Abnormal Ch 7

Whereas suicide is relatively rare among children, the prevalence of such behaviors increases starting at around age __________ and continues to increase into the early- to mid-20s. 36 5 12 24

12

According to research presented in this module, somewhere between __________ and __________ percent of adolescents experience either major depressive disorder or subclinical levels of depression at some point. 10; 20 8; 24 25; 40 40; 65

25; 40

Generally speaking, a person who has just started taking antidepressants should not expect to experience a significant reduction in depressive symptoms for about __________. 4 to 6 months 3 to 5 weeks 7 to 10 days 2 to 3 years

3 to 5 weeks

In order for a person with bipolar disorder to be described as having a rapid cycling pattern, he or she would have to have at least __________ episodes of manic or depressive cycles in a given year. 4 52 10 8

4

The average concordance rate for bipolar disorder is about __________ percent for monozygotic twins, compared to __________ percent for dizygotic twins. 15; 75 90; 60 5; 25 60; 12

60; 12

How might one most aptly distinguish between a relapse and a recurrence of depressive symptoms? A recurrence is the appearance of exactly the same symptoms; a relapse occurs when depressive symptoms change into bipolar symptoms. A recurrence is a re-emergence of previous symptoms; a relapse is the emergence of a new episode of depression. A relapse is the appearance of exactly the same symptoms; a recurrence occurs when depressive symptoms change into bipolar symptoms. A relapse is a re-emergence of previous symptoms; a recurrence is the emergence of a new episode of depression.

A relapse is a re-emergence of previous symptoms; a recurrence is the emergence of a new episode of depression.

Allen is contemplating suicide, but he does not want to receive treatment. Given what you learned from this module, which of the following factors is Allen most likely to say keeps him from seeking treatment? Allen knows his thinking and decision making are impaired, and he wants to wait for it to pass. Allen does not trust psychologists. Allen does not think that he needs help. Allen received psychological treatment in the past, and does not want to do it again.

Allen does not think that he needs help.

Jill's marriage has suffered ever since the birth of her second child. Since the birth, she has been depressed and has had little interest in intimacy with her husband. Jill feels unattractive with the additional weight she carries since the birth and has been rejecting her husband's advances. After Jill discussed her feelings with Dr. Tora, Dr. Tora decided to prescribe her an antidepressant. Considering the problems she has been having in her marriage, which of the following is Dr. Tora most likely to prescribe? Prozac Bupropion Imipramine Venlafaxine

Bupropion

__________ disorder is marked by repeated experiences of hypomanic symptoms for a period of at least __________. Bipolar IV; 1 year Bipolar I; 6 months Cyclothymic; 2 years Persistent depressive; 1 month

Cyclothymic; 2 years

Bipolar: Describe the symptom duration, onset, prevalence and gender ratios

Duration: 1 week Onset: 18-22 Prevalence: 2-3% Equal in men/women

MDD: Describe the symptom duration, onset and prevalence, and the gender ratios

Duration: 2 weeks Onset: Adolesence Prevalence: 17% Gender ratios: 2:1

Marian is severely depressed and wants to commit suicide. She feels guilty about the harm she may inflict on her mother because both her father and her mother's sister committed suicide. Which of the following statements describes the influence of familial suicides on Marian's suicidal ideation? Marian is ten times more likely to commit suicide than someone from a family with no suicides. Evidence points to the correlation between familial suicide and Marian's increased risk for suicide. Marian's desire to commit suicide is independent of any suicides in her family's past Research suggests that there is no correlation between risk for suicide and history of familial suicide.

Evidence points to the correlation between familial suicide and Marian's increased risk for suicide.

Why is a person who demonstrates symptoms of mania without any history of depression still given a diagnosis of bipolar disorder? Since there are no medications that treat manic symptoms and such patients are treated with antidepressant drugs, bipolar disorder is the more appropriate diagnosis. Because a "mania only" disorder is considered much more socially stigmatizing, and so bipolar disorder is diagnosed to help a client feel less ostracized. The treatment of unipolar mania is extremely costly and lasts years, so insurance companies are only willing to pay for a shorter-term treatment of bipolar disorder. It is assumed that either they have had undiagnosed depressive symptoms or that such symptoms will occur in the future.

It is assumed that either they have had undiagnosed depressive symptoms or that such symptoms will occur in the future.

Lecture: Before treatment, there was _____ activation of regulatory centers and ____ activation of the limbic system. After treatment, there was _____ activation in regulatory system, and ____ activation in the limbic system. What is the cause of this?

Less; more More; less Psychotherapy works on the frontal lob and gives strategies to control cognitive limbic thinking, while psychopharmtherapy changes physiologically that you don't feel like you need to activate the limbic system.

Which of the following best describes the likely long-term course of bipolar disorder? Most people with a diagnosis of bipolar disorder experience a relapse of symptoms, with depressive symptoms being the most likely to recur. Most people with a diagnosis of bipolar disorder experience a relapse of symptoms, with psychotic symptoms being the most likely to recur. Most people with a diagnosis of bipolar disorder experience full recovery within 2 months, regardless of treatment. Most people with a diagnosis of bipolar disorder experience full recovery within 2 years once they receive effective treatment (e.g., mood-stabilizing medications).

Most people with a diagnosis of bipolar disorder experience a relapse of symptoms, with depressive symptoms being the most likely to recur.

What was Dr. Jack Kevorkian known for? Lowering the risk of suicide in terminally ill people Increasing the number of drugs available to treat people contemplating suicide. Developing suicide hotlines across the United States. Making it possible for more than 130 gravely-ill people to commit suicide

Making it possible for more than 130 gravely-ill people to commit suicide

Which researcher was the first to propose the idea of learned helplessness as being a significant contributing factor to the symptoms of a major depressive episode? Albert Ellis Sigmund Freud Martin Seligman Aaron T. Beck

Martin Seligman

atypical features

Mood reactivity - brightens to positive events

In biolar disorders: Higher BMI and weight gain leads to

Smaller brain volumes, peripheral inflamaation and greater illness effects

In the 2004 World Mental Health Study conducted by the World Health Organization, the prevalence and characteristics of psychological disorders were examined in 20 different countries. The 12-month prevalence rate of depression was found to be lowest in __________. Canada Australia the United States Nigeria

Nigeria

Bipoloar: Describe the psychological/biological casual factors, and treatments

Psychological -Stressful life events -Neuroticism/pessimissm -High achievement/reward sensitivity Biological -Highest heritability -Increased cortisol during depression, increased norep during manic -Decreased norep/dopamine during depression -Less activity in prefrontal cortex Treatment -SSRIs -CBT -ECT, TMS -Behavioral activation treatment -Interpersonal therapy

MDD: Describe the psychological/biological casual factors, and treatments

Psychological: -Stressful life events/interpersonal stress -Neuroticism/introversion -Responses no longer produce positive reinforcement -Depressogenic schemas Biological -Monozygotic twins 2x more likely to develop -s/s allele -Sustained cortisol levels and proinflammatory responses -Serotonin/dopamine deficiencies Treatments -CBT -SSRIS -ECT, TMS, bright light

Relapse and recurrence

Relapse: Return of original symptoms Recurrence: New occurance/episode of disorder after remission

Rumination

Repeatedly thinking about past events

Catatonic features

Severe disturbances in motor function

Which figure, described in your text as the "godfather of suicide research," has written extensively about what constitutes a suicidal mind? Groth-Marnat Shaw Shneidman Durkheim

Shneidman

Which of the following might explain why rates of depression are low in China and Japan? Mental illnesses are not stigmatized, thus those who are depressed receive much social support and do not seek treatment. The heavy emphasis on the individual decreases the likelihood of blaming the self for failure. Both positive and negative emotional extremes are rare in China and Japan. Symptoms of depression tend to be described in terms of physical problems rather than in psychological terms.

Symptoms of depression tend to be described in terms of physical problems rather than in psychological terms.

Which of the following describes a benefit offered by transcranial magnetic stimulation for the treatment of mood disorders? It is the first non-pharmaceutical treatment that is effective for bipolar disorder. The treatment does not cause any deficit in cognitive performance or memory skills like those that occur with electroconvulsive therapy (ECT). While it cannot be used with children and adolescents, it is only slightly less effective than electroconvulsive therapy (ECT) for adults. The treatment is far more painful than electroconvulsive therapy (ECT), and also more painful than the use of antidepressant medications.

The treatment does not cause any deficit in cognitive performance or memory skills like those that occur with electroconvulsive therapy (ECT).

What is the relationship between the experience of depressive symptoms and significant levels of anxiety? There is a very high level of comorbidity between depressive and anxiety disorders. Despite common misconception, there appears to be almost no correlation between depressive and anxiety symptoms. Depression has been found to preclude anxiety disorders in a vast majority of cases. The DSM-5 states that anxiety disorders and depressive disorders cannot be concurrently diagnosed.

There is a very high level of comorbidity between depressive and anxiety disorders.

Why might a physician be somewhat unwilling to give a person with major depressive disorder a prescription for tricyclic antidepressants (TCAs) as the first pharmaceutical approach to addressing their symptoms? A rare but potentially fatal blood disease called aplastic anemia can develop as a result of taking even a slight excess of this type of medication. These drugs are more dangerous than other antidepressants and can be used for fatal suicide attempts. The side effects of TCAs can include severe muscular tics and tremors that, if allowed to continue, can become permanent. While TCAs were the first type of antidepressant thought to be effective, it is now known that they help only about 5 percent of those who take them.

These drugs are more dangerous than other antidepressants and can be used for fatal suicide attempts.

Why is seasonal affective disorder much more common in the fall and winter months than in spring and summer? Those seasons provide a reduction in the amount of available light. People do not usually go on vacation or have fun parties during the fall and winter months, which can lead to a reduction in overall happiness. Fall and winter months include reduced ambient temperatures, which cause a reduction in specific neurotransmitters. Those months are associated with a statistically significant increase in negative life events.

Those seasons provide a reduction in the amount of available light.

Which of the following people has the least likelihood of receiving some sort of treatment? Tremaine, who was first diagnosed with bipolar II disorder at age 23 and still fights serious symptoms of the illness at age 40 Ulie, who has been diagnosed with a mild to moderate case of major depressive disorder Steven, who has dealt with serious bipolar I disorder for years Richard, who suffers from very severe major depressive disorder

Ulie, who has been diagnosed with a mild to moderate case of major depressive disorder

Jarli is a young Australian Aboriginal man who lives in a native community in the Northern Territory of Australia. If Jarli were clinically depressed, what types of behaviors would he likely exhibit? Expressing guilt over past behaviors would most likely be observed. Venting of hostilities onto others might be observed. A tendency to engage in self-abnegation is likely. He would engage in suicidal thoughts.

Venting of hostilities onto others might be observed.

Which of the following is true about suicide prevention hotlines? These 24-hour call centers are associated with reduced rates of suicide. We lack evidence that these 24-hour call centers reduce suicide rates. There are very few suicide hotlines in the United States. These 24-hour call centers are primarily staffed by well-trained psychologists.

We lack evidence that these 24-hour call centers reduce suicide rates.

Which of the following individuals exhibits symptoms that are consistent with a diagnosis of bipolar II? Zenia alternates between hypomanic and major depressive episodes. Veronica has been diagnosed with bipolar I disorder in the past but now is only experiencing depressive symptoms. Wilma has experienced very minor depressive symptoms (not enough to be diagnosed as a major depressive episode) combined with manic symptoms. Yolanda goes through manic episodes but has never had a depressive period.

Zenia alternates between hypomanic and major depressive episodes.

Several different neurotransmitters seem to be involved in the regulation of mood states in human beings. They include all but which of the following? dopamine norepinephrine acetylcholine serotonin

acetylcholine

The __________, an area of the brain involved in selective attention, shows __________ in patients with depression. anterior cingulate cortex; decreased volume and abnormally low levels of activation hypothalamus; increased activation pituitary gland; decreased production of dopamine brain stem; decreased volume and lower levels of activation

anterior cingulate cortex; decreased volume and abnormally low levels of activation

Stressful life events _________ do not generally precipitate an initial manic episode, but tend to play more of a role over time. do not trigger manic episodes. appear to increase the time to recovery from a manic episode. play no role in the development or progression of bipolar II disorder.

appear to increase the time to recovery from a manic episode.

Angela has had several periods of extremely "up" moods. They last for a couple of weeks and she has gotten into trouble several times. During those times she doesn't sleep, spends way too much money, gets involved in bad business decisions, talks quickly and thinks even more quickly, and believes she can do anything. The best diagnosis for Angela is ________ bipolar I disorder. manic disorder. bipolar II disorder. cyclothymic disorder.

bipolar I disorder.

tricyclic antidepressants

block reuptake of serotonin and norepinephrine

In order to meet the criteria for a major depressive episode, a person must have __________. feelings of grandiosity over a period of three weeks ongoing intense irritability or violent outbursts disinterest in pleasurable activities for at least two weeks racing thoughts for at least a week

disinterest in pleasurable activities for at least two weeks

Lavinia has been going through very difficult times lately, with both an increase in life stressors and the emergence of depressive symptoms. If her physician were to take a sample of blood from her, it is likely that she would find elevated levels of which stress hormone? cortisol oxytocin melatonin luteinizing hormone

cortisol

The disorder that is most prevalent among those who die by suicide is __________. bipolar disorder anorexia nervosa depression schizophrenia

depression

Quentin is severely depressed and presents an immediate and serious suicide risk. In the past he has not responded to tricyclics. A wise course of action is to treat him with _________ lithium because suicide is almost always accompanied by manic episodes. anticonvulsants such as carbamazepine and valproate because they can prevent future depressions. Prozac because it can reduce symptoms in 12 to 24 hours. electroconvulsive therapy because it can rapidly reduce symptoms.

electroconvulsive therapy because it can rapidly reduce symptoms.

Marcela has been feeling depressed and down for most of the day, nearly every day, over the past two months. In addition to this low mood, she reports not being interested in doing anything, including watching soccer, even though her favorite soccer team made it to the World Cup. She also reports getting little to no sleep, not feeling hungry, having difficulty making decisions, and irrational guilt. Which of the following would preclude Marcela from qualifying for a diagnosis of major depressive disorder? having experienced a hypomanic episode in the past having had a previous episode of depression being under 18 years of age having a diagnosis of specific phobia

having experienced a hypomanic episode in the past

The Food and Drug Administration (FDA) has required pharmaceutical companies to place warnings on the packaging for antidepressant medications that state that these drugs might __________. increase the risk of suicidal behaviors contribute to the development of both Type I and Type II diabetes lead to intracerebral bleeding and a risk of stroke increase blood pressure in those with a medical history of hypertension, leading to a risk of sudden cardiac death

increase the risk of suicidal behaviors

In a single word, what did Sigmund Freud feel was at the root of most people's symptoms of depression? loss conflict sex dreams

loss

Lao lives in China, where he has resided with his family for his entire life. Recently, he has begun experiencing symptoms of depression. Which symptom would he most likely demonstrate, given the cultural influences of his surroundings? a desire to isolate himself socially an overwhelming sense of guilt feelings of worthlessness loss of sexual interest

loss of sexual interest

What type of therapy aimed at the treatment of depression involves meditation techniques that emphasize patients' awareness of unwanted thoughts, feelings, and sensations? rational emotive behavioral therapy mindfulness-based cognitive therapy directive Gestalt therapy in-vivo exposure therapy

mindfulness-based cognitive therapy

Angelina, age 12, sits several times a week in a locked bathroom in her home and uses a razor blade to cut the inside of her thighs. The practice is painful to her, but she experiences that pain as a positive sensation rather than a negative one. Angelina's behavior would be classified as __________. nonlethal suicide attempts suicide attempts nonsuicidal self-injury (NSSI) suicidal thoughts

nonsuicidal self-injury (NSSI)

In classical Greece, a person who was extremely ill could __________. petition the gods for early entrance into the afterlife so he could end his life end his life without governmental or religious mandates or interference petition the state and receive permission to end his life face scorn and ridicule from members of the community for wanting to end his life

petition the state and receive permission to end his life

A rapid return of symptoms immediately after drug treatment is terminated is a common example of ________; a return to depressive symptoms after a period of spontaneous remission of symptoms is called a ________. mood-congruent depression; mood-incongruent depression melancholia; recurrence relapse; recurrence recurrence; relapse

relapse; recurrence

Recent neuroimaging research indicates that when suicidal people think about suicide, they show greater activation in brain regions associated with __________ compared to people who have no history of suicidal thoughts or behaviors. fear escape self-referential thought pain

self-referential thought

Henry suffers from bipolar disorder and experiences one or two manic episodes in a given year, more when he is not taking his medication. Between episodes, which of the following symptoms is he most likely to experience? substantial sleep difficulties unwanted weight gain and loss in a "yo-yo" cycle skin irritations that lead to painful rashes and eczema thinning hair and brittle finger- and toenails

substantial sleep difficulties

Since the 1960s, the availability of competent assistance at times of suicidal crisis has been expanded through the establishment of __________. halfway houses community mental health centers suicide hotlines urgent psychiatric care facilities

suicide hotlines

According to twin studies, monozygotic twins who have a co-twin with major depressive disorder are about __________ as likely as dizygotic twins to develop depression. twice four times three times one-half

twice

Marcellus has been struggling with the symptoms of a major depressive episode for quite some time. Dr. Ting, his therapist, notes that Marcellus meets the criteria for a major depressive episode and, in addition, seems to have lost interest or pleasure in almost all activities, even recently turning down a chance to go to a concert of his favorite musician for no discernable reason. The diagnosis of major depressive disorder would probably best include the specifier of "__________." with atypical onset with psychotic indicators with seasonal pattern with melancholic features

with melancholic features