CH 7 Mood Disorders and Suicide Flashcards
7.1 What are the two key moods involved in mood disorders?
Depression and mania
7.1 Unipolar Depressive Disorders
Mood disorders in which a person experiences only depressive episodes
7.1 Bipolar disorders
Mood Disorders in which a person experiences BOTH depressive AND manic episodes (or hypomanic and depressive, or mania and no depression)
7.1 Depressive Episode
The most common form of mood disturbance, in which a person is markedly depressed or loses interest in formerly pleasurable activities (or both) for at least two weeks (most days, nearly every day)
Other symptoms include:
• changes in sleep/constantly tired - insomnia/hypersomnia
• changes in appetite and weight
• difficulty in concentration and focus
• feelings of worthlessness among others
• suicidal ideation and self harm
• psychomotor agitation
7.1 DSM-5 Criteria for a Manic Episode
A person shows a markedly elevated, euphoric, or expansive mood
Often interrupted by occasional outbursts of intense irritability or even violence
Persist for at least a week
3 other symptoms must be present
• inflated self-esteem or grandiosity
• decreased need for sleep
• more talkative than usual or pressure to keep talking
• flight of ideas or subjective experience that thoughts are racing
• distractability
• increase in goal-directed or psychomotor agitation
• excessive involvement in activities that have high potential for painful consequences
7.1 DSM-5 Criteria for Manic Episode
A. Distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day, nearly every day (any duration if hospitalization is necessary)
B. 3 or more of the following are present to a significant degree (noticeable change from usual behavior)
1. Inflated self-esteem/grandiosity
2. Decreased need for sleep
3. More talkative/pressure to keep
talking
4. Flight of ideas or subjective
experience that thoughts are racing
5. Distractibility
6. Increase in goal-directed activity or
psychomotor agitation
7. Excessive involvement in activities
with a high potential for painful
consequences
C. Mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self/others or there are psychotic features
D. Episode is not attributable to the physiological effects of a substance
7.1 Describe the prevalence of depression
15-20 times more frequent than schizophrenia
Almost the same rate as all anxiety disorders taken together
Second most prevalent worldwide, following anxiety disorders
Higher in women
Inversely related to SES
7.1 Describe the prevalence of bipolar disorders
Less common than unipolar depression
7.2 DSM-5 Criteria for Major Depressive Disorder
A. 5 or more of the following
1. Depressed mood most of the day
and nearly every day
2. Markedly diminished
interest/pleasure in most/all
activities most of the day and nearly
every day
3. Significant weight loss NOT by
dieting OR weight gain
4. Insomnia/hypersomnia nearly every
day
5. Psychomotor agitation or
retardation nearly every day
6. Fatigue or loss of energy nearly
every day
7. Feelings of worthlessness/excessive
guilt nearly every day
8. Diminished ability to concentrate,
indecisiveness, nearly every day
9. Recurrent thoughts of death, suicidal
ideation
B. Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
C. Episode is not attributable to the physiological effects of a substance or another condition
D. Occurrence of the major depressive episode is NOT better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other schizo/psychotic disorders
E. There has NEVER been a manic or hypomanic episode
7.2 Relapse vs. Recurrence
Relapse - the return of symptoms within a short period, reflects the fact that the episode has not yet run its course
Recurrence - the onset of a new episode
7.2 Specifiers
Different patterns of symptoms that sometimes characterize major depressive episodes that may help predict the course and preferred treatments
7.2 List specifiers of major depressive episodes
With…
Melancholic features
Psychotic features
Atypical features
Catatonic features
Seasonal pattern
7.2 Melancholic features
3 of the following: early morning awakening, depression worse in the morning, marked psychomotor agitation or retardation, loss of appetite or weight, excessive guilt, qualitatively different depressed mood
7.2 Psychotic features
Delusions or hallucinations; feelings of guilt and worthlessness common
7.2 Atypical features
Mood reactivity–brightens to positive events;
2/4 of the following: weight gain or increased appetite, hypersomnia, leaden paralysis, being acutely sensitive to interpersonal rejection
7.2 Catatonic features
A range of psychomotor symptoms from motoric immobility to extensive psychomotor activity, as well as mutism and rigidity
7.2 Seasonal pattern
At least 2+ episodes in the past 2 years occurred at the same time, usually fall or winter, and full remission at the same time, usually spring, NO OTHER nonseasonal episodes in the same period
7.2 DSM-5 Criteria for Persistent Depressive Disorder
A. Depressed mood most of the day for most days for at least 2 years
B. 2 or more of following:
1. Poor appetite or overeating
2. Insomnia or hypersomnia
3. Low energy or fatigue
4. Low self-esteem
5. Poor concentration or difficulty
making decisions
6. Feelings of hopelessness
C. During 2 year period (1 for children/adolescents), the individual has never been without criteria A and B symptoms for more than 2 months at a time
D. Criteria for MDD may be continuously present for 2 years
E. There has NEVER been a manic/hypomanic episode, and criteria have NEVER been met for cyclothymic disorder
F. Disturbance is not better explained by schizo or psychotic disorders
G. Symptoms are not attributable to substances
H. Symptoms cause clinically significant distress or impairment in functioning
7.2 Double Depression
Co-occurence of MDD and PDD
7.3 Biological causal factors for unipolar mood disorders (depression)
Moderate genetic contribution to vulnerability to depression
Depression is associated with multiple interacting disturbances in neurochemical, neuroendocrine, and neurophysiological systems
Disruptions in circadian and seasonal rhythms
7.3 Psychosocial theories of causes of depression
Beck’s cognitive theory
Reformulated helplessness and hopelessness theories (diathesis-stress models)
Cognitive diathesis
7.3 Personality variables like _______ may also serve as diatheses for depression.
neuroticism
7.3 Beck’s Cognitive Theory
Early experiences can lead to the formation of dysfunctional assumptions that leave one vulnerable to depression later in life if certain critical incidents activate those assumptions
Once activated, assumptions trigger automatic thoughts that produce depressive symptoms
7.3 Helplessness Theory of Depression
Seligman and colleagues
Dogs
Lack of percieved control > unmotivated to respond to future situations
7.3 Hopelessness Theory of Depression
Abramson and colleagues
Pessimistic attributional style + negative life events =/= depression UNLESS one is already hopeless
7.3 Ruminative Response Styles Theory of Depression
Nolen-Hoeksema
Ruminate > more lengthy periods of depressive symptoms and full-blown episodes of MDD
Women are more likely to ruminate
7.4 Cyclothymia
Repeated experience of hypomanic symptoms for a period of AT LEAST 2 years
NO MANIC EPISODES AND NO DEPRESSIVE EPISODES
7.4 Bipolar I
Full-blown mania
Episodes of mania and periods of depression, even if periods of depression do not reach the threshold for a major depressive episode
7.4 Bipolar II
Periods of hypomania, but below threshold of full-blown mania
Periods of depressed mood that meet criteria for major depression
7.5
TRUE OR FALSE
Biological causal factors probably play a more prominent role in unipolar disorders than bipolar disorders.
FALSE, opposite
7.5 How do stressful life events relate to bipolar disorder?
They may be involved in precipitating episodes, but it is unlikely that they cause the disorder
7.6 How can cultural factors influence the expression of mood disorders?
Factors such as differing rates of stigma, stressors, risk factors for mood disorders, and a different manifestation of symptoms across cultures all have been suggested as possible explanations for the different rate and expression of mood disorders across cultures.
7.7 Describe and distinguish between different treatments for mood disorders.
Biologically based treatments such as meds and electroconvulsive therapy are often used for severe major disorders
Psychosocial treatments like cognitive therapy, behavioral activation treatment, and interpersonal therapy are also being used to good effect in many cases of severe AND mild cases
Recurrent depression is best treated by specialized forms of psychotherapy or maintenance on medications for prolonged periods
7.8 Describe the prevalence and clinical picture of suicidal behaviors
Suicide is a leading cause of death worldwide
Nearly 10% of adults report that they have seriously considered and nearly 3% have attempted
The rate of suicidal thoughts and behavior increases DRASTICALLY in adolescent and young adult years, mood disorders are especially at risk
7.9 Explain efforts currently used to prevent and treat suicide
Suicide prevention programs generally include crisis intervention in the form of suicide hotlines
Efficacy is unclear atm
7.1 Describe the BASIC DIFFERENCES between hypomania and mania
Mania has a minimum of 1 week, hypomania has a minimum of 4 days
Hypomania involves the same symptoms, but to a lesser severity
People do NOT suffer in daily functioning and do NOT need to be hospitalized
Loss of interest or pleasure
Anhedonia
Who is most associated with cognitive therapy?
Aaron Beck
