Outline the clinical characteristics of depression. (4 marks) PLAN. Behavioural symptoms e.g. social withdrawal, restlessness

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1 Outline the clinical characteristics of depression. (4 marks) PLAN The symptoms and severity of the symptoms will vary in people with depression. However, there are four recognisable symptoms common to all: Affective symptoms e.g. depressed mood, sadness, feeling low Cognitive symptoms e.g. feeling guilty about shortcomings or seeing oneself as worthless Behavioural symptoms e.g. social withdrawal, restlessness Physical symptoms e.g. sleep pattern disruption, lack of energy or appetite The formal diagnosis of MDD requires the presence of 5 of the following symptoms, including 2 core symptoms of either depressed mood or loss of interest and pleasure in usual activities. The symptoms must have persisted for 2 weeks and must not be attributed to use of a psychoactive substance (e.g. alcohol, drugs) or loss of a loved one. These symptoms include: Sad, depressed mood Loss of interest and pleasure in usual activities Difficulties in sleeping Shift in activity level Poor appetite and weight loss, or opposite Loss of energy and great fatigue Negative self- concept, feelings of worthlessness and guilt Difficulty concentrating Recurrent thoughts of death or suicide.

2 Discuss issues related to the classification and/or diagnosis of depression. (8+16) PLAN Intro Classification process by which the mental illnesses are separated into types according to the way the symptoms cluster together Diagnosis the process by which a clinician assesses an individual patient and decides which type of illness they are suffering from according t pattern of symptoms Why we classify? S timulating research to make classification and diagnosis more reliable T appropriate treatment so this can be chosen U nderstanding so the impications of diagnosis understood C ommunication making communication between professionals working in psychopathology easier C auses so these can be understood Why we diagnose? Treatment Depression diagnosed using DSM V and DSM IV The formal diagnosis of MDD requires the presence of 5 of the following symptoms, including 2 core symptoms of either depressed mood or loss of interest and pleasure in usual activities. The symptoms must have persisted for 2 weeks and must not be attributed to use of a psychoactive substance (e.g. alcohol, drugs) or loss of a loved one. These symptoms include: Sad, depressed mood Loss of interest and pleasure in usual activities Difficulties in sleeping Shift in activity level Poor appetite and weight loss, or opposite Loss of energy and great fatigue Negative self- concept, feelings of worthlessness and guilt Difficulty concentrating Recurrent thoughts of death or suicide. AO1 Reliability should be reliable so patients get correct diagnosis every time. Consistency of outcomes = inter rater reliability. Early editions of the DSM used vague descriptions and had low reliability BUT current better. Still has problems with reliability e.g. problems with differentiating between illnesses. KELLER.

3 Validity should be valid so patients are given correct diagnosis and aren t given treatment for something they are not suffering from. Predictive validity important this means if somebody improves after being given treatment to help with that diagnosis then the diagnosis can be validated. Differential diagnosis. VWB Gender bias (beta bias) AO2/3 Gender bias (beta bias) women twice as likely to be diagnosed. Issue with diagnosis is that it may not be a true reflection of whether men are more depressed than men, or whether the toll we have are gender bias. Women ruminate more, hormonal changes, paid less. Socially sensitive labelling lead to stigma (women). Men do not get help is we do not account for gender differences. Conclusion - High inter rater - High accuracy in diagnosis - CBT and ECT used to treat depression treatment implications - DSM IV - > DSM V

4 Outline one biological explanation for depression. (4 marks) Evaluate one or more biological explanations for depression. (16 marks) Discuss biological explanations for depression. (8+16) PLAN AO1 Genetics- there is evidence that the predisposition to develop depression is inherited. Wender, Harrington, McGuffin (can gain AO1 by describing studies) Biochemical explanations - serotonin theory of depression. Serotonin is a NT linked strongly with depression. Low levels are found in the brains of individuals with depression. IT is suggested that serotonin production is normal in depressed but presynaptic neuron deactivates the serotonin and then reuptakes it, meaning the serotonin message (impulse) does not get passed on ultimately leading to depression. McNeal and Cimbolic, Zhang, Teuting. Brain structure AO2/3 - Genes may be a trigger for depression, where life events make the person depressed, but only if they have a specific genetic make up genetic predisposition. - Environment may have more of an impact than implied, DZ twins may be of opposite sex and participate in different activities e.g. one sporty/one not - > red risk of depression.

5 - Simple explanation for a complex disease provides pract implications. If serotonin reuptake too high then drugs designed to block reuptake should reduce depression. SSRIs e.g. Prozac block reuptake of serotonin, increase amount of serotonin passed across synapse. - Genes and NTs cannot explain on their own link between serotonin and genes Zhang or holistic outlook Teuting. +ve SSRIs work if theory leads to effective treatment then high predictive validity. Backed up by evidence - ve Overly narrows and ignores role of psychological factors Reductionist as it reduces complex disease into simple deficiency in one neurotransmitter +ve of approach - ve of approach Evidence from genetic studies strong Genetic studies difficult to run without suggesting genetic link including environment Genetic explanation supported by link Deterministic and remove free will form between genes and serotonin patients and family with depression Effective and appropriate treatments Serotonin reductionist Removes blame from patient Some anti- Ds work by boosting serotonin levels Evol approach supports Side effects and dependency Depression serves honest signal someone is struggling and needs help in group.

6 Discuss biological therapies for depression (8+16) Outline and evaluate one biological therapy for depression (4+6) AO1 Antidepressants SSRIs. Suggested that depression is caused by low serotonin levels/ Low serotonin levels are caused by too much reuptake of serotonin by the presynaptic neurone. SSRIs e.g. Prozac works by blocking the reuptake at the presynaptic nerve. Mean the serotonin NT has longer to move across the synapse without being broken down or enduring reuptake. ECT - patient given general anaesthetic, nerve blocking agent, oxygen and a muscle relaxant (prevent tensing and breaking bones during seizure). ECT unilateral where one electrode placed on patient s temple and one on forehead, or bilateral where on both temples. 0.6A current for half a second, inducing a minute long seizure in patient. 3 times a week for between 1-5 weeks. TMS non- invasive method uses magnetism to temporarily turn off parts of the brain. Found to be almost as effective as ECT. But does not involve anaesthetic and no side effects. AO2/3 Efficacy of SSRIs Furuwaka Evaluate ethics of Furukawa giving depressed patient placebo. Contradictory evidence Kirsch who found little evidence that SSRIs were better than a placebo. Turner pub bias Appropriateness of SSRIs Barbui Further eval of antidepressants side effects e.g. nausea and blunted feelings, dependency, relapse rates.

7 Efficacy of ECT Gregory, Scott Appropriateness of ECT Scott, Rapoport last resort. Further eval of ECT General anaesthetic dangerous Side effects of ECT headaches, cardiovascular changes and memory loss ECT administered in severely suicidal. Found that 59% given without consent ethics. TMS effectiveness Cheng- La Ti +ve of therapies Evidence for efficacy of treatments Can be used when patient too unmotivated or suicidal to approach psychological treatments Can be used in conjunction with psych treatments immediate intervention - ve of therapies Not all data available to measure efficacy Treat symptoms not cause Severe side effects

8 Outline two psychological explanations of depression. (8 marks) Evaluate psychological explanations of depression. (16 marks) Outline at least one biological explanation and at least one psychological explanation (8 marks) Evaluate biological and psychological explanations of depression (16 marks) AO1 Psychodynamic suggests that depression is a result of a real or imagine loss of affection in childhood, such as the death of a parent, or the birth of a younger sibling which takes some affection. Freud proposed that the anger at the loss of affection is not allowed by the superego part of the psyche, as it states you should love your parents. The anger is displaced into feelings of guild and is turned inwards. This unconscious inward anger and guilt is then reawaken in adult life, after a trigger that will regress the adult towards its childhood (i.e. a divorce). Cognitive Beck s theory states that depression is a result of faulty thinking. Negative schemas including negative self- evaluation schemas which relentlessly remind a patient of their worthlessness and self blame schemas make a depressed patient feel responsible for all failures. Also believes in the interaction of the cognitive triad. States that depressed patients think in a negative style, seeing failures as internal (because of them), stable over time and applicable to all of their behaviour. AO2/3 Psychodynamic explanation flimsy and unscientific. Unconscious cannot be tested empirically and falsifiable, deeming it too subjective to be widely acknowledged as a valid theory. Cannot be compared to scientific serotonin theory. More simple explanation for depression being caused by loss such as loss leading to a change in thinking of the child and leading to a negative attributional style. Valid theory should have valid treatment. Talking theory of psychoanalysis, focusing on resolving childhood feelings of loss. But ineffective in treating depression, showing low predictive validity. Support ALSO focus on childhood loss has support form Bowlby who highlighted problems of privation on later happiness of children. STRENGTH first to try explain depression as a result of faulty thinking, something that has led to cognitive explanations. First approach to use talking therapy, which is essential now CBT.

9 Cognitive Strong Support Cause and Effect is a limitation of theory BUT bidirectional! Validity assessed through efficacy of its treatment. suggests that Cog is a worthwhile explanation, pus treatment avoids pitfalls of antidepressants and ECT as lower relapse and side effects. Psych>Bio - amalgamation Psych look at patients as individuals, rather than simple biological mechanisms. Although less scientific evidence for actual origin of depression, these explanations give further details about depression symptoms and can be used in conjuct with bio to gain a more holistic view of what depression is caused by. +ve of approach Effective non intrusive therapy low relapse rates and no side effects/dependency Treat root cause not JUST symptoms - ve of approach Difficult to test empirically. Depressed patients find it more difficult to talk about feelings honestly unmotivated. Correlational research.

10 Outline and evaluate two psychological therapies for depression. (8+16) Outline and evaluate two or more psychological therapies for depression. (8+16) AO1 Psychoanalysis psychodynamic approach explains depression as resulting from unresolved conflict stemming from a real or imagined loss of affection in childhood. This is triggered by a loss in adult life, repressing the depressed patient to the childhood state of inward anger and guilt. Aim of psychoanalysis is to uncover the unconscious conflict and feelings of loss and manage them to restore a balanced and peaceful psyche. Free association allows patients to relax and talk about feelings, while analyst tries to make sense of them and uncover the feelings of loss. Transference observes the way the patient treats the analyst, the analyst s job again is to observe feelings of anger or loss displaced at the analyst and make the patient aware of them. Dream analysis allowed the analyst to uncover symbols of anger from the patient s dreams (e.g. patient may dream being lost, symbolising losing affection when a younger sibling was born). CBT works on assumption that depression is caused by faulty thinking. Cognitive explanations suggest that negative schemas and an internal, stable and global attributional style cause depression. Cognitive element aims to address faulty thinking, behaviour aims to use operant conditioning to reward positive, adaptive behaviours and reward the addressing of faulty thinking. Generally done across 20 weeks, includes four stages. Firstly, client will draw up schedule with the therapist. Secondly, client will be asked to keep a diary of all negative thoughts addressed with therapist. Finally, negative thoughts tested with therapist to prove that they are faulty. Client encouraged to take part in pleasurable activities throughout therapy. AO2/3 Psychoanalysis effectiveness - Not effective by American Psychiatric Association Psychoanalysis appropriateness - Requires introspection, not all depressed patients are motivated to do, or capable of doing so verbally - Expensive, not suitable for lower incomes - Time consuming, not appropriate for someone who needs immediate help Psychoanalysis ethical Encouraged to uncover difficult distressing memories analyst has a lot of power and has to be careful not to further distress patient.

11 CBT effectiveness CBT appropriateness - Requires introspection, not all depressed patients are motivated to do, or capable of doing so verbally - Evidence showed that patients with difficulty concentrating become frustrated with CBT and don t improve - CBT requires motivation. +ve of therapies Cause over symptom Lower relapse rates than biological, dependence free and no side effects - ve of therapies Time consuming Introspection required Conc Use in conj with biological so any difficulties with introspection or motivation can be dealt with reducing symptoms Effectiveness of therapy depends on competency of therapist. Unlike bio, CBT will vary in effectiveness depending on how good the therapist is.