Chapter 7- Depression and Suicide

Question 1

Define Major Depression Disorder

Answer 1

Depression is a mood disorder that has persistent sad or low mood which is severe enough to impair a person’s interest in, or ability to engage in normal enjoyable activities.

Question 2

What is Major Depression Disorder Categorized as ?

Answer 2

Mood disorder

Question 3

T or F

Anxiety and Depression might be related genetically because they’ve often associated with each other.

Answer 3

True

Question 4

What is a symptom of anxiety disorder for pre teens/ young children ?

Answer 4

Young children lack the vocabulary and insight to describe depressed mood

1. Headaches
2. Stomach aches
3. irritability
4. Hostility
5. Decline in schoolwork and relationships
6. May become reckless and impulsive.

Question 5

Major Depression

Age of onset:
Prevalence:
Gender ratio:
Comorbidity:

Answer 5

Typical age of onset: Late 20’s. Over the last 10 years, there’s been a spike in adolescent depression.

Prevalence rate: 8%

Gender ratio: women to men = 2:1

Comorbidity: One of the anxiety disorders, substance abuse disorder (drugs or alcohol), impulse control disorder, eating disorders.

Question 6

Depression Specifiers include :

Answer 6

1. Depression with peri-partum onset
2. Depression with season pattern
3. Depression with Psychotic features

Question 7

Depression with Peri-Partum Onset include:

Answer 7

1. Depression that comes on during pregnancy or shortly after childbirth (almost always after birth)

2.Increased risk for developing depression after childbirth if you’ve been depressed in the past and in particular if you’ve had it during the post-partum period in the past.

3. Don’t confuse this with Baby/Maternity Blues which is not considered a disorder and affects 80% of women
   Milder depressive symptoms
   Usually lasts a few days to two weeks and spontaneously remits.

Question 8

Define Depression with seasonal pattern:

Answer 8

Repeated relationship between onset of symptoms and the seasons (fall & winter; less sunlight)

Remission during spring and summer

Question 9

Define Depression with Psychotic Features:

Answer 9

With hallucinations and or delusions.

Question 10

What is the gender ratio in young children ?

Answer 10

Throughout early childhood the gender ratio is the same, then in teen years, 2:1 girls to boys.

Question 11

Name 2 facts about children who suffer from depression:

Answer 11

1. The earlier in life they develop depression, the more serious the disorder will be for them and the more likely it will be a life-long struggle. Parents are afraid to have children take medication or see therapist at a younger age.
2. Sometimes depression is misdiagnosed as ADHD, anxiety, or a behavioral disorder due to irritability and concentration issues

Question 12

Explain Persistent Depressive Disorder:

Answer 12

1. Milder form of depression (fulfils fewer DSM-5 criteria than depression)
2. Not episodic as depression is.
3. Typically lasts a minimum of two years without relief.
4. Most people suffer for years and don’t present themselves for treatment, they think this is how everyone feels, so never get diagnosed.
5. Higher risk for depression.

Question 13

Biological Perspective of Depression include:

Answer 13

1. Estimates are that about 40% of the cause of depression is due to genetic factors, the other 60% is the environment.
2. The earlier the age of onset and the more recurrent it is, usually, the higher the genetic loading.
3. When we talk about the levels of your neurotransmitters not being where they should be, that’s a genetic/inherited predisposition to develop a mood disorder.
4. Neurotransmitters being low

Question 14

Name 2 neurotransmitters involved in depression:

Answer 14

Neurotransmitters involved in depression: Serotonin & Norepinephrine, either levels too low or not being optimally utilized by the post-synaptic neuron.

Question 15

Common environmental factors that can be the trigger for those predisposed to depression:

Answer 15

1. Prolonged stress
2. Loss
3. Grief
4. Threats to relationships
5. Health and occupational difficulties

Question 16

Psychological Perspective for depression includes :

Answer 16

1.Psychodynamic Theory: Sigmund Freud
2. Attachment Theory: John Bowlby (1907-1990)
3. Behavioral Theory: B.F. Skinner (1904-1990)
4. Learned Helplessness: Martin Seligman
5. Cognitive Theory: Aaron Beck

Question 17

What was psychodynamic theory’s psychological perspective for major depression ?

Answer 17

1. Anger turned inward after experiencing loss, either real loss (death) or perceived loss (parent emotionally unavailable).
2. Freud looked at the behaviors of those who were depressed and thought they were similar to those who were grieving. Behaviors and feelings such as decreased self-esteem, inability to enjoy themselves, guilt, anger.
3. He concluded that those who were depressed had experienced a loss, either a concrete or perceived loss that they hadn’t emotionally acknowledged.

Question 18

What was attachment theory’s psychological perspective for major depression ?

Answer 18

1. Looked at the various types and stages of attachment between child and parent.
2. If something goes wrong along the attachment process when the child is very young, Bowlby saw this as leaving someone vulnerable to depression, anxiety, and attachment issues as adults.

Question 19

What was behavioral theory’s psychological perspective for major depression ?

Answer 19

1. As children they may get too many punishments, too few rewards for their behaviors.
2. As adults they duplicate that situation for themselves (surround themselves with people who put them down and don’t appreciate their strengths).

Question 20

What was learned helplessness psychological perspective for major depression ?

Answer 20

1. Looked at how people stop trying after repeated failures or abuse.
2. Repeated failures leads to feelings of helplessness and hopelessness, which leads to depression.

Question 21

Who conducted the learned helpless experiment and what did they do ?

Answer 21

Martin Seligman
Conducted experiment with dogs in 1975.

Question 22

What was cognitive theory psychological perspective for major depression ?

Answer 22

1. Believed depressed people have distorted and irrational thinking, all, or nothing (black & white) thinking, over-generalizing, catastrophizing, personalizing.
2. They develop a habit of thinking this way.
3. Negative thoughts cause us to have negative feelings, which cause us to behave in a negative way.
4. Thoughts lead to feeling with lead to behavior

Question 23

What are some facts about depression:

Answer 23

1. It’s estimated that only 50% of those depressed reach out for professional help.
2. 59% of U.S. mental health drug prescriptions are written by family doctors (PCP), not psychiatrists. PCPs have very little training in mental health (4-8 weeks, depending upon the medical school).
3. Some people are hesitant to admit that they’re depressed (stigma) or don’t know enough about depression to recognize it.
4. Some are hesitant to take medication.
5. Parents hesitant to treat teens with medication. Parents often believe that medication will always be part of the treatment when it may only be psychotherapy their child needs.
6. Psychotherapy may involve insurance coverage disparities.
7. If depression is mild to moderate, best practice suggests trying Cognitive Behavior Therapy (CBT) or Dialectical Behavior Therapy (DBT) first, then add medication if psychotherapy & lifestyle change is not providing enough relief.
8. For more severe depression, especially if there’s suicidal ideation, medication will probably be part of the treatment plan from the beginning, along with psychotherapy & lifestyle change.
9. Lifestyle change is crucial, and most often overlooked.

Question 24

Name some facts about psycho-therapy?

Answer 24

1. Psychotherapy is an umbrella term that refers to any type of talk therapy.
2. Generally delivered by psychologist, or LCSW, and rarely, by a psychiatrist (they’ve become more diagnosis/medication oriented).
3. Often meet weekly.
4. Work on more effective ways to deal with environmental factors, lifestyle change, developing awareness of the effect their thoughts, feelings and behavior are having on themselves and others, improve social skills deficits and lifestyle that contribute to depression.

Question 25

Name some facts about psycho-therapy:

Answer 25

1. Cognitive-Behavioral Therapy (CBT)
2. Client becomes aware of how they think.
3. Learn how to think differently.
4. Challenge hypothesis of your worse-case scenario.
5. Therapist gives homework (read a book on CBT, keep a journal, modify behavior, etc.)
6. Activity Scheduling
7. Identify situations that trigger depressive thoughts and feelings, modify thoughts surrounding them or change situation if possible.
8. This type of therapy focuses on the here and now, not the past
9. Client asked to identify a couple of specific problems they want to work on
10. Time-limited (specific number of sessions)
11. Behavioral portion focuses on increasing chances for rewards and avoiding punishing situations.

Question 26

Name some facts about Dialectical Behavior Therapy (DBT)

Answer 26

1. DBT is a type of therapy that combines cognitive-behavioral techniques foremotional regulation with the following 4 skills
2. Mindfulness Training Skills: Bringing one’s attention to the present moment, both internally and externally.
3. Distress Tolerance Skills: Learn to bear pain skillfully, acceptance of reality doesn’t mean approval of reality.
4. Interpersonal Effectiveness Skills: Assertiveness training. Most people are either too passive or too aggressive.
5. Emotional Regulation Skills: Learn techniques to regulate emotionality.

Question 27

Name 2 major types of antidepressants:

Answer 27

SSRI and SNRI

Question 28

Name some examples of SSRI’s:

Answer 28

1.Prozac
2.Lexapro
3.Celexa
4.Zoloft
5.Luvox

Question 29

Define Serotonin Norepinephrine Reuptake Inhibitors (SNRI’s):

Answer 29

inhibits the reuptake or reabsorption of serotonin & norepinephrine at the presynaptic neuron making more of it available to be absorbed by the postsynaptic neuron. SNRI’s also help with the physical symptoms of depression some individuals experience (aches and pains).

Question 30

Name some examples of SNRI’s:

Answer 30

1. Cymbalta
2. Effexor

Question 31

Define Selective Serotonin Reuptake Inhibitors (SSRI’s):

Answer 31

inhibits the reuptake or reabsorption of serotonin at the presynaptic neuron making more of the serotonin available to be absorbed by the postsynaptic neuron. Most commonly used antidepressants.

Question 32

Name some facts about SNRI and SSRI’s:

Answer 32

1. Take about 4-6 weeks to work.
2. Side effects: possible weight gain, decreases libido.
3. Never stop medications abruptly, severe anxiety if not weaned off slowly.
   4.If given to children and teens, small increased risk of suicide, important to be monitored very carefully, especially during the first month.

Question 33

Alternative Treatments For Treatment Resistant Depression, Often With Suicidality include :

Answer 33

1. ECT: Electro-Convulsive Therapy
2. Transcranial Magnetic Stimulation (TMS)

Question 34

ECT: Electro-Convulsive Therapy is only for individuals who fulfill the following three specific criteria:

Answer 34

1. severely depressed
2. actively suicidal
3. various medications and psychotherapy haven’t worked.

Question 35

Define Transcranial Magnetic Stimulation (TMS):

Answer 35

1. This is a noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression.
2. This treatment for depression involves delivering repetitive magnetic pulses.
3. TMS is typically only used for treatment resistant depression with suicidality.

Question 36

Theories of the Etiology/Causes of Depression include:

Answer 36

1. Biological Perspective:
2. Psychological Perspective:

Question 37

Name some facts about suicide:

Answer 37

1. 10th leading cause of death in US
2. 2nd leading cause for 10-24 year-olds (accidents is #1)
3. Unsure of actual rates due to possible misclassification of accidental deaths. (accidentally firing a gun)

Question 38

Define Passive suicidal ideation:

Answer 38

thinking about suicide or wanting to be dead, or more often wanting the pain to stop, but no plan.

Question 39

Define Active suicidal ideation:

Answer 39

includes plan as to where, how, and sometimes when.

Question 40

Suicidal Gestures include:

Answer 40

1. A term that refers to attempts at suicide that others mistakenly believe are not serious, such as wrist slashing, over-dosing.
2. Some refer to these individuals as not really wanting to die, just crying for help, but they are suicidal and should be taken seriously.
3. 40% of those who commit suicide, made previous attempts.
   All attempts should be taken seriously and require immediate attention.

Question 41

Define Covert Suicides:

Answer 41

Refers to the METHOD of suicide used that makes it difficult to know if it was a suicide or an accident.
Example: driving off the road on a rainy night, mixing drugs and alcohol.

Question 42

Give an example of covert suicides:

Answer 42

1. Driving off the road on a rainy night
2. Mixing drugs and alcohol.

Question 43

Explain the gender ratio for suicide:

Answer 43

1. Women 3X more likely to attempt suicide.
2. Men 3X more likely to complete the act.
3. Men use more lethal means such as hanging or guns.

Question 44

Risk factors for suicide:

Answer 44

1. Previous attempts
2. Existence of mood disorders such as depression, bipolar, substance abuse, conduct disorder
3. Availability of firearms!!!!
4. Family history of suicide. Family history contributes to both genetic and environmental factors (learned behavior).
5. Severe depression: 90% of those who attempt suicide are severely depressed.
6. Bipolar Disorder: 50% of those with bipolar disorder attempt suicide.

Question 45

They have higher rates of all mood disorders.

Answer 45

Creative population:

Question 47

Men use more lethal means like hanging or guns
Men tend to use more aggressive mean
Suicide is covert because people want to avoid

Question 48

What do people with suicidal ideation usually do ?

Answer 48

1. Telling others
2. Most people who are suicidal tell at least one other person.
   Often the person doesn’t take them seriously, or refuses to get involved, or tells them they’ll feel better in the morning, etc.
   The person being told about it should respond by erroring on the safe side.
   Never leave an actively suicidal person alone (if they have a plan).

Question 49

ECT is usually given to people along with:

Answer 49

1.Sedative
2. Shocks to the brain
3. Usually given to people who are hospitalized
4. Given until the person is no longer suicidal

Question 50

Suicide is a continuum of a feeling ranging from …

Answer 50

Passive suicidal ideation to Active suicidal ideation

Question 51

Can people with severe depression hide it?

Answer 51

NO

Question 52

Define contract for safety

Answer 52

A short-term promise the patient/client makes to the therapist not to harm themselves.

Question 53

Video of woman sitting down talking , learned helpless with school teacher,