Diagnosis and Classification of Depression

A mindmap on the diagnosis and classification of Depression

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  • Created by: Jessica
  • Created on: 07-03-13 17:01
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  • Diagnosis and Classification
    • DSM
      • Depression differs in severity. There are 4 different domains.
        • Affective Symptoms - feeling low and saddness
        • Cognitive Symptoms - feeling guilty about shortcomings
        • Behavioural  symptoms - social withdrawal
        • Physical Symptoms - changes in sleep patterns and energy levels
      • In order to be diagnosed as depressed the person MUST have at least 5 symptoms, including 1 and 2
        • Symptoms must cause clinically significant distress or impairment
          • Symptoms must be present most or all of the time and have been present for longer than 2 weeks
          • 1.  Sad, depressed mood              2. Loss of interest and pleasure in usual activities         3. Insomnia or hypersomnia 4. Change in activity level    5. Significant change in appetite          6. Loss of energy and fatigue             7. Negative self concept   8. Difficulty in concerntrating 9. Recurrent feelings of death or suicide
            • In order to be diagnosed as depressed the person MUST have at least 5 symptoms, including 1 and 2
              • Symptoms must cause clinically significant distress or impairment
                • Symptoms must be present most or all of the time and have been present for longer than 2 weeks
                • 1.  Sad, depressed mood              2. Loss of interest and pleasure in usual activities         3. Insomnia or hypersomnia 4. Change in activity level    5. Significant change in appetite          6. Loss of energy and fatigue             7. Negative self concept   8. Difficulty in concerntrating 9. Recurrent feelings of death or suicide
        • Validity
          • McCullough et al. compared 681 outpaitents with various types of depression. They found few differences on a range of clinical, psychosocial and treatment response variables
            • Suggests that distinctions between the different subtypes of depression may not be valid
          • Goodwin et al. found that the odds of having suicidal thoughts was 5 times higher in patients with major depression alone, compared to patients with no psychiatric disorder. However, patients with major depression comorbid with panic disorder had triple that ratio
          • For most people, a diagnosis of depression is given by their local GP.     Van Weel- Baumgarten et al. suggests that diagnoses made by GPs are made against a background of previous patient knowledge and so could be a biased result
        • Reliability
          • Keller et al. suggests that inter-rater reliability is 'fair to good' and test- retest reliability is 'fair'
            • Multi- site study designed to explore the reliability of the DSM classification system for depression
            • Each participant was interviewed using the DSM criteria and then interviewed again 6 months later to establish a measure of test - retest reliability
          • Keller et al. suggested a number of possible reasons why DSM diagnoses of depression might lack reliability
            • Major depression to be diagnosed, a minimum of 5 out of 9 symptoms must be present             -A one item disagreement makes the difference between a diagnoses of major depression or a less severe illness
          • Zimmerman et al. claims that the DSM criteria for major depressive disorder are unnecessarily lengthy, and that doctors frequently have difficulty recalling all 9 symptoms, which leads to an unreliable diagnoses
      • BDI
        • The Beck Depression Inventory differentiates between severe depression and less severe depression
        • Comprises of a 21 item self report questionaire
          • Items 15 - 21 look at physical symptoms
          • Items 1- 14 look at Psychological symptoms
        • Reliability
          • Lobbestael et al. assessed the inter- rater reliability of the structured clinical interview for the assessment of major depressive disorder in a mixed sample of participants and non- participant controls
            • Results revealed moderate agreement with an inter- rater reliability coeffient of .66
          • Beck et al. studied the responses of 26 outpatients tested at two therapy sessions one week apart using BDI. There was a correlation of .93 indicating a significant level of test- retest reliability
        • Validity
          • Considered to be high in content validity because it was constructed as a result of a consensus among mental health clinicians concerning symptoms found among psychiatric patients
          • Beck et al. has consistently demonstrated concurrent validity between the BDI and other measures of depression
      • Classified as a mood disorder. Two main types: - Unipolar and Bipolar

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