Depression case studies

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  • Created by: 8cburton
  • Created on: 26-05-15 18:53
Labelling
Self identity + behaviour of individual may be determined or influenced by the terms used to describe or classify them. Could lead to discrimination, issues with employment
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Sick role
Expected behaviour of a ill person. Gives on obsessive focus on the disorder, influences the way people act and creates cycle of negative cognitions as it changes how you perceive yourself
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Co-morbidity and diagnosis
Have to identify and treat the primary disorder accurately as it is the root cause of the second disorder
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Gender and daignosis
Women are 2X more likely to be diagnosed because they go to the doctors more often
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Culture and diagnosis- Davidson and Neal
Asian cultures people are praised for showing no emotional expression and physical symptoms are shown instead
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Culture and diagnosis- Kua et al
72% of people in china who 1st presented with chest or abdominal pains or headaches were later found to have a mental health disorder
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Inter-rater reliability- Beck
Inter-rater reliability between 2 psychiatrists low as 54%
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Inter-rater reliability- Zanarini et al
0.9 correlation coefficient so shows strong positive
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reliability of DSM- Zanarini et al
External reliability (test-rest), 0.61 correlation coefficient so moderate positive correlation but some problems with consistency
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Inter-rater reliability- Lobbestael et al
using audio tape, 0.66 moderate positive correlation
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Validity of diagnosis- Wittchen et al
Large sample filled out depression screening questionnaire. 4.2% had depression according to the DSM. 11.3% fulfilled cirteria for depression using ICD-10. General recognition that there is a higher threshold for diagnosing depression with DSM
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Validity of diagnosis- More findings from Wittchen et al
Doctors diagnosed their patients looking at the questionnaires. Found 75% of DSM and 59% of ICD diagnosis recognised by doctors. However 11.7% the doctors diagnoses did not meet ICD or DSM
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AO1 biological explanations to depression
Runs in families. Gene 5 HTT (serotonin transport protein transports serotonin from synapses to presynaptic neurons. The gene has short and long variants). Those with shorter variants more likely to get depression
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Biological approach- Weissman, Kidd and Prusoff
2X the cases of depression in the 1st degree relatives compared to 1st degree relatives who dont suffer from the disorder. Higher in female relatives
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Biological approach- McGuffin
214 pairs of twins depression. 46% concordance rate for MZ and 20% for DZ
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Biological approach- Allen
40% MZ and 11% DZ
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Biological approach- Wender et al
biological relatives of adopted sufferers were 7X more likely that the adoptive parents to have depression
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Biochemical explanation to depression AO1
Genetic factors influence amount of catechlomines (serotonin, noradrenaline and dopamine). A deficit of these catecholamines causes despression
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Biochemical approach- Wender and Klein
Drugs to rats which lower levels of noradrenaline result in them becoming sluggish and inactive
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Biochemical approach- Mintun et al
Used brain imaging technique (PET scan) to compare brain activity of severely depressed + control group. Serotonin receptors shown by marking them with chemical tracer. Depressed people had fewer serotonin receptors
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Biochemical approach- Anti depressants
decrease depression by increasing levels of noradrenaline (inhibiting reuptake). Can lead to mania and take 3-4 wks to alleviate symptoms. Prozac increases levels of serotonin
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Biological treatments- Tricyclics (TCAs)
Block reuptake of serotonin and norepinehhrine making them more available
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Biological treatments- SSRIs
Selective serotonin reuptake inhibitors
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Biological treatments- ECT
Sending electrical current through brain to trigger epileptic fit. Muscle relaxants used and patient anaesthetised
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effectiveness of drugs- Hollon
Compared SSRI treatment and CBT and found 58% reduction in symptoms in both. CBT had relapse rate 31%, drug throughout 47% relapse rate and drug stopped 76% relapse rate
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AO3 of effectiveness of drugs- Turner et al
Claimed publication bias would occur so most of the research would be pointing in the drugs favour due to the drug companies invested interest
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Effectiveness of ECT- Gregory et al
When ECT is compared to shame ECT the real ECT produces the significant difference
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effectiveness of ECT- Scott
reviewed 18 studies comparing ECT with antidepressants and showed ECT more effective in the short term
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Appropriateness of ECT- Rose et al
Concluded at least 1/3 of patients complained of persistent memory loss after ECT.
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Cognitive approach AO1- Beck
The cognitive triad, silent assumptions and information processing (catastrophising, Personalising, over generalisation and selective thinking)
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Cognitive approach- Lewiwsohn, Joiner and rohde
Measured negative life attitudes in adolescents not having depression. 1 year later they assessed negative life events. Those with negative life events had an increased risk of developing depression only if they initially had dysfunctional attitudes
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Cognitive approach- Mezulis
Examined the origins of cognitive vulnerability (Becks idea of parental criticism). 289 US children followed 11 years looking at parenting style, life events and cognitive style using questionnaires. Found parental behaviour was not associated
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Cognitive approach- Evans et al
Assessed dysfunctional self-beliefs in women in the 18th Wk of pregnancy. Women with highest scores were 60% more likely to become depressed. They found that negative self-beliefs predicted the onset of depression 3 years later
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Rational-emotive behavioural therapy theorist
Aaron Beck
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Effectiveness of CBT- Holmes
Limitations= trials are of highly selected patients with only depression and no complex problems
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Effectiveness of CBT- Royal college or Psychiatrists and NICE
Recommended CBT as most effective psychological treatment for moderate and severe depression
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Effectiveness of CBT- Butler
Review 16 meta-analyses of CBT concluded is was very effective with a large body of evidence
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Effectiveness of CBT- Hollon's study on drugs
Showed CBT as the superior treatment due to lowest relapse rate of 31%
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Psychodynamic theory- introgect
When child becomes the parent whose affection they have lost
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Psychodynamic theory- Bonanno
Claims fewer than 10% of people get depressed when they suffer a loss of a parent
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Types of psychological treatment
Psychoanalysis and Psychoanalytic psychotherapy
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Catharsis
Emotions discharged in a safe way
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Free association
client asked to express the free flow of feelings, thoughts or images without censorship. Associations should arise and therefore reflect the internal dynamic conflict helping the person see the root cause
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Transference
Client redirects feelings towards the therapist that are consciously directed towards their loved one but have been censored from their mind. Reverses repression of negative thoughts and allows negative cycle to be highlighted
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Effectiveness of psycho therapy- Eysench
Compared 2 studies of psychoanalysis and a control. 66% improvement in the control group spontaneously and 44% improvement receiving psychanalysis
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effectiveness of psycho therapy- Bergins
Reviewed this data and found control group were receiving other treatment. By selecting different outcome criteria the psychoanalysis group improved to 83% and the control group dropped to 30%
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effectiveness of psycho therapy- Burnand et al
Compared treatment by antidepressants alone and psychotherapy combined with drugs. Both groups improves but the combined group had less treatment failure, better work adjustment and global functioning
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Appropriateness of psycho therapy- Driessen et al
341 depressed adults randomly assigned to CBT or short term psychodynamic supportive therapy. Severely depressed patients also received antidepressants. No significant difference between the treatments. But 16 weeks not long enough for psycho therapy
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Card 2

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Expected behaviour of a ill person. Gives on obsessive focus on the disorder, influences the way people act and creates cycle of negative cognitions as it changes how you perceive yourself

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Sick role

Card 3

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Have to identify and treat the primary disorder accurately as it is the root cause of the second disorder

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Card 4

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Women are 2X more likely to be diagnosed because they go to the doctors more often

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Card 5

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Asian cultures people are praised for showing no emotional expression and physical symptoms are shown instead

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