PSYA4 Depression Notes

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  • Created on: 16-06-13 10:48
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DEPRESSION
CLINICAL CHARACTERISTICS OF DEPRESSION
Cognitive- Loss of self-esteem, negative/ suicidal thoughts, lack of ability to concentrate
Behavioural- Loss of appetite, disordered sleep patterns, poor self-care
Physical- Loss of weight, loss of energy, menstrual change
Emotional- Sadness, lack of pleasure, LOW MOOD
The patient must have experienced at least five of these symptoms for two weeks, for MDD (Major
Depressive Disorder) to be diagnosed.
The symptoms must not be able to be explained by a recent loss.
ISSUES SURROUNDING THE CLASSIFICATION AND DIAGNOSIS
Two methods for classification: ICD-10 and DSM-IV
SUBJECTIVITY- All professionals are using the same diagnostic criteria- Minimises professional
bias
--> Opinions are still needed- possible influences of bias
Culturally Biased- Based on western society so the characteristics for a person to be described as
having depression may be different in the east compared with the west.
-> when does grief become abnormal- Different for different cultures.
GPs are usually not specialised with Depression so this can lead to misdiagnosis
May not admit to having depression- leads to wrong diagnosis, correct treatment is NOT
prescribed
Comorbidity- Validity Issue- Individual may have two or more disorders at the same time so it is
difficult to focus on which disorder should be treated first. Also means that DSM-IV and ICD-10
diagnostic criteria is very similar- GP could misdiagnose one condition for another i.e. MDD instead
of Bi Polar
Individual differences may be overlooked- doesn't take into account the impact and severity of the
disorder
Must display five symptoms for two weeks to be diagnosed but could have had three symptoms for
three months and not be diagnosed. How can low mood be measured?
Labelling- Diagnosis could cause the individual to be branded- likely to be affected when it comes
to applying for jobs, insurance, etc
RELIABILITY- Inter-rater Reliability- two professionals arrive at the same diagnosis.
Beck- 154 patients, 54% agreed diagnosis Low reliability.
Brown- 1400 participants, measured interviewer reliability. Threshold to which two disorders differ,
one professional diagnosed one disorder i.e. mania, the other diagnosed chronic worry. Patient's
description of their illness could differ from consultation to consultation which affects
diagnosis.
BIOLOGICAL EXPLANATIONS OF THEIR CHOSEN DISORDER, FOR EXAMPLE,
GENETICS, BIOCHEMISTRY
GENETICS
Twin Studies- Genetically similar, more likely to both suffer depression when one does
--> McGuffin- Chance one MZ twin suffering if the other does- concordance= 46%, for DZ, 20%
o Concordance for Bi Polar for MZ was 40% and 6% for DZ
Figures are higher than diagnostics of 7% for MDD and 1% for Bi Polar

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Family Studies- Child more likely to possess when parent has MDD or Bi Polar
--> Gershon- Rates of depression were 2-3 times the rate of the rest of the population in parents
of sufferers.
o Amish family- 11/81 suffered from Bi Polar, markers found on those individuals
genes that were different to non-sufferers. Next to gene involved in monoamine
production- associated with depression.
Adoption Studies- Biological parents of sufferers were 7 times more likely to have MDD than
adoptive parents.…read more

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High and low levels of Cortisol- Cushing's (HIGH) and Addison's (LOW) both show
increased depression levels.
Bao- Females are more likely to experience depression- Oestrogen stimulates CRH whereas
Androgens in males suppress it.
Exposure to stress hormones in the womb can cause loss of synapses in the pre-frontal
cortex does not function properly in depressed people.
CRH may cause reduction in Serotonin levels, which is why the person has depression.…read more

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Abramson- Attributions have three dimensions:
o Internal-External Is the person to blame (internal) or other forces (external)
o Stable-Unstable If a failure is a one-off (unstable) or seen as being inevitably repeated
(stable)
o Global-Specific If a failure is seen as a representation of the individuals personality and
life (global representation) or if the failure is seen as a result of an event (specific).
Internal, Stable and Global attributions are associated closely with the likelihood of developing learned
helplessness, which could ultimately develop into depression.…read more

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More likely to find themselves in situations that provide limited control.
BIOLOGICAL THERAPIES FOR THEIR CHOSEN DISORDER, INCLUDING THEIR
EVALUATION IN TERMS OF APPROPRIATENESS AND EFFECTIVENESS
DRUG THERAPY TRICYCLI
C S
Amount of Serotonin and Noradrenaline available in the brain is increased as Tricyclics prevent
their re-uptake.
Enhance the action of Monoamines.
Slows down the reabsorption of Serotonin so it keeps stimulating the post-synaptic neurone.…read more

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ELECTROCONVULSIVE THERAPY (ECT)
Small electrical current passed through brain to induce an epileptic-like seizure. Patient is
given a muscle relaxant beforehand and anaesthetised.
Applied to left hand side of brain- prevents loss of language memory- however, not as effective.
Last form of action, after drug therapy.
Better response than to drug therapy. 80% : 64%
AO2
APPROPRIATENESS
Memory loss induced- 30% found ECT distressing and reported severe memory loss.
Unclear how and why it works- argued that it shouldn't be used if it isn't understood.…read more

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It treats the underlying cause and not just the symptoms- less likely to relapse as they have the
tools they need to change their mindset.
EFFECTI
VENESS
Is at least as effective as other treatments.
Low relapse rate
Can be combined with other therapies and treatments such as drug therapy.
PSYCHODYNAMIC
Free Association- client talks openly. Allows unconscious thoughts to slip through.
Dream Analysis- symbolic and can be interpreted by a therapist to reveal inner desires.…read more

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