depression.

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  • Created by: Kelseyb
  • Created on: 10-06-16 22:53
clinical characteristics?
two core symptoms- depressed mood most of day, most days + loss of interest/pleasure in all/most activities. Others- sig. weight loss/gain, inosomnia/hypersomnia, psychomotor agitation/retardation, fatigue, feelings of worthlessness, poor concentrat
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inter rater reliabilty
agreement between independent clinicians examining same patient. reliable diagnosis- same with whomever they visit.
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Spitzer
reliability most important in diagnoses
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Becker et al
153 new referrals. randomly assigned to be interviewed by 2 of 4 psychiatrists. correlation statistic of i.r. (KAPPA) and concordance of less than 50%
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inter rater reliability across cultures
different norms + beliefs. some cultres diagnosis manuals dont deal with affective disorders.
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cooper
recordings of psychiatric interviews to US, UK and Canadian psychs. one case mdd ranged from UK 2% to 69% in US.
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validity
whether clinician can accurately identify who is and who isnt suffering from dep.
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validity- clinical expertise + objectivity
5% of pop dep. GPS not experts lack of knowledge/experience. wrong treatment, economic burden, loss of public confidence
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Mitchell
meta analysis of 118 studies that assesed accuracy of unassisted diagnoses by GPS. correctly identified dep in 47% cases/ more false positives.
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co-morbidity validity
shares common aspects with e.g.sz. such as reduced thinking skills, indecisivness + lethargic behaviour. also comorbid with psychical conditions e.g. cancer, heart disease, loss of limbs. assumption treating primary treats secondary. not always case.
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Tylee
to establish whether presence of physical illness affected GPS recognition of mdd in females. 72 females, assesed by GP, researcher then contacted + assesed using GHQ. more patients with unrecognised dep sufered physical illness and were tired.
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continued
.. those with physical illness 5x more llikely to be unrecognised
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gender bias
twice as high in females diagnostic practice rather than real difference. e.g. more acceptable for women to admit + seek help. seen as more 'female disorder'. stereotypical views in clinician.
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Potts et al
mental health specialists sig. more likely to identify depressiion in females. females- false pos. males- false neg.
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bio depression (HMWTDCK)
harrington et al, mcguffin, wegner, teuting, delgado, kendler
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harrington et al
20% of first degree relatives of deps. also has dep compared to 10% of general pop.
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McGuffin
177 dep sufferers. MZ twins- 46% DZ 20%
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Wegner et al
bio relatives 8 times more likely to suffer too compared to adoptive relatives
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Teuting
deps abnormally low levels of by-products associated with noradrenaline in urine samples.
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Delgado et al
deps diets lowered serotonin (taking antis) resulted in dep symptoms. dissapeared once diet stopped.
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Claridge et al
people not suffering from disorder given drugs to reduce serotonin + noradrenaline did not display dep.
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kendler et al
high rate of mental disorders between twins when searching for dep and generalised anxiety disorder compared to looking for dep alone.
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bio therapies (GHJTSBD)
gitlin, hollon et al, janicak et al, taylor, sackeim, bregin, department of health
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gitlin
antidepressants 65-75% effective only 33% of placebos
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hollon et al
only effective continue to take them, relapse rate high.
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Janicak
80% severely dep responded well to ECT compared to 64% drugs.
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taylor
ECT response rate of 55% dep, and 80-90% in severely deps in initial treatment
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sackeim
84% patients relapsed within 6 months
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Bregin
ECT only effective for 4 weeks
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department of health
700 patients, 59% had not consented.
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psychological explanations (LSBSSBHL)
lewinsohn, seligman, beck, seligman, seligman, butler and beck, hollon
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lewinsohn
dep pccured due to reduction in pos reinforcement
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seligman
learned helplessness
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beck
negative cognitive schemas
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seligman
dogs in inescapable, stressful, unavoidable situaton, displayed helplessness in subsquent situation
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seligman
humans noise or shock unavoidable. similar resuls of animals
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butler n beck
14 meta analyses CBT more successful than drugs and lower relapse rate
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psychological therapies (KERWE)
kuyken, evans, rush, williams, elkin
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kuyken
15% of variance in outcome attributed to therapists level of consistency
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evans et al
CBT lower relapse than other treatments
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rush et al
cbt is as effective as anti-deps
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williams
cbt strongest for effectivnes but weekly face to face mad it inappropriate
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elkin
cbt unsuitable for people with high levels of dysfunctional beliefs that arre both rigid and resistant to change
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inter rater reliabilty

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agreement between independent clinicians examining same patient. reliable diagnosis- same with whomever they visit.

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Spitzer

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Becker et al

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inter rater reliability across cultures

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