Chapter 7

Question 1

What were mood disorders formerly called?

Answer 1

Affective disorders

Question 2

Mood disorders

Answer 2

Disturbances of mood that are intense and persistent enough to lead to serious problems in relationships and work performance. They are diverse in nature. In all mood disorders, extremes of emotion or affect, soaring elation or deep depression, dominate the clinical picture. Other symptoms are also present but abnormal mood is the defining feature. The two key moods involved in mood disorders are depression and mania. Normal mood states can occur between both types of episodes. Sometimes a person may have symptoms of mania and depression during the same time.

Question 3

Depression in the mood disorders

Answer 3

Involves feelings of extraordinary sadness and rejection

Question 4

Mania in mood disorders

Answer 4

Characterized by intense and unrealistic feelings of excitement and euphoria

Question 5

Mixed episode cases of mood disorders

Answer 5

Sometimes an individual may have symptoms of mania and depression during the same time. The person experiences rapidly alternating moods such as sadness, euphoria, and irritability, all within the same episode of illness

Question 6

Types of mood disorders

Answer 6

Unipolar depressive disorders
Bipolar and related disorders

Question 7

Unipolar depressive disorders

Answer 7

In which a person experiences only depressive episodes

Question 8

Bipolar and related disorders

Answer 8

In which a person experiences both depressive and manic episodes

Question 9

Depressive episode

Answer 9

Involved in The most common form of a mood disturbance. Where a person is markedly depressed or loses interest in formally pleasurable activities or both for at least two weeks, as well as other symptoms such as changes in sleep or appetite or feelings of worthlessness

Question 10

Manic episode

Answer 10

The other primary kind of mood episode. Where a person shows a marketly elevated, euphoric or expensive mood, often interrupted by occasional outbursts of intense ear debility or even violence; particularly when others refuse to go along with the manic persons wishes and schemes. These extreme moods must persist for at least a week for this diagnosis to be made. Also three or more additional symptoms must occur in the same time period, ranging from behavioural symptoms such as notable increase in goal directed activity, to mental symptoms where self-esteem becomes grossly inflated and mental activity may speed up, to physical symptoms such as decreased need for sleep

Question 11

Hypomanic episode

Answer 11

A milder form of a manic episode. Where a person experiences abnormally elevated, expansive or irritable mood for at least four days. Also the person must have at least three other symptoms similar to those involved in mania but to a lesser degree: inflated self-esteem, decreased need for sleep, flights of ideas, pressured speech etc. There is much less impairment in social and occupational functioning in hypomania and hospitalization is not required

Question 12

DSM five criteria for major depressive disorder

Answer 12

A. Five or more of the following symptoms have been present during the same two week period and represent a change from previous functioning; at least one of the symptoms as either depressed mood or loss of interest or pleasure:
1. Depressed mood most of the day, nearly every day, as indicated by either subjective report or observation made by others
2. Markedly diminished interest or pleasure in all or almost all activities most of the day, nearly every day
3. Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day
4. Insomnia or hypersomnia nearly every day
5. Psycho motor agitation or retardation nearly every day
6. Fatigue or loss of energy nearly every day
7. Feelings of worthlessness or excessive or inappropriate guilt nearly every day
8. Diminished ability to think or concentrate or indecisiveness nearly every day
9. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan

B. The symptoms caused clinically significant distress or impairment in social, occupational or other important areas a functioning

C. The episode is not attributable to the physiological effects of a substance or another medical condition

D. The occurrence of the major depressive episode is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder or other specified or unspecified schizophrenia spectrum or other psychotic disorders

E. There has never been a manic episode or a hypomanic episode

Question 13

Major depressive disorder symptoms and responses to a significant loss

Answer 13

Responses to a significant loss may include the feelings of intense sadness, rumination about the loss, insomnia, poor appetite, and weight loss which may resemble a depressive episode. Although such symptoms may be understandable or considered appropriate to the loss, the presence of a major depressive episode in addition to the normal responses to a significant loss should also be carefully considered. This decision inevitably requires the exercise of clinical judgement based on the individuals history and the cultural norms for the expression of distress in the context of loss

Question 14

Prevalence of mood disorders: Unipolar Major depression

Answer 14

Mood disorders occur at least 15 to 20 times more frequently than schizophrenia and at almost the same rate as all anxiety disorders it taken together. Major depressive disorder is the most common and its occurrence has increased in recent decades. The lifetime prevalence rates of unipolar major depression are 17%, with 12 months prevalence rates nearly 7%. Worldwide mood disorders are the second most prevalent type of disorder following anxiety disorders with a 12 month prevalence ranging from 1 to 10% across different countries.

Question 15

Gender differences in unipolar major depression

Answer 15

Rates for unipolar major depression are higher for women than for men, usually about two to one, Similar to sex differences for most anxiety disorders. These differences occur in most countries around the world. In the US, this sex difference starts in adolescence and continues until about age 65, when it seems to disappear. Get among school children, boys are equally likely or slightly more likely to be diagnosed with depression

Question 16

Prevalence rates of bipolar disorder

Answer 16

The lifetime risk of developing the classic form of this disorder is about 1% and there is no discernable difference in the prevalence rates between sexes.

Question 17

Race differences of mood disorders in US residents

Answer 17

Mood disorders occur less frequently among African-Americans then among European white Americans and Hispanics, whose rates are comparable. Native Americans have significantly elevated rates compared to white Americans. There are no significant differences among such groups for bipolar disorder

Question 18

DSM five criteria for manic episode

Answer 18

A. 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 one week and present most of the day, nearly every day

B. During the period of mood disturbance and increased energy or activity, three or more of the following symptoms (four if mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior:
1. Inflated self-esteem or grandiosity
2. Decreased need for sleep
3. More talkative than usual or pressure to keep talking
4. Flight of ideas or subjective experiences that thoughts are racing
5. Distractibility, as reported or observed
6. Increase in goal directed activity or psycho motor agitation
7. Excessive involvement in activities that have a high potential for painful consequences

C. The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or two necessitate hospitalization to prevent harm to self or others, or there are psychotic features

D. The episode is not attributable to the physiological effects of a substance or to another medical condition

Question 19

Manic episodes that emerged during anti-depressant treatment

Answer 19

A full manic episode that emerges during antidepressant treatment but persists at a fully syndromal multilevel beyond the physiological effect of that treatment is sufficient evidence for a manic episode and therefore a bipolar one diagnosis

Question 20

Rates of unipolar depression and a Socio economic status

Answer 20

Rates of unipolar depression are inversely related to Socio economic status; higher rates occur and lower socioeconomic groups. This may be because low socioeconomic status leads to adversity and life stress. However in spite of earlier indications that rates of bipolar disorder are elevated among those in a higher socio economic groups, current evidence from a carefully controlled studies has not found bipolar disorder to be related to Socio economic class

Question 21

Mood disorders and individuals who have high levels of accomplishment in the arts

Answer 21

A good deal of evidence has shown that both unipolar and bipolar disorder, but especially bipolar disorder, occur with alarming frequency in poets, writers, composers and artists. For a number of such famous creative individuals, their periods of productivity co-vary with the manic or hypo manic, and depressive phases of their illnesses. One possible hypothesis to explain this relationship is that mania or hypomania actually facilitates the creative process or that the intense negative emotional experiences of depression provide material for creative activity. A study of eminent poet Emily Dickinson provides support for the latter part of this hypothesis; evidence supports the idea that Dickinsons painful experiences with panic disorder and depression provided ideas for her work during those times. Also her hypo manic symptoms increased her motivation and output but not her creativity per se

Question 22

Normal depression

Answer 22

Mild and brief depression may actually be normal and adaptive in the long run. By slowing us down, mild depression sometimes saves us from wasting a lot of energy in the futile pursuit of unattainable goals. Usually normal depressions would be expected to occur in people undergoing painful but common life events such as significant personal, interpersonal or economic losses

Question 23

What does the diagnostic criteria for major depressive disorder require?

Answer 23

It requires that a person must be in a major depressive episode and never have had a manic, hypo manic or mixed episode

Question 24

Depression and anxiety

Answer 24

Few depressions, including milder ones, occur in the absence of significant anxiety. There is a high degree of overlap between measures of depressive and anxious symptoms in self reports and clinician ratings. There are very high levels of comorbidity between depressive and anxiety disorders. The issues surrounding the cooccurrence of depression and anxiety have received a great deal of attention in recent years and are very complex

Question 25

How long do depressive episodes last?

Answer 25

Depressive episodes typically last about 6 to 9 months if untreated. In approximately 10 to 20% of people with depression, the symptoms do not permit for over two years, in which case persistent depressive disorder is diagnosed. Chronic major depression has been associated with serious childhood family problems and an anxious personality in childhood

Question 26

Persistent depressive disorder

Answer 26

When symptoms of major depressive disorder do not remit for over two years

Question 27

When are depressive episodes said to remit?

Answer 27

When symptoms have largely been gone for at least two months

Question 28

Return of depressive symptoms

Answer 28

The most depressive episodes remit, depressive episodes often return at some future point. This return of symptoms is of one of two types: relapse and recurrence

Question 29

Relapse

Answer 29

Refers to the return of symptoms within a fairly short period of time, a situation that probably reflects the lack of the underlying episode of depression has not yet run its course. For example relapse may commonly occur when pharmacotherapy is terminated prematurely; after symptoms have remitted but before the underlying episode is really over

Question 30

Recurrence

Answer 30

Refers to the onset of a new episode of depression, occurs in approximately 40 to 50% of people who experience a depressive episode. The probability of recurrence increases with the number of prior episodes and also when the person has comorbid disorders. People who experience multiple depressive episodes often are not symptom free in between episodes, but instead have some depressive symptoms half to 2/3 of the time. People with some residual symptoms or with significant psychosocial impairment following an initial depressive episode are more likely to have recurrences than those whose symptoms remit completely

Question 31

When does the onset of unipolar depressive disorders most often occur?

Answer 31

During late adolescence up to middle adulthood, however reactions may begin at any time from early childhood to old age

Question 32

Depression in school age children

Answer 32

Recent research has estimated that about 1 to 3% of school-age children meet the criteria for some form of unipolar depressive disorder, with a smaller percentage exhibiting dysthymic disorder than major depression. Recurrence rates are high in children

Question 33

Incidence of Depression in adolescence

Answer 33

Incidence of depression rises sharply during adolescence; a period of great turmoil for many people. Approximately 15 to 20% of adolescence experienced major depressive disorder at some point, and sub clinical levels of depression affect a further 10 to 20%. Sex differences in rates of depression first emerge during this time. The long-term effects of major depressive disorder in adolescence can last at least through young adulthood, when such individuals show small but significant psychosocial impairments in many domains, including their occupational lives, interpersonal relationships and general quality of life. Major depression that occurs in adolescence is very likely to occur in adulthood

Question 34

Incidence of depression in later life

Answer 34

Though the prevalence of major depression is significantly lower and people over age 65 than younger adults, depression and older adults is still considered a major public health problem. Depression and later life can be difficult to diagnose because many of the symptoms overlap with those of several medical illnesses and dementia. It is important to try and diagnose it reliably because depression in later life has many adverse consequences for a persons health, including doubling the risk of death and people who have had a heart attack or stroke

Question 35

Specifiers for major depressive episodes

Answer 35

Some individuals who meet the basic criteria for diagnosis of a major depressive episode also have additional patterns of symptoms or features that are important to note when making a diagnosis because these patterns have implications for understanding more about the course of the disorder and it’s most effective treatment. These different patterns of symptoms or features are called specifies in the DSM five

Question 36

Types of specifiers of major depressive episodes (5)

Answer 36

With melancholic features
With psychotic features
With atypical features
With catatonic features
With seasonal pattern

Question 37

Specifiers of major depressive episodes: with melancholic features

Answer 37

Three of the following: early morning awakening, depression worse in the morning, marked psycho motor agitation or retardation, loss of appetite or weight, excessive guilt, qualitatively different depressed mood

Question 38

Specifiers of major depressive episodes: with psychotic features

Answer 38

Delusions or hallucinations, usually mood congruent; feelings of guilt and worthlessness common. Individuals who are psychotically depressed are likely to have longer episodes, more cognitive impairment, and a poor long-term prognosis than those suffering from depression without psychotic features, and any recurrent episodes are also likely to be characterized by psychotic symptoms. Treatment generally involves an antipsychotic medication as well as an anti-depressant

Question 39

Specifiers of major depressive episodes: with atypical features

Answer 39

Mood reactivity - brightens to positive events; two of the four following symptoms: weight gain or increase in appetite, hypersomnia, leaden paralysis (arms and legs feel as heavy as lead), being acutely sensitive to Interpersonal rejection. A disproportionate number of individuals with atypical features are females, who have an earlier than average age of onset and two are more likely to show suicidal thoughts. Atypical depression is linked to a mild form of bipolar disorder that is associated with hypommenc rather than manic episodes. There are indications that individuals with atypical features may preferentially respond to a different class of anti-depressants, the monoamine oxidase inhibitors, then do most other individuals with depression

Question 40

Specifiers of major depressive episodes: with catatonic features

Answer 40

A range of psycho motor symptoms from motoric immobility to extensive psycho motor activity, as well as mutism and rigidity. Catatonia is known more as a sub type of schizophrenia, but is actually more frequently associated with certain forms of depression and mania than with schizophrenia 

Question 41

Specifiers of major depressive episode: with seasonal pattern

Answer 41

At least two or more episodes in past two years that have occurred at the same time, usually fall or winter, and full remission at the same time, usually spring. No other non-seasonal episodes in the same two year. prevalence rates suggest that winter seasonal affective disorder is more common in people living at higher latitudes and in younger people

Question 42

When delusions or hallucinations present are mood congruent

Answer 42

They seem in some sense appropriate to serious depression because the content is negative and tone, such as themes of personal inadequacy, guilt, deserved punishment, death or disease.

Question 43

Persistent depressive disorder

Answer 43

Formerly called dysthymic disorder or dysthymia. A disorder characterized by persistently depressed mood most of the day, for more days than not, for at least two years (One year for children and adolescents).  individuals must have at least two of the six additional symptoms when depressed. Periods of normal mood may occur briefly but they usually last for only a few days to a few weeks and for a maximum of two months. These intermittently normal moods are one of the most important characteristics distinguishing persistent depressive disorder from major depressive disorder. In spite of the intermittently normal moods, because if it’s chronic course people with persistent depressive disorder show poor outcomes and as much impairment as those with major depressive disorder

Question 44

Double depression

Answer 44

When persistent depressive disorder occurs in the same person at the same time as major depressive disorder. Moderately depressed on a chronic basis, meeting symptom criteria for persistent depressive disorder, but undergo increased problems from time to time, during which they also meet criteria for a major depressive episode. Although nearly all individuals with double depression appear to recover from their major depressive episodes, reoccurrence is common. In DSM-V, double depression is classified as a form of persistent depressive disorder disorder

Question 45

Prevalence of persistent depressive disorder

Answer 45

The lifetime prevalence is estimated at between 2.5 and 6%. The average duration of persistent depressive disorder is 4 to 5 years but it can last for 20 years or more.

Question 46

Stress and persistent depressive disorder

Answer 46

Chronic stress has been shown to increase the severity of symptoms over a 7.5 year follow-up.

Question 47

Age of onset of persistent depressive disorder

Answer 47

Persistent depressive disorder often begins during adolescence and over 50% of those who present for treatment have had an onset before age 21. In a study of 97 individuals with early onset persistent depressive disorder, it was found that 74% recovered within 10 years but that, among those who recovered, 71% relapsed, with most relapses occurring within approximately three years of follow up

Question 48

DSM-V criteria for persistent depressive disorder

Answer 48

A. 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 two years

B. Presence, well depressed of two or more of the following:
1. Poor appetite or over eating
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 the two-year period of the disturbance, the individual has never been without the symptoms in criteria a and B for more than two months at a time

D. Criteria for a major depressive disorder maybe continuously present for two years

E. There has never been a manic episode or a hypomanic episode, and criteria have never been met for cyclothymic disorder

F. The disturbance is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum or other psychotic disorder

G. The symptoms are not attributable to the physiological effects of a substance or another medical condition

H. The symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning

Question 49

Four phases of normal response to the loss of a spouse or close family member

Answer 49

1. Numbing and disbelief
2. Yearning and searching for the dead person
3. Disorganization and despair that sets in when the person excepts the loss as permanent
4. Some re-organization as the person gradually begins to build his or her life

Question 50

Bereavement and the DSM five

Answer 50

The normal nature of exhibiting a certain number of grief symptoms led DSM four to suggest that a major depressive disorder usually should not be diagnosed for the first two months following the loss, even if all the symptom criteria are met. However in a controversial move, this two month bereavement exclusion was dropped in DSM five

Question 51

Why it was bereavement exclusion removed from the DSM five

Answer 51

The issue was raised on whether it was justifiable to consider depression in response to the loss of a loved one is normal and depression in response to other losses as a form of mental disorder. It was found that bereavement triggered depression and depression triggered by other forms of loss were very similar on eight of nine symptoms in depression. There was therefore no evidence to support granting bereavement special status. However instead of expanding the bereavement exclusion to include other forms of loss, it was removed completely.

Question 52

What are the issues with removing the bereavement exclusion in the DSM five

Answer 52

Dropping the bereavement exclusion may now create the risk that a normal grief reaction becomes misdiagnosed as a major depressive episode leading to unnecessary treatment, stigmatization or other negative consequences. On the other hand, the assumption that any depressive response to the loss of a loved one is normal could lead to delays in receiving needed treatment.

Question 53

A finding in support of keeping the bereavement criterion as it was in the DSM four

Answer 53

People who experience symptoms of major depression following death of a loved one or not at elevated risk for a recurrence of later major depression the way people who have major depressive episodes under other conditions are, so they may indeed be a special group

Question 54

Loss not followed by depression

Answer 54

Not all loss is followed by depression. 50% of people who have experienced the loss of a spouse, life partner or parent exhibit genuine resilience in the face of loss, with minimal, very short-lived symptoms of depression or bereavement. These resilient individuals are not emotionally maladjusted or unattached to their spouses

Question 55

Postpartum blues

Answer 55

In the past it was believed that postpartum major depression and mothers was relatively common, but more recent evidence suggests that only postpartum blues are very common. The symptoms of postpartum blues typically include changeable mood, crying easily, sadness and irritability, often liberally intermixed with happy feelings. These symptoms occur and as many as 50 to 70% of women within 10 days of the birth of their child and usually subside on their own. Hypomanic symptoms are also frequently observed, intermixed with more depression like symptoms

Question 56

Premenstrual dysphoric disorder

Answer 56

A new disorder added to the depressive disorders category in DSM five. This disorder is diagnosed if a woman has had a certain set of symptoms in the majority of her menstrual cycles for the past year. In particular she must have at least one of four symptoms in the final week before the onset of menses these symptoms must start to improve within a few days after the onset of menses, and become minimal or absent in the week post menses. This is one form of depression or hormones play an important role

Question 57

Symptoms of premenstrual dysphoric disorder

Answer 57

Four symptoms which must occur include:
1. Marked effective lability such as mood swings
2. Marked irritability or anger or increased interpersonal conflict
3. Marked depressed mood or feelings of hopelessness or self deprecating thoughts
4. March anxiety, tension or feelings of being keyed up or on edge

Seven other symptoms are listed and a total of five symptoms it must be experienced. These other symptoms include:
1. Decreased interest usual activities
2. Subjective sense of difficulties in concentration
3. Lethargic, easy fatigability, or lack of energy
4.  marked changes in appetite or over eating
5. Hypersomnia or insomnia
6. A sense of being overwhelmed or out of control
7. Physical symptoms such as breast tenderness or swelling, a sense of bloating, weight gain etc.

Question 58

Prevalence of major depression in women during the postpartum period.

Answer 58

It appears that major depression in women occurs no more frequently in the postpartum period than would be expected in women of the same age and socioeconomic status who have not just given birth. The ones firmly held a notion that women are especially high risk for major depression in the postpartum period has not been upheld. There is however a greater likelihood of developing a major depression after the postpartum blues, especially if they are severe

Question 59

Reasons that contribute to the development of postpartum blues and depression

Answer 59

Hormonal readjustment and alterations in serotonergic and noradrenergic functioning may play a role in postpartum blues and depressions, so the evidence is mixed. A psychological component is present as well. postpartum blues or depression may be especially likely to occur if the new mother has lack of social support or has a difficulty in adjusting to her new identity and responsibilities, or if the woman has a personal or family history of depression that leads to heightened sensitivity to the stress of childbirth

Question 60

Hippocrates theory of depression

Answer 60

Hippocrates theorized that depression was caused by an excess of black bile in the system.

Question 61

Genetic influences of depression: Prevalence

Answer 61

Family studies have shown that the prevalence of mood disorders is approximately 2 to 3 times higher among blood relatives of people with clinically diagnosed unipolar depression than it is in the population at large. Twin studies also suggest a moderate genetic contribution to major depressive disorder. Monozygotic Co-twins of a twin with MDD are about twice as likely to develop the disorder as our dizygotic co-twins, with about 31 to 42% of the variance in liability due to genetic influences. The estimate is higher for more severe early onset or recurrent depressions.

Question 62

Genetic contribution to depression

Answer 62

The results from family and twin studies make a strong case for a moderate genetic contribution to the causal patterns of MDD, although not as large a genetic contribution has for bipolar disorder. The evidence for a genetic contribution to persistent depressive disorder is slim because there has been very little research done.

Question 63

Identifying genes responsible for genetic influences leading to MDD

Answer 63

Attempts to identify specific genes have not yet been successful, although there are some promising leads. One candidate for a specific gene that might be implicated is the serotonin transporter gene.

Question 64

Serotonin transporter Gene & MDD

Answer 64

This gene is involved in the transmission and reuptake of serotonin. Two different kinds of versions or alleles are involved: the short allele (s) and the long allele (l). People either have two short alleles, S/S, too long alleles, L/L, or one of each, S/L. Having SS alleles might predispose a person to depression relative to a person having LL alleles. 

Question 65

2003 study on genotype environment interaction between alleles of the serotonin transporter gene and MDD

Answer 65

A study in 2003 tested for the possibility of a genotype environment interaction involving these two alleles of the serotonin transporter gene. The results were: individuals who possessed the genotype with the SS alleles were twice as likely to develop a major depressive episode following four or more stressful life events in the past five years as those who possessed the genotype with the LL alleles and had experienced four or more stressful events. They also found that those who had the SS alleles and had experienced severe maltreatment as children were also twice as likely to develop a major depressive episode as those with the LL alleles who had had severe maltreatment and also as compared to those with the SS alleles who had not been maltreated as children. These findings support a diathesis stress model. Studies have found similar results for a genotype environment interaction between the alleles of these this gene. The gene environment result is robust if the studies use it sensitive interview-based measures of life stress. This also suggests that the search for candidate genes likely involved in major depression is likely to be much more fruitful if research also test for genotype environment interactions Beyond examining the effects of a genotype itself

Question 66

Monoamine theory of depression

Answer 66

Hey Siri that depression was at least sometimes due to an absolute or relative depletion of one or both of these neural transmitters at important receptor sites in the brain. These neurotransmitters are of the Monoamine class, norepinephrine and serotonin. This depletion could come about through impaired synthesis of these neurotransmitters in the presynaptic neuron, through increased degradation of the neural transmitters once they were released into the synapse, or through altered functioning of postsynaptic receptors. These neurotransmitters are now known to be involved in the regulation of behavioural activity, stress, emotional expression, and vegetative functions: all of which are disturbed in mood disorders

Question 67

Why was the monoamine theory of depression debunked in the 1980s?

Answer 67

By the 1980s it was clear that no such straightforward mechanisms could possibly be responsible for causing depression. Some studies found the opposite of what was predicted by the monoamines hypothesis, especially in those with severe or melancholic depression. Also only a minority of patients with depression have lowered serotonin activity, and these tend to be patients with high levels of suicidal ideation and behavior. Also even though the immediate short-term effects of antidepressant drugs are to increase the availability of norepinephrine and serotonin, the long-term clinical effects of these drugs do not emerge until 2 to 4 weeks later, when neurotransmitter levels may have normalized

Question 68

What neurotransmitter is suggested to play a role in depression in more recent research

Answer 68

Dopamine. More recent research suggests that dopamine disfunction plays a significant role in at least some forms of depression, including depression with atypical features and bipolar depression. Because dopamine is so prominently involved in the experience of pleasure and reward, such findings are in keeping with the prominence of anhedonia, the inability to experience pleasure, which is such an important symptom of depression

Question 69

Anhedonia

Answer 69

The inability to experience pleasure

Question 70

Which theory replaced the early Monoamine theory of depression?

Answer 70

The early Monoamine theory has not been replaced by a compelling alternative. Altered neural transmitter activity in several systems is clearly associated with major depression, but research for the past 20 to 25 years has focussed on complex interactions of neurotransmitters. A number of integrative theories have been proposed that include a role for neurotransmitters, not alone but rather as they interact with other disturbed hormonal and general physiological patterns and biological rhythms

Question 71

Hypothalamic pituitary adrenal HPA axis

Answer 71

Majority of attention in the study of mode disorders has been focussed on this axis, in particular the hormone cortisol, which is excreted by the outermost portion of the adrenal glands and is regulated through a complex feedback loop. The human stress response is associated with elevated activity of the HPA axis, which is partly controlled by norepinephrine and serotonin. The perception of stress or threat can lead to norepinephrine activity in the hypothalamus, causing the release of corticotropin releasing hormone, CRH, from the hypothalamus, which intern triggers the release of adrenocorticotropic hormone, ACTH, from the pituitary. AC TH then travels through the blood to the adrenal cortex of the adrenal glands were cortisol is released.

Question 72

Cortisol activity

Answer 72

Elevated cortisol activity is a highly adaptive in the short term because it promotes survival in response to life-threatening or overwhelming life circumstances. But sustained elevations are harmful to the organism, including promoting hypertension, heart disease, and obesity, all of which are elevated in depression. Sustained elevations of cortisol can result from increased CRH activation, increased secretion of ACTH, or the failure of feedback mechanisms

Question 73

Cortisol and depression

Answer 73

Blood plasma levels of cortisol are known to be elevated in some 20 to 40% of outpatients with depression and in about 60 to 80% of hospitalized patients with severe depression.

Question 74

Failure of feedback mechanisms and depression

Answer 74

A line of evidence that indicates the failure of feedback mechanisms in some patients with depression comes from findings that in about 45% of patients with serious depression, dexamethasone, a potent suppressor of plasma cortisol in normal individuals, either fails entirely to suppress cortisol or fails to sustain its suppression. This means that the HPA access is not operating properly.

Question 75

Dexamethasone non-suppressor patients

Answer 75

It was initially thought that dexamethasone non-suppressor patients constituted a distinct sub group of people with severe or melancholic depression. But subsequent research has shown that several other groups of psychiatric patients, such as those with panic disorder, also exhibit high rates of non-suppression, suggesting that non-suppression may merely be a nonspecific indicator of generalized mental distress

Question 76

Cognitive problems related to elevated cortisol

Answer 76

Patients having depression with elevated cortisol also show memory impairments and problems with abstract thinking and complex problem-solving. Some of these cognitive problems may be related to other findings showing that prolonged elevations in cortisol result in cell death in the hippocampus.

Question 77

Stress in infancy and early childhood, and the HPA axis

Answer 77

Other research has shown that stress in infancy and early childhood can promote long-term changes that increase the reactivity of the HPA axis which may in turn help explain why children reared in environments with early adversity are at higher risk of developing depression later in life when they are exposed to acute stressors

Question 78

Hypothalamic pituitary thyroid axis And depression

Answer 78

Another endocrine axis that has relevance to depression. People with low thyroid levels often become depressed and approximately 20 to 30% of patients with depression who have normal thyroid levels nevertheless show dysregulation of this axis. Some patients who do not respond to traditional antidepressant treatments show improvement when administered thyrotropin releasing hormone, which leads to increased thyroid hormone levels

Question 79

Depression and the immune system

Answer 79

Many studies have shown that depression is also accompanied by dysregulation of the immune system. Depression is associated with activation of the inflammatory response system as evidenced by increased production of pro inflammatory cytokines such as interleukin and interferon. Both of these can contribute directly to the development of depressive symptoms

Question 80

Depression and brain damage

Answer 80

Research has found that neurological damage for example from a stroke to the left but not the right anterior prefrontal cortex often leads to depression. This led to the idea that depression and people without brain damage may be linked to lower levels of brain activity in this same region. A number of studies support this idea

Question 81

Brain activity In the prefrontal regionsand depression

Answer 81

People with depression show lower activity in the left hemisphere in the prefrontal regions of the brain, and higher activity in the right hemisphere. Patients in remission show the same pattern, as do children at risk for depression. This may be a way to identify people at risk. Left frontal asymmetry in never depressed individuals predicted onset of major and minor depressive episodes over a three-year period. The lower activity on the left side of the prefrontal cortex in depression is thought to be related to symptoms of reduced to positive affect and approach behaviours to rewarding stimuli, and increased right side activity is thought to underlie increased anxiety symptoms and increased negative affect associated with increased vigilance for threatening information

Question 82

Abnormalities in brain areas in patients with depression: orbital prefrontal cortex

Answer 82

Several regions of the prefrontal cortex including the orbital prefrontal cortex, which is involved in responsibility to reward, show decreased volume and individuals with recurrent depression relative to normal controls. Lower levels of activity in the dorsolateral prefrontal cortex, which are associated with decreased cognitive control, have also been observed in individuals with depression compared to controls and seem to normalize following treatment with anti-depressant medication.

Question 83

Abnormalities in brain areas in patients with depression: anterior cingulate cortex

Answer 83

The anterior cingulate cortex shows decreased volume and abnormally low levels of activation in patients with depression. This area is involved in selective attention, which is important in prioritizing the most important information available, and therefore in self-regulation and adaptability

Question 84

Abnormalities in brain areas in patients with depression: amygdala

Answer 84

The amygdala, which is involved in the perception of threat and in directing attention, tends to show increased activation in individuals with depression and anxiety disorders, which may be related to their biased attention to negative emotional information

Question 85

Abnormalities in brain areas in people with depression: hippocampus

Answer 85

The hippocampus is also involved, which is critical to learning and memory and regulation of adrenocorticotropic hormone. Prolonged depression can lead to decreased hippocampal volume. Evidence of decreased hippocampal volume in never depressed individuals at high risk for depression suggests that reductions in hippocampal volume may proceed the onset of depression.

Question 86

Characterization of sleep

Answer 86

Sleep is characterized by five stages that occur in relatively envirended sequence throughout the night: stages one to four of non-REM sleep and REM sleep make up a sleep cycle. The sleep wake cycle is thought to be regulated by the suprachiasmatic nucleus of the hypothalamus.

Question 87

Rem sleep

Answer 87

Rapid eye movement sleep sleep. Characterized by rapid eye movements and dreaming as well as other bodily changes. The first REM period Does not usually begin until near the end of the first sleep cycle, about 75 to 80 minutes into sleep

Question 88

Sleep and depression

Answer 88

People who are depressed often show one or more of a variety of sleep problems, ranging from difficulty falling asleep to periodic awakening during the night to early morning awakening. Such changes occur in about 80% of hospitalized patients with depression and in about 50% of outpatients with depression and are particularly pronounced in patients with melancholic features

Question 89

Depression and rem sleep

Answer 89

Using EEG recordings as found that many patients with depression enter the first period of REM sleep after only 60 minutes or less of sleep, 15 to 20 minutes sooner than non-depressed patients, show greater amounts of REM sleep during the early cycles and have more intense and frequent rapid eye movements. Most Deep Sleep occurs during stages three and four, and people with depression also appear to get a lower the normal amount of deep sleep. Both the reduced latency to enter REM sleep and the decreased amount of deep sleep often preceded the onset of depression and persist following recovery, which suggests that they may be vulnerability markers for certain forms of major depression

Question 90

Circadian rhythms

Answer 90

Humans have many circadian cycles that the body uses to respond to the changing environment. These circadian rhythms are controlled by two related central oscillators, which act as internal biological clocks

Question 91

Circadian rhythms and depression

Answer 91

Researchers found some abnormalities in these rhythms in patients with depression including drastic changes in mood, sleep, appetite and social interactions. The more research is needed to figure out exactly how circadian rhythm abnormalities might contribute to the symptoms of depression, it is clear that circadian rhythms, the human stress response and disorders such as depression are closely related

Question 92

Seasonal affective disorder

Answer 92

A different kind of rhythm abnormality or disturbance, in which most of those affected seemed to be responsive to the total quantity of available light in the environment. Most people with the disorder become depressed in the fall or winter and normalize in the spring and summer. Many seasonal variations in basic functions such as sleep, activity and appetite are related to the amount of light in a day. Research supports the therapeutic use of controlled exposure to light, even artificial light, which may work by establishing normal biological rhythms. Anti-depressant medication‘s may also be useful but the use of light therapy is more cost-effective in the long term

Question 93

Biological explanations for sex differences in people with depression

Answer 93

It has been suggested that hormonal factors such as normal fluctuations in ovarian hormones account for sex differences in depression. But studies examining this hypothesis have yielded inconsistent results and are not very supportive. It seems for the majority of women, hormonal changes occurring at various points do not play a significant role in causing depression. But it remains possible that there is a causal association that has not yet been discovered. Also for a small minority of women who are already at risk, hormonal fluctuations may trigger depressive episodes, possibly by causing changes in the normal processes that regulate neurotransmitter systems. Some studies have suggested that women have a greater genetic vulnerability to depression than men but many other studies have not supported this idea

Question 94

Stressful life events as causal factors for depression

Answer 94

Many studies have shown that severely stressful life events often served as a precipitating factors for unipolar depression. This is especially true for young female adults for him stressful life events are more likely to show a stronger stress depression relationship that is the case for men.

Question 95

What type of episodic stressful life events me precipitate depression

Answer 95

Loss of a loved one, serious threats to important close relationships or to one’s occupation, or severe economic or serious health problems. The stress of being a caregiver to a spouse with a debilitating disease such as Alzheimer’s is also known to be associated with the onset of both major depression and generalized anxiety disorder in the caregiver

Question 96

Independent versus dependent life events and depression

Answer 96

Independent life events are stressful life events that are independent of the persons behaviour and personality such as losing a job because one’s company is shutting down or having one‘s house hit by a hurricane. Dependent life events or events that may have been at least partly generated by the depressed persons behaviour or personality. For example people with depression sometimes generate stressful life events through their poor interpersonal problem-solving such as being unable to resolve conflicts with a spouse, which is often associated with depression. another example of a dependent life event is failing to keep up with routine tasks such as paying bills. Evidence to date suggests that dependent life events play an even stronger role in the onset of major depression then do independent life events

Question 97

How cognitive symptoms of depression can change a depressed person’s perceptions of stress

Answer 97

People with depression have a distinctly negative view of themselves in the world around them. That’s their own perceptions of stress may result from the cognitive symptoms of their disorder rather than cause their disorder. Their pessimistic outlook may lead them to evaluate events as stressful that other non-depressed people would not.

Question 98

Measuring life stress in people with depression

Answer 98

Because people with depression have a pessimistic outlook, researchers have developed more sophisticated interview based measures of life stress that do not rely on the depressed persons self report of how stressful an event is and they take into account the biographical context of a persons life. Trained independent readers evaluate what the impact of a particular event would be expected to be for an average person who is experienced this event in these particular life circumstances. The persons subjective evaluation of stress or not recorded or taken into account in the rating of impact. Conclusions derived from using these more sophisticated interview-based techniques are more reliable and valid in predicting depressive episodes

Question 99

Life stress and a causal role in depression

Answer 99

Measurements of life stress suggest that severely stressful episodic life events play a causal role in about 20 to 50% of cases. People with depression who have experienced a stressful life events tend to show more severe depressive symptoms than those who have not experienced a stressful life event. This relationship between severely stressful life events and depression is much stronger and people who are having their first onset then in those undergoing recurrent episodes. About 70% of people with the first onset of depression have had a major stressful life event recently, but only 40% of people with recurrent episode have had a recent major life event

Question 100

Mildly stressful events and depression

Answer 100

It is unclear if mildly stressful events are also associated with the onset of depression, with conflicting findings. Studies have generally not found mine are stressful events to be associated with the onset of clinically significant depression. An interesting hypothesis has been raised that minor events may play more of a role in the onset of recurrent episodes in the initial episode

Question 101

Chronic stress and depression

Answer 101

Studies have demonstrated that chronic stress is associated with increased risk for the onset, maintenance and recurrence of major depression. Chronic stress has been defined in different ways but usually refers to one or more forms of stress ongoing for at least several months

Question 102

Individual differences in how people respond to the experiences of episodic and chronic life stress, and the risk for depression

Answer 102

Women at genetic risk for depression not only experience more stressful life events but also are more sensitive to them. Those it hygienic risk for depression appear to be much more likely to respond to stressful life events with depression than those at low genetic risk

Question 103

Personality diathesis for depression

Answer 103

Neuroticism is the primary personality variable that serves as a vulnerability factor for depression. Eroticism refers to a stable and heritable personality trait that involves a temperamental sensitivity to negative stimuli. People who have high levels of this trait are prone to experiencing a broad range of negative moods. Studies have shown that neuroticism predicts the occurrence of more stressful life events which lead to depression. It is associated with a worse prognosis for complete recovery from depression. Some researchers attribute sex differences in depression to sex differences in neuroticism.
Limited evidence that high levels of introversion may also serve as vulnerability factors for depression, either alone or when combined with neuroticism. Positive affectivity involves a disposition to feel joyful energetic bold proud enthusiastic and confident; people low on this disposition 10 to feel unenthusiastic unenergetic dollar flat and board. This might make them more prone to developing depression of the evidence is mixed

Question 104

Cognitive diathesis for depression

Answer 104

Generally focusses on particular negative patterns of thinking that make people who are prone to depression more likely to become depressed when faced with one or more stressful life events. For example people who attribute negative events to internal, stable and global causes may be more prone to becoming depressed then are people who actually be at the same events to external, unstable and specific causes

Question 105

Early adversity as a diathesis for depression

Answer 105

A range of adversities in the early environment can create a short term and a long-term vulnerability to depression. Such factors operate by increasing an individuals sensitivity to stressful life events in adulthood, with similar findings having been observed in animals. The long-term effects of such early environmental adversities may be mediated by both biological variables and psychological variables. It’s important to realize that certain individuals who have undergone early adversity remain resilient and if the exposure to early adversity is moderate rather than severe, a form of stress inoculation may occur that makes the individual bless susceptible to the effects of later stress. These stress inoculation effects seem to be mediated by strengthening Socio emotional and neuroendocrine resistance to subsequent stressors

Question 106

Psychodynamic theories for depression

Answer 106

Freud noted the important similarity between the symptoms of depression and the symptoms seen in people mourning the loss of a loved one. He hypothesized that when a loved one dies the morning regresses to the oral stage of development and intra-jacks or incorporates the lost person, feeling all the same feelings towards the self as towards the last person. These feelings were thought to include anger and hostility Because Freud thought we unconsciously hold negative feelings towards those we love. This led to the psychodynamic idea that depression is anger turned inward. Freud hypothesized that depression could also occur in response to imagined or symbolic losses. For example failing in school. Later psychodynamic theorists proposed a number of variance on this theory. The most important contribution of the psychodynamic approach is to depression has been there noting the importance of loss to the onset of depression and noting the striking similarities between the symptoms of mourning and the symptoms of depression

Question 107

Behavioural theories for depression

Answer 107

In the 70s and 80s, it was believed in the behavioural tradition that people become depressed either when their responses no longer produce positive reinforcement or when the rate of negative experiences increases. These theories are consistent with research showing that people with depression do indeed receive fewer positive verbal and social reinforcements from families and friends and people who are not depressed and also experience more negative events. also they have lower activity levels and their moods seem to vary with both the positive and negative experiences rates. These theories do not show that depression is caused by these factors and instead it may be that some of the primary symptoms of depression such as pessimism and low levels of energy cause the person with depression to experience lower rates of reinforcement, which intern may help maintain the depression. New research has demonstrated that a novel form of behavioural treatment inspired by these behavioural theories seems to be an effective treatment for depression

Question 108

Beck’s cognitive theory of depression

Answer 108

Since 1967, one of the most influential theories of depression. Back hypothesized that the cognitive symptoms of depression often proceed and cause the effective or mood symptoms rather than vice versa. Certain kinds of early experiences can lead to the formation of dysfunctional assumptions that leave a person vulnerable to depression later in life if certain critical incidents, stressors, activate those assumptions. Once activated, these dysfunctional assumptions trigger automatic thoughts that intern produce depressive symptoms, which further fuelled the depressive automatic thoughts. This is a diathesis stress theory in which negative cognitions are Central. Each of the components of cognitive theory serves to reinforce the others. These negative thoughts can produce some of the other symptoms of depression such as sadness, dejection and lack of motivation

Question 109

Dysfunctional beliefs in Beck’s cognitive theory of depression

Answer 109

Known as Depressogenic schemas. Rigid, extreme and counterproductive. An example is: if everyone doesn’t love me, then my life is worthless. Such a belief would predispose the person holding it to develop depression if they perceived social rejection according to the cognitive theory. These depression producing beliefs or schemas are thought to develop during childhood and adolescence as a function of negative experiences with parents and significant others and I thought to serve as the underlying diathesis or vulnerability to developing depression. They may lie dormant for years in the absence of significant stressors. When activated by current stressors or depressed mood, they tend to fuel the current thinking pattern, creating a pattern of negative automatic thoughts. They tend to centre on the three themes of what back calls the negative cognitive triad

Question 110

Negative automatic thoughts

Answer 110

Thoughts that often occur just below the surface of awareness and involves unpleasant, pessimistic predictions. These pessimistic predictions tend to centre on the three themes of what back calls the negative cognitive triad

Question 111

Becks negative cognitive triad

Answer 111

Include negative thoughts about self, world, and future. Back also postulated that the negative cognitive triad tends to be maintained by a variety of negative cognitive biases or errors. Each of these involves biased processing of negative self relevant information. Examples include:
-Dichotomous or all or nothing reasoning
-Selective abstraction
-Arbitrary inference

Question 112

Dichotomous or all or nothing reasoning

Answer 112

A tendency to think in extremes. For example: if I can’t get 100% right, there’s no point in doing it at all

Question 113

Selective abstraction

Answer 113

Involves a tendency to focus on one negative detail of a situation while ignoring other elements of the situation for example: “I didn’t have a moment of pleasure or fun today”, Not because this is true but because they selectively remember only the negative thoughts that happened

Question 114

Arbitrary inference

Answer 114

Involves jumping to a conclusion based on minimal or no evidence. A depressed person might say: the therapy will never work for me

Question 115

Evaluating Beck’s theory as a descriptive theory

Answer 115

It has been well supported as a descriptive theory that explains many prominent characteristics of depression. Patients with depression of all subtypes are considerably more negative and they’re thinking especially about themselves or issues highly relevant to the self than people who are not depressed, and they are also more negative than they usually are when they are not depressed. People with depression think more negatively about themselves and the world around them, especially their own personal world, then people who are not depressed, and are quite negative about the future especially their own future. People who are not depressed show a tendency to process emotional information in an overly optimistic, self enhancing manner which may serve as a protective factor against depression

Question 116

Beck’s theory about stressors and depression, and more recent research

Answer 116

Beck originally proposed that stressors are necessary to activate depressive schemas or dysfunctional beliefs that lie dormant between episodes, but more recent research has shown that stressors are not necessary to activate these depressive schemas between episodes. Simply inducing a depressed mood in an individual who is previously depressed is generally sufficient to activate latent Depressogenic schemas

Question 117

Evidence for certain cognitive biases for negative self relevant information in depression

Answer 117

For example people with depression show better or biased recall of negative information and negative autobiographical memories, whereas people who are not depressed tend to show biased recall of positive emotional information and positive autobiographical memories. People with depression are more likely than people who are not depressed to draw negative conclusions they go beyond the information presented in a scenario and to underestimate the positive feedback they have received. If one is already depressed, remembering primarily the bad things that of happened is likely to maintain or exacerbate the depression, this is called the vicious cycle of depression

Question 118

Evaluating the causal aspects of Beck’s theory

Answer 118

Research towards confirming the causal hypotheses of Becks theory has yielded more mixed results. The causal hypotheses are usually tested with a prospective study design. People who are not depressed or tested for their cognitive vulnerability, after which measurements of life stress are administered. Only some studies have found that dysfunctional beliefs or attitudes in interaction with stressful life events predict depression. Results of one study indicated that those who had started with high levels of dysfunctional beliefs and who experienced high stress were more likely to develop major depression than those with low stress or those with low dysfunctional beliefs and high stress. Another study found that dysfunctional beliefs predicted new onset and recurrences of major depressive episodes. However this study did not find evidence of a diathesis stress interaction and dysfunctional beliefs did not have additional predictive value beyond that afforded by knowing a prior history of a persons depressive episodes. Marie search is still needed to fully assess the causal aspects of Beck’s cognitive theory of depression

Question 119

The learned helplessness theory of depression

Answer 119

Originated out of observations in an animal research laboratory. And this laboratory, it was noted that laboratory dogs who were first exposed to uncontrollable shocks later acted in a passive and helpless manner when they were in a situation where they could control the shocks. Animals first exposed to equal amounts of controllable shocks had no trouble learning to control the shocks. They learned helplessness hypothesis was developed to explain these effects. It states that when animals or humans find that they have no control over aversive events, they may learn that they are helpless, which makes them unmotivated to try to respond in the future. They exhibit passivity and even depressive symptoms. They are also slow to learn that any response they do make it effective, which may parallel the negative cognitive set in human depression. For the research demonstrated that helpless animals also show other depressive symptoms such as lower levels of aggression, loss of appetite and weight, and changes in Monoamine neurotransmitter levels. It was then proposed that learned helplessness may underlie some types of human depression: People undergoing stressful life events over which they have a little or no control may develop a syndrome like the helplessness syndrome scene and animals

Question 120

The reformulated helplessness theory of depression

Answer 120

New research addressed some of the complexities of what humans do when faced with uncontrollable events. In particular it was proposed that when people are exposed to uncontrollable negative events, they ask themselves why, and the kinds of attributions that people make are intern central to whether they become depressed. These investigators proposed three critical dimensions on which attributions are made. They proposed that a depressive genic or pessimistic attribution for a negative event is an internal, stable and global one. It was proposed that people who have a relatively stable and consistent pessimistic attributional style have a vulnerability or die a thesis for depression when faced with uncontrollable negative life events. This cognitive style develops through social learning. This reformulated helplessness theory led to a great deal of research

Question 121

Three critical dimensions on which attributions are made

Answer 121

Internal/external, global/specific, and stable/unstable

Question 122

Studies on the reformulated helplessness theory of depression

Answer 122

Many studies demonstrated that depressed people do indeed have this kind of pessimistic attributional style, but this doesn’t mean that it plays a causal role. Many studies have examined the ability of a pessimistic attributional style to predict the onset of depression in interaction with negative life events. Some results have supported this theory and some have not. The helplessness theory has been used to explain sex differences in depression

Question 123

The helplessness theory and sex differences in depression

Answer 123

The theory proposes that by virtue of the rules in society, women are more prone to experiencing a sense of lack of control over negative life events. These feelings of helplessness might stem from poverty, discrimination in the workplace, high rates of sexual and physical abuse against women, role overload, and less perceived control over traits that men value when choosing a long-term mate, such as beauty, fitness and youth. There is at least some evidence that each of these conditions is associated with higher than expected rates of depression, although whether the effects involve a sense of helplessness has not yet been established. It is important to note that there is evidence that people who are high on neuroticism are more sensitive to the effects of adversity relative to those low on neuroticism. Given that women have higher levels of neuroticism and experience more uncontrollable stress, the increased prevalence of depression in women becomes less surprising

Question 124

The hopelessness theory of depression

Answer 124

Proposed that having a pessimistic attributional style in conjunction with one or more negative life events was not sufficient to produce depression unless one first experienced a state of hopelessness. Was also proposed that the internal/external dimension of attributions was not important to depression. Specifically it was proposed that depression prone individuals not only tend to make global and stable attributions for negative events but also tend to make negative inferences about other likely negative consequences of event and negative inferences about the implications of the event for the self-concept

Question 125

A hopelessness expectancy: definition

Answer 125

Defined by the perception that one has no control over what was going to happen and by the absolute certainty that an important bad outcome was going to occur or that I highly desired good outcome was not going to occur.

Question 126

Research for the hopelessness theory of depression

Answer 126

A study of several hundred college students who are hypothesized to be at high risk for unipolar depression because they were had a pessimistic attributional style and high levels of dysfunctional beliefs has healed and evidence supportive of some of the major tenets of the hopelessness theory. Students in the high-risk group who had never previously been depressed were about four times more likely to develop a first episode of major depression than those in the low risk group. For those who had already had a previous episode of depression prior to entry into the study, the high-risk group was about three times more likely to experience a recurrent episode of major depression in the 2.5 year follow up. Several smaller studies have shown evidence for the interaction of cognitive vulnerability with life stress and predicting depressive symptoms and onset of depression, although others have not. Research has begun to integrate hopelessness theory with a motivational theory of depression

Question 127

Integrating hopelessness theory with a motivational theory of depression

Answer 127

Posits that depression is associated with decreased approach behavior. Some researchers hypothesized that cognitively vulnerable individuals are at risk for decreased approach related behaviour as a result of increased hopelessness under stress, contributing to depression. There is empirical support for this notion. The relationship between cognitive vulnerability and stress with goal directed behaviour was mediated by increased feelings of hopelessness. More research is needed

Question 128

Ruminative response style cognitive theory of depression by Nolen-Hoeksema

Answer 128

Focusses on different kinds of responses that people have when they experience feelings and symptoms of sadness and distress, and how their differing response styles affect the course of their depression. When some people have such feelings, they tend to focus intently on how they feel and why they feel that way, a process called rumination. Other people have more action oriented or problem-solving responses to such feelings and distract themselves with another activity or actually try to do something that will solve the problem. There are stable individual differences in the tendency to ruminate and that people who ruminate a great deal tend to have more lengthy periods of depressive symptoms. They are also more likely to develop full-blown episodes of major depressive disorder. Those who had negative cognitive styles who also tended to ruminate a lot or most likely to develop depressive episodes.

Question 129

Rumination

Answer 129

A process which involves a pattern of repetitive and relatively passive mental activity, or a person tends to focus intently on how they feel and why they feel that way

Question 130

Sex differences in rumination

Answer 130

Women are more likely than men to ruminate when they become depressed. Self focussed rumination leads to increased recall of more negative autobiographical memories, feeding a vicious circle of depression. When gender differences and rumination are statistically controlled, gender differences and depression are no longer significant. The origin of these sex differences in response to depression is unclear

Question 131

Men’s response/reaction to a depressed mood

Answer 131

Men are more likely to engage in a distracting activity or consume alcohol when they get in a depressed mood and distraction seems to reduce depression. Distraction might include going to a movie, playing a sport, or avoiding thinking about why they are depressed. The origin of these sex differences in response to depression is unclear

Question 132

Why do sex differences in a unipolar depression emerge during adolescence?

Answer 132

Sex differences begin between ages 12 and 13 and reaches its most dramatic peak between ages 14 and 16, so it is actually more tied to pubertal status than age. It has been proposed there is a cognitive vulnerability stress model of the development of gender differences during adolescence. During early adolescence, gender differences in attributional style, rumination and in stressful life events emerge such that girls tend to have a more pessimistic attributional style, to show more rumination and to experience more negative life events. This may lead to a rise in depression and adolescent girls. The experience of negative life events may contribute to greater cognitive vulnerability, which intern increases susceptibility. Depressive symptoms are likely to result in more dependent life stress being generated, which intern may exacerbate depression. Girls not only experienced more negative life events than boys but also encode them in greater detail and show better memory for emotional events. It was also emphasized the role of negative cognitions about attractiveness and body image in the emergence of sex differences in depression during adolescence. girls are more likely than boys to make pessimistic attributions and other negative inferences about negative events that may occur related to the domain of physical attractiveness.

Question 133

Comorbidity of anxiety and depression

Answer 133

Overlap between measures of depression and anxiety occur at all levels of analysis: patient self report, clinician ratings, diagnosis, and family and genetic factors. Just over half of the patients he received a diagnosis of a mood disorder also received a diagnosis of an anxiety disorder at some point in their lives and vice versa. There is considerable evidence from genetic and family studies of the close relationship between anxiety and unipolar depressive disorders. The shared genetically based factor among these disorders seems to be at least in part the personality trait of neuroticism. Depressed and anxious individuals can’t be differentiated on the basis of their high level of negative affect, but they do differ in their reports of positive affect. Depressed persons tend to be characterized by low levels of positive affect, but anxious individuals usually are not. People with anxiety but not people with depression also tend to be characterized by high levels of another mood dimension known as anxious hyper arousal, symptoms of which include racing heart, trembling, dizziness and shortness of breath. Each of the other anxiety disorders has its own separate and relatively unique component as well

Question 134

Interpersonal effects of mood disorders

Answer 134

Interpersonal problems and social skills deficits may play a causal role in at least some cases of depression. Depression also creates many interpersonal difficulties with strangers and friends and family

Question 135

Lack of social support and social skills deficits, depression

Answer 135

A study reported that women without a close confiding relationship were more likely than those with at least one close confident to become depressed if they experienced a severely stressful event. People who are lonely, socially isolated or lacking social support are more vulnerable to becoming depressed and that individuals with depression have smaller and less supportive social networks, which tends to perceived the onset of depression. Also some people with depression have social skills deficits. They speak more slowly and monotonously and maintain less eye contact and are less skilled at solving interpersonal problems

Question 136

The effects of depression on others

Answer 136

The behaviour of someone who is depressed often places others in the position of providing sympathy, support and care. Positive reinforcement does not necessarily follow. Depressive behaviour can elicit negative feelings sometimes including hostility and rejection in other people, including strangers, roommates and spouses. Although these negative feelings me initially make the person who is not depressed feel guilty, which leads to sympathy and support in the short term, ultimately a downwardly spiralling relationship usually results, making the person with depression feel worse. Social rejection may be especially likely if the person with depression engages in excessive reassurance seeking

Question 137

Marriage and family life and people with depression

Answer 137

A significant proportion of couples experiencing marital distress have at least one partner with clinical depression, and there is a high correlation between marital dissatisfaction and depression for both women and men. Marital distress spells a poor prognosis for a spouse with depression who’s symptoms have remitted. A person who is depression clears up is likely to relapse if they have an unsatisfying marriage especially one characterized by high levels of critical and hostile comments from the spouse

Question 138

Why is criticism in a marital relationship linked to relapse Of depression?

Answer 138

Criticism perturbs some of the neural circuitry that underlies depression. Even after full recovery, criticism may still be a powerful trigger for those who are vulnerable to depression. They study showed that when people with depression or exposed to criticism, their brains responded differently from the healthy controls when challenged by criticism. These areas have been implicated in depression. Also brain activity in the amygdala was much higher in the recovered depressed participants than any controls. This suggests that criticism might be associated with relapse and depression because it is capable of activating some of the neural circuits that are thought to be involved in the disorder. It also suggests that people who are vulnerable to depression may be especially sensitive to criticism even after they have made a full recovery

Question 139

Parental depression and children

Answer 139

Parental depression puts children at high risk for many problems but especially for depression. The effects of maternal depression are somewhat higher. Children of parents with depression who become depressed themselves tend to become depressed earlier and show a more severe and persistent course then control children who become depressed who don’t have a parent with depression. This probably occurs because these children inherit a variety of traits such as temperament, low levels of positive emotions, and poor ability to regulate emotions that are risk factors for depression. Also many studies have documented the damaging effects of negative interactional patterns between mothers with depression and their children. Although genetically determined vulnerability is currently involved, psychosocial influences clearly also play an important role and evidence shows that inadequate parenting is what mediate the association between parental depression and their children’s depression

Question 140

Negative interactional patterns between mothers with depression and their children

Answer 140

Mothers with depression it show more friction and have fewer playful, mutually rewarding interactions with their children. They are less sensitively attend to their infants and less affirming of their infants experiences. As well three young children are given multiple opportunities for observational learning of negative cognitions, depressive behaviour and depressed affect. 

Question 141

Distinction of bipolar disorders from unipolar disorders

Answer 141

The presence of manic or hypo manic episodes, which are nearly always preceded or followed by periods of depression. A person who experiences a manic episode has a markedly elevated, euphoric and expansive mood, often interrupted by occasional outbursts of intense irritability or even violence, particularly when others refuse to go along with somatic persons wishes or schemes. Hypomanic episodes can also occur; these involve milder versions of the same symptoms but there is much less impairment in hypomania and hospitalization is not required

Question 142

Cyclothymic disorder

Answer 142

Refers to the repeated experience of hyprometic symptoms for a period of at least two years. This is a less serious version of full-blown bipolar disorder because it lacks the extreme mood and behaviour changes, psychotic features and marks impairment scene in bipolar disorder. These are cyclical mood changes that are more severe than normal, but less severe than the mood swings scene and bipolar disorder

Question 143

Symptoms of the hypo manic phase of cyclothymia

Answer 143

Are the opposite of the symptoms of persistent depressive 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 144

What is necessary for the diagnosis of cyclothymia?

Answer 144

There must be at least a two year span during which there are numerous periods with hypo manic and depressive symptoms and the symptoms must cause clinically significant distress or impairment in functioning. Individuals are a greatly increased risk of later developing full-blown bipolar disorder

Question 145

Symptoms in the depressed phase of cyclothymic disorder

Answer 145

A persons symptoms are very similar to what is seen in persistent depressive disorder but without the duration criterion. The individuals mood is dejected and they experience a distinct loss of interest or pleasure in customer activities in past times. The person may show other symptoms such as low energy, feelings of inadequacy, social withdrawal and a pessimistic, brooding attitude

Question 146

Manic depressive insanity

Answer 146

An early term for bipolar disorder. Recurrent cycles of mania and melancholia. It’s described as a disorder as a series of attacks of elation and depression, with periods of relative normality in between

Question 147

Bipolar I disorder vs MDD

Answer 147

Distinguished from MDD by the presence of mania.

Question 148

Bipolar I vs bipolar II disorder

Answer 148

Bipolar I: A person has full-blown mania. The 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

Bipolar II: person experiences periods of hypo mania, but their symptoms are below the threshold for full-blown mania. The person experiences periods of depressed mood that meet the criteria for major depression

Bipolar II disorder evolves into bipolar I disorder only about 5 to 15% of cases, suggesting that they are distinct forms of the disorder.

Question 149

A mixed episode characteristics

Answer 149

A mixed episode is characterized by symptoms of both full-blown manic and major depressive episodes for at least one week, either intermixed or alternating rapidly every few days. Mixed episodes were once thought to be relatively rare, but a recent review of studies found that approximately 28% of bipolar patients experienced mixed states at least some of the time. Many patients in a manic episode have some symptoms of depressed mood, anxiety, guilt and suicidal thoughts, even if these are not severe enough to qualify as a mixed episode. 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 150

When a person only shows manic symptoms

Answer 150

If a person shows only manic symptoms, it is nevertheless assumed that I bipolar disorder exists and that a depressive episode will eventually occur. Those some researchers have noted the probable existence of a unipolar type of manic disorder, critics of this diagnosis argue that such patients usually have bipolar relatives and may well have had mild depression‘s that went unrecognized

Question 151

Bipolar II disorder

Answer 151

A distinct form of bipolar disorder. The person does not experience full-blown manic or mixed episodes but experiences clear-cut hypomanic episodes as well as major depressive episodes. Bipolar II disorder is equally or somewhat more common than bipolar I disorder. Recently a subthreshold form of bipolar two disorder also has been recognized and as many as 40% of individuals diagnosed with MDD have a similar number of hypomanic symptoms, although not with a sufficient number or duration to qualify for a hypomanic episode.

Question 152

Prevalence of bipolar disorder

Answer 152

When bipolar I and bipolar II disorder are combined there are estimates that about 2 to 3% of the US population will suffer from one or the other disorder

Question 153

Gender differences in bipolar disorder

Answer 153

Bipolar disorder occurs equally in males and females, although depressive episodes are more common in women than men, and usually starts in adolescents and young adulthood, with an average age of onset of 18 to 22 years. Bipolar II disorder has an average age of onset approximately five years later than bipolar I disorder.

Question 154

Recurrence of bipolar disorders

Answer 154

Both bipolar disorders are typically recurrent disorders, with people experiencing single episodes extremely rarely. As with unipolar major depression, the recurrences can be seasonal in nature, in which case “bipolar disorder with a seasonal pattern” is diagnosed

Question 155

Patterns of mania and depression and bipolar disorders

Answer 155

In about 2/3 of cases, the manic episodes either immediately proceed or immediately follow a depressive episode; in other cases, the manic and depressive episodes are separated by intervals of relatively normal functioning. Most patients with bipolar disorder experience periods of remission during which they are relatively symptom-free, so this may occur on only about 50% of days. As many as 20 to 30% continue to experience significant impairment most of the time and 60% have chronic occupational or interpersonal problems between episodes.

Question 156

Features of bipolar disorder

Answer 156

The duration of manic and hypo manic episodes tends to be shorter than the duration of depressive episodes, with typically about three times as many days spent depressed as manic or hypo manic. people with bipolar disorder suffer from more episodes during their lifetimes than people with unipolar disorder, though these episodes tend to be somewhat shorter

Question 157

Distinguishing between symptoms of the depressive episodes of bipolar disorder and the scene and unipolar major depressive episodes

Answer 157

There is a high degree of overlapping symptoms, but there are some significant differences. Relative to people with a unipolar depressive episode, people with a bipolar depressive episode tend to show more mood lability, more psychotic features, more psycho motor retardation, and more substance abuse. Individuals with unipolar depression show more anxiety, agitation, insomnia, physical complaints and weight loss. Research indicates that major depressive episodes in people with bipolar disorder are more severe than those seen and unipolar disorder and they also cause more role impairment

Question 158

Missed diagnosis of bipolar and unipolar depression

Answer 158

Miss diagnoses are unfortunate because there are so much different treatments for unipolar and bipolar depression. There is also evidence that some anti-depressant drugs used to treat what is thought to be unipolar depression may actually precipitate manic episodes in patients who actually have bipolar disorder, thus worsening the illness

Question 159

Rapid cycling

Answer 159

A pattern experienced by people with bipolar disorder where they experience at least four episodes, either manic or depressive, every year. This is experienced by as many as 5 to 10% of people with bipolar disorder. 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, do you have a history of more episodes, to have an earlier average age of onset, and to make more suicide attempts. It is sometimes precipitated by taking certain kinds of antidepressants. For about 50% of cases, rapid cycling is a temporary phenomenon and gradually disappears within about two years

Question 160

Bipolar disorder and full recovery

Answer 160

The probabilities of full recovery from bipolar disorder are discouraging, even with widespread use of mood stabilizing medication such as lithium,. Estimates are the patients with bipolar disorder spent about 20% of their lives in episodes. Depressive symptoms are three times more common than manic or hypo manic symptoms

Question 161

Biological versus psychological causal factors of bipolar disorder

Answer 161

Biological causal factors are dominant, and the role of psychological causal factors has received significantly less attention. Biological causal factors include genetic, neurochemical, hormonal, neurophysiological, Nuro anatomical, and biological rhythm influences. Psychological causal factors include stressful life events, poor social support, in certain personality traits and cognitive styles

Question 162

Genetic influences for bipolar disorder

Answer 162

Proximately 8 to 10% of the first-degree relative of a person with bipolar I illness can be expected to have bipolar disorder, compared to 1% in the general population. The first- degree relatives of a person with bipolar disorder also are at elevated risk for unipolar major depression, although the reverse is not true

Question 163

Bipolar disorder and twin studies

Answer 163

The concordance rates for these disorders are much higher four identical than four fraternal twins. The average concordance rate is about 60% for monozygotic twins and only about 12% for dizygotic twins. This suggests that genes account for about 80 to 90% of the variance in the liability to develop bipolar one disorder. This is higher than heritability estimates for unipolar disorder or any of the other major adult psychiatric disorders, including schizophrenia

Question 164

Chromosome sites for the implicated genes in bipolar disorder

Answer 164

Efforts to locate the chromosomal sites suggest that it is polygenic. No consistent support yet exists for any specific amount of genetic transmission of bipolar disorder. Different disorders seem to share their genetic ideology. For example some of the genetic polymorphisms that are seen in those with bipolar disorder are also seen in those with schizophrenia and depression

Question 165

The early Monoamine hypothesis and bipolar disorder

Answer 165

This hypothesis was extended to bipolar disorder, with the hypothesis being that if depression is caused by deficiencies of norepinephrine or serotonin, then perhaps mania is caused by excesses of these neural transmitters. 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 166

Neurochemical factors in bipolar disorder

Answer 166

There is evidence for increased norepinephrine activity during manic episodes and less consistent evidence for lowered norepinephrine activity during depressive episodes. Serotonin activity appears to be low in both depressive and manic phases. There is evidence for the role of dopamine showing that increased dopaminergic activity in several brain areas may be related to manic symptoms of hyperactivity, grandiosity, anti-for you. I doses of drugs such as cocaine and amphetamines, which are known to stimulate dopamine, also produce manic like behavior. Drugs like lithium reduce dopaminergic activity and or antimanic. And depression there appears to be decreases in both norepinephrine and dopamine functioning. Disturbances in the balance of these neurotransmitters seem to be one of the keys to understanding this illness

Question 167

Cortisol levels and bipolar disorder

Answer 167

Cortisol levels are elevated in bipolar depression, as they are in unipolar depression, but they are usually not elevated during manic episodes.

Question 168

Dexamethasone suppression test (DST) and bipolar disorder

Answer 168

People with bipolar disorder who are in a depressed episode show evidence of abnormalities on the dexamethasone suppression test at about the same rate as two people experiencing a unipolar depression, and these abnormalities persist even when the patients have been fully remitted and asymptomatic for at least four weeks. During a manic episode, the rate of DST abnormalities generally has been found to be much lower.

Question 169

Hypothalamic pituitary thyroid axis and bipolar disorder

Answer 169

Abnormalities of thyroid function are frequently accompanied by changes in mood. Many bipolar patients have subtle but significant abnormalities in the functioning of this axis, and administration of thyroid hormone often makes anti-depressant drugs work better. However thyroid hormone can also precipitate manic episodes in patients with bipolar disorder

Question 170

What do studies using neural imaging techniques shown about the brain and people with bipolar disorder?

Answer 170

Several imaging studies using PET and other neural imaging 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. There are shifting patterns of brain activity during mania and during depressed and normal moods.

Question 171

Neurophysiological findings from patients with bipolar disorder

Answer 171

Show about similarities and differences from patients with unipolar disorder and normal controls. There are deficits in activity in the prefrontal cortex and bipolar disorder. These seem related to Nuro psychological deficits that people with bipolar disorder show in problem-solving, planning, working memory, shifting of attention and sustained attention on cognitive tasks. This is similar to what is seen in unipolar depression, as are deficits in the anterior cingulate cortex. Structural imaging studies suggest that certain subcortical structures, including the basal ganglia and amygdala, are enlarged in bipolar disorder but reduced in size and unipolar depression. The decreases in hippocampal volume that are often observed and unipolar depression are generally not found in bipolar depression. There is also increased activation in bipolar patients in subcortical brain regions involved in emotional processing, such as the thalamus and amygdala, relative to unipolar patients and normal control subjects. There is initial meta-analytic support for dysregulation in frontal limbic activation in individuals with bipolar disorder compared to controls

Question 172

Circadian rhythms in bipolar disorder

Answer 172

During manic episodes, patients with bipolar disorder tend to sleep very little, seemingly by choice, and this is the most common symptom to occur prior to the onset of a manic episode. During depressive episodes, they tend toward hypersomnia. Even between episodes people with bipolar disorder shows substantial sleep difficulties, including high rates of insomnia. Bipolar disorder also sometimes shows a seasonal pattern in the same way unipolar disorder does, suggesting disturbances of seasonal biological rhythms. This focus on disturbance in biological rhythms may hold promise for future integrative theories. Patients with bipolar disorder seem especially sensitive to and easily disturbed by any changes in their daily cycles that require a resetting of their biological clocks

Question 173

Stressful life events and bipolar disorder

Answer 173

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 and recent life stressors during adulthood increase the likelihood of ever developing bipolar disorder as well as having reoccurrences

Question 174

How much stressful life events operate to increase the chance of relapse in bipolar disorder?

Answer 174

The diathesis stress model suggests that stressful life events influence the onset of episodes by activating the underlying vulnerability. One hypothesized mechanism is through the D stabilizing effects that stressful life events may have on critical biological rhythms. Evidence is preliminary but it appears to be a promising hypothesis especially for manic episodes

Question 175

Other psychological factors in bipolar disorder

Answer 175

Other social environmental variables may also affect the course of bipolar disorder. There is also evidence that personality and cognitive variables may interact with a stressful life events in determining the likelihood of relapse. Personality variables and cognitive styles that are related to goals driving, drive, and incentive motivation have been associated with bipolar disorder. People with a pessimistic attributional style who also experience negative life events show an increase in depressive symptoms whether they had bipolar or unipolar disorder.

Question 176

Social environmental variables and bipolar disorder: example

Answer 176

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

Question 177

Examples of personality variables and cognitive styles related to Kohl’s driving, drive an incentive motivation, and bipolar disorder

Answer 177

Two personality variables associated with high levels of achievements driving an increased sensitivity to rewards in environment predicted increases in manic episodes, especially during periods of active gold striving or goalinement. Another example found that students with a pessimistic attributional style who also experienced negative life events showed an increase in depressive symptoms whether they had bipolar or unipolar disorder. 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 178

Why has it been difficult to provide conclusive evidence for mood disorders among different countries?

Answer 178

Because of various methodological problems, including widely differing diagnostic practises in different cultures, and because the symptoms of depression appear to vary considerably across cultures

Question 179

Cross cultural differences in depressive symptoms

Answer 179

Depression occurs in all cultures that have been studied however the form that it takes differs widely, as does its prevalence. In western cultures the psychological symptoms of depression 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 nonwestern cultures tend to exhibit the more physical symptoms.

Question 180

What are possible reasons for symptom differences between Western and nonwestern cultures?

Answer 180

Reasons may stamp 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 an Asian cultures is that western cultures view the individual as independent and autonomous, so when failures occur, internal attribution‘s are made. By contrast in many Asian cultures individuals are viewed as inherently interdependent with others. Nevertheless as countries like China have incorporated some western values over the course of becoming increasingly industrialized and urbanized, rates of depression ever isn’t a good deal relative to several decades ago. A study of adolescents found levels of depressive symptoms and hopelessness to be higher in the adolescence from Hong Kong compared to the US

Question 181

Cross cultural differences in prevalence of bipolar disorder

Answer 181

Prevalence rates for mood disorders very a great deal across countries. The WHO world mental health survey, which assesses the prevalence and characteristics of psychological disorders across more than 20 countries reveals that the 12 month prevalence of mood disorders varies from 0.8% to 9.6%.

Question 182

Why is there such why variation in prevalence of mood disorders around the world?

Answer 182

The reasons for such a wide variation are very complex and a lot of work remains to be done before we fully understand them. Ideas that are being explored include differences in willingness to report the presence of a mental disorder due to stigma, and the different levels of important psychosocial risk variables in different cultures and different levels of stress. There appear to be 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 don’t know whether the same risk variables are operative in different cultures. Researchers are beginning to explore this and there is some initial evidence that factors like rumination, hopelessness and pessimistic attributional style are associated with risk for depression in other countries such as China

Question 183

Mood disorders and seeking treatment

Answer 183

Many patients with mood disorders never seek treatment. Even without formal treatment, the great majority of individuals with mania and depression will recover, often only temporarily, within less than a year. But more and more people who experience these disorders are seeking treatment. There was a rapid increase in the treatment of depression from 1987 to 1997 and there has been a more modest increase since. There is now greatly increased public awareness of the availability of effective treatments and during a time in which significantly less stigma is associated with experiencing a mood disorder. Only about 40% of people with mood disorders receive minimally adequate treatment, with the other 60% receiving no treatment or in adequate care. The probability of receiving treatment is somewhat higher for people with severe unipolar depression and bipolar disorder then for those with less severe depression

Question 184

Pharmacotherapy in the treatment of unipolar and bipolar disorders

Answer 184

Antidepressant, mood stabilizing, and antipsychotic drugs are all used in the treatment of unipolar and bipolar disorders. The first category of antidepressant medication is the monoamine oxidase inhibitors (MAOIs). In the 1960s to the early 1990s the drug treatment of choice for patients who are moderately it too seriously depressed was tricyclic antidepressants (TCAs). Side effects and toxicity of TCAs have led physicians to increasingly prescribe selective serotonin reuptake inhibitors (SSRIs). In the past decade several new atypical anti-depressants have also become increasingly popular, each with its own advantages

Question 185

Monoamine oxidase inhibitors, MAOIs

Answer 185

A category of antidepressant medications developed in the 1950s. They inhibit the action of mono aiming oxidades, the enzyme responsible for the breakdown of nor inephrine and serotonin once released. They can be as effective in treating depression as other categories of medications, but they have potentially dangerous or fatal side effects if certain foods rich in the amino acid tyramine are consumed, example red wine, beer, aged cheese, salami. They are not used very often today unless other classes of medication have failed. Depression with atypical features is the one sub type of depression that seems to respond preferencely to the MAOI‘s

Question 186

Tricyclic antidepressants, TCAs

Answer 186

The drug treatment of choice from the 1960s to the early 1990s, to treat patients who are moderately to seriously depressed. TCAs increase in a row transmission of the Monoamines, primarily norepinephrine and to a lesser extent serotonin. In studies showing the efficacies of TCAs, only about 50% show that what is considered clinically significant improvement and many of these patients still have significant residual depressive symptoms. But 50% of those who do not respond to an initial trial of medication will show a clinically significant response when switched to a different antidepressant or a combination of medication‘s

Question 187

Side effects of TCAs

Answer 187

TCAs can have unpleasant side effects for some people, dry mouth, constipation, sexual disfunction and weight gain. The side effects often diminish overtime but they are so unpleasant to many patients that they stop taking my medications before the side effects go away. Because these drugs are highly toxic when taking in large doses, there is some risk in prescribing them for suicidal patients who might use them for an overdose

Question 188

Selective serotonin reuptake inhibitors, SSRIs

Answer 188

Increasingly prescribed due to the side effects and the toxicity of TCAs. SSRIs are generally no more effective than the tricyclics, some findings suggest that TCAs are more effective than SSRIs for severe depression. But the SSRIs tend to have many fewer side effects and are better tolerated by patients and are less toxic. SSRIs can treat severe depression and Miles depressive symptoms. Recent research has shown the antidepressant medication is superior to placebo only for patients with very severe depressive symptoms with negligible treatment effects observed for those with less severe symptoms

Question 189

Negative Side effects of SSRIs

Answer 189

Problems with orgasm and lowered interest in sexual activity, insomnia, increased physical agitation, and gastrointestinal distress

Question 190

New atypical antidepressants that are neither tricyclics nor SSRIs

Answer 190

Bupropion 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.
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.

Question 191

The course of treatment with anti-depressant drugs

Answer 191

Anti-depressant drugs usually require at least 3 to 5 weeks to take affect. If there are no signs of improvement after about six weeks, physicians try a new medication because 50% do not respond to the first drug prescribed but do respond to a second. Discontinuing the drugs when symptoms have omitted may result in a relapse. The natural course of an untreated depressive episode is typically 6 to 9 months so when depressed patients take drugs for 3 to 4 months and then stop, they are likely to relapse because the underlying depressive episode is actually still present and only it’s symptomatic expression has been expressed.

Question 192

Treatment with anti-depressant drugs to prevent recurrence

Answer 192

Physicians recommend that patients continue for very long periods of time on the drugs in order to prevent recurrence. The medication‘s can be effective in prevention and treatment for patients subject to recurrent episodes. About 25% of patients continuing to receive medication during the maintenance phase of treatment show recurrence of MDD. Patients showing residual symptoms are most likely to relapse, indicating the importance of trying to treat the patient to full remission of symptoms

Question 193

Lithium therapy for mood stabilization

Answer 193

Lithium therapy has become widely used as a mood stabilizer in the treatment of both depressive and manic episodes of bipolar disorder. Lithium has both antimanic and anti-depressant effects, and exerts mood stabilizing effects in either direction. Lithium has been more widely studied as a treatment of manic episodes then of depressive episodes, and estimates are that about 3/4 of those in a manic episode show at least partial improvement. In the treatment of bipolar depression lithium may be no more effective than traditional anti-depressants but about 3/4 show at least partial improvement. But treatment with anti-depressants is associated with significant risk of precipitating manic episodes or rapid cycling but the risk of this happening is reduced if the person also takes lithium.

Question 194

Lithium for preventing cycling

Answer 194

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 periods of time, even when not manic or depressed simply to prevent new episodes. Studies have found that only about 1/3 of patients maintained on lithium remained free of an episode over a five-year follow up. Nevertheless patients unless you (maintenance) do you have your episodes and then patients who discontinue the medication

Question 195

Unpleasant side effects of lithium therapy

Answer 195

Unpleasant side effects include lethargy, cognitive slowing, weight gain, decreased motor coordination, and gastrointestinal difficulties. Long-term use of lithium is occasionally associated with kidney Malfunction and sometimes kidney damage, though and stage renal disease seems to be a very rare consequence of long-term lithium treatment. These side effects sometimes create problems with compliance and taking the drug

Question 196

Anticonvulsants for treating bipolar disorder

Answer 196

Evidence has emerged for the usefulness of anticonvulsants for treating bipolar disorder. These drugs are often effective in patients who do not respond well to lithium or to develop unacceptable side effects from it and they may also be given in combination with lithium. A number of studies have indicated that risks for attempted and completed suicide was nearly 2 to 3 times higher for patients on these medications then for those on lithium, Suggesting one major advantage of giving lithium to patients who can tolerate its side effects.

Question 197

Antipsychotic medication for mood disorders

Answer 197

Both people with bipolar and unipolar depression who show signs of psychosis, hallucinations and delusions, may also receive treatments with antipsychotic medications in conjunction with her antidepressant or mood stabilizing drugs

Question 198

Electroconvulsive therapy, ECT, for treating depression

Answer 198

ECT is often used with patients who are severely depressed, especially the elderly, who may present an immediate and serious suicidal risk, including those with psychotic or melancholic features. It’s also used in patients who cannot take antidepressant medications or who are otherwise resistant to medications. When done properly, a complete remission of symptoms occurs for many patients after about 6 to 12 treatments, with treatments administered about every other day. The treatments, which induced seizures, are delivered under general anaesthesia 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 slow response time. (maintenance) dosages of an antidepressant and mood stabilizing drug are then ordinarily used to maintain the treatment gains achieved until the depression has run its course. ECT is also very useful in the treatment of manic episodes, showing improvement in 80% of patients with mania. Maintenance on mood stabilizing drugs following ECT is usually required to prevent relapse

Question 199

Transcranial magnetic stimulation, TMS, to treat mood disorders

Answer 199

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 simulations are delivered in each treatment session. Treatment usually occurs five days a week for 2 to 6 weeks. Many studies have shown it to be quite effective. Research suggests that TMS is a promising approach for the treatment of unipolar depression in patients who are moderately resistant to other treatments. TMS has advantages over ECT in that cognitive performance and memory or not effective adversely and sometimes even improve. TMS appears to be safe for use with children and adolescents, with only low rates of mild and transient side effects such as headache and scalp discomfort

Question 200

Deep brain stimulation in the treatment of mood disorders

Answer 200

Being explored as a treatment approach for individuals with refractory depression who have not responded to other treatment approaches such as medication, psychotherapy and ECT. Involves implanting an electrode in the brain and then stimulating that area with electric current. More research is needed but initial results suggest that it may have potential for treatment in unrelenting depression

Question 201

Bright light therapy for treating mood disorders

Answer 201

This was originally used in the treatment of seasonal affective disorder, but it has now been shown to be effective in non-seasonal depression‘s as well

Question 202

Cognitive behavioural therapy for the treatment of mood disorders

Answer 202

A brief form of treatment that focusses on here and now problems rather than the more remote causal issues that psychodynamic psychotherapy often addresses. It 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 talked to identify and correct their biases or distortions in information processing and to uncover and challenge their underlying depressogenic assumptions and beliefs. Relies heavily on an empirical approach and that patients are taught to treat their beliefs as hypotheses that can be tested through the use of behavioural experiments.

Question 203

Studies on the effectiveness of cognitive therapy for mood disorders

Answer 203

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. Evidence is beginning to accumulate that it can prevent recurrence several years following the episode when the treatment occurred. Recent brain imaging studies have shown that the biological changes in certain brain areas that occur following effective treatment with cognitive therapy versus medication‘s are somewhat different, suggesting that the mechanisms through which they work are also different. One possibility is that medication‘s may target the limbic system but cognitive therapy may have greater effects on cortical functions

Question 204

Cognitive therapy versus medications for treating severe depression

Answer 204

CBT and medication‘s are equally effective in the treatment of severe depression. For example one study of moderate to severe depression found that 58% responded to either cognitive therapy or medication. But by the end of the two-year follow up, when all cognitive therapy and medication‘s have been discontinued for one year, only 25% of patients treated with cognitive therapy had had a relapse versus 50% in the medication group

Question 205

Mindfulness-based cognitive therapy

Answer 205

A variant on cognitive therapy, developed to be used with people with highly recurrent depression. The treatment is based on findings that people with recurrent depression are likely to have negative thinking patterns activated when they are simply in a depressed mood. Rather than trying to alter the contents of the 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. This group treatment involves training in mindfulness meditation techniques and developing patient’s awareness of their unwanted thoughts, feelings and sensations so that they no longer automatically try to avoid them but rather learn to except them for what they are: simply thoughts and not a reflection of reality. this treatment is an effective treatment for reducing risk of relapse in those with a history of three or more prior to depressive episodes who have been treated with antidepressant medication

Question 206

CBT in the treatment of bipolar disorder

Answer 206

The vast majority of research on CBT has focussed on unipolar depression, but recently there have been indications that I modified form of CBT may be quite useful, in combination with medication, in the treatment of bipolar disorder as well. There is preliminary evidence that mindfulness-based cognitive therapy may be useful in treating bipolar patients between episodes

Question 207

Behavioural activation treatment

Answer 207

A new and promising treatment for unipolar depression. Focusses intensely on getting patients to become more active and engaged with their environment and with their interpersonal relationships. These techniques include scheduling daily activities and reading pleasure and masturbate while engaging in them, exploring alternative behaviours to reach goals, and role-playing to address specific deficits. Traditional CBT attends to these same issues but to a lesser extent. Behavioural activation treatment does not focus on implementing cognitive changes directly but rather on changing behavior. The goals are to increase levels of positive reinforcement and reduce avoidance and withdrawal.

Question 208

Effectiveness of behavioural activation treatment

Answer 208

Early results were very promising, suggesting it may be as effective as more traditional CBT and there is now support for this notion. Patients with moderate to severe depression who received behavioural activation treatment did as well as those on medication and even slightly better than those who received cognitive therapy. However the slight superiority of behavioural activation treatment relative to cognitive therapy was not maintained, with some results indicating a trend for cognitive therapy to be slightly superior at follow up. Since it’s easier to train therapists to administer behavioural activation treatment then CBT, it’s likely they will be increased attention paid to this relatively new treatment

Question 209

Interpersonal therapy, IPT

Answer 209

There’s not been subject to as extensive and evaluation as CBT and is not as wirely available. It focusses on current relationship issues, trying to help the person understand and change maladaptive interaction patterns. It can also be useful in long-term follow up for individuals with severe recurrent unipolar depression.

Question 210

Effectiveness of interpersonal therapy

Answer 210

Studies that have been completed strongly support its effectiveness for treating unipolar depression. Interpersonal therapy seems to be about as effective as medication‘s or CBT. Patients who received continued IPT once a month or who received continued medication were much less likely to have a recurrence than those maintained on a placebo. There is support for the notion that a combined maintenance treatment of IPT and medication is associated with lower recurrence rates than (maintenance) medication treatment alone.

Question 211

Interpersonal therapy, IPT, and treating bipolar disorder

Answer 211

IPT has been adapted for treatment of bipolar disorder by adding a focus on stabilizing daily social rhythms that, if they become disableized, may play a rule in precipitating bipolar episodes. This new treatment is called interpersonal and social rhythm therapy, and patients are taught to recognize the effect of interpersonal events on their social and circadian rhythms and to regularize these rhythms. This treatment seems promising

Question 212

Recurrence of depression due to certain aspects a family life

Answer 212

The relapse in unipolar and bipolar disorders is correlated with certain negative aspects of family life. Behaviour by a spouse that can be interpreted by a former patient as criticism seems especially likely to produce depression relapse. For bipolar disorder some types of family interventions directed at reducing the level of expressed emotion or hostility and increasing the information available to the family about how to cope with a disorder have been found to be very useful in preventing relapse in these situations.

Question 213

Marital therapy

Answer 213

For married people who have unipolar depression and marital discord, marital therapy is as effective as cognitive therapy in reducing unipolar depression and the depressed spouse. Marital therapy has the further advantage of producing greater increases in marital satisfaction then cognitive therapy

Question 214

Mortality rate for individuals with depression and bipolar disorder

Answer 214

The mortality rate for individuals with depression is higher than that for the general population, partly because of the incidence of suicide but also because there is excess of deaths due to natural causes such as heart disease. Patients with mania also have a high risk of death from accidents, neglect of proper health precautions, or physical exhaustion.

Question 215

The risk of suicidal behaviour and psychological disorders

Answer 215

The risk of suicide is a significant factor in all types of depression. Virtually all psychological disorders increase the risk of suicidal behavior; approximately 98 to 95% of those who die by suicide have a history of at least one psychological disorder. But depression is a disorder that is most commonly linked to a suicidal behavior. Individuals with two or more mental disorders are an even greater risk than those with only one

Question 216

Prevalence of suicide

Answer 216

Suicide is currently the 15th leading cause of death in the world, accounting for 1.4% of all deaths. There are more deaths each year around the world by suicide then due to all wars, genocide and interpersonal violence combined. Also the number of actual suicides is even higher than the number officially reported. In addition to suicide death, estimates are that approximately 5% of Americans have made a non-lethal suicide attempt at some time in their lives and 15% have experienced suicidal thoughts.

Question 217

Transitioning from suicidal thoughts to suicide attempts

Answer 217

Only about 1/3 of people who think about suicide go on to make a suicide attempt. The risk of transitioning from suicidal thoughts to suicide attempt is highest in the first year after onset of suicidal thinking, and the longer a person goes thinking about suicide without making a suicide attempt, the less likely that individual is to ever make an attempt

Question 218

Nonsuicidal self injury, NSSI

Answer 218

Direct, deliberate destruction of body tissue, often taking the form of cutting or burning ones on skin, in the absence of any intent to die. Approximately 15 to 20% of adolescents and young adults report engaging in NSSI at least once and the primary reasons given for engaging in this behaviour include that it helps both to decrease high levels of distress and to elicit help from others. Psychologists are still working to understand why people engage in NSSI and how to best predict and prevent it. NSSI disorder recently was added to DSM five as a condition requiring further study

Question 219

Most people who die by suicide or make non-lethal suicide attempts are _________ about taking their own lives.

Answer 219

Ambivalent. 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. Many do not really want to die.

Question 220

Studies of people who have lost a loved one through suicide

Answer 220

There is long lasting distress among those left behind. Studies of survivors show that the loss of a loved one through suicide is one of the greatest burdens individuals and families may endure

Question 221

Gender differences in who is likely to die by suicide

Answer 221

In almost every country around the world in which suicidal behaviour has been examined, women are significantly more likely than men to think about suicide and to make non-lethal suicide attempts but men are four times more likely than women to die by suicide. This difference is explained in large part by the fact that men tend to use more lethal means in their suicide attempts then do women

Question 222

Suicide and children

Answer 222

Suicide is rare in children due in large part to the fact that young children do not understand the finality of death and often lack the means to act on suicidal thoughts in the unlikely event that they have them. But suicidal thoughts and behaviours increase in prevalence starting around age 12 and continue to increase into the early to mid-20s.

Question 223

Suicide and age

Answer 223

suicidal thoughts and behaviours 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 peaking in middle-age and a slight decrease and levelling off for the remainder of the lifespan. A 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 224

Rate of suicide and adolescents

Answer 224

There has been an increased risk among adolescents and young adults for suicide attempts and completed suicides

Question 225

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

Answer 225

This is a period during which depression, anxiety, alcohol and drug use, and conduct disorder problems also show increasing prevalence, and these are all factors associated with increased risk for suicide. Increased risk of firearms also probably plays a role as well. Exposure to suicides through the media, where they are often portrayed in dramatic terms, has potentially also contributed to these aggregate increases in adolescent suicide, perhaps because adolescents are highly susceptible to suggestion and imitate her behavior. In addition the media rarely discusses the mental disorders suffered by the suicide victims which may further increase the likelihood of imitation.

Question 226

College students and suicidal ideation

Answer 226

College students also seem very vulnerable to the development of suicidal ideation and plans. The combined stressors of academic demands, social interaction problems, and career choices make it impossible for some students to continue making the adjustments their life situation as demand.

Question 227

How and why with so many different disorders be associated with suicide?

Answer 227

Recent research has revealed that different disorders are associated with different parts of the pathway to suicide. Even though depression is the disorder most strongly predictive of which people develop suicidal thoughts, it does not predict which people go onto act on them and make suicide attempts. Instead it is the disorder is characterized by agitation and aggression and impulsiveness that predict acting on one’s suicidal thoughts, such as PTSD, bipolar disorder, conduct disorder, and intermittent explosive disorder that predict this transition transition

Question 228

Dose response relation that is consistently observed between the number of Disorders present and the risk of suicidal behaviour

Answer 228

A recent study across 17 different countries around the world revealed that compared to people with no history of psychological disorders, those with only one psychological disorder have no increased risk of suicidal thoughts or behaviors. But those with two disorders, compared to those with none, showed a doubling in the risk of suicidal behavior, whereas those with three or more disorders show a 6 to 9 fold increase in the risk of suicidal behavior.

Question 229

Warning signs for suicide

Answer 229

Immediate warning signs:
-Someone threatening to hurt or kill themselves
-Someone looking for ways to kill themselves: seeking access to pills, weapons or other means
-Someone talking or writing about death, dying or suicide

Concerning warning signs that do not require immediate attention:
-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 230

Psychosocial factors associated with suicide

Answer 230

Research has subsequently supported the link between pain, both psychological and physical, and suicide. Why do some people experience such intense psychological pain and feel the need to die by suicide as an escape? Research suggests that the answer is not simple and suicide may be best understood as the end product of a combination of many different factors stretching back to childhood.

Question 231

Early experiences and suicide

Answer 231

People who become suicidal often come from backgrounds in which there was some combination of a good deal of family psychopathology, child maltreatment, and family instability. These early experiences are thought to interact with biological vulnerabilities that increase the risk of personality traits such as hopelessness, impulsiveness, aggression, pessimism, and negative effectivity, which may intern increase the risk of suicide.

Question 232

Symptoms that seem to predict suicide more reliably in the short term and patience with major depression

Answer 232

Severe anxiety, panic attacks, severe Anhedonia (Inability to experience pleasure), Global insomnia, delusions and alcohol abuse. In a study of people who had committed suicide with being hospitalized, the hospital records revealed that 79% of these people have been severely anxious and agitated in the week prior to committing suicide

Question 233

Implicit associations

Answer 233

Mental associations that people hold between two concepts that they are unwilling or unable to report. Such associations can be measured using reaction time tests, such as the implicit association test, which asks people to classify words into one of two groups, example “like me” or “not like me”.

Question 234

Implicit association and suicide

Answer 234

There is evidence that people who have a strong implicit association between the self and death or suicide are at elevated risk of future suicide attempts, even over and above the effects of other non-risk factors. Researchers have found that suicidal people are faster in classifying suicide related words in the “like me“ group then in the “not like me“ group, providing a new method of detecting and better predicting suicidal behaviour

Question 235

Twin studies and a suicide

Answer 235

The concordance rate for suicide in identical twins is about three times higher than that infraternal twins. This genetic vulnerability seems to be at least partly independent of the genetic vulnerability for major depression

Question 236

Neurochemical correlates of suicide

Answer 236

Suicide victims often have alterations in serotonin functioning, with reduced serotonergic activity being associated with increased suicide risk especially for violent suicide. This association appears to be independent of psychiatric diagnosis, including suicide victims with depression, schizophrenia, and personality disorders. These neurochemical correlates of suicide may be linked to genetic vulnerability

Question 237

The short allele serotonin transporter gene and suicide

Answer 237

The short allele serotonin transporter gene controls the uptake of serotonin from the synapse. Several studies have tried to document an association between suicide and this gene. This gene is implicated in the vulnerability to depression. Though inconsistent, studies have found that people with one or two copies of the short allele are at heightened risk for suicide following stressful life events. There’s also growing support for associations between additional serotonergic gene variants and suicide attempts

Question 238

Theoretical models of suicidal behaviour

Answer 238

Many researchers conceptualized suicide by using diathesis stress models in which underlying vulnerabilities interact with stressful life events to produce suicidal thoughts and behaviors. Others have outlined more specific models to explain suicidal behavior, for example joiners interpersonal psychological model of suicide. No existing models have adequately explained suicidal behaviour however researchers continue to work toward a better understanding

Question 239

Joiner’s interpersonal psychological model of suicide

Answer 239

Suggests that the psychological state of perceived burdensomeness, example of feeling like a burden to others, and thwarted belongingness, feeling alone, interact to produce suicidal thoughts and desires. But it is only in the presence of a third factor, the acquired capacity 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 240

Percentage of people with suicidal thoughts or attempts who receive treatment

Answer 240

Only about 40% of people with suicidal thoughts or attempts around the world receive treatment. Rates of treatment receipt are much higher and higher income countries than low income countries and this treatment is most often from a general practitioner rather than a healthcare professional.

Question 241

Why do people with suicidal thoughts not seek treatment

Answer 241

The primary reasons suicidal people give for not seeking treatment is that they didn’t think they needed help, 58%, or they wanted to handle the problem on their own, 40%.

Question 242

Three main parts of preventative efforts for suicide

Answer 242

Treatment of the person‘s current mental disorders, crisis intervention, and working with high-risk groups

Question 243

Preventing suicide through treatment of mental disorders

Answer 243

In the case of depression, such treatment is often in the form of antidepressant medication. There’s been a great deal of recent controversy regarding this as their potential for actually increasing the risk of suicidal behaviour especially among adolescents. lithium also seems to be especially powerful and he suicide agent over the long-term, although not in acute situations. Benzodiazepines are also suggested to be useful and treating the severe anxiety and panic that’s so often precede suicide attempts

Question 244

Controversy in using anti-depressants to treat depression and reduce suicide

Answer 244

There is a potential for antidepressant medications to increase the risk of suicidal behaviour especially among adolescence. A recent review of trials revealed higher rates of suicidal thoughts and behaviours in those receiving anti-depressants relative to those receiving placebo. This led the FDA to require pharmaceutical companies to put warnings on the labels of these medication‘s. Many studies have been completed, some suggesting that antidepressants increase the risk of suicidal behaviour in use, and others suggesting they are safe and effective and that the FDA warning lead to an increase in the suicide rate due to a decrease in antidepressant use. There is less argument about adults, for whom there is evidence that anti-depressants can decrease suicidal thoughts and behaviours and seem to do so via a reduction in depression symptoms

Question 245

Crisis intervention to reduce suicides

Answer 245

The primary objective of crisis intervention is to help a person cope with an immediate life crisis. When people contemplating suicide or willing to discuss their problems with someone at a suicide prevention center, it’s often possible to avert an actual suicide attempt. The primary objective is to help these people regain their ability to cope with their immediate problems as quickly as possible. Emphasis is placed on maintaining supportive and often highly directive contact with a person over a short period of time; helping the person to realize that acute distress isn’t pairing their ability to assess the situation accurately and to see that there are better ways of dealing with a problem; and helping the person to see that the present distress and emotional turmoil will not be endless

Question 246

Suicide hotlines

Answer 246

Suicide hotlines have increased since the 1960s, and there are now more than several thousand in the US, but questions have been raised about the quality of care offered by the majority of them. These centres are geared primarily toward crisis intervention, usually via the 24 hour a day availability of telephone contact. Suicide hotlines are usually staffed by non-professionals who are supervised by psychologists and psychiatrists. The worker attempts to establish the seriousness of the collars intent and tries to show empathy and convince the person not to attempt suicide. Unfortunately these hotlines and suicide prevention centres it has not revealed much impact on suicide rates

Question 247

Focus on high-risk groups and other measures in reducing suicides

Answer 247

Recent research has focussed on providing treatment aimed directly at decreasing suicidal thoughts and behaviours among those already experiencing them. A recent study test of the effectiveness of cognitive therapy for reducing the risk of suicide attempt in adults who had already made at least one prior attempt. This treatment was beneficial in reducing further attempts. Patients in the CBT group were 50% less likely to re-attempt suicide then patients in the usual care group, and their depressive and hopelessness symptoms were also lower than those of the usual care group. More research suggests that CBT for suicide prevention is also feasible for use with adolescents who have attempted suicide