Psychology Exam 2- 3/26/18

Suicide- Gender differeces

- *2-3 times more women than men attempt suicide.* - *Men are more likely to complete suicide.* - *Women are more likely to use drugs to overdose.* With this method, there is a *window of time* before the drugs go into effect where someone can save the person attempting suicide. - *Men are more likely to use a firearm. There is no taking the bullet back once the gun is fired. This is why men are more likely to complete suicide. Men who attempt suicide tend to be more sure in their intent to die than women.*

Depressants: Alcohol

Alcohol: In low doses, make people feel confident. Increasing doses induce symptoms of depression like fatigue, lethargy, decreased motivation, sleep disturbances, depressed mood, and confusion. - Stomach full or empty is how quickly they become intoxicated. - Takes less alcohol to reach high blood alcohol level in women than men because women are generally smaller and have lower body water content, leading to higher concentrations of alcohol in the blood for a given dose. - Unintentional alcohol-related injuries due to car accidents, drowning, burning, poisoning, falling. - More than half o all murders intoxicated with alcohol. People who attempt of commit suicide often do so under intoxication - *3 stages of alcohol withdrawal-* 1) within a few hours after drinking has stopped includes tremulousness, weakness, profuse perspiration. Anxiety. A headache, nausea, abdominal cramps and may vomit. 2) convulsive seizures (12 hrs after drinking stops but most often on second or third day). 3.) Delirium Tremens (DT's)- auditory, visual and tactile hallucinations. bizarre/terrifying delusions. fatal in approx 10% cases. Death may occur from hyperthermia or collapse of the peripheral vascular system. 11% of people with severe alcohol use experience DT's. - Alcohol misuse continuum- broad range from occasional to binge drinking. - Gender differences: - Men more likely to drink alcohol and drink heavily. more likely to develop alcohol use disorders - *Strong age differences: 4 reasons-* 1.) Older people become intoxicated faster with more severe and quicker negative effects because with age the liver metabolizes alcohol at a slower rate and the lower percentage of body water increases the absorption of alcohol. 2.) As people grow older, they are more mature in their choices. 3.) Older people have grown up with stronger prohibitions against alcohol use and abuse than younger people. 4.) People who have used alcohol excessively for years may die from alcohol-related diseases before they are old. - *Cultural differences-* - *Deaths related to alcohol are 5 times more common among Native Americans* than the general US Population because of *excessive rates of poverty and unemployment, lower levels of education, greater sense of helplessness and hopelessness.* - *Long-term effects of stomach, esophagus, pancreas, and liver.* - *Most common: low-grade hypertension.* This combined with increases in levels of triglycerides and low-density lipoprotein cholesterol puts alcohol abuse at increased risk for *heart disease.* - Heavy use *increases the risk for cancer,* especially breast cancer in women. - *Malnourishment* because chronic alcohol ingestion decreases absorption of critical nutrients from the gastrointestinal system and in part because they *"drink their meals". * - *Dementia* from the heavy prolonged use of alcohol. - *Subtler deficits* due to central nervous system demand are observed in chronic abusers even after quitting. - Heavy prolonged use of alcohol during teens and early adulthood permanent *negative effects on the brain*. deficits in performance on cognitive tests. - *Red wine: good cholesterol, prevent damage to blood vessels.* - Abstainers are more likely than moderate drinkers to be older, less well educated, physically inactive and overweight and to have diabetes, hypertension, and high cholesterol.

Schizotypal Personality Disorder

*A lifelong pattern of significant oddities in their self-concept, ways of relating to others, and their thinking and behavior. Do not have a strong sense of self, have trouble setting goals, emotional expression is restricted.* They have *few close relationships.* Perceive people as *hostile and deceitful.* *Socially anxious and isolated because of their suspiciousness.* *Easily distracted or fixate on one object for a long time.* - some have episodes symptomatic of brief psychotic disorder and some eventually develop the full syndrome of schizophrenia.

Theories of Depression- Psychological theories- Sociocultural theories-

*Cohort Effects:* - Cohort effects are a *phenomenon of historical changes that may have put more recent generations at a higher risk for depression than previous generations.* - *Theorists suggest more recent generations are at a higher risk for depression because of the rapid changes in social values* beginning in 1960's *and the disintegration of the family unit.* - *Younger generations have unrealistically high expectations for themselves that older generations did not have.* Gender Differences: - *Men are more likely to turn to alcohol to cope with and deny their depression. Therefore, more likely to develop disorders like alcohol abuse.* - *Women are more likely to ruminate about their feelings/problems,* which makes them *appear to be more likely to develop depression.* Due to gender socialization, *women tend to be more interpersonally oriented.* Women's strong interpersonal networks *give them support* but *women are more likely to report depressive symptoms when bad things happen to others or when there is conflict in their relationship. Women also base their self-worth on the health of their relationships.* - Women in most societies have *less status and power* and as a result, they *experience more prejudice, discrimination, and violence. Sexual abuse, particularly in childhood, contributes to depression in women throughout their lifetime.* - *Social norms make it acceptable for men to turn to alcohol and for women to ruminate.* Ethnicity/Race Differences: - *African Americans have lower rates of depression than Caucasian Americans. They also have high rates of anxiety disorder* (suggesting the stress of their social status may make them prone to anxiety disorder rather than depression). - *High rates of depression in Native Americans*, especially the young. *Youth is tied to poverty, hopelessness, and alcoholism.* - *Asain Americans show lower rates of depression* than other ethnic groups. Because of cultural differences, *people of Asain descent may experience depression in a more somatic form* (report headache rather than negative thinking).

Schizoaffective Disorder

*Full blown Schizophrenia with an affective/mood disorder* (bipolar/depression). - At least *2 weeks of only schizophrenia and then the mood disorder sets in.* - *Prominent mood symptoms meeting the criteria for a major depressive or manic episode.*

Delusional Disorder

*Functions regularly* with work, school and relationships. They have *one central delusional theme but the rest of their word is just fine.* They have *no negative symptoms, hallucinations, or disordered thought.* - *Erotomania- the idea that there is an intimate relationship between the person and a high-status person when they don't even know each other.* - *Obsessional jealousy- what we are used to. Person gets jealous and then calms down.* - *Delusional jealously- can't be talked out of it.* - *Delusions can be bizarre and non bizarre.* - The living museum.

Biological Treatments for Mood Disorders- Mood Stabilizers

*Lithium*- -*Improve functioning of the intercellular processes found in mood disorders.* - *People with bipolar disorder take lithium even without symptoms of mania or depression to prevent relapse.* - Quite effective in *reducing suicide risk.* - Small difference between an effective dose and a toxic dose. Needs to be *carefully monitored by physician.* - Lithium is adequate to *relieve symptoms* but not so large to induce toxic side effects. - Side effects range from annoying to life- threatening- pain, nausea, vomiting, diarrhea, tremors, twitches, blurred vision, problems in concentration and attention that interfere with ability to work, diabetes, hypothyroidism, kidney dysfunction and can contribute to birth defects if taken during first trimester of pregnancy. *Anticonvulsant and Atypical Antipsychotic Medications:* - *Valprate*- *first discovered as meds that help reduce seizures helped stabilize mood in people with bipolar disorder.* - Has fewer side effects and is used more often than carbamazepine. - Another antiepileptic medication- *Carbamazepine- has been approved for use in treating bipolar.* - Side effects include blurred vision, fatigue, vertigo, dizziness, rash, nausea, drowsiness, liver disease. - Both anti-epileptics can cause birth defects if taken while pregnant, do not prevent suicide as effective as lithium does, may work by restoring the balance between the neurotransmitter system in the amygdala. - *Atypical antipsychotic medications are also used to quell the symptoms of severe mania.* They *reduce functional levels of dopamine* and seem to be *useful in the treatment of psychotic manic symptoms.* Side effects: weight gain, and problematic metabolic changes. - With increased recognition of bipolar and related syndroms in children (disruptive mood regulation disorder) there have been an increase in the use of meds to treat kids (mood stabilizers, atypical antipsychotics and antidepressants).

Mood disorder with psychotic features

*Mood disorder appears at first and then psychotic features set in.* - Mood disorders cause biochemistry in the brain to change, which causes psychotic features to come into effect.

Biological Treatments for Mood Disorders- Newer Methods of Brain Stimulation

*Repetitive Transcranial Magnetic Stimulation (rTms)*- scientists *expose clients to repeated, high-intensity magnetic pulses focused on particular brain structures.* - Researchers have targeted the *left prefrontal cortex which tends to show abnormally low metabolic activity in people with depression.* - Patients are *awake to avoid possible complications of anesthesia.* *Vagus Nerve Stimulation (VNS)*- *Vagus nerve* (part of autonomic nervous system) *carries info from the head, neck, thorax, and abdomen to several areas of the brain including the hypothalamus and amygdala which are involved in depression.* - *Vagus nerve is stimulated by small electronic device implanted under skin in the left chest wall.* *Deep Brain Stimulation-* - *electrodes are surgically implanted in specific areas of the brain.* connected to a pulse generator that is placed under skin and *stimulates brain areas relieving interactable depression.*

Biological perspective of Schizophrenia

*Schizophrenia is a biologically based disorder.* There is widespread agreement b/w the other perspectives. Genetic Contributors: - *No single genetic abnormality accounts for this disorder.* - The *closer relation* to the schizophrenic person *increases likely of shared schizophrenia.* - First degree relatives of a person with schizophrenia, who shares about 50 % of genes with that person, has about a 10 person chance of developing it. - General population has a risk of 1-2 percent. - Several adoption studies addressing the question of genes versus environment indicates that genetics plays an important role in schizophrenia. - *Twin studies show 50% concordance rate indicating genetics is involved.* Brain abnormalities: - *Gross reduction in gray matter in the cortex* of schizophrenic people, particularly in the *medial, temporal, superior temporal, and prefrontal areas.* - *People at risk because of family history but haven't developed the disorder show abnormalities in the prefrontal cortex* (important in language, emotional expression, planning, and carrying out plans). The prefrontal cortex connects to all other cortical regions as well as the limbic system (involved in emotion and cognition) and to the basal ganglia (involved in movement). - The prefrontal cortex undergoes development during adolescents and early adult years, indicating the emergence of this disorder during those ages. - *The hippocampus* (formation of long term memories) *differs in schizophrenic people.* Schizophrenic people *show abnormal hippocampus activity when encoding information for storage in their memory.* - *Show abnormalities in the volume and shape of their hippocampus*, which are shown in first degree relatives. - *Brains show abnormalities in white matter, which are present even before they develop overt symptoms.* This suggests *these are early signs rather than consequences.* - *White matter abnormalities create difficulties in the working together of various areas of the brain, which leads to severe deficits seen in schizophrenia.* - Show *enlargement of ventricles* (fluid-filled spaces in the brain), *suggesting atrophy, or deterioration in other brain tissue.* Causes them to *tend to show social, emotional, and behavioral deficits long before they fully develop symptoms.*

Substance use with psychotic features

*Substance use first and then psychotic features set in as a result of the substance use.* - *Addictive substances cause the release of dopamine.* Having *too much dopamine leads to psychotic features.* If someone has a *predisposition for schizophrenia, one use of substances can bring on symptoms of schizophrenia.*

Biological Treatments for Mood Disorders- Light Therapy

*Where SAD* (where people become depressed in winter months with less daylight hours. Moods are improved in summer with more daylight hours) *patients are exposed to bright light for a few hours each day in winter months.* - Significantly reduces symptoms. - 57% of people with SAD who completed a trial of light therapy showed remission of their symptoms and 79% of those who had both light therapy and cognitive therapy showed remission, compared to 23% of a control group who didn't receive intervention. - *One theory is that light therapy reduces seasonal affect disorder* (SAD) *by resetting circadian rhythms, natural cycles of biological activity that occurs ever 24 hours.* These *rhythms produce several hormones and neurotransmitters regulated by internal clocks* but can be *affected by environmental stimuli (light).* People with *depression show dysregulation of their circadian rhythms.* Light therapy may *work to reset these rhythms and normalize the production of hormones and neurotransmitters.* - Another *theory is that light therapy works by decreasing levels of melatonin,* which is secreted by the pineal gland. Decreasing melatonin levels can *increase the levels of norepinephrine and serotonin, reducing the symptoms of depression.*

Brief Psychotic Disorder

*a sudden onset of delusions, hallucinations, disorganized speech, and/or disorganized behavior.* - *Episode lasts between one day and 1 month, after which the symptoms completely remit.* - *The faster the symptoms set in, the faster they go away.* - 1 in 10,000 women experience a brief psychotic disorder after giving birth. - *High risk of relapse, but most people show an excellent outcome.*

Cognitive Symptoms for Depression (thoughts)

- (not content, but process) - negative, racing, irrational, catastrophic thoughts. - worry (repetitive thoughts are what worry is). - self- destructive. - trouble concentrating/ memorizing information (making it hard to study when depressed). - narrow thoughts (normally people have a broad range of thoughts. A suicidal person only has one thought of "Should I live or die" and they aren't thinking of anything else). - trouble decision making (when depressed, the person isn't thinking at their best and isn't realizing it). - trouble thinking clearly and organizing thoughts. - Lose touch of reality in severe cases. - Might have delusion that they committed a terrible sin.

Diagnosis of Schizophrenia

- *1883, Emil Kraeplin labeled it as "dementia praecox"* because he believed that the *disorder results from premature deterioration of the brain.* - *Eugen Bleuler* labeled it as *schizophrenia* because he believed this disorder *involved the splitting of usually integrated psychic functions of the mental associations, thoughts, or emotions.* He argued that the *primary problem of symptoms is the breaking of association among thought, language, memory, and problem-solving.* The *attentional problems are due to a lack of necessary links between aspects of the mind* and the *disorganized behavior is due to an inability to maintain a train of thought.* - Acute phase: symptoms acutely present for at least 1 month. - *Individuals must have symptoms for at least 6 months that impair functioning, cannot be due to ingestion of substances, a medical disease, or a mood disorder.* - During the first 6 months before and after the active phase, the individual may show predominantly negative symptoms. - *Prodromal symptoms- before the acute phase.* - *Residual symptoms- after the acute phase.* - They may have *strange perceptual experiences* (sensing another person is in the room) *without reporting full-blown hallucinations.* - They may *speak in somewhat disorganized or tangential way but remain coherent.* - *During the prodromal phase, family members may say the person is "gradually slipping away". * - Left untreated, schizophrenia is both chronic and episodic; after the first onset of acute episode, individuals may have chronic residual symptoms punctuated by relapse into acute episodes. - The odd behaviors can resemble symptoms of autism. - Diagnosis criteria specify that it can only be diagnosed if delusions and/or hallucinations are clearly present.

Suicide- Suicide in Children and Adolescents

- *3rd most common cause of death in adolescents (13-24 years old)* - *4th most common cause of death in adults.* - *5th most common cause of death in children (under 15 years old).* - *Adolescents are experiencing crisis' for the first time and don't know how to deal with it so it leads them to a higher risk of suicide. They don't realize that life won't always be like that. * 3 reasons why suicide may become more common in adolescents than childhood- - *the rates of several types of psychopathology tied to suicide including depression, anxiety disorders, and substance abuse, increase in adolescents*. - adolescents are more sophisticated than children in their thinking and can *contemplate suicide more clearly.* - adolescents simply *have readier access to the means to commit suicide* than do children. - Same case as adults, girls are more likely to attempt than boys, but boys are more likely to succeed. Males are 6 times more likely than females in this age range to commit suicide. - Homosexual and bisexual adolescents have rates of suicide 2-6 times higher than heterosexual adolescents. - *Hispanic females have high rates of suicidal thoughts and plans and attempted suicides.* - Luis Zayas suggest these high rates are linked to clashes between Hispanic girls, who are highly acculturated to American values, and their parents, who may hold traditional cultural values of familism and may reject their daughter's bid for independence. -*"Fad Suicides"- With the youth, a kid kills themself and there's alot of attention, love and support towards family and child. Other young kids see this outpouring love and think they want it too (they don't realize that if they kill themselves, they won't experience the love they are craving) and kill themselves too.*

Rapid Cycling Bipolar Disorder

- *4 or more mood episodes that meet criteria for manic, hypomanic, or major depressive episode within 1 year leads to diagnosis of this disorder.*

Types of hallucinations

- *Auditory*- *person hearing something that isn't there.* (hearing voices) *Most common*. Often have a *negative quality* of criticizing the person or telling them to harm themselves or other people. - *Visual*- *seeing something that isn't there but it looks real to them.* - *Tactile*- *touch*- *feeling something that isn't there.* Example: spiders crawling under skin- the belief is a somatic delusion, the feeling is tactile hallucination. - *Olfactory*- *smell*- *smelling something that isn't there.* Example: a person has a delusion that little people are living in her attic and putting bad smells in her house. - *Gustatory*- *taste*- *tasting something that isn't there.*

Theories of Bipolar Disorder- Subcultural and Functional Brian Abnormalities

- *Bipolar disorder is associated with abnormalities in the structure and functioning of the amygdala.* - In contrast to depression, bipolar disorder has not consistently been associated with alterations in the size or functioning of the hippocampus. - *Striatum* (part of a structure called the basal ganglia) is involved in the *processing of environmental cues of reward.* This area of the brain is *activated abnormally in people with bipolar disorder but not in people with major depression*, suggesting that *people with bipolar may be hypersensitive to rewarding cures in the environment.* - A *circuit from the prefrontal cortex through the striatum to the amygdala is involved in the adaptation to changing contingencies of reward.* Individuals with bipolar have *abnormalities in the functioning of this circuit that leads them to have inflexible responses to reward.* When they are in a manic phase, they inflexibly and excessively seek reward. When in a depressive phase, they are highly insensitive to reward. - People with bipolar respond to incentives and social rewards with more positive emotion- reactivity is linked with sensitivity in the striatum. - *Young people with bipolar have abnormalities in the white matter of the brain, particularly the prefrontal cortex.* White matter abnormalities are found in children at their first episodes of bipolar before they are medicated and in children at risk for bipolar because of family history. - *White matter abnormalities could result in the brain's prefrontal area having difficulty communicating with and exerting control over other areas like the amygdala, leading to the disorganized emotions and extreme behavior characteristic of bipolar disorder.*

Theories of Bipolar Disorder- Genetic Factors

- *Bipolar disorder is strongly linked to genetic factors but no specific genetic abnormalities that contribute to this disorder are known yet.* 80% concordance rate. - *First degree relatives* of people with bipolar disorder have 5-10 times higher rates of both bipolar disorder and depressive disorder than relatives of people without bipolar disorders. - *Identical twins* of individuals with bipolar disorder are 45-75 times more likely to develop the disorder than people in general population.

Theories of Depression- Biological theories- Structural and Functional Brain Abnormalities

- *Catecholamine Hypothesis: If the person doesn't have enough norepinephrine, they feel depressed.* - *Permissive Hypothesis: If the person doesn't have enough serotonin, it permits the level of norepinephrine from being enough.* - *Low levels of Gaba* appears to be tied to depression. Gaba is important in the *production of norepinephrine.* If the person *doesn't have enough Gaba, there won't be a production of norepinephrine.* - *Abnormalities in at least 4 areas of the brain with depression- the prefrontal cortex, anterior cingulate, hippocampus, and amygdala.* * Prefrontal cortex facts- - Critical functions of the *prefrontal cortex include attention, working memory, planning, and novel problem-solving.* - *Reduced metabolic activity* and a *reduction in the volume of grey matter* in the prefrontal cortex particularly on the *left side* in people with depression. Electroencephalographic (EEG) studies show lower brain-wave activity on left side of prefrontal cortex in depressed people. - The *left prefrontal cortex is involved in motivation and goal orientation, and inactivity* in this region may be associated with *motivational difficulties like those seen in depression.* - Successful treatment of depression with *antidepressant medications is tied to increase in metabolic and brain-wave activity in the left prefrontal cortex.* * Anterior cingulate- - the *subregion of the prefrontal cortex* that plays an important *role in the body's response to stress, in emotional expression, and in social behavior.* Depressed people have *different levels of activity in the anterior cingulate* relative to controls. Altered activity can be associated with *problems in attention, planning of appropriate responses, coping, and with anhedonia found in depression.* * Hippocampus- - *Critical in memory and fear-related learnings.* - *Smaller volume and lower metabolic activity in the hippocampus* in people with major depression. - *Damage to the hippocampus* can be *the result of chronic arousal of the body's stress response.* - People with depression show *chronically high levels of the hormone cortisol from overreaction to stress* and their body *can't return to normal levels of cortisol.* - *Antidepressants or electroconvulsive therapy results in the new growth of cells.* * Amygdala- - *Abnormalities in structure and functioning of the amygdala are found in depression.* - *Enlargement and increased activity* in people with mood disorders. - Differences in brain functions may *begin emerging in childhood even before a depressive episode.* Girls are at high risk for depression (because their mothers have had depression) exhibit decreased neutral reactivity to rewarding stimuli.

Disorganized behavior

- *Frightens others* sometimes. - Display *unpredictable and untriggered agitation.* - May occur in *response to hallucinations or delusions.* - People with schizophrenia often have *trouble organizing their daily routines of bathing, dressing properly, or eating regularly.* - *Catatonia is disorganized behavior that reflects unresponsiveness to the environment.* Ranges from lack of response to instructions (negativism) to showing rigid, inappropriate or bizarre posture to a complete lack of verbal or motor responses. In catatonic excitement, the person shows *purposeless and excessive motor activity for no apparent reason.* Person may *articulate a number of delusions or hallucinations or may be incoherent.*

Suicide facts

- *Completed suicide- ends in death.* - *Suicide attempts- may not end in death.* - *Suicidal ideation- thought.* - *Suicide attempts are 20 times as common as completed suicide. * - Accurate *rates are hard to obtain because the stigma against suicide is a great incentive for labeling a death anything but a suicide.* - *Mental disorders* that are associated with an elevated risk for suicide are- *mood and personality disorders, schizophrenia, anorexia, and PTSD.* - Individuals with mood disorders (Major Depressive Disorder, Persistent Depressive Disorder and Bipolar Disorder) have 6% risk, 94% don't kill themselves. - 90% of people who commit suicide have clinical depression. - Previous attempt increases risk of actually killing themselves by 40 times. - *Military*- especially those that have been in combat. Military people have access to firearms. - *Doctors*- They see a lot of trauma and suffering all day. - *Golden Gate Bridge Study*-interviewed people who jumped off the Golden Gate bridge in a suicide attempt and lived to tell about it. Psychologists were able to get info on the level 10 method for suicide. *The most interesting thing from this study was that all of those who survived the jump said the immediately regretted jumping as soon as they jumped.*

Cultural factors in Schizophrenia

- *Culture plays a strong role.* - *More benign course in developing countries* than in developed countries. - In countries such as *India, Nigeria, and Colombia are less disabled by the disorder* in the long term than people in Great Britain, Denmark, and the U.S. - *Social environment in developing countries may facilitate adaptation and recovery.* In developing countries, *broader and closer family networks surround people with schizophrenia. This lowers relapse rates for family members with schizophrenia.*

Cognitive Deficits of Schizophrenia

- *Difficulty focusing and maintaining their attention* at will. - *Deficits in working memory*, which is the ability to hold information in memory or manipulate it. - *Difficult for them to pay attention to relevant information* and *suppress unwanted or irrelevant information.* Difficulty to *distinguish the thoughts in their mind that are relevant to the situation and to ignore stimuli in their environment that are not relevant to what they are doing.* - May *contribute to hallucinations, delusions, disorganized thought and behavior and avolition (low motivation) of people with schizophrenia.* - *Hard for them to maintain a coherent stream of thought or conversation, perform a basic task, or distinguish between real and unreal.* - Longitudinal studies suggest that many *people show these cognitive deficits before they develop acute symptoms.* These cognitive deficits often do not improve over time or with treatment. These deficits may contribute to the development of other symptoms.

Interpersonal and Social Rhythm Therapy (ISRT)

- *Enhancement of interpersonal therapy designed specifically for people with bipolar disorder.* - *Combines interpersonal techniques with behavioral techniques to help the client maintain regular routines of eating sleeping and activities and stability in relationships.* *Reduces relapse and improves functioning.* - By *self-monitoring*, therapists can help clients *understand how a change in sleep patterns, circadian rhythms, and eating habits can provoke symptoms*. Work together to *develop a plan to stabilize routines.* *Learn how stressors in family and work relationships affect their mood and develop better strategies for coping with these stressors.* - *Show fewer symptoms and relapses over time* than patients who don't receive ISRT.

Suicide- Ethnic and Cross-Cultural Differences

- *European Americans have higher suicide rates than all other groups.* 12 people per 100,000. - Native Americans are close behind with 11 people per 100,000. *Suicide among Native Americans is tied to poverty, lack of education and hope, discrimination, substance abuse, and the easy availability of firearms.* - *African American male rates have increased greatly in recent decades.* - There is a cross-national difference in suicide rates, with high rates in much of Europe, the former Soviet Union and Chine and lower rates in Latin America and South America. The rates in Australia, the U.S., Canada, and England fall between the two extremes. - *The differences may be due to cultural and religious norms. Followers on religions that expressly forbid suicide are less likely to attempt it.*

Behavioral Therapy for mood disorders

- *Focuses on increasing positive reinforcers and decreasing aversive experiences by helping the depressed person change his or her patterns of interaction with the environment and other people.* - *First phase:* functional analysis of the connections between specific circumstances and the depressed person's symptoms. The analysis helps the therapist pinpoint the behaviors that need attention. *It helps the client understand the connections between their symptoms and their daily interactions/activities.* - Once circumstances that precipitate depression are identified, *the therapists help the client change their environment that contributes to their depression* (isolation). The therapist *teaches the client skills for changing their negative circumstances* (negative social interaction), *relaxation techniques* (managing mood in unpleasant situations).

Persistent Depressive Disorder

- *Formerly dysthymic disorder and chronic major depressive disorder.* - *Depressed mood for most of the day, for more days than not for at least 2 years.* - *Dysthymia and Major Depressive Disorder periods. A person has constant mild depression with spikes/periods of major depression.* - In children and adolescents- requires depressed or irritable mood for at least 1 year duration and at least 2 or more of the following symptoms: poor appetite, insomnia or hypersomnia, lower energy or fatigue, low self-esteem, poor concentration and/or hopelessness. - During these 2 years (1 year in youth) the person must never be without the symptoms for longer than 2 months. - Individuals with Persistent Depressive Disorder *show a higher risk for comorbid disorders* than those with Major Depressive Disorder alone, particularly *anxiety and substance use disorders*, and tend to *experience worse functional consequences.* - Over 70% of those diagnosed with Major Depressive Disorder or Persistent Depressive Disorder also have another psychological disorder at some time in their lives. *The most common disorders that occur with depression are substance abuse (alcohol abuse), anxiety disorders (panic disorder), and eating disorders. Sometimes depression precedes and may cause the other disorder.*

Bipolar II: Hypomania + Depression

- *Have to have depression (meets criteria for major depression).* - *Hypomania- low levels of mania that aren't severe enough to interfere with daily functioning, do not involve hallucinations or delusions and last at least 4 consecutive days.* - Hyper= high. Hypo= low. - Only 0.4% of people will experience bipolar II.

Negative Symptoms of Schizophrenia

- *Loss of expected qualities- normal behaviors of the disorder are missing.* *The 5 A's:* - *Alogia*- *Poverty of content- saying words but not communicating, no message, no content.* *Perseveration: saying something over and over again.* Once repeated enough, *there isn't a message anymore.* *Clanging: rhyming of words.* Doesn't mean anything. No content/message. Just words rhyming. - *Avolition*- *low motivation*- common in depression too. - *Anhedonia*- *loss of pleasure in previously pleasurable experiences.* - *Affect*- (flat, inappropriate)- *Emotional state*- *Flat: person doesn't have shifts in mood during conversation.* "monotone voice" but in emotional state- its stays the same all the time. *Inappropriate: emotional state doesn't match situation.* Laughing at a funeral but the person is *laughing at what is going on in their head in a location where their reaction is inappropriate.* - *Attention- trouble focusing.*

Mania in bipolar disorder

- *Mood: elevated, expansive, euphoric, irritable.* Elevated/euphoric mood= feeling so good that they behave in dangerous ways. Person feels so good they think they can fly and accidentally kills themselves. These moods are still mixed with irritation and agitation. Expansive mood= The positive mood is generalized- transferred to everything. A person is amazed at an average table. - *Grandiosity: person has exaggerated sense of self-importance* and feels very special and too good compared to others. These thoughts are delusional and hallucinations. Content of delusions and hallucinations vary person to person. - *Increased energy and activity: person cannot sit down- they keep going and going, pacing.* -lack of regard for consequences of behavior & - poor judgment: Person thinking they can fly is putting them in danger. this lack of regard for consequences of behavior is poor judgment. - *Flight of ideas: racing thoughts that cant slow down.* the person thinks these are fantastic ideas/thoughts. - *Decrease in need to sleep: Person has no sleep for long period of time (several days).* They are too excited and are going and going and don't feel the need to sleep. Might sleep for an hour and then get up and go. - *Distractability: easily distracted.* - *Pressured speech: Often called "push of speech"- person has all these ideas and thoughts and feels a constant need to talk.* the talking is so rapid and the person keeps going on to different topics and is very hard, almost impossible, to stop them.

Stimulants: Caffeine

- *Most heavily used stimulant.* - average 2 cups a day - stimulates *central nervous system increasing levels of dopamine, norepinephrine, and serotonin.* Increases *metabolism*, body temp, and blood pressure. appetite wanes, feel more alert. upset stomach, heart beat irregular. trouble sleeping. - Large doses cause extreme agitation, seizures, restart failure and cardia problems. - experiences significant distress or impairment in functioning as a result of symptoms. - caffeine uses develop tolerance and undergo withdrawl if stop ingesting.

Suicidal- Nonsuicidal Self-Injury (NSSI)

- *Most often in adolescents- repeatedly cut, burn, puncture, or otherwise significantly injure their skin with no intent to die.* - Relatively common. 13-45 % of adolescents. - Dramatic increase in NSSI in recent years. - *Increased risk for suicide attempt.* - Elevated rate across *most mood and anxiety disorders and is a prominent feature of borderline personality disorder.* - Functions as a way of *regulating emotions and/or influencing the social environment.* - People who engage in NSSI report the experience of *feeling the pain and seeing the blood actually calms them and releases tension.* - People with NSSI do *have more difficulty regulating their emotions and use their behavior to regulate distress.* - Self-injury also *draws support and sympathy from others or may punish others.*

Theories of Depression- Biological theories- Neuroendocrine Factors

- *Neuroendocrine system* regulates important hormones which affect *basic functions like sleep, appetite, sexual drive, and ability to experience pleasure.* - 3 components of the neuroendocrine system- the *hypothalamus, pituitary, and adrenal cortex.* They work together in a biological feedback system *interconnected with the amygdala, hippocampus, and the cerebral cortex.* This system is known as the *hypothalamic-pituitary-adrenal axis (HPA) that is involved in fight or flight response.* - People with depression tend to show *elevated levels of cortisol and CHR,* indicating *chronic hyperactivity in the HPA axis and difficulty in the axis's returning to normal functioning following a stressor.* - People exposed to chronic stress may *develop poorly regulated neuroendocrine systems* and when they are exposed to even *minor stress* later in life the *HPA axis overreacts and doesn't return easily to the baseline.* The overreaction *changes the functioning of the monoamine neurotransmitters and an episode of depression is likely to follow.* - *Early traumatic stress* (sexual abuse, neglect, exposed to chronic stress) may lead to some of the *neuroendocrine abnormalities* in people with depression. Children exposed to abuse or neglect have an exaggerated or blunt reaction to stress. - *Women who were sexually abused as children show altered HPA responses to stress as adults* even if they aren't stressed. - Changes in *ovarian hormones, estrogen, and progesterone affect the serotonin and norepinephrine neurotransmitter systems and could affect mood.* There are increases in a depressed mood when levels of estrogen and progesterone are in flux (pregnancy, postpartum period, premenstrually). Girls show an increase in depression during age 13-15 because of hormonal changes in puberty. The hormonal changes of puberty, the menstrual cycle, the peripartum period, and menopause may trigger depression only in women with genetic or other biological vulnerability to the disorder.

Theories of Depression- Biological theories- Neurotransmitter theories

- *Neurotransmitters implicated most often in depression- monoamines, norepinephrine, serotonin, and dopamine.* - These neurotransmitters are found in *limbic system- a part of the brain associated with regulation of sleep, appetite, and emotional processes.* A number of processes within brain cells that affect the functioning of neurotransmitters may go awry in depression. - *Serotonin and norepinephrine are released by one neuron* into the synapse and then bind to receptors on another neuron. The *release process is abnormal in depression.* Also, the *receptors for serotonin and norepinephrine on the postsynaptic neurons may be less sensitive in depression* or malfunction.

Bipolar I: Manic Episodes

- *No depression required- only manic episodes required.* - Almost all cases eventually fall into *depressive episode; mania without depression is rare.* - Some people with bipolar I have depression as severe as major depressive disorder. Other people with bipolar I have very mild and infrequent episodes of depression. Some people have mixed episodes with criteria for full manic and at least 3 key symptoms for major depressive disorder episodes in the same day every day for at least one week. - Only 0.6% of people will experience bipolar I.

Postitive Symptoms of Schizophrenia

- *Overt expression of unusual qualities.* Expression of something we can understand if described. - *Delusions.* - *Hallucinations.* - *Disordered thought.*

Substance use myths

- The myth of a person being able to function means they don't have a substance use problem is false. *A person with a substance use problem will still show up to work every day but their performance is poor.* - The myth that the person has to use it a certain number of times a day to have a problem is false. *A person can go years without a drink and still considers themselves an alcoholic because when they did use, it was excessive and interfered with their life.*

Theories of Depression- Psychological theories- Behavioral theories-

- *People who have been cut off from their reward system* (a loved one dies or relationship ends). The *positive reinforcement is removed and the person gets depressed.* *Consistent punishment* (constantly being yelled at from boss at work) leads to depression. *Circumstances* cause depression (people will often become depressed while in prison and depression goes away once released from prison). - These theories focused on the *roles of uncontrollable stressors in the production of depression.* - *Behavioral theories* of depression suggest that *life stress leads to depression because it reduces the positive reinforcers in a person's life.* The person begins to withdraw, which leads to further reduction in reinforcers, which leads to more withdrawal, creating a *self-perpetuating chain*. - Theory suggests that *such a pattern is likely in people with poor social skills* because they are more likely to experience rejection and withdraw in response to rejection. Once a person begins to engage in depressive behaviors, these behaviors are reinforced by the sympathy and attention they engender in others. - *Learning helplessness theory*- another behavioral theory- suggests that an *uncontrollable negative event is most likely to be the type of stressful event that leads to depression.* - *People lose their motivation and reduce their actions that might control the environment, which leads them to be unable to learn how to control situations that are controllable.* - Similar to the symptoms of depression- *low levels of motivation, positivity, and indecisiveness.*

Types of Delusions

- *Persecution (paranoia)*- *the most common.* *Someone is out to harm you in some way if that person doesn't like them.* Example: thinking pharmacist doesn't like the schizophrenic person and they think the pharmacist is trying to poison them because the pills are a different color. - *Identity*- *Someone thinks they are someone else* (typically a famous person or of a higher power). During the episode, the person truly thinks they are another person and after the episode, the person says they truly thought they were that other person for a period of time. The person can believe they are another person who has already died in real life. It can happen with roles, too. A person can believe they are a doctor or even Jesus or another important role/religious figure. The person can believe they are different people by episode to episode. - *Reference*- *There is a specific significance tied to a person or object that isn't really there.* Example: a person thinking Oprah is sending them a special message everytime she is on TV. - *Grandiose*- *person thinking they are unusually special, unique or have a power.* The past example of a person thinking they can fly is an example of grandiosity, which is a mild form of grandiose. - *Somatic*- *bodily*- *thinking something has happened to their body.* Not in touch with reality. The example of the person thinking they are living without internal organs is a somatic delusion. - *Thought control*- *Something is going wrong with the person's thoughts.* *Insertion:* thinking *someone else is injecting/putting these thoughts in the person's brain and that they wouldn't be thinking those thoughts if someone wasn't placing them there.* *Broadcasting: Thinking that everyone is going to know your thoughts, thoughts will be broadcasted without communicating them.*

Personality and Cognitive Factors in Suicide

- *Personality characteristic that seems to predict suicide best is impulsivity*- the general tendency to act on one's impulses rather than to inhibit them when it is appropriate. - When impulsivity is overlaid on another psychological problem (such as depression, substance abuse or living in a chronically stressful environment), it can be a potent contributor to suicide. - Children of parents with a mood disorder who also scored high on measures of impulsivity were at much greater risk of attempting suicide. - *The cognitive variable that has most consistently predicted suicide is hopelessness* Thomas Joiner (2005) says hopelessness is feeling like a burden and never belonging- especially linked to suicide. It may be one reason why people who are suicidal often do not seek treatment.

Bipolar Disorder

- *Previously known as manic depressive disorder/illness.* - *Less common than depressive disorders.* - 4% in U.S. are diagnosed. 25 years ago 1% were diagnosed. -2% around the world are diagnosed. - *U.S.'s high rate of diagnosis compared to the rest of the world suggests we are either overdiagnosing or we just have higher rates.* - Average age of onset is *late adolescence to early adulthood* (20-30) but also in older adults. - Bipolar disorder is all about *mania and sometimes depression.* It is alterations between *periods of depression*, not someone switching between moods from moment to moment. *it occurs over a long period of time- the person can be in a depression for months and then go months without depression.* - *Men and women are equally likely to experience this disorder- no consistent difference among race, gender, or culture.* - These facts suggest that *biological factors may be more responsible for bipolar disorder than for depressive disorder.* - Like in depression, often face *chronic problems on the job or in their relationships.* - People with bipolar disorder also *meet criteria for other psychiatric disorders* (most often anxiety disorder). - Bipolar disorder often tied to *substance abuse* (such as alcohol or drugs). - Most people with bipolar disorder, especially in developing countries, do not receive treatment. - *Some of the most influential people in history had bipolar disorder or depression* Abraham Lincoln, Alexander Hamilton, Winston Churchill, Napoleon Bonaparte, Benito Mussolini, Martin Luther, George Fox have been diagnosed by psychiatric biographers as having periods of mania, hypomania, or depression. - During periods of depression, these leaders often were incapacitated. During periods of mania, they accomplished extraordinary feats and devised brilliant and daring strategies for winning wars and solving national problems and had the energy, self-esteem, and persistence to carry out these strategies. - *Writers, artists, and composers have a higher than normal prevalence of mania and depression.* Artists and writers experienced 2 or 3 times the rate of mood disorders, psychosis, and suicide attempts than comparably successful people in business, science, and public life. - *Children can be misdiagnosed with bipolar when they really have ADHD* (similar symptoms) and vice versa. Children with bipolar disorder have trouble in school.

Theories of Depression- Freudian/psychodynamic-

- *Some underlying conflict* or trauma that *takes the form of depression.* Believes depression is *anger turned inward.*

Family Focused Therapy (FFT)

- *designed to reduce interpersonal stress in people with bipolar disorder (within the context of families).* - *Educated about the disorder and trained in communication and problem-solving skills.* - Adults receiving FFT show *lower relapse rates over-time.* - FFT to adolescents have *promise in helping youths and their families manage symptoms and deduce impact of the disorder in the adolescents' functioning and development.* - Patients with bipolar disorder are *strongly affected by social environment.* Including family appears to be an overall positive addition to treatment.

Depressants: Benzodiazepines an Barbiturates

- sold by prescription. - Sedatives for treatment of anxiety and insomnia. - Muscle relaxers and antiseizure. - Abused in combo with psychoactive substances to produce feelings of euphoria or release agitation caused by other substances. - Decreases in blood pressure, respiratory rate, and heart rate. - Overdose linked to use with alcohol.

Jeopardy Game

- *Substance*- Any natural or synthesized product that alters perceptions, thoughts, emotions, and behaviors. - *Oral use* (swallowing)- snorting, smoking, or injecting to get drugs to the brain faster with this form of use. - *Behavioral intervention*- intervention based on adverse classical conditioning, such as the drug Antabuse, fall into this category of treatment. - *Binge drinking*- the consumption of 4 or more alcoholic drinks for women and 5 for men in a short amount of time. - *Gambling*- this is the newest diagnosis in the DSM-5 section on substance and addictive disorders. - *blackout*- Amnesia for events occurring after the consumption of a large amount of alcohol. - *Substance use disorder*- the primary diagnostic feature for this disorder is consuming lots of alcohol and drugs. - *Genetics*- Family history suggesting that genetics accounts for 50% of a person's risks for substance use disorders. - *Stimulant*- Cocaine. - *Depressant*- Benzodiazepine. - *Alcoholics Anonymous*- This disease model for alcoholism, which is used by some for recovery is a popular form of intervention. - *Cognitive intervention*- intervention based on identifying beliefs and expectations associated with drinking fall into this type of intervention. - *Nucleus accumbens*- brain structure in limbic system is part of the neural pathway for increase pleasure with drug use. - *Relapse*- the central feature of substance abuse is addressed in prevention programs. - *Intoxication*- Changes in behavior and emotion resulting from effects of a substance. - *Depressant*- A substance that slows the central nervous system. - *Red wine*- this alcoholic beverage in moderation is associated with health benefits. - *Social*- Interpersonal relationship problems created by substance use are called social impairment. - *Occupational*- Work-related difficulties caused by substance use are called occupational impairment. - *Stimulant*- Methamphetamine. - *Intoxication*- In most states, the blood alcohol level of .08 is the legal definition of this. - *Withdrawal*- The behavior and physiological effects of stopping heavy long-term substance use. - *Dependence*- Substance abuse and _____ disorders were combined into a single disorder in the DSM-5. - *Depressant*- Valium. - *Opioids*- Morphin, Heroine, Codine, are classified as this form of substance. - *Gaba*-The anti-anxiety of alcohol occur by enhancing the activity of this neurotransmitter. - *Delirium Tremens, DT's*- The 3rd, final and most dangerous stage of alcohol withdrawal is called this. - *Opioids*- Methadone helps reduce extreme withdrawal symptoms of this drug. - *Craving*- Chronic use of drugs reduces dopamine levels causing this condition of wanting more drugs. - *Stimulant*- Nicotine.

Delusions

- *Thoughts.* - *Extremely irrational beliefs held despite all evidence to the contrary. They cannot be talked out of their beliefs.* Bizarre vs. Non- Bizarre: - *Bizarre- never going to happen, impossible.* Example: A person living without their organs. - *Non- Bizarre- not happening, but can happen.* Example: CIA spying. - Delusions occur in other disorders too. - *Content of delusions differ across countries. Reflects differences in the cultures' beliefs systems as well as differences in people's environments.* - Theorists suggest that off or impossible beliefs that are part of a culture's shared belief system cannot be considered delusions. People who hold extreme manifestations of their culture's shared belief system are considered delusions.

Prevalence and Course of Depressive Disorders- based on gender

- *Twice as many women are more likely to get diagnosed with depression than men.* Reasons behind the difference in gender: 1. The world does a *poor job at teaching little boys to express emotions* leading grown men to not tell anyone they are depressed. The world does a better job at teaching little girls to express emotions leading to grown women being more willing to express emotions. 2. *Men handle their depression differently* (substances) to reduce depression. 3. The *number of women sexually assaulted leads to higher number of depressed women.* 4. There is a *bias in diagnosis*. 5. *Combination of all of these possibilities.*

Genetic factors of Schizophrenia

- *Women* tend to have a *better prognosis*, are *hospitalized less often* and for *briefer periods*, show *milder negative symptoms between periods of active-phase symptoms*, have a *better social adjustment.* They are *more likely to have better prior history*, *graduate from college/high school*, *have a family*, and have *good social skills.* They also show *fewer cognitive deficits than men with the disorder.* - This is because the *onset of schizophrenia in women tends to be in the late twenties or early thirties*, whereas *men develop it in their late teens or early twenties.* - *Estrogen may affect the regulation of dopamine*, in ways that are *protective for women.* - The *pace of prenatal brain development is slower in males* and *place men at higher risk for abnormal brain development.* - *Exposure to toxins in utero increase risk of abnormal brain development and the development of schizophrenia.* *Males with schizophrenia show greater abnormalities in brain structure and functioning.* - *Both men and women* (with schizophrenia) *functioning seems to improve with age.* They find treatments and their families learn to recognize symptoms. The aging of the brain may reduce the likelihood of new episodes, this might be related to a reduction in dopamine levels in the brain with age.

Schizophrenia disorder

- *a thought disorder* (problems with thinking). - *Disorganized thinking* (something wrong with organization of thoughts). - *Psychosis- not in touch with reality.* - *"Split" from reality*, not personality (DID). - At times, *person can function normal but during actives periods of their illness, they lose touch with reality, their speech and thoughts are disorganized, and have a difficult time taking care of themselves.* - A person can have *multiple types of the different hallucinations/delusions at one time.* - *Delusions and hallucinations aren't required for diagnosis.* A person can have a *diagnosis with no delusions or hallucinations but have* the third criteria of *disordered thought.* - To be diagnosed, *the person has to have delusions and/or hallucinations and/or disordered thought. One of the three is required.* - *Disorganized behavior: unusual mannerisms, childlike behavior, strange clothing.* - *Social isolation/withdrawal:* Person is *suffering with the severe disorder and protects themselves by isolation.* People have trouble interacting with schizophrenic people and most of the time they are alone. - *Deterioration in functioning:* *functioning in social and occupational is dropped and never fully returns.* *The slower the symptoms come on, the slower they go away and less likely they are to ever fully go away.* - Duration: 6 mths. - Onset: *late teens to early 20's.* - 1% prevalence worldwide. - *Concordance rate of 50%* showing that there is are genetic contributions and other factors.

Controversial area of bipolar

- *bipolar disorder in youth.* - it was assumed that bipolar disorder cannot be diagnosed in reliably until individuals were in their late teens or early adulthood. - Researchers have been interested in *identifying early signs of bipolar disorder in children and young teens so interventions can be initiated and researchers can investigate the causes and course of the disorder in youth.* - Some children show the *alternating episodes of mania and depression interspersed with periods of normal mood characteristic of bipolar disorder* and other children show *chronic symptoms and rapid mood switches with frequent temper tantrums*- *these children are at an increased risk for developing anxiety and depressive disorders later in life and do not tend to develop the classic bipolar disorder.* - *it is difficult to distinguish the agitation and risky behavior that accompany mania in youth from the symptoms of ADHD* (hyperactivity, poor judgment, and impulsivity) *and from the symptoms of Oppositional Defiant Disorder* (chronic irritability, and refusal to follow the rules).

Theories of Depression- Biological theories- Genetic factors

- *first degree relatives of people with Major Depressive Disorder* are 2-3 times more likely to also have depression. - Twin studies show higher concordance rate for monozygotic twins (identical twins) indicating there is a genetic processes in the disorder. *The concordance rate for depression is 50%* (meaning that 50% of depression can be counted for as a genetic predisposition). In this study, if one twin has depression and the other twin does, that means there is a gene for depression. The concordance rate is the chances of one twin having depression and the other twin not having depression. There is an 80% concordance rate for bipolar disorders. - *Depression that begins early in life has stronger genetic base* than depression that begins in adulthood. - It's probable that *multiple genetic abnormalities* contribute to depression. - Serotonin transporter gene plays a role too. - Serotonin is one of the neurotransmitters implicated in depression. *Abnormalities on the serotonin transporter gene could lead to dysfunction in the regulation of serotonin, which in turn could affect the stabilities of individuals' moods.* - People with abnormalities on the serotonin transporter gene were at *increased risk for depression when they faced negative life events.*

Substance use

- *intoxication*- behavioral and psychological changes as a result of physiological effects of substance to the central nervous system. - *Setting can influence* types of intoxication people develop. - *Environment can influence* how maladaptive the intoxication is. (Drink only at home- less likely to harm themselves). - *Withdrawal*- set of physiological and behavioral symptoms result from using heavy and then stopping. - *Abuse*- recurrent use of substance results in significant harmful consequences. First, fails to fulfill important obligations at work, school or home. second, using substances where it's hazardous to do so. third, repeatedly has legal issues as result of substance use. fourth, continues to use despite social or legal issues. - *Dependence*- closes to what people consider drug *addiction*.

Cyclothymic Disorder: Low levels of Hypomania + Depression

- *low levels of already low mania.* - *Have to have depression.* - At least 2 years. - The hypomania and depressive symptoms are of insufficient number, severity or duration to meet criteria for hypomania or major depressive episode. - *During periods of hypomania, the person may function but during periods of depression, there is interference with daily functioning although the episodes are less severe than major depressive disorder.* - *increased risk of developing bipolar disorder.* - *Less severe but more chronic form of bipolar disorder.*

Opioids

- *morphine, heroin, codeine, methadone.* - sap of opium poppy. - *relieve pain.* - *Endorphins and enkephalins are our natural opioids.* - Morphine used a pain reliever until found highly addictive. - Heroin developed from morphine in 19th central for medical purposes. - when used illegally, opioids often are injected into veins. sensation in abdomen like thrill. - pain is reduced. - Severe intoxication can lead to unconsciousness, coma and seizures. -Opioids can suppress repository and cardiovascular systems to the point of death. Drugs are dangerous when combined with depressants such as alcohol or sedatives. - Withdrawal symptoms include dysphoria- itchy feeling in back of legs, increased sensitivity to pain and a craving for more opioids. May experience nausea, vomiting, profuse sweating, goose bumps, diarrhea, and fever. - Street heroin cut with other substances and users don't know actual strength or true contents. Risk of overdose or death. Risk of contracting HIV through needles or unprtecfted sex, which many opioid abusers exchange for more heroin. - use and misuse of prescription opioid pain relievers such as oxycodone of vicodnid have increased recently.

Stimulants: Nicotine

- *one of most addictive substances known.* - operates central nervous system and peripheral nervous system. - helps release several biochemicals; *dopamine, norepinephrine, serotonin, and endogenous opioids.* - Physiological effects resembled *fight or flight response.* - *Relatively cheap and available.* Dependants tend to not worry about supply. The worry when they run out of cigarettes if replacements are available. Spend lots of time smoking or chewing tobacco. - skip situations where smoking is prohibited - E-cigs vaporize a flavored fluid. less harmful than real. help people quit. - quitting is hard. patches and gum help.

Hallucinations

- *perceptions* (based on sensations) not thoughts. *Interpretation of senses.* - Not precipitated by sleep deprivation, stress and drugs. - Also occur in other disorders. A study of people with visual hallucinations found that 60% were diagnosed with schizophrenia, 25% with depession, and 15% with bipolar. - *The types of hallucinations people experience in different cultures appear to be similar but the content can be culturally specific.*

Theories of Depression- Psychological theories- Cognitive theories-

- *thinking negative thoughts leads to being depressed.* - Theorists have argued that *the ways people think can contribute to, and maintain depression.* - *Negative cognitive triad: they have negative views of themselves, the world, and the future.* Their negative thinking *both causes and perpetuates their depression.* *Reformulated Learned Helplessness Theory* explains how *cognitive factors might influence whether a person becomes helpless and depressed following a negative event.* - This theory focuses on *people's causal attributions for events* (explanation of why an event happened). People who *habitually explain negative events by causes that are internal*, stable, and global *tend to blame themselves for these negative events, expect negative events to happen again the future and in many areas of their lives.* This leads them to experience *long-term learned helplessness deficits* as well as loss of self-esteem in many areas of their lives. *Hopelessness Depression develops when people make pessimistic attributions for the most important events* in their lives and *perceive that they have no way to cope with the consequences of these events.* - Both the reformulated learned helplessness theory and the hopelessness theory have led to more research- studying college students who have identified with hopeless attributional styles and those with optimistic attributional styles. Among students with no history of depression, those with a hopeless attributional style were more likely to develop the first onset of major depression than those with an optimistic attributional style. Among students with a history of depression, those with a hopeless style were more likely to have a relapse of depression than those with optimistic style. - *Pessimistic attributional style predicted both first onset and relapse of depression.* - Another cognitive theory- the *Ruminative Response Styles Theory*- focuses on the *process of thinking as a contributor to depression.* - *When some people are sad, they focus intently on how they feel* (symptoms of fatigue, poor concentration, hopelessness) and can *identify many probable causes but don't do anything about these causes and instead continue to engage in rumination about their depression.* People with this more ruminative coping style are *more likely to develop major depression.* Ruminative thinking is one way stressful experiences can *give rise to depression for some people. Linked to genetic, neural, and physiological processes, consistent with the biopsychosocial approach.* - Depressed people show *bias toward negative thinking in basic attention and memory processes*, are more likely to dwell on negative stimuli (sad faces) and have trouble disengaging their attention from the negative stimuli. They recall more negative words than positive words. *These biases in attention to and memory for negative information could be a basis for depressed people's tendency to see the world in negative light.* - Depressed people show *over-general memory*. When asked to give a memory to the word "angry" they are more likely to offer memories that are highly general instead of concrete. - Mark Williams suggests that depressed people develop the tendency to store and recall memories in general fashion as a way of coping with the traumatic past. *Vague memories are less emotionally charges and less painful than memories rich in concrete detail. Thus they help reduce their pain they feel from their past.* - *PTSD can also be characterized by overgeneral memory.*

Guns and Suicide

- 53% of suicides involve guns. - *The most frequent use of a gun in the home is for suicide.* - *The presence of a gun in the house appears to be a risk factor for suicide when other risk factors are taken into account, especially when handguns are improperly secured or are kept loaded.* - A gun in the home increased the risk of suicide by 3 times for people with a mental disorder and 33 times for people without a mental disorder. - This is the result of the dramatic increase in impulsive suicides seen among residents of homes containing a loaded gun, even among people without a known risk factor such as psychopathology. - In the U.S., in states with unrestrictive firearm laws, rates of suicide by firearm were 3.7 times higher among men and 7.9 times higher among women than in states with restrictive firearm laws. - Although people who are intent on committing suicide can find other means to do so when guns are not available, restricting ready access to them appears to reduce impulsive suicides by guns. *The unavailability of guns seems to give people a cooling off period during which their suicidal impulses can wane.*

Prevalence and Course of Depressive Disorders- Extra facts

- 75% of people who experience a first episode of depression will experience subsequent episodes. - Depression is a costly disorder to individuals and society. People with major depression lose an average of 27 days of work a year. - *Those who undergo treatment tend to recover more quickly and reduce the risk of relapse.* - Some people wait years after the onset of symptoms before they seek care, or never go. One reason for never seeking treatment is the lack of insurance, the lack of money to pay for care, they expect to get over the symptoms on their own or that the symptoms are simply a phase that will pass with time and that won't affect their lives over the long term.

Psychological Disorders and Suicide

- 90% of people who commit suicide probably have been suffering from a diagnosable mental disorder. - Depression increases the odds of the attempt by 6 times and bipolar disorder increases the odds of the attempt by 7 times. - *Best predictor of future suicidal thoughts or behavior is past suicidal thoughts and behavior.* - Among adolescents, a history of a previous suicide attempt increases the odds of suicide by 30 times among boys and 3 times among girls. - Interventions can be made regardless of what other psychological problems the person may have. - *Interpersonal violence (especially sexual abuse) is the traumatic event most strongly linked to suicidal thoughts or attempts. These experiences are not only immediate triggers of suicidal thoughts and behaviors but also are associated with increased risk over the victim's lifespan.* - *Loss of loved one is consistently related to suicide attempts or completions.* The person feels they cannot go on without the lost person and wish to end their pain. - Studies on women found *physical abuse by a partner is a potent predictor of attempts.* - *Economic hardship*- another event linked to increased vulnerability to suicide. *Loss of a job can precipitate suicidal thoughts and attempts.* - *African American males can be tied to perceptions that their economic futures are uncertain as well as to comparisons of their economic status to the majority culture.* - *Rates of African American males in the U.S. are highest in communities where the occupational and income inequalities are greatest.* - *Physical illness is a risk factor for suicidal ideation*, plans, and attempts even if the person doesn't have a mental disorder. *Epilepsy is the illness most strongly related to suicidal thoughts and behaviors*.

Disruptive Mood Disorder

- A young person must show *severe temper outbursts that are grossly out of proportion in intensity and duration to a situation and inconsistent with developmental level.* - During these outbursts, these children may *rage at others verbally* and become *physically violent towards others.* Between outbursts, their mood is persistently and obviously irritable and angry. - Child must have at least *3 temper outbursts per week for at least 12 months in at least 2 settings.* - DSM-5 decided to distinguish children with these temper tantrums from children with more classic bipolar disorder by adding a new diagnosis for youth age 6 and older

Video material

- Alcohol *replaced* everything she loved. - *Personality changed* on heroin. - Doctor tried to get a image of desire in the brain If they know where in the brain the *drug craving* is, they can create drugs to change cells to stop cravings. - *Disease because its a result of drugs changing body.* - Repeat episodes of addiction. - A different state. - "Took me from reality and put me where I wanted to be". - *Brain becomes reliant on drugs. Once addicted, it no longer feels okay without the drug. Once nucleus accumbus has increased dopamine, it no longer feels okay without the drug.* - *Natural chemicals (drugs) fool the brain.* - A different person once addicted. - The person will know the paranoia while on the drugs. - With addiction, something has changed in the brain. - *Change persists even with stopping, goes back to the drug to feel normal.* - People will do drugs just to get out of bed and live their lives. - *No longer seek natural pleasures because drugs are driving the system. There is a control mechanism with natural pleasures (food, sex) but the artificial pleasures (drugs) is different and the reward system (dopamine) is depleted and we only get pleasure from artificial pleasure.* - *Relapse is a cardinal feature of addiction.* - *Drug use stimulates dopamine and overtime the person cant produce it anymore (used it all up), and they won't get any pleasure from natural pleasures, only from the drugs.*

Disordered thought

- Also called *Formal Thought Disorder* - *loose associations* (derailment)- *thoughts are loosely connected.* - *Tangential thoughts- thoughts are barely connected, maybe by one word.* - *"Word salad"- no meaning or message being communicated. Just a bunch of words.* - Incoherent thoughts. - *Trouble following.* - Might made up words (Neologisms)

Suicide- Suicide in Older Adults

- Although there has been a 50 percent decline in suicidal rates among adults over the age 65 in the past few decades, older people (particularly older men) still remain at high risk for suicide. - Highest risk is among European American men over age 85. - When attempting, *older people are more likely than younger people to be successful.* - *Most older people who attempt suicide fully intend to die.* - Some older people commit suicide because they *cannot tolerate the loss of their spouse or other loved ones.* Rates are highest in the first year after a loss and remain high for several years. - Other older people who commit suicide *wish to escape the pain and suffering of debilitating illness, which may be a strong motive for suicide among men who are reluctant to become a burden to others.* 44% of older adults think they cannot bear being placed in a nursing home and would rather be dead. - Most older adults who lose a spouse or become ill don't commit suicide. Those with a history of depression or other psychological problems are at the greatest risk for responding to the challenges of old age with suicide. - Higher suicide rates among older adults may also *reflect the impairments in cognitive abilities that older adults sometimes experience during depressive episodes.* - *They know the end of their life is near and they dont see a point in staying around when they can see the end of their life.*

Motor Symptoms for Depression (behavior)

- Behavior slowing down (psychomotor retardation) moving/ talking more slowly. Have more accidents than normal because of slower reaction time. - Chronic fatigue. - Isolation/social withdrawal. - Crying. - Self-harm. - Psychomotor agitation- physically agitated- can't sit still, constantly fidgeting. - Anhedonia- lack of motivation.

Substance use disorder-

- Combination of substance abuse and dependence. - Hard to distinguish between the two, so DSM-5 made it one diagnosis. - Must show 2 or more symptoms associt4ed with this disorder over a year to be diagnosed. - 10 substance classes around which substance use disorders emerge- - *Depressants*: alcohol, barbiturates, benzodiazepines, inhalants. - *Stimulants*: Cocaine, amphetamines, nicotine, caffeine. - *Opioids*- heroin, morphine. - Hallucinogens and phencyclidine (PCP) - Cannabis

Somatic Symptoms of Depression (bodily features)

- Loss in energy. - Change in appetite/eating (some have loss, some have increase). - Change in sleep (some people have trouble sleeping (insomnia) some people sleep more (hypersomnia), but most of the time its insomnia. - The association of hypersomnia with depression is when people don't want to get out of bed, by hypersomnia is actually sleeping). - Early morning awakening (long-term depression impairs sleep cycle and the person will wake up at odd hours of the night and not go back to sleep). - Aches/pains (sometimes depression can physically hurt). - Weight loss/gain (directly related to appetite changes). - Reduced sex drive.

Biological Treatments for Mood Disorders- Electroconvulsive Therapy

- Consists of a *series of treatments in which a brain seizure is induced by passing electrical currents through the patients head.* Patients are first anesthetized and given muscle relaxants. -*ECT results in decreased in metabolic activity in frontal cortex and the anterior cingulate.* - ECT can *lead to memory loss and difficulty learning new information*, particularly in the days following treatment. - In modern ECT (unilateral administration), patients are less likely to experience significant, long-term memory loss or learning difficulties, but still experience a significant increase in memory problems. - Sometimes unilateral administration is not as effective as bilateral administration, some people are still given bilateral administration. - Relapse rate among ECT is as high as 85% with 30% of patients relapsing in the first 6 months.

Freud's historical perspective on suicide

- Depressed people *express anger at themselves instead of at the people they feel have betrayed or abandoned them.* - When anger becomes so great in depressed people that they wish to annihilate the image of the post person, they destroy themselves.

Major Depressive Disorder

- Depression can take several forms. - Has to have depressive symptoms for at least two weeks and they must interfere with the person's ability to function daily. - *Major Depressive Disorder single episode- when the person experiences one depressive episode.* - *Major Depressive Disorder, recurrent episode- experiencing two or more episodes separated by at least 2 months without symptoms.* - *Complicated grief*- person has difficulty accepting death or loss of loved one (People who show complicated grief after a loss are more likely to be functioning poorly 2-3 years after the loss than those who show milder grief reactions or who show only symptoms of Major Depressive Disorder).

Cognitive Behavioral Therapy for mood disorders

- Designed to be brief and time-limited. (6-12 weeks). - *Focus on specific problems that are connected to depression.* - *2 general goals.* - *First:* *aims to change the negative, hopeless pattern of thinking* described by the cognitive models of depression. - *Second:* *aid to help people with depression solve concrete problems in their lives* and *develop skills* for being more effective in their world so they no longer have the deficits in reinforcers described by behavioral theories of depression. - *First step:* Clients *discover the negative automatic thoughts they habitually have and understand the link between the thoughts and their depression.* Often have *homework of tracking the times they feel sad* and writing down on a record sheet. - *Second step:* *Challange negative thoughts. Learn an alternative way of thinking about situations and the pros and cons of these alternatives.* - *Third step:* *help clients recognize the deeper, beliefs or assumptions they might hold that are fueling their depression.* The therapist will help client question these beliefs and decide if they truly want to base their lives on them. - Also, *use behavioral techniques to train clients in new skills they might need to cope better.* People with depression are unassertive in making requests of other people or in standing up for their rights. This lack of assertiveness can be the result of negative automatic thoughts. The therapist may assign them homework to practice new skills like assertiveness.

Sociologist Emile Durkheim (1897) 3 types of suicide

- He focused on the *mind-sets certain societal conditions can create that increase the risk for suicide.* - His theory suggests that *social ties and integration into a society will help prevent suicide if the society discourages suicide and supports individuals in overcoming negative situations in ways other than suicide.* If a society supports suicide as a beneficial act, then ties with such a society may promote suicide. - *Egoistic Suicide- committed by people who feel alienated from others, empty of social contacts and alone in an unsupportive world.* - *Anomic suicide- committed by people who experience severe disorientation because of a major change in their relationship to society. A complete confusion of role and worth in society.* - *Altruistic suicide- committed by people who believe that taking their life will benefit society.*

Affect Symptoms of Depression (emotions)

- Hopelessness (most important because it's directly tied to suicide). - Emptiness, Loneliness, Sadness, Shame. -Anhedonia (orgin: hedionistic- pleasure seeking. Where the person doesn't experience pleasure in previously pleasurable activities). - Anger- irritable-rage, inadequacy (feelings of worthlessness). - Loss of self-esteem, helplessness (feels like there is nothing you can do to help yourself). - Alexithymia (emotionally numb, feeling anger and no other feelings because anger pushes away all other feelings. "thymia"- mood state, have no feeling).

Substance use patterns of use

- If a person doesn't have any of these 8 concerns, there is no problem. *The closer to 8 concerns they get, the more likely there is a problem.* - *Tied to the release of dopamine. Addictions are tied to dopamine*- food, alcohol, gambling, internet addictions, sex addictions, shopping. 1.) *Pre-Occupation*- spending time and energy thinking about the next time they will use. (alcohol, legal or illegal substances). 2.) *Change in tolerance*- person uses an increase in the amount of substance in order to get the same effect. 3.) *Blackouts*- memory loss following consumption of some substance. Blackout while using/drinking doesn't give off warning that they will black out. 4.) *using alone*- using the substance is *more important than other things going on* The person drinking at a party is only interested in the high of the substance, not the interaction with people at the party. 5.) *rapid in-take*- *consuming substance quickly in order to get and maintain a certain level of high.* If a person doesn't want to use infront of other people, the person will get to desired level of high/drunk before going to the party and continuing using once they get to the party to maintain the level. Can also be someone trying to get the courage to do something so they drink or get high quickly to get the courage. 6.) *Violate planned use*- *someone makes a plan and doesn't do it.* A person will decide to not drink as much or stop after 2 drinks. The person will get to 2 drinks and forgets/stops caring about their plan to stop at 2 drinks and continues to drink more. *The person violates their own plan.* 7.) *Self-medication*- *#1 reason why people report they drink or use substances* is to take the edge off of something going on. *Using it for medication.* *Short term*- it can work. Alcohol consumption has anti-anxiety effects in short term, but if used to control anxiety without discovering the cause of the anxiety, the person will have the same anxiety problem and an alcohol addiction as well. 8) *Concerns for the supply*- *if a person thinks they are running low on their supply, they will feel panicked.* A person will save drugs before going to a party because they don't want to run out of it before they can afford to buy more. example: people rushing to the liquor store before they close and wont be open on sunday.

Suicide- College Students

- In a survey, 9% have thought about committing suicide. 1% have attempted suicide. - Students who contemplated or attempted suicide were more likely to experience depression and hopelessness, loneliness, and problems with their parents. - 20% of the students who contemplated suicide had sought any type of counseling.

Suicide rates

- More than 33,000 people kill themselves per year in the U.S. (90 per day). - 3% of the population make a suicide attempt. - More than 13% have had suicidal thoughts at some time. - Internationally, 1 million people die by suicide per year (1 person every 40 seconds).

Psychological Contributors to Bipolar Disorder

- Psychologists have been examining the relationships between bipolar disorder and behavioral indicators of sensitivity to reward. - Studies confirm that *people with bipolar, even when they are asymptomatic, show greater sensitivity to reward than do people without the disorder.* - Studies show that *those with greater sensitivity to reward relapsed into manic or hypomanic symptoms sooner.* - Individuals with *high sensitivity to punishment relapsed into depressive episodes sooner.* *Another psychological factor is stress- experiencing *stressful events and living in an unsupportive family may trigger new episodes* of bipolar disorder. - Even *positive events can trigger new episodes of mania or hypomania if they involve striving for goals seen as highly rewarding.* - *Completing exams tended to trigger hypomanic symptoms among students who were highly sensitive to rewards.* - *Goal striving situations may trigger high reward sensitivity*, which in turn *triggers manic or hypomanic symptoms in people with bipolar disorder.* - *Changes in bodily rhythms or usual routines trigger episodes* in people with bipolar disorder. *Irregular or inadequate sleep* appears to be a characteristic of many bipolar individuals that *can lead to increased symptoms.* - *Significant changes in daily routine* can do the same, particularly if they are due to *changes in the social climate* (starting a new job). - There is a *close relationship between social and bodily rhythms and disruption in the neural and psychological symptoms underlying reward.*

Biological Factors in Suicide

- Runs in families. Children of parents that attempted suicide were 6 times more likely to also attempt than children of parents with mental disorders but didn't attempt suicide. - *Clustering of suicides in families may be due to environmental factors* (family members modeling each other or sharing common stressors). - Twin and adoption studies show the involvement of genetics as well. - Risk of suicide attempts increases 5.6 times if a person's monozygotic twin has attempted suicide, and 4 times if a person's dizygotic twin has attempted suicide. - Link between *low levels of serotonin*. - *People with family history of suicide or have attempted suicide are more likely to have abnormalities in genes that regulate serotonin*. People with low serotonin levels who attempt suicide are 10 times more likely to make another attempt than people with higher levels of serotonin. - *Low levels of serotonin are linked to suicidal tendencies even in people who are not depressed* suggesting the connection between serotonin and suicide is not due entirely to a common connection to depression.

Biological Treatments for Mood Disorders- Drug Treatments for Depression

- SSRI's, Norepinephrine re uptake inhibitors, tricyclic antidepressants, monoamine oxidase inhibitors. - Changes occur within hours or days of taking the drugs, whereas reduction in depressive symptoms typically don't appear for weeks. - More recent theories suggest these drugs have slow-emerging effects on intracellular processes in the neurotransmitter systems and the action of genes that regulate neurotransmission, the limbic system, and the stress response. - *Antidepressant drugs reduce depression* in about 50-60% of those who take them. The medications work better for treating severe or persistent depression than for treating mild-to-moderate depression. - *Antidepressant drugs are used to relieve the acute symptoms of depression.* - Usually stay on antidepressants for 6 months after their symptoms subside to prevent relapse. - Discontinuing antidepressant use during first 6-9 months after symptoms subside seems to double the risk of relapse in severe depression. - *Bipolar disorder often take antidepressants continually to prevent a relapse in depression.* *Selective Serotonin Re-uptake Inhibitors:* - SSRI's are *widely used to treat depression* but aren't more effective in treatment than other anitdepressants. They have fewer difficult to tolerate side effects. They are much *safer if taken in overdose* than other medications (such as tricyclic antidepressants and the monoamine oxidase inhibitors). Have postive effects on a wide range of symptoms that co-occur with depression (anxiety, eating disorders, and impulsiveness). - SSRI side effects- gastrointestinal symptoms, tremor, nervousness, insomnia, daytime sleep, diminished sex drive, and difficulty achieving orgasm. *Selective Serotonin Norepinephrine Re-uptake Inhibitors*: - *SNRI's designed to affect levels of norepinephrine and serotonin.* - Influence both neurotransmitters and show slight advantage over the SSRI's in preventing a relapse of depression. The dual action of this drug may account for their slight broader array of side effects than SSRI's. *Bupropion*: A Norepinephrine Dopamine Re uptake Inhibitor: - *Useful in treating people suffering from psychomotor retardation, anhedonia, hypersomnia, cognitive slowing, inattention, and craving.* (Bupropion can help stop people from craving cigarettes). - Overcomes the sexual dysfunction side effects of the SSRI's and this sometimes is used in conjunction with them. *Tricyclic Antidepressants*: - Some of the *first drug shown to consistently relieve depression*, but are used less frequently than other drugs because of numerous side effects. - Anticholingeric effects- related to levels of the neurotransmitter acetylcholine. - Drop in blood pressure and cardiac arrhythmia in people with heart problems. - Tricyclic can be fatal in overdose. - Physicians are wery of prescribing this drug espeically to people with depression who might be suicidal. *Monoamine Oxidase Inhibitors (MAOI's)* - *MAO is an enzyme that causes the breakdown of the monoamine neurotransmitters in the system.* - MAOI's *decrease action in MAO and thereby increase levels of these neurotransmitters* in the system. - As effective as tricyclic antidepressants but with particularly quite dangerous side effects. - When people taking MAOI's ingest aged cheese, red wine, or beer, they can experience potentionally fatal rise in blood pressure. - Can also interact with many drugs (antihypertension meds and over the counter meds like antihistamines) - Can cause liver damage, weight gain, severe low blood pressure, and several of the same side effects as tricyclic antidepressants.

Suicide treatment

- Some people require hospitalization to prevent an immediate attempt. May voluntarily agree to go to the hospital or are hospitalized involuntarily for a short period of time. * Intervention: Crisis Intervention Services and Dialectical Behavior Therapy. - *Community-based crisis intervention* programs are to *help suicidal people deal (in short term) with their feelings and get referred to a mental health professional for longer-term care.* - Crisis intervention can be done over the phone (suicide hotlines), walk-in clinics, or suicide prevention centers. - *Aim to reduce the risk of another immediate attempt by providing the person with someone to talk to who understand their feelings.* Counselor can help mobilize support from family members and friends and can make a plan to deal with specific problem situations in the short term. - Counselor may contract with the person that they will not attempt suicide or at least contact the counselor as soon as suicidal feelings return. Help the person identify other people they can turn to when feeling panicked. Make follow up appointments. Refer him to another counselor for long-term treatment. * Medication: - *reduce the risk of suicide by Lithium*. Those not treated with lithium are 13 times more likely to commit or attempt suicide than those treated with lithium. - *SSRI's may reduce risk* because they reduce depressive symptoms and regulate levels of serotonin, which may have an independent effect on suicidal intentions. - Some evidence that SSRI's increase the risk in children and adolescents. * Psychological therapies: - *Dialectical Behavior Therapy (DBT)*- treat people with *borderline personality disorder, who frequently attempt suicide.* - This therapy *focuses on managing negative emotions and controlling impulsive behaviors. Aims to increase problem-solving skills, interpersonal skills, and skills at managing negative emotions.* - Can reduce suicidal thoughts and behaviors and improve interpersonal skills. - Most people never seek treatment because they are in denial and have a fear of being stigmatized. - Suicide attempts are a strong predictor of future attempts and completed suicide. Suicide attempts tend to increase in intent and lethality after the first attempt. - Receiving professional attention early on is critical for suicidal individuals.

What to do if a friend is suicidal

- Take the person seriously. - Get help. - Express concern. - Pay attention. - Ask direct questions about whether the person has a plan for suicide and what the plan is. - Acknowledge the person's feelings in a nonjudgmental way. - Reassure the person that things can be better. - Don't promise confidentiality. - Make sure guns, old medications, and other means of self-harm are not available. - Don't leave the person alone. - Take care of yourself.

Theories of Bipolar Disorder- Neurotransmitter factors

- The *monoamine neurotransmitter has been implicated in bipolar disorder* as well as in major depressive disorder. - *Dysregulation in the dopamine system contributes to bipolar disorder.* - *High levels of dopamine are associated with high reward seeking. Low levels of dopamine are associated with insensitivity to reward.* - *Dysregulation in the dopamine system may lead to excessive reward seeking during the manic phase and a lack of reward seeking during the depressed phase.*

Prevalence and Course of Depressive Disorders- based on ages

- The average age of depression is between 25 and 65- people can have depression at a young age. - 16% of Americans experience an episode of major depression at some time in their life. - 18-29-year-olds are most likely to have had a Major Depressive episode in the past year. Rates of depression go down steadily and are lowest in people over age 65. Rates of depression rise among people over the age of 85. *Depressions in older people tend to be severe, chronic and debilitating.* - Diagnosing depression in older adults is complicated for 3 reasons- 1. Older adults may be *less willing to report the symptoms of depression because they grew up in a society less accepting of depression.* 2. Depressive symptoms in older adults often *occur in the context of serious medical illness* (interferes with making an appropriate diagnosis). 3. Older people are *more likely to have a mild to severe cognitive impairment* and it is *often difficult to distinguish between a depressive disorder and the early stages of a cognitive disorder.* - Reasons why the low rate in older adult depression is valid- 1. Depression appears to interfere with physical health and people with a history of depression are *more likely to die before they reach an old age.* 2. As people age, they *develop more adaptive coping skills* and a psychologically healthier outlook on life. 3. There has been *historical changes in people's vulnerability to depression.* - *Depression is less common in children*- 2.5% of children and 8.3% of adolescents can be diagnosed with major depression. 1.7% of children and 8% of adolescents can be diagnosed with Persistent Depressive Disorder. 24% of youth will experience an episode of major depression by 20 years old. *Children show irritability of sadness, instead of losing weight, they fail to gain weight expected for their developmental period.*

Theories of Depression- Psychological theories- Interpersonal theories-

- Theorists have considered the *role of relationships in causing and maintaining depression.* - Interpersonal theories of depression focus on these relationships. - *Interpersonal difficulties and losses frequently precede depression and are the stressors most commonly reported as triggering depression.* - Depressed people are more likely to have *chronic conflict in their relationships*, act in ways that engender interpersonal conflict due to deficits in social and communication skills, *have heightened need for approval* and expressions of support from others, *easily perceive rejection from others- Rejection Sensitivity.* They need *constant reassurance* that they are loved and always go back for more. Family/friends catch on and become frustrated. The person picks up on cues of annoyance, panics, and feels more insecure and engages in excessive reassurance seeking. *Social support may be withdrawn altogether leading to increased and longer depression. It might be a result of negative thinking patterns, history of maltreatment and even genetic vulnerabilities.* - *Social and interpersonal factors* also affect the internal factors of depression. *Parental interaction* with children affects the child's development of cognitive and behavioral factors implicated in depression later on. As do *peer interaction* in adolescents. - A longitudinal study of adolescents found that genetic and neural predictors of depression at age 18 depend on parenting behaviors when the child is 12. - In adulthood, an *individual's social relationships can influence how he or she copes with negative events.* - *Having more close relationships can provide protection against maladaptive coping patterns and depressive symptoms.*

Seasonal aspect to bipolar disorder

- There appears to be a *seasonal aspect to bipolar disorder* for some people, as in unpopular depression. - 25% of people with bipolar disorder experience their depressive or manic episodes in a seasonal pattern.

Cycles of bipolar disorder

- about 90% of people with bipolar disorder have multiple episodes or cycles during their life. - *Length of one episode varies from person to person.* - Most people are in a manic state for several weeks or months before moving to a depressed state. Rarely do people switch within a matter of days or even in the same day. - *Number of lifetime episodes varies on person.* but a relatively common pattern is for episodes to become more frequent and closer together over time.

Stimulants

- activate the nervous system causing feelings of energy, happiness, and power. decrease desire for sleep and diminished appetite. - Cocaine and amphetamines- used with severe substance use disorders. - psychological lift or rush. Dangerous increases in blood pressure and heart rate, lead to heart attacks, respiratory attest and seizures. - Cocaine, amphetamines, nicotine, caffeine.

Hallucinogens and PCP

- hallucinogens and phencyclidine produce *perceptual changes even in small doses.* - hallucinogens are a mixed group of substances including *lysergic acid diethylamide and peyote.* - 1943 Dr. Albert Hoffman accidentally swallowed a small amount and experienced visual hallucinations. - One symptom of intoxication from LSD and other hallucinogens is *synesthesia- the overflow from one sensory modality to another. Hear color and see sounds.* Moods shift from *depression to elation to fear.* Anxious. - Experiences lent to the drugs label *psychedelic.* - Hallucinogens are *dangerous drugs. * - Severe anxiety, paranoia and loss of control. *Bad trips* where they walk off a roof or jump out a window. - Some reexperience their psychedelic experiences especially visual disturbances, long after the drug has worn off. *PCP*- - also known as *Angel Dust, PeaCePill, Hog, and Tranq* - Powder or smoked. - produces a sense of intoxication, euphoria or affective dulling, talkativeness, lack of concern, slowed reaction time, vertigo, eye twitching, mild hypertension, abnormal involuntary movements, weakness. - User may become hostile, belligerent, and even violent. - Higher doses of PCP produces amnesia and coma, analgesia sufficient to allow surgery, seizures, severe respiratory problems, hypothermia, hyperthermia. Effects begin right after injecting, snorting, smoking and peak without minutes. - *Phencyclidine or other hallucinogen use disorder is diagnosed with individuals repeatedly fail to fulfill major role obligation at school, work, or home due to intoxication with the drugs.* - Drugs in dangerous situations. - *Frequent user finds occupational and social relationships to be impacted.*

Suicide prevention

- intervention and prevention programs appear to reduce the risk of suicide. - Prevention programs focus on educating people broadly about suicide risk and the steps to take if they are/they know someone suicidal - Often based on schools or colleges. - *Broad-based prevention or education programs do not tend to be very helpful and might even do harm. One major problem is they often simultaneously target both the general population of students and students who are at risk for suicide.* - *The programs attempt to destigmatize suicide by making it appear quite common in hopes that suicidal students will feel freer to seek help.* - *This backfires and makes suicide seem like an understandable response to stress.* - *Adolescents who made previous attempts generally react negatively to these programs and think that they were less inclined to seek help after attending the program than before.* - David Shaffer does diagnostic interviews with high-risk adolescents and then interviews them to determine the most appropriate referral to a mental health specialist. These programs have had success in identifying high-risk youth and getting them effective treatment. - Parents and school officials often worry that asking teenagers about thoughts of suicide might "put the idea in their head" but there is no evidence that answering questions about suicide induced teenagers to consider suicide.

Stimulants: Amphetamines

- methamphetamines- stimulants for the treatment of addiction problems. - supervision. - "speed", "meth", "chalk". - *release of neurotransmitters dopamine and norepinephrine and block the reuptake.* - Symptoms of intoxication: euphoria, self-confidence, alertness, paranoia - Like cocaine, amphetamines can produce *perceptual illusions.* - *Hear frightening voices, see sores on body, feel snakes crawl on their arms.* - *Legal problems typically arise due to aggressive or inappropriate behavior while intoxicated.* - Tolerance develops quickly. - Acute withdrawal symptoms subside within a few days. - Chronic users have mood instability, memory loss, confusion, paranoid thinking, perceptual abnormalities for weeks, months, or years. - Abuse leads to irregular heartbeat, increased blood pressure, stroke-producing damage to small blood vessels. extended use people can become irritable or hostile or need more stimulants to avoid withdrawal symptoms.

Depressants-

- slow nervous system. - relaxation. - Alcohol, barbiturates, benzodiaphines, inhalants.

Stimulants: Cocaine

- white powder from coca plant. *one of most addictive substances known.* Snort or inject. 1970's uses developed method for separating chemicals in cocaine by heating it up. - *Instant rush.* heightened sense of self-esteem. alertness. energy. feelings of competence and creativity. - Users *crave increasing amounts.* - Leads of grandiosity, impulsivity, hypersexuality, compulsive behavior, agitation, anxiety to the point of panic or paranoia - Stopping use can induce exhaustion and depression. -Cocaine actives areas of the brain that register reward and pleasure. - Cocaine *blocks reuptake of dopamine* into the neuron. staying in synapses and *maintains pleasurable feeling.* - Rapid, strong effects of cocaine on the brains reward centers make substance to lead to stimulating use disorder. - Effects wear off quickly. takes frequent doses to maintain high. tolerance develops. - Heart rhythm disturbances and heart attacks. strokes. seizures a headache. blurred vision. muscle spasms. convulsions and comas.

10 Myths and Facts of Suicide

1. Myth: People who talk about suicide don't do it. Fact: *Over 80% of those who kill themselves have told somebody.* 2. Myth: Suicide happens without warning Fact: There are *always warning signs* (Change in behavior, big mood changes, adolescents giving away meaningful possessions because they don't need them anymore). 3. Myth: Suicidal persons really way to die. Fact: Suicide *happens at the height of a crisis.* Thinking is not rational at these times. 4.Myth: The suicide crisis is over when the person starts feeling better. Fact: There is a *critical 90 day period.* Just because the immediate crisis has ended doesn't mean the risk of suicide is gone. Most of the time when suicidal, the person gets support from family and checked on every day, once the person says they are better, the family members will go back to their lives and not check in as much- leaving the person to feel abandoned and become suicidal again. 5. Myth: Suicide is an inherited characteristic. Fact: There is *no suicide gene*- not genetically determined. It does run in families, not by gene patter but a behavioral pattern. Suicide runs in families by behavior- families with often suicides, the kids will know that suicide is an option. Mood disorders have a genetic contribution (50% for depression and 80% for bipolar) but it doesn't mean there a genetic contribution for suicide. 6. Myth: Suicidal individuals are crazy. Fact: *Fewer than 2% of suicidal individuals are psychotic* (out of touch with reality). 7. Myth: If you let someone talk about suicide, they are more apt (more likely) to do it. Fact: *Most suicidal people are relieved to talk about how they feel*. People are worried that they might say the wrong thing to a suicidal person and will push them to actually commit suicide. However, most suicidal people are protected from suicide by talking about how they feel. If someone is suicidal, you have to do something- talk to them, get a mental health professional for them, etc. 8. Myth: An unsuccessful attempt means the person wasn't serious about it. Human bodies fight to live. Fact: *Some people are naive about how to kill themselves and don't know how to do it or have access.* Asking someone what their plan is, helps determine what intervention they need and how long they have been planning to kill themselves. Stigmas deter people from getting them help they need or talking to others. 9. Myth: Only people of a certain social class, race/ethnicity, religion, sex orientation, gender identity, or personality kill themselves. Fact: *Suicide is an equal opportunity event. Any person of any type can be suicidal.* 10. Myth: Once suicidal, always suicidal. Fact: *Once past, for most, it doesn't return.*

Nine subtypes of depression

1.) *Depression with anxious distress*- anxiety is extremely common with depression. People with this subtype have prominent anxiety symptoms as well as depressive symptoms. 2.) *Depression with mixed features*- People that meet criteria for Major Depressive Disorder and have at least 3 symptoms of mania, but they do not meet the full criteria for a manic episode. 3.) *Depression with melancholic features*- where physiological symptoms of depression are particularly prominent. 4.) *Depression with psychotic features*- people experience delusions and hallucinations. The content of them may be consistent with typical depressive themes of personal inadequacy, guilt, death, or punishment (mood-congruent), or their content is unrelated to depressive themes or mixed (mood-incongruent). 5.) *Depression with catatonic features*- people show strange behaviors collectively known as catatonia, which range from a complete lack of movement to excited agitation. 6.) *Depression with atypical features*- the criteria for this subtype are an odd assortment of symptoms. 7.) *Depression with seasonal pattern*- Seasonal Affective Disorder (SAD)- history of at least 2 years of experiencing and fully recovering from Major Depressive episodes. They become depressed when the daylight hours are short and recover when daylight hours are long. Person's mood changes cannot be the result of psychosocial events (for example: regularly unemployed during the winter). Rather, the mood changed must seem to come on without reason or cause. Only 5% of U.S. population have a diagnosable seasonal affective disorder and only 1 to 5 percent internationally. Individuals living in northern latitudes were more likely to meet the criteria for SAD than individuals living in southern latitudes. 8.) *Depression with peripartum onset*- Given to women when the onset of Major Depressive episode occurs during pregnancy or in the 4 weeks following childbirth. They are called "peripartum episodes" because 50% of "postpartum" major depressive episodes actually begin prior to delivery. Rarely do women develop mania postpartum and are given the diagnosis of bipolar disorder with peripartum onset. In the first few weeks after giving birth, 30% of women experience the postpartum blues- emotional lability (unstable and quickly shifting moods), frequent crying, irritability, and fatigue. For most women, these symptoms cease within 2 weeks of birth. About 1 in 10 women experience postpartum depression serious enough to warrant a diagnosis of Major Depressive Disorder with peripartum onset. 9.) *Premenstrual dysphoric disorder*- women experience a significant increase in distress during the premenstrual phase of their menstrual cycle. Symptoms are often a mixture of depression, anxiety and tension, and irritability and anger, which may occur in mood swings during the week before the onset of menses, improve once mensus has begun, and become minimal or absent in the week post mensus. Physiial symptoms of breast tenderness or swelling, bloating or weight gain, and joint and muscle pain. Only about 2% of women meet the diagnostic criteria for the premenstrual dysphoric disorder.

Problem areas in substance abuse

1.) *Family*- families will *break/fall apart over substance issues.* Family members and friends say the person changes when they use, their behavior isn't the same. 2.) *Social*- Friends will *say the person changes when they use.* Some friends also use the substnace and enhance the behavior. People either spend their free time doing the substance or if its illegal, they will spend their free time trying to get the substance. 3.) *Economic*- money, finances. Unless the person is rich, they will use funds intended for something else. Teens will steal from their house to get money for substances. *Financial consequences* 4.) *Job/school*- substance abusers do a good job when they show up, but they *miss a lot of work/school.* Some *jobs have routine drug testing* and people will lose their jobs. 5.) *Health*- regular substance users have a *suppressed immune system- get sick easier.* heavy use over time can have real *effects on health (liver damage from drinking).* The possibility of *overdose and death.* Accidental overdose. *Major health consequences.* 6.) *Legal*- even with legal substances, there can be *legal problems.* *Legal to drink, illegal to drink and drive.* Illegal substances are a legal problem. If a person doesn't learn from the first legal problem, they have a bigger issue.

Schizophreniform Disorder

Duration is 1-6 months. *Everything is the same as schizophrenia.* If the *person has had symptoms for 3 months, they are diagnosed with this until they have symptoms for 6 months to meet the requirement for schizophrenia diagnosis.*

Interpersonal therapy for mood disorders

Look for *4 types of problems* - *First: Many depressed people are grieving the loss of a loved one.* Help clients *face such losses and explore their feelings about them and begin to invest in new relationships.* - *Second:* *Interpersonal role disputes,* which arise when people *do not agree on their roles in a relationship*. Help the client *recognize the dispute, guide them in making choices* about what concession might be made to the other person in the relationship, *modify or improve their patterns of communication with others in relationships.* - *Third:* *Role transitions*, such as the transitions from college to work or from work to full-time motherhood. Sometimes depression is seen over roles people have to leave behind. *Help client develop more realistic perspectives toward roles that are lost and learn to regard new roles in a more positive manner and develop a sense of mastery in the new role.* - *Fourth:* *Problems caused by deficits in interpersonal skills.* Reviews clients past relationships, especially childhood relationships, and helps them *understand these relationships and how they might be affecting their current relationships.*

Suicidal Contagion

Suicide Cluster: - *When 2 or more suicides or attempted suicides are nonrandomly bunched together in time* (a series of suicides in a high school). Primarily among adolescents. - *Most of those who attempted suicide or have active thoughts were friends of those students who had completed suicide.* - *Other suicide clusters occur not among close friends- people who are linked by media exposure to the suicide of a stranger, often a celebrity*. Individuals who had attempted suicide in the month prior to the media coverage of the celebrity suicide were nearly 12 times more likely to report another suicide attempt in response to the media coverage than those who had not had a previous attempt before the media coverage. Suicide Contagion: - Maybe *modeling the behavior of the friend or admired celebrity who committed suicide.* - May *make the idea of suicide more acceptable* and thus *lower inhibitions for suicidal behavior in survivors.* - The local and media *attention given to a suicide can be attractive to people feeling abandoned.*