1. Clinical characteristics of Depression

2. Starter- Discuss and note take What is an affective disorder? What are the four characteristics of major depression? What two well known documents help practitioners diagnose depression?

3. Today and this week Clinical characteristics of Depression Diagnosis of Depression Issues with classification and diagnosis Friday Anomalistic mock

4. Characteristics of depression Depression is classified as a affective or mood disorder The symptoms of major depression can be divided into four categorise – behavioural, physical, emotional and cognitive To be diagnosed with major depression, a doctor or psychiatrist would look for symptoms described in one of the mental health criteria manuals: ICD-10 and the DSM-V Complete the handout identifying the categories

5. DSM and ICD Categorise mental health criteria Used by health practitioners to diagnose What is the difference? Have a look and highlight similarities and differences

6. DSM At least one of the following, occurring most days, most of the time for at least two weeks:  Persistent sadness or low mood  Marked loss of interest or pleasure PLUS at least five of these: Disturbed sleep Loss of appetite or weight Fatigue, low energy Agitated or slower movements Poor concentration, hard to make decisions Feeling worthless or inappropriate guilt Suicidal thoughts or acts ICD All three of the following must be present:  Persistent sadness or low mood present most days, most of the time for at least two weeks  Loss of interest or pleasure  Fatigue or low energy PLUS most of the following to give a total of at least 8: Disturbed sleep Loss of appetite Poor concentration and attention Low self-esteem and self-confidence Feeling guilty and unworthy Suicidal thoughts, acts or self-harm Bleak, pessimistic views of the future

7. Case studies- You are the doctor Would the individuals be diagnosed with depression under DSM / ICD Both? Neither? Other diagnosis?

8. Case study one For the past few weeks Jessica has felt unusually fatigued and found it increasingly difficult to concentrate at work. Her coworkers have noticed that she is often irritable and withdrawn, which is quite different from her typically upbeat and friendly disposition. She has called in sick on several occasions, which is completely unlike her. On those days she stays in bed all day, watching TV or sleeping. Although she hasn’t ever considered suicide, Jessica has found herself increasingly dissatisfied with her life. She’s been having frequent thoughts of wishing she was dead. She gets frustrated with herself because she feels like she has every reason to be happy, yet can’t seem to shake the sense of doom and gloom that has been clouding each day as of late

9. Case Study Two Kristen is a 38 year-old divorced mother of two teenagers. She has had a successful, well-paying career for the past several years in upper-level management. Even though she has worked for the same, thriving company for over 6 years, she’s found herself worrying constantly about losing her job and being unable to provide for her children. This worry has been troubling her for the past 8 months. Despite her best efforts, she hasn’t been able to shake the negative thoughts. Ever since the worry started, Kristen has found herself feeling restless, tired, and tense. She often paces in her office when she’s there alone. She’s had several embarrassing moments in meetings where she has lost track of what she was trying to say. When she goes to bed at night, it’s as if her brain won’t shut off. She finds herself mentally rehearsing all the worse-case scenarios regarding losing her job, including ending up homeless

10. What is Concurrent Validity? This is the degree to which a test corresponds to an external criterion that is known concurrently Read the research by Wittchen et al (2001) Does this suggest the tests have concurrent validity?

11. What does this article suggest about depression? What is comorbidity?

12. Starter Outline the Clinical Characteristics of Depression (5 marks)

13. To be diagnosed with depression, a person must display a persistent low mood for at least two weeks, and five other symptoms including sleep disturbance, weight gain or loss, loss of energy, loss of interest in pleasure activities, difficulty in making decisions, excessive guilt for real or imagined deeds, and thoughts of or specific plan or attempt at suicide. It is useful to see how depression affects the whole person, and the symptoms can be separated into four categories. Mood (sadness, anxiety etc), Cognitions (pessimism, guilt etc), Behaviour (low energy, crying, neglect of personal appearance) and Physiology (disturbed appetite, constipation, sleep disturbance etc.)

14. What do we need to know Clinical characteristics of depression Issues surrounding the classification and diagnosis of depression, including reliability and validity

15. Validity and depression Internal Concurrent External

16. Issues with characteristics and diagnosis Last lesson we adopted the role of a practitioner and diagnosed individuals with symptoms of depression Some of us disagreed with the diagnosis Some of us diagnosed under the DSM but not the ICD

17. Reliability Last lesson we adopted the role of a practitioner and diagnosed individuals with symptoms of depression Some of us disagreed with the diagnosis Some of us diagnosed under the DSM but not the ICD How could we assess the reliability of practitioners diagnosing depression? P5

18. Complete packs Co-morbidity Complete page 6 P7

19. Cultural Relativism What does this suggest about characterising and diagnosing depression across cultures?

20. Cultural relativism Davidson and Neal (1994) believe that in Asian cultures, for instance, people are praised for showing no expression of emotional turmoil. People tend to display physical symptoms of depression instead. Kua et al (1993) reported that 72% of people in China who first presented with chest or abdominal pains or headaches were later found to have a mental health problem. In some countries, there is no word for ‘depression’. P6

21. Watch the clip What impact has the diagnosis of depression had on her? What does the individual seem to be concerned about? https://www.youtube.com/watch?v=3tn8I3eQYac

22. Labelling Research the following and make notes Self-fulfilling prophecy Sick role Prejudice and discrimination Extn- Can you link in the examples from the video? P7

23. Gender, Depression and Diagnosis Discuss and list 7 Reasons why women are more likely to be diagnosed with depression Consider explanations on Biological Psychological Social/ Cultural

24. Biological explanations 1. Compared to men, women may have a stronger genetic predisposition to developing depression. 2. Compared to men, women are much more subjected to fluctuating hormone levels. This is especially the case around the time of childbirth and at the menopause, both of which are associated with an increased risk of developing depression.

25. Psychological explanations 3. Women are more ruminative than men, that is, they tend to think about things more—which, though a very good thing, may also predispose them to developing depression. In contrast, men are more likely to react to difficult times with anger, or substance misuse. 4. Women are generally more invested in relationships than men. Relationship problems are likely to affect them more, and so they are more likely to develop depression.

26. Sociocultural explanations 5. Women come under more stress than men. Not only do they have to go work just like men, but they may also be expected to bear the brunt of maintaining a home, bringing up children, caring for older relatives, and putting up with all the sexism (pressure from a focus on looks, influence of media, harassment, being paid less)! 6. Women live longer than men. Extreme old age is often associated with bereavement, loneliness, poor physical health, —and so with depression. 7. Women are more likely to seek out a diagnosis of depression. They are more likely to consult a physician and more likely to discuss their feelings with the physician. Conversely, physicians (whether male or female) may be more likely to make a diagnosis of depression in a woman.

27. Issues- So far what we have covered? Validity – Internal and Concurrent Reliability- inter-rator, test-rest Co-morbidity- validity and reliability. Two people can be diagnosed with depression but show different symptoms with little overlap. This is important as establishing the primary disorder influences the treatment offered. Diagnosis can produce benefits in access to treatment, but labelling can have negative effects, on employment prospects, motivation etc. Cultural differences in symptom presentation (e.g. physical/somatic presentation in non- Western cultures). Gender bias – Women are more likely to be diagnosed. Could be biological or psychological however more likely to be due to likelihood of females visiting a physician

28. Anomalistic assessment Start 8:35 Finish 9:15 If finish- Complete last page in depression pack 1 Start reading and completing depression pack 2- genetics

29. Evaluation of issues Complete points based on discussion last lesson Benefits of diagnosis Gender and diagnosis P8

30. What are the possible advantages and limitations/ issues when characterising and diagnosing depression? Advantages Issues/Limitations (impact?)

31. Advantages Issues/Limitations Prognosis: an accurate diagnosis can provide valuable information about the likely cause of a disorder. This can be helpful in planning the treatment and management of mental disorders. Treatment is most effective when diagnosed early Treatment: treatments are often specific to one disorder e.g. certain schizophrenia drugs would not help those with depression. Diagnosis can point to the most appropriate therapy. Communication shorthand: Often those suffering with mental disorders have numerous symptoms. It's much easier to incorporate these into a single diagnosis and makes communication between mental health professional easier. Historical and cultural context: disorders included in the manual can reflect social/political attitudes at the time e.g. homosexuality was included in early manuals Labelling: diagnosis leads to labeling and this can be stigmatising and can lead to a self- fulfilling prophecy Misdiagnosis: this can lead to inappropriate therapy or even being wrongly institutionalised. Co-morbidity establishing the primary disorder influences the treatment offered.

32. Explanations and Treatments How would the following approaches explain/treat depression Extn- Advantages/Limitations? Behaviourism/SLT Cognitive Psychodynamic Biological Humanism Tip- NHS Choices website is useful

33. Homework Read information on Genetics-Tuesday Complete pages 2/3/4 of Pack 2 on Genetics For Wednesday