Depression

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What is depression
a mood disorder
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5 key symptoms identified by the DSM IV
suicidal thoughts, sleep disturbance, weight change (signif), loss of pleasure in previously enjoyable activities, state of sadness for most of the day
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how long do these symptoms have to last for it to be classified as depression
at least two weeks uninterrupted
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what is reliability in relation to depression
it considers the extent to which the diagnosis of depression is consistent over time (test retest) and between different diagnoses (inter rater)
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what did Keller et al find
a concordance rate of 0.6 for test retest and 0.8 for inter rater
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what is validity in relation to depression
the extent to which different disorders are really that distinct from each other. E.g. depression and anxiety often have over lapping symptoms, so diagnosis for these symptoms may be invalid because you're not diagnosing what you aim to diagnose
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2 factors affecting reliability and validity of diagnosing depression
1. many symptoms are subjective (e.g. feeling sad) and self report (e.g. suicidal thoughts). Responsibility is placed on the patient to not exaggerate/understate their symptoms. 2. GP's make the diagnosis but they aren't fully trained in mental healt
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2 more factors
1. co-morbidity. Many disorders can exist side by side (e.g. anxiety and depression) so it can be hard to separate the symptoms and one may be ignored. 2. the DSM IV isn't used in all countries. This could create a cultural difference
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what are the two parts of the biological model
genes and biochemicals
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what is the theory behind genes and depression
people inherit genetic pre-dispositions to depression
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what kind of studies are used to investigate genetic dispositions
twin, family and adoption studies
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what did Gershon find
gershon found that people with a relative with depression were 3 times more likely to develop it themselves than those without a relative with the disorder
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what did Allen find
a concordance rate of 40% for MZ twins and only 11% for DZ
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why are genes linked to depression
there's evidence to suggest that genes involved in serotonin may be faulty
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what did Ogilivie find
abnormal SERT genes in depressed people (makes a serotonin transporter protein)
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what is ten times more likely in depressed patients
a mutant gene that reduces the levels of trytophan (crucial in the production of serotonin)
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what's the idea behind biochemicals and depression
fluctuating hormones and chemicals in the brain will affect mood, particularly the monamines (noradrenaline, serotonin and dopamine)
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whats the permissive amine theory
Kety thought that fluctuations in levels of noradrenaline could cause depression. Serotonin controls the levels of noradrenaline, so a lack of serotonin causes depression.
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what did Teuting find
low levels of waste found in urine thats associated with noradrenaline in depressed patients. Suggests low levels of serotonin and noradrenaline in depressed patients
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What's the link with hormones and depression
women are three times more likely to develop depression and also suffer from many more fluctuating hormones through pms, childbirth etc. post natal depression etc.
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what did Halbreich find
43% of women report depressive symptoms at some point int their cycle
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why isn't the biological approach hollistic
it fails to take into account environmental factors and life experiences. e.g if genes caused depression all by themselves, concordance rates for MZ twins would be 100%
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why may gene studies have diagnostic unreliability
if one member of a family is known to have depression, it may be more likely that another is diagnosed as well, influenced by the family history
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what did claridge and dawn find
non-sufferers of depression that were given drugs that lower monamines didn't develop depression
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why cant we establish cause and effect when it comes to biochemicals
we dont yet know if they're a symptom or cause of the depression
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what did Freud notice
similarities between people in mourning and people suffering with depression
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what did this lead Freud to creating
the theory that loss and grief caused depression
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what did this theory involve
loss (symbolic as in loss of a job or actual as in death) causes us to relieve childhood traumas or bereavements, with regression occurring in extreme cases
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how are anger and aggression involved in this theory
death causes feelings of anger at our loss, but because this isn't a suitable response for the superego, these feelings are directed inwards. creating feelings of guilt and despair. maybe even depression.
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what did Parker feel about this theory
he couldn't find a link between loss in childhood and depression
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a criticism of this theory
it fails to explain depression in cases where loss isn't a factor (the majority of incidences)
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why is this theory unfalsifiable
there's no scientific evidence behind it or a way to test its theories. All evidence for it comes from case studies and self report thats all very subjective
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what does the Behavioural theory centre around
the theory of learned helplessness, developed by Seligman ad Maier
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how did Seligman investigate depression
gave dogs electric shocks. In the control group they could escape the room, in the other condition they couldn't.
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what did Seligman find from this experiment
the second time round, when the dogs in the 2nd condition could escape, they didnt even try because they had learned that they had no control over the outcomes
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how does this link to humans
Seligman noticed a similarity with these dogs and depressed patients because depressed people often become passive and accepting of their situations
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how do rats reinforce the idea of learned helplessness
rats showed a reduction in serotonin and noradrenaline levels when they were in a helpless situation
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what did Hiroto find
by getting people to endure an inescapable loud noise, the second time round (when they could escape the noise) he found that they just sat back and endured it
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what did Lewinsohn's theory revolve around
the idea of operant conditioning
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what was it
if some one suffers a reduction in positive events like loss of a job so less money to go out and do things, then positive reinforcement decreases, making them vulnerable to depression
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what may continue this cycle of depression
the positive reinforcement they get for the depressive behaviour that comes from attention from family and friends
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what is a strength of Lewinsohn's theory
it has practical applications, having provided a useful therapy
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what is a weakness of Seligman's theory
it assumes that stress has the same effect as depression. we dont know this
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what theory does the cognitive approach revolve around
Abramsons hopelessness theory
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what is this theory
it builds on Seligman's ideas with attributions. Any experience we have we try and account for using attributions
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according to this theory how will a depressed person attribute failure
internally (it was my fault), stable (things will always be bad) and globally (I will fail at everything)
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what did Metalksy do
interviewed students who had just failed a psychology test. those with the three key attributions were still suffering mild depression two days later
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why cant we establish cause and effect
because the attributions are clearly a vulnerability, not a cause. Something else has to happen to trigger the attributions
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two strengths of this theory
explains why not all people experiencing negative life events develop depression and it's holistic because it considers the impact of life events
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whats wrong with the evidence behind th cognitive and behavioural theories
mostly done on animals
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what is Beck's cognitive triad
Beck believes that a negative set of schemas would have been developed in childhood, schemas which revolve around self (I'm a failure), world (the whole world thinks I'm a failure) and future (I will always fail)
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what influences these schemas
cognitive biases
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why can't we establish cause and effect
because we dont know if the faulty thinking causes the depression or if the depressive moods cause the faulty thinking. Davison and Neale believed it was a two way process
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what are three forms of drug treatment for depression
SSRIs, tricyclics and MAOIs
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what do MAOIs do
raise the levels of the monamines in the body by inhibiting the enzyme that breaks them down
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how effective are they
according to Bernett they are 50% effective, but they also have side effects like increased blood pressure
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what do tricyclics do
block the re-uptake sites that reabsorb serotonin and noradrenaline, meaning that more is available in the synapse for longer
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how effective are they
around 60-65 % for mild to severely depressed patient
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what is a big problem with them
they can be deadly in large doses -> possibility of an overdose
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what do SSRIs do
they are selective serotonin re-uptake inhibitors. they only work for serotonin by blocking the receptor sites
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what's good about them
they have generally fewer side effects and are much harder to overdose on
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what did Hollon et al find
used two groups of depressed patients, gave one group CBT for 16 weeks and the other SSRIs for 16 weeks. found the relapse rate for CBT to be 31%, for the drugs it was 76%
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what does this show
drugs are a short term solution that only treat the symptoms, not the cause
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whats a strength of drug therapy
its holistic (can be used in conjunction with CBT and other therapies)
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what does ECT involve
2 nodes placed on the sides of the head (can be unilateral or bilateral) with 150 volts passed through them for 0.5 secs, creating a seizure lasting up to a minute. the patient is anaesthetised. this is done 3 times a week for 5 weeks
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how does it work
we dont know how, but it raises serotonin levels
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what did Petrides find
the effectiveness was between 65% and 85%
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what are the possible side effects
memory loss, headaches, fractures etc
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another weakness of ECT
it may not treat the cause (depends on what you believe the cause is)
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what is CBT
cognitive behavioural therapy-works to change faulty cognitions the patient may possess
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what are the first two steps
the patient will identify the feelings and thoughts towards situations that distress them and then identify the faulty and irrational ones
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next three steps
they will recognise the link between the cognitions and their mood and work to change the negative, irrational thoughts to more positive ones. they will then practise these thoughts in a safe environment
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what did Hollon find
relapse rate for CBT patients was around 31%, so it's a long term treatment
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what did Rush find
CBT was more effective in raising moods that tricyclics
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whats another strength of CBT
it may treat the perceived cause of the depression
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what is BAT
behavioural action therapy, developed by Lewinsohn
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what does it involve
patients trying to resume the activities that used to give them pleasure because this would provide positive reinforcement
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why was group therapy used
because depression sufferers are often socially incompetent or dont get the positive reinforcement from having friends
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why would group therapy help
people would then see how they weren't alone and could develop social skills in a safe environment. it provided positive reinforcement
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how did Rehm expand on this
in his therapy the patient was in control of their own improvement, emphasising self control. They would set their own goals with the therapist and were encouraged to self reinforce positive social behaviour
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whats good about BAT
attempts to tackle the cause of depression and it's holistic. Rehm's therapy in particular is empowering to the patient
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whats the diathesis stress model
the idea that everyone is a time bomb waiting for the right combination of triggers for depression to take effect.
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how are we all a time bomb
people may have a genetic predisposition and/or early adverse events which creates a vulnerability. Stress/trauma tghen leads to brain changes which ends up in depression.
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how does the model help explain different rates of depression in social minorities and different cultures
people will have different daily stresses, e.g. social minorities may suffer from discrimination. different cultures may have more social support to get them through stress
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how does the model explain different rates between women and men
women and men handle stress differently, e.g. women are more likely to attribute failure to themselves
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what did Bifulco find
people with early life adversity are more likely to get depression
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5 key symptoms identified by the DSM IV

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suicidal thoughts, sleep disturbance, weight change (signif), loss of pleasure in previously enjoyable activities, state of sadness for most of the day

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how long do these symptoms have to last for it to be classified as depression

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Preview of the front of card 3

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what is reliability in relation to depression

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what did Keller et al find

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