Depression: epidemiology and biological basis

Question 1

Give some stats on depression

Answer 1

world’s leading cause of disability!
- 1 in 4 have depression
- 332 million people live w. depression
- worldwide issue - not just western

Depression peaks at age 60 + more common in females than males

Question 2

What is the economic cost of depression?

Answer 2

• 12.7% of sick leave due to mental health
• 181,600 cannot join labour force due to mental health problems
• UK GDP would be £25 billion higher without mental health issues

Question 3

compare 3 different disease classification systems?
ICD 10 vs DSM-V vs ICD-11

Answer 3

ICD-10 - international classification of diseases
- WHO, covers mental + physical illnesses

DSM-V = american psychiatric association & diagnostic/statistic manual of only mental disorders

ICD-11 since 2022
coding/classification - allows appropriate amount of funding per condition

Question 4

Outline the ICD 10 criteria for depression

Answer 4

Core symptoms: low mood, Anhedonia, less energy

Psychological:
Reduced concentration, self-esteem, guilt
Bleak views of future
Ideas/acts of self-harm/ suicide

biological: disturbed sleep, less appetite

Question 5

Outline the ICD 11 criteria for depression

Answer 5

Five of Ten everyday, most of the day for 2 weeks (must include 1. or 2.):

depressed mood
anhedonia
reduced concentration (marked indecisiveness)
low self-worth, inappropriate guilt
suicidal ideation
hopelessness
too little/too much sleep
too little/too much appetite
low energy
psychomotor retardation/agitation

Same as ICD 10- 3 differences:
- too little/much sleep / appetite
- psychomotor retardation/ agitation

can be classified as mild, moderate or severe based on table below

Question 6

Relate the ICD 11 criteria to bereavement

Answer 6

• ICD11 – bereavement exclusion

Symptoms unlikely to occur in ‘normal’ grief:
extreme low-worth, guilt, psychotic symptoms, suicidal ideation, psychomotor retardation - all lasting over 1 month

Question 7

What are the psychotic symptoms in depression?

Answer 7

auditory, olfactory, visual Hallucinations

Delusions: false fixed belief, eg:
- poverty
- personal inadequacy
- feeling responsible for world events
- deserving of punishments

Question 8

Give the less common symptoms of depression

Answer 8

Pain disorders: headache, atypical chest, low back, facial pain
- fatigue
- weight loss
- poor memory

Question 9

Describe some of the biological aetiology of depression

Answer 9

genetically transmitted - but how is still unclear
Neuroendocrine: high cortisol in depressed patients
Neuroanatomy: abnormalities shown on scans. Predisposition due to early cerebral damage (e.g stroke patients)

Question 10

Describe some of the psychological aetiology of depression

Answer 10

Beck’s cognitive triad:
Cognitive bias: polar reasoning, abstraction (ignores successes). Overgeneralisation (this went bad so everything else will)

Negative triad to do w the self, world, future.

Personality: perfectionist, needing to be in control, tendency to blame themselves

Question 11

Describe some of the psychological/social aetiology of depression

Answer 11

• adverse childhood experience -all types of abuse
• witnessing domestic abuse
• parental separation or divorce
• imprisonment of a family member
• lack of care / overprotection from parent
• bullying

Question 12

Describe social aetiology of depression

Answer 12

• vulnerability factors which increase the risk of depression if a provoking agent is present
  
  • 3 or more children under 14
  • not working outside the home
  • lack of confiding relationship
• austerity / poverty
• physical illness
• poor education
• 70% of depressive episodes are preceded by life events

Question 13

What is the SRRS?

Answer 13

Question 14

What is Beck’s unified model of depression?

Answer 14

Question 15

What is the biopsychosocial model and formulation?

Answer 15

biopsychosocial model of depression incorporates: biomedical model, psychosocial model
biopsychosocial formulation: a way of describing a patient unique situation

Question 16

Outline the 4 Ps related to depression

Answer 16

Predisposing – making them vulnerable (genetics, early developmental experience)
Precipitating – triggers (psychosocial stress, significant life event)
Perpetuating- keeping them in that position (sick role, learned helplessness)
Protective (good stuff- family, meaningful work, religion)