Chapter 4: Mood Disorders and Suicide Flashcards
Mood
pervasive qualities of an individual’s emotional experience, as in depressed mood, anxious mood, or elated mood
Unipolar
pertaining to a single pole or direction, as in unipolar (depressive) disorders
Bipolar
characterized by opposites, as in bipolar disorder
Major Depressive Disorder (MDD)
severe depression characterized by the occurrence of major depressive episodes in the absence of a history of manic episodes
MDD is characterized by a range of features such as depressed mood, lack of interest or pleasure in usual activities, lack of energy or motivation, and changes in appetite or sleep patterns
Manic
relating to mania, as in the manic phase of a bipolar disorder
Hypomanic Episodes
mild manic episodes
Major Depressive Disorder with Seasonal Pattern
major depressive disorder that occurs seasonally
also known as seasonal affective disorder
Major Depressive Disorder with Peripartum Onset
major depressive disorder that occurs during pregnancy or following childbirth
Persistent Depressive Disorder
chronic type of depressive disorder last at least two years
Bipolar I Disorder
bipolar disorder characterized by manic episodes
Manic Episodes
periods of unrealistically heightened euphoria, extreme restlessness, and excessive activity characterized by disorganized behavior and impaired judgement
Pressured Speech
outpouring of speech in which words seem to surge urgently for expression, as in a manic state
Rapid Flight of Ideas
a characteristic of manic behavior involving rapid speech and changes of topic
Bipolar II Disorder
bipolar disorder characterized by periods of major depressive episodes and hypomanic episodes
Cyclothymic Disorder
disorder characterized by a chronic pattern of mild mood swings between depression and hypomania that are not of sufficient severity to be classified as bipolar disorder
Mouring
normal feelings or expressions of grief following a loss
Cognitive Triad of Depression
in Aaron Beck’s theory, the view that depression derives from the adoption of negative views of oneself, the world, and the future
Selective Abstraction
in Beck’s theory, a type of cognitive distortion involving the tendency to focus selectively only on the parts of one’s experiences that reflect on one’s flaw and to ignore those aspects that reveal one’s strengths or competencies
Automatic Thoughts
thoughts that seem to pop into one’s mind, in Aaron Beck’s theory, automatic thoughts that reflect cognitive distortions induce negative feelings such as anxiety or depression
Learned Helplessness
in Martin Seligman’s model, a behavior pattern characterized by passivity and perceptions of lack of control that develops because of a history of failure to be able to exercise control control over one’s environment
Attributional Style
personal style for explaining cause-and-effect relationships between events
Internal Attribution
in the reformulated helplessness theory, a type of attribution involving the belief that the cause of an event involved factors within oneself
External Attribution
in the reformulated helplessness theory, a type of attribution involving the belief that the cause of an event involves factors outside the self
Stable Attribution
in the reformulated helplessness theory, a type of attribution involving the belief that the cause of an event involved stable rather than changeable factors
Unstable Attribution
in the reformulated helplessness theory, a type of attribution involving the belief that the cause of an event involved changeable rather than stable factors
Global Attribution
in the reformulated helplessness theory, a type of attribution involving the belief that the cause of an event involved generalized rather than specific factors
Specific Attribution
in the reformulated helplessness theory, a type of attribution involving the belief that the cause of an event involved specific rather than generalized factor
Interpersonal Psychotherapy (IPT)
a brief, psychodynamic form of therapy that focuses on helping people resolve interpersonal problems
Cognitive Therapy
a form of psychotherapy in which clients learn to recognize and change their dysfunctional thinking patterns
Anomie
lack of purpose or identify; aimlessness
What are mood disorders?
as the mane implies, mood disorders are a type of disorder characterized by disturbances of mood
they can take a variety of forms
What are the different types of mood disorders?
mood episodes
depressive disorders
bipolar disorders
other mood disorders
What is major depressive disorder (MDD)?
severe mood disorder characterized by the occurrence of major depressive episodes in the absence of a history of manic episodes
What are the features that characterize major depressive disorder?
depressed mood
lack of interest or pleasure in usual activities
lack of energy or motivation
changes in appetite or sleep patterns
What is the criteria of major depressive disorder in the DSM?
at least five of the following symptoms have been present during the same 2-week period and represent a change from previous functioning: at least one of the symptoms is either depressed mood or loss of interest or pleasure
depressed mood most of the day, nearly every day, as indicated either by subjective report or observation made by others
markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day
insomnia or hypersomnia nearly every day
psychomotor agitation or retardation nearly every day
fatigue or loss of energy nearly every day
feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
diminished ability to think or concentrate
recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or specific plan for committing suicide
When are changes in mood considered abnormal?
persistent or severe changes in mood or cycles of extreme elation and depression may suggest the presence of a mood disorder
What are the statistics of mood disorders in Canada?
depressive disorders are most common in adolescence and early adulthood (15-24 years of age)
through adolescence and adulthood (15-64 years of age) women have a higher prevalence of depressive disorders compared to men
older adults (65 and older) have the lowest prevalence of depressive disorders, and no significant difference between men and women
What are the different types of MDD specifiers?
with anxious distress (combination of anxiety and depression)
with mixed features
with melancholic features (high degree of psychomotor retardation)
with atypical features
with mood-congruent psychotic features
with mood-incongruent psychotic features
with catatonia (don’t move anymore)
with peripartum onset (recently added, very similar to MDD, can occur weeks before actually giving birth)
with seasonal pattern (recurrent episode only, result of shortened daylight hours)
What are the risk factors for depression?
age: more often starts in younger adulthood
socioeconomic status
marital status (single men more likely to develop MDD)
women are nearly twice as likely as men to develop major depression (less pronounced difference in later years, greater array of life stressors)
coping styles (active copers don’t get depression as much)
What are the features of seasonal affective disorders?
correctly called MDD with seasonal pattern
fatigue
excessive sleep
craving carbohydrates
weight gain
What is MDD with seasonal pattern?
affects women more often than men
is most common among young adults
possibly occurs in children but not as commonly as in young adults
What is postpartum depression?
correctly termed: MDD with peripartum onset
persistent and severe mood changes that occur following childbirth
in fact, about half begin in the late stages of pregnancy (hence the switch to peripartum)
prevalence: 10 to 15%
What is persistent depressive disorder (dysthymia)?
previously called dysthymic disorder
a milder form of depression, seems to follow a chronic course of development that often begins in childhood or adolescence
What is the DSM criteria for persistent depressive disorder?
depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years
presence, while depressed, of two (or more) of the following: poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, feelings of hopelessness
during the 2 year period of the disturbance, the individual has never been without symptoms for more than 2 months at a time
What is the DSM criteria for premenstrual dysphoric disorder?
characterized by mod changes that revolve around a woman’s menstrual cycle
in the majority of menstrual cycles, at least five symptoms must be present in the final week before the onset of menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week post menses
one (or more) of the following symptoms must be present: marked affective lability (e.g. mood swings, feeling suddenly sad or tearful, or increased sensitivity to rejection, marked irritability or anger or increased interpersonal conflicts, marked depressed mood, feelings of hopelessness, or self-deprecating thoughts, marked anxiety, tension, and/or feelings of being keyed up or on edge
What are the symptoms of premenstrual dysphoric disorder listed in the DSM?
- decreased interest in usual activities (e.g. work, school, friends, hobbies)
- subjective difficulty in concentration
- lethargy, easy fatigability, or marked lack of energy
- marked change in appetite, overeating, or specific food cravings
- hypersomnia or insomnia
- a sense of being overwhelmed or out of control
- physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of “bloating”, or weight gain
What is bipolar disorder I?
features states of extreme elation (manic episodes); major depressive episodes are a common feature
What is bipolar disorder II?
features states of abnormally elevated mood (hypomania) and major depressive episodes
What is a manic episode?
periods of unrealistically heightened euphoria, extreme restlessness, and excessive activity characterized by disorganized behavior and impaired judgement
What is pressured speech?
outpouring of speech in which words seem to surge urgently for expression, as in a manic state
What is rapid flight of ideas?
a characteristic of manic behavior involving rapid speech and changes of topics
What are the characteristics of a manic episode stated in the DSM-5?
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 (or any duration if hospitalization is necessary)
during the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior
What are the symptoms of a manic episode stated in the DSM-5?
- inflated self-esteem or grandiosity
- decreased need for sleep (e.g. feels rested after only 3 hours of sleep)
- more talkative than usual or pressure to keep talking
- flight ideas or subjective experience that thoughts are racing
- distractibility (i.e. attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed
- increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e. purposeless non-goal-directed activity)
- excessive involvement in activities that have a high potential for painful consequences (e.g. engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)
What is the criteria for bipolar I disorder in the DSM -5?
criteria have been met for at least one manic episode
the occurrence of the manic and major depressive episode(s) is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder
What is the criteria of a hypomanic episode in the DSM-5?
a distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day
during the period of mood disturbance and increased energy and activity, three (or more) of the following symptoms have persisted (four if the mood is only irritable), represent a noticeable change from usual behavior, and have been present to a significant degree
the episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic
the disturbance in mood and the change in functioning are observable by others
NOT severe enough to require hospitalization or cause of major disruption
What are the symptoms of a hypomanic disorder stated in the DSM-5?
- inflated self-esteem or grandiosity
- decreased need for sleep
- more talkative
- flight of ideas
- distractibility
- increase in goal-orientated activity
- excessive involvement
What is the criteria of bipolar II disorder in the DSM-5?
criteria have been met for at least one hypomanic episode and at least one major depressive episode
there has never been a manic episode
the occurrence of the hypomanic episode(s) is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum or other psychotic disorder
the symptoms of depression or the unpredictability caused by frequent alternation between period of depression and hypomania causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
What is cyclothymic disorder?
mood disorder characterized by a chronic pattern of mild mood swings between depression and mania that are not of sufficient severity to be classified as bipolar disorder
What are the symptoms of cyclothymic disorders?
numerous periods of hypomanic symptoms for at least two years that fail to meet criteria for manic episodes
numerous periods of depressive symptoms that fail to meet the criteria for a major depressive episode
the person has experienced the periods mentioned above for at least half the time, and the person has not been without symptoms for longer than two months
the symptoms experienced are not due to another mental health condition
the symptoms experienced are not caused by a medical condition or substance
the symptoms experienced impair the person’s ability to socialize, work, or function in other areas of his or her life
What are the theoretical perspectives on mood disorders?
stress and mood disorders: strong correlation, even childhood experiences can later emerge as risk factors, symptoms of depression may lead to interpersonal conflict and job loss = more stress
strong social supports and healthy coping style can be protective factors
What are the psychodynamic perspectives on mood disorders?
anger at an internalized (introjected) love object is inwardly directed (“I feel like I lost a part of myself…”)
mourning (uncomplicated) is healthy and represents a form of psychological separation
becomes pathological as a result of ambivalence (i.e. anger and guilt)
chronically depressed patients appear to engage in excessive self-focusing following loss or failure, but so do other clinical groups
What are the humanistic perspectives on mood disorders?
what happens when we lose our sense of direction?
according to the humanistic-existential perspective, depression may result from the inability to find meaning and purpose in one’s life
What are the learning perspectives on mood disorders?
reinforcement and depression
learned helplessness
interactional theory (James Coyne, 1999)
reciprocal interaction: social interactions and how they are reinforced affects you
What were Seligman’s learned helplessness experiments?
training phase: 3 groups (no shocks, avoidable shock, non-avoidable shock)
test phase: all in shuttle box
groups 1 and 2: learned avoidance
group 3: failed to learn avoidance response
affective and behavioral differences
clinical implications: depression is caused by non-contingent punishment
What are the cognitive perspectives of mood disorders?
learned helplessness (Seligman)
attributional style: internal attribution, stable vs. unstable attribution, global attribution vs. specific attribution
Aaron Beck’s cognitive theory: cognitive distortions, automatic thoughts
What is the depressive triad?
negative views of: self, environment, future
thinking positively toward any of these would likely lessen negative affect
What are some examples of cognitive distortions?
all-or-nothing thinking
overgeneralization
mental filter
disqualifying the positive
jumping to conclusions
magnification/minimization
emotional reasoning
“should” statements
labelling/mislabeling
personalization
What are the biological perspectives of mood disorders?
genetic factors (if your parent has a mood disorder, higher chance you’ll get it too)
biochemical factors and brain abnormalities in depression
What are the psychodynamic approaches to the treatment of mood disorders?
interpersonal therapy (IPT)
problems are rooted in unhealthy relationships
What are the behavioral approaches to the treatment of mood disorders?
“coping with depression” (CWD) course
manualized, element of education, mind shift
What are the cognitive approaches to the treatment of mood disorders?
cognitive therapy
less with behavior, more with thinking patterns
What are the biological approaches to the treatment of mood disorders?
antidepressant drugs
lithium (mood stabilizer for BPD)
electroconvulsive therapy (ECT)
What is St. john’s Wort?
hypericum perforatum, used for centuries to heal wounds
early small-scale studies supported benefits of St. John’s Wort with few reported side effects in cases of mild to moderate depression
unclear as to whether it is effective in treating severe depression, continues to be evaluated
Who commits suicide?
24% of deaths in Canada for 15-24 year olds
suicide is one of the leading causes of death in both men and women from adolescence to middle age
Why do people commit suicide?
discouraged, trapped, hopeless, MDD and BPD, substance abuse and intoxication, exit events (big, stressful events), personality disorders
What are the theoretical perspectives on suicide?
“accidental suicides” want attention but actually die, they will bring regret to everyone when they die, joining a loved one, social contagion (immitation)
What actions can you take to prevent suicide?
- draw the person out
- be sympathetic
- suggest that means other than suicide can be discovered to work out their problems
- inquire as to how the person expects to commit suicide
- propose that the person accompany you to see a professional right now
- don’t degrade the individual (“you’re talking crazy…”)
