PSYA4 Depression

Full notes on the Depression unit

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  • Created on: 29-04-14 16:55
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DEPRESSION
Depression is a mood disorder involving prolonged and fundamental disturbance of emotions. There
are two main types, unipolar and bipolar, and depression can also be broken down into endogenous
depression, related to internal biochemical and hormonal factors and exogenous (reactive)
depression, related to stressful experiences, though sufferers can have elements of exogenous and
endogenous depression combined.
Classification system: is a system used to categorising groups of symptoms into mental disorders
and those disorders into classes of disorder.
Comer 1999- `A comprehensive list of mental dysfuctioning including descriptions of the symptoms
of disorders and guidelines for assigning people to these categories'
DSM-IV ICD-10
Published in 1952-revised 5 times Includes every known disease- not a treatment
Guidelines on how to diagnose-most widely model
used Used more for clinical diagnosis
Includes standard interviews called SCIDs World Health Organisation- devised by a panel
(structured clinical interviews for DSM) with a much broader cultural base (still fairly
Consists of three major components: the western)
diagnosis classification, the diagnosis criteria set Most trustworthy
and the descriptive text
Techniques of assessment include behavioural observation, clinical interview, psychological tests and
physiological tests.
Clinical characteristics for diagnosis
MDD DD Bipolar
Cyclical- symptoms come Characterised by constant Diagnosis when patients
and go although usually less suffer from mania- high
Symptoms, when present severe symptoms arousal with irritable or
are severe- typically last Longer than 2 years for a excited mood
4-6 months (on average formal diagnosis, although Highly energetic- happy or
MDD patients are treatment can begin earlier irritable. They need little
depressed 27.5% of the sleep and may have a
time) stronger than usual sex
5+ symptoms for a 2 week drive, are highly impulsive
period- must be drastic and judgement may be
change impaired- e.g.
One symptom must be overspending or
depressed mood or loss of overambitious business
interest plans
Issues in diagnosis and classification
Reliability
Refers to the consistency of a measure (repeated similar findings)
Presented via PPV and Cohen's Kappa (for test-retest)

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Inter-rater reliability= if several consultant agree on the same diagnosis, a system can be seen as
reliable
Test-retest reliability= assess the patient two or more times and see whether they consistently
receive the same diagnosis
Zanarini '00- MDD inter-rater reliability correlation of 0.8
Beck '96- 93% test-retest reliability when using the Beck Depression Inventory
Pontizovsky '06- PPV 83% for test-retest for all mood disorders
Baca-Garcia '07- PPV 55% for depression and 35% for bipolar for test retest and a kappa of 0.…read more

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Cultural Relativism
Davison and Neale (1994) found in Asian cultures, those experiencing emotional turmoil are praised
and rewarded if they don't show it, in contrast, in certain Arabic cultures it is understood and people
are often encouraged to publicly outpour emotions
Language Difficulties
The use of professional jargon is also an issue as the meaning of symptoms can be `lost in translation'.…read more

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There is a possibility with twin studies of diagnostic unreliability ­ that is, if researchers are
aware that one twin suffers from depression, then this clouds their judgement in assessing
the other twin
Twin/family studies do not consider whether social class or socio-psychological factors play a
role.…read more

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IDAs- reductionism, determinism
Endocrine
-Higher levels of cortisol results in depression. Carroll (1982) found that techniques that suppress
cortisol were successful in helping depressed patients. This would suggest depressed people
have an over-active HPAC
-Oestrogen-progesterone imbalance also plays a role according to Dalton (1964). PM
depression is due to increased levels of oestrogen and lower levels of progesterone. In PPD
both levels drop suddenly after high levels during pregnancy. In menopause, oestrogen drops.…read more

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The theory doesn't account for depression that lasts for a few years as surely adjusting to a
new position in the hierarchy would not take this long (Social Competition theory)
Reductionism.…read more

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Evaluation
Eranti et al (2007) - 46 MDDs assigned to ECT or magnetic fields randomly. The ppts
were assessed immediately, 1 month later and 6 months later. 59% of ECT patients had
no symptoms just after and at 1 month later vs 17% of controls.…read more

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Evaluation
Empirical support for effectiveness. The MAOIs, the Tricyclics, and the SSRIs have proved
consistently effective in the treatment of major depressive disorder, but the Tricyclics are
generally more effective than the MAOIs, and produce fewer side effects
Treatments can either cure the processes causing the disorder (curative treatments) or
suppress the symptoms of a disorder without changing the underlying processes (palliative
treatments).…read more

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Evaluation
Although behaviourism explains depression in terms of being a secondary gain- for example,
the sympathetic attention of others following a negative life event- it cannot explain why
depression continues after such attention declines
Kanter et al (2004) states that behaviourism has yet to offer an account for depression that
addresses its complexity satisfactorily
Ferster (1973) demonstrates that reinforcement schedules and environmental influences
were important factors in depressive behaviour, creating opportunities to develop specific
behavioural techniques for treatment of the disorder itself
Learned helplessness has…read more

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The research is inconsistent and so we cannot be sure if negative cognitions cause or are a
consequence of depression resulting in a lack of reliability
Research into cognitive factors relies on self-report, e.g. the Beck Depression Inventory.…read more

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