What is clinical depression often confused with that may lead to an increase in diagnoses in recent times?
Intense sadness
Why does intense sadness often get incorrectly diagnosed as a depressive disorder?
Because diagnosticians fail to take into account context i.e. if the person has just experienced something very sad
What are the 3 main factors that influence the ‘depression epidemic’?
- Multinational drug companies
- Medical practitioners
- The public
In what parts of the world can psychologists prescribe medication?
- 7 states of the US
- Alberta, Canada
- Guam
- South Africa
What are some of the arguments for the prescriptive privileges of psychologists?
- Many GPs feel they don’t have adequate training to diagnose and treat mental disorders, while psychologists do
- Psychologists will be able to evaluate client mental health needs more effectively and only prescribe when necessary
- Psychologists often have more time for ongoing dialogue about client views and expectations
- Will increase access to medication for those in rural areas and prisons
- Many other non-medically trained providers (dentists, podiatrists etc) have prescribing privileges which have enhanced health services
What are some of the arguments against prescriptive privileges for psychologists?
- They don’t have the medical training
- They will quickly turning to writing prescriptions
- Increase likelihood of mis-prescribing
- Those who don’t prescribe will pay higher rates to cover those who do
- Psychotropics are amongst the most dangerous drugs, which increases the risk for consumers
- Will extend the duration of a psychology degree
What are the 3 main sections of DSM-5?
- General information
- Diagnostic criteria
- Emerging conditions
What are some of the diagnostic changes to DSM-5?
- Removal of Aspergers Syndrome
- Removal of subtype classifications for some forms of schizophrenia
- Revision of treatment and naming for gender dysphoria
- Inclusion of a form of mood dysregulation for young children
- Changed elements for bipolar, personality disorders, OCD and PTSD
Explain the changes to the bereavement exclusion criteria between DSM-3 and DSM-5.
- DSM-3/DSM-4: Bereavement exclusion criteria existed for MDD. Diagnosis of MDD was not to be made if the individual’s mood symptoms were regarded as a timely bereavement reaction.
- DSM-4-TR: Bereavement exclusion criteria existed up to a period of 2 months post-loss
- DSM-5: Bereavement exclusion criteria removed completely
What do proponents of the bereavement exclusion removal from DSM-5 use as their main support for this decision? What is a counter-argument?
Supporters of the bereavement exclusion removal say there is a large body of research that shows grief is different from depression, and therefore clinicians should be able to delineate between the two and not incorrectly diagnose someone with depression when its just grief.
Others say while there is research suggesting grief is different, there isn’t specific evidence to say the exclusion criteria should therefore be removed from the DSM.
What should clinicians do to overcome uncertainty around the bereavement exclusion debate?
- Consider both sides of the argument
- Critically evaluate the research
- Consider the findings of meta-analyses
- Engage in PD
- Seek advice
What symptoms of depression are particularly evident in grief?
- Low mood
- Tearfulness
- Sadness
- Longing to be with lost loved one (not necessarily suicidal)
- Sleep disturbance
- Changes on appetite
- Changes in weight
What symptoms of depression are less evident in grief?
- Worthlessness
- Guilt outside of bereavement experience
- Hallucinations
- Psychomotor retardation
- Suicidal ideation
What is thanatology?
The study of death, dying, grief and loss
Thanatologists study, teach, research, and care for the psychological health of those responding to both death and non-death losses
What is palliative care?
The medical care of patients and families with life-threatening illnesses, such as symptom management and pain
What is disenfranchised grief?
Grief experienced after losses that cannot be openly acknowledged, publicly mourned, or socially supported
What is complicated grief?
When the experience of grief becomes debilitating and results in impairment in daily functioning
What is developmental, or maturational, grief?
Grief over life transitions. Often includes relinquishing activities and friends, and the loss of abilities through functional decline and degeneration
How has grief been dealt with in DSM-5?
Persistent Complex Bereavement Disorder has been listed as a category requiring further study
What are some risk factors for more pathological grief?
- Personality style
- Attachment style
- Relationship with deceased
- If deceased was a child
- If deaths were multiple or traumatic
What is the major change in treatment strategies for grief now versus 50 years ago?
Today, thanatologists actually encourage attachment with the lost person/item, whereas 50 years ago people were encouraged to stop thinking about it and move on with life
What is reminiscence therapy?
When thanatologists encourage grief sufferers to bring with them memories
What is considered one of the most critical issues in grief?
The reconstruction of meaning
What were the 3 steps involved in Freud’s ‘grief work’?
1) Freeing the bereaved from bondage to the deceased
2) Readjustment to new life circumstances without the deceased
3) Building of new relationships
