THE CLASSIFICATION & DIAGNOSIS OF DEPRESSION.

It is the most common mental disorder.

Clinical Depression = physical, mental, emotional and behavioural experiences that are more prolonged, severe and damaging.

MDD - Major Depressive Disorder (also referred to as, Uni-Polar).

15% of men & 24% of women will have a bout of depression some point in their life.

Women more higher risk due to:Hormonal changes-puberty/menopause/pregancy.

Men are more likely to go undiagnosed and less likely to seek help!

There are NO clinical tests for diagnosing depression!

However...

Detailed INTERVIEWS & QUESTIONNAIRES used = Diagnosis.

There are two Classifications that are used:

• the DSM - Diagnostic & Statistical Manual of Mental Disorders.

-this is a system based on all known symptoms associated with a particular mental condition. GP will ask patient if they have certain symptoms = enabling them to look at the system to identify the condition.

• the ICD - International Classification of Diseases.

-similar system to DSM. Covers all diseases - not just mental.

A person who suffers from MDD must have depressive mood or loss in interest/pleasure in daily activities consistently for at least 2weeks.

This mood must represent a change from the person's normal mood:

-Social/Occupational/Educational & others that is negatively impaired due to mood.

Symptoms:

• Social Isolation.
• Anxiety.
• Loss of sex drive.
• Disturbed sleeping patterns.
• Suicidal thoughts. 

MDD is characterized by the presence of 5+ of these symptoms over 2weeks.

1.Depressed mood most of the day, nearly every day. Either by self-report (feeling sad/empty) or observed by others.

2.Diminshed interest/pleasure in all, or almost all activities most of the day.

3.Significant weight loss/gain - ie. change of more than 5% in a month.

4.Insomnia/hypersomnia nearly everyday.

5.Psychomotor agitation or retardation nearly every day.

6.Fatigue or loss of energy nearly every day.

7.Recurrent thoughts of death, recurrent suicidal ideas without specific plan.

DSM assesses the individual by the 5 criterias/AXIS.

MULTI-AXIAL

• AXIS 1 - Clinical disorders/Conditions.
• AXIS 2 - Personality disorders + Retardation.
• AXIS 3 - Other general medical conditions.
• AXIS 4 - Psychosocial + Environmental problems.
• AXIS 5 - Global assessment of functioning (GAF) code 1-100.

The patient is catagorised into these 5 criterias for diagnosis.

Validity - the extent to which a diagnostic system measures what it claims to measure.

Only valid if it predicts what is happening and if the treatment works.

 Underlying causes useful for validity and few are known.

Many treatments exist for the same disorder = validity = difficult.

Szasz ~ argues...that diagnosis is made on political & social grounds and merely attach stigmatising labels.

Scheff ~ labelling creates a self-fulfilling prophecy!

Reliability - the extent to which the diagnosis of depression is consistent.

Reliable only if 1+ psychiatrists give same diagnosis of an individual.

BECK - gave 2 psychiatrists 153 patients to diagnose = only agreed 54% of the time = NOT V.RELIABLE.

ROSENHAM - 1st study found reliability = all diagnosed the same. 2nd study when warned of impostors not reliable.

It was examined to why diagnosis might be unreliable = it is objective + goes on perception.

Categorising = describing, not explaining. But explanation is inherent.

Categorising suggests in/out but most mental illness along a continuum.

Many bases for diagnosis - biological/self-report/past history...no consistency.

Psychiatrists have biases = gender/age etc.

Culture differences.

POSITIVES:

• Diagnosis usually made on the basis of a classification system.
• Diagnosis = treatment!
• Causes can be identified with common labelling.