Chapter 7 Flashcards
1
Q
Mood disorders definition
A
- abnormal mood is the defining feature
- disturbances of mood are intense and persistent enough to lead to serious problems in relationships/at work
- two key moods are depression and mania (can be just depression or can be both, can feel ‘normal’ in between)
2
Q
Depressive mood state
A
- feelings of extraordinary sadness and dejection
3
Q
Manic mood state
A
- characterized by intense/unrealistic feelings of excitement and euphoria
4
Q
Mixed-episode cases
A
- when a person has symptoms of mania and depression during the same time period
- rapidly alternating moods within same episode of illness
5
Q
Unipolar depressive disorders
A
- mood disorder in which a person experiences only depressive episodes
6
Q
Bipolar disorders
A
- mood disorders in which a person experiences both manic and depressive episodes
7
Q
The most common form of mood disturbance involves…
A
a depressive episode (markedly depressed or loss of interest in formerly pleasurable activities for 2 weeks+; plus other symptoms like changes in sleep or appetite)
8
Q
Manic episode
A
- markedly elevated, euphoric, or expansive mood (often interrupted by periods of intense irritability or violence)
- persist for at least a week
- plus 3 or more additional symptoms (behavioral, mental, or physical)
9
Q
Hypomanic episode
A
- abnormally elevated, euphoric, or expansive mood for at least 4 days
- must have at least 3 other symptoms involved in mania
- don’t have to have as many symptoms as for manic
10
Q
DSM-5 criteria for Manic Episode
A
A: distinct period of abnormally elevated, expansive, or irritable mood + increased goal-directed activity or energy lasting at least 1 week (most of the day on most days)
B: three or more additional symptoms from:
- Inflated self-esteem or grandiosity
- Decreased need for sleep
- More talkative than usual
- Racing thoughts
- Distractibility
- Increase in goal-directed activity or psychomotor agitation
- Excessive involvement in activities that have high potential for painful consequences
C: disturbance sufficiently severe to cause impairment in social/occupational functioning
D: episode not attributable to effects of a substance or medical condition
11
Q
Mood disorders occur ___x more frequently than schizophrenia
A
15 to 20 (almost same rate as all anxiety disorders together)
12
Q
Major depressive disorder
A
- MDD, major depression, unipolar depression
- most common serious mood disorder
- occurrence has increased in recent decades
- US lifetime prevalence rate 17% (12mo rate 7%)
13
Q
Mood disorders worldwide prevalence
A
- second most prevalent (second to anxiety disorders)
- 12mo prevalence of 1-10% across diff. countries
- highest in United States, lowest in Nigeria (might be ab measurement and not actual prevalence)
14
Q
Gender differences in MDD
A
- higher in women (about 2:1); similar to anx. disorders
- boys equally or more likely to be diagnosed as schoolchildren
- women more likely to be diagnosed in starting in adolescence until 65
15
Q
Bipolar disorder prevalence
A
- lifetime risk of developing classic form is 1%
- no discernable sex differences
16
Q
Ethnicity and prevalence of mood disorders in the US
A
- less frequent among African Americans vs European white Americans and Hispanics
- Native Americans have higher rates vs white americans
- no significant differences for bipolar
17
Q
SES and unipolar/bipolar disorders
A
- low SES = higher rates of unipolar disorders
- bipolar not related, despite previous research indicating it was linked to high SES
18
Q
Artists and mood disorders
A
- elevated rates, esp. for bipolar
- productivity of some artists dramatically increases during manic episodes
- mania or hypomania might facilitate creative process
- intense negative emotions of depression may provide material for creative activity
19
Q
Mild and brief depression may be…
A
“normal” and adaptive in the long run
20
Q
DSM5 Criteria for Major Depressive Disorder
A
A: 5+ symptoms present in same 2-week period; at least 1 is depressed mood or loss of interest/pleasure
- depressed mood most of day on most days
- markedly diminished interest/pleasure in almost all activities
- significant weight loss or increase/decrease in appetite
- insomnia or hypersomnia
- psychomotor agitation or retardation (has to be observable by others!)
- fatigue or loss of energy
- feelings of worthlessness or excessive guilt
- diminished ability to think/concentrate
- recurrent thoughts of death, suicidal ideation, suicide attempt or plan
B: clinically significant distress or impairment
C: episode not attributable to substance or medical condition
D: not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other schizophrenia spectrum/psychotic disorders
E: there has never been a manic or hypomanic episode
21
Q
There is a high comorbidity or depressive disorders with…
A
anxiety disorders!
22
Q
Length of MDD
A
- typically 6 to 9mo if untreated
- in 10-20% of cases, systems do not remit for over 2 years (persistent depressive disorder)
23
Q
Relapse vs. recurrence
A
- relapse: return of symptoms within short period of time (usually bc underlying episode has not yet run its course)
- recurrence: onset of a new episode of depression (40-50% of ppl who have one episode)
- probability of recurrence increases w additional past episodes and w comorbid conditions
- might have symptoms 1/2-2/3 of time in between episodes (this group more likely to have recurrence)
24
Q
PHQ-9
A
- patient health questionnaire
- self-report depression questionnaire
- diagnostic interview (gold standard) takes 1h30
- most studies use self-report bc it takes much less time
25
Depression in childhood
- used to think kids can't have depression
- fairly uncommon, 1-3% of school-age children
- recurrence rates are high like with adults
26
Depression in adolescence
- onset most often late adolescence to middle adulthood
- 15-20% of teens experience MDD at some point
- another 10-20% experience subclinical depression
- sex differences first emerge (2x more women)
- can have long-lasting effects throughout young adulthood
- very likely to recur in adulthood
27
Depression in adults
- prevalence lower in those over 65
- difficult to diagnose later in life bc many symptoms overlap with other issues associated w ageing
- many adverse consequences, 2x risk of death for those who've had a heart attack or stroke
28
Specifiers
- diff. patterns of symptoms that sometimes characterize MD episodes that may help predict course and preferred treatments for the condition
29
Major depressive episode with melancholic features
- specifier of MDD
- might involve: wake up very early, depression worse in morning, psychomotor agitation/retardation
- applied when person meets criteria for major depressive episode AND has lost pleasure/interest in activities or does not react to usually pleasurable stimuli
- more heritable than other forms of depression
- often associated w history of childhood trauma
30
Severe major depressive episode with psychotic features
- specifier of MDD
- depressive and psychotic symptoms (loss of contact w reality, delusions, hallucinations)
- usually delusions/hallucinations are mood congruent
- likely to have longer episodes, more cognitive impairment, and poorer long-term prognosis
- recurrent episodes likely to involve psychotic symptoms
- treatment usually involves antipsychotics and antidepressants
31
Major depressive episode with atypical features
- specifier of MDD
- pattern of symptoms characterized by mood reactivity (mood brightens in response to potential positive events)
- more often women, earlier than average age of onset, more likely to show suicidal thoughts
- linked to mild form of bipolar associated w hypomanic rather than manic episodes
- might respond better to different class of antidepressants (monoamine oxidase inhibitors)
32
Major depressive episode with catatonic features
- specifier of MDD
- marked psychomotor disturbances (ie mutism and rigidity)
- catatonia known more as subtype of schizophrenia but more associated w certain forms of depression and mania
33
Recurrent major depressive episode with a seasonal pattern
- specifier of MDD
- seasonal affective disorder
- at least 2 episodes in past 2 years at same time of year (most commonly spring)
- cannot have had another nonseasonal episode in same 2 years; most of lifetime episodes must be seasonal
- winter affective disorder more common in ppl living at higher latitudes (northern climates) and in younger ppl
34
Persistent depressive disorder general info
- formerly called dysthymic disorder or dysthymia
- depressed mood most of day, more days than not, for at least 2 years (1 year for kids/teens)
- periods of normal mood can occur from a few days to 2 months
- show poorer outcomes and as much impairment as MDD
35
DSM5 Criteria for Persistent Depressive Disorder
A: depressed mood for most of day on most days for at least 2 years
B: 2 or more of following symptoms during depressive periods
- poor appetite/overeating
- insomnia/hypersomnia
- low energy/fatigue
- low self-esteem
- poor concentration
- feelings of hopelessness
C: in 2 years, never been without A and B for more than 2 months
D: criteria for MDD may be continuously present for 2y
E: never been a manic/hypomanic episode or cyclothymic disorder
F: not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other schizophrenia spectrum/psychotic disorders
G: not attributable to substance/medical condition
H: clinically significant distress/impairment
36
Double depression
- persistent depressive disorder and MDD
- moderately chronically depressed, but undergo increased problems sometimes (when they meet criteria for MD episode)
- study of 100 ppl w early-onset dysthymia for 10 years found 84% experienced at least one MD episode
- most ppl recover, but recurrence is frequent
- in DSM5 is classified as form of persistent DD
37
Lifetime prevalence of persistent DD
2.5-6%
38
Duration of persistent DD
- avg. 4-5 years
- can last 20 years or more
- chronic stress increases severity of symptoms over 7.5 year follow-up period
39
Onset of persistent DD
- often during adolescence (over 50% before age 21)
- in study of early-onset dysthymia found 74% recovered within 10y but 71% of recovered cases relapsed within about 3 years
40
Depression is nearly always precipitated by....
stressful life events! (like death or birth)
41
Gender differences in grief
- more difficult for men vs women
42
Bowlby's 4 phases of normal response to loss of a spouse or close family member
1. numbing and disbelief
2. yearning and searching for the dead person
3. disorganization and despair (when they accept death as permanent)
4. reorganization as person gradually rebuilds life
- depressive symptoms tend to peak 2-6mo after loss
43
Bereavement exclusion and the DSM
- in DSM4, can't be diagnosed w MDD within 2 months after loss of loved one (doesn't apply to loss of job or divorce...)
- DSM5 removed it instead of expanding definition, was very controversial
44
Loss and depression
- about 50% of ppl exhibit genuine resilience
- show minimal, short-lived symptoms of depression/bereavement
- these people are not emotionally maladjusted!
45
Premenstrual dysphoric disorder DSM5
(not on exam)
- diagnosed if woman has set of symptoms in majority of cycles for past year
- symptoms week before period, improve few days after
- marked affective lability (ie mood swings)
- marked irritability/anger/conflicts
- marked depressed mood/hopelessness
- marked anxiety/tension
- PLUS 5/7 of: decreased interest, difficulties in concentration, fatigued, changes in appetite, hyper/insomnia, being overwhelmed, physical symptoms
- form of depression where hormones play important role
46
Postpartum depression
- thought to sometimes occur in new mothers (occ. fathers!)
- "postpartum blues" more common; mix of bad and good feelings (depression and hypomania); occurs in 50-70% of women within 10 days of birth and subside on their own
- doesnt exist any more, its blues or MDD
47
Risk factors of postpartum blues/depression
- MDD in women postpartum occurs no more frequently than expected in normal women same age and SES
- greater likelihood of MDD after postpartum blues
- might be partly bc of hormonal readjustments and alterations in serotonergic/noradrenergic functioning
- especially likely if mom has lack of social support, difficulty adjusting to new role, or family history of depression
48
Hippocrates and depression
- believed depression was caused by excess of black bile
49
Genetic influences on unipolar depressive disorders
- 2-3x prevalence of mood disorders among relatives of someone diagnosed w unipolar DD
- MZ twin of someone w MDD 2x more likely than DZ twin to develop MDD
- 31-42% of liability due to genetic diff.; 70-80% for severe/early-onset/recurrent
- nonshared environment plays bigger role
50
Serotonin-transporter gene
- candidate for gene implicated in depression
- alleles are s/s, s/l, or l/l
- longitudinal study found genotype-environment interaction
- s/s 2x as likely to develop MD episode after 4+ stressful live events in last 5 years vs l/l
- s/s who experienced severe severe maltreatment as children w l/l 2x as likely to develop MDD
- findings support diathesis-stress model
- findings not replicable
51
Neurochemical factors in depression
- early attention in 60s and 70s on monoamines norepinephrine and serotonin
- lead to monoamine theory of depression: depression sometimes due to depletion of one or both of these nts at important receptor sites in brain
- by 80s, clear it cant be this straightforward
- some studies showed HIGHER norepinephrine in MDD (esp. severe or melancholic)
- minority of patients had lowered serotonergic functioning; tend to have higher suicidal ideation behavior
- dopamine dysfunction plays role in some forms (incl. atypical and bipolar)
- now integral theories have been proposed, neurotransmitters are only one part of puzzle
52
Norepinephrine and serotonin
- regulation of behavioral activity, stress, emotional expression, vegetative functions (appetite, sleep, arousal)
- all disturbed in mood disorders!
53
Stress response, HPA axis, and cortisol
- perception of stress/threat leads to activity in hypothalamus, released CRH which triggers release of ACTH from pituitary
- ACTH travels through blood to adrenal cortex of adrenal glands where cortisol is released
- sustained elevations of cortisol are bad for us; can result from increased CRH or ACTH or failure of feedback mechanisms
- elevated in 20-40% of outpatients w depression and 70-80% of hospitalized patients w severe depression
54
Dexamethasone
- potent suppressor of plasma cortisol
- research found that 45% of patients w serious depression dexamethasone fails to suppress cortisol
- nonsuppression might be nonspecific indicator of generalized mental distress (bc it is found in other groups like those w panic disorder)
55
Patients w depression and elevated cortisol tend to show....
memory impairments and problems w abstract thinking/complex problem solving
56
Prolonged elevations in cortisol result in cell death in the ___
Hippocampus (part of limbic system heavily involved in memory functioning)
57
Stress in infancy and childhood can increase reactivity of...
the HPA axis
58
Hypothalamic-pituitary-thyroid axis
- ppl with low thyroid levels often become depressed
- 20-30% of patients w depression and normal thyroid levels still show dysregulation of the axis
- thyrotropin-releasing hormone can be used as treatment when traditional treatments dont work
59
Depression and the immune system
- depression accompanied by dysregulation of immune system
- activation of inflammatory response (proinflammatory cytokines) can contribute directly to development of depressive symptoms
60
Tricyclics
- early antidepressants
- fairly nonspecific, acted more on norepinephrine than serotonin
- lots of side effects due to action on norepinephrine system
- drugs now more serotonin specific
61
Key brain regions involved in affect and mood disorders (NOT TESTED)
- orbital prefrontal cortex (reward)
- ventromedial prefrontal cortex
- dorsolateral prefrontal cortex (cognitive control)
- hippocampus (learning and memory)
- amygdala
- anterior cingulate cortex (selective attention)
**these areas have decreased function in depression**
62
Stressful life events as causal factors
- sle's involved in precipitating depression (loss, severe economic or health problems)
- depressed ppl might perceive things as more stressful so we need to use strict interview to objectively determine how stressful events were
- dependent life events (depressed person behaves in ways that makes situation more stressful)
- minor events may play more of a role in onset of recurrent episodes vs initial episode
63
SES and depression
- low SES/adverse environments increases risk of depression
- one of clearest findings in terms of risk factors
64
Cognitive diatheses for depression (3)
- neuroticism or negative affectivity
- perfectionism
- perceived injustice
65
Psychodynamic theories and depression
- Freud: depression occurs when anger is turned inwards (ie subconscious anger toward mother for having control over you is turned inward by superego when she dies)
- Freud+Karl Abraham hypothesized that when a loved one dies, the mourner regresses to oral stage of development
66
Behavioral theories and depression
- depression occurs when response no longer produces positive reinforcement or when rate of negative reinforcement increases
- ie leaving uni and starting job (dont get As for working hard!)
67
Beck's cognitive theory and depression
- most dominant theory of depression
- psychoanalyst, questioned if everything that went wrong was about the subconscious, focus on conscious
- hypothesized that cognitive symptoms of depression often precede and cause affective mood symptoms
- negative cognitions are central to theory
- underlying dysfunctional beliefs (depressogenic schemas) are rigid, extreme, and counetrproductive
- when dysfunctional beliefs are activated by current stressors or depressed mood, they create a pattern of negative automatic thoughts
- negative cognitive triad includes negative thoughts ab self, world, and future
68
Evaluating Beck's theory
- research on theory has generated effective treatment (cognitive therapy)
- research supports most of descriptive aspects of theory
- research on causal hypothesis has yielded mixed results
69
Reformulated Helplessness Theory
- Abramson and colleagues
- proposed when ppl are exposed to uncontrollable negative events, they ask themselves why
- attributions we make central to if we become depressed
- ppl w pessimistic attributional style have vulnerability for depression when faced w uncontrollable negative events
70
Hopelessness Theory of Depression
- having pessimistic attributional style in conjunction w negative life event not sufficient cause for depression
- hopelessness expectancy (no one has control so something bad will happen) thought to be sufficient cause for depression
71
Ruminative Response Styles Theory of Depression
- rumination: pattern of repetitive and relatively passive mental activity
- higher risk for developing depression (bad event keeps happening in their head afterwards)
72
Comorbidity of anxiety and mood disorders
- high rate of comorbidity
- occurs at all levels of analysis (patient self-report, clinical ratings, diagnosis, family and genetic factors)
73
Interpersonal effects of mood disorders
- lack of social support makes you more vulnerable
- depressive behavior can elicit negative feelings and rejection in other ppl
- high correlation between marital dissatisfaction and depression; marital distress increases relapse; parental depression puts kids at high risk
74
Bipolar disorders general info
- distinguished from unipolar disorders by presence of manic or hypomanic episodes
- Bipolar 1, 2, or cyclothymic disorder
75
Cyclothymic disorder
- repeated experience of hypomanic episodes for a period of at least 2 years
- less serious version of bipolar disorder (lacks extreme mood and behavior changes)
76
Symptoms of a manic episode
3 or more of:
- inflated self-esteem/grandiosity
- decreased need for sleep
- increased talkativeness
- racing thoughts
- distracted easily
- increase in goal-directed activity/psychomotor agitation
- engaging in risky activities
77
Bipolar I disorder
- distinguished from MDD by presence of manic episode
- can be pure or mixed (symptoms of both manic and depressive episodes for at least 1 week -- intermixed or alternating rapidly)
- periods of depression don't need to meet DSM criteria of MDD for bipolar I diagnosis
- on average ppl w bipolar will spend 32% of life in depressive episode, 9% in manic episode, and don't meet diagnostic criteria rest of time
78
Bipolar II disorder
- clear-cut hypomanic (manic episodes of less severity) and major depressive episodes
- recurrences can be seasonal (bipolar disorder w seasonal pattern)
- periods of depressed mood meet criteria for MDD
79
Genetic influences on bipolar disorders
- genes account for 80-90% of variance in liability to develop bipolar I (probably most genetically determined disorder)
- efforts to locate specific gene not super successful (probably polygenic)
80
Neurochemical factors in bipolar disorders
- mania: increased dopamine (lot of drugs that increase dopaminergic activity ie cocaine and speed create mania-like symptoms)
- depressive and manic episodes: low serotonin activity
81
Hormonal regulatory systems and bipolar disorders
- cortisol (gets us ready to do stuff ie in fight or flight) elevated in bipolar depression (not manic episodes)
- many bipolar patients have abnormalities in functioning of hypothalamic-pituitary-thyroid axis
- thyroid hormone can precipitate manic episodes in patients w bipolar
- low activity of thyroid can mimic symptoms of depression, increased activity can mimic symptoms of mania
82
Neurophysiological and neuroanatomical influences (NOT TESTED)
- blood flow in left PFC reduced in depression, increased in other parts of PFC during mania
- basal ganglia and amygdala enlarged in bipolar but reduced in unipolar depression
83
Sleep and biological rhythms in bipolar disorder
- in manic episodes often engage in very little sleep; often hypersomnia in depressive episodes
84
Psychological causal factors of bipolar
- stressful life events can activate underlying vulnerability
- low social support = more depressive recurrences
- neuroticism associated w symptoms of depression and mania
85
Cross-cultural differences in mood disorders
- North America: more psychological symptoms of depression (guilt, suicidal ideation)
- not prominently reported in non-Western cultures (physiological aspects more prominent)
86
Pharmacotherapy and bipolar disorders
- 1950s: monoamine oxidase inhibitors (MAOIs) are first category of antidepressants (many side effects; involved not eating dairy or alcohol bc you could die)
- 1960s-90s: tricyclic antidepressants (TCAs); also anxiolytic effects; not super specific, affected norepinephrine system to created more side effects than treated symptoms (ex helps sleep so much its hard to get up in the morning)
- side effects of TCAs led to prescribing of SSRIs
87
Course of treatments with antidepressant drugs
- block reuptake of serotonin as soon as you start taking
- antidepressant effects only take hold 3-5 weeks later
- suggested that antidepressants don't change absolute level of neurotransmitters, but change how system is functioning
- 50% of patients don't respond to first drug prescribed
- discontinuing drug when symptoms have remitted can cause relapse
- biggest impact on highest levels of severity; not much difference between drug and placebo at lower levels
88
Lithium and mood stabilizing drugs
- lithium widely studied to treat manic episodes (therapeutic window just below toxicity levels for drug)
- anticonvulsants often effective in those who don't respond well to lithium
89
Electroconvulsive therapy (ECT)
- invented to try to cure schizophrenia
- often used in patients who are severely depressed and are at immediate suicidal risk
- common side effects: confusion, period of amnesia, slowed response time
- might just feel better bc you forget what made you depressed
90
Transcranial magnetic stimulation
- treatment for depression
- sends magnetic pulses into brain, depolarizes nerve cells where pulse goes
- soma data suggests that it can be as or more effective than antidepressants (but not often used as first line of treatment)
- 30-60minute sessions every day (so less desirable bc more costly)
91
Deep brain stimulation
- electrodes implanted into brain to stimulate area w electrical current
- used for individuals who don't respond to other treatments
92
Bright light therapy
- originally used in treatment of SAD
- now shown to be effective in depression without seasonal pattern
93
Cognitive behavioral therapy and depression
- most use psychological intervention
- try to change nature of thoughts contributing to depression
- less likely to relapse after treatment vs taking meds
- mindfulness-based cognitive therapy used in highly recurrent depression, works on learning to accept negative thoughts/feelings/sensations as just thoughts and not reality (could be useful for ppl w bipolar between episodes!)
94
Behavioral activation treatment
- textbook says it's new but it's not (acc. same time as CBT)
- goals are to increase positive reinforcement and to reduce avoidance and withdrawal (set goals with clients and work on giving them experiences of achievement)
- can be used by non mental health professionals!
95
Interpersonal Therapy (IPT)
- as effective as CBT but not as studied/available
- short-term psychodynamic based therapy intervention
- focus on current relationship issues, try to help person understand and change maladaptive interaction patterns
96
Family and Marital Therapy
- as effective as cognitive therapy in reducing unipolar depression in a depressed spouse
97
Even without therapy, the great majority of ppl w mania and depression...
recover from a given episode in less than a year
98
Suicide
- intentional taking of one's life
- depression most commonly linked to suicidal behavior (but risk increases for any mental health disorder)
- belief-based, distress-based
- not same as nonsuicidal self-injury (NSSI) -- motivation is not to end their life
- bipolar might be at increased risk bc they are more likely to act on impulse
- high rates in Russia, medium in north america
- psychiatrists more at risk for suicide
99
Suicide accounts for ____% of all deaths worldwide
1.4% (more deaths by suicide than wars/murder/IPV combined)
100
Prevalence of suicidal thoughts and attempts (U.S.)
- 15% experience suicidal thoughts in lifetime
- 5% have made a nonlethal attempt (1/3)
- risk of transitioning from suicidal thoughts to an attempt is highest in first year
101
Differences in suicide attempts and deaths
- underreporting of suicidal deaths in some cultures where it is taboo
- women more likely to think ab suicide and make nonlethal attempts
- men 4x more likely to die by suicide
- increase in suicidal thoughts starts at 12 until mid 20s
- suicide rate for white men in US shows dramatic increase at age 75
- higher risk if depressed, even higher if 2 comorbid disorders
102
Suicide methods in men (in order)
- firearms
- hanging
- asphyxiation or suffocation
- jumping
- moving objects
- sharp objects
- vehicle exhaust gas
103
Suicide methods in women (in order)
- self-poisoning (more time for others to intervene probably plays role in lower rate of deaths; women don't want to leave a mess for others when they die)
- exsanguination (bleeding out from cut)
- drowning
- hanging
- firearms
104
Suicide and the trans community (U.S. 2015)
- 40% of trans adults have attempted suicide
- 50% of trans men reported suicide attempt in last year
- 42% or NB teens reported self-harm in previous year
105
Risk factors of suicide
- any psychological disorders (esp. comorbidity)
- strong implicit association between self and death (IAT)
- background of child maltreatment and family instability
- concordance rate much higher in MZ twins
106
Joiner's Interpersonal-Psychological Model of Suicide
- perceived burdensomeness and thwarted belongingness (don't feel like you truly belong) interact to produce suicidal thoughts
- only if person also has acquired capability for suicide will they have the desire/ability to make a lethal attempt
107
Suicide prevention
- treating depression leads to reduction in suicidal thoughts
- in antidepressants there is an increased risk of suicide in first few weeks (esp. in teens)
- crisis intervention
- focus on high-risk groups (those who have already attempted) for 'suicidal inoculation' (cognitive therapy)
108
Crisis Intervention
- most widely used type of intervention for suicide prev.
- call lines
- goal is maintaining supportive contact w person, help them realize that acute stress is impairing ability to assess situation accurately, help them realize that present distress will not be endless
- not much difference in suicide rates in areas that have crisis lines
