Lecture 5 Flashcards
What is suicidal self-injury?
Any action that is self inflicted and results in injury or the potential for injury, with an intent to die
What is suicidal ideation?
It involves a variety of cognitions, from “fleeting thoughts that life is not worth living” to “very concrete, well-thought out plans for killing oneself”
What is suicidality?
It is the construct that includes suicidal ideation, parasuicide and suicide
What is the continuum for suicidal thoughts and actions?
Ideations, plan in place, attempt, death
What are the warning signs (behavior) of suicide?
- Increased use of alcohol or drugs
- Acting recklessly
- Isolating and withdrawing from activities
- Change in sleep, appetite, energy level
- Visiting or calling people to say goodbye
- Giving away prized possessions
- Aggression or agitation
- Discomfort due to psychosis
What are the warning signs (verbal) of suicide?
Things they could say:
- wanting to kill themselves
- having no reason to live
- being a burden to others
- feeling trapped
- unbearable pain
- feeling hopelessness
What are the warning signs (mood) of suicide?
- depression
- despair
- loss of interest
- rage
- irritability
- humiliation
What are the statistics of suicide?
- Suicide is the 11th leading cause of death in the US
- Men died by suicide 3.9 times more than women
- White males accounted for almost 70% of the deaths of suicide in 2021
- Suicide is the 2nd leading cause of death among children and adolescents
What are the statistics of suicide on adolescents?
- Adolescent girls are twice as likely as boys to have suicidal thoughts or make suicidal plans
- Adolescent girls are thrice as likely than boys to attempt suicide
- Boys are twice as likely than girls to die from suicide due to more lethal strategies
- Suicides among boys increased from 7.6 to 9.7
- Suicides among girls increased from 2.3 to 4.2
How does age play apart in suicide?
- Suicide death is higher in adolescents than children
- The suicide rate among prepubescent children is very low
- Suicidal ideation is rare in children but becomes slightly more common during early adolescence and then increases between the ages of 15 and 18
- Death by suicide increases with age
What does the interpersonal-psychological theory of suicide include?
- Perceived burdensomeness
- Thwarted belongingness
- Capability for suicide
What are the two categories of risk in the interpersonal-psychological theory of suicide?
- Dysregulated impulse control
- Intense psychological pain
What are the clinical features of a major depressive disorder?
- One or more major depressive episodes, absence of manic episodes, separated by periods of remission
- A single episode is highly unusual
- Recurrent episodes are more common
- Waxes and wanes
-Duration 4-5 months
What are the psychotic features with MDD?
- Delusions
- Hallucinations
- Disorganized speech (frequent derailment or incoherence)
- Grossly disorganized behavior
What are the DSM-5 specifiers of MDD with mood-congruent psychotic features?
The content of all delusions and hallucinations is consistent with the typical depressive themes of personal inadequacy, guilt, disease, death, nihilism, or deserved punishment
What are the DSM-5 specifiers of MDD with mood-incongruent psychotic features?
The content of all delusions or hallucinations does not involve typical depressive themes of personal inadequacy, guilt, disease, death, nihilism, or deserved punishment, or the content is a mixture of mood-incongruent and mood-congruent themes
What does catatonia include as a feature of depression?
- Stupor (no psychomotor activity, not actively relating to the environment)
- Catalepsy (passive induction of a posture held against gravity)
- Waxy flexibility (slight, even resistance to positioning by the examiner)
- Mutism (no, or very little, verbal response)
- Negativism (opposition or no response to instructions or external stimuli)
- Posturing (spontaneous and active maintenance of a posture against gravity)
- Stereotypy (repetitive, abnormally frequent, non-goal-directed movements)
- Agitation, grimacing, echolalia (mimicking another’s speech)
- Echopraxia (mimicking another’s movements)
What is the relationship between catatonia and incontinence?
Incontinence (urinary or fecal) is not part of the criteria listed in the DSM-5 for catatonia
Some clinicians believe it should be included as a sign of catatonia since clinical improvement is associated with improvement in incontinence and incontinence improves as catatonia improves with treatment
What is persistent depressive disorder?
Being depressed most of the day, more days than not for a minimum of 2 years for adults
You cannot be symptom-free for more than two months
What are the symptoms of PDD?
Must include two of the following symptoms
- Increased or decreased appetite
- Increased or decreased sleep
- Fatigue
- Low self-worth
- Concentration and decision-making difficulties
- Feelings of hopelessness
What are the differences between major depressive disorder and persistent depressive disorder?
PDD has a minimum of symptoms required
Is more chronic
Has higher rates of comorbidity
Is less responsive to treatment and shows a slower rate of improvement over time
What relationships are there between major depressive disorder and persistent depressive disorder?
- About 20% of patients with an MDE report chronicity of this episode for at least two years, and therefore meet the criteria for PDD
- Approximately 22% of people with PDD with few symptoms eventually experienced an MDE
- Individuals who suffer from both MDE and PDD with fewer symptoms are said to have double depression
What is the difference between the early and later onset of PDD?
Early onset has increased comorbidity, ACE’s, and family history of depression
Late onset is associated with stress
What are some of the complications with diagnosis and treatment of PDD?
Mild and moderate depression may feel normal to the person experiencing it, and if they do seek treatment
- it is easy to miss PDD and diagnose a major depressive episode or another disorder
- it is difficult to get a comprehensive history to determining that the patient had PDD
What is the relationship of MDD with peripartum onset?
- Approximately 15% of women experience this including minor depressive episodes
- Rates in adolescent mothers are higher (26-53%)
- 60% of women have their first depressive episode in the postpartum period
- Can present either with or without psychotic features
- Infanticide is associated with postpartum psychotic episodes
-Psychotic symptoms can also occur in severe postpartum mood episodes with specific delusions or hallucinations involving the infant
What are the common symptoms of major depressive disorder with peripartum onset?
- Extreme difficulty in day-to-day functioning
- Feelings of guilt, anxiety and fear
- Loss of pleasure in life
- Insomnia
- Bouts of crying
- Thoughts of hurting oneself or the infant
What does MDD with peripartum onset feature?
- Hallucinations
- Delusions
- Confusion
- Labile mood
- Thoughts of harming oneself or the infant
Approximately 1 of every 1000 births
Women who have bipolar disorder or schizoaffective disorder are at increased risk
What is included with late-life depression LLD?
- Depression in the elderly between 14% and 42%
- Co-morbid with anxiety disorders
- Less gender imbalance after 65 years of age
- Cultural differences exist
- They can say they are “heartbroken”
Native American population has four times the rate of depressive disorders as the general population
What is electroconvulsive therapy?
- It is now a safe and effective treatment for severe depression
- It is administered every other day for 6-10 treatments
- Electric shock is administered directly through the brain for <1 second
- Produces seizures for several minutes
- Patients are anesthetized to reduce discomfort
- Muscle-relaxing medication to prevent bone breakage from seizures
What are the side effects of electroconvulsive therapy?
- Nausea
- Headache
- Limited short-term memory loss
- Confusion
- Usually disappear after a week or two
- Some patients have long-term memory problems
