Chapter 8 - Mood Disorders and Suicide Flashcards
imagined loss
the individual unconsciously interprets other types of events as severe loss events ex. argument with friend
why is clinical depression different
longer duration and more severe
Types of mood disorders
unipolar and bipolar
what is unipolar?
depression
what is bipolar?
depressive and manic symptoms
how long must the symptoms for major depressive disorder be present
for at least two weeks
how much more time do individuals that meet the criteria for symptoms of major depressive disorder require to sleep?
more than an hour to fall asleep every night
depressive disorders
involve a change in mood in the direction of depression
bipolar and related disorders
involve periods of depression cycling with periods of mania
symptoms of major depressive disorder
1) persistent low mood and/or lack of enjoyment in activities
2) changes in weight
3) changes in mood
4) agitation/retardation
5) tired/low energy
6) feeling worthless/ excessive guilt
7) trouble concentrating/indecisive
8) trouble concentrating/indecisive
9) suicidal thoughts
how many symptoms must be present for MDD?
5
symptoms of MDD classification
must show persistent sad mood and/or lack of pleasure or enjoyment in activities for at least two weeks and must be accompanied by 4 other symptoms
how much of the population does MDD affect
5%
gender differences in MDD
twice as common in women
average time episodes last
6-9 months, can last for years though
average age onset for MDD
early twenties to mid-twenties (early adulthood/teenage years)
gender differences data study showed
equal rates of depression for both sexes throughout childhood then begin to diverge at about age 10
do most individuals with MDD suffer from one or more additional mental disorders?
yes - most common is anxiety disorders
persistent depressive disorder/ dysthymia
chronic low mood, lasting for at least two years along with three associated symptoms (full criteria of MDD has been met)
what are some symptoms for PDD
1) changes in eating
2) changes in sleep
3) tired/low energy
4) low self-esteem
5) trouble concentrating/indecisive
6) feeling hopeless
prevalence of PDD
3%
differences between PDD and MDD
PDD has the following: higher levels of impairment, younger age of onset, higher rates of comorbidity, a stronger family history of psychiatric disorder, lower levels of social support, higher levels of stress, and higher levels of dysfunctional personality traits, and treatment response
Mania
distinct period of elevated, expansive, or irritable mood that lasts at least one week and is accompanied by at least 2 symptoms
symptoms of mania
1) grandiosity
2) decreased need for sleep
3) talkative
4) racing thoughts
5) distractable
6) increased goal-directed behaviour or psychomotor agitation
7) involvement in activities with high change of negative consequences
8) increased energy
Hypomania
less severe form of mania that involves a similar number of symptoms, but those symptoms need to be present for only four days
can you have depressive and manic/hypomanic symptoms at the same time?
yes - called a “mixed state”
Bipolar I disorder
- history of one or more manic episodes
- may or may not have had a depressive episode
Bipolar II disorder
- history of one or more hypomanic episodes
- history of one or more depressive episodes
prevalence of bipolar I
0.8%
prevalence of bipolar II
0.5%
gender differences for bipolar disorder
equally in men and women
age onset in bipolar disorder
20 years is mean onset, some adult patines can experience it before age 17
cyclothymia
chronic, less sever form of bipolar disorder
how long must symptoms show for cyclothymia
at least 2 years in duration of altering between hypomania and subthreshold depression (depression that does not meet full criteria for major depression)
prevalence for cyclothymia
0.4%-1%
seasonal affective disorder (SAD)
can occur in both unipolar depression and bipolar disorder that are tied to changing seasons
prevalence of SAD
general population - 3%
MDD patients - 11%
melatonin theory SAD
melatonin - secreted at night by pineal gland, as sunlight increases, melatonin decreases - causes body temperature to rise, triggering body processes to their awake state. during winter months, more darkness so melatonin remains high and nothing switches body from sleep state to wake state
peri - or postpartum depression
last month of gestation (peri-partum) up to a couple months post-birth
theory about peri- and postpartum depression
hormones decrease, especially progesterone
psychodynamic theories
relationships between parents and children are important in shaping a child’s temperament and that neglectful/abusive parenting confers a strong risk for later depression. individuals that have experienced this interpret life events as having a greater impact
cognitive theories
one’s emotional response to a situation is determined by the manner in which that situation is appraised or evaluated
what are the 4 cognitive theories
1) all-or-nothing thinking
2) overgeneralization
3) magnification (catastrophizing)
4) jumping to conclusions
all-or-nothing thinking
it’s one side or the other ex. C on math exam = I’m a failure I’ll never get into med school
overgeneralization
single negative event is a never-ending patter ex. late for doctors appointment = I’m always screwing up
magnification (catastrophizing)
exaggerate the importance of your errors or problems ex. forget someone’s name while introducing them = thinking this is horrible
jumping to conclusions
interpret things negatively when there are no definite facts to support your conclusion ex. boyfriend doesn’t return call = thinking they don’t care about you anymore
schemas
hypothetical structures in the mind that contain core beliefs about the self, world, and the future
cognitive triad
self, world, future
negative feedback seeking
tendency to actively seek out criticism and other negative interpersonal feedback from others
excessive reassurance seeking
tendency to repeatedly seek assurance about one’s worth and lovability from others, regardless of whether such assurances have already been provided
stress generation hypothesis
depressed individuals have been found to generate stressful life events in the interpersonal domain, including fights, arguments, and interpersonal rejection - depressed individuals contribute to the occurrence of these events due to their maladaptive interpersonal behaviours
adoption study
32% for bipolar disorder in the biological parents of affectively ill adoptees as compared to 12% in the adoptive parents
twin studies
genetic cause for mood disorders - twins both diagnosed with disorder are said to be concordant - consistent with genetic contribution to mood disorders, high concordance rates for unipolar major depression in identical twins. Concordance rates for bipolar disorder are 65% in identical twins and 14% in non-identical
low levels of neurotransmitters is equal to what
mood disorders
what are norepinephrine and serotonin related to
semantic and cognitive development (also linked to depression)
what do high levels of dopamine cause
psychosis
hypothalamic-pituitary-adrenal (HPA) axis
depressed people with chronic stress have elected levels of cortisol
Sleep neurophysiology
depressive people spend more time in REM sleep than average, and bipolar disorder - sleep deprivation is a risk factor
what are both bipolar and unipolar depression associated with in neuroimaging
decreased blood flow and glucose metabolism in the frontal cortex - particularly left side
what happens in neuroimaging when patients shift from depression into mania
decreased blood flow and glucose metabolism in the frontal cortex - particularly right side
when does increased glucose metabolism occur
depression (occurs in several subcortical regions)
CBT techniques
activity scheduling, thought records, behavioural experiments
activity scheduling
clients make a list of activities they used to engage in - found pleasurable and will eventually schedule these
thought record
challenge negative thinking patterns - break down problem - situation, how you feel about it, what your mood was, evidence supporting your thought, evidence against though, alternatives, new mood after thinking about situation
behavioural experiments
challenge negative and pessimistic beliefs - pick problem and then work out different solutions and try them out
CBT vs. medication
CBT has better long-term outcomes vs. medication
Behavioural components
as effective as full CBT, as effective as medication in short-term, more effective that medication in long-term
mindfulness-based cognitive theory
more effective at preventing depression relapses vs. visiting family doctor/medication
interpersonal theory (IPT)
presumes depression that occurs in an interpersonal context and that addressing current problems that depressed clients face in the interpersonal realm is key to relieving symptoms (12-16 sessions)
what are the four areas IPT works on
1) interpersonal disputes
2) role transitions
3) grief
4) interpersonal deficits
interpersonal disputes
conflicts in marital, family, or other social relationships - identifying sources of misunderstanding and using communication and problem-solving training to empower the client to change the situation
role transitions
situations in which client has difficulty adapting to a life change - intervened by helping the client to reappraise the old and new roles, identify problems in adapting to the new role and use cognitive restructuring to alter his or her dysfunctional appraisals of the new role
grief
IPT therapist uses empathic listening to help the client work through the mourning process, and encourages the client to form new relationships
interpersonal deficits
main problem for a client who reports either a low number or poor quality of interpersonal relationships - identify personality issues in the client that may be interfering with formation of close relationships
Tricyclic antidepressants
block reuptake of norepinephrine and sometimes serotonin - effective but poor side effects and lethal in overdose
monoamine oxidase inhibitors
break down enzymes that break down neurotransmitters - dangerous side effect profile, require dietary restrictions, can raise blood pressure
selective serotonin reuptake inhibitors
block serotonin reuptake - mild side effect, sage - first line treatment for unipolar depression
other antidepressants
serotonin-norepinephrine reputake inhibitors
- some increase dopamine, others affect GABA levels
antidepressants vs. placebo
antidepressant was no more effective than placebo in unipolar depression
lithium
effective treatment for mania, requires physician monitoring, high risk of relapse, interferes with regulation of sodium and water levels
anticonvulsants
increase GABA levels or decrease glutamate levels, often used alone or with lithium (glutamate has excitatory effect on brain)
antipsychotics
may be used as short-term treatment or can have a mood-stabilizing effect
antidepressants
treat depressive episodes, can trigger manic episodes, often used along with a mood stabilizer
combining psychotherapy and medication for depression
no benefit seen
what are the four exceptions to combing psychotherapy and medication for depression
1) severe depression: IPT + meds better than either on their own
2) persistent depression: CBT + meds better than either on their own
3) non-response to medication: add CBT
4) adolescents: CBT + meds better than either on their own
combining psychotherapy and medication for bipolar disorder
most effective treatment is medication but in some cases high risk of relapse, substantial impairment
three effective adjunctive treatments
family focused therapy, IPSRT, cognitive therapy
family focused therapy
education for both patient and family members about disorder and effect on the patient’s functioning as well as communication and problem-solving training
IPSRT
based on theory that disruptions in daily routines and conflicts in interpersonal relationships can cause relapses of bipolar episodes - patients are taught to regulate their routines and cope more effectively with stressful events
cognitive therapy
how to regularize their sleep and daily routines, how to regularly monitor their mood to help identify early triggers, for manic episode relapses, importance of medication compliance
SAD psychotherapy
phototherapy:
40% remission in severe depression
60% in mild depression
can trigger manic episodes in bipolar patients
ECT
- creates seizure in brain that lasts approximately 25 seconds, used for treatment-resisitant depression or depression with life-threathening consequences and need for immediate results
TMS
currents from magnetic pulse stimulate nerve cells in the region of the cortex under the coil - helps because patients with depression have low levels of brain activity so this increases blood flow and nerve stimulation as well as glucose metabolism
Vagus nerve stimulation
information on this nerve travels from major organs to it, device is planted and stipulations are delivered every 30 seconds for 5 minutes
deep brain stimulation
surgically implanting wires into brain
self-harm rates
general population: 1-4%
teenagers: 14-39%
college students: 15%
gender differences in suicide
men are 3x more likely to complete suicide while women are 3x more likely to attempt
biological factors for suicide
identical twins are 5-10x more likely to commit suicide, and in adoption studies it is shown that the rate of suicide in biological relatives of adoptees was more than 6x higher than for the group of adoptees who had committed suicide
what neurotransmitter is involved with suicide
low levels of serotonin
psychache
feeling of unendurable psychological pain and frustration
treatment for suicide
CBT = identify and modify thoughts, images and core beliefs
