Abnormal Psychology Exam 2 (Chapters 7-9)

Causes of Suicide: Psychodynamic View

Suicide results from: -Depression and anger at others that is redirected towards self -Introjecting lost person (real or symbolic loss); unconsciously incorporating the person into their own identity and feel toward themselves as they had felt toward the other -Later suicidal behaviors related to childhood losses (parental loss is more common among suicide attempters) -Death instincts/*Thanatos*: Thanatos ("death instinct") opposes life instinct

Beck's Cognitive Therapy

Used to guide clients in 4 phases to recognize and change negative cognitive processes (cognitive therapy) 1) Increase activities and elevate mood (active and confident) 2) Challenging automatic thoughts (educate about automatic thoughts--document and list those thoughts) 3) Identifying negative thinking and biases (therapist show how illogical thinking processes are contributing to those thoughts and change style) 4) Changing primary attitudes (change maladaptive attitudes that set stage for depression) -*Maladaptive attitudes lead people to cognitive triad (repeatedly viewing oneself, the world, and the future in negative ways)*

Comparing Treatments for Unipolar Depression

-Cognitive-behavioral, interpersonal, and biological therapies are all effective in treating unipolar depression. -Cognitive-behavioral and interpersonal have lower relapse rate. -Psychodynamic therapies are less effective than others. -*Psychotherapy and drug therapy is better than any other treatment alone* -Among biological treatments, ECT works best

Symptoms of Depression (5)

1. *Emotional*: Miserable and empty; anxiety and anger; anhedonia (inability to experience pleasure at all) 2. *Motivational*: Lose of desire to pursue usual activities; lack of drive; social withdrawal 3. *Behavioral*: Less active and less productive; stays in bed for long periods; move and speaks slowly 4. *Cognitive*: Negative views about one's self; poor memory and easily distracted; pessimism (nothing will improve/feelings of hopelessness) 5. *Physical*: Headaches, indigestion, general pain, loss of appetite and sleep

Treatment for Depressive and Bipolar Disorders: Cognitive-Behavioral Therapy

*Behavioral activation*: Therapists work systematically to increase # of constructive and pleasurable activities and events in a client's life; 3 key components to the approach: 1) Reintroduce pleasurable events and activities 2) Appropriately reward non-depressive and depressive behaviors 3) Help improve social skills >Most effective when combined with cognitive techniques Ex: Introducing positive activities to increase better mood and guide clients to monitor their negative behaviors ->*contingency management approach*: therapist systematically ignoring client's depressive behaviors while praising or rewarding constructive behavior, such as going to work. -Behavioral side: get the clients moving again (engage in and enjoy more activities) -Cognitive side: guide the clients to think in more adaptive, less negative ways -2 of the leading approaches are: behavioral action and Beck's cognitive theory

Causes of Unipolar Depression: Biological View

*Biological View* >Genetic Factors, Biochemical factors, brain circuits, and immune system -*Genetic Factors*: Three kinds of research (Family Pedigree studies, Twin Studies, and Gene Studies) suggest people inherit predisposition to unipolar depression -> Family Pedigree Studies: Select people w/ unipolar depression as probands--person who is the focus of the study and examine their relatives in comparison to proband who does not have depression and see its effects on other members of family (30% of relatives related to proband who has depression will develop, compared to 10% of general pop.) -> Twin Studies: If an identical twin has unipolar depression, there's a 38% chance the other will develop it too -> Depressed individuals have abnormality of 5-HTT Gene (responsible for serotonin activity), low levels of serotonin=depression -*Biochemical Factors*: *Low activity of two neurotransmitters, norepinephrine and serotonin, linked to unipolar depression* -> Body's hormones also linked to depression (when confronted with stressors in our life, our brain triggers two stress pathways--HPA pathway which causes temporary heightened state of arousal, tends to overreact in PTSD and certain anxiety disorder individuals--excess cortisol) ->*Dracula hormone*: (melatonin) released only in the dark; people who experience a recurrence of depression each winter (seasonal affective disorder) apparently secrete more melatonin during the winter's long nights than others -*Brain Circuits*: *Subgenual cingulate (Brodmann Area 25)* is unique to depression but plays role in other disorders as well ->Prefrontal cortex, hippocampus is undersized, and its production of neurons is low -*Immune System* -> Under extreme stress, dysregulation of immune system occurs and contributes to depression; slower functioning of lymphocytes (WBC) and increase CRP production (protein that spreads throughout body and causes inflammation + illnesses) -> Higher incidence of migraines, irritable bowel syndrome, rheumatoid arthritis, and other illnesses caused by CRP production

DSM-Checklist for Bipolar I and Bipolar II Disorder

*Bipolar I Disorder* 1. Occurrence of manic episode (listed above) 2. Hypomanic or major depressive episodes may precede or follow the manic episode (full manic and major depressive episodes may alternate--weeks of mania followed by periods of wellness, and weeks of depression) -> Full blown mania *Bipolar II Disorder* 1. Presence or history of major depressive episodes 2. Presence or history of hypomanic episodes 3. No history of a manic episode -Hypomanic episodes (mildly manic) alternate and some people accomplish a huge amount of work during manic episode -- -Some have *mixed features* where they have both manic and depressive symptoms within the same episode (racing thoughts amidst feelings of extreme sadness) -W/o treatment, mood episodes tend to recur for people with either types of bipolar disorder. -If a person has 4 or more episodes within one-year episode, it's considered *rapid cycling*. -People with bipolar disorder tend to experience depression more than mania.

Non-drug biological treatments

*Brain stimulation* 1. *Electroconvulsive therapy (ECT)*: Severely depressed people; electrodes attach to patient's head and send electrical current through brain causing convulsion (leads to brain seizures) 2. *Vague nerve stimulation*: vague nerve (longest nerve in the human body) runs from brain stem through the neck down the chest and onto the abdomen; stimulate brain by electrically stimulating vague nerve through pulse generator 3. *Transcranial Magnetic Stimulation (TMS)*: Electromagnetic coil placed on/above patient's head and sends current into their brain 4. *Deep Brain Stimulation (DBS)*: Electrodes are implanted in a key component of the depression-related brain circuit (subgenus cingulate) and attach to a battery

Suicide and Age

*Children*: -Suicide is infrequent among children but increasing *Adolescents*: -Suicidal actions become much more common after age of 18 -Suicidal attempts outnumber success -Factors linked to suicide attempts: competition for jobs/college position/academics, weakening family ties, availability of alcohol/drugs, mass media -Highest rate of suicide are among American Indians *Elderly*: -Most likely to commit suicide and most successful -Contributory factors: illness, loss of close friends/relatives, loss of control over one's life, loss of social status, and ethnicity

Causes of Unipolar Depression: Cognitive-Behavioral View

*Cognitive-Behavioral View* -Depression results from problematic behaviors and dysfunctional thinking -Theoretical perspectives: 1) Explanations focused on behavioral realm (Behavioral dimension) -> Depression is linked to significant changes in the number of rewards and punishments that people receive in their lives -> Large reduction in positive life rewards may cause increasingly fewer positive behaviors; even lower positive rewards rate, and eventually depression -> Social rewards are important in downward depression spiral *# of rewards people receive in their life is related to or absence of depression* 2) *Negative thinking*: (Beck) Unipolar depression is produced by a combination of maladaptive attitudes, cognitive triad, errors in thinking, and automatic thoughts. -> *cognitive triad*: individuals repeatedly interpret 1. their experiences, 2. themselves, and 3. their futures, in negative ways that lead to depression -> Depressed people make errors in their thinking by drawing *arbitrary inferences* (negative conclusions based on little evidence); Ex: a student makes A on exam, but concludes that it's due to the professor's generosity (minimization); same student must miss class and thinks that they won't be able to keep up with the rest of the semester (magnification) -> *automatic thoughts*: steady train of unpleasant thoughts that keep suggesting to them that they are inadequate and that their situation is hopeless (happen as if by REFLEX) -*Seligman's Learned Hopelessness Theory*: Depression occurs when people feel loss of control over life reinforcements (rewards and punishments) and assume responsibility for helpless state -> loss is attributed to internal, global, and stable causes -*Attribution-Helplessness Theory*: modified version; people question self when events are beyond control -> Attribution to internal causes (global + stable)= depression; Ex: "I am inadequate at everything and I will always be" -> Attribution to more specific, unstable, or external causes= less likelihood of learned helplessness and depression Ex: Specific ("The way I've behaved the past couple of weeks blew this relationship"), Unstable ("I don't know what got into me--I don't usually act like that"), or External ("She never did know what she wanted")--less likely to lose control again and would not probably experience helplessness and depression -> Liu and others: attribution that produce helplessness= depression --- Ex: I failed the test Internal: I didn't study Global: I suck at everything, all is wrong (beyond this one situation) Stable: Consistently (all of the time)

Depression and Mania

*Depression*: Low, sad state in which life seems dark and its challenges overwhelming *Mania*: Opposite of depression; state of breathless euphoria or at least frenzied energy, in which people may have an exaggerated belief that the world is theirs for the taking -Mood problems are at the center of 2 groups of disorder: depressive disorders and bipolar disorders

Depressive and Bipolar Disorder

*Depressive Disorder*: Only suffer from depression, a pattern called unipolar depression (depression without history of mania and returns to normal or nearly normal mood when depression lifts); marked by unipolar depression *Bipolar disorder*: Periods of mania that alternate with periods of depression *Unipolar mania*: Suffer from mania only (uncommon)

Causes of Unipolar Depression: Developmental Psychopathology Perspective

*Developmental Psychopathology Perspective* -Unipolar depression is caused by a combination of these factors cited by various models -Genetically inherited biological predisposition influenced by significant early life trauma (Genetic predisposition + significant early life trauma=depression)

Causes of Unipolar Depression: Sociocultural View (Family-Social Perspective, Multi-cultural Perspective)

*Family-Social Perspective*: -Decline in social rewards impacts depression (similarly to cognitive-behavioral therapy) -Depressed people have weak social skills and communicate poorly; cause avoidance by others (they constantly seek reassurances from others, thereby decreasing their social contacts/rewards) -Depression is linked to weak or unavailable social support, isolation, and lack of intimacy. *Multi-cultural Perspective*: 1) Links between gender and depression: >*Artifact theory*: women and men are equally prone to depression but clinicians fail to detect it in men (women may display more emotional symptoms such as sadness and crying) >*Hormone explanation*: hormonal changes trigger depression in many women especially during puberty, pregnancy, and menopause >*Life stress theory*: women in our society are subject to more stress than men (poverty, menial jobs, less inadequate housing, and more discrimination) >*Body dissatisfaction explanation*: females in western society are taught, almost from birth, but particularly during adolescence to seek low body weight and slender body >*Lack of control theory*: draws on the learned hopelessness research and proposes that women may be more prone to depression bc they feel less in control of their lives >*Rumination theory*: women are more likely to ruminate (overthink) when their mood darkens 2) Ties between cultural and ethnic background and depression: -Depressed people in non-Western society are more likely to be troubled by physical symptoms of depression than cognitive ones

DSM-5 Checklist for Major Depressive Episode and MDD

*Major Depressive Episode*: 1. 2 week period: Increase in depressed mood for majority of each day and/or decrease in enjoyment or interest across most activities for majority of each day 2. Experience 3 or 4 of the following symptoms: Considerable weight change/appetite change, daily insomnia/hypersomnia, daily agitation or decrease in motor activity, daily fatigue/lethargic, worthlessness or excessive guilt, daily reduction in concentration or decisiveness 3. Repeated focus on death or suicide, a suicide plan, or suicide attempt 4. Significant distress or impairment *Major Depressive Disorder (MDD)*: 1. Presence of major depressive episode (all mentioned above) 2. No pattern of mania or hypomania ------ -Must have at least 1 of these 2: 1. Depressed mood 2. Anhedonia + 3 more symptoms (If you have both major symptoms, need 3 additional minor symptoms for diagnosis; if you have only 1 major symptom, you need 4 more minor)

DSM-5 Checklist for Manic Episode

*Manic Episode* 1. 1 week or more, person displays a continually abnormal, inflated, unrestrained, or irritable mood as well as continually heightened energy or activity for most of everyday 2. At least 3 of the following symptoms: grandiosity or overblown self-esteem, reduced sleep need, increased talkativeness, or drive to continue talking, rapidly shifting ideas or the sense that one's thoughts are moving too fast, attention pulled in many directions, heightened activity or agitated movements, excessive pursuit of risky and potentially problematic activities 3. Significant distress or impairment

Treatment for Depressive and Bipolar Disorders: Psychological Approach

*Psychodynamic therapy*: Unipolar depression results from unconscious grief over real or imaged loss, compounded by excessive dependence on other people; psychodynamic therapists seek to bring the issues to consciousness and work through (free association, therapist interpretation, and review of past events and feelings) Strengths -Most successful with modestly or moderately depressed clients with a clear history of abuse (extreme self-criticism) -Long-term therapy is only occasionally helpful in unipolar depression cases (short-term is better especially when combined with psychotropic medications) Weaknesses -Depressed clients may be too passive or weary to join fully in therapy (resistance) -Clients may become discouraged and end treatment too early

Causes of Unipolar Depression: Psychological View (Most widely applied to unipolar depression is psychodynamic and cognitive-behavioral model)

*Psychological View*: -Freud and Abraham: 1st psychodynamic explanation of depression (compare depression to when people experience real or imagined loss--symbolic loss) 1) Regression to earlier stage of development (oral): infants cannot distinguish themselves from their parents 2) *Introjection*: Direct all feelings for the loved one--including sadness and anger towards themselves (anger turned inward) 3) Eventually become depressed -> *symbolic or imagined loss*: Loss of valued object that is unconsciously interpreted as the loss of a loved one (Ex: employment) -> Object-relations theorists: (psychodynamic therapists that emphasize relationships) propose that depression results from when people's relationships leave them feeling unsafe/insecure -Strengths: >General research support; depression may be triggered by major loss; early losses set stage for later depression >Depression after loss related to poorly met childhood needs -Weaknesses: >Early losses and inadequate parenting sometimes lead to depression but may not be typically responsible for development of the disorder >Inconsistent and some parts of model are difficult to test

What are the different types of depressive disorders? (4) What are the different types of bipolar disorders? (3)

*Unipolar Depression*: 1. Major Depressive Disorder 2. Persistent depressive disorder 3. Pre-menstrual dysphoric disorder 4. Disruptive mood dysregulation disorder *Bipolar Disorder* 1. Bipolar I 2. Bipolar II 3. Cyclothymic disorder

Interpersonal View

-*Interpersonal-Psychological Theory*: People are more likely to commit suicide if: 1. *Perceived burdensomeness*: believe that their existence places a heavy and permanent burden on their family, friends, or society 2. *Thwarted belongingness*: Feel isolated and alienated from others--not an integral part of a family or social network 3. Psychological ability to carry out suicide -Important to examine variables collectively

Causes/Diagnosis of Bipolar Disorder

-*Neurotransmitters*: Mania may be related to high norepinephrine activity along with low levels of serotonin (also ties to GABA -> bipolar) -*Ion Activity*: Disruption in transport of ions can cause neurons to fire too easily (mania) or not fire (depression) -*Brain structure*: Basal ganglia and cerebellum are abnormal brain structures found in people with bipolar disorder -*Genetic factors*: Identical twins have a 40-70% chance, frateneral twins have a 5-10% chance, and general pop is 1-2.6%

Suicide vs para-suicide, Sub-intentional death, Self-injury

-*Suicide*: Self-inflicted death in which the person acts intentionally, directly, and consciously 4 kinds of people who acts intentionally to end their lives: 1. *Death seekers*: Clearly intend to end his/her life while attempting suicide (clear in their wish to die and acts in a way that will guarantee it); singleness of purpose may last a short time, change to confusion the next hour or day, and return again 2. *Death initiators*: believes that the process of death is already underway and that they are simply hastening the process (common in elders and terminally ill people) 3. *Death ignorers*: Attempts suicide w/o recognizing finality of death (don't believe that their death is the end of their existence); Ex: children who commit suicide believing that they're going to heaven 4. *Death darers*: Mixed feelings or ambivalence about their intent to die at the moment of their attempt; Ex: Russian roulette or a person who attempts suicide decides to tell someone about it -*Para-suicide*: A suicide attempt that does not result in death -*Sub-intentional death*: victim plays indirect, hidden, partial, or unconscious role (drugs, alcohol, medication mismanagement) -*Self-injury or self-mutilation*: Cutting or burning oneself or banging one's head (can be addictive in nature bc pain brought on by injury seems to offer some sort of relief from tension)

Disruptive Mood Dysregulation Disorder

-Both persistent depression and recurrent outbursts of severe temper -Emerges during mid-childhood or adolescence

Persistent Depressive Disorder

-Chronic unipolar depression marked by repeated major depressive episodes (technically called *Persistent depressive disorder with major depressive episodes*) -Less severe and disabling symptoms: *Persistent depressive disorder with dysthymic syndrome*

Unipolar Depression

-Depression without history of mania and returns to normal or nearly normal mood when depression lifts -Women 2x as likely as men to have it -Average age of onset is 19 yrs old, with peak being late adolescence or early adulthood -More than half of people who recover from severe depression have at least one other episode later on in life -*Reactive (exogenous) depression*: Follows clear-cut stressful events -*Endogenous depression*: Response to internal factors -Today's clinicians concentrate on recognizing both internal and situational aspects of any given case of unipolar depression (points to biological, psychological, and sociocultural)

Depression vs Sadness

-Depression: Clinical disorder that causes considerable distress and impairment, features range of symptoms -Sadness: One of the symptoms found in depression (context-specific: ends when the loss situation ends, intensity of sadness is proportionate to the triggering loss)

What is the best treatment for depression and bipolar disorder?

-Depression: More complex; cognitive-behavioral, interpersonal, couple, drug, and brain stimulation -Bipolar: Anti-depressant with psychotherapy

Pre-Menstrual Dysphoric Disorder

-Diagnosis given to certain women who repeatedly have significant depression and related symptoms a week before menstruation

New wave Cognitive-behavioral therapy

-Disagrees with Beck's proposition about the need to fully discard negative cognitions to overcome depression -Practice acceptance and commitment therapy (ACT), mindfulness therapy, and other techniques to help clients recognize negative cognitions are streams of thinking -- Maladaptive attitudes + cognitive triad + illogical thinking= automatic thoughts and symptoms of depression -Acceptance and commitment therapy (ACT) ignores the negative thoughts while Beck's cognitive therapy is changing it

Biological View

-Genetics: Early twin studies point to genetic links to suicide -Brain Development: >Low serotonin and abnormalities in depression-related circuits contribute to suicide >Contribute to production of aggressive feelings and impulse behavior >Key psychosocial factors (such as childhood traumas)

Family-Social treatments

-Interpersonal psychotherapy and couple therapy= Most effective -*Interpersonal psychotherapy (IPT)*: Any of the 4 interpersonal problems areas may lead to depression and must be addressed: 1) *Interpersonal loss*: loss of a loved one (new ways of remembering person and new relationships) 2) *Interpersonal role dispute*: 2 people have dispute over expectation of their relationship roles 3) *Interpersonal role transition*: Major life changes (divorce or child birth) 4) *Interpersonal deficits*: Extreme shyness/social awkwardness -Useful for depression related to social conflicts or social role changes; studies show that IPT is as effective as cognitive therapy -*Couple therapy*: 2 people sharing long term relationship -*Integrative behavioral couples therapy*: Combine cognitive-behavioral therapy and sociocultural techniques to teach the couple specific communication and problem-solving techniques >More effective than other techniques when one couple member is depressed (may enhance marriage satisfaction) >If marriage is filled with conflict, is as effective as other therapies for reducing depression

Mania and Depression

-Mania: Low serotonin, high norepinephrine -Depression: Low serotonin, low norepinephrine -Suicide: Low serotonin

Cyclothymic disorder

-Numerous periods of hypomanic symptoms and mild depression symptoms (mild manic, mild depression) >Continues for 2+ years with normal moods for days or weeks in between >No gender differences >May evolve into Bipolar I or Bipolar II

Major Depressive Disorder

-Period of two or more weeks marked by at least 5 symptoms of depression, including sad mood and/or loss of pleasure; extreme cases can include psychotic symptoms marked by loss of contact with reality + bizarre ideas without foundation (delusions) and perceptions of things that are not actually there (hallucinations) -Severe pattern of depression w/o history of mania Diff Types of MDD: 1. *Seasonal*: Changes with seasons--such as recurring each winter 2. *Catatonic*: Immobility or excessive activity 3. *Peripartum*: During pregnancy or within 4 weeks of giving birth 4. *Melancholic*: Totally unaffected by pleasurable events >Some cases of MDD can be a depressive episode that occurs within a larger pattern of bipolar disorder but the person's manic episode hasn't yet appeared (When manic appears at later time, diagnosis is changed to bipolar disorder)

Adjunctive Psychotherapy

-Psychotherapy or mood stabilizers alone is rarely effective for bipolar disorder -Individual, group, or family therapy is often used as an adjunct to lithium (or other medication based) therapy -Improves variety of client's behaviors, especially those with cyclothymic disorder (standard of care)

Causes of Suicide: Durkheim's Sociocultural View

-Suicide probability is determined by attachment to social groups such as family, religious institutions, and community Suicide categories: 1. *Egoistic suicide*: society has little or no control (these people are not concerned with societal norms or rules of society) -> isolated, alienated, non-religious people 2. *Altruistic suicide*: (opposite) very well-integrated into social structure that they intentionally sacrifice their lives for its well being -> socially, well-integrated people Ex: soldiers throwing themselves on a grenade to save other's lives 3. *Anomic suicide*: people whose social environment fails to provide stable structure (let down by society) -> unstable social environment and structure Ex: Economic depression

Symptoms of Bipolar Disorder

-Unlike those experiencing depression, people in a state of mania typically experience dramatic and inappropriate rises in mood -Symptoms: 1. *Emotional*: Mood of euphoric joy and well-being is out of all proportion to the actual happenings in the person's life; some instead become very irritable and angry 2. *Motivational*: Constant excitement, involvement, and companionship; constantly seeking new friends 3. *Behavioral*: Very active, move quickly as though there's not enough time, talk rapidly and loudly 4. *Cognitive*: Poor judgement and planning, filled with optimism, and rarely listens to others 5. *Physical*: Energetic, get little sleep yet feel wide awake

Treatments for Bipolar Disorder

1. *Lithium*: effective treatment for bipolar disorder; developed in 1970 >Increases size of hippocampus, symptoms can vary from diarrhea to death >Determining correct dosage for a given patient is a delicate process (too low= no effect, too high= lithium intoxication/poisoning) 2. *Mood stabilizing, or anti-bipolar drugs* were later developed >Works best without side effects of lithium >Depakote (can treat bipolar w/o negative side effects of lithium) >Tegretol (anti-seizure meds for epilepsy)

How is suicide studied?

1. *Retrospective analysis*: psychological autopsy in which clinicians piece together information about person's suicide from friends, family, relatives, suicide notes (not always available) 2. *Studying the people who survive their suicide attempt* -Women are 3x more likely to attempt suicide, but men are 3x more likely to die from their attempts

DSM-5 Checklist for Persistent Depressive Disorder

1. Person experiences symptoms of major or mild depression for at least 2 years 2. Symptoms not absent for more than 2 months at a time during two year period 3. No history of mania or hypomania 4. Significant distress or impairment

What triggers suicide?

1. Stressful events: -Immediate stressors: >loss of love one through death, divorce, or rejection >loss of job or significant financial loss >natural disasters -Long term stressors: -> Social isolation -> Serious illness -> Abuse -> Occupational stress 2. Mood and thought changes: >Hopelessness >Sadness, anxiety, tension, frustration, shame >*Psychache* (psychological pain thats intolerable) >*Dichotomous thinking* (viewing problems and solutions in rigid either/or terms) 3. Alcohol and other drug use: 70% of suicide attempters drink alcohol before act; a quarter of these people are legally intoxicated 4. Mental disorders: Majority of suicide attempter shave a psychological disorder; risk increases with multiple disorders 5. Modeling: *Social contagion effect* is where there's an increase in risk of suicide among relatives and friends of people who recently commit suicide; serves as a model for other acts especially among teens

DSM-5 Checklist for Postpartum (peri-partum depression)

1. Symptoms may last up to a year or more 2. Extreme sadness, despair, insomnia, anxiety, intrusive thoughts, compulsions, panic attacks, suicidal thoughts 3. Impact on mother-infant relationship + child well-being *Causes*: -Triggered by hormonal changes of child birth -Genetic predisposition -Psychological and social change *Treatment*: -Self-help groups -Anti-depressant meds, cognitive-behavioral therapy, interpersonal psychotherapy, or combination -Tx helps most women if sought

Treatment for Sucide

2 categories: Treatment after suicide has been attempted and Suicide prevention 1. *Tx after suicide attempt*: >Medical care >Appropriate follow-up with psychotherapy or drug therapy -> Therapies such as psychodynamic, drug, group/family, cognitive-behavioral, mindfulness-based (aware of painful thoughts and feelings), or dialectical behavior therapy (DBT)--coping and problem solving skills -Therapy Goals: Keep patient alive, reduce psychological pain, achievement of non-suicidal state of mind and sense of hope, and development of better ways of stress management 2. *Suicide prevention*: >Prevention programs and crisis hotlines -> *Suicide prevention programs*: helps identify people who are at risk for killing themselves and offer them crisis intervention -> *Crisis intervention*: helps suicidal people see situations more accurately, make better decisions, and overcome their crisis.

Bipolar Disorders

2 kinds of bipolar disorder: 1. *Bipolar I disorder*: Full manic and major depressive episodes (alternate) 2. *Bipolar II disorder*: Hypomanic (mildly manic) alternate with major depressive -*Full manic episode*: at least 1 week of abnormally high or irritable mood, increased activity or energy, and at least 3 other symptoms of mania (may feature delusions or hallucinations) -*Hypomanic episode*: Symptoms of mania are less severe (little impairment) -No gender differences, but higher rates in low-income populations

Biological Approach: Anti-depressant drugs (Depression and Bipolar Disorder)

2 kinds of drugs were found to reduce the symptoms of depression: 1) *Monoamine oxidase (MAO) inhibitors*: increases in blood pressure with certain foods, must stay on strict diet; MAO inhibitors block MAO from carrying out activity (break down/degrade neurotransmitters serotonin and norepinephrine= increase levels of serotonin and norepinephrine) 2) *Tricyclics*: Reduce depression through neurotransmitter "re-uptake" mechanisms of neurons and helps neurotransmitters to stay in synapses longer >Relapse can occur if treatment ended too soon 3) *Selective Serotonin Re-uptake Inhibitors (SSRI)*: Increase serotonin levels without affecting norepinephrine or other neurotransmitters (Prozac, Zoloft, Lexapro) >Structurally different from MAO inhibitors and tricyclics -Serotonin norepinephrine re-uptake inhibitors: Increase both serotonin and norepinephrine activity