Chapter 8

Question 1

Mood Disorders

Answer 1

Group of disorders involving severe and enduring disturbances in emotionality ranging from elation to severe depression.

Characterized by severe deviations in mood. In the DSM-5, they are grouped by two adjacent categories: depressive disorders, and bipolar and related disorders

Question 2

Major Depressive Episode

Answer 2

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. If left untreated, it can last for nine months

Question 3

Anhedonia

Answer 3

Inability to experience pleasure

Question 4

Central indicators of Major Depressive Episodes

Answer 4

Physical changes (sometimes called somatic or vegetative symptoms)

Behavioural and emotional shutdown, as reflected by low behavioural activation

Question 5

Mania

Answer 5

Period of abnormally excessive elation or euphoria, associated with some mood disorders.

They become extraordinarily active (hyperactive), requiring very little sleep, and may develop grandiose plans, believing they can accomplish anything they desire. The DSM-5 highlights this feature by adding “persistently increased goal-directed activity or energy”

Question 6

Hypomanic episode

Answer 6

Less severe and less disruptive version of a manic episode that is one of the criteria for several mood disorders.

Hypomanic episode is not in itself necessarily problematic, but it does contribute to the definition of several mood disorders.

Question 7

Unipolar mood disorder

Answer 7

their mood remains at one “pole” of the depression-mania continuum

Question 8

Is unipolar mania rare?

Answer 8

Mania by itself (unipolar mania) probably does occur but seems to be rare, because most people with a unipolar mood disorder eventually develop depression

Question 9

Bipolar mood disorder

Answer 9

Someone who alternates between depression and mania is said to have a bipolar mood disorder, travelling from one pole of the depression–elation continuum to the other and back again. This label is somewhat misleading, however, because depression and elation may not exactly be at opposite ends of the same mood state; in fact, though related, they are often relatively independent.

Question 10

Mixed features

Answer 10

Condition in which the individual experiences both elation and depression or anxiety at the same time. Also known as dysphoric manic episode or mixed manic episode.

Question 11

How does the DSM-5 identify mixed features?

Answer 11

In the DSM-5, the term “mixed features” requires specifying whether a predominantly manic or predominantly depressive episode is present, and then noting if enough symptoms of the opposite polarity are present to meet the mixed features criteria.

Question 12

Temporal course

Answer 12

patterns of recurrence and remittance

Question 13

Major depressive disorder

Answer 13

Mood disorder involving one (single episode) or more (separated by at least two months without depression, recurrent) major depressive episodes.

If two or more major depressive episodes occurred and were separated by at least two months during which the individual was not depressed, the major depressive disorder is noted as being recurrent.

Question 14

what is the median lifetime number and duration of major depressive episodes?

Answer 14

The median lifetime number of major depressive episodes is four to seven; in one large sample, 25 percent experienced six or more episodes.

The median duration of recurrent major depressive episodes is four to five months

Question 15

Persistant depressive disorder (dysthymia)

Answer 15

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. (Can last 20-30 years with fewer symptoms)

Question 16

Difference between Persistent depressive disorder and major depressive disorder?

Answer 16

Persistent depressive disorder differs from a major depressive disorder in the number of symptoms required, but mostly in the chronicity. It is considered more severe, since patients with persistent depression present with higher rates of comorbidity with other mental disorders, are less responsive to treatment, and show a slower rate of improvement over time

Question 17

Double depression

Answer 17

Severe mood disorder typified by major depressive episodes superimposed over a background of dysthymic disorder. These individuals, who suffer from both major depression 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.

Question 18

Pure dysthymic syndrome

Answer 18

one has not met criteria for a major depressive episode in at least the preceding two years, “with persistent major depressive episode,” indicating the presence of a major depressive episode over at least a two-year period, or “with intermittent major depressive episodes,”

Question 19

What are the 8 basic specifiers of the DSM-5?

Answer 19

1) with psychotic features (mood-congruent or mood-incongruent),

2) with anxious distress (mild to severe),

3) with mixed features,

4) with melancholic features,

5) with atypical features,

6) with catatonic features,

7) with peripartum onset, and

8) with seasonal pattern.

Question 20

What are the 8 basic specifiers of the DSM-5?

Answer 20

1) with psychotic features (mood-congruent or mood-incongruent),

2) with anxious distress (mild to severe),

3) with mixed features,

4) with melancholic features,

5) with atypical features,

6) with catatonic features,

7) with peripartum onset, and

8) with seasonal pattern.

Question 21

Psychotic features specifiers

Answer 21

Some individuals in the midst of a major depressive (or manic) episode may experience psychotic symptoms, specifically hallucinations (seeing or hearing things that aren’t there) and delusions (strongly held but inaccurate beliefs)

Question 22

Somatic (physical) delusions

Answer 22

believing, for example, that their bodies are rotting internally and deteriorating into nothingness

Question 23

Auditory Hallucinations

Answer 23

Some may hear voices telling them how evil and sinful they are

Question 24

Mood congruent hallucinations and delusions

Answer 24

they seem directly related to the depression. Delusions of grandeur accompanying a manic episode are mood congruent.

Question 25

Mood in-congruent hallucinations or delusions

Answer 25

On rare occasions, depressed individuals might have other types of hallucinations or delusions such as delusions of grandeur (believing, for example, they are supernatural or supremely gifted) that do not seem consistent with the depressed mood. This is a mood-incongruent hallucination or delusion. Although quite rare, this condition signifies a serious type of depressive episode that may progress to schizophrenia (or may be a symptom of schizophrenia to begin with)

Question 26

Peripartum onset specifier

Answer 26

Peri means “surrounding”—in this case, the period of time just before and just after giving birth. This specifier can apply to both major depressive and manic episodes

Question 27

Seasonal pattern specifier

Answer 27

This temporal specifier applies to recurrent major depressive disorder (and also to bipolar disorders). It accompanies episodes that occur during certain seasons (e.g., winter depression). The most usual pattern is a depressive episode that begins in the late fall and ends with the beginning of spring.

Question 28

Seasonal affective disorder (SAD)

Answer 28

Mood disorder involving a cycling of episodes corresponding to the seasons of the year, typically with depression occurring during the winter.

Unlike more severe melancholic types of depression, people with winter depressions tend toward excessive sleep (rather than decreased sleep) and increased appetite and weight gain (rather than decreased appetite and weight loss), symptoms shared with atypical depressive episodes. Although SAD seems a bit different from other major depressive episodes, family studies have not yet revealed any significant differences that would suggest winter depressions are a separate type.

Question 29

The mean age of onset for major depressive disorder with and without treatment

Answer 29

The mean age of onset for major depressive disorder is 25 years in community samples who are not in treatment and 29 years for patients who are in treatment. But average seems to be decreasing.

Question 30

Persistency between adults and children:

Answer 30

Investigators have found a lower (0.07 percent) prevalence of persistent mild depressive symptoms in children compared with adults (3 to 6 percent) (Klein et al., 2000), but symptoms tend to be stable throughout childhood

Question 31

Differences in persistent depressive disorder in children and adults.

Answer 31

Persistent depressive disorder may last 20 to 30 years or more, although a preliminary study reported a median duration of approximately five years in adults (Klein et al., 2006) and four years in children.

Even worse, patients with persistent depressive disorder with less severe depressive symptoms (dysthymia) were more likely to attempt suicide than a comparison group with (nonpersistent) episodes of major depressive disorder during a five-year period.

Question 32

Integrated grief

Answer 32

Grief that evolves from acute grief into a condition in which the individual accepts the finality of a death and adjusts to the loss.

Integrated grief often recurs at significant anniversaries, such as the birthday of the loved one, holidays, and other meaningful occasions, including the anniversary of the death. This is all a very normal and positive reaction.

Question 33

Complicated grief

Answer 33

Grief characterized by debilitating feelings of loss and emotions so painful that a person has trouble resuming a normal life; designated for further study as a disorder by the DSM-5.

Question 34

Pathological grief reaction:

Answer 34

include intrusive memories and distressingly strong yearnings for the loved one and avoiding people or places that are reminders of the loved one

Question 35

Premenstrual dysphoric disorder (PMDD)

Answer 35

Disorder of mood whose symptoms include physical symptoms, severe mood swings, and anxiety that cause incapacitation during most menstrual cycles, starting in the final week before the onset of menses, improving within a few days after the onset of menses, and becoming absent in the week post-menses.

Question 36

disruptive mood dysregulation disorder

Answer 36

Condition in which a child has chronic negative moods such as anger and irritability without any accompanying mania.

Question 37

Bipolar II disoder

Answer 37

Alternation of major depressive episodes with hypomanic episodes (not full manic episodes).

Question 38

Bipolar I disorder

Answer 38

Alternation of major depressive episodes with full manic episodes.

Question 39

What happens during manic or hypomanic stages?

Answer 39

During manic or hypomanic phases, patients often deny they have a problem. Even after spending inordinate amounts of money or making foolish business decisions, these individuals, particularly if they are in the midst of a full manic episode, are so wrapped up in their enthusiasm and expansiveness that their behaviour seems perfectly reasonable to them. The high during a manic state is so pleasurable, people may stop taking their medication during periods of distress or discouragement in an attempt to bring on a manic state once again; this is a serious challenge to professionals.

Question 40

cyclothymic disorder

Answer 40

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. Individuals with cyclothymic disorder tend to be in one mood state or the other for many years with relatively few periods of neutral (or euthymic) mood. This pattern must last for at least two years (one year for children and adolescents) to meet criteria for the disorder.

In typical cases, cyclothymia is chronic and lifelong. In about one-third to one-half of patients, cyclothymic mood swings develop into full-blown bipolar disorder

Question 41

What specifier is unique to Bipolar I and II?

Answer 41

rapid-cycling specifier. Some people move quickly in and out of depressive or manic episodes.

An individual with bipolar disorder who experiences at least four manic or depressive episodes within a year is considered to have a rapid-cycling pattern, which appears to be a severe variety of bipolar disorder that does not respond well to standard treatments.

In most cases, rapid cycling tends to increase in frequency over time and can reach severe states in which patients cycle between mania and depression without any break. When this direct transition from one mood state to another happens, it is referred to as rapid switching or rapid mood switching and is a particularly treatment-resistant form of the disorder

Question 42

Ultra-rapid cycles

Answer 42

There are also cases of ultra-rapid cycle lengths that only last for days to weeks and ultra-ultra-rapid cycling in cases where cycle lengths are less than 24 hours. In ultra-ultra-rapid cycling, switches into depression occurred at night and switches into mania occurred at daytime, suggesting a link to circadian aspects.

Question 43

Differences between bipolar disorders and depressive disorders?

Answer 43

Bipolar is acute onset, younger onset, and the onset is often preceded by minor oscillations in mood or mild cyclothymic mood swings.

Question 44

Prevalence of Mood disorders

Answer 44

With regard to depression specifically, the best estimates of the worldwide prevalence suggest that approximately 16 percent of the population experience major depressive disorder over a lifetime, and approximately 6 percent have experienced a major depressive disorder in the last year.

As Roger Bland, a leading psychiatric epidemiologist from the University of Alberta, has pointed out, different research methods may account for the differing rates of prevalence

Women are about twice as likely to have mood disorders as men; In fact, women were more likely to have a major depressive episode than men in all age groups except those 65 years and older. Bipolar disorders are distributed approximately equally across gender.

Question 45

Are there childhood mood disorders in the DSM-5?

Answer 45

Therefore, no “childhood” mood disorders in the DSM-5 are specific to a developmental stage, with the exception of disruptive mood dysregulation disorder, which can be diagnosed only up to 12 years of age.

Question 46

How does the look of depression change with age?

Answer 46

It seems clear, however, that the look of depression changes with age. For example, children under three years of age might manifest depression by their facial expressions, as well as by their eating and sleeping. In children between the ages of 9 and 12, many of these features would not occur.

Question 47

Frequency of depressive disorders in children vs adults.

Answer 47

The general conclusion is that depressive disorders occur less frequently in children than in adults but rise dramatically in adolescence, when, if anything, depression is more frequent than in adults

Question 48

Prevalence of different disorders in childhood and adolesence

Answer 48

in young children, dysthymia is more prevalent than major depressive disorder, but this ratio reverses in adolescence. Like adults, adolescents experience major depressive disorder more frequently than dysthymia. Major depressive disorder in adolescents is also largely a female disorder.

Question 49

Mania in children

Answer 49

children under the age of nine seem to present with more irritability and emotional swings as compared with classic manic states, and they are often mistaken as being hyperactive. In addition, their symptoms are more chronic in that they are always present rather than episodic as in adults.

Question 50

Bipolar disorder in children

Answer 50

Bipolar disorder seems to be rare in childhood, although case studies of children as young as four years of age displaying bipolar symptoms have been reported although the diagnosis may be mistaken for conduct disorder or ADHD.

However, the prevalence of bipolar disorder rises substantially in adolescence, which is not surprising in that many adults with bipolar disorder report a first onset during the teen years

Question 51

Emotional Swing

Answer 51

or oscillating manic states that are less distinct than in adults, may also be characteristic of children, as are brief or rapid-cycling manic episodes lasting only part of a day

Question 52

Developmental differences between children and adults

Answer 52

Is comorbidity.

For example, childhood depression (and mania) is often associated with and sometimes misdiagnosed as ADHD or, more often, conduct disorder in which aggression and even destructive behaviour are common. Conduct disorder and depression often co-occur in bipolar disorder. But, once again, many of these children might now meet the criteria for disruptive mood dysregulation disorder, which would better account for this comorbidity

Question 53

What are late-onset depressions diagnosed with?

Answer 53

Late-onset depressions are associated with marked sleep difficulties, illness anxiety disorders, and agitation. It can be difficult to diagnose depression in seniors because the presentation of mood disorders is often complicated by the presence of medical illnesses or symptoms of dementia.

Question 53

What are late-onset depressions diagnosed with?

Answer 53

Late-onset depressions are associated with marked sleep difficulties, illness anxiety disorders, and agitation. It can be difficult to diagnose depression in seniors because the presentation of mood disorders is often complicated by the presence of medical illnesses or symptoms of dementia.

Question 54

How does depression in older adults compare to the population?

Answer 54

Nevertheless, the overall prevalence of major depressive disorder is the same or slightly lower in the older adults as in the general population

Question 55

What disorders are prevalent in older adults?

Answer 55

Anxiety disorders frequently accompany depression in seniors (in about a third of cases), particularly generalized anxiety disorder and panic disorder

Question 56

When does the gender imbalance in depression disappear?

Answer 56

The earlier gender imbalance in depression disappears after the age of 65. In early childhood, boys are more likely to be depressed than girls, but an overwhelming surge of depression in adolescent girls produces an imbalance in the sex ratio. That is maintained until old age, when just as many women are depressed, but increasing numbers of men are also affected

Question 57

The tendency of anxiety taking physical forms in cultures:

Answer 57

nstead of talking about fear, panic, or general anxiety, many people describe stomachaches, chest pains or heart distress, and headaches. Much the same tendency exists across cultures for mood disorders

Question 58

Cultural differences in mood disorders

Answer 58

Although somatic symptoms that characterize mood disorders seem roughly equivalent across cultures, it is difficult to compare subjective feelings. The way people think of depression may be influenced by the cultural view of the individual and the role of the individual in society.

For example, in societies that focus on the individual instead of the group, it is common to hear statements such as “I feel blue,” or “I am depressed.” In cultures where the individual is tightly integrated into the larger group, however, someone might say, “Our life has lost its meaning,” referring to the group in which the individual resides

Question 59

Where are the highest rates of major depressive disorder?

Answer 59

the highest rates of major depressive episode were observed in the U.S. sample (17 percent prevalence), and the lowest in the Japanese sample (3 percent prevalence). Compared with the prevalence rates in the other countries, the rates in the Canadian sample were moderate (8 percent prevalence).

Question 60

Indigenous’ experiences of major depressive disorder

Answer 60

the appalling social and economic conditions faced by many groups of Indigenous Peoples in North America, as well as their long history of cultural oppression and marginalization, fulfill all the requirements for chronic major life stress, which is strongly related to the onset of mood disorders, particularly major depressive disorder. The lifetime prevalence for any mood disorder was 19 percent in men, 37 percent in women, and 28 percent overall, approximately four times as high as in the general population.

Question 61

Is creativity associated with depression or mania?

Answer 61

recent studies confirm that creativity is specifically associated with manic episodes and not depressive states. But, as noted by the late Norman Endler (1990), “It is one thing to have the high degree of energy that exists in a manic state; it is another thing to channel it in a direction that creates new works and accomplishes effective tasks”. It is also possible that the genetic vulnerability to mood disorders is independently accompanied by a predisposition to creativity. In other words, the genetic patterns associated with bipolar disorder may also carry the spark of creativity.

While the bipolar patients were not any more creative than the patients with other disorders, the researchers did find that moderately ill patients were significantly more creative than severely ill patients. These findings suggest that creativity may peak at a stage of the illness where symptoms are moderate but that creativity may actually decline as symptoms become progressively worse.

Question 62

Family studies and mood disorders

Answer 62

In family studies, we look at the prevalence of a given disorder in the first-degree relatives of an individual known to have the disorder (the proband). We have found that, despite wide variability, the rate in relatives of probands with mood disorders is consistently about two to three times that in relatives of people who don’t have mood disorders. Increasing severity, recurrence of major depression, and earlier age of onset in the proband is associated with the highest rates of depression in relatives.

Question 63

Twin-studies and mood-disorders

Answer 63

In a large meta-analysis of twin studies, Sullivan et al. (2000) estimated the heritability of depression to be 37 percent. Shared environmental factors have little influence, whereas 63 percent of the variance in depression can be attributed to nonshared environmental factors.

Question 64

Sex differences in genetic vulnerability to depression

Answer 64

found the characteristically higher rate of depressive disorders in women. Estimates of heritability in women ranged from 36 to 44 percent, consistent with other studies. But estimates for men were lower and ranged from 18 to 24 percent. It concludes that environmental events play a larger role in causing depression in men than in women.

Question 65

Does the pro-band with bipolar disorder increase the risk of family to develop bipolar disorder?

Answer 65

Note that bipolar disorder confers an increased risk of developing some mood disorder but not necessarily bipolar disorder. This conclusion supports the notion that bipolar disorder may simply be a more severe variant of mood disorders rather than a fundamentally different disorder. Thus, individuals with bipolar disorder are genetically susceptible to depression and independently genetically susceptible to mania. This hypothesis still requires further confirmation.

Question 66

Are mood disorders familial?

Answer 66

such disorders are familial and almost certainly reflect at least a small underlying genetic vulnerability, particularly for women. As with other psychological disorders, it seems unlikely that we will find any single dominant gene that is responsible, although occasional reports appear to that effect.

Question 67

Join heritability of anxiety and depression

Answer 67

These findings suggest, once again, that the biological vulnerability for mood disorders may not be specific to that disorder but may reflect a more general predisposition to anxiety or mood disorders, or, more likely to a basic temperament underlying all emotional disorders, such as neuroticism. The specific form of the disorder would be determined by unique psychological, social, or additional biological factors.

Question 67

Join heritability of anxiety and depression

Answer 67

These findings suggest, once again, that the biological vulnerability for mood disorders may not be specific to that disorder but may reflect a more general predisposition to anxiety or mood disorders, or, more likely to a basic temperament underlying all emotional disorders, such as neuroticism. The specific form of the disorder would be determined by unique psychological, social, or additional biological factors.

Question 68

Permissive hypothesis

Answer 68

when serotonin levels are low, other neurotransmitters are permitted to range more widely, become dysregulated, and contribute to mood irregularities, including depression

Question 69

Neurohormones

Answer 69

Hormones that affect the brain and are increasingly the focus of study in psychopathology.

Question 70

Sleep patterns of depression

Answer 70

In addition to entering REM sleep more quickly, depressed patients experience REM activity that is more intense, and the stages of deepest sleep, called slow wave sleep, don’t occur until later, if at all. The increase in REM and reduction in slow wave sleep seem to be less pronounced in depressed children than in adults, perhaps because children are very deep sleepers. Depression is more often accompanied by prominent delays in the sleep-wake cycle in younger individuals, while the sleep-wake cycle of older individuals with depression seems to have a lower amplitude, suggestive of a weaker circadian signal.

Question 71

Sleep patterns of bipolar disorder

Answer 71

Sleep disturbances also occur in bipolar patients, where they are particularly severe and are characterized not only by decreased REM latency but also by severe insomnia and hypersomnia (excessive sleep).

But the investigators discovered that the relationship between sleep and mood was bidirectional in both groups. That is, negative mood predicted sleep disruptions and sleep disruptions subsequently resulted in negative mood. Treating the insomnia of patients with bipolar I between episodes with CBT has been shown to reduce the risk of relapse and improve sleep, mood, and functioning

Question 72

Does abnormal sleep affect treatment?

Answer 72

Finally, abnormal sleep profiles and, specifically, disturbances in REM sleep and poor sleep quality predict a somewhat poorer response to psychological treatment (

Question 73

Findings of brain structure and function

Answer 73

depressed individuals exhibit greater right-sided anterior activation of their brains, particularly in the prefrontal cortex (and less left-sided activation and, correspondingly, less alpha wave activity) than nondepressed individuals

In contrast, one recent study suggests that bipolar spectrum patients (individuals with subthreshold swings in mood) show elevated rather than diminished relative left-frontal EEG activity and that this brain activity predicts the onset of a full bipolar I disorder

Question 74

What percentage of psychological disorder is psychological experience?

Answer 74

we noted that fully 60 to 80 percent of the causes of depression could be attributed to psychological experiences. Furthermore, most of those experiences are unique to the individual. Stress and trauma are among the most striking unique contributions to the etiology of all psychological disorders.

Question 75

How does stress affect bipolar disorder?

Answer 75

First, stressful life events seem to trigger early mania (Alloy et al., 2012) and depression, but as the disorder progresses these episodes seem to develop lives of their own. In other words, once the cycle begins, a process takes over and ensures the disorder will continue (e.g., Post, 1992; Post et al., 1989). Second, some of the precipitants of manic episodes seem to be related to loss of sleep, as in the postpartum period (Goodwin & Jamison, 1990), or as a result of jet lag, that is, disturbed circadian rhythms (Alloy et al., 2015). In most cases of bipolar disorder, nevertheless, stressful life events are implicated not only in provoking relapse but also in preventing recovery (Johnson & Miller, 1997).

Question 76

Learned helplessness theory of depresssion

Answer 76

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).

Question 77

Depressive attributional Style

Answer 77

internal, in that the individual attributes negative events to personal failings (“It is all my fault”),

stable, in that, even after a particular negative event passes, the attribution that “additional bad things will always be my fault” remains, and

global, in that the attributions extend across a wide variety of issues.

Question 78

Aaron T. Becks theory on depression:

Answer 78

suggested that depression may result from a tendency to interpret everyday events in a negative way. According to Beck, people with depression make the worst of everything; for them, the smallest setbacks are major catastrophes. In his extensive clinical work, Beck observed that all his depressed patients thought this way, and he began classifying the types of cognitive errors that characterized this style. From the long list he compiled, two representative examples are arbitrary inference and overgeneralization. Arbitrary inference is evident when a depressed individual emphasizes the negative rather than the positive aspects of a situation. As an example of overgeneralization, when your professor makes one critical remark on your paper, you then assume you will fail the class, despite a long string of very positive comments and good grades on other papers. You are overgeneralizing from one small remark.

Question 79

Cognitive Triad

Answer 79

Aaron T. Beck’s theory that depression may result from a tendency to think negatively about three areas: the self, the immediate world, and the future.

Question 80

What is a self-blame schema?

Answer 80

In a self-blame schema, individuals feel personally responsible for every bad thing that happens. With a negative self-evaluation schema, they believe they can never do anything correctly. In Beck’s view, these cognitive errors and schemas are automatic—that is, not necessarily conscious. Indeed, an individual might not even be aware of thinking negatively and illogically. Thus, very minor negative events can lead to a major depressive episode.

Question 81

Kuiper et al. study

Answer 81

Research by Nicholas Kuiper and his colleagues at the University of Western Ontario has focused on the self-component of Beck’s cognitive triad. For example, Derry and Kuiper (1981) asked depressed and nondepressed individuals to complete a “self-referent encoding task” in which they rated a series of traits as to whether or not each described them. The depressed group viewed traits with depressive content (e.g., stupid, boring) as being significantly more applicable to themselves than did nondepressed participants. Conversely, the depressed group viewed traits with nondepressive content (e.g., nice, attractive) as being significantly less applicable to themselves.

Question 82

Marital conflict and mood disorders

Answer 82

But conflict within a marriage seems to have different effects on men and women. Depression seems to cause men to withdraw or otherwise disrupt the relationship. For women, in contrast, it is problems in the relationship that most often cause depression. Thus, for both men and women, depression and problems in marital relations are associated, but the causal direction is different

Question 83

Sex-ratio of mood disorders

Answer 83

Although bipolar disorder is evenly divided between men and women, almost 70 percent of the individuals with major depressive disorder and persistent depressive disorder are women (this is also consistent around the world)

Question 84

Why might mood disorders be higher in women?

Answer 84

• Taught to be passive (Feel as though they have less control)
• The value women place on intimate relationships may also put them at risk. Disruptions in such relationships, combined with an inability to cope with the disruptions, may be far more damaging to women than to men
  -Another potentially important gender difference is that women tend to ruminate more than men about their situation and blame themselves for being depressed (Men tend to ignore their feelings, perhaps engaging in activity to take their minds off them)
• Another issue to consider is that the majority of the people living in poverty in North America are women and children
• Single, divorced, and widowed women experience significantly more depression than men in the same categories
  A further possible contributing factor to the higher rates of depression in women pertains to a particular type of stressor—specifically, abuse histories

Question 85

Psychological vunerabilites

Answer 85

• Depression and anxiety may often share a common, genetically determined biological vulnerability
• One genetic pattern implicated in this vulnerability is in the serotonin transporter gene-linked polymorphic region
• People who develop mood disorders also possess a psychological vulnerability experienced as feelings of inadequacy for coping with the difficulties confronting them
• As noted earlier, triggering stressful life events also activate a dormant psychological vulnerability characterized by negative thinking and a sense of helplessness and hopelessness

Question 86

Anti-depressant

Answer 86

Medication used to treat depressive disorders, such as tricyclic antidepressants, monoamine oxidase (MAO) inhibitors, and selective serotonin reuptake inhibitors.

Question 87

What are the three basic types of anti-depressants?

Answer 87

tricyclic antidepressants, monoamine oxidase (MAO) inhibitors, and the newer selective-serotonin reuptake inhibitors (SSRIs).

Question 88

Tricyclic antidepressants

Answer 88

Tricyclic antidepressants are widely used treatments for depression. The best-known variants are probably imipramine (Tofranil) and amitriptyline (Elavil). It is not yet clear how these drugs work, but initially, at least, they block the reuptake of certain neurotransmitters, allowing them to pool in the synapse and, as the theory goes, desensitize or down regulate the transmission of that particular neurotransmitter (so less of the neurochemical is transmitted). Tricyclic antidepressants seem to have their greatest effect by down regulating norepinephrine, although other neurotransmitter systems, particularly serotonin, are also affected. This process takes a while to work, often between two and eight weeks. During this time, many patients feel a bit worse and develop side effects such as blurred vision, dry mouth, constipation, difficulty urinating, drowsiness, weight gain (at least six kilograms), and, sometimes, sexual dysfunction.

Question 89

MAO inhibters

Answer 89

MAO inhibitors work very differently; as their name suggests, they block the enzyme monoamine oxidase that breaks down such neurotransmitters as norepinephrine and serotonin. The result is roughly equivalent to the effect of the tricyclics. Because they are not broken down, the neurotransmitters pool in the synapse, ultimately leading to a down regulation or desensitization. The MAO inhibitors seem to be as effective as the tricyclics (American Psychiatric Association, 2010), with somewhat fewer side effects. But MAO inhibitors are used far less often because of two potentially serious consequences

Question 90

SSRIs’

Answer 90

These SSRIs specifically block the presynaptic reuptake of serotonin. This temporarily increases levels of serotonin at the receptor site, but again the precise long-term mechanism of action is unknown (Gitlin, 2009; Thase & Denko, 2008). Perhaps the best-known drug in this class is fluoxetine (Prozac).

Question 91

What are the two newer anti-depressants?

Answer 91

Venlafaxine is related to tricyclic antidepressants but acts in a slightly different manner, reducing some of the associated side effects and the risk of damage to the cardiovascular system. Other typical side effects remain, including nausea and sexual dysfunction. Nefazodone is closely related to the SSRIs but seems to improve sleep efficiency instead of disrupting sleep. Both drugs are roughly comparable in effectiveness to older antidepressants and also Hypericum (St. John’s wort, right) is popular as a natural treatment in Europe and in North America.

Question 92

How is Lithium different from other drugs and what disorder does it treat?

Answer 92

Lithium, however, has one major advantage that distinguishes it from other antidepressants: It is often effective in preventing and treating manic episodes. For this reason it is most often referred to as a mood-stabilizing drug. (Bipolar disorder)

Question 93

electroconvulsive therapy (ECT)

Answer 93

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. We do not really know why ECT works. Repeated seizures induce massive functional and perhaps structural changes in the brain, which seems to be therapeutic. There is some evidence that ECT increases levels of serotonin, blocks stress hormones, and promotes neurogenesis in the hippocampus. Because of the controversial nature of this treatment, its use declined considerably during the 1970s and 1980s

Question 94

transcranial magnetic stimulation (TMS)

Answer 94

and it works by placing a magnetic coil over the individual’s head to generate a precisely localized electromagnetic pulse. Anaesthesia is not required, and side effects are usually limited to headaches. Initial reports, as with most new procedures, showed promise in treating depression (George et al., 2013), and recent observations and reviews have confirmed that TMS can be effective (De Raedt et al., 2015; Mantovani et al., 2012; Schutter, 2009). But results from several important clinical trials with severe or treatment-resistant psychotic depression reported ECT to be clearly more effective than TMS

Question 95

Non-drug approach of treatment

Answer 95

agus nerve stimulation involves implanting a pacemaker-like device that generates pulses to the vagus nerve in the neck, which, in turn, is thought to influence neurotransmitter production in the brain stem and limbic system

Deep brain stimulation has been used with a few severely depressed patients. In this procedure, electrodes are surgically implanted in the limbic system (the emotional brain). These electrodes are also connected to a pacemaker-like device. Initial results show some promise in treatment-resistant patients, but time will tell if this is a useful treatment

Question 96

Cognitive Therapy

Answer 96

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 behaviour and coping styles.

Treatment involves correcting cognitive errors and substituting less depressing and (perhaps) more realistic thoughts and appraisals. Later in therapy, underlying negative cognitive schemas (characteristic ways of viewing the world) that trigger specific cognitive errors are targeted, not only in the clinic but also as part of the client’s daily life. The therapist purposefully takes a Socratic approach, making it clear that therapist and client are working as a team to uncover faulty thinking patterns and the underlying schemas from which they are generated.

Between sessions, clients are instructed to monitor and log their thought processes carefully, particularly during situations in which they might feel depressed. They also attempt to change their behaviour by carrying out specific activities assigned as homework, such as tasks in which clients can test their faulty thinking This part of treatment is called a behavioural experiment because the client makes a hypothesis about what’s going to happen (usually a depressing outcome) and then, most often, discovers it is incorrect (“My colleagues congratulated me on my presentation”)

Question 97

Interpersonal psychotherapy (IPT)

Answer 97

Therapy that focuses on resolving problems in existing relationships and learning to form important new interpersonal relationships.

Question 98

Four interpersonal issues of IPT

Answer 98

dealing with interpersonal role disputes, such as marital conflict;

adjusting to the loss of a relationship, such as grief over the death of a loved one;

acquiring new relationships, such as getting married or establishing professional relationships; and

identifying and correcting deficits in social skills that prevent the person from initiating or maintaining important relationships (Gillies, 2001).

Question 99

After we identify the dispute in IPT there are three stages:

Answer 99

Negotiation stage: Both partners are aware it is a dispute, and they are trying to renegotiate it.

Impasse stage: The dispute smoulders beneath the surface and results in low-level resentment, but no attempts are made to resolve it.

Resolution stage: The partners are taking some action, such as divorce or separation.

Question 100

Benefits of combining CBT and drugs

Answer 100

Until we develop such methods, studies continue to compare groups of individuals who share the same diagnosis. Moreover, it is possible that medication, when it works, does so more quickly than psychological treatments for the most part, which in turn have the advantage of increasing the patient’s long-range social functioning (particularly in the case of IPT) and protecting against relapse or recurrence (particularly cognitive-behavioural therapy). Combining treatments, therefore, might take advantage of the drugs’ rapid action and the psychosocial protection against recurrence or relapse, thereby allowing eventual discontinuation of the medications.

Question 101

What is the rate of relapse?

Answer 101

Given the high rate of recurrence in depression, it is not surprising that well over 50 percent of patients on antidepressant medication relapse if their medication is stopped within four months after their last depressive episode. In several studies, cognitive therapy reduced rates of subsequent relapse in depressed patients by more than 50 percent over groups treated with antidepressant medication.

Question 102

Maintenance treatment

Answer 102

Combination of continued psychosocial treatment or medication designed to prevent relapse following therapy.

Question 103

Mindfulness-based cognitive therapy

Answer 103

It is a group therapy designed to teach recovered depressed patients to disengage from the kinds of negative thinking that can precipitate a relapse to depression. More specifically, they are trained in mindfulness meditation to help them become more aware of their thoughts and feelings and to view their thoughts as mental events rather than as accurate reflections of reality.

Question 104

Sex ratio in Suicide

Answer 104

Regardless of age, in every country around the world except China, men are more likely to commit suicide than women. Although it was previously thought that men were at least three times as likely to commit suicide as women, recent work by the WHO (2014) demonstrated that this is likely a phenomenon specific to high-income countries. In high-income countries, the ratio of male-to-female suicides was 3.5, compared to a ratio of 1.6 in middle- and low-income countries.

Question 105

Sex differences in suicide form

Answer 105

Men generally choose far more violent methods, such as guns and hanging; women tend to rely on less violent options, such as drug overdose

Question 106

Suicide mortality rate

Answer 106

Globally, the suicide mortality rate is lowest among young people 15 years of age or younger and highest among those 70 years of age and older.

Question 107

Suicide rates in canada

Answer 107

In Canada, suicide is the second-leading cause of death, after accidents (Navaneelan, 2012). However, this ranking changes as Canadians age. Suicide is the second-leading cause of death for Canadians between 15 and 34 years of age (accounting for 28 percent of deaths for those 15 to 19 years of age, 23 percent for those 20 to 24 years, and 20 percent of those 25 to 34 years). Suicide drops to the third-leading cause of death among 35- to 44-year-olds and to the fourth-leading cause among 45- to 54-year-olds

Question 108

Sex ratio of suicide attempts

Answer 108

Although males commit suicide more often than females in most of the world (e.g., CDC, 2013), females attempt suicide more often (Berman & Jobes, 1991). The high incidence of suicidal attempts among women may reflect the fact that more women than men are depressed and that depression is strongly related to suicide attempts

Question 108

Sex ratio of suicide attempts

Answer 108

Although males commit suicide more often than females in most of the world (e.g., CDC, 2013), females attempt suicide more often (Berman & Jobes, 1991). The high incidence of suicidal attempts among women may reflect the fact that more women than men are depressed and that depression is strongly related to suicide attempts

Question 109

Deirkhiem’s suicide definitions

Answer 109

One type is “formalized” suicides that were approved of, such as the ancient custom of hara-kiri in Japan, in which an individual who brought dishonour to himself or his family was expected to impale himself on a sword. Durkheim referred to this as altruistic suicide. Durkheim also recognized the loss of social supports as an important provocation for suicide; he called this egoistic suicide. (Seniors who kill themselves after losing touch with their friends or family fit into this category.) Finally, fatalistic suicides result from a loss of control over our own destiny. The mass suicide of 39 Heaven’s Gate cult members is an example of this type, because the lives of those people were largely in the hands of Marshall Applewhite, a supreme and charismatic leader.

Question 110

Psychological autopsy

Answer 110

Post-mortem psychological profile of a suicide victim constructed from interviews with people who knew the person before death. [The psychological profile of the person who committed suicide is reconstructed through extensive interviews with friends and family members who are likely to know what the individual was thinking and doing in the period before death. This and other methods have allowed researchers to identify a number of risk factors for suicide.]

Question 111

Family history and suicide

Answer 111

If a family member committed suicide, the risk increases that someone else in the family will also- In fact, among depressed patients, the strongest predictor of suicidal behaviour was having a family history of suicide.

Question 112

Neurobiology and suicide

Answer 112

A variety of evidence suggests that low levels of serotonin may be associated with suicide and with violent suicide attempts- It is very possible then that low levels of serotonin may contribute to creating a vulnerability to act impulsively. This impulsiveness may include suicide, which is sometimes a very impulsive act.

Question 113

Suicide and existing psychological disorders

Answer 113

More than 90 percent of people who kill themselves have a psychological disorder.(some investigators have isolated hopelessness, a specific component of depression, as strongly predictive of suicide/Hopelessness also predicts suicide among individuals whose primary mental health problem is not depression)
Combinations of disorders, such as substance abuse and mood disorders in adults or mood disorders and conduct disorder in children and adolescents, seem to create a stronger vulnerability than any one disorder alone.

Question 114

Stressful life events and stress

Answer 114

Perhaps the most important risk factor for suicide is a severe, stressful event experienced as shameful or humiliating, such as a failure (real or imagined) in school or at work, an unexpected arrest, or rejection by a loved one. Physical and sexual abuse are also important sources of stress .

Question 115

Suicide replication

Answer 115

First, suicides are often romanticized in the media: An attractive young person under unbearable pressure commits suicide and becomes a martyr to friends and peers by getting even with the (adult) world for creating such a difficult situation.

Little is reported about the paralysis, brain damage, and other tragic consequences of the incomplete or failed suicide or about the fact that suicide is almost always associated with a severe psychological disorder. More important, even less is said about the futility of this method of solving problems

Question 116

How is suicide treated and prevented?

Answer 116

If a risk is present, clinicians attempt to get the individual to agree to or perhaps even sign a “no-suicide contract.” Usually, this includes a promise not to do anything remotely connected with suicide without contacting the mental health professional first- if the person at risk refuses a contract (or the clinician has serious doubts about the patient’s sincerity) and the suicidal risk is judged to be high, immediate hospitalization is indicated, even against the will of the patient.

Question 117

Public health and suicide

Answer 117

In view of the public health consequences of suicide, many programs have been implemented to reduce the rates of suicide both in Canada and in other parts of the world. They include curriculum-based programs in which teams of professionals go into schools or other organizations to educate people about suicide and provide information on handling life stress