Depression

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  • Created by: GripariM
  • Created on: 29-04-15 20:09

Depression- Classification and Diagnosis

Clinical Characterstics of Depression

  • Clinical characteristics are found in the DSM IV.
  • It suggests that to have a diagnosis of Major Depressive Disorder one must have at least five of the mentioned symptoms such as a depresesd mood, lack of pleasure or interest, low libido, changes in sleeping and eating patterns and lethargy.

 

 

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Depression- Classification and Diagnosis

 Reliability of Classifcation and Diagnosis of Depression

  • Inter-rater reliability: (an agreement or concordance in the degree of a agreement among psychologists.) Lobbestael et al. reported moderate inter-rater reliability using a Structured Clinical interview, which is how people are diagnosed. This suggests that although diagnosis and classification is accepted there are still issues with how this is done and whether all doctors and psychologists diagnose individuals in the same way.
  • Test-retest reliability: (a measure of reliability obtained by administering the same test twice over period of time to a group of individuals,  results can  be correlated to evaluate the test) Beck suggested that there were high levels of test-retest reliability using the Beck Depression Inverntory.

Evaluation

  • Keller et al. and Zanarini et al. found generally good inter-rater reliability for diagnoses using the DSM but only fair at best for the test-retest relibility.
  • A lack of reliability could be down to subjectivity(personal judgement shaping the outcome)of the interpretation of the symptoms
  • Zimmerman et al. suggested that only using mood and cognitive symptoms would produce a more reliable diagnosis

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Depression- Classification and Diagnosis

Validity of Classification and Diagnosis of Depression

  • Comorbidity: having an anxiety disorder is the biggest clinical risk for the development of depression.
  • Concurrent: (a type of evidence that can be gathered to defend the use of a test for predicting other outcomes) is high between Beck’s depression inventory and measures such as Hamilton’s depression scale (Beck).
  • Content validity: (validity of a test as a result of the use of previously tested concepts) Becks depression Inventory is considered high in content validity due to a result of consensus among mental health clinicians in regards to symptoms of depression. 

Evaluation

  • McCullough et al. found an overlap in symptoms, making it difficult to justify different forms of depressive illnesses.
  •  found that diagnoses made by GP's were less objective than those made by specialists.
  • Goodwin et. al found that consequences of comorbidity include increased risk of suicide when combined with panic disorder.
  • Andrews et al. compared DSM and ICD and concluded no differences in vailidity in diagnosis of depression
  • Karasz found that depression is less accepted as 'illness' among Asian cultures in comparison Europeans because of the stigma attached to illness.

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Depression- Therapies for Depression

Biological Therapies

  • Anti-Depressants:Tricyclics block the mechanism that reabsorbs serotonin and noradrenaline into presynaptic cell. This results in more being avaible in the synapse.
  • SSRI's (selective serotonin reputake inhibitors) selectvily block the reabsorption of serotonin and so increase the amount avaiable, which stimulates the neighbouring brain cells.

Evaluation

  • Kirsch et al. SSRI's only effective in the most severe case of dperession. Placebo's had some effect on moderately depressed group.
  • SSRI's vs. Non-SSRI's there was no significant differences outcomes.
  • Anti-depressants are less appropriate for children and teens as they may not work well with the biological changes in the brain and so aren't compatible with the brain chemistry.
  • There is a risk of suicide when taking SSRI's which greater in adolescents.
  • There is an age bias towards older individuals who's symptoms might be ignored or put down to old age.
  • There is a publication bias, which tends to publsich studies with positive outcomes, so highlights the benefits of taking anti-depressants.

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Depression-Therapies for Depression

Biological Therapies for Depression

  • ECT: works by using small amounts of electric current which is passed through the brain, this result in seizure, which is suggested to restore the brain's ability to regulate mood.
  • It is often used for patients who are suffering with Major Depressive Disorder in it's most severe forms. Furthermore, it is used for patients who aren't responsive to psychotherapy or drugs.

Evaluation

  • There is a signficant difference between of ECT and 'sham' ECT which involves creating a placebo effect of the treatment. ECT's effectiveness is proven in treatment resistant depression.
  • In comparison with anti-depressant treatments, it has been found that ECT is more effective in short-term treatment, but it was not compared with SSRI's.
  • The side-effects of ECT include impaired memory and cardiovascular changes others have reported permenant fear and anxiety.
  • But, cognitive problems can be minimised with unilateral rather than Bilateral ECT.
  • Ethical issues arise by using placebo treatment, which contradicts the duty of care, and furthermore many people do not give consent for the treament

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