Chapter 7: Mood Disorders and Suicide Flashcards
(196 cards)
1
Q
How do mood disorders differ from feeling depressed from time to time?
A
Mood disorders involve much more severe alterations in mood for much longer periods of time. In such cases the disturbances of mood are intense and persistent enough to lead to serious problems in relationships and work performance.
2
Q
What are the two key moods involved in mood disorders?
A
Depression and Mania.
3
Q
Out of the two key moods, how can depression best be described?
A
Involves feelings of extraordinary sadness and dejection
4
Q
Out of the two key moods, how can mania best be described?
A
Involves intense and unrealistic feelings of excitement and euphoria.
5
Q
What is it called when individuals have symptoms of mania and depression (the person experiences rapidly alternating moods such as sadness, euphoria, and irritability, all within the same episode of illness) during the same time period?
A
Mixed-episode cases.
6
Q
Name the types of mood disorders.
A
Unipolar depressive disorders and bipolar and related disorders.
7
Q
What is a unipolar depressive disorder?
A
Person experiences only depressive episodes
8
Q
What is a bipolar and related disorder?
A
Person experiences both depressive and manic episodes
9
Q
What episode is the most common form of mood disturbance?
A
A depressive episode, in which a person is markedly
depressed or loses interest in formerly pleasurable activities (or both) for at least 2 weeks, as well as other symptoms such as changes in sleep or appetite, or feelings of worthlessness (as opposed to a manic episode)
10
Q
What is a manic episode?
A
Person shows a markedly elevated, euphoric, or expansive mood, often interrupted by occasional outbursts of intense irritability or even violence—particularly when others refuse to go along with the manic person’s wishes and schemes.
Moods must persist for at least a week for this diagnosis to be made.
Three or more additional symptoms must occur in the same time period, ranging from behavioral symptoms (such as a notable increase in goal-directed activity), to mental symptoms where self-esteem becomes grossly inflated and mental activity may speed up (such as a “flight of ideas” or “racing thoughts”), to physical symptoms (such as a decreased need for sleep or psychomotor agitation).
11
Q
What is a hypomanic episode?
A
Person experiences abnormally elevated, expansive, or irritable mood for at least 4 days.
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.).
Although the symptoms listed are the same for manic and hypomanic episodes, there is much less impairment in social and occupational functioning in hypomania, and hospitalization is not required.
12
Q
Prevalence of mood disorders?
A
Major mood disorders occur with alarming frequency—at least 15 to 20 times more frequently than schizophrenia
13
Q
Of the two types of serious mood disorders, what is the most common?
A
Of the two types of serious mood disorders, major depressive disorder (MDD), in which only major depressive episodes occur (also known as unipolar major depression), is the most common, and its occurrence has apparently increased in recent decades
14
Q
Is unipolar major depression higher for women or men?
A
Women
15
Q
Beside Major Depressive Disorder (MDD), what is the other type of major mood disorder?
A
Bipolar disorder.
16
Q
Is bipolar disorder more or less common than major depressive disorder?
A
Less.
17
Q
What is the lifetime risk of developing (classic) bipolar?
A
Less than 1%.
18
Q
Is there a difference in the lifetime risk of developing (classic) bipolar between the sexes?
A
No.
19
Q
T or F: Rates of unipolar depression are inversely related to socioeconomic status (SES); that is, higher rates occur in lower socioeconomic groups?
A
True. Epidemiologic research indicates that rates of
unipolar depression are inversely related to socioeconomic status (SES); that is, higher rates occur in lower socioeconomic groups.
20
Q
Why might rates of unipolar depression be inversely related to socioeconomic status (SES); that is, higher rates occur in lower socioeconomic groups?
A
Low SES leads to adversity and life stress
21
Q
What has new research discovered about bipolar and SES?
A
That it is not related.
22
Q
T or F: To be diagnosed with MDD, you cannot have manic, hypomanic, or mixed episodes.
A
True.
23
Q
T or F: Anxiety is often comorbid with all types of depression.
A
True. Few if any depressions—including milder ones—occur in the absence of significant anxiety.
24
Q
What also happens when a diagnosis of MDD is made?
A
When a diagnosis of MDD is made, it is usually also specified whether this is a first, and therefore single (initial), episode or a recurrent episode (preceded by one or more previous episodes).
25
How long do depressive episodes last if left untreated?
6 to 9 months
26
If symptoms of MDD do not remit over 2 years, what is diagnosed?
If the symptoms of MDD do not remit for over 2 years, in which case persistent depressive disorder is diagnosed
27
What percentage of people get diagnosed with persistent depressive disorder after symptoms do not remit?
10 to 20 percent
28
How long do symptoms have to be gone to be considered "remitted" from most depressive episodes?
At least two months.
29
The return of symptoms (depressive episodes) can be one of two types. What are the two types?
Relapse and recurrence.
30
What is relapse? (referring to depressive episodes).
Relapse refers to the return of symptoms within a fairly short period of time, a situation that probably reflects the fact that the underlying episode of depression has not yet run its course
31
What is recurrence? (referring to depressive episodes).
The onset of a new episode of depression
32
Regarding recurrence (for depressive episodes), what percentage of people does this occur?
Occurs in approximately 40 to 50 percent of people who experience a depressive episode
The probability of recurrence increases with the number of prior episodes and also when the per-son has comorbid disorders.
33
When is the onset of unipolar depressive disorders most likely to occur?
The onset of unipolar depressive disorders most often occurs during late adolescence up to middle adult-hood, but such reactions may begin at any time from early childhood to old age.
34
What percentage of adolescents experience major depressive disorder at some point?
15-20%
35
When do sex differences in rates of depression first emerge?
In adolescence
36
T or F: Major depression that occurs in adolescence is very likely to recur in adulthood.
True.
37
What are specifiers (in the DSM-5)?
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 its most effective treatment.
38
What are the five specifiers outlined in the DSM-5 for MDD?
MDD with melancholic features/psychotic features/atypical features/catatonic features/seasonal pattern.
39
What is MDD with melancholic features?
This designation is applied when, in addition to meeting the criteria for a major depressive episode, a patient either has lost interest or pleasure in almost all activities or does not react to usually pleasurable stimuli or desired events.
40
What is MDD with psychotic features?
Psychotic symptoms, characterized by loss of contact with reality and delusions (false beliefs) or hallucinations (false sensory perceptions), may sometimes accompany other symptoms of major depression (severe major depressive episode with psychotic features).
Ordinarily, any delusions or hallucinations present are mood congruent—that is, they seem in some sense appropriate to serious depression because the con-tent is negative in tone, such as themes of personal inadequacy, guilt, deserved punishment, death, or disease.
Individuals who are psychotically depressed are likely to have longer episodes, more cognitive impairment, and a poorer long-term prognosis than those suffering from depression without psychotic features
41
What is MDD with atypical features?
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.
42
What is MDD with catatonic features?
A range of psychomotor symptoms from motoric immobility to extensive psychomotor activity, as well as mutism and rigidity
43
What is MDD with seasonal pattern?
Used when individuals who experience recurrent depressive episodes show a seasonal pattern, recurrent major depressive episode with a seasonal pattern, also commonly known as seasonal affective disorder.
At least two or more episodes in past 2 years that have occurred at the same time (usually fall or winter), and full remission at the same time (usually spring). No other nonseasonal episodes in the same 2-year period.
44
What type of MDD-specifier combination is more heritable than most other forms of depression and is often associated with a history of childhood trauma?
Major depressive episode with melancholic features
45
How do you treat MDD with psychotic features?
With psychotic medication or antidepressants.
46
Which sex is more likely to have MDD with atypical features?
A disproportionate number of individuals who have atypical features are females, who have an earlier-than-average age of onset and who are more likely to show suicidal thoughts
47
What disorder is MDD with atypical features linked to?
Atypical depression is linked to a mild form of bipolar disorder that is associated with hypomanic rather than manic episodes
48
Why is MDD with atypical features important?
There are indications that individuals with atypical features may preferentially respond to a different class of antidepressants—the monoamine oxidase inhibitors—than do most other individuals with depression.
49
What is Catatonia considered to be a sub-type of?
Catatonia is known more as a sub-type of schizophrenia, but it is actually more frequently associated with certain forms of depression and mania than with schizophrenia
50
What do prevalence rates suggest about winter seasonal affective disorders?
That winter seasonal affective disorder is more common in people living at higher latitudes (northern climates) and in younger people.
51
What is persistent depressive disorder?
A disorder characterized by persistently depressed mood most of the day, for more days than not, for at least 2 years (1 year for children and adolescents).
In addition, individuals must have at least two of 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 2 months). This is the biggest distinguisher between MDD and PDD.
52
T or F: Because of its chronic course people with persistent depressive disorder show poorer outcomes and as much impairment as those with MDD
True.
53
When PDD and MDD co-occur, what is this condition called?
Double depression
54
In the DSM-5, what is double depression classified under?
In the DSM, double depression is classified as a form of persistent depressive disorder.
55
T or F: Persistent depressive disorder is quite common.
True. Persistent depressive disorder is quite common, with a lifetime prevalence estimated at between 2.5 and 6 percent
56
What is the average duration of PDD?
The average duration of persistent depressive disorder is 4 to 5 years, but it can last for 20 years or more
57
When does PDD often begin?
Persistent depressive disorder often begins during adolescence, and over 50 percent of those who present for treatment have an onset before age 21.
58
T or F: Depressions are nearly always precipitated by stressful life events.
True. These dramatic events often can push a person into a depressive episode, and psychologists have struggled with how to appropriately diagnose (or not) a person’s response to them.
59
Bowlby’s (1980) classic observations revealed that there are usually four phases of normal response to the loss of a spouse or close family member. What are they?
(1) numbing and disbelief
(2) yearning and searching for the dead person
(3) disorganization and despair that sets in when the person accepts the loss as permanent
(4) some reorganization as the person gradually begins to rebuild his or her life.
60
T or F: All loss is followed by depression.
False.
61
What do recent studies show on those experiencing loss of a spouse, life partner, or parent?
Recent studies of those experiencing the loss of a spouse, life partner, or parent reveal that about 50 percent 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
62
T or F: Recent research has found that postpartum depression is more common that postpartum blues.
False. In the past it was believed that postpartum major depression in mothers was relatively common, but more recent evidence suggests that only “postpartum blues” are very common.
63
What are postpartum blues?
Symptoms of postpartum blues typically include changeable mood, crying easily, sadness, and irritability, often liberally intermixed with happy feelings
64
What percentage of women do postpartum blues occur in?
As many as 50 to 70 percent of women within 10 days of the birth of their child and usually subside on their own
65
T or F: There is a greater likelihood of developing major depression after the postpartum blues—especially if they are severe.
True.
66
T or F: Postpartum blues or depression may be especially likely to occur if the new mother has lack of social support or has difficulty in adjusting to her new identity and responsibilities
True.
67
T or F: Postpartum blues or depression may be especially likely to occur if the woman has a personal or family history of depression that leads to heightened sensitivity to the stress of childbirth
True.
68
T or F: Family studies have shown that the prevalence of mood disorders is approximately two to three times higher among blood relatives of persons with clinically diagnosed unipolar depression than it is in the population at large.
True.
69
T or F: Twin studies suggest that there is a moderate genetic contribution to MDD.
True.
70
Although attempts to identify specific genes that are responsible for genetic influences on mood disorders have been unsuccessful thus far, what is one specific gene that may be implicated?
The serotonin-transporter gene.
71
What does the serotonin-transporter gene do?
It is involved in the transmission and reuptake of serotonin, which is one of the key neurotransmitters involved in depression.
72
Regarding the serotonin-transporter gene, what are the two different kinds of versions or alleles that are involved?
The short allele (s) and the long allele (l).
73
Regarding the short allele (s) and the long allele (l), what compositions usually show in humans?
People either have two short alleles (s/s), two long alleles (l/l), or one of each (s/l).
74
What does previous work with animals suggest about the alleles involved in the serotonin-transporter gene?
Although previous work with animals has suggested that having ss alleles might predispose a person to depression (in comparison to someone having l/l alleles), human work on this issue has provided mixed results.
75
T or F: The monoamine theory of depression - that depression was at least sometimes due to an absolute or relative depletion of one or both of the monoamine neurotransmitters (serotonin and norepinephrine) at important receptor sites in the brain - is still influential to this day.
False. It was one influential - in the 1980s, it was clear that no such straightforward mechanism could possibly be responsible for causing depression.
It has not be replaced with an alternative explanation.
76
Why does dopamine dysfunction have a significant role in some forms of depression, including depression with atypical features and bipolar depression?
Because dopamine is prominently involved in the experience of pleasure and reward - which would impact the prominence of anhedonia (the inability to experience pleasure).
77
The human stress response is associated with elevated activity of the...
Hypothalamic-pituitary-adrenal (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 corticotrophin-releasing hormone (CRH) from the hypothalamus, which in turn, triggers the release of adrenocorticotrophic hormone (ACTH) from the pituitary.
The ACTH then typically travels through the blood to the adrenal cortex of the adrenal glands, where cortisol is released.
78
T or F: Patients having depression with elevated cortisol also tend to show memory impairments and problems with abstract thinking and complex problem solving.
True.
79
Patients having depression with elevated cortisol also tend to show memory impairments and problems with abstract thinking and complex problem solving. Why might this be the case?
This may be due to prolonged elevation in cortisol results in cell death in the hippocampus - a part of the limbic system heavily involved in memory functioning.
80
What other endocrine axis, besides the hypothalamic-pituitary-adrenal (HPA) axis, is relevant to depression and why?
The hypothalamic-pituitary-thyroid axis. People with low thyroid levels (hypothyroidism) often become depression.
81
T or F: Depression is associated with activation of the inflammatory response system as evidenced by increased production of pro-inflammatory cytokines (interleukin and interferon).
True. Both interleukin and interferon can contribute directly to the development of depressive symptoms.
82
T or F: Damage to the right side, as opposed to the left side, of the anterior prefrontal cortex often leads to depression.
False. Damage to the left often leads to depression.
83
T or F: People with depression show lower activity in the left hemisphere and higher activity in the right hemisphere.
True. The relatively lower activity on the left side of the prefrontal cortex in depression is thought to be related to symptoms of reduced positive affect and approach behaviours to rewarding stimuli, and increase right-side activity is thought to underlie increased anxiety symptoms and increased negative affect associated with increased vigilance for threatening information.
84
T or F: The orbital prefrontal cortex (involved in response to reward) shows decreased volume with recurrent depression.
True.
85
T or F: Lower activity in the dorsolateral prefrontal cortex has been observed in depressed individuals.
True.
86
T or F: The anterior cingulate cortex (involved in selective attention) does not show decreased volume or abnormally low levels of activation in patients with depression.
False.
87
What is REM sleep (rapid eye movement 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 75-80 minutes into sleep. This normal sleep-wake cycle is thought to be regulated by the suprachiasmatic nucleus of the hypothalamus.
88
T or F: People with depression have the reduced latency to enter REM sleep and also have decreased amount of deep sleep.
True.
89
What are circadian rhythms?
Circadian rhythms are a type of biological clock that the body uses to respond appropriately to the changing environment.
90
T or F: Light therapy is less effective, although more cost effective, than medication for seasonal affective disorder.
False.
91
T or F: The suggestion that hormonal factors such as normal fluctuations in ovarian hormones account for sex differences in depression are true.
False. There has been inconsistent results that are overall not supportive of this hypothesis.
92
What are independent life events when considering stressful events?
Stressful life events that are independent of the person's behaviour and personality.
93
What are dependent life events when considering stressful events?
Events that may have been at least partly generated by the depressed person's behaviour or personality.
94
When considering independent life events and dependent life events, which one plays a stronger role in the onset of major depression?
Dependent life events.
95
T or F: People with depression who have experienced a stressful life event do not tend to show more severe depressive symptoms than those who have not experienced a stressful life event.
False.
96
What is the primary personality variable that serves as a vulnerability factor for depression?
Neuroticism (stable and heritable personality trait that involves a temperamental sensitivity to negative stimuli).
97
T or F: Some researchers attribute sex differences in depression to sex differences in neuroticism.
True.
98
T or F: If exposure to early adversity is moderate rather than severe, a form of stress inoculation may occur that makes the individual less susceptible to the effects of later stress.
True.
99
What led to the psychodynamic idea that depression is anger turned inward?
Freud and his colleague Karl Abraham (1927) both hypothesized that when a loved one dies the mourner regresses to the oral stage of development (when the infant cannot distinguish self from others) and introjects or incorporates the lost person, feeling all the same feelings toward the self as toward the lost person.
These feelings were thought to include anger and hostility because Freud believed that we unconsciously hold negative feelings toward those we love, in part because of their power over us.
100
What is the most important contribution of the psychodynamic approaches to depression?
Their noting the importance of loss (both real and symbolic or imagined) to the onset of depression and noting the striking similarities between the symptoms of mourning and the symptoms of depression
101
T or F: A novel form of behavioral treatment inspired by these behavioral theories—behavioral activation treatment—seems to be an effective treatment for depression.
True.
102
T or F: Beck hypothesized that the cognitive symptoms of depression often precede and cause the affective or mood symptoms rather than vice versa.
True.
103
In Beck’s theory, a diathesis–stress theory, what are dysfunctional beliefs?
Also known as depressogenic schemas, they are rigid, extreme, and counterproductive thoughts that lead to the development of depression.
104
In Beck’s theory, a diathesis–stress theory, what are negative automatic thoughts?
Thoughts that often occur just below the surface of awareness and involve unpleasant, pessimistic predictions.
105
In Beck’s theory, a diathesis–stress theory, what three themes do pessimistic predictions (as a result of negative automatic thoughts) center around?
These pessimistic predictions tend to center on the three themes of what Beck calls the negative cognitive triad, which include negative thoughts about (1) self (“I’m worth-less”); (2) world (“No one loves me”); and (3) future (“It’s hopeless because things will always be this way”)
106
Beck outlined 3 cognitive biases that maintained the cognitive triad. What are they?
Dichotomous or all-or-none reasoning, selective abstraction, and arbitrary inference.
107
Beck outlined 3 cognitive biases that maintained the cognitive triad. What is dichotomous or all-or-none reasoning?
Involves a tendency to think in extremes.
108
Beck outlined 3 cognitive biases that maintained the cognitive triad. What is selective abstraction?
Involves a tendency to focus on one negative detail of a situation while ignoring other elements of the situation.
109
Beck outlined 3 cognitive biases that maintained the cognitive triad. What is arbitrary inference?
Involves jumping to a conclusion based on minimal or no evidence.
110
T or F: Aaron Beck's Cognitive Therapy has not been found effective for the treatment of depression.
False.
111
T or F: There are certain cognitive biases for negative self-relevant information in depression.
True.
112
T or F: Learned helplessness theory of depression originated out of observations in an animal research laboratory.
True.
113
What is Learned Helplessness?
When animals or humans find that they have no control over aversive events (such as shock), they may learn that they are helpless, which makes them unmotivated to try to respond in the future. Instead they exhibit passivity and even depressive symptoms.
Abramson and colleagues proposed that when people (probably unlike animals) are exposed to uncontrollable negative events, they ask themselves why, and the kinds of attributions that people make are, in turn, central to whether they become depressed.
114
Abramson and colleagues added to the original research on Learned Helplessness (reformulated hypothesis theory) by proposing that humans make attributions that in turn, can lead to them feeling depressed. What are the three critical dimensions on which attributions are made?
These investigators pro-posed three critical dimensions on which attributions are made: (1) internal/external, (2) global/specific, and (3) stable/unstable. They proposed that a depressogenic or pessimistic attribution for a negative event is an internal, stable, and global one.
115
Regarding the reformulated hypothesis theory (learned helplessness), what was found in recent research about the pessimistic attributional style?
Many studies demonstrated that depressed people do indeed have this kind of pessimistic attributional style, but of course this does not mean that pessimistic attributional style plays a causal role.
116
T or F: Combining the neuroticism theory with the helplessness theory, 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.
True.
117
The original proposal of learned helplessness was revised twice. What is the hopelessness theory?
Abramson and colleagues (1989) propose 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.
They also proposed that the internal/external dimension of attributions was not important to depression.
118
Describe the process of rumination?
Involves a pattern of repetitive and relatively passive mental activity.
119
What has research shown about individuals who ruminate?
Research has consistently shown that 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
120
T or F: Women are more likely than
| men to ruminate when they become depressed
True. 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.
121
T of F: Just over half of the patients who receive a diagnosis of a mood disorder also receive a diagnosis of an anxiety disorder at some point in their lives, and vice versa
True
122
This tripartite model of anxiety and depression explains what features anxiety and depression share... which are?
high negative affect
123
This tripartite model of anxiety and depression explains what features anxiety and depression share and what features they differ on. What features do they differ on?
low positive affect for depression and anxious hyper-arousal for panic
124
Brown and Harris (1978), in their classic study of community women in a poor area of inner London, reported that...
Women without a close, confiding relationship were more likely than those with at least one close confidant to become depressed if they experienced a severely stressful event.
125
T or F: A significant proportion of couples experiencing marital distress have at least one partner with clinical depression.
True. There is also a high correlation between marital dissatisfaction and depression for both women and men
126
Hooley and colleagues (2009) exposed healthy (never-depressed) controls and women with a past history of depression to critical remarks from their own mothers. What were the results?
Even though all the young women in the recovered-depressed group were completely well and had no symptoms of depression, their brains still responded differently from the healthy controls when challenged by criticism.
When they heard criticism from their mothers, the recovered-depressed participants showed less brain activation in the dorsolateral prefrontal cortex and anterior cingulate cortex than the never-depressed controls did.
In contrast, during criticism, brain activity in the amygdala was much higher in the recovered-depressed participants than it was in the controls.
127
T or F: the effects of paternal depression are somewhat larger than the effects of maternal depression.
False. Many studies have documented the damaging effects of negative interactional patterns between mothers with depression and their children.
128
What is cyclothymic disorder?
Cyclothymic disorder refers to the repeated experience of hypomanic symptoms for a period of at least 2 years. This is a less serious version of full-blown bipolar disorder.
129
T or F: Individuals with cyclothymia are at greatly increased risk of later developing full-blown bipolar I or II disorder.
True.
130
T or F: In the depressed phase of cyclothymic disorder, a person’s symptoms is similar to what is seen in persistent depressive disorder.
True.
131
How is Bipolar I disorder distinguished from MDD?
By the presence of mania
132
What is a Bipolar mixed episode?
A mixed episode is characterized by symptoms of both full-blown manic and major depressive episodes for at least 1 week, either intermixed or alternating rapidly every few days.
133
What is Bipolar I?
Person has full-blown mania and 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.
134
What is Bipolar II?
Person experiences periods of hypomania, but his or her symptoms are below the threshold for full-blown mania.
Person experiences periods of depressed mood that meet the criteria for major depression.
135
T or F: Bipolar I disorder is equally or somewhat more common than bipolar I disorder.
False. Bipolar II disorder is equally or somewhat more common than bipolar I disorder.
136
What are the gender differences in occurrence for bipolar disorder?
Bipolar disorder occurs equally in males and females
137
What is the onset for bipolar?
Usually starts in adolescence and young adulthood, with an average age of onset of 18 to 22 years, BUT bipolar II disorder has an average age of onset approximately 5 years later than bipolar I disorder.
138
What is bipolar disorder with a seasonal pattern?
As with unipolar major depression, the recurrences of bipolar can be seasonal in nature (winter).
139
T or F: Unipolar mania (marked by more mania than depression) is not rare.
False. It is a very rare condition.
140
For those with bipolar, do they spend more days in mania or depression?
The duration of manic and hypomanic episodes tends to be shorter than the duration of depressive episodes
141
Regarding the differences in major depressive episodes between those with unipolar disorder and those with bipolar disorder, what has research found?
Research clearly indicates that major depressive episodes in people with bipolar disorder are more severe than those seen in unipolar disorder, and, not surprisingly, they also cause more role impairment
142
T or F: Some antidepressant drugs used to treat what is thought to be unipolar depression may actually precipitate manic episodes in patients who actually have as-yet-undetected bipolar disorder, thus worsening the course of the illness.
True.
143
Regarding bipolar disorders, what is rapid cycling?
As many as 5 to 10 percent of per-sons with bipolar disorder experience at least four episodes (either manic or depressive) every year, a pattern known as rapid cycling.
Sometimes precipitated by taking certain kinds of anti-depressants
Fortunately, rapid cycling is a temporary phenomenon and gradually disappears within about 2 years.
144
T or F: Biological causal factors are clearly dominant for bipolar disorders.
True.
145
Are genetic influences more prominent for unipolar or bipolar disorders?
Bipolar. Approximately 8 to 10 percent of the first-degree relatives of a person with bipolar I illness can be expected to have bipolar disorder, compared to 1 percent in the general population.
146
The early monoamine hypothesis for unipolar disorder was extended to bipolar disorder, the hypothesis being that if depression is caused by deficiencies of norepinephrine or serotonin, then perhaps mania is caused by excesses of these neurotransmitters. What does the evidence show?
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.
*norepinephrine, serotonin, and dopamine are all involved in regulating our mood states
Evidence for the role of dopamine stems in part from research showing that increased dopaminergic activity in several brain areas may be related to manic symptoms of hyperactivity, grandiosity, and euphoria (cocaine and amphetamines are known to stimulate dopamine and in turn, manic-like behaviours - whereas drugs like lithium reduce dopaminergic activity and are antimanic).
147
T or F: Cortisol levels are elevated in bipolar depression (as they are in unipolar depression), but they are usually not elevated during manic episodes.
True.
148
What do PET scans indicate about blood to the prefrontal cortex during depression versus mania?
Blood flow to the left pre-frontal cortex is reduced during depression, but during mania it is increased in certain other parts of the prefrontal cortex. This indicates that there are shifting patterns of brain activity during mania and during depressed and normal moods
149
T of F: the basal ganglia and amygdala, are enlarged in bipolar disorder but reduced in size in unipolar depression.
True.
150
T or F: The decreases in hippocampal volume that are often observed in unipolar depression are also found in bipolar depression.
False.
151
What is the relationship between sleep and manic episodes for bipolar?
During manic episodes, patients with bipolar disorder tend to sleep very little (seemingly by choice, not because of insomnia), and this is the most common symptom to occur prior to the onset of a manic episode.
152
What is the relationship between sleep and depressive episodes for bipolar?
During depressive episodes, they tend toward hypersomnia (too much sleep).
153
How does stress influence the onset of bipolar?
Stressful life events during childhood (e.g., physical and sexual abuse) and recent life stressors during adulthood (e.g., problems with friends and partners, financial hardship) increase the likelihood of ever developing bipolar disorder as well as having recurrences.
The diathesis–stress model would suggest that stressful life events influence the onset of episodes by activating the underlying vulnerability.
154
T of F: Personality variables and cognitive styles that are related to goal striving, drive, and incentive motivation have been associated with bipolar disorder
True.
155
What are the cross-cultural differences in depression?
Depression occurs in all cultures that have been studied. However, the form that it takes differs widely, as does its prevalence. People in non-Western cultures tend to exhibit the more “physical” symptoms (e.g., sleep disturbance, loss of appetite, weight loss, and loss of sexual interest) as opposed to Western cultures that emphasize psychological symptoms.
156
T or F: The probability of receiving treatment is somewhat higher for people with severe uni-polar depression and with bipolar disorder than for those with less severe depression.
True.
157
What are monoamine oxidase inhibitors (MAOIs)?
A category of antidepressant medications which inhibit the action of monoamine oxidase, the enzyme responsible for the breakdown of norepinephrine and serotonin once released.
The MAOIs can be as effective in treating depression as other categories of medications, but they have potentially dangerous (even potentially fatal) side effects if certain foods rich in the amino acid tyramine are consumed (e.g., 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 subtype of depression that seems to respond preferentially to the MAOIs.
158
What are tricyclic antidepressants (TCAs)?
Tricyclic antidepressants were the drug treatment of choice from the 1960s to the early 1990s.
TCAs increase neurotransmission of the monoamines, primarily norepinephrine and to a lesser extent serotonin.
The efficacy of TCAs in significantly reducing depressive symptoms has been demonstrated in hundreds of studies, however, only about 50 percent show what is considered clinically significant improvement.
Unfortunately, TCAs have unpleasant side effects for some people (e.g., dry mouth, constipation, sexual dysfunction, and weight gain).
159
What are selective serotonin reuptake inhibitors (SSRIs)?
SSRIs are generally no more effective than the tricyclics; indeed some findings suggest that TCAs are more effective than SSRIs for severe depression. However, the SSRIs tend to have many fewer side effects and are better tolerated by patients, as well as being less toxic in large doses.
The primary negative side effects of the SSRIs are problems with orgasm and lowered interest in sexual activity, although insomnia, increased physical agitation, and gastrointestinal distress also occur in some patients
SSRIs are used not only to treat severe depression
but also to treat people with mild depressive symptoms
160
T or F: Antidepressants appear to be most effective for severe depression, but are no more effective than placebo for mild or moderate depression.
True.
161
After six weeks of an antidepressant not working, why do doctors generally change the medication?
Because 50 percent of those who do not respond to the first drug prescribed do respond to a second one.
162
The term mood stabilizer is often used to describe...
...lithium and related drugs because they have both antimanic and antidepressant effects—that is, they exert mood-stabilizing effects in either direction.
163
What is lithium?
Lithium has been more widely studied as a treatment of manic episodes than of depressive episodes, and estimates are that about three-quarters of those in a manic episode show at least partial improvement.
Lithium is often effective in preventing cycling between manic and depressive episodes (but not necessarily for rapid cycling).
Lithium therapy can = unpleasant side effects
such as lethargy, cognitive slowing, weight gain, decreased motor coordination, and gastrointestinal difficulties.
Long-term use = (associated with) kidney malfunction and sometimes permanent kidney damage
164
What are anticonvulsants?
These drugs are often effective in patients who do not respond well to lithium or who develop unacceptable side effects from it, and they may also be given in combination with lithium (regarding bipolar... *lithium = antimanic).
A number of studies have indicated that risk for attempted and completed suicide was nearly two to three times higher for patients on anticonvulsant medications than for those on lithium
165
T or F: Both people with bipolar or unipolar depression who show signs of psychosis (hallucinations and delusions) may also receive treatments with antipsychotic medications in conjunction with their antidepressant or mood-stabilizing drugs
True.
166
What is electroconvulsive therapy (ECT)?
Often used with patients who are severely depressed and who may present an immediate and serious suicidal risk, including those with psychotic or melancholic features.
The treatments, which induce seizures, are delivered under general anesthesia and with muscle relaxants.
Maintenance dosages of an antidepressant and a mood-stabilizing drug such as lithium are then ordinarily used to maintain the treatment gains achieved until the depression has run its course.
167
What is transcranial magnetic stimulation (TMS)?
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 stimulations are delivered in each treatment session.
TMS is a promising approach for the treatment of unipolar depression in patients who are moderately resistant to other treatments
168
What advantages does transcranial magnetic stimulation (TMS) have over electroconvulsive therapy?
TMS has advantages over ECT in that cognitive performance and memory are not affected adversely and sometimes even improve, as opposed to ECT, where memory-recall deficits are common.
169
What is deep brain stimulation?
Deep brain stimulation involves implanting an electrode in the brain and then stimulating that area with electric current. More research is needed.
170
One of the two best-known psychotherapies for unipolar depression is...
Cognitive Behavioural Therapy (CBT).
171
What is Cognitive Behavioural Therapy?
Cognitive therapy 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 taught to identify and correct their biases or distortions in information processing and to uncover and challenge their underlying depressogenic assumptions and beliefs.
172
Brain imaging studies have shown that biological changes in certain brain areas occur following effective treatment with CBT versus medication. So far, how has this been explained?
One possibility is that medications may target the limbic system, whereas cognitive therapy may have greater effects on cortical functions.
173
T or F: Recent evidence suggests that CBT and medications are equally effective in the treatment of severe depression
True.
174
Why population has mindfulness-based cognitive therapy been used with?
Used with people with highly recurrent depression.
175
How does mindfulness-based cognitive therapy help its clients?
This group treatment involves training in mindfulness meditation techniques aimed at developing patients’ awareness of their unwanted thoughts, feelings, and sensations so that they no longer automatically try to avoid them but rather learn to accept them for what they are—simply thoughts occurring in the moment rather than a reflection of reality.
176
What is behavioural activation treatment?
Treatment for unipolar depression that focuses on getting patients to become more active and engaged with their environment and with their interpersonal relationships. These techniques include scheduling daily activities and rating pleasure and mastery while engaging in them, exploring alternative behaviours to reach goals, and role-playing to address specific deficits.
177
What is the difference between behavioural activation treatment and cognitive behavioural therapy (CBT)?
Behavioural activation treatment does not focus on implementing cognitive changes directly but rather on changing behaviour.
178
T or F: CBT is more effective than behavioural activation treatment?
False. One study found that 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.
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
179
What is the interpersonal therapy (IPT) approach?
*Not yet been subjected to as extensive an evaluation as CBT, nor is it as widely available, but studies that have been completed strongly support its effectiveness for treating unipolar depression
IPT focuses on current relationship issues, trying to help the person understand and change maladaptive interaction patterns
180
What is interpersonal and social rhythm therapy?
Interpersonal therapy has been adapted for treatment of
bipolar disorder by adding a focus on stabilizing daily social rhythms that, if they become destabilized, may play a role in precipitating bipolar episodes. In this new treatment, called interpersonal and social rhythm therapy, patients are taught to recognize the effect of interpersonal events on their social and circadian rhythms and to regularize these rhythms.
181
T or F: Approximately 90 to 95 percent of those who die by suicide have a history of at least one psychological disorder
True.
*individuals with two or more mental disorders are at even greater risk than those with only one
182
T or F: Anxiety is the disorder that is most commonly linked with suicidal behaviour.
False. Depression is.
183
T oR F: Only about one-third of people who think about suicide go on to make a suicide attempt.
True.
184
If a person goes longer thinking about suicide without making a suicide attempt...are they more or less likely to make an attempt?
They are less likely to ever make an attempt.
185
What is nonsuicidal self-injury (NSSI)?
The direct, deliberate destruction of body tissue (often taking the form of cutting or burning one’s own skin) in the absence of any intent to die.
186
T or F: [all around the world] women are significantly more likely than men to think about suicide and to make nonlethal suicide attempts
True.
187
T or F: Men are more likely than women to die by suicide
Men are four times more likely than women to die by suicide
188
T or F: The most widely studied risk factors for suicidal behaviours are the presence of different psychological disorders.
True.
189
T or F: Research has supported the link between pain—both psychological and physical—and suicide
True.
190
T or F: 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
True. These early experiences are thought to interact with biological vulnerabilities to increase the risk of personality traits such as hopeless-ness, impulsiveness, aggression, pessimism, and negative affectivity, which may in turn increase the risk for suicide
191
What are a few symptoms that seem to predict suicide more reliably in the short term in patients with major depression?
Severe anxiety, panic attacks, severe anhedonia (inability to experience pleasure), global insomnia, delusions, and alcohol abuse
192
T or F: Suicide sometimes runs in families and that genetic factors may play a role in the risk for suicide
True.
*This genetic vulnerability seems to be at least partly independent of the genetic vulnerability for major depression
193
It has been found that suicide victims have a reduction in what type of brain functioning?
Suicide victims often have alterations in serotonin functioning, with reduced serotonergic activity being associated with increased suicide risk—especially for violent suicide.
194
What is Joiner’s interpersonal-psychological model of suicide?
Suggests that the psychological states of perceived burdensomeness (e.g., feeling like a burden to others) and thwarted belongingness (e.g., feeling alone) interact to produce suicidal thoughts and desires.
It is only in the presence of a third factor,
the acquired capability 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.
195
What is the primary objective of crisis intervention?
The primary objective of crisis intervention is to help a person cope with an immediate life crisis.
196
What are the three things that crisis intervention emphasizes?
Emphasis is usually placed on:
(1) maintaining supportive and often highly directive con-tact with the person over a short period of time—usually one to six contacts;
(2) helping the person to realize that acute distress is impairing his or her ability to assess the situation accurately and to see that there are better ways of dealing with the problem; and
(3) helping the person to see that the present distress and emotional turmoil will not be endless.
