Treatment and management of mood (affective) disorders — practice questions

(a) AO1 — CBT:

• Identify negative automatic thoughts (self/world/future triad).
• Challenge evidence for distortions; set behavioural activation tasks to break withdrawal cycle.
• Homework records thoughts and alternative interpretations.

AO1 — Biological (SSRIs):

• e.g. fluoxetine — selective serotonin reuptake inhibitor.
• Increases synaptic serotonin — aims to restore mood regulation over several weeks.

(b) AO3 — ECT evaluation:

• AO1 — Use: Reserved for severe, treatment-resistant depression, catatonia, or urgent risk — rapid response possible.
• Strengths: Meta-analyses show short-term efficacy when drugs/CBT fail; can be life-saving.
• Limitations: Retrograde amnesia and cognitive side effects; mechanism unknown — raises scientific concern.
• Ethics: Involuntary ECT controversial; stigma from historical misuse; patient must give informed consent where possible.
• Comparison: CBT trials (e.g. Hollon et al.) show durable effects with lower side effects — ECT not first-line for moderate cases like this scenario.

Judgement: For this patient, CBT ± SSRI is appropriate; ECT only if escalation needed — benefits must outweigh memory and ethical costs.

(a) Calculation of Percentage Reduction:

Formula: Percentage Reduction = [ (Initial Score - Final Score) / Initial Score ] * 100

Step 1: Find the difference in scores. Initial Score = 38 Final Score = 12 Difference = 38 - 12 = 26 points

Step 2: Divide the difference by the initial score. 26 / 38 ≈ 0.6842

Step 3: Convert to a percentage. 0.6842 * 100 = 68.42%

Answer: The patient's BDI-II score reduced by approximately 68.4%. [3 marks]

(b) Explanation: A 68.4% reduction in symptoms is a clinically significant improvement, moving the patient from 'severe' (30-40) to 'mild' (10-18) depression on the BDI-II scale. This strong positive outcome supports an interactionist approach because it demonstrates the synergistic effect of combining treatments. The SSRI likely reduced the biological symptoms (e.g., low energy, anhedonia), making it possible for the patient to engage with and benefit from CBT. The CBT, in turn, would have provided skills to manage negative thought patterns, contributing to the substantial score reduction and providing long-term relapse prevention skills. [2 marks]