Depression

Depression is classified under DSM-IV as a mood disorder, what is a mood disorder? (AO1)

Something which effects a persons emotional state.

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What are the 9 symptoms of major depression?(AO1)

1)Sad, depressed mood. 2)Loss of interest and pleasure in usual activites. 3)Insomnia. 4)Shift in activity level. 5) Poor appetite. 6)Loss of energy. 7)Negative self concept.8) Difficulty in concentrating. 9)Thoughts of suicide.

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Within depression, what does validity refer to?(AO1)

Validity refers to the extent a diagnosis represents something that is real and distinct from other disorders and the extent that a classification system (ICD or DSM) measures what it claims.

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What are the 3 types of validity considered with depression?(AO1)

Comorbidity, content validity and concurrent validity.

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What is comorbidity?(AO1)

It refers to the extent that 2 (or more) conditions co-occur.

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What has been shown to be the biggest clinical risk for the development of depression. (AO1)

The presence of an anxiety disorder.

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What did Goodwin et al (2001) find? (AO2)

The odds of having suicidal thoughts were 5 times more higher in patients with depression alone compared to patients with no psychiatric disorder. However, patients with MDD and a panic disorder were 15 times more likely to have suicidal thoughts.

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What did Van wee-Baumgarten (2006) suggest? (AO2)

that diagnoses of depression made by GP's rather than secondary care specialists are made against a background of previous patient knowledge and so could be biased as a result.

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Within depression, what is reliability?(AO1)

Reliability refers to the consistency of a measuring instrument (e.g. questionnaire).

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What are the 2 types of validity considered with depression? (AO1)

Inter-rater reliability and test-retest reliability.

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What is inter-rater reliability?(AO1)

Inter-rater reliability assess whether 2 assessors give similar diagnosis.

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What did Lobbestael et al (2011) find in a sample of patients of non patient controls? (AO1)

Assessed inter-rater reliability of the structured clinical interview for the assessment of major depressive disorder. Results revealed moderate agreement with an inter-rater reliability coefficient of 0.66.

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What did Beck (1961) find when looking at inter-rater reliability?(AO2)

Is is actually quite low at 54% meaning that diagnosis were only agreed on for 54% of the 154 individuals. However,Beck noted that in all 154 cases the patients gave different information to the 2 health professionals.

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What did Keller et al (1995) find within their mult-site study designed to explore the reliability of the DSM-IV? (AO2)

Results showed that inter-rater reliability across different sites was 'fair to good', but test-retest reliability was 'fair'.

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What did Keller suggest was the cause of low reliability of the DSM? (A02)

For a diagnosis of major depression to be given, a minimum of 5 out of 9 symptoms must be present. I the presence of 1 symptom is subtle, a one item disagreement could mean the difference between a diagnosis of MDD or a less serious illness.

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What does Zimmerman argue?(AO2)

That it is the length of the criteria needed for a diagnosis that causes issues, suggesting that doctors have difficulty recalling all 9 potential symptoms, which could lead to faulty diagnosis.

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What did Krupinski et al find? (AO2)

they found only 25% of GP's in Austalia and New Zealand could list all 9 symptoms. They argue that if more simple and straightforward criteria are applied then consistency of diagnosis will improve.

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What did McNeal and Cimbolic find that suggests serotonin causes depression? (AO1)

They found that cerebrospinal fluid in depressed patients (especially suicidal ones) contains reduced amounts of a major serotonin by-product, signifying reduced levels of serotonin in the brain.

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Describe Delgado et al (1990) study which suggests serotonin leads to depression. (AO1)

They gave depressed patients a special diet that lowered their levels of one of the precursors of serotonin- tryptophan. The majority of patients experienced a return of depressive symptoms, which disappeared when their diets returned to normal.

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What did Ruhe et al find? (AO2)

That the link between neurotransmitters and depression isn't that straightforward. Studies using patients in remission found that when given a tryptophan deficient amino acid mixture, the patients became more depressed. Not in those no depression.

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Explain how the use of SSRI's supports the biochemical explanation. (AO2)

Because SSRI's increase the levels of serotonin which reduces the symptoms of depression, meaning that low levels of serotonin must be the cause in order for SSRI's to be sucessful.

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Explain what research into the blood pressure drug Reserpine has found. (AO2)

It can cause depression. A side effect of Reserpine is reduced levels of serotonin which can be an explanation why many people on the drug experience depression and also highlight the fact low levels of serotonin cause depression.

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What did Bunney et al (1965) find? (AO1)

That indirect markers of noradrenaline levels in the brain were often low in depressed indivduals.

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What have post-mortem studies revealed? (AO1)

Increased densities of certain noradrenaline receptors in the brains of depressed suicide victims.When transmitter molecules become unusually scarce, post synaptic cells expand receptor numbers in a compensatory attempt to pick up signals available.

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What did Leonard (2000) find?(AO2)

That drugs that lower noradrenaline levels being about depressive states and drugs that increase noradrenaline levels show antidepressant effects.

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What did Kraft et al find when they studied 96 patients with major depression? (AO2)

Those who were treated with a dual serotonin- noradrenaline re-uptake inhibitor (SNRI) showed a much more positive response than those treated with a placebo.

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What are probands and why do family studies use them?(AO1)

Probands are people who already have depression and family studies examine members of their family to see whether they have had or will develop depression.

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What did Harrington et al (1993) find?(AO1)

That around 20% of first degree relatives have depression compared with 10% for the population at large.

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What did Zhang et al (2005) find? (AO2)

That a mutant gene that starves the brain of serotonin is 10 times more common in depressed patients than control individuals.The mutant gene codes for the brain enzyme tryptophan hydroxlase 2 which makes serotonin and can result in a 80% reduction.

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What did Caron et al find? (AO2)

That this version of the gene was carried by 9 out of 87 depressed patients but only 3 out of 219 healthy controls.

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Explain Freuds theory of 'mourning and melancholia' (AO1)

Freud suggests that when a person loses someone, there is first a mourning period and then after a while life returns to normal. However, for some people the mourning period never seems to end.

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What did Shah and Waller (2000) find?(AO2)

Found that people who suffered from depression described their parents as 'affectionless'. This supports Freud's theory of loss through withdrawal of affection.

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What did Barnes and Prosen (1985) find? (AO2)

Found that men who lost their fathers through death during childhood scored higher on a depression scale, than those who had not lost their fathers.

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What did Paykel and Cooper (1992) find?(AO2)

Only 10% of those who experience early loss later become depressed.

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What did comer show? (AO2)

The treatment associated with Freud's theory (psychoanalysis) has not proved very effective with cases of depression.

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Explain Beck's cognitive theory (AO1)

Beck believed that depressed individuals feel as they do because their thinking is biased towards negative interpretations of the world. Depressed people have acquired a negative schema.These schema are activated in situations similar to when created

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Whats Beck's negative triad? (AO1)

A pessimistic view of the world, the self and the future.

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What did Hammen and Krantz (1976) find? (AO2)

That depressed women made more errors in logic when asked to interpret written material than non-depressed patients.

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What did Bates et al (1999) find?(AO2)

That depressed patients who were given negative automatic thought statements became more and more depressed.

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What did Butler and Beck (2000) find when they reviewed 14 meta analyses that have investigated the effectiveness of CBT? (AO2)

About 80% of adults benefited from the therapy compared to controls who had no therapy.

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Explain Seligman's learned helplessness theory.(AO1)

Depression may be learned when a person tries but fails to control unpleasant experiences. As a result they acquire a sense of being unable to exercise control over their life and so become depressed. This impairs their performance.

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What did Hiroto and Seligman find?

That college students who were exposed to uncontrollable aversive events were more likely to fail cognitive tasks.

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What did Miller and Seligman find?

That depressed students performed worst of all on similar tasks. These findings show that having some degree of control and not feeling completely helpless greatly improves performance.

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What are antidepressants? what are they used to treat? what are the two main types? (AO1)

Antidepressants are drugs that are used with moderate-severe depressive illnesses. These drugs are used to treat imbalances neurotransmitters such as serotonin and noradrenaline, in the brain. The two main types are SSRI's and Tricyclics.

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What do SSRI's do?(AO1)

SSRI's mainly block the re-absorption of serotonin and so increase the quantity of serotonin available. This reduces depressive symptoms.

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What do triclyclics do? (AO1)

Tricyclics block the transporter mechanism that re-absorbs of both serotonin and noradrenaline, into the pre-synaptic cell after it has fired. As a result large quantities are left in the synapse, making transmission to the next impulse easier.

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What are the 3 phases of antidepressants?(AO1)

Acute, maintenance and continuation.

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It is thought that antidepressants do not...(AO2)

actually cure depression, they simply mask or treat symptoms (e.g recurring thoughts of suicide) and these symptoms may reappear once an individual stops taking them.

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What did Ferguson et find when they compared SSRI's with other treatments and a placebo conditon? (AO2)

They found that those treated with SSRI's were twice as likely to commit suicide.

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What did Barbui et al find?(AO2)

That although the risk of suicide was increased among adolescents, the risk was decreased among adults aged 65 or older.

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What did Hammen suggest?(AO2)

That SSRI's are less useful with children and adolescents.

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What did Geller et al find when they conducted a double blind study? (AO2)

Antidepressants did not show superiority over placebo conditions. This may have something to do with developmental differences in brain neurochemistry during puberty and developmental stages.

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When is ECT used? What is is meant by 'bilateral ECT' and 'unilateral ECT'? (AO1)

ECT is used as a last resort, in severely depressed patients when other treatments have failed and there is a risk of suicide. Bilateral ECT=electrodes above both temples. Unilateral ECT= electrode above non dominant temple and 1 in middle forehead.

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Describe the process of ECT. (AO1)

Given anesthetic, nerve blocking agent and oxygen. A small 0.6 amp electric current,lasting around half a second, is passed through the brain. This induces a seizure which lasts up to one minute. Need between 3-15 treatments. Alter way brain works.

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What did Datto (2000) suggest?(AO2)

The 3 main side effects of ECT are impaired memory, cardiovascular changes and headaches.

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What did Rose et al conclude?(AO2)

That at least one third of patients complained of persistent memory loss after ECT.

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What did Weiner (1980) find?(AO2)

ECT was linked with a general slowing of cognition.

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How does Sackeim propose that the side effects of ECT can be reduced?(AO2)

Using unilateral ECT rather than bilateral ECT, because unilateral ECT is less likely to cause cognitive problems.

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Ethics has been shown to be a problem with ECT, what did the DOH report (1999) find?

Of the 700 patients who received ECT when sectioned under the mental health act, 59% had not consented to treatment. Where patients receive treatment involuntarily there remains the issue of being full informed about the potential side effects.

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What is CBT and what are its aims?(AO1)

CBT was developed by Aaron Beck and it emphasises the role of maladaptive thoughts and beliefs in the origins and maintenance of depression. Therefore the aim of CBT is to identify and alter these maladaptive cognitions and behaviours.

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Explain the 2 main components of CBT-1)Thought catching. (AO1)

Within thought catching, individuals are taught how to see the link between their thoughts and the way they feel. They challenge the dysfunctional thoughts and replace them with more constructive ones.

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Explain the 2 main components of CBT-2) Behavioural activation (AO1)

Behavioural activation is based on the idea that being active leads to rewards, that act as an antidote to depression. Therapist and client identify potentially pleasureable activities and over come any possible cognitive obstacles.

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What did Babyak (2000) find when they studied 156 adult volunteers with major depression, who were randomly allocated to a 4 month course of drugs, aerobic exercise or a combination? (AO2)

Patients in all 3 groups exhibited significant improvement. 6 months after the end of the study, those in the exercise group had significantly slower relapse rates than those in the medication group. Particularly those who had continued on their own.

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What did Butler and Beck (2000) find when they reviewed 14 meta analyses that have investigated the effectiveness of CBT? (AO2)

About 80% of adults benefited from the therapy compared to controls who had no therapy.

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A meta analysis was conducted by Robinson et al (1990), what did they find?

That CBT was not significantly more effective than a placebo in alleviating the symptoms of depression. This suggests that it isn't very effective because a placebo can reduce symptoms just as well as CBT.

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Describe Robert Hobsons(1985) Psychodynamic Interpersonal Therapy(AO1)

It emphasies the fact that the mutual task of therapist and client is to engage in a therapeutic conversation. In this conversation, problems are not only talked about as past events but are also actively relived in the present and resolved.

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There are 7 main components of PIT, explain exploratory rationale (AO1)

Interpersonal difficulties in the individuals lives are identified and the therapist tries to find a rationale for the individual.

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There are 7 main components of PIT, explain shared understanding (AO1)

The therapist tries to understand exactly what the individual is really feeling and experiencing.

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There are 7 main components of PIT, explain focus on difficult feelings (AO1)

The individual may express an emotion of which they are unaware of or may not display an appropriate emotion.

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What did Guthrie (1999) suggest? (AO2)

That PIT was more beneficial than CBT because CBT and other cognitive treatments ignore the important role of interpersonal relationships. This makes PIT particularly important in the treatment of cases of depression that result from faulty relations

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A strength of PIT is that it seems to be effective even when treatment is administered by trainees, explain (AO2)

NHS psychotherapy patients were randomly allocated to 12 weeks of PIT (administered by psychiatry trainees) or to ask as waiting list controls. There were significant improvements in those who completed the treatment (33/54).

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54 patients entered the NHS study and 33 completed it, there were high attrition rates, what does this mean?

Participant attrition refers to the tendency of people undergoing psychotherapy to drop out of the study during treatment. Hunt and Andrews (2007) found that the average drop out rate was 8%.

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Explain consequences of the high attrition rates in the NHS study. (AO2)

This means that when participants drop out because they believe that treatment isn't working, results for the remaining participants look artificially positive. This ultimately reduces the validity of the study.

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Depression

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