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Psych Exam 3 > Chapter 7: Mood Disorders and Suicide > Flashcards

Chapter 7: Mood Disorders and Suicide Flashcards

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1
Q

Define Anhedonia

A

no interest in activities they previous found as fun

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2
Q

what are some themes surrounding depressive thoughts

A

worthlessness, guilt, hopelessness, and possible suicide

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3
Q

difference between hallucinations and delusions

A

hallucinations: false perceptions

delusions: false beliefs

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4
Q

pyschomotor agitation and retardation

A

physical symptoms of depression, cause individuals to not be able to sit still, fidget or move vary slowly

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5
Q

what symptoms must be present for a Major Depressive Disorder diagnosis

A
  1. depressed mood or loss of interest in usual activities
  2. at least four other symptoms
  3. chronic for at least 2 weeks
  4. interfere with person’s ability to function in everyday life
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6
Q

some statistics about MDD

A
  1. 70% of those diagnosed have another psych disorder at the same time (most common substance abuse, anxiety disorders, and eating disorders
  2. most common mental health disorders (leading cause of disability and morbidity)
  3. 7% of US adults diagnosed with
  4. reported higher in females (8.7%) compared to males (5.3%)
  5. 1/2 of those who take meds fail to respond and its very hard to gain full remission very likely to continue to have depressive episodes
  6. average individual experiences 4 episodes that last 14-17 weeks for a mild and 23 weeks for severe
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7
Q

what are the specifiers of Depression

A
  1. anxious distress
  2. mixed feature (have at least 3 symptoms of mania but not full diagnosis)
  3. melancholic (physiological symptoms)
  4. psychotic (delusions and hallucinations)
  5. catatonic features (lack of movement to excited agitation)
  6. atypical (odd symptoms)
  7. seasonal (start fall/winter and resolve by spring)
  8. peripartum
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8
Q

persistent depressive disorder

A

depressed mood for most of day and more days than not for at least 2 years
- in adolescents must be for a year
- has to include 2+ of these symptoms:
1. poor appetite
2. insomnia or hypersomnia
3. low energy
4. low self-esteem
5. poor concentration
6. hopelessness

cant be without symptoms for more than 2 months during the 2 years

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9
Q

what percent around the world suffers from Premenstrual dysphoric disorder

A

2-8%

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10
Q

what are the comorbidities with PMDD (premenstrual)

A
  1. GAD
  2. agoraphobia
  3. social phobia
  4. bipolar
  5. PTSD
  6. major depression
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11
Q

Disruptive mood dysregulation disorder

A

negative mood, severe outburts - previously misdiagnosed as bipolar
- should only apply to those 6-18
-frustrations are usually shown physically
-comorbid with: oppositional defiant disorder, conduct disorder, ADHD, learning difficulties, depression, social issues
- usually treat with meds and CBT possible exposure therapy (to frustrating situations)
- prevalence 2-5%
- more seen in school ages males

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12
Q

psychological resilience

A

psychosocial process where exposed to sustained adversity or potentially traumatic events experience positive psych adaptation over time
- significant factor in lower rates of depression in minority racial groups

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13
Q

what are the four types of bipolar disorder

A
  1. bipolar (I)
  2. bipolar (II)
  3. cyclothymic
  4. rapid cycling
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13
Q

MDD in children and adolescents

A
  • 12.8% of adolescents in US struggle with and 70% of depressive episodes cause functional impairment.
  • have different signs than adults so can go under-recognized
  • prevalence: 0.5% in children 3-5, 2% in 6-11 and 12% 12-17yrs
    -during childhood diagnosis is equal between females and males but after puberty females have increased rates
    -treatment: psychotherapy, antidepressant meds (SSRIs, prozac) 96.4% successfully recover from episode when using both
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14
Q

what is a manic episode

A

abnormal and persistent elevated or irritable mood with goal-directed activity or energy lasting at least 1 week
- impulsive behaviors, rapid speech, and racing thoughts

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15
Q

define euthymia

A

balanced mood state

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16
Q

characteristics of Bipolar 1 disorder

A

experience full manic and depressive episodes
- the depressive episodes can be as bad as MDD or less severe
- can have full criteria of manic episodes and 3 key symptoms of MDD same day, for 1 week

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17
Q

characteristics of cyclothymic disorder (less severe but more chronic form of bipolar 2 W/O major depressive episodes

A

some hypomanic symptoms and depressive symptoms chronically for at least 2 years
- not full bipolar, hypomania or depressive diagnosis so they are given this diagnosis
- hypomania seems to not interfere with daily living but depressive episodes can mess with daily functioning
- rarely diagnosed but more often in children and adolescents

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17
Q

characteristics of Bipolar 2 disorder

A
  • have hypomania (mild mania) not severe enough to interfere with daily functioning no hallucinations or delusions and at least 4 days (not week)
  • must experience MDD episodes unlike bipolar 1 which they can have
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17
Q

bipolar in children

A

no full criteria for a childhood bipolar disorder but curious if they can provide interventions earlier to stop full bipolar.
- can have rapid mood changes and those children are at risk for anxiety and depression later in life but not as likely to develop classic bipolar disorder
- hard to distinguish impulsive behaviors from ADHD

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17
Q

characteristics of rapid cycling bipolar disorder

A

4+ episodes meeting manic, hypomanic, or MDD criteria within 1 year
- have poorer prognosis and greater disease burden
-25% experience depressive or manic episodes seasonal

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18
Q

statistics of bipolar disorder

A

2.8% annual prevalence in US
- equally likely between males and females
- symptoms usually present late adolescence or early adulthood average onset 25
- repeated depressive episodes is associated with more negative impact

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19
Q

bio theories of depression

A
  • 20% prevalence worldwide
  • 3-4X more likely if first degree family member is diagnosed
  • genetic correlation with anorexia nervosa, ADHD, schizophrenia, and bipolar
  • serotonin, monoamines,
    norepinephrine abnormalities
  • could be problem in synthesizing these neurotransmitters like tryptophan and tyrosine
    -postsynaptic neuron could be less sensitive or malfunction
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20
Q

structural and functional brain abnormalities

A

-prefrontal cortex (attention, working memory, planning, novel problems solving) anterior cingulate, hippocampus, and amygdala
- neural plasticity problems
- smaller value of grey matter in prefrontal cortex particularly left side which is the side associated with motivation and goal orientation
- anterior cingulate is a subregion of the prefrontal cortex and has a role in body’s stress response, emotional expression, and social behavior
- hippocampus: memory and fear-related learning usually smaller and less active in depressive individuals could be due to increased levels of cortisol
- amygdala is important for directing attention to stimuli that have emotional significance for individual could potentially be reason for rumination over negative memories

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21
Q

neuroendocrine factors of depression

A
  • chronic hyperactivity of HPA axis and idea that minor stresses cause an overreaction and is not easily able to return to baseline which disrupts monoamine neurotransmitters and depressive episodes in likely to happen next
22
Q

define adverse childhood experiences (ACEs)

A

physical, sexual, or psychological abuse neglect or living in dysfunctional household prior to 18
-associated with chronic conditions like depression, smoking, and alcohol use

23
Q

gut microbial and depression

A

disruption to balance in gut microbial could lead to imbalance in neurotransmitters, inflammation, heightened HPA axis and stress response.

24
Q

inflammation and depression

A

neuroinflammation can occur in the brain or spinal cord due to stress, injury, infection, or disease
- reducing inflammation could have benefit for MDD

25
Q

behavioral theories on depression: focus on how uncontrollable stressor produce depression

A
  • life stress can reduce positive reinforcers once they begin these behavior they are reinforced from sympathy and attention they receive from others
  • learned helplessness theory: uncontrollable negative event is most likely to cause depression
  • protective factor to lessen helplessness is psychological flexibility
  • ruminative thinking
  • tend to store and recall generalized memories to cope with traumatic event because it doest hold same emotion as a concrete example
26
Q

define hopelessness depression

A

pessimistic attributions for most important events in life and perceive that they will have no way to cope with consequences

27
Q

interpersonal theories

A

may have difficulty with relationships and how to communicate and socialize.
- rejection sensitivity and want constant reassurance from family and friends

28
Q

sociocultural theories of depression

A

focuses on how social conditions differ between demographic groups and could lead to difference in depression vulnerability

  • cohort effect: differences in psych variables based on era they were born and lived. Today people are more open about the topic and have more stimuli to become depressed.
  • gender differences: women 2x as likely as men women are more likely to ruminate, base self worth on relationships and feel more stressed when relationships are not going well
  • ethnic racial differences: culture origin, 1st vs 2nd generation, and acculturation youth native Americans are highest rate
29
Q

bio theories of bipolar disorder

A

2/3 shared genetic influence between MDD, schizophrenia, and bipolar
- family history most powerful predictor
- 5-10x more probable if first degree relative has.

30
Q

structural and functional brain abnormalities in bipolar disorder

A
  • amygdala (processing emotions), prefrontal cortex (planning, judgement, emotion), possible smaller hippocampus
  • abnormalities in striatum (basal ganglia) and processing rewards but not consistently working incorrectly:
  • during mania will be excessively focused on reward, depressive phase does not care about reward,
  • possible in children to have issue with white matter in prefrontal cortex which makes it difficult for areas of brain to communicate and lead to disorganized emotions and extreme behavior
31
Q

neurotransmitter factors of bipolar disorders

A

dopamine thought to have significant impact on this disorder, when you have too much its associated with the manic period of high reward seeking and when low its associated with the depressed phase of lack of reward seeking

32
Q

psychosocial contributors to bipolar disorder

A
  • focuses on changes in reward sensitivity, stress, bodily and social routines
  • higher sensitivity to rewards = manic
  • higher sensitivity to punishment = depression
  • changes to circadian rhythm (changes to routine) can flair disorder could use social rhythm therapy
33
Q

bio treatment for mood disorders: drugs, ECT, rTMS, VNS, SAD

A
  • drugs: will help lower symptoms in 50-60% of those who take them. will want to continue for longer than 6-9 months because if stopped during this time frame you double your risk of relapse in severe depression
    -SSRIs usually most prescribe because it have fewer difficult side effects can also help with other disorders like anxiety, impulsiveness, eating disorders
  • however they still have side effects such as gastrointestinal symptoms, insomnia, nervousness, diminished sex drive, could cause someone to have manic episode
    -SNRIs: slight advantage because they also impact norepinephrine and serotonin
    -bupropion (impact norepinephrine and dopamine) by increases amount of these neurotransmitters throughout brain. can help with psychmotor retardation, anhedonia (inability to feel pleasure), inattention, craving, etc
    doesnt seem to inhibit sexual drive like SSRIs and others
  • tricyclic: nots as prescribe anymore very easy to overdose and have negative health side effects
  • monoamine oxidase inhibitors: causes breakdown of monoamine in synapse can have fatal rise in blood pressure after consuming aged cheese, red wine, and beer
34
Q

mood stabilizers

A

can help to lessen symptoms of mania
-lithium: only substanct to prevent new depressive and manic episodes and reduce suicidal thoughts )alters catecholamines and serotonin and abnormal intracellular processes)
but has many side effects and very small difference between therapeutic dosage and toxic dosage
-anticonvulsant medications usually used for seizures but seen helpful in bipolar. valproate seems to have the lowest side effects, lamotrigine used for maintenance treatment but can cause birth defects if taken by pregnant women
-atypical antipsychotic meds: reduce functional levels of dopamine and help psychotic manic symptoms

35
Q

electroconvulsive therapy

A

induce seizure from electrical current through brain
- 50-80% of clients achieve remission and higher rates compared to medications
- idea that is induces plasticity in areas such as hippocampus, anterior cingulate, basal ganglia, etc
- can cause memory loss and difficulty learning new information, so now administer usually on right side of brain which is less involved in these functions

36
Q

repetitive transcranial magnetic stimulation

A
  • repeated high intensity magnetic pulses focused on particular brain structure
  • depression: target left prefrontal cortex
37
Q

vagus nerve stimulation

A

surgically implanting a brain stimulator at vagus nerve. has good outcomes but hard to receive surgery because rarely covered by insurance

more invasive option: deep brain stimulation where they place stimulators are specific areas of brain all towards helping symptoms of depression

38
Q

light therapy

A

can help those with SAD (seasonal depression) who are more sensitive to changes in amount of light they receive each day
- 57% with light therapy had remission
- 79% remission with light therapy and CBD
- could directly increase levels of serotonin

39
Q

psych treatments for mood disorders: behavioral therapy

A
  • increase positive reinforcements by decreasing adverse experiences in individuals life with environment and others (what situations make the person feel better? worse?)
  • CBT: goals to change hopeless patterns of thinking and solve problems to develop skills to become more effective in world, identify habitual negative thoughts and how they are connected to their depression. want them to challenge their negative thoughts and identify their basic beliefs that may be fueling their depression. possibly help unassertiveness,
  • Interpersonal therapy: look at four problems: grieving loss of someone (not just death), interpersonal role disputes ( not agreeing on role in relationship), role transition (college student to full time employee), deficits in interpersonal skills
40
Q

interpersonal and social rhythm therapy

A

only in bipolar disorders treatment and is combination of interpersonal therapy and behavioral techniques to maintain regular sleeping, eating, activity, and personal relationships

41
Q

family focused therapy

A

can be positive addition to psychosocial treatment because of strong impact of social environment on mental health. trained in bipolar disorders communication and problem-solving skills

42
Q

comparison of treatments for mood disorders

A
  • thought different therapies target different parts of disorder they all seem to be effective in treatment
  • best when you can combine treatments, but if just using one type the most effective: behavioral, cognitive, drug
  • possible to have “maintenance” therapy of appointments once a month or staying on drug
    -preventative programs
43
Q

suicide

A
  • 3 leading causes of death worldwide for those 15-44, 10th leading cause in US
  • suicide attempts for 20x more common than completed suicide
  • 3x more likely for males than females contributing factors: less likely to receive diagnosis and help, more lethal ways of suicide (firearms)
  • common ways based on gender: females 10-24 hanging, 25-44 firearms, 45 and older poisoning
    males: 10-14 equal between suffocation and firearms and more likely to use firearms with increasing age
44
Q

racial/ ethnic differences in suicide

A

african americans more likely at a younger age compared to caucasians
- harmful impact of discrimination with poor coping mechanisms
- highest rates in Europe, china, former soviet union and lower in latin america and south american, US, austrailia, candana, and england fall in middle

45
Q

suicide in children and adolescents

A
  • 2nd leading cause of death 10-18
  • risk factors: mental health problems, bio factors, family problems, peer victimization and bullying
  • 10x more likely if you have self-harmed in last 6 months
  • males in this age are 6x more likely to commit suicide
  • feelings of hopelessness and depression are more linked to suicide ideation
  • history of self-harm and alcohol more likely to attempt suicide
  • hispanic females highest rates of ideation and attempts
46
Q

LGBTQI

A
  • face prejudice, denial of civil rights, human rights, harassment and family rejection
  • more likely if they have experiences isolation from family and friends, history of mental health disorder, bullying and abuse
    -2-6x higher than their heterosexual counterparts
  • 85% report verbal harassment in school, 40% in higher frequency, 27% physically
  • LGBTQ are 2x as likely to experience suicide ideation and depressive symptoms compared to hetersexual peers, and transgender are 2x as likely as LGBTQ individuals
  • even in adults transgender individuals 4x as likely to experience mental health conditions
47
Q

college students

A
  • suicide 2nd leading cause of death among traditionally aged college students
  • 10% seriously consider, with 1.5% engaging in the behavior
  • psych programs at school have been created to provide service and those are seek help are usually 3x more likely than school peers to report high suicide ideation, 5x more likely to have a previous suicide attempt
48
Q

suicide in older adults

A
  • older men more likely: European American men over 85
  • more successful than younger individuals who attempt
  • highest during first year after losing loved ones/ spouse
  • escape from illness and disabilities (dont want to be a burden to others)
  • 44% said they did not want to be put in a nursing home and would rather be dead
  • could also be do to diminished cognitive abilities like problem solving and resisting impulses
49
Q

non-suicidal self-injury

A

inflicting significant injuries to one’s self without intent to die
- lifetime prevalence 18% internationally (17% adolescents, 13% young adults, 5.5% adults)
- way to regulate emotions and control/influence social environment

50
Q

understanding suicide: psych disorders and suicide

A

-90% of those who commit suicide have been suffering from a diagnosable mental disorder
- depression: 6x more likely

(1 in four for bipolar 1 have attempted, 1 in 5 for bipolar 2)
-bipolar: 7x

51
Q

stressful life events and suicide

A
  • more likely if one has experienced: abuse, interpersonal loss, perceived failure, economic hardship, physical illness
  • childhood sexual abuse: women 2-4x more likely, men 4-11x
  • jobs: more common african american men who are in communities where occupational and income inequalities are greatest
52
Q

suicide cluster

A

2+ suicides or attempts occur together in space or time (usually in adolescents)

53
Q

suicide and media

A

can have a postive impact if you should those overcoming their obstacles
- but if using suicide contagion when the events of a celebrity are dramatic
- posts on social media that discuss parts of suicide get more views then those that do not
- the more exposure you have the more acceptable the behavior becomes

54
Q

bio factors in suicide

A
  • children of those who have attempted suicide are 6x more likely to try as well compared to those who’s parents have not

-5.6% times if monozygotic twin has and 4x for dizygotic

  • low levels of serotonin
54
Q

personality and cognitive factors in suicide

A
  • impulsivity, especially when those are struggling with mental health as well
  • hopelessness (feelings like a burden to others and never belonging with others) could also be reason why some do not seek treatment
55
Q

Treatment of suicidal persons

A
  • can be involuntarily hospitalized for short period
  • have crisis intervention to reduce imminent suicide attempt
  • dialectical behavioral therapy to help those with borderline personality disorder who frequently attempt suicide through managing negative emotions and control impulsive behavior
56
Q

Suicide attempt stats

A

71% of cases happen within 1 hr of deciding
24% of cases within 5 minutes
Presence of gun 4-5x more likely for suicide if in home

57
Q

What to do if friend is suicidal

A

1 take them serious
2 get help
3 express concern
4 pay attention
5 ask direct question about their plan
6 acknowledged feelings in none judge mental way
7 reassure things can get better
8 don’t promise confidentiality
9 make sure self harms things are not available
10 try not to leave them alone
11 take care of yourself

Psych Exam 3 (4 decks)

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