Week 3

Question 1

Define case formulation

Answer 1

In simple terms, case formulation describes what is going on, and what you are going to do about it.

Question 2

What are the steps involved in case formulation?

Answer 2

1. Obtain a comprehensive problem list
2. Develop a diagnosis
3. Propose an explanatory hypothesis from psychological theory and evidence (4 Ps)
4. Planning treatment

Question 3

What are the 4 Ps?

Answer 3

• Predisposing factors
• Precipitating factors
• Perpetuating factors
• Protective factors

Question 4

Explain predisposing factors (from the 4 Ps)

Answer 4

Factors that make a person susceptible to a diagnosis. E.g. developmental milestones, social, familial, cultural factors.

Question 5

Explain precipitating factors (from the 4 Ps)

Answer 5

What triggered the behaviour - why now?

Can be distal (within the individual) or proximal (around the individual)

Question 6

Explain perpetuating factors (from the 4 Ps)

Answer 6

Maintaining factors - cognitive and behavioural factors that maintain the problem or make it worse

Question 7

Explain protective factors (from the 4 Ps)

Answer 7

Characteristics in the person’s life that should facilitate problem solving.

Question 8

What percentage of the Australian population is affected by depression?

Answer 8

10%

Question 9

What are some of the difficulties associated with diagnosing depression?

Answer 9

• it is both under and over diagnosed
• Only half of depressed people are recognised as having depression
• there are difficulties in differentiating clinical depression with sub-threshold depression

Question 10

What are the DSM-IV criteria for diagnosing major depressive disorder?

Answer 10

Have 5 or more of the following for at least 2 weeks:
- Depressed mood
           OR
- Anhedonia
ALONG WITH
- weight/appetite change
- Sleep problems
- Psychomotor agitation or retardation
- Fatigue
- Feelings of worthlessness/guilt
- Poor concentration/indecisiveness 
- Suicidal ideation

Question 11

What 4 divisions can symptoms of major depressive disorder be divided into?

Answer 11

• Mood
• Behaviour
• Physical/Somatic
• Cognition

Question 12

What percentage of people who have major depressive disorder, single episode have another depressive episode in their lifetime?

Answer 12

35-85%. 20% chance of having another episode in the 1st year and 40% in the second year, and 60% in 5 years.

Question 13

What is the median lifetime number of major depressive episodes?

Answer 13

4-7. 25% of people experience 6 or more episodes.

Question 14

What is the median length of major depressive episodes?

Answer 14

4-5 months, somewhat shorter than the length of the first episode.

Question 15

With treatment, what are the recovery rates of depression?

Answer 15

80% recover within 2 years of initial onset.

Question 16

What are the response rates to placebo antidepressants, CBT, and a combination of both?

Answer 16

• 42-47% placebo
• 60% CBT
• 60% antidepressants
• 85% combination

Question 17

What is a dysphoric/mixed manic episode?

Answer 17

When an individual experiences manic symptoms but feels somewhat depressed/anxious at the same time.

Question 18

What are some factors associated with depression?

Answer 18

• family history
• early childhood experience
• stress
• low/high social support
• activity levels
• substance use

Question 19

What are some psychological factors associated with depression?

Answer 19

• Perfectionism
• Neuroticism/anxiety
• Anxious attachment
• Pessimism
• Learned helplessness/hopelessness
• Decreased self-esteem
• Rumination
• Memory biases towards negatives
• Emotion regulation difficulties

Question 20

What are some treatment modalities shown to be effective in treating depression?

Answer 20

• diathesis-stress model
• cognitive behaviour model
• medical treatment

Question 21

Explain the diathesis-stress model

Answer 21

The more stressful life experiences someone has, the less genetic predisposition they need to develop depression.