for diagnosis
• Centre for epidemiological studies depression
  
  • 20 items
• DASS
  
  • 42 or 21 items
• PHQ
  
  • 2 item screening scale or 9 item full scale
  • assess DSM5 symptoms
• Edinburgh postnatal depression scale
  
  • 10 items
• Beck depression Inventory II
  
  • 21 items
  • minimal (0-13), mild (14-19, mod (20-28), severe (29-63)

Question 16

Persistent depressive disorder (dysthymia)

Answer 16

3+ symptoms

2 + years

(1 year for kids/adolescents)

Question 17

Premenstrual dysphoric disorder

Answer 17

final week of menstrual cycle, improves few days after period onset