Abnormal Psychology ch. 7: Mood Disorders and Suicide

delusions

false beliefs

mania

intense and unrealistic feelings of excitement and euphoria

what tends to protect one from suicide?

involvement/identity with other people -being married and having children

those at low genetic risk for depression are more _____________ to the effects of major stressors

invulnerable

Is there a difference in prevalence rates btwn sexes for bipolar disorder?

no

bipolar II disorder

person doesn't experience full-blown manic (or mixed) episodes but has experienced clear-cut hypomanic episodes, as well as major depressive episodes

bipolar disorders

person experiences both mania and depressive episodes

unipolar depressive disorders

person experiences only depressive episodes

True or False? Medication is not effective in prevention, as well as treatment, for patients subject to recurrent episodes.

FALSE. medication CAN be preventative

True or False? most individuals who complete suicides leave notes.

FALSE. only 15-25% leave notes. They are usually brief.

T or F? symptoms and impairment following death can be identical to those following other important losses? If true, name some losses.

TRUE. marital dissolution, unexpected economic misfortunes, job loss

MDD is often co-morbid with

anxiety

what is a psychological factor in bipolar disorder?

low social support

how can some people with bipolar disorder be misdiagnosed

they exhibit depressive symptoms, but no manic symptoms

True or False? bipolar disorder occurs equally in males and females.

true

most common symptom to occur prior to onset of manic episode

very little sleep (out of choice, not because of insomnia)

3 main thrusts of preventive efforts against suicide

1) treatment of person's current mental disorder(s) 2) crisis intervention 3) working with high-risk groups

RECURRENT major depressive episode with a seasonal pattern (also known as SEASONAL AFFECTIVE DISORDER)

-SPECIFIER applied if individuals meet criteria for maj. depress. epis. plus SHOW A SEASONAL PATTERN -must have had at least 2 episodes of depression in past 2 years occurring at same time of the year (fall/winter most common) -full remission must occur at same time of year (most commonly spring) *more common in people living at higher latitudes and in younger people

severe major depressive episode with psychotic features

-SPECIFIER status applied when, in addition to meeting critera for maj. depress. epis. a patient has psychotic symptoms like loss of contact with reality, delusions, or hallucinations -delusions/hallucinations present are MOOD CONGRUENT (i.e. they seem "appropriate" to serious depression b/c content is negative in tone) *psychotic depressed individuals have longer episodes and poorer long-term prognosis than nonpsychotic depressives

bipolar I disorder (also called manic-depressive illness)

-distinguished from major depressive disorder by at least 1 MANIC EPISODE or MIXED EPISODE

MDD diagnosis can be of 2 types

-single -recurrent

negative cognitive triad

1)negative thoughts about the self ("I'm ugly", "I'm a failure") 2) negative thoughts about one's experiences and the surrounding world ("No one loves me") 3) negative thoughts about one's future ("It's hopeless because things will always be this way") *NEGATIVE COG. TRIAD can be maintained by negative cognitive biases/errors

natural course of untreated depressive episode lasts how long?

6 to 9 months -so if patients have taken medication for 3 months and are feeling better, they shouldn't discontinue medication because symptoms could relapse

average duration of untreated episode of depression

6-9 months

True or False? Postpartum depression is common.

FALSE. Postpartum blues are common, but not postpartum depression.

4 phased to normal response to loss of spouse/close family member (grief)

NYDR 1) Numbing and disbelief. May last few hours to week. May be interrupted by intense distress/panic/anger. 2) yearning and searching for dead person (more similar to anxiety than depression). May last weeks-months. Typical symptoms are restlessness, insomnia, preoccupation with dead person. 3) disorganization and despair. Person accepts loss as permanent and tries to establish new identity. Criteria for MDD may be met during phase. 4) Reorganization. People begin to rebuild their lives, sadness abates, zest for life returns.

mood disorders, conduct disorders, and substance abuse (esp. alcohol) are risk factors for

attempted/completed suicide

depression

feelings of extraordinary sadness and dejection

who is more likely to attempt suicide? women or men

women -about 3x as likely

transcranial magnetic stimulation

-alternative biological treatment for depression -noninvasive technique; brief but intense pulsating magnetic fields induce electrical activity in certain parts of cortex -treatment occurs 5 days/wk for 2-6 wks -no adverse memory side effects, as in ECT

mixed episode

-characterized by symptoms of both full-blown manic and major depressive episodes for at least a week -symptoms can be intermixed or alternate rapidly

major depressive episode with catatonic features

-SPECIFIER applied if individuals meet criteria for maj. dep. epis. and also show MARKED PSYCHOMOTOR DISTURBANCES from catalepsy (immobility) to extensive psychomotor activity, mutism to rigidity

major depressive disorder with atypical features

-SPECIFIER status applied when individual meets criteria for maj. dep. epis. and also has symptoms of MOOD REACTIVITY--mood brightens in response to potential positive events--plus 2 or more of 4 symptoms: 1) significant weight gain or increase in appetite 2) hypersomnia (Sleeping too much) 3) leaden paralysis (heavy feeling in arms/legs) 4) long-standing pattern of being acutely sensitive to interpersonal rejection *disproportionate number of individuals w/atypical features are female and tend to show suicidal thoughts *linked to mild form of bipolar disorder associated w/hypomanic rather than manic episodes *those with atypical symptoms are more likely to respond to MAO inhibitors than nonatypical

specifiers

-SPECIFIERS are additional patterns of symptoms that have implications for understanding course of disorder and most effective treatment -ex: major depressive episode with melancholic features

completed suicides

-about 4x more men than women die from completed suicides in U.S. -difference in gender pattern with those w/bipolar disorder -highest rate of completed suicide rates in elderly (65+)--high proportion are divorced/widowed and suffer from chronic physical illness -women tend to use drug ingestion; men tend to use methods more likely to be lethal: gunshot

cognitive-behavioral therapy (cognitive therapy or CBT)

-developed by Beck and colleagues -10-20 sessions (relatively brief form of treatment) -focuses on here and now problems, rather than potentially remote causal issues -highly structured, systematic attempts to teach people w/unipolar depression to evaluate systematically their dysfunctional beliefs & negative automatic thoughts -patients taught to identify/correct their biases or distortions in information processing & to uncover/challenge underlying depressogenic assumptions & beliefs -relies on empirical approach: patients are taught to treat beliefs as hypotheses that can be tested through use of behavioral experiments

features of bipolar disorder

-duration of manic shorter than duration of depressive episodes (3x as many days spent depressed than manic)

what are two special advantages of CBT

-it seems to have the ability to prevent relapse, similar to that of staying on medication -brain-imaging studies show CBT results in biological changes in certain brain areas following effective treatment (versus medication--idea that medication targets limbic system, whereas CBT works on cortical functions)

dysthymic disorder

-mild to moderate intensity depression; primary hallmark is chronicity -persistently depressed mood most of day, for more days than not, for at least 2 years (1 yr for kids/adolescents) -must also have 2 of 6 symptoms when depressed -intermittent normal moods another important characteristic distinguishing dysthymia from MDD -people with dysthymia show poorer outcomes/as much impairment as those with MDD

lithium

-more widely used as treatment for manic episodes than depressive episodes -used in preventing cycling btwn manic/depressive episodes -difficulty in compliance in taking drug (because of side effects and also bc patients miss energetic highs associated with hypomanic episodes)

major depressive disorder

-most common form of mood episode -markedly depressed (show marked loss of interest in pleasurable activities) most of every day for at least 2 weeks -must show 3-4 other symptoms that range from COGNITIVE (feelings of worthlessness/guilt, thoughts of suicide) to BEHAVIORAL (fatigue) to PHYSICAL (changes in appetite/sleep patterns)

behavioral activation treatment

-new treatment for unipolar depression -focuses on getting patients to become more active/engaged with their environment & interpersonal relationships -techniques incld: scheduling daily activities & rating pleasure/mastery while engaging in them, exploring alternate behaviors to reach goals, role-playing to address specific deficits -if CBT focuses on changing cognition, BAT focuses on changing behavior -goal to increase positive reinforcement and reduce avoidance/withdrawl -easier to train therapists in this technique than in CBT

interpersonal therapy (IPT)

-not widely tested yet but appears to be as effective as medication or CBT -focuses on current relationship issues, trying to help patient understand/change maladaptive interaction patterns -version called INTERPERSONAL AND SOCIAL RHYTHM THERAPY--used to treat bipolar episodes--patients taught to recognize effect of interpersonal events on social/circadian rhythms and to regulate these rhythms

electroconvulsive therapy (ECT) -what patient populations use this treatment

-often used with severely depressed patients (esp. among elderly) if they present immediate/serious suicidal risk (since antidepressants take 3-4 weeks to kick in) -also used in patients who are resistant to other medications -treatments induce seizures -loss of memory and confusion can be side effects

bright light therapy

-originally used in treatment of seasonal affective disorder; shown to be effective in nonseasonal depressions

manic episode

-other primary kind of mood episode -markedly elevated, euphoric, or expansive mood, often interrupted by occasional outbursts of irrationality or violence -extreme moods persist for at least a week -3 or more symptoms at same time period like BEHAVIORAL (notable increase in goal-directed activity, loosening of personal/cultural inhibitions) to MENTAL (self-esteem grossly inflated and mental activity speeds up) to PHYSICAL (decreased need for sleep)

bipolar disorders

-presence of mania or hypomanic episodes nearly always preceded or followed by periods of depression -extreme moods must persist for at least a week for diagnosis to be made -in addition, 3 of more symptoms must be present -must be significant impairment of occupational and social functioning (hospitalization is often necessary)

what 2 sleep cycle abnormalities are vulnerability markers for major depression

-reduced latency to enter REM sleep (depressed individuals enter REM sleep 20 minutes before nondepressed) -decreased amount of deep sleep

relapse

-return of symptoms within fairly short period of time -relapses probably reflects the fact that underlying episode of depression hasn't yet run its course -commonly occur when pharmacotherapy is terminated prematurely; after symptoms have remitted but before underlying episode is really over

mood disorders

-severe alterations in mood for long periods of time-->soaring elation or deep depression -abnormal mood is defining feature -also called affective disorders

cross-cultural differences in prevalence rates for bipolar disorders

-similar across many countries for bipolar disorders -depression varies

hypomanic episode

-similar symptoms to manic episode -4 days of persisting abnormally elevated expansive, elevated, irritable mood -3 other symptoms (self-esteem inflation, decreased need for sleep, pressured sleep) -less impairment in social/occupational functioning in hypomania than manic episode (hospitalization not required)

cyclothymic disorder

-symptoms of cyclic mood changes that persist for at least 2 years -defined as less serious version of full-blown bipolar disorder -symptoms of depressed phase similar to those in someone with dysthymia -symptoms of hypomanic phase opposite of dysthymia symptoms -may be significant periods between episodes in which person functions in adaptive manner

suicide

-taking one's own life -50-90% who commit suicide do so during depressive episode or in recovery phase -often occurs at point when person appears to be emerging from deepest phase of depressive attack -suicide ranks among 10 leading causes of death in Western countries

suicide attempts are most common in people btwn what ages

-used to be btwn 25 and 44 years old -now btwn 18 and 24 yrs old

mindfulness-based cognitive therapy

-variant of cognitive therapy -used to help prevent further recurrences -theory is that rather than trying to alter content of their negative thinking, it may be more helpful to change the way in which these people relate to their thoughts, feelings, bodily sensations -MBCT trains patients to develop an awareness of their unwanted thoughts, feelings, sensations so they don't automatically try to avoid them but learn to accept them as thoughts occurring in the moment, not a reflection of reality

Double depression

-when major depression coexists with dysthymia -individuals are moderately depressed on chronic basis, but undergo increased problems from time to time when they meet criteria for Maj. Depress. Ep.

customarily, we differentiate among mood disorders in terms of these two characteristics

1) SEVERITY: number of dysfunctions experienced and relative degree of impairment evidenced in those areas 2) DURATION: whether disorder is acute, chronic, or intermittent

3 critical dimensions on which attributions are made

1) internal/external 2) global/specific 3) stable/unstable

greater genetic contribution to unipolar disorder or bipolar I disorder?

BIPOLAR I has greater genetic contribution -genes account for 80-90% of variance in liability to develop *This is higher than heritability estimates for any other major adult psychiatric disorder, incld schizophrenia -idea that those with bipolar are genetically susceptible to both depression and mania and that these are INDEPENDENT susceptibilities

differences in depressive symptoms btwn depressive episodes in bipolar and unipolar depressive disorders

BIPOLAR: more mood lability, more psychotic features, more motor retardation, more substance abuse UNIPOLAR: more anxiety, agitation, insomnia, physical complaints, and weight loss *shared symptoms btwn bipolar and unipolar are more SEVERE for bipolar

which is more common, Bipolar I or II?

Bipolar II is equally or more common than Bipolar I diagnosis *Bipolar II evolves into Bipolar I only 5-15% of cases, suggesting they ARE DISTINCT FORMS of the disorders

is there a higher genetic factor for unipolar major depression or bipolar disorder?

Bipolar disorder has a higher genetic contribution

True or False? Rates for unipolar depression are always much higher for women than for men.

TRUE.

except among young males, whites have significantly ___________ rates of suicide than African-Americans

HIGHER (same for young males)

True or False? Even more variance in liability to most forms of major depression is due to nonshared environmental influences (experiences family members do not share) than to genetic factors

TRUE

True or False? Mild mood disturbances are on the same continuum as the more severe disorders.

TRUE

even though a patient may be exhibiting only manic symptoms, it is assumed a bipolar disorder exists and that a depressive episode will eventually occur

TRUE--meaning, there are no officially recognized "unipolar" manic/hypomanic counterparts to dysthymia or major depression

T or F? DSM-IV-TR states that MDD can't be diagnosed for first 2 months following loss, even if all criteria are met

TRUE.

True or False? CBT is as effective as medication in treating severe unipolar depression.

TRUE.

True or False? Normal depression nearly always the result of recent stress.

TRUE.

what 3 personality traits are associated with increased risk for suicide?

impulsivity, aggression, and pessimism

which is more common? Unipolar major depressive disorder or bipolar major depressive disorder.

UNIPOLAR -it has increased in recent decades

anhedonia

inability to experience pleasure-important symptom of depression

hallucinations

false sensory perceptions

independent life events

stressful life events independent of person's behavior and personality (losing a job b/c one's company is shutting down)

dependent life events

stressful life events may have been at least partly generated by depressed person's behavior/personality **poor problem solving example: failing to keep up with routine tasks like paying bills

treatment of adolescent mood disorders with antipressant medications can produce slightly increased for what

suicidal ideation (thoughts)

recurrence

symptoms recurr at some future point