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What is depression?
An affective disorder which is a contuum
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What is a problem with labelling someone with depression?
Can have an impact on life eq jobs, the label stays with the person
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What are the common symptoms of depression?
1. Lack of self esteem, 2.Reduced concentration, 3. Pessimism, 4. Disturbed sleeping and eating behaviour, 5. Sometimes ideas of self harm, 6.Lack of interest, 7.Tiredness, 8.Sad mood, 9.Feel nothing
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What are the domains of depression?
Affective symptoms eq depressed mood or sadness, Cognitive syptoms eq thinking you're worthless, Physical symptoms eq changes in sleep pattern and appertite, Behavioural symptoms eq social withdrawal
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How can depression effect daily lives?
Struggle to work, hard to be with family and friends and stop enjoying the things they normally do
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What are the different types of depression?
Majore depressive disorder, Dysthymia, Seasonal Affective Depression(SAD), Postnatal depression, Bi-polar depression
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How common is depression?
1 in 10 of us will develop it at some stage of our lives, about 1 in 50 of us will develop a major episode of depression
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Why is there problems with language difficulties?
The clinician might not speak the same language as the person they're trying to diagnose, so certain things may be lost in the diagnosis, which could lead to improper treatment
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Why is there problems in the NHS?
There is short funding in the mental health, there is limited time and resources available, diagnosis can be made in a rush, preoccupied with only admitting the most serious cases in order to safe guard resources
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Why are ethnicity minority groups in the UK less likely than white people to seek help for depression?
There is a stigma attached to mental health in some cultures and see depressive symptoms as social problems
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What did Zimmerman claim?
The DSM criteria for major depressive disorder are unneccessarily lengthy
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What did Zimmerman develop?
Briefer definitions of major depressive disorder
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Why did this create problems for collectivist cultures?
It only composed cognitive and mood symptoms of the DSM, where as collectivist cultures only report the behavioural and physical side of depression, which are wiped out in the method
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How many symptoms must you experience in the DSM-IV to be classified as depressed?
5 or more
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Why are the books a problem when diagnosing cultures like African tribes?
African tribes talk to the dead, which is seen as depression/begrievement, but is the norms there
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Why can the relationship formed with the GP effect the diagnosis?
If comfortable they will open up to you more, where as if not they may be more closed
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Why is there a problem with the standardised method of recognising depression?
The books are made and they use the behaviour of the individual so it is open to some interpretations and the process is subjective
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What study showed the subjectivity of the diagnosistic tools?
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What do people think is the cause of depression?
Nature vs nurture or neurotransmitters eq serotonin, noradrenaline and dopamine
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Why is there ethical issues in the implications in depression?
Is it ethically right to use drugs when scientists and doctors don't actually know how they work
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What is the nurture debate on depression?
Environment has a large impact on depression eq Traumas such as ****, death, debt, loneliness and jobs
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How is depression treated?
Anti depressants, Cognitive Behavioural Therapy (CBT), Psychodynamic Interpersonal Therapy (PIT) and counselling
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What is the DSM-IV?
The American Psychiatric association, a book to diagnose mental disorders
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What is the ICD-10?
International statistical Classification of Diseases, produced by the world health organisation
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What does the psycho dynamic approach focus on?
How unconscious motives drive our behaviour and experience
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What did Freud claim the explanation for depression lies?
Could lie in the early relationship with our parents
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How can the loss of a parent lead to depression?
Lead to emotions being repressed which may result in them being resurfaced in adulthood when another loss is experienced,
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What is depression accompanied with?
Accompanied by feelings of anger and betrayal at the loss
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How can these unresolved feelings cause depression?
Unresolved feelings of hostility towards the parents can be directed inwards as guilt, which can lead to feelings of worthlessness eq suicide
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What did Freud suggest happens with a loss?
Actual or symbolic losses lead to re experience parts of our childhood , causing regression and becoming clingy or dependent
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What does PIT suggest causes depression?
A depressed persons negative interpersonal behaviours cause other people to reject them
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Why does depressed peoples symptoms worsen?
Because rejection and aviodance
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Why was PIT designed?
To help depressed people break out of this negative spiral
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What did Beck believe causes depression?
He believed people suffer from depression due to their negative views of the world (negative schemas) learned in child hood
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What does Beck believe causes these negative thoughts?
Parental and peer rejection or teacher criticism
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When are the negative schemas activated?
In a new situation eq exams
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What are cognitive distortions?
Selective abstraction, Make conclusions based on 1 event, Overgeneralising, Exagerrate negatives, Minimise positives
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What is the Depressed Attributional Style?
The depressed person sees events dues to internal, global and stable causes
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What is a healthy way to see events as bad?
External, Situational and Unstable
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What is an unhealthy way to see events bad as?
Internal, Global and Stable
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When does learned helplessness occur?
When a person tries but fails to control unpleasant experiences
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What does this cause?
People to acquire a sense of being unable to control events in their life
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What do depressed people look at unpleasant events like?
In a pessimistic manner than others
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What is the diathesis-stress model for depression?
A genetic vulnerability may act as a diathesis with life events (eg loss of parent) and act as a trigger for those who are vulnerable to depression
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What could the depressive attributional style act as?
The diathesis to lead to even small events trigger the onset of depression
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What did Pagkel and Cooper estimate those who experienced early loss later become depressed?
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What did Corner find?
Freudian psychoanalytic approach has not been proven effective with cases of depression
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What did Hammen and Krantz find?
Depressed women made more errors in logic when asked to interpret written material than non depressed participants
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What did Bates et al find?
Depressed participants who were given negative automatic thought statements more and more depressed
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What is the MZ twins (identical) concordance rate for depression?
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What is the DZ twin (unidentical) concordance rate for depression?
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What is in utero?
Even if put up for adoption the mother is still under stress
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How does what the mother feels effect the child?
Whatever is in the mothers blood stream eg stress (noradrenaline) or drugs, the baby will get it and will be impacted
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What do studies into depression in families use?
People who already have been or might be diagnosed with depression (probands)
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What do studies into depression in families examine?
Whether other members of family have been or might be diagnosed with depression
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What should people who already have depression relatives show if there is a genetic link?
Higher rates of depression than the rest of the population
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What did Harrington find?
Around 20% of relatives of probands have depression, compared to 10% of normal population
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What are Monozygotic twins?
Identical twins who are natural clones of each other and have all genes in common
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What are dzygotic twins?
Fraternal twins who share half their genes
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What do genetic factors act as?
A diathesis in a diathesis stress relationship
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What is a genetic predisposition?
A vulnerability
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What happens when a genetic predisposition to depression interacts with environmental stressors?
Produces a depressive reaction
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What might we expect environmental stressors to affect more?
Those with a genetic predisposition differently to those without
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What did Zhang find?
A mutant gene which starves the brain of serotonin is 10x more common in depressed patients than in control individuals
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What can the mutant gene result in?
An 80% reduction of normal serotonin levels in the brain
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What did Caron find?
This version of the gene was carried by 9/87 depressed patients but only 3/219 healthy controls
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Why is the explanation of serotonin and depression reductionist?
Over simplifies the explanation of serotonin, where serotonin is a complex neurotransmitter
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What are the most common co-morbid disorders?
Depression and anxiety
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What a co-morbid disorder?
Medical condition that co-occurs with another
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Why is this a strange co-morbid disorder?
Because anxiety is associated with high serotonin and depression is associated with low serotonin
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What did Bunney find?
Found indirect makers of noradrenaline levels in the brain (eg by-products found in urine) were often lower in depressed individuals
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What have post mortem studies found?
Revealed increased densities of noradrenaline receptors in brains of depressed suicide victims- which are created to try and catch noradrenaline because they're lacking it
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What happens when transmitter molecules become unusually scarse in synapse?
The amount of receptors expand in order to attempt to pick uo whatever signals are available
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What is tryptophan?
A precursor to depression (what you need in order to make)
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What did they find in depressed and suicidal patients?
In the cerebrospinal fluid (brain fluid) contains reduced amounts of serotonin waste, hence must have low level of serotonin in the brain itself
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What to SSRIs such as prozac do?
Block serotonin reuptake to stop serotonin getting absorbed
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What is electro convulsive used for?
Generally severely depressed patients, Where risk of suicide, When all other treatments have failed-last resort
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How does ECT work?
The seizure generates improvement in depressive symptoms, it appears to restore the brains ability to regulate moods, may enhance the transmission of neurochemicals or improve blood flow in the brain
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What is the procedure of ECT?
Small current of 0.6 amps creating a seizure lasting 1/2 a second, oxygen is given to compensate for their inability to breathe, Also given a nerve blocking agent paralysing the muscles to prevent contracting during treatment and causing fractures
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What is Bilateral ECT?
Placed electrodes on both temples
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What is Unilateral ECT?
One electrode above none dominant temple and a second on the forehead
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What are the side effects of ECT?
Impaired memory, Cardiovascular changes & headaches
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What did Rose et al find?
At least 1/3 of Ps complained about memory loss after ECT
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How can you minimise cognitive side effects?
Use unilateral ECT
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What did Sackheim find?
It is likely to cause problems than bilateral but just as effective
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What did the department of mental health find?
30% of Ps who received ECT had permanent fear and anxiety
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What are ethical issues of ECT?
Lack of informed consent- issue of not informing those receiving it of the possible side effects, however they're usually not in the right frame of mind so hard to gain proper informed consent
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What are Tricyclics?
The first drug developed to treat depression and lead to more research
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What did Tricyclics lead to?
SSRIs being developed because the tricyclics had a lot of side effects such as addiction
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How do Tricyclics work?
Blocking the absorption of serotonin and noradrenaline back in to the nerve ending
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How do SSRIs work?
Same way as Tricyclics but instead of blocking reuptake of different neurontransmitters they only block mainly serotonin
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What is the best SSRI?
Prozac (Fluoxetine)
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What is the first stage of treatment?
Acute stage- Try diff drugs to find out the right dosage for individual and let symptoms stabalised
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What is the second stage of treatment?
Continuation stage- Keep person on dosage 4-6 months to let mood and symptoms be monitored
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What is the third stage of treatment?
Discontinuation stage - gradually decrease dosage given and let body take over and produce correct serotonin levels
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What are antidepressants?
Drugs which relive symptoms of depression, typically used on moderate to severe patients
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What is depression thought to be?
When a nerve ending doesn't produce enough neurotransmitters eg noradrenaline to activate neighbouring cell
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How are the actions of neurotransmitters stopped?
Either reabsorbed into nerve endings or broken down by enzymes
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How do antidepressants work?
By either reducing reabsorption rate of neurotransmitters or blocking enzymes from breaking down - this increases the amount of neurotransmitters available to activate the neighbouring cells
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Card 2


What is a problem with labelling someone with depression?


Can have an impact on life eq jobs, the label stays with the person

Card 3


What are the common symptoms of depression?


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Card 4


What are the domains of depression?


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Card 5


How can depression effect daily lives?


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