Chapter 7 Mood Disorders and Suicide Flashcards
Mood disorders
- Depressive disorders, affective disorders, depressive neuroses
- Group of disorders involving severe and enduring disturbances in emotionality ranging from elation to severe depression.
- Experiences of depression and mania, either singly or together
Major depressive episode
- The most commonly diagnosed and most severe depression
- An extremely depressed mood state that lasts at least 2 weeks and includes cognitive symptoms and disturbed physical functions to the point that even the slightest activity or movement requires an overwhelming effort
- Is typically accompanied by a general loss of interest in things and an inability to experience any pleasure from life
- The most central indicators of a full major depressive episode are the physical changes (somatic or vegetative symptoms), along with the behavioral and emotional “shutdow”
- Anhedonia: loss of energy and inability to engage in pleasurable activities or have any “fun”
- Most common and severe experience of depression, including feelings of worthlessness, disturbances in bodily activities such as sleep, loss of interest, and the inability to experience pleasure, persisting at least two weeks.
Mania
- The second fundamental state in mood disorders is abnormally exaggerated elation, joy or euphoria
- Individuals find extreme pleasure in every activity
- Became extraordinarily active (hyperactive), require little sleep, and may develop grandiose plans, believing they can accomplish anything they desire.
- Persistently increased goal-directed activity or energy
- Speech is typically rapid and may become incoherent, because the individual is attempting to express so many exciting ideas at once- flight of ideas
- Require duration of only 1 week, less if the episode is severe enough to require hospitalization
- Irritability
- Being anxious or depressed
- The duration of an untreated manic episode is typically 3 to 4 months
- Dysphoric (anxious or depressive)
Hypomanic episode
- A less severe version of manic episode that does not cause marked impairment in social or occupational functioning and need last only 4 days rather than a full week
- Not in itself necessarily problematic, but its presence does contribute to the definition of several mood disorders
Mixed features
- An individual can experience manic symptoms but feel somewhat depressed or anxious at the same time; or be depressed with a few symptoms of mania
Major depressive disorder
- The absence of manic, or hypomanic episodes before or during the disorder
Recurrent
- If two or more major depressive episodes occurred and were separated by at least 2 months during which the individual was not depressed
- Predicting the future course of the disorder, as well as in choosing appropriate treatments
Persistent depressive disorder (dysthymia)
- Shares many of the symptoms of major depressive disorder but differs in its course
- May be fewer symptoms
- Depression remains relatively unchanged over long periods, sometimes 20 or 30 years or more
- Depressed mood that continues at least 2 years, during which the patient cannot be symptom free for more than 2 months at a time even though they may not experience all of the symptoms of a major depressive episode
- Differs from a major depressive disorder in the number of symptoms required, but mostly in the chronicity
- More severe
- With higher rates of comorbidity with other mental disorders
- Less responsive to treatment
- Slower rate of improvement over time
Double depression
- Severe mood disorder typified by major depressive episodes superimposed over a background of dysthymic disorder.
Severe mood disorder typified by major depressive episodes superimposed over a background of dysthymic disorder - 22% of people suffering from persistent depression with fewer symptoms (called dysthymia) eventually experienced a major depressive episode
- These individuals who suffer from both major depressive episodes and persistent depression with fewer symptoms
- Typically, a few depressive symptoms develop first, perhaps at an early age, and then one or more major depressive episodes occur later only to revert to the underlying pattern of depression once the major depressive episode has run its course.
Clinicians use eight basic specifiers to describe depressive disorders
- With psychotic features (mood-congruent or mood-incongruent)
- With anxious distress (mild to severe)
- With mixed features
- With melancholic features
- With atypical features
- With catatonic features
- With peripartum onset
- With seasonal pattern
- Some of these specifiers apply only to major depressive disorder. Others apply to both major depressive disorder and persistent depressive disorder.
Psychotic features specifiers
- Hallucinations
- Delusions
- Somatic physical delusions, believing
- Auditory hallucinations
- Mood congruent
- Delusions of grandeur
Hallucinations
seeing or hearing things that aren’t here
Delusions
Strongly held but inaccurate beliefs
Delusions of grandeur
Believing, for example, they are supernatural or supremely gifted
Anxious distress specifier
- The presence and severity of accompanying anxiety, whether in the form of comorbid anxiety disorders (anxiety symptoms meeting the full criteria for an anxiety disorder) or anxiety symptoms that do not meet all the criteria for disorders
Mixed features specifier
Predominantly depressive episodes that have several (at least three) symptoms of mania
Melancholic features specifier
- If the full criteria for a major depressive episode have been met, whether in the context of persistent depressive disorder or not.
- Some of the more severe somatic (physical) symptoms
Catatonic features specifier
- Can be applied to major depressive episodes whether they occur in the context of a persistent depressive order or not, and even to manic episodes, although it is rare- and rarer still in mania.
- Catalepsy
Catalepsy
- Absence of movement (a stuporous state)
- The muscles are waxy and semirigid, so a patient’s arms or legs remain in any position in which they are placed.
- Involve excessive but random or purposeless movement
- More commonly associated with schizophrenia, but some recent studies have suggested it may be more common in depression than in schizophrenia.
Atypical features specifier
- This specifier applies to both depressive episodes, whether in the context of persistent depressive disorder or not.
- Oversleep and overeat during their depression and therefore gain weight, leading to a higher incidence of diabetes.
- Although they also have considerable anxiety, they can react with interest or pleasure to somethings, unlike most depressed individuals.
- Is associated with a greater percentage of women and an earlier age of onset.
- Has more symptoms, more severe symptoms, more suicide attempts, and higher rate of comorbid disorders including alcohol abuse
Peripartum onset specifier
- Can apply to both major depressive and manic episodes
- Women giving birth
- After birth
Seasonal pattern specifier
- Recurrent major depressive disorder
2. Accompanies episedes that occur during certain seasons
Seasonal affective disorder (SAD)
- The most usual pattern is a depressive episode that begins in the late fall and ends with the beginning of spring
- Must have occurred for at least two years with no evidence of non seasonal major depressive episodes occurring during that period of time
Integrated grief
- Finality of death and its consequences are acknowledged and the individual adjusts to the loss
- Often recurs at significant anniversaires
Complicated grief
- Persistent intense symptoms of acute grief
- The presence of thoughts, feelings, or behaviors reflecting excessive or distracting concerns about the circumstances or consequences of the death
Premenstrual Dysphoric Disorder (PMDD)
- Suffered from severe and sometimes incapacitating emotional reactions during the premenstrual period
- Uncomfortable premenstrual symptoms (PMS)
- Combination of physical symptoms, severe mood swings, and anxiety
Disruptive Mood Dysregulation Disorder
- Severe recurrent temper outburst manifested verbally and/or behaviorally that are grossly out of proportion in intensity or duration to the situation or provocation
- Temper outbursts occur, on average, three or more times per week
- Persistently irritable or angry most of the day
Bipolar I Disorders
- Alternation of major depressive episodes with full manic episodes.
Bipolar II Disorders
- Alternation of major depressive episodes with hypomanic (not full manic) episodes.
Cyclothymic disorder
- Chronic (at least two years) mood disorder characterized by alternating mood elevation and depression levels that are not as severe as manic or major depressive episodes.
Learned helplessness theory of depression
- Seligman’s theory that people become anxious and depressed when they make an attribution that they have no control over the stress in their lives (whether in reality they do or not).
- Depression may follow marked hopelssness about coping with the difficult life events
- The depressive attributional style is internal, in that the individual attibutes negative events to personal failings; stable, in that even after a particuar negative event passes, the attribution that “additional bad things will always be my fault” remains; and global, in that the attibutions extend across a variety of issues.
Mood-stabilizing drug
- Lithium
- Effective in preventing and treating manic episodes
- Gold standard for treatment of bipolar disorder
- a medication used in the treatment of mood disorders, particularly bipolar disorder, that is effective in preventing and treating pathological shifts in mood
Electroconvulsive therapy (ECT)
- The most controversial treatment for psychological disorders after psychosurgery
- Biological treatment for severe, chronic depression involving the application of electrical impulses through the brain to produce seizures. The reasons for its effectiveness are unknown.
Cognitive therapy
Treatment approach that involves identifying and altering negative thinking styles related to psychological disorders such as depression and anxiety and replacing them with more positive beliefs and attitudes-and, ultimately, more adaptive behavior and coping styles.
Interpersonal psychotherapy (IPT)
Newer brief treatment approach that emphasizes resolution of interpersonal problems and stressors such as role disputes in marital conflict, or forming relationships in marriage or a new job. It has demonstrated effectiveness for such problems as depression.
Maintenance treatment
Combination of continued psychosocial treatment or medication designed to prevent relapse following therapy.
Suicidal ideation
Serious thoughts about committing suicide
Suicidal plans
the formulation of a specific method for killing oneself
Suicidal attempts
Efforts made to kill oneself; the person survives
Chological auopsy
Postmortem psychological profile of a suicide victim constructed from interviews with people who knew the person before death.
depressive cognitive triad
Aaron T. Beck’s theory that depression may result from a tendency to think negatively about three areas: oneself, one’s immediate world, and one’s future.
Dysthmic Disorder
Mood disorder involving persistently depressed mood, with low self esteem, withdrawal, pessimism or despair, present for at least two years, with no absence of symptoms for more than two months.
impacted/pathological grief reaction
Extreme reaction to the death of a loved one that involves psychotic features, suicidal ideation, or severe loss of weight or energy, or that persists more than two months.
mixed episode/dysphoric manic episode
Condition in which the individual experiences both elation and depression or anxiety at the same time.
neurohormones
Hormones that affect the brain and are increasingly the focus of study in psychopathology.
phototherapy
Treatment of seasonal affective disorder with large doses of exposure to bright light.
psychological autopsy
Postmortem psychological profile of a suicide victim constructed from interviews with people who knew the person before death.
list the types of suicide
altruistic, egoistic, anomic, and fatalistic
altruistic
brought dishonor to themselves or family
egoistic
loss of social support
anomic
marked disruptions
fatalistic
loss of control over one’s life
what disorder is time-limited?
major depressive disorder
most common and extreme mood disorder
major depressive episode
cyclothymic disorder is a milder but more chronic form of __________
bipolar disorder
Last week, as he does about every 3 months, Ryan went out with his friends, buying rounds of drinks, socializing until early morning, and feeling on top of the world. Today, Ryan will not even get out of bed to go to work, see his friends, or even turn on the lights.
Bipolar I disorder
Feeling certain he would win the lottery, Charles went on an all-night shopping spree, maxing out all his credit cards without a worry. We know he’s done this several times, feeling abnormally extreme elation, joy, and euphoria.
Mania
Ayana has had some mood disorder problems in the past, although some days she’s better than others. Many days it seems like she has fallen into a rut. Although she manages to get by, she has trouble making decisions because she doesn’t trust herself.
Persistent depressive disorder
For the past few weeks, Jennifer has been sleeping a lot. She feels worthless, can’t get up the energy to leave the house, and has lost a lot of weight. Her problem is the most common and extreme mood disorder.
Major depressive episode
Eusebio is always down and a bit blue, but occasionally he becomes so depressed that nothing pleases him.
Double depression
T or False- Women are approximately twice as likely as men to be diagnosed with a mood disorder.
True
T or False- Depression requires some life experience, indicating that babies and young children cannot experience the disorder.
False. It does not require life experience.
T or False- It’s often difficult to diagnose depression in the elderly because its symptoms are similar to those of medical ailments or dementia.
True
T or False- Somatic symptoms characterizing mood disorders are nearly equivalent across cultures.
True
List five biological sources that can contribute to mood disorders
Genetics, neurotransmitter system abnormalities, endocrine system, circadian or sleep rhythms, neurohormones
What psychological factors can have an impact on mood disorders?
Stressful life events, learned helplessness, depressive cognitive triad, a sense of uncontrollability
Name several social and cultural dimensions that contribute to mood disorders
Marital dissatisfaction, gender, few social supports
The controversial but somewhat successful treatment involving the production of seizures through electrical current to the brain.
Electroconvulsive therapy
This teaches clients to carefully examine their thought process and recognize “depressive” styles in thinking.
Cognitive therapy
These come in three main types (tricyclics, MAO inhibitors, and SSRIs) and are often prescribed but have numerous side effects.
Antidepressants
This antidepressant must be carefully regulated to avoid illness but has the advantage of affecting manic episodes.
Lithium
This therapy focuses on resolving problems in existing relationships and learning to form new interpersonal relationships.
Interpersonal psychotherapy
This is an effort to prevent relapse or recurrence over the long run.
Maintenance treatment
Ralph’s wife left him and took the children. He is a well-known television personality, but, because of a conflict with the new station owners, he was recently fired. If Ralph kills himself, his suicide would be considered___________.
Anomic
Sam killed himself while a prisoner of war in Vietnam
Fatalistic
Sheiba lives in a remote village in Africa. She was recently caught in an adulterous affair with a man in a nearby village. Her husband wants to kill her but won’t have to because of a tribal custom that requires her to kill herself. She leaps from the nearby “sinful woman’s cliff”
Altruistic
Mabel lived in a nursing home for many years. At first, her family and friends visited her often; now they come only at Christmas. Her two closest friends in the nursing home died recently. She has no hobbies or other interests. Mabel’s suicide would be identified as what type?
Egoistic
