Ch.7 Cont, Bipolar Disorders

Question 1

Cyclothymic disorder

Answer 1

refers to the repeated experience of hypomanic symptoms for a period of at least 2 years. This is a less serious version of full-blown bipolar disorder because it lacks the extreme mood and behavior changes, psychotic features, and marked impairment seen in bipolar disorder.
-Symptoms of the hypomanic phase of cyclothymia are essentially the opposite of the symptoms of persistent depressive disorder. In this phase of the disorder, the person may become especially creative and productive because of increased physical and mental energy. There may be significant periods between episodes in which the person with cyclothymia functions in a relatively adaptive manner.

Question 2

Cyclothymia and bipolar I and II risk

Answer 2

Individuals with cyclothymia are at greatly increased risk of later developing full-blown bipolar I or II disorder

Question 3

Depressive phase of cyclothymic disorder

Answer 3

person’s symptoms are very similar to what is seen in persistent depressive disorder but without the duration criterion. The individual’s mood is dejected, and he or she experiences a distinct loss of interest or pleasure in customary activities and pastimes. In addition, the person may show other symptoms such as low energy, feelings of inadequacy, social withdrawal, and a pessimistic, brooding attitude.

Question 4

Kraeplin and manic depressive insanity

Answer 4

Kraepelin described the disorder as a series of attacks of elation and depression, with periods of relative normality in between. Today we call this illness bipolar disorder, although the term manic-depression is still commonly used as well.

Question 5

How is bipolar I different from MDD?

Answer 5

Bipolar I disorder is distinguished from MDD by the presence of mania.
- A mixed episode is characterized by symptoms of both full-blown manic and major depressive episodes for at least 1 week, either intermixed or alternating rapidly every few days.
-Mixed states were once thought to be rare: now we know that 28% of patients experience them at least some of the time
People whose first episode of mania is a mixed episode have a worse long-term outcome than those originally presenting with a depressive or a manic episode

Question 6

Differences between Bipolar I and Bipolar II

Answer 6

I: Person has full-blown mania.
-Person experiences episodes of mania and periods of depression. Even if the periods of depression do not reach the threshold for a major depressive episode, the diagnosis of bipolar I disorder is still given.

II: Bipolar II: Person experiences periods of hypomania, but his or her symptoms are below the threshold for full-blown mania.
Person experiences periods of depressed mood that meet the criteria for major depression.

Question 7

What is diagnosed if a person shows only manic symptoms?

Answer 7

If a person shows only manic symptoms, it is nevertheless assumed that a bipolar disorder exists and that a depressive episode will eventually occur. Although some researchers have noted the probable existence of a unipolar type of manic disorder (i.e., “pure mania”; Kessler et al., 1997; Solomon et al., 2003), critics of this diagnosis argue that such patients usually have bipolar relatives and may well have had mild depressions that went unrecognized

Question 8

Prevalence of bipolar II and its discriminant validity

Answer 8

s. Bipolar II disorder is equally or somewhat more common than bipolar I disorder, and, when combined, estimates are that about 2 to 3 percent of the U.S. population will suffer from one or the other disorder
Bipolar II disorder evolves into bipolar I disorder in only about 5 to 15 percent of cases, suggesting that they are distinct forms of the disorder

Question 9

Gender differences in bipolar

Answer 9

Bipolar disorder occurs equally in males and females (although depressive episodes are more common in women than men) and usually starts in adolescence and young adulthood, with an average age of onset of 18 to 22 years

Question 10

Differences between cyclomythia and BIPOLAR II and bipolar I

Answer 10

People with a cyclothymic personality have more marked and regular mood swings, and people with cyclothymic disorder go through periods when they meet the criteria for dysthymia (except for the 2-year duration) and other periods when they meet the criteria for hypomania. People with bipolar II disorder have periods of major depression and periods of hypomania. Unipolar mania is an extremely rare condition. Finally, people with bipolar I disorder have periods of major depression and periods of mania.

Question 11

Significant differences between depressive symptoms of BDD and unipolar Major depressive episodes

Answer 11

-The most widely replicated differences are that, relative to people with a unipolar depressive episode, people with a bipolar depressive episode tend to show more mood lability, more psychotic features, more psychomotor retardation, and more substance abuse
-By contrast, individuals with unipolar depression, on average, show more anxiety, agitation, insomnia, physical complaints, and weight loss
- research clearly indicates that major depressive episodes in people with bipolar disorder are more severe than those seen in unipolar disorder, and, not surprisingly, they also cause more role impairment

Question 12

rapid cycling in bipolar disorder

Answer 12

. As many as 5 to 10 percent of persons with bipolar disorder experience at least four episodes (either manic or depressive) every year, a pattern known as rapid cycling. In fact, those who go through periods of rapid cycling usually experience many more than four episodes a year. People who develop rapid cycling are slightly more likely to be women, to have a history of more episodes (especially more manic or hypomanic episodes), to have an earlier average age of onset, and to make more suicide attempt
SOMETIMEES PRECIPITATED Y TAKING SOME KINDS OF ANTIDEPRESSANTS
Rapid cycling is typically temporary

Question 13

Genetic contributions to bipolar I tha unipolar disorder

Answer 13

There is a greater genetic contribution to bipolar I disorder than to unipolar disorder. Approximately 8 to 10 percent of the first-degree relatives of a person with bipolar I illness can be expected to have bipolar disorder, compared to 1 percent in the general population
he first-degree relatives of a person with bipolar disorder also are at elevated risk for unipolar major depression, although the reverse is not true
-studies suggest that genes account for about 80 to 90 percent of the variance in the liability to develop bipolar I disorder
-higher than heritability estimates for unipolar disorder or any of the other major adult psychiatric disorders, including schizophrenia

Question 14

Chromosomal sites of bipolar

Answer 14

Efforts to locate the chromosomal site(s) of the implicated gene or genes in this genetic transmission of bipolar disorder suggest that it is polygenic

Question 15

Schizophrenia and bipolar polymorphisms

Answer 15

some of the genetic polymorphisms that are seen in those with bipolar disorder are also seen in those with schizophrenia (perhaps pointing toward why people with both disorders experience psychotic features) and with depression (perhaps explaining why people with these two disorders both experience depressive symptoms)

Question 16

Monamine hypothesis for bipolar disorder

Answer 16

hypothesis being that if depression is caused by deficiencies of norepinephrine or serotonin, then perhaps mania is caused by excesses of these neurotransmitters. There is good evidence for increased norepinephrine activity during manic episodes and less consistent evidence for lowered norepinephrine activity during depressive episodes
- However, serotonin activity appears to be low in both depressive and manic phases.

Question 17

Increased dopaminergic activity and mania

Answer 17

Evidence for the role of dopamine stems in part from research showing that increased dopaminergic activity in several brain areas may be related to manic symptoms of hyperactivity, grandiosity, and euphoria
-High doses of drugs such as cocaine and amphetamines, which are known to stimulate dopamine, also produce manic-like behavior

Question 18

Lithium antimanic drugs

Answer 18

. Drugs like lithium reduce dopaminergic activity and are antimanic.

Question 19

Cortisol in bipolar depression vs mania / dexamethasone suppression test

Answer 19

Cortisol levels are elevated in bipolar depression (as they are in unipolar depression), but they are usually not elevated during manic episodes Similarly, people with bipolar disorder who are in a depressed episode show evidence of abnormalities on the dexamethasone suppression test (DST; a test that reveals how much cortisol the body is releasing) at about the same rate as do people experiencing a unipolar depression

Question 20

PET scans and brain glucose metabolic rates in bipolar

Answer 20

. Several summaries of the evidence from studies using PET and other neuroimaging techniques show that, whereas blood flow to the left prefrontal cortex is reduced during depression, during mania it is increased in certain other parts of the prefrontal cortex

Question 21

deficits in activity in the prefrontal cortex in bipolar disorder vs unipolar depression

Answer 21

These seem related to neuropsychological deficits that people with bipolar disorder show in problem solving, planning, working memory, shifting of attention, and sustained attention on cognitive tasks
-similar to what is seen in unipolar depression, as are deficits in the anterior cingulate cortex

Question 22

Basal ganglia, HPC and amydgala volume in bipolar vs unipolar

Answer 22

r, structural imaging studies suggest that certain subcortical structures, including the basal ganglia and amygdala, are enlarged in bipolar disorder but reduced in size in unipolar depression. The decreases in hippocampal volume that are often observed in unipolar depression are generally not found in bipolar depression

Question 23

Hypersomnia

Answer 23

too much sleep seen in depressive episodes

Question 24

Seasonal biological rythms and bipolar

Answer 24

Bipolar disorder also sometimes shows a seasonal pattern in the same way unipolar disorder does, suggesting disturbances of seasonal biological rhythms, although these may be the result of circadian abnormalities in which the onset of the sleep–wake cycle is set ahead of the onset of other circadian rhythms.

Question 25

Psychological causal factors of bipolar and why stress may contribute to it

Answer 25

-Stressful life events appear to be as important in precipitating bipolar depressive episodes as they are in triggering unipolar depressive episodes. Both stressful life events during childhood (e.g., physical and sexual abuse) and recent life stressors during adulthood (e.g., problems with friends and partners, financial hardship) increase the likelihood of ever developing bipolar disorder as well as having recurrences
-e diathesis–stress model would suggest that stressful life events influence the onset of episodes by activating the underlying vulnerability. One hypothesized mechanism is through the destabilizing effects that stressful life events may have on critical biological rhythms.

Question 26

Social support bipolar

Answer 26

people with bipolar disorder who reported low social support showed more depressive recurrences over a 1-year follow-up, independent of the effects of stressful life events, which also predicted more recurrences

Question 27

Pessimistic attributional style and negative life events bipolar

Answer 27

students with a pessimistic attributional style who had also experienced negative life events showed an increase in depressive symptoms whether they had bipolar or unipolar disorder. Interestingly, however, the students with bipolar disorder who had a pessimistic attributional style and experienced negative life events also showed increases in manic symptoms at other points in time

Question 28

Depression and culture and way it is expressed

Answer 28

Depression occurs in all cultures that have been studied. However, the form that it takes differs widely, as does its prevalence
Western cultures the “psychological” symptoms of depression (e.g., guilt, worthlessness, suicidal ideation) are prominent, whereas they are not prominently reported in non-Western cultures such as China and Japan, where rates of depression are relatively low. Instead people in non-Western cultures tend to exhibit the more “physical” symptoms (e.g., sleep disturbance, loss of appetite, weight loss, and loss of sexual interes

Question 29

Reasons for eastern vs western expression diff of depression

Answer 29

Several possible reasons for these symptom differences stem from Asian beliefs in the unity of the mind and body, a lack of expressiveness about emotions more generally, and the stigma attached to mental illness in these cultures
-Another reason why guilt and negative thoughts about the self may be common in Western but not in Asian cultures is that Western cultures view the individual as independent and autonomous, so when failures occur, internal attributions are made.

Question 30

Why do worldwide prevalence rates for mood disorders vary so much?

Answer 30

0.8 percent in Nigeria to 9.6 percent in the United States,
-differences in willingness to report the presence of a mental disorder due to stigma, as well as different levels of important psychosocial risk variables in different cultures and different levels of stress
-cross-cultural differences in hypothesized risk variables such as pessimistic attributional style, although how these differences might translate into different rates of depression is unclear because we do not yet know whether the same risk variables are operative in different cultures
rumination, hopelessness, and pessimistic attributional style are associated with risk for depression in other countries, such as China

Question 31

monamine oxidase inhibitors and treatment for unipolar and bipolar disorder, 1950s

Answer 31

they inhibit the action of monoamine oxidase, the enzyme responsible for the breakdown of norepinephrine and serotonin once released. The MAOIs can be as effective in treating depression as other categories of medications, but they have potentially dangerous (even potentially fatal) side effects if certain foods rich in the amino acid tyramine are consumed (e.g., red wine, beer, aged cheese, salami). Thus, they are not used very often today unless other classes of medication have failed. Depression with atypical features is the one subtype of depression that seems to respond preferentially to the MAOIs.

Question 32

tricyclic antidepressants , 1960s-1990s

Answer 32

-TCAs; called this because of their chemical structure) such as imipramine. TCAs increase neurotransmission of the monoamines, primarily norepinephrine and to a lesser extent serotonin
-only about 50% of people tend to show improvement
TCAs have unpleasant side effects for some people (e.g., dry mouth, constipation, sexual dysfunction, and weight gain). Although these side effects often diminish over time, they are so unpleasant to many patients that they stop taking their medications before the side effects go away.

Question 33

SSRIs

Answer 33

SSRIs are generally no more effective than the tricyclics; indeed some findings suggest that TCAs are more effective than SSRIs for severe depression. However, the SSRIs tend to have many fewer side effects and are better tolerated by patients, as well as being less toxic in large doses. The primary negative side effects of the SSRIs are problems with orgasm and lowered interest in sexual activity, although insomnia, increased physical agitation, and gastrointestinal distress also occur in some patients

Question 34

SSRIS and which disorders they can treat

Answer 34

SSRIs are generally no more effective than the tricyclics; indeed some findings suggest that TCAs are more effective than SSRIs for severe depression. However, the SSRIs tend to have many fewer side effects and are better tolerated by patients, as well as being less toxic in large doses. The primary negative side effects of the SSRIs are problems with orgasm and lowered interest in sexual activity, although insomnia, increased physical agitation, and gastrointestinal distress also occur in some patients
Antidepressants appear to be most effective for severe depression, but are no more effective than placebo for mild or moderate depression.

Question 35

atypical antidepressants

Answer 35

, bupropion (­Wellbutrin) does not have as many side effects (especially sexual side effects) as the SSRIs and, because of its activating effects, is particularly good for depression involving significant weight gain, loss of energy, and oversleeping. In addition, venlafaxine (Effexor) seems superior to the SSRIs in the treatment of severe or chronic depression, although the profile of side effects is similar to that for the SSRIs. Sev

Question 36

How long do antidepressants take to have effect?

Answer 36

Antidepressant drugs usually require at least 3 to 5 weeks to take effect. Generally, if there are no signs of improvement after about 6 weeks, physicians try a new medication because about 50 percent of those who do not respond to the first drug prescribed do respond to a second one.
-Thus, when depressed patients take drugs for 3 to 4 months and then stop because they are feeling better, they are likely to relapse because the underlying depressive episode is actually still present, and only its symptomatic expression has been suppressed

Question 37

Natural course of untreated episode of depression

Answer 37

6-9 months

Question 38

Lithium and treating biplar depression

Answer 38

In the treatment of bipolar depression, lithium may be no more effective than traditional antidepressants (study results are inconsistent), but about three-quarters show at least partial improvement

Question 39

Risk of treatment with antidepressants

Answer 39

treatment with antidepressants is associated with significant risk of precipitating manic episodes or rapid cycling, although the risk of this happening is reduced if the person also takes lithium
Lithium is often effective in preventing cycling between manic and depressive episodes (although not necessarily for patients with rapid cycling), and patients with bipolar disorder frequently are maintained on lithium therapy over long time periods, even when not manic or depressed, simply to prevent new episodes.

Question 40

Lithium therapy side effects

Answer 40

Lithium therapy can have some unpleasant side effects such as lethargy, cognitive slowing, weight gain, decreased motor coordination, and gastrointestinal difficulties. Long-term use of lithium is occasionally associated with kidney malfunction and sometimes permanent kidney damage, although end-stage renal disease seems to be a very rare consequence of long-term lithium treatment

Question 41

Anticonvulsants and treating bipolar and risks

Answer 41

These drugs are often effective in patients who do not respond well to lithium or who develop unacceptable side effects from it, and they may also be given in combination with lithium. However, a number of studies have indicated that risk for attempted and completed suicide was nearly two to three times higher for patients on anticonvulsant medications than for those on lithium

Question 42

elctroconvulsive therapy ECT and side effects

Answer 42

, electroconvulsive therapy (ECT) is often used with patients who are severely depressed (especially among the elderly) and who may present an immediate and serious suicidal risk, including those with psychotic or melancholic features
-It is also used in patients who cannot take antidepressant medications or who are otherwise resistant to medications
the treatments, which induce seizures, are delivered under general anesthesia and with muscle relaxants. The most common immediate side effect is confusion, although there is some evidence for lasting adverse effects on cognition, such as amnesia and slowed response time
ECT is also very useful in the treatment of manic episodes; reviews of the evidence suggest that it is associated with remission or marked improvement in 80 percent of patients with mania

Question 43

transcranial magnetic stimulation (TMS)

Answer 43

TMS is a noninvasive technique allowing focal stimulation of the brain in patients who are awake. Brief but intense pulsating magnetic fields that induce electrical activity in certain parts of the cortex are delivered
-The procedure is ­painless, and thousands of stimulations are delivered in each treatment session. Treatment usually occurs 5 days a week for 2 to 6 weeks. Many studies have shown it to be quite effective—indeed in some studies quite comparable to unilateral ECT and antidepressant medications
Moreover, TMS has advantages over ECT in that cognitive performance and memory are not affected adversely and sometimes even improve, as opposed to ECT, where memory-recall deficits are common

Question 44

deep brain stimulation

Answer 44

treatment approach for individuals with refractory depression who have not responded to other treatment approaches, such as medication, psychotherapy, and ECT.
Deep brain stimulation involves implanting an electrode in the brain and then stimulating that area with an electric current

Question 45

Bright Light Therapy

Answer 45

This was originally used in the treatment of seasonal affective disorder, but it has now been shown to be effective in nonseasonal depressions as well

Question 46

Beck cognitive-behavioral therapy (CBT)

Answer 46

One of the two best-known psychotherapies for unipolar depression
- focuses on here-and-now problems rather than on the more remote causal issues that psychodynamic psychotherapy often addresses.
- consists of highly structured, systematic attempts to teach people with unipolar depression to evaluate systematically their dysfunctional beliefs and negative automatic thoughts. They are also taught to identify and correct their biases or distortions in information processing and to uncover and challenge their underlying depressogenic assumptions and beliefs
-When compared with pharmacotherapy, it is at least as effective when delivered by well-trained cognitive therapists. It also seems to have a special advantage in preventing relapse, similar to that obtained by staying on medication

Question 47

Brain regions that medication work on vs that CBT works on

Answer 47

Perhaps not surprisingly, some recent interesting brain-imaging studies have shown that the biological changes in certain brain areas that occur following effective treatment with cognitive therapy versus medications are somewhat different, suggesting that the mechanisms through which they work are also different. One possibility is that medications may target the limbic system, whereas cognitive therapy may have greater effects on cortical functions.

Question 48

mindfulness-based cognitive therapy

Answer 48

used with people with highly recurrent depression
people with recurrent depression are likely to have negative thinking patterns activated when they are simply in a depressed mood. Perhaps rather than trying to alter the content of their negative thinking as in traditional cognitive therapy, it might be more useful to change the way in which these people relate to their thoughts, feelings, and bodily sensations\
-mindfulness meditation techniques aimed at developing patients’ awareness of their unwanted thoughts, feelings, and sensations so that they no longer automatically try to avoid them but rather learn to accept them for what they are—simply thoughts occurring in the moment rather than a reflection of reality.

Question 49

Behavioral Activation Treatment

Answer 49

-This treatment approach focuses intensively on getting patients to become more active and engaged with their environment and with their interpersonal relationships. These techniques include scheduling daily activities and rating pleasure and mastery while engaging in them, exploring alternative behaviors to reach goals, and role-playing to address specific deficits
- does not focus on implementing cognitive changes directly but rather on changing behavior. The goals are to increase levels of positive reinforcement and to reduce avoidance and withdrawal

Question 50

interpersonal therapy (IPT)

Answer 50

-has not yet been subjected to as extensive an evaluation as CBT, nor is it as widely available. However, the studies that have been completed strongly support its effectiveness for treating unipolar depression- interpersonal therapy seems to be about as effective as medications or cognitive-behavioral treatment

Question 51

Family and Marital Therapy

Answer 51

some types of family interventions directed at reducing the level of expressed emotion or hostility, and at increasing the information available to the family about how to cope with the disorder, have been found to be very useful in preventing relapse in these situations
- For married people who have unipolar depression and marital discord, marital therapy (focusing on the marital discord rather than on the depressed spouse alone) is as effective as cognitive therapy in reducing unipolar depression in the depressed spouse. Marital therapy has the further advantage of producing greater increases in marital satisfaction than cognitive therapy

Question 52

mortality rate for individuals with depression when compared to the rest of population

Answer 52

s significantly higher than that for the general population, partly because of the higher incidence of suicide but also because there is an excess of deaths due to natural cause
Patients with mania also have a high risk of death from accidents (often with alcohol as a contributing factor), neglect of proper health precautions, or physical exhaustion

Question 53

suicide rates and mental disorders

Answer 53

approximately 90 to 95 percent of those who die by suicide have a history of at least one psychological disorder/ depression most commonly linked
Moreover, individuals with two or more mental disorders are at even greater risk than those with only one
-we are each more likely to die by our own hand than someone else’s.

Question 54

nonsuicidal self injury NSSI

Answer 54

direct, deliberate destruction of body tissue (often taking the form of cutting or burning one’s own skin) in the absence of any intent to die
-t helps both to decrease high levels of distress and to elicit help from others

Question 55

when are suicide attempts most likely to happen

Answer 55

Suicide attempts most often are made when people are alone and in a state of severe psychological distress and anguish, unable to see their problems objectively or to evaluate alternative courses of action.-Thus, one tragedy is that many do not really want to die. A second tragic concern arises from the long-lasting distress among those left behind. Studies of those who have lost someone to suicide show that the loss of a loved one through suicide is associated with feelings of depression, social withdrawal, and perceived stigma from others

Question 56

Gender differences in suicide

Answer 56

In virtually every country around the world in which suicidal behavior has been examined, women are significantly more likely than men to think about suicide and to make nonlethal suicide attempts
-men are four times more likely than women to die by suicide (WHO, 2015a). This difference in likelihood of suicide death is explained in large part by the fact that men tend to use more lethal means in their suicide attempts (e.g., firearms) than do women.

Question 57

Age onset of typical suicidal ideation

Answer 57

suicidal thoughts and behaviors increase in prevalence starting around age 12 and continue to increase into the early to mid-20s The rate of suicide death follows a similar pattern, followed by a peak in middle age (45–55 years) and a slight decrease and leveling off for the remainder of the life span. One notable exception to this pattern is that the suicide rate for white men in the United States shows another dramatic increase beginning at age 75

Question 58

Why has there been such a surge in suicide attempts and completed suicides in adolescence?

Answer 58

One obvious reason is that this is a period during which depression, anxiety, alcohol and drug use, and conduct disorder problems show increasing prevalence, and these are all factors associated with increased risk for suicide
-ncreased availability of firearms has probably played a role as well. In addition, exposure to suicides (especially those of celebrities) through the media, where they are often portrayed in dramatic terms, has likely contributed to these aggregate increases in adolescent suicide, perhaps because adolescents are highly susceptible to suggestion and imitative behavior (contagion factors)

Question 59

Suicide rates throughout US cities and ethnic distribution

Answer 59

Racial/ethnic differences are also seen: 90 percent of suicides in the United States are classified as people who are white, 6 percent black, 3 percent Asian/Pacific Islander, and 1 percent American Indian or Alaskan Natives
the suicide rate is highest in the Western United States (especially Wyoming, Montana, Alaska, Colorado, and New Mexico) and lowest in the Mid-Atlantic states (such as New Jersey, New York, Maryland, and the District of Columbia)

Question 60

Disorders that predict transition from suicidal thoughts to attempts

Answer 60

. Instead, it is disorders characterized by agitation and aggression/impulsiveness that predict acting on one’s suicidal thoughts, such as posttraumatic stress disorder, bipolar disorder, conduct disorder, and intermittent explosive disorder that predict this transition

Question 61

Warning Signs for Suicide

Answer 61

Hopelessness

Rage, anger, seeking revenge

Acting reckless or engaging in risky activities, seemingly without thinking

Feeling trapped—like there’s no way out

Increasing alcohol or drug use

Withdrawing from friends, family, or society

Anxiety, agitation, unable to sleep, or sleeping all the time

Dramatic changes in mood

No reason for living; no sense of purpose in life

Question 62

Comorbid disorders and suicide

Answer 62

However, those with two disorders (compared to those with none) show a doubling in their risk of suicidal behavior, whereas those with three or more disorders show a six- to ninefold increase in the risk of suicidal behavior

Question 63

why do some people become suicidal?

Answer 63

In almost every case suicide is caused by … psychological pain, or “psychache.” … Suicidal death, in other words, is an escape from pain. … Pain is nature’s great signal. Pain warns us; pain both mobilizes us and saps our strength; pain, by its very nature, makes us want to stop it or escape from it. … Psychache is the hurt, anguish, or ache that takes hold in the mind … the pain of excessively felt shame, guilt, fear, anxiety, loneliness, angst, and dread of growing old or of dying badly. …
Suicide happens when the psychache is deemed unbearable and death is actively sought to stop the unceasing flow of painful consciousness

Question 64

Implicit associations between the self and death/suicide

Answer 64

at elevated risk of future suicide attempts, even over and above the effects of other known risk factors
-Such associations can be measured using reaction time tests, such as the Implicit Association Test (IAT), which asks people to classify words into one of two groups (e.g., “like me” or “not like me”). Researchers have found that suicidal people are faster in classifying suicide-related words (e.g., “death,” “suicide”) in the “like me” group than in the “not like me” group, providing a new method of detecting and better predicting suicidal behavior

Question 65

genetic volunerability in monozygotic twins vs dizygotic

Answer 65

concordance rate for suicide in identical twins is about three times higher than that in fraternal twins (Baldessarini & Hennen, 2004). Moreover, this genetic vulnerability seems to be at least partly independent of the genetic vulnerability for major depression
OVERALL, biological factors are only weakly associated with suicidal outcomes—too weak to be helpful in accurately predicting suicidal thoughts or behaviors

Question 66

Reduced sertongeric activity and suicide

Answer 66

reduced serotonergic activity being associated with increased suicide risk—especially for violent suicide.

Question 67

Joiner’s interpersonal-psychological model of suicide ­(3)

Answer 67

­suggests that the psychological states of perceived burdensomeness (e.g., feeling like a burden to others) and thwarted belongingness (e.g., feeling alone) interact to produce suicidal thoughts and desires
= only in the presence of a third factor, the acquired capability for suicide (believed to be acquired through pain or provocative experiences), that a person has the desire and ability to make a lethal suicide attempt

Question 68

ways of preventing suicide

Answer 68

-One way to help prevent suicide might be through treating the underlying mental disorder(s) the potentially suicidal person has. In the case of depression, such treatment is often in the form of antidepressant medications
-crisis intervention: The primary objective of crisis intervention is to help a person cope with an immediate life crisis. If a serious suicide attempt has been made, the first step involves emergency medical treatment, followed by referral to inpatient or outpatient mental health facilities in order to reduce the risk for future attempts

Question 69

antidepressants and suicidal thoughts

Answer 69

• A recent review of placebo-controlled randomized clinical trials revealed higher rates of suicidal thoughts and behaviors in those receiving antidepressants relative to those receiving placebo
  -led the Food and Drug Administration (FDA) to require pharmaceutical companies to put warnings on the labels of these medications informing the public of this effect
  -Lithium also seems to be an especially powerful antisuicide agent over the long term.
  -Benzodiazepines are suggested to be useful in treating the severe anxiety and panic that so often precede

Question 70

Crisis intervention goals/ suicide prevention hotlines

Answer 70

(1) maintaining supportive and often highly directive contact with the person over a short period of time—usually one to six contacts; (2) helping the person to realize that acute distress is impairing his or her ability to assess the situation accurately and to see that there are better ways of dealing with the problem; and (3) helping the person to see that the present distress and emotional turmoil will not be endless.
-information on the assessment of the effects of these hotlines and suicide prevention centers has not revealed much impact on suicide rates.

Question 71

right to die/ Oregon Death with Dignity Act (ODDA)

Answer 71

there is still very heated debate all over the country about the right of people who are terminally ill or who suffer chronic and debilitating pain to shorten their agony.

Question 72

Dr. Jack Kevorkian

Answer 72

• helped over 130 gravely ill people commit suicide and, in so doing, tried to get Michigan to pass laws permitting such acts.
  convicted in April 1999, of second-degree murder and was released and paroled for good behavior in 2007 after serving 8 years of a 10- to 25-year term in prison. In spite of Kevorkian’s failure to prompt the passage of laws supporting assisted suicide for such gravely ill individuals (indeed, Michigan passed a law prohibiting assisted suicide!), substantial numbers of people, including many physicians and dying patients, have come to sympathize with this position

Question 73

Right to suicide in non termionally ill cases

Answer 73

rights of suicidal people who are not terminally ill and who have dependent children, parents, a spouse, or other loved ones who will be adversely affected, perhaps permanently (Lukas & Seiden, 1990; Maris et al., 2000), by their death? Here a person’s “right to suicide” is not immediately obvious, and physicians are very unlikely to provide assistance in such cases (Rurup et al., 2005). The right to suicide is even less clear when we consider that, through intervention, many suicidal people regain their perspective and see alternative ways of dealing with their distress.

Question 74

suicide prevention vs intervention

Answer 74

focusing on suicide “prevention,” some have suggested suicide “intervention” both as a more appropriate term and as descriptive of a more ethically defensible professional approach to suicidal behavior. According to this perspective, suicide intervention embodies a more neutral moral stance than suicide prevention—it means interceding without the implication of preventing the act—and, in certain circumstances, such as when people are terminally ill, it may even encompass the possibility of facilitating the suicidal person’s objective