2-Ch 7/8: Mood Disorders/suicide Flashcards
Mood disorders
problems with moods/emotions NOT due to physical or other mental disorders
Unipolar
Typically just Depression
Bipolar
“Manic-depression”
2 poles: Mania & Depression
Prevalence of depression
more in females
prevalence of bipolar
equally male/female
risk of depression
increases with each additional episode of depression
1 episode = 50%
2 episodes = 70%
3 episodes = 90% risk
Depressive disorder core symptoms
- Depressed Mood
2. Diminished interest/pleasure in nearly all activities (Anhedonia)
Depressive disorders ( 9 symptoms)
- Depressed mood*
- Diminished interest/pleasure in nearly all activities*
- Significant weight loss/gain
- Insomnia/hypersomnia
- Psychomotor agitation or retardation
- Significant fatigue/loss of energy
- Feelings of worthlessness or guilt
- Diminished ability to think/concentrate
- Recurrent thoughts of death/suicidal ideation
Dysthymia
“milder”, less intense depressive disorder–>more chronic
Dysthymia DSM
- Sx’s not absent for more than 2 months at a time
- Chronic-duration = 2-20 years
- similar sx’s to depression but less intense
- increased risk for experiencing major depressive episode
Double Depression
both dysthymia & major depression
Major Depressive Disorder specifiers
Mild = just meet criteria
Moderate =Meet criteria a bit more
Severe = meet several criteria, with or without psychotic features
- Other:
- with Seasonal Patterning (SAD)
- with Peripartum onset (postpartum)
Catecholamine hypothesis of depression
Availability of NT’s at synapse
-serotonin, dopamine, norepinephrine
Genetic hypothesis of depression
Much evidence for genetic contribution
-based on twin & pedigree studies
Freud theory of depression
“prolonged grief” related to a significant early loss
Bibring theory of depression
the loss itself is not what’s important, its the lost of what the person represented to you
(psychodynamic)
Bowlby theory of depression
attachment theory-unhealthy early attachment
psychodynamic
Behavioral theory of depression
lack of positive reinforcement in person’s environment
Behavioral Activation Therapy (BAT)
expose individual to positive reinforcement of environment
Beck’s cognitive errors
overgeneralizing
selective abstraction
catastrophizing
dichotomous thinking
overgeneralizing
assume circumstances in one situation will be the same in all similar situations
selective abstraction
attend only to failure or deprivation AND ignore any positives
Catastrophizing
always imagining the worse of any given scenario
“worst case scenario”
Dichotomous thinking
rigid thinking-all or nothing
Attributional model
assigning causes to situations
- Internal: it’s all their fault
- Stable: part of who they are
- Global: not good at anything
Cognitive accuracy
“depressive realism hypothesis”
-are depressed people just more realistic?
Moore & Fresco meta-analysis
There was a small but significant effect supporting depressive realism
Humanistic/Existential theory of depression
Depression related most strongly to: a loss of self-esteem
-Carl Rogers: discrepancy b/w real & ideal self
Sociocultural theory of depression (US vs China)
culture plays role in symptom presentation & prevalence rates
US: higher rates among Native Americans & Southeast Asian Americans
China: report more somatic sx’s, fewer cognitive/affective sx’s
Diathesis-stress model
Diathesis = predisposition/vulnerability
Predisposition to depression + significant stress = onset of depression
Pharmacotherapy
Antidepressants
- Medications: SSRI’s
- ->increase availability of Serotonin, dopamine, norepinephrine
Phototherapy
light therapy
-used for major depression with seasonal patterning
*results of studies have mixed reviews
Electroconvulsive Therapy (ECT)
used for severe, major depression (last resort)
–>results in release of all NT’s
Transcranial direct stimulation
magnetic stimulation
- previously only used for severe depression
- currently also used for resistant depression
Psychodynamic treatment of depression
- uncover unconscious conflicts–>”work through” conflicts
- work through grief over earlier loss
Behavioral treatment of depression
- increase positive reinforcement of one’s environment (BAT)
- Training in social skills that may be lacking
Cognitive Therapy of depression
- work on dysfunctional thinking (rational-emotive therapy)
- cognitive restructuring
- ACT
ACT-Acceptance Commitment Therapy
Accept-emotions, thoughts, feelings, sensations
Know-that’s all they are, mindfullness (stay in the moment)
Commit to-taking action toward life values
Humanistic treatment of depression
- work towards more realistic real/ideal self
- focus on self-esteem
Bipolar disorder: depression
may look exactly like major depression
Bipolar disorder: mania
- little sleep
- elevated mood
- rapid speech & racing thoughts
- irritability (sometimes violent)
- risky impulsivity
- increase in psychomotor activity
- may show psychotic symptoms (delusions/hallucinations)
Bipolar I
Major depression & full on mania
Bipolar II
Major depression & hypomania
bipolar rapid cyclers
DSM-at least 4 episodes in 12 months
Bipolar onset of symptoms
- most evident in young adulthood
- genetic links
- much co-morbidity across all mood disorders
- some links with early chaotic upbringing
- stress can trigger mania
Cyclothymia
“lesser” bipolar disorder
depressed mood & hypomania
Sx’s must have lasted at least 2 years
Treatment of bipolar
- antidepressants for depressive phase–>can trigger mania, must be watched closely
- lithium: potentially toxic, must be monitored–decreases mood swings, but not to extent of “normal” person
Problems with nonadherence to drugs for bipolar
- unpleasant side-effects
2. they miss the highs
Study of suicide in children
Found in 5-11 year olds
-black children increasing at alarming rate, white boys decreasing
“good behavior game” reduces risk of future suicide by 50%
Suicide definition
self-inflicted death that is an intentional, conscious, direct effort to end one’s life
Parasuicide
An attempt to harm oneself and/or an unintentional suicide attempt
Parasuicide differs from suicide
- more impulsive
- use less aggressive means
- does not commit the act
Schneidman
influential writer on this topic
4 types & subintentional death
Death-seekers
have clear intentions of dying; take clear actions to be ‘successful’
Death initiators
Believe they are already dying, just trying to hasten the process
Death-ignorers
believe that dying will lead to a different/perhaps better existence
Death-darers
an ambivalent attempt to die-but behave in risky ways
*often motivated more by getting attention, getting back at someone, making others feel guilty, etc.
Sub-intentional death
“suicide like”
behaviors more covert, unconscious, indirect in leading to death
e.g., heart patients eating high fat diet, not taking meds, drug abuse, etc.
Suicide rates in US
10th leading cause of death
8th in WA
Highest rates of suicide
Asia, Eastern Europe, parts of central Europe
Lowest rates of suicide
South America, Greece, Egypt, Spain
Gender difference in suicide rates
Females make more attempts
-more males actually commit suicide
Highest suicide rates in US states
- Montana
- Alaska
- Wyoming
- New York
- Washington
- Hawaii
Marital status & suicide rates
high–>low:
divorced, widowed, single, married
Ethnic group & suicide rates (native, white, african/hispanic/asian americans)
Native: recently had highest rates
White: now has highest rates
African/Hispanic/Asian: lowest rates
*but estimated rates among african americans may not be accurate
Suicide in children
Rates are stable EXCEPT for African American children rising (ages 5-11)
Typical preceding events in child suicide
- running away
- aggressive acting out
- temper tantrums
- self-criticism
- social withdrawal/loneliness
- sensitivity to criticism
- notable change from usual behavior
- unusual interest in death/suicide
Adolescents & suicide rates in ethnic groups
2nd leading cause of death
Native: rates increasing sharply (greatest increase)
White: next highest group
Black: approaching rates of White
*1/2 suicides related to depression
Elderly (>65 years) suicide rates
2nd highest rate among age groups
(highest is 45-65 years)
whites: highest
Native: relatively lower
African: lower rates
Fewer warnings (completion rate higher)
60% preceded by depression
factors of elderly suicide
- illness
- loss of loved ones/pers
- loss of control over life
- loss of status in society (in our culture)
Approaching the suicidal
- validate person’s feelings: avoid discounting
- Understand problem: active listen, help see circumstances/feelings transient, explore alternatives
- Assess potential for suicide: degree of stress, specificity of plan, have the means?
- Help them identify resources: talk about relatives/friends
- follow up plan: get them to commit to a plan, call external resources if it seems imminent
