Friday, 9 May 2014

Cognitive treatment for depressive disorder

 

Management

Cognitive treatment for depressive disorder

What is the cognitive treatment for depressive disorder?

Cognitive behavioral therapy

Cognitive treatment for depressive disorder

Who and when was it developed?

Beck et al in the 1960s

Cognitive treatment for depressive disorder

What does it combine?

Cognitive and behavioral aspects

Cognitive treatment for depressive disorder

Is it available on the nhs?

Yes

Cognitive treatment for depressive disorder

What is the individual told to focus on and consider?

Focus on negative thoughts and then consider new ways of thinking

Cognitive treatment for depressive disorder

What are the 2 main focuses on cognitive behavior therapy?

 -change distorted thinking present in those with depressive disorder -train patients to use more adaptive methods

Cognitive treatment for depressive disorder

What are the 3 main aims of the treatment?

Challenge negative thinking and replace with constructive positive thoughts that will lead to healthy behaviour -make cognitive errors conscious and then challenge then, make it look like there is no basis

Cognitive treatment for depressive disorder

When does it usually occur?

Once a week/fortnight for 5 to 20 sessions lasting 50-60 mins

Cognitive treatment for depressive disorder

How does the course normally start?

Education phase, patient taught about relationship between thoughts, emotions and actions, ethical issues

Cognitive treatment for depressive disorder

Why is an agenda set?

So the client can do what they want at their own pace

Cognitive treatment for depressive disorder

How does therapist help break down problem?

 -downward arrow technique -breaks down into parts that can be connected

Cognitive treatment for depressive disorder

What does it mean by solution based?

Doesn't dwell in the past, all about the here and now, how thinking is unrealistic

Cognitive treatment for depressive disorder

Why are homework assignments set?

Ao that patient can practice changes talked about, normally hypothesis testing putting self in situations not normally experience

Cognitive treatment for depressive disorder

What other tools are used for the client outside treatment?

To discover self concept, speaking to friends and family to find out things about themselves

Cognitive treatment for depressive disorder

What can the therapy help change?

How you think and what you do

Cognitive treatment for depressive disorder

What does the therapy challenge?

Negative thoughts

Cognitive treatment for depressive disorder

What does the therapist summarise at the start?

The agenda to check full understanding

Cognitive treatment for depressive disorder

What is a mood diary, what does it enable to patient to do?

Log and monitor their thought processes outside therapy

Cognitive treatment for depressive disorder

Who is the programme backed up by? (s)

Government funding by the uk

Cognitive treatment for depressive disorder

What is a strength of the stud in terms of time etc?

Fairly quick, cheap to provide and less side effects when looking at drugs, why the government backs it up

Cognitive treatment for depressive disorder

What did butler conclude? (s)

That cognitive behavior therapy was effective for treating depressive disorder after reviewing several studies and meta analysis where the treatment was used

Cognitive treatment for depressive disorder

What did nice find? (s)

It was the most effective treatment in treating severe and moderate depressive disorder

Cognitive treatment for depressive disorder

What did williams find? (s)

His study is based on cognitive behavior therapy and is our contemporary study he found that cognitive behavior therapy alone combined with an imagery treatment was successful in treating depressive disorder of a woman named carol

Cognitive treatment for depressive disorder

Why is the study ethical?

It has no side effects, so can be regarded more ethical than the drug treatment

Cognitive treatment for depressive disorder

What belief is cognitive behavior therapy based on and why might this idea cause a relapse?

It is based on the belief that depressive disorder is caused by faulty thinking, which might be a result of depressive disorder not a cause, when depressive disorder is removed so is negative thoughts, shows that removing cause may not remove the cause, resulting in a relapse

Cognitive treatment for depressive disorder

What are some ethical implications for the treatment? (w)

It essentially blames the person for their disorder as it is their thoughts that cause it, ethical implication based on how it makes the patient feel

Cognitive treatment for depressive disorder

What type of data is normally gathered to study the treatment?

Self report

Cognitive treatment for depressive disorder

Why is the data gathered to study this treatment unreliable and in valid?

Self report may try to please the clinician and say treatment is working also may depend on mood which will change day to day social desirability

Cognitive treatment for depressive disorder

What did chan et al find? (w)

That drug therapy could be useful as an addition to cognitive behavior therapy and a combination was more effective than cognitive behavior therapy on its own

Cognitive treatment for depressive disorder

Williams contemporary (icbt and cbm)

What was the aim of the study?

Find out if combined treatment of cognitive biased modification immediately followed by icbt would be effective in treating depressive disorder

Where were participants recruited from?

Applied research unit for anxiety and depressive disorder in Sydney online screenings

How many applied through online screenings?

232

What happened to successful applicants?

They were rang for a diagnostic interview using the mini

What is the mini?

Multi international neuropsychiatric interview

Why were participants excluded?

No internet access, drug abuse and suicidal idealization

How many participants met all inclusion criteria and what disorder did they have?

69 and major depressive disorder

How many were in the intervention group at the start and then the finish?

38 and 20

How many were in the control group at the start and finish?

31 and 22

Who many participants were in the baseline questionnaires in both groups?

I-35 c-28

How long was the treatment?

11 weeks

How long was the cbm?

One week

How long was the icbt?

Ten weeks

What was the criteria for participants?

Had to have major depressive disorder no history of psychotic mental illness

What age did participants have to be between?

18-65

What was depressive disorder severity measured by?

-beck depressive disorder inventory 2nd edition -phq-9

What were the primary outcome measures?

Severity of depressive disorder distress interpretation bias

What is the phq-9?

Nine item depressive disorder scale of patient health questionnaire

A recent survey suggested that patients and attendants in the hospitals face difficulties finding places due to the complexity of the building structure and the hustle adding to their distress. You have opted to conduct a study at your hospital to evaluate whether colored hospital map for healthcare staff to guide patients would help them. What would you measure the reduction in distress with?

The K10 is a self-report inventory used often as a simple measure of treatment-outcome for common health conditions, and to identify need for treatment, or measure psychological distress. It is in the public domain. It has a five-point Likert scale, options include: all, most, some, little, to none of the times, scored 5-to-1, respectively. A score of 10 is the minimum for no distress, ranging up to a largest score of 50 for the most severe distress. For further information on the K10 please refer to www.crufad.org or Andrews, G Slade, T. Interpreting score on the Kessler Psychological Distress Scale (K10). Australia and New Zealand Journal of Public Health: 2001; 25:6: 494-497.

K10

General health questionnaire

Patient health questionnaire

Daily Hassles

State-trait anxiety inventory 

 

 

What is the k10

Measures distress ten item kestrel psychological distress scale

How was interpretation bias measured?

Sst

What is the scrambled sentence test?

scrambled sentence test measures interpretation-bias

What were the secondary outcome measures?

Other factors associated with depressive disorder that may affect treatment such as anxiety

What was anxiety as a second outcome measured by?

Stai-t s

What does the STAI-A help you measure in the evaluation of patients presenting with excessive stress an worry. 

The State-Trait Anxiety Inventory (STAI) is self-report, a 4-point Likert scale with 40 questions used to measure state anxiety, or anxiety about an event, and trait-anxiety, individuals with anxiety-personalities. Higher scores correlate with increased severity of anxiety. Form-Y is Its most recent, available in 40 different languages. State-trait anxiety inventory-A is the trait version. It helps assess trait-anxiety, anxiety prone personalities.

Severity of current anxiety

Whether the individual is prone to anxiety

Stress in general adaptation syndrome

Compares state and trait anxiety

It identifies Type-A individuals

 

 

What is the CBM?

Computerized training program in which the individuals are presented with ambiguous scenarios always resolved in a positive manner.

What was the final measure used?

Researchers used their own adapted version of treatment expectancy and outcomes questionnaire

After intervention group had post scores what happened?

Control group took part

What measure was not carried out in post treatment outcomes?

Interpretation bias

Results: what were there no significant differences in?

Baseline measures pre treatment

What percentage had social phobias in each group? (baseline measure)

I-34% c-25%

What was found in the treatment expectancy out outcomes questionnaire?

There were no differences in patients ratings of treatment expectations

What did intervention group show? (results)

Improvement in scores on all measures

Which group had most improvement?

Intervention group

What were some conclusions?

Combined intervention effective in reducing depressive symptoms icbm can reduce symptoms in just one week useful to intergrate cbmi into icbt as a new form of delivery treatment

Why was the internet recruitment a strength? (s)

Allowed to collect a broad sample from all over australia

Why is it useful? (s)

Cognitive behavior therapy was not widely used due to resources encourages the integration of internet based technologies to treat depressive disorder

Ethics? (s)

All 69 gave informed consent beforewent through a screening process to make sure ppts suitable for treatment right to withdraw

Random assignment? (s)

Reduces any bias of ppts characteristics

Reliability?(s)

Easily replicable standardised procedure questionnaires

Use of interviews and questionnaires? (s)

Didn't just reply on one type of data collection method, increased validity

Self report data? (s)

Quick and easy comparison to be made reduces costs of manpower needed

Who was the study approved by? (s)

Human rights ethics committee of st vin cents hospital in sydney

Self report data? (w)

Social desirability lack validity

Cause and effect? (w)

Results could not establish whether change was due to one programme or both

Generalisability? (w)

Inclusion data 18-65

Validity of withdrawal? (w)

May not have worked on those who withdrew

Long term? (w)

No follow up study so no way to tell may relapse §

What % of people in both groups showed changes?

I - 65% c - 35%

Bio treatment for depressive disorder-drugs

Antidepressants are given to patients on the belief that depressive disorder is caused by what?

An imbalance of neurotransmitters in the brain

Bio treatment for depressive disorder-drugs

What do antidepressants help to increase?

The levels of monoamine nt in the brain

Bio treatment for depressive disorder-drugs

What effect should antidepressants have?

Restoring the balance of nt and therefore reducing the symptoms of depressive disorder

Bio treatment for depressive disorder-drugs

What are antidepressants?

Antagonists

Bio treatment for depressive disorder-drugs

How do antagonists work?

By increasing the level of activity, usually by blocking re up take or by preventing the enzyme that breaks them down in the synapse

Bio treatment for depressive disorder-drugs

Where is the nt available for longer when given drugs?

Synapse

Bio treatment for depressive disorder-drugs

Where does activity increase?

Affected neural pathways

Bio treatment for depressive disorder-drugs

What form do ad take form?

Tablet normally

Bio treatment for depressive disorder-drugs

How long do patients normally take then before feeling an effect?

7 days

Bio treatment for depressive disorder-drugs

When first prescribed what dosage is given?

The lowest possible thought necessary

Bio treatment for depressive disorder-drugs

How does a doctor decide on which drug to prescribe?

Uses trial and error, prescribes on sees if it works if not prescribes another

Bio treatment for depressive disorder-drugs

After four weeks and no effect what might the doctor do?

Increase dosage or try alternative medication

Bio treatment for depressive disorder-drugs

How long does a course of treatment usually last?

6 months

Bio treatment for depressive disorder-drugs

Who is given a two year course?

People with a history of depressive disorder

Bio treatment for depressive disorder-drugs

Who is advised to take them indefinitely?

People with recurrent depressive disorder

Bio treatment for depressive disorder-drugs

What does ssri stand for?

Selective seretonin reuptake inhibitors

Bio treatment for depressive disorder-drugs

How do ssris work and is there any side effects?

Normally start by prescribing these safer cause fewer side effects block reuptake of serotonin less likely serious effects if overdose

Bio treatment for depressive disorder-drugs

What is an example of an ssri?

Fluoxetine

Bio treatment for depressive disorder-drugs

What are moais?

Monomine oxidase inhibitors

Bio treatment for depressive disorder-drugs

How do moais work and is there side effects?

Given as a last resorthave serious side effects stop enzymes breaking down monamines in synapse have to have strict diet as can react with certain foods such as cheese and pickles

Bio treatment for depressive disorder-drugs

What percentage of the effect of drugs is placebo effect? (w)

30-40%

Bio treatment for depressive disorder-drugs

What is the placebo effect a weakness?

Means the drugs don't actually work it is just in the patients mind

Bio treatment for depressive disorder-drugs

One the drug is stopped, what rates are high? (w)

Recurrence and relapse rates

Bio treatment for depressive disorder-drugs

What does palliative mean?

Relieving pain rather than dealing with the cause

Bio treatment for depressive disorder-drugs

Why are drugs palliative and not curative? (w)

They do not directly cure the disease or target the cause but relieve some of the symptoms

Bio treatment for depressive disorder-drugs

Are all drugs used for mental health palliative?

Yes

Bio treatment for depressive disorder-drugs

Why is it a weakness if patients reposing well to antidepressants?

They may have to take them indefinitely in order to stop recurrence

Bio treatment for depressive disorder-drugs

If psychotherapy and other treatments doe not work why is drugs a strength? (s)

They are the only treatment that will work

Bio treatment for depressive disorder-drugs

What is a weakness in terms of ethics? (w)

Cause serious side effects, especially old fashioned ones, ssris have been to linked to suicidal ideation in young people

Bio treatment for depressive disorder-drugs

Why are drugs practical? (s)

They are cheaper and can be provided immediately whereas there is usually a waiting list for other therapies

Bio treatment for depressive disorder-drugs

Why might there be ethical concerns in the patient to doctor relationship?(w)

Doctor is prescribing the meds so patient may feel like they have no power and that therefore drugs is there only option as they are just following what the gp says

Bio treatment for depressive disorder-drugs

What treatment is used when drugs does not work as a last resort?

Electroconvulsive treatment

Bio treatment for depressive disorder-drugs

Which drugs has been linked to suicidal ideation in young people?

Ssri

Bio treatment for depressive disorder-drugs

What did pin quart d find?

Reviewed the effectiveness of drug treatment and psychological treatments and found that psychological treatments were most effective

Bio treatment for depressive disorder-drugs

EMOTION & THE RELATED DISORDERS

What is mood? Is anxiety a type of mood? Do we separate pleasure, from euphoria? What is the exact boundary between normal and abnormal mood? How do we differentiate elation and euphoria? What is dysphoria? What is sadness, and how it compares to depression in mood disorder? Is there a difference between mood and affect? What is flattened affect and how does it differ from apathy? What is inappropriate affect? How does anhedonia differ from apathy? What is congruence and incongruence of mood? What do we mean by a labile mood? What is cyclothymic and hyperthymic mood? What is What is the difference between labile mood and cyclothymic mood. What is alexithymia? What is dysthymia? How de we differentiate dysthymia, dysphoria, and displeasure? Is loss of interest different from anhedonia? How do we differentiate between lability and incontinence of mood? How do we differentiate apathy from blunting? What is reactive mood and its importance? What exactly are mood-incongruent delusions and their significance?

What is stress? What is eustress? How eustress differs from distress? If you are the feeling pressure, are you experiencing stress? How do we compare trauma and stress? 

What is emotion? Is stress an emotion? What is blunting of emotional responses? What is emotional incontinence?

What

In this section we will cover the concepts and mechanisms of emotions including normal stress, sadness, pleasure and happiness, worry, eustress. Then we will describe the abnormal variations like clinical anxiety, depression, elation, euphoria, euthymia, eustress, distress, pleasure, dysphoria, anhedonia,  and

Major Depressive Disorder

Must last at least 2 weeks At least Five or more symptoms have been present in the same 2-week period1. Depressed mood most of the day 2. Markedly diminished in interest of pleasure in all, or almost all activities most of the day3. Significant weight loss4. Insomnia or hypersomnia everyday5. Psychomotor agitation or retardation 6. Fatigue or loss of energy7. Feelings of worthlessness or inappropriate guilt8. Diminished ability to think or concentrate9. Recurrent thoughts of death, suicidal tendencies with or without a plan Must cause clinically significant distress or impairment

Mood Disorders

Bipolar I Disorder

Patients with one lifetime Manic episode and patients with both Manic and Depressive episodes. Patients do not need to have diagnosis of MDD for Bipolar I

Mood Disorders

Bipolar II Disorder

Patients with Hypomanic episodes and Major Depressive episode - but never a Manic episode.

Mood Disorders

Mania

A period of abnormally and persistently elevated, expansive or irritable mood lasting for at least one week or less if a patient must be hospitalized. Associated with Inflated self-esteem Grandiosity Decrease need for sleep Distractibility Great physical and mental activity and over-involvement in pleasurable behavior

Mood Disorders

Hypomania

Hypomanic episode lasts at least 4 days and is like a manic episode except it does not sufficiently severe to cause impairment in social or occupational functioning

Mood Disorders

Dysthymia

Characterized by at least 2 years of depressed mood that is not sufficiently severe to fit the diagnosis of MDD.

Mood Disorders

Cyclothymia

A mild form of Bipolar II disorder. Characterized by at least 2 years of frequently occurring hypomanic symptoms that cannot fit the diagnosis of Manic episode and of depressive symptoms that cannot fit the diagnosis of MDD.

Mood Disorders

Prevalence of Major depressive disorder

5-17% - Has the highest lifetime prevalence of any psychiatric disorder

Mood Disorders

Prevalence of Bipolar illness

Less than 1 percent

Mood Disorders

Mood Disorders (with Psychotic features)

Significant treatment implications, eg., antipsychotic drugs along with antidepressants. Distinguished at mood congruent, or mood incongruent. Mood congruent: in harmony with the disorder, eg., I deserve to be punished because i am so bad) Mood incongruent: not in harmony with the mood disorder. - may have schizophrenia or schizoaffective disorder.

Mood Disorders

Mood disorder with Melancholic Features

Used to describe the dark mood of depressive disorder Severe Anhedonia, early morning wake ups, weight loss, and profound feelings of guilt. Associated with changes in the autonomic nervous system and in endocrine functions. Can be applied to MDD, Bipolar I and II Disorder.

Mood Disorders

Mood Disorders with Atypical features

Patients with atypical depressive disorder symptoms include overeating and oversleeping. Sometimes referred to as, "reversed vegetative symptoms" and the pattern sometimes called "hysteroid dysphoria" Typically have a younger age of onset compared to depressive disorder with typical features,

Mood Disorders

Mood-congruent psychotic symptoms

In harmony with the mood disorder," I deserve to be punished because I am so bad “typically those with mood-congruent psychoses have a psychotic type of mood disorder

Mood Disorders

Mood-incongruent psychotic symptoms

Not in harmony with the disorder Delusions or hallucinations whose content does not involve typical depressive themes of personal inadequacy, guilt, disease, death, nihilism, or deserved punishment. Typically have schizoaffective or schizophrenia

Mood Disorders

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