Bipolar Disorders & Suicide

Question 1

Characteristics of manic episodes

Answer 1

marked increase in activity level (work, social, sexual); unusual talkativeness and rapid speech; flight of ideas or racing thoughts; less than normal sleep, inflated self-esteem; distractibility, excessive involvement in pleasurable but dangerous activities

Question 2

2 kinds of episodes in bipolar disorder

Answer 2

manic or mixed episodes and major depressive episodes

Question 3

Problems associated with bipolar disorder

Answer 3

high suicide risk, domestic violence, divorce, truancy, occupational failure, substance abuse, episodic antisocial behavior

Question 4

Is there a gender difference in bipolar disorder?

Answer 4

No

Question 5

Ratio of depressed to manic days

Answer 5

3:1

Question 6

Average age of onset of bipolar disorder

Answer 6

18-22

Question 7

Biological factors of bipolar disorder

Answer 7

highest risk for unipolar depression in 1st degree relatives; 85% of monozygotic twins develop bipolar disorder vs 14% of dizygotic twins

Question 8

Psychosocial factors of bipolar disorder

Answer 8

pessimistic attributional style, neuroticism, high levels of achievement striving, dependent stressful life events, low social support

Question 9

Biological treatment for bipolar disorders

Answer 9

pharmacotherapy (mood stabilizers like lithium and anticonvulsants, and antipsychotics), TMS, ECT

Question 10

How effective is lithium in treating bipolar disorder?

Answer 10

the go-to treatment with a relapse rate of 34% (vs. 81% with placebo) over 1 year but not effective over a long haul (36% over 5 years)

Question 11

When does lithium lead to a good vs bad prognosis?

Answer 11

good when one has family history of bipolar illness; bad when one has rapid cycling, multiple prior episodes, and engages in substance abuse

Question 12

Psychological treatment for bipolar disorder

Answer 12

CBT (cognitive restructuring and behavioral activation), MBCT, DBT (CBT with acceptance)

Question 13

Mindfulness-based cognitive therapy

Answer 13

increases the acceptance of one’s thoughts and emotions

Question 14

Social treatment for bipolar disorder

Answer 14

interpersonal and social rhythm therapy; family and marital therapy

Question 15

Benefit of interpersonal and social rhythm therapy

Answer 15

setting a schedule such that interpersonal interactions are done at an optimal time influences daily rhythms and stabilizes moods

Question 16

Benefit of family and marital therapy

Answer 16

reduces the expression of criticism and hostility, which prevents the increase in relapse rates

Question 17

Sex differences in the likelihood and methods of suicide

Answer 17

men are 4x more likely to complete a suicide attempt typically by gun and hanging; women are 3x more likely to attempt and survive suicide typically by overdose

Question 18

Which age group most commonly commits suicide attempts?

Answer 18

18-24 yr olds

Question 19

Comorbidity of suicide attempts

Answer 19

mood disorders

Question 20

Which age group most commonly commits suicide completions?

Answer 20

65+ white males

Question 21

Comorbidities of suicide completions

Answer 21

bipolar disorder, conduct disorder, PTSD, intermittent explosive disorder, substance abuse, panic disorder

Question 22

Psychosocial factors of suicide

Answer 22

impulsivity, aggression toward self and others, pessimism, family psychopathology or instability, hopelessness, negative affectivity

Question 23

When does someone have the highest tendency of attempting suicide?

Answer 23

when one is just coming out of depression

Question 24

Risk factors of suicide

Answer 24

being caucasian, male, middle age, elderly, first nations; suicide of a friend/family member; psychiatric disorder; substance use; sudden loss; hopelessness; bereavement; divorce; physical illness; unemployment; access to guns; low serotonin

Question 25

What are the challenges to predicting suicide?

Answer 25

lower base rates than expected (difficulty measuring); difficulty applying risk factors to individuals (e.g. short-term vs long-term risk, interactions between them)

Question 26

What test has the possibility of predicting suicide?

Answer 26

implicit association test (IAT)

Question 27

Protective factors of suicide

Answer 27

cognitive flexibility, strong social support, hope, receiving treatment for psychiatric disorder

Question 28

Myths about suicide

Answer 28

talking about it won't lead to doing it; suicidal people always want to do it; improved mood means less risk; suicidal ideation is rare; asking someone about suicide makes them more likely to do it

Question 29

Why do people commit suicide?

Answer 29

seen as the solution to the problem of intense suffering in order to stop the pain by ceasing consciousness

Question 30

3 alternative solutions to suffering (instead of suicide)

Answer 30

reducing suffering, helping one to identify other options, pulling back even a little from the suicidal act

Question 31

Joiner's theory

Answer 31

the desire for suicide (perceiving oneself as a burden and thwarted belongingness) and the acquired capacity for suicide leads to suicidal attempts

Question 32

Treatments for suicide prevention

Answer 32

pharmacology (antidepressants and mood stabilizers), psychotherapy (DBT, CBT, IPT)

Question 33

Crisis intervention

Answer 33

suicide prevention when there is imminent risk or when coping with an immediate crisis

Question 34

Crisis intervention methods

Answer 34

validate emotional pain; help clarify problems; help manage distress; maintain supportive contact; encourage them to seek professional help; reach out to their family/friends

Question 35

4 components of the experience of an emotion

Answer 35

physical sensations, thoughts, urges, actions

Question 36

Non-suicidal self-injury (NSSI)

Answer 36

self-inflicted damage to own tissue without necessarily having the intention to die; common and contagious

Question 37

What aspects of NSSI increase the risk for suicide?

Answer 37

number of different methods used, habituation to pain in a certain body part, unintentional death

Question 38

4 factor model

Answer 38

explains the function of NSSI based on type of reinforcement (positive or negative) and target (automatic or social)

Question 39

Treatments for NSSI

Answer 39

acceptance and commitment therapy (ACT), CBT, DBT