Chapter 6: Mood disorders and suicide

An integrative theory for mood disorders

Biological vulnerability Psychological vulnerability (depressive cognitive styles) Psychosocial (stressful life events) (Early learning may interact with specific genetic vulnerabilities and personality characteristics to produce the rich variety of emotional disorders).

Indicate which type of treatment for mood disorders is being described: The controversial but somewhat successful treatment involving the production of seizures through electrical current in the brain:

Electroconvulsive therapy

Psychological autopsy

postmortem psychological profile of a suicide victim constructed from interviews with people who knew the person before death

Timeframe for Dysthymia

At least two years with no absence of symptoms for more than two months Considered more serious because of higher rates of comorbidity, less responsive to treatment, slower rate of improvement over time, and more likely to attempt suicide

An individual who is experiencing an elevated mood, a decreased need for sleep, and distractibility is most likely experiencing: A) Panic disorder B) Mania C) Depersonalization D) Hallucinations

B

Choose the corresponding disorder: Fred is always down in a bit blue, but occasionally he becomes so depressed that nothing pleases him: A) Mania B) Double depression C) Persistent depressive disorder D) Major depressive episode F) Bipolar I disorder

B

Indicate which type of treatment for mood disorders is being described: This teaches clients to carefully examine their thought process and recognize depressive styles in thinking:

Cognitive therapy

In treating depression clients, a psychologist helps them think more positively about themselves, about their place in the world, and about the prospect for the future. The psychologist is basing her techniques on whose model of depression? A)Sigmund Freud B)Carl Rogers C) Rollo may D) Aaron Beck

D

Match the following with the correct suicide type: Sam killed himself while a prisoner of war in Vietnam: A) altruistic B) egoistic C) anomic D) Fatalistic

D

Choose the corresponding disorder: Last week, as he does about every three months, Ryan went out with his friends, buying rounds of drinks, socializing until early morning, and feeling on top of the world. Today Ryan will not even get out of bed to go to work, see his friends, or even turn on the lights. A) Mania B) Double depression C) Persistent depressive disorder D) Major depressive episode F) Bipolar I disorder

F

Depression requires some life experience, indicating that babies and young children cannot experience the disorder: True or false

False

Risk factors for suicide

Family History Neurobiology (Low levels of serotonin; Extremely low levels associated with impulsivity, and stability, and the tendency to overreact to situations) Existing psychological disorders and other psychological respecters (And people seeing themselves as a burden, Alcohol use, past suicide attempts, BPD with depression) Stressful life events

Timeframe for Cyclothmic disorder

For at least two years and the person has not been without the symptoms for more than two months at a time

Timeframe for a hypomanic episode

Four days

Indicate which type of treatment for mood disorders is being described: This antidepressant must be carefully regulated to avoid illness but has the advantage of affecting manic episodes:

Lithium

Indicate which type of treatment for mood disorders is being described: This is an effort to prevent relapse or recurrence over the long run:

Maintenance treatment

Timeframe for bipolar I disorder

Manic episode must last for at least seven days or be so severe and requires a hospitalization if before seven days Two weeks for the major depressive episode

Psychological treatments for bipolar disorder

Medication along with Psychological intervention - Helping regulate circadian Rhythms by helping patients regulator eating and sleeping cycles and other daily schedules as well as cope more effectively with stressful life events, particularly in a personal issues. Some evidence that CBT is effective for bipolar patients with rapid cycling features

unipolar mood disorder

Mood disorder characterized by depression or mania but not both. Most cases involve unipolar depression.

Persistent Depressive Disorder (Dysthymia)

Mood disorder involving persistently depressed mood, with low self-esteem, withdrawal, pessimism, or despair, present for at least 2 years, with no absence of symptoms for more than 2 months. Differs from major depressive disorder and the number of symptoms required (fewer) but mostly it is in the chronicity. It is considered more severe, since patients with this present with higher rates of comorbidity with other mental disorders, are less responsive to treatment, in a lower rate of improvement over time. More likely to attempt suicide

Lifespan developmental influences on mood disorders

Mood disorders are fundamentally similar and children and adults so no childhood mood disorders are in DSM-5 with the exception of disruptive mood dysregulation disorder. However, the "look" of depression changes with age. As far as mania, children under nine seem to present with more irritability and emotional swings but irritability alone is insufficient to diagnose mania.

Onset and duration of major depressive disorder

Risk is fairly low until the early teens. Symptoms follow a U-shaped pattern with age. The incidence of depression and suicide seem to be increasing. Typical duration for the first episode is 2 to 9 months. Probability of remission is 90% within one year. (But if symptoms don't clear up entirely, another episode is much higher and treatment should continue much longer in these cases)

premenstrual dysphoric disorder

a disorder marked by repeated episodes of significant depression and related symptoms during the week before menstruation 2-5% of women suffer from this

Major depressive disorder

a mood disorder in which a person, for no apparent reason, experiences two or more weeks of depressed moods, feelings of worthlessness, and diminishes interest or pleasure in most activities Mood disorder involving a single episode or more, separated by at least two months without depression (recurrent for more than one). Always time-limited

hypomanic episode

less severe and less disruptive version of a manic episode that is one of the criteria for several mood disorders It does not cause marked impairment in social or occupational functioning and need last only four days rather than a full week.

Name several social and cultural dimensions that contribute to mood disorders (3)

marital dissatisfaction, gender, few social supports

mixed features

term for experiencing depressive symptoms during a manic or hypomanic episode, or experiencing manic symptoms during a depressive episode Also known as dysphoric manic episode or mixed manic episode DSM-five require specifying whether a predominantly manic or predominantly depressive episode is present and then noting if enough symptoms of the opposite polarity our present to meet the next features criteria

Biological causes of mood disorders

1. Neurotransmitters: Treatment: Prozac, Zoloft, and Pazil--increase serotonin's availability--reuptake inhibitors 2. Brain Structure: depression--lowered brain energy consumption, especially in left frontal lobe 3. Familial and genetic influences (Bipolar disorder confers an increased risk of developing some mood disorder in close relatives, but not necessarily bipolar disorder) - For depression the genetic contribution is around 40% for women and 20% for men - So 60 to 80% of depression is caused by environmental factors 4. The endocrine system - Stress hypothesis of the etiology of depression: focuses on the over activity in the hypothalamus pituitary adrenocortical (HPA) access, which produces stress hormones. (Cortisol levels are elevated in depressed patients and stress hormones can be harmful to neurons) 5. Sleep and circadian rhythm's

Suicide

10th leading cause of death in the United States and third leading cause among adolescents And understanding suicidal behavior, three indices are important: -Suicidal ideation (serious thoughts about committing suicide) -Suicidal plans (a detailed method for killing oneself) - Suicidal attempt (that are not successful) Overwhelmingly a white phenomenon 1/2 with firearms Suicide is contagious

Bipolar I disorder is characterized by_______, whereas bipolar II Is characterized by______: A) Full manic episodes; hypomanic episodes B) Hypomanic episodes; full manic episodes C) Both depressive and manic episodes; full manic episodes D) Full manic episodes; both depressive and manic episodes

A

Choose the corresponding disorder: Feeling certain he would win the lottery, Charles went on and all night shopping spree, maxing out all his credit cards without a worry. We know he's done this several times, feeling abnormally extreme elation, joy and euphoria. A) Mania B) Double depression C) Persistent depressive disorder D) Major depressive episode F) Bipolar I disorder

A

Match the following with the correct suicide type: Shiva lives in a remote village in Africa. She was recently caught in an adulterous affair with a man and a nearby village. Her husband wants to kill her but won't have to because of a travel custom that requires her to kill herself. She leaps from the cliff: A) altruistic B) egoistic C) anomic D) Fatalistic

A

Treatment for bereavement often includes: A) Finding meaning in the loss B) Replacing the loss person with someone else C) Finding humor in tragedy D) Replacing sad thoughts about the loss person with more happy thoughts

A

Which of the following is a risk factor for suicide? A) Having a relative who committed suicide B) Playing aggressive, full contact sport C) A history of multiple marriages D) An abstract, philosophical cognition

A

Bipolar I Disorder Symptoms

Alternation of major depressive episodes with full manic episodes. 1. Mania with functional impairment (3 of the following): -Inflated self-esteem -Decreased sleep -Talkative -Flight of ideas -Distractibility 2. Major depression As with major depressive disorder, for the manic episodes to be considered separate, there must be symptom-free period of At least two months between them

Types of suicide

Altruistic: Formalize suicide that are proved of such as the ancient customs for people who brought dishonor upon himself or family. Egoistic: The loss of social support is an important provocation for this type Anomic: Feeling lost and confused. Result of March disruptions, such as the sudden loss of a high prestige job Fatalistic: results from the loss of control over one's own destiny

Treatment for suicide risk

Asking if someone is suicidal if there is any indication Check for any possible recent humiliation If a risk is present make a contract and if they won't immediate hospitalization is indicated 10 sessions of cognitive therapy for recent suicide attempt or's got the risk of additional attempts by 50% over the next 18 months

causes of suicide

Current thinking considers social and psychological factors but also highlights the potential importance of biological contributions Borderline personality disorder Drugs and alcohol Stressful life events including natural disasters and sexual and physical abuse Traits of impulsiveness Hopelessness Mood disorders (That can occur in their absence or in the presence of other disorders)

Choose the corresponding disorder: For the past few weeks, Jennifer has been sleeping a lot. She feels worthless, can't get up the energy to leave the house, and has lost a lot of weight. Her problem is the most common and extreme mood disorder: A) Mania B) Double depression C) Persistent depressive disorder D) Major depressive episode F) Bipolar I disorder

D

Maintenance treatment for depression can be important because it can prevent: A) Transmission B) Bereavement C) Incidence D) Relapse

D

major depressive episode

Most common and severe experience of depression, including feelings of worthlessness, disturbances in bodily activities such as sleep, loss of interest, and inability to experience pleasure, persisting at least 2 weeks. - Involving one (single episode) or more (Separated at least by two months without depression, recurrent) The most central indicator of a full depressive episode are physical changes, along with the behavioral and emotional shut down, as reflected by low behavior activation (Anhedonia) Duration if untreated is 4 to 9 months

cyclothmic disorder

at least 2 years (chronic) with numerous periods of hypomanic and depressive symptoms that do not meet the criteria for a manic episode or a major depressive episode These individuals tend to be in one mood state or the other for years with relatively few periods of neutral mood. Many people think they are just moody, but it is substantial enough to interfere with functioning and should be treated so that they do not develop the more severe bipolar I or II disorder

maintenance treatment

combination of continued psychosocial treatment, medication, or both designed to prevent relapse following therapy - Psychological treatments for depression are most notable for their enduring ability to prevent relapse or recurrence, especially for the more chronic or severe cases

List five biological sources that can contribute to mood disorders:

genetics Neurotransmitter system abnormalities endocrine system circadian or sleep rhythms neurohormones

Timeframe for a manic episode

At least one week

Timeframe for major depressive episode

At least two weeks

Social and cultural causes of mood disorders

- Disruptions in relationships - Gender (Besides bipolar being equal almost 70% of those with major depressive disorder are women) (cultural conditioning, inequality, women ruminate more than men and men tend to ignore their feelings, harassment, abuse, poverty - lack of social support

manic episode

-A distinct period of abnormally and persistently elevated, expensive, or irritable mood last seen at least one week - Includes at least three of the following: inflated self-esteem, distractibility, decreased need for sleep, increase in goal directed activity or psycho motor agitation, excessive talkativeness, racing thoughts, excessive involvement in high-risk activities -Severe enough to cause impairment in normal functioning or requires hospitalization, or there are psychotic features

Psychological causes of mood disorders

-Beck's Cognitive Theory - patient's beliefs about the world, themselves, and the future cause them to be depressed (with bipolar it is this along with Ambitious driving for goals, perfectionism, and self criticism) * And cognitive vulnerability for depression -Learned Helplessness - depressed people no longer think they have control over what happens to them so they simply stop trying - stressful life events (ie - The break up of a relationship, humiliation, loss, and social rejection) (20 to 50% of people who experience severe stress develop mood

Mindfulness-based therapy

-designed to prevent relapse into depression -utilises CBT -Adds mindfulness and mindfulness meditation -focus on being aware of all incoming thoughts/feelings and accepting them -not attaching or reacting to them -interrupt the autonomic process to focus less on reacting and rather accepting and observing w/o judgement - reaction = reflection

Disruptive Mood Dysregulation Disorder (DMDD)

A condition in which a child has chronic irritability and anger that culminates in frequent tantrums that are inappropriate to the circumstances and to the child's age. (Without any accompanying mania). The mood between temper outbursts is persistently irritable or angry most of the day, nearly every day, and is observable by other than at least two of the three settings There has never been a distinct. Lasting more than one day during which the full symptom criteria, except duration, for a manic or hypomanic episode haven't been met Diagnosis should not be made before age 6 or after age 18.

Indicate which type of treatment for mood disorders is being described: These come in three main types (tricyclics, MAO inhibitors SSRIs) and are often prescribed but have numerous side effects:

Antidepressants

Match the following with the correct suicide type: Mabel lived in a nursing home for many years. At first her family and friends visited her often; now they only come at Christmas. Her two closest friends in the nursing home died recently. She has no hobbies or other interests. Mabel suicide would be identified as what type? A) altruistic B) egoistic C) anomic D) Fatalistic

B

Which theory suggests that depression occurs when individuals believe they have no control over the circumstances in their lives? A). Attribution theory B). Learned helplessness C). Social learning theory D). Theory of equafinality

B

electroconvulsive therapy (ECT)

Biological treatment for severe, chronic depression involving the application of electrical impulses through the brain to produce seizures. The reasons for its effectiveness are unknown.

Onset and duration of bipolar disorder

Bipolar I - Average age 15 to 18 Bipolar II - Average age 19 to 22 (Rare to develop after 40, but if so it is chronic) - Bipolar disorders develop more acutely then depressive disorders Cyclothymia - Is chronic and lifelong in most cases (1/3 develop full blown bipolar disorder)

interpersonal psychotherapy (IPT)

Brief treatment approach that emphasizes resolution of interpersonal problems and stressors, such as role disputes in marital conflict, forming relationships in marriage, or a new job. It has demonstrated effectiveness for such problems as depression.

Choose the corresponding disorder: Anna has had some mood disorder problems in the past, although some days she's better than others. Many days it seems like she has fallen into a rut. Although she manages to get by, she has trouble making decisions because she doesn't trust her self. A) Mania B) Double depression C) Persistent depressive disorder D) Major depressive episode F) Bipolar I disorder

C

Match the following with the correct suicide type: Ralph's wife left him to look after the children. He is a well-known television personality, but because of a conflict with the news station owners, he was recently fired. If Ralph kills himself, his suicide would be: A) altruistic B) egoistic C) anomic D) Fatalistic

C

What is the general agreement among mental health professionals about the relationship between bereavement and depression? A) Bereavement is less severe than depression in all cases B) Depression can lead to bereavement in many cases C) Bereavement can lead to depression in many cases D) Symptoms of bereavement and depression really overlap

C

Which of the following explains why some people refused to take medication to treat their depression or take those medications and then stop? A) The medications are in short supply and are unavailable B) The medication didn't work for most people C) For some people the medications cause serious side effects D) The medications work in the short term but not in the long term

C

Which statement best characterizes the relationship between anxiety and Depression: A) Anxiety usually precedes the development of depression B) Depression usually precedes the development of anxiety C) Almost all depressed patients are anxious, but not all anxious patients are depressed D) Almost all anxious patients are depressed, but not all depressed patients are anxious

C

Psychological treatments for depression

CBT (and related approaches are Cognitive behavioral analysis system of psychotherapy, and mindfulness-based therapy) - Increased activity alone can help Interpersonal psychotherapy Prevention

complicated grief

Grief characterized by debilitating feelings of loss and emotions so painful that a person has trouble resuming a normal life; designated for further study as a disorder by DSM-5. - Many of the psychological and social factors related to mood disorders in general, including a history of past depressive episodes, also predict the development of this. - The very strong yearning in complicated grief seems to be associated with the activation of the dopamine neurotransmitter systems; this is in contrast to major depressive disorder, in which activation is reduced in the system.

Timeframe for premenstrual dysphoric disorder

In the majority of menstrual cycles with at least five symptoms in the final week before the onset of menses, starts to improve within a few days after the onset of menses, and become minimal or absent in the week post menses

Indicate which type of treatment for mood disorders is being described: This therapy focuses on resolving problems in existing relationships and learning to form new interpersonal relationships:

Interpersonal psychotherapy

double depression

Severe mood disorder typified by major depressive episodes superimposed over a background of dysthymic disorder.

What psychological factors can have impact on mood disorders (4)

Stressful life events Learned helplessness Depressive cognitive triad A sense of uncontrollability

Somatic symptoms characterizing mood disorders are nearly equivalent across cultures. True or false

T

Timeframe for disruptive mood dysregulation disorder

Three or more times a week for 12 months

It is often difficult to diagnose depression in the elderly because it's symptoms are similar to those of medical ailments or dementia. True or false

True

Women are approximately twice as likely as men to be diagnosed with a mood disorder. True or false

True

integrated grief

grief that evolves from acute grief into a condition in which the individual accepts the finality of a death and adjusts to the loss

recurrent

if two or more major depressive episodes occurred and were separated by at least 2 months during which the individual was not depressed 35-85% Of people will experience a second episode. This is a chronic condition that waxes and Wayne's overtime but seldom disappears.

Treatment of Mood Disorders

medications (antidepressants, lithium Electroconvulsive therapy (ECT) - biological (last resort6 Psychological treatment - Cognitive Therapy (Beck): Treatment approach that involves identifying and altering negative thinking styles related to psychological disorders such as depression and anxiety and replacing them with more positive beliefs and attitudes (More adaptive behavior and coping styles) - Interpersonal psychotherapy (IPT): brief treatment approach that emphasizes resolution of the interpersonal problems and stressors, such as role disputes and marital conflicts, forming relationships and marriage, or a new job. It has demonstrated effectiveness for depression

Bipolar II Disorder Criteria

one must have at least 1 hypomanic (for 4 DAYS) and at least 1 major depressive (for 2 WEEKS) episode. Alternation of major depressive episodes with hypomanic episodes (Not for manic episodes)

mood disorders

psychological disorders characterized by emotional extremes. See major depressive disorder, mania, and bipolar disorder. The fundamental experience of depression or mania contribute, either singularly or together, to all the mood disorders.