What are the 3 types of depression?
- bipolar (manic) depression
- unipolar depression
- dysthymia
What is bipolar depression?
What characterises it?
- Excessive elation, irritability, talkativeness
- inflated self-esteem
This is followed by a period of depression
What characterises unipolar depression?
There is no mania
What is dysthymia?
A persistent low grade mood
What is the difference between depression and not being happy?
Everyone goes through periods of not being happy - a reason can usually be identified
Depression is an illness and the sufferer has relatively little control over it
What are the 5 questions that should be used in diagnosing depression?
Is the depression:
- an illness or normal unhappiness?
- secondary to a physical illness or alcohol/drugs?
- presenting with physical symptoms?
- co-occurring with anxiety?
- placing person at risk of suicide?
What are the 3 cores features of depression?
- pervasive low mood
- anhedonia (loss of interest and enjoyment)
- reduced energy and diminished activity
What is meant by a pervasive low mood?
A constant low mood that does not recede
What are examples of anhedonia?
People losing interest in things that they used to enjoy
Examples of behaviours include people stopping going out and engaging in social activities
What are the 2 main questions that can diagnose 85-90% of people with depression?
- Have you been low in spirits?
2. Have you been able to enjoy the things you usually enjoy? (anhedonia)
What is important to consider when asking screening questions for depression?
Context and history
Someone may answer yes to both questions, but may have had a recent bereavement in the family
What is meant by the biological basis for depression?
Depression is associated with natural biological change
e.g. childbirth, menstrual cycle
What are drug therapies used for depression?
- Monoamine oxidase inhibitors (MAOIs)
- Tricyclic antidepressants
- SSRIs
What are the 3 physical treatments for depression?
- drug therapy
- physical activity/exercise
- electro-convulsive therapy (ECT)
When is physical activity/exercise used as treatment for depression and why?
Mild depression
It is as effective as antidepressants or CBT
When is electro-convulsive therapy used as a treatment for depression?
it is only used in intractable or psychotic depression
ECT acts as an end-point treatment for patients who have failed to respond to other treatments
What theory is the basis for Cognitive Behavioural Therapy?
Beck’s cognitive theory of depression
How do physical and psychological treatments for depression interact?
they work alongside each other
Drugs tend to relieve some of the more severe side effects, allowing people to engage in psychological treatment
What is meant by the cognitive triad in Beck’s cognitive theory of depression?
- negative view of self
- negative view of experience
- negative view of future
These 3 components together produce depression
What are the errors in logic suggested by Beck’s cognitive theory of depression?
- overgeneralisation
failing in one thing means you are useless at everything
- magnification and minimisation
this is making disasters and failure to take praise
- personalisation
this is taking all the blame
What is involved in cognitive therapy?
It is a talking therapy that involves 6 - 20 sessions
It is as good as antidepressants in mild to moderate depression
What are the 2 main cognitive therapy techniques?
- reality testing automatic thoughts
(setting up situations in which people can re-learn what they predict of the future)
- changing depressogenic assumptions
What is an example of a depressogenic assumption?
In order to be happy, I have to be successful in everything I do
What are the 4 terms that are used to refer to the same collection of self-harm behaviours?
- deliberate self-harm
- self-harm
- parasuicide
- attempted suicide
What are the two main types of self-harm?
- self-poisoning
2. self-injury
What is the definition of self-harm?
Intentional self-poisoning or self-injury, irrespective of motivation
What is involved in self-poisoning?
The use of:
- prescribed or over-the-counter drugs
- recreational drugs
- non-ingestible substances
What are examples of self-injury?
- self-cutting
- jumping from a height
- attempted hanging
- swallowing foreign bodies
- self-burning
What are the gender differences in self-harm?
It is slightly more common in women up to the age of 20
After this age, it is no more common in women than in men
What are the 8 motivations for self-harm?
- relief from state of mind
- escape from impossible situation
- show how much you love someone
- show somebody how you feel
- find out if someone loves you
- seek help
- frighten someone/make them sorry
- influence someone
How is self harm characterised by:
i. age
ii. males and females
iii. methods
iv. link with mental illness
v. rates
i. it reduces with age
ii. it is equally common in males and females
iii. cutting/poisoning
iv. weak link with mental illness
v. rates are rising
How is suicide characterised by:
i. age
ii. males and females
iii. methods
iv. link with mental illness
v. rates
i, increases with age
ii. more common in males
iii. violent methods
iv. strong link to mental illness
v. rates are falling
What are the similarities between self harm and suicide?
- they are increasing in young men
- they are associated with alcohol misuse
- they occur in the same people
What are the 5 individual influences on suicide?
- loneliness and loss
- history of self-harm
- substance misuse - especially alcohol
- presence of a mental disorder
- physical illness
What is meant by modelling as a social influence on suicide?
Suicide contagion
There is guidance on how the media should report suicide
e.g. not giving too much detail as you do not want someone copying the method
What is meant by the availability of methods as a social influence on suicide?
Reducing the pack size of paracetamol has reduced the numbers of suicides
