Chapters 7 and 8 - Mood Disorders and Suicide

Question 1

Unipolar vs. Bipolar disorders

Answer 1

• Unipolar: depression

* Bipolar: “manic depression” 2 poles: mania (euphoria) and depression (dysphoria)

Question 2

Prevalence of mood disorders?

Answer 2

• Depression: more females
• Bipolar: equal male and female
• Risk increases with each additional episode of depression

Question 3

Core depression symptoms?

Answer 3

1) Depressed mood

2) Diminished interest or pleasure in nearly all activities (ankedonia)

Question 4

Other depression symptoms?

Answer 4

• Significant weight loss or gain
• Insomnia or hypersomnia
• Psychomotor agitation or retardation
• Significant fatigue or loss of energy
• Feelings of worthlessness or guilt
• Diminished ability to think or concentrate
• Recurrent thoughts of death or suicidal ideation

Question 5

What is dysthymia?

Answer 5

Milder, less intense depressive disorder - more chronic

Question 6

Diagnosis criteria for dysthymia?

Answer 6

Symptoms not absent for more than 2 months at a time, chronic duration of 2-20 years

Question 7

What is double depression?

Answer 7

Individual possesses symptoms of both dysthymia and major depressive episode

Question 8

What is major depressive disorder?

Answer 8

More intense experiences of symptoms

Question 9

Specifiers of major depressive disorder?

Answer 9

• Mild - just meet criteria
• Moderate - meet criteria and a bit more
• Severe - meet several criteria, also with or without psychotic features (delusions or hallucinations)
• Other specifiers - with seasonal patterning, with peripartum onset

Question 10

Biological theory of depression

Answer 10

• Catecholamine hypothesis - deficiency of 5HT, NE, DA at synapse
• Genetics: based on twin studies and pedigree studies

Question 11

Psychodynamic theory of depression

Answer 11

• Freud - prolonged grief related to earlier loss
• Bibring - loss itself is not important, but loss of what the person represented to you
• Bowlby - attachment theory; unhealthy early attachment

Question 12

Behavioral theory of depression

Answer 12

• Depression - lack of positive reinforcement in person’s environment
• Treatment - behavioral activation therapy

Question 13

Cognitive theory of depression

Answer 13

• Beck’s cognitive errors
• Attributional model
• Depressive realism hypothesis

Question 14

What were Beck’s cognitive errors?

Answer 14

• Overgeneralizing: assume circumstances in one situation will be the same in all similar situations
• Selective abstraction: attend only to failure or deprivation and ignore any positives
• Catastrophizing: always imagining the worst of any given situations, always entertains the worst case scenario
• Dichotomous thinking: rigid thinking, all or nothing thinking

Question 15

What is the attributional model?

Answer 15

Assigning causes to situations - internal, stable, global attributions for negative situations

Question 16

What is the depressive realism hypothesis?

Answer 16

Are depressed people just more realistic than non-depressed? Research finds that there was a small but significant effect supporting depressive realism

Question 17

Humanistic/Existential theory of depression

Answer 17

Depression related mostly to loss of self-esteem

*Carl Rogers: discrepancy between real and ideal self

Question 18

Sociocultural theory of depression

Answer 18

Culture plays a role in symptom presentation and prevalence rates

• US: higher rates seen among Native Americans and Southeast Asian Americans
• China: report more somatic symptoms, fewer cognitive symptoms

Question 19

Diathesis stress model

Answer 19

Predisposition to depression and add on to major life stressors - this leads to onset of depression

Question 20

Biological treatment of depression

Answer 20

• Pharmacotherapy: antidepressants (SSRIs)
• Phototherapy: “light therapy” - used for major depression with seasonal patterning, results of outcome studies are mixed
• ECT: mainly used for severe major depression, results in massive release of all NTs
• Transcranial direct stimulation - magnetic stimulation, which is less invasive and targets specific areas, also used for resistant depression

Question 21

Psychodynamic treatment of depression

Answer 21

Uncover unconscious conflicts, then work through such conflicts - work through grief over earlier loss

Question 22

Behavioral treatment of depression

Answer 22

Increase positive reinforcement in one’s environment (BAT)

Training in social skills that may be lacking

Question 23

Cognitive treatment of depression

Answer 23

• Work on dysfunctional thinking (rational-emotive therapy)
• Cognitive restructuring
• ACT - Acceptance Commitment Therapy
  
  • Accept: emotions, feelings, thoughts - depression related
  • Know: they are only emotions
  • Commit to: take action towards life values

Question 24

Humanistic treatment of depression

Answer 24

• Work toward a more realistic Real and Ideal Self

* Focus on self-esteem and self-concept

Question 25

Characteristics of mania

Answer 25

Little sleep, elevated mood, rapid speech, irritability, risky impulsivity, increase in psychomotor activity, may show psychotic symptoms

Question 26

Types of bipolar disorder

Answer 26

* Bipolar I: major depression and full-on mania | * Bipolar II: major depression and hypomania (lesser mania)

Question 27

DSM characteristic of diagnosis of bipolar

Answer 27

Rapid cycles - at least 4 episodes in 12 months

Question 28

Onset of symptoms of bipolar

Answer 28

* Most evident: young adulthood * Genetic links * Co-morbidity across mood disorders * Some links with early chaotic upbringing * Stress can trigger mania

Question 29

What is cyclothymia?

Answer 29

"Lesser" bipolar disorder - depressed mood and hypomania | *DSM: symptoms must have lasted at least 2 years

Question 30

Bipolar treatments

Answer 30

* Antidepressants for depressive phase may trigger mania * Lithium - but potentially toxic * Problems with non-adherence: side effects are not pleasant and they miss their highs

Question 31

What is suicide?

Answer 31

Self-inflicted death that is an intentional, conscious, direct effort to end one's life

Question 32

What is parasuicide?

Answer 32

An attempt to harm oneself and/or an unintentional suicide attempt

Question 33

How is parasuicide different than suicide?

Answer 33

* More impulsive * Use less aggressive means * Does not commit act

Question 34

What are Schneidman's types of suicidal people?

Answer 34

* Death Seekers: clear intentions of dying, takes clear actions to die * Death Initiators: already dying and are just speeding process * Death Ignorers: believe that dying would lead to better existence * Death Darers: ambivalent attempts to die, acts in risky ways. Motivated by attention-seeking * Sub-intentional death: suicide-like category, behaviors more covert or unconscious, indirect in leading to death

Question 35

Places with highest rates of suicide?

Answer 35

Asia, Eastern Europe, parts of Central Europe

Question 36

Places with lowest rates of suicide?

Answer 36

South America, Greece, Egypt, Spain

Question 37

What is cause of different places having different rates of suicide?

Answer 37

Mainly culture - perhaps suicide is more acceptable in some cultures than others

Question 38

Gender differences in suicide

Answer 38

More females attempt, more males commit

Question 39

Suicidal rates ranked by relationship status

Answer 39

1) Divorced 2) Widowed 3) Single 4) Married

Question 40

Suicide rates in ethnic groups

Answer 40

* Native Americans: recently had higher rates * White Americans: have highest rates * African Americans and Hispanic Americans: lower rates (Asian Americans too)

Question 41

How to approach the suicidal

Answer 41

* Validate the person's feelings * Understand person's problems * Assess potential for suicide * Help them identify strengths and resources, get them to talk about themselves and friends * Follow-up plan - get them to commit to a plan