Week 2 Lecture - Common mental health disorders: Depression

Question 1

Major depressive disorder according to DSM5

Answer 1

• 5+ symptoms in a 2 week period, representing a change from previous functioning, in addition to either depressed mood and/or loss of interest or pleasure (anhedonia)

o Sig weight loss or gain
o insomnia or hypersomnia
o psychomotor agitation or retardation
o fatigue/loss of energy
o feelings of worthlessness and/or guilt
o diminished ability to concentrate or indecisiveness
o suicidal ideation

Question 2

cultural differences and depression - who and what?

Answer 2

Haroz et al., 2017) - symptoms different everywhere and between everyone. The below symptoms were present in other cultures.

• Social isolation/loneliness
• Crying a lot
• Anger
• General aches and pains
• Headaches
• Thinking too much
• Worry

Question 3

who gets depression?

Answer 3

5% of population

Increasing prevalence

Largest contributor to non-fatal health loss (7.5% of all years lives with disability) (disabling disorder)

Most prevalent in low and middle income countries

2:1 female to male ratio

Comobrid with anxiety

WHO, 2021

Question 4

consequences of MDD

Answer 4

• Cognitive functioning (can be so severe that they get confused for dementia)
• Occupational functioning (not functioning at work properly)
• Social relationships (e.g. loss of libido, tendency to be angry and egocentric etc)
• Suicide (11-15% with depression die from suicide)

Question 5

biological aspects of MDD

Answer 5

• Symptoms
• Runs in families (genetic link?)
• Brain imaging of functional and structural changes in brain (e.g. size of brain shrinks in long term depression, lack of proper functioning in brain)
• Changes in NT and hormone levels
• Success of biological treatments in treating MD (antidepressants, ECT) (pharmacological treatments still the most widely used treatment method)

Question 6

the monoamine hypothesis

Answer 6

• Pathophysiologic basis of depression - depletion in the levels of serotonin, norepinephrine, and/or dopamine in the central nervous system. (required for memory etc)
• A significant proportion of patients with MDD are resistant to monoaminergic antidepressant therapies.

Question 7

STAR*D trial

Answer 7

Pigott H. E. (2015)

1/3 of patients achieve remission with initial antidepressant pharmacological treatment
* Not even a high rate of remission so why are we still prescribing these?

Question 8

what are the early psychological models of depression?

Answer 8

reinforcement theory

Positive reinforcement and behavioural activation

REBT

Cognitive theory of depression

Question 9

Reinforcement theory as a psychological model of depression

Answer 9

o Ferster (1973) functional analysis: viewed depression as a generalized reduction of rates of response to external stimuli.
* How contextual factors influenced behaviour
o Developed by Lewinsohn (1974): depression as a response to insufficient response-contingent positive reinforcement, to maintain adequate functioning.

Question 10

Positive reinforcement and behavioural activation as a psychological model of depression

Answer 10

o Psycho-educational approach: “The Coping with Depression Course” (Lewinsohn, Antonuccio, Breckenridge, & Teri, 1987)
o + negative reinforcers: Behavioural Activation (Martell et al., 2001)
* Goes through activities someone could do to ‘cope’ and whether they have had the desired effect overtime
o + matching theory: Behavioral Activation Treatment for Depression (Lejuez et al., 2002)

Question 11

REBT as a psychological model of depression

Answer 11

o ABC model of distress
o Adversity, beliefs, consequences
o Challenge and dispute ABC relationship through argument and testing evidence

Question 12

Cognitive theory of depression as a psychological model of depression

Answer 12

(Beck, 1972)
o Cognitive triad
o Negative view of self, view of world and view of future
o Schemata: structural units of stored info that also function to interpret new experience
o Latent depressive schemata reactivated when loss is perceived

Question 13

cognitive distortions that lead to automatic negative thoughts

Answer 13

arbitrary inference
selective abstraction
magnification and minimisation
inexact labelling

Question 14

arbitrary inference

Answer 14

the arbitrary assumption that some negative event was caused by oneself.

Question 15

selective abstraction

Answer 15

focus on the negative element in an otherwise positive set of information.

Question 16

magnification and minimisation

Answer 16

overemphasising negatives and underemphasising positives.

Question 17

inexact labelling

Answer 17

giving a distorted label to an event and then reacting to the label rather than to the event.

Question 18

theory to therapy

Answer 18

• Complex collection of techniques: interpretations of events rational and realistic
• Theory focuses on behaviour, automatic thoughts and underlying assumptions
• Highly efficacious to depressed patients, with positive effects maintained over the longer term

Question 19

cognitive theory evaluation

Answer 19

• Influential in clinical psyc and valuable through its theoretical, experimental and therapeutic applications
  o Responsibility of patient
• CBT, umbrella term (including cognitive therapy, REBT) consistently shown to be effective
• Adopted by NICE

Question 20

psychological apporaches to depression

Answer 20

• Lewinsohn - reduction in interrelated behaviours as the response to a loss, or lack of response-contingent positive reinforcement from an important and generalised reinforcer.
• Beck’s - an extensive negative view of the world and self that is reactivated when loss is perceived.