Lecture 8: Depressive and Bipolar Disorders Flashcards
depression
low mental state characterized by significant levels of sadness, lack of energy, low self-worth, guilt, or related symptoms
mania
state or episode of euphoria or frenzied activity in which people may have an exaggerated belief that the world is theirs for the taking
depressive disorders
group of disorders marked by unipolar depression
unipolar depression
depression without a history of mania. episodes of unipolar depression are often triggered by stressful events
emotional symptoms
feeling negative emotions and experiencing little pleasure
anhedonia
the inability to experience joy
motivational symptoms
no desire to take part in activities
behavioral symptoms
being less active and less productive
cognitive symptoms
having negative thoughts, negative self-view, and being pessimistic
physical symptoms
headaches, dizziness, problems with the digestive system, and general pain
major depressive episode
a period of at least 2 weeks with significant distress or impairment characterized by:
- an increase in depressed mood and/or a decrease in enjoyment or interest across most activities
- at least. 3 of the following symptoms: weight or appetite change, daily insomnia or hypersomnia, daily agitation or decrease in motor activity, daily fatigue or lethargy, daily feelings of worthlessness or excessive guilt, daily reduction in concentration or decisiveness, focus on death or suicide
major depressive disorder
major depressive episode and no pattern of mania or hypomania
peirpartum
type of MDD that occurs during or after childbirth. this disorder may also be seasonal, for example, it may reoccur every winter
melancholic
type of MDD where pleasant events do not affect the person
catatonic form
form of MDD that is characterized by immobility, or excessive mobility and rigid movements
persistent depressive disorder
when major depressive disorder is present for at least 2 years
premenstrual dysphoric disorder
depressive symptoms occurring the week before menstruation
disruptive mood dysregulation disorder
characterized by a combination of persistent depressive symptoms and recurrent outbursts of severe temper. emerges in mid-childhood or adolescence
biological view of causes of unipolar depression
- genetic factors: genetic predisposition for depression
- biochemical factors: unbalanced levels or neurotransmitters, especially low norepinephrine and serotonin activity. hormones and HPA pathways might also have a relationship with depression
- brain anatomy: low activity in the PFC, small hippocampus, less neuronal growth, high activity in the amygdala, small and more active subgenual cingulate, problematic interconnectivity between these structures
- immune system: prolonged stress causes immune dysregulation, which can contribute to depression
psychodynamic view of causes of unipolar depression
- depression as a consequence of not being able to move on after losing a loved one
- depression without loss of a loved one, the cause is symbolic or imagined loss = unconsciously interpreting something as loss of a loved one
sociocultural view of causes of unipolar depression
- family social perspective: no available social support and lack of social reward can lead to depression
- multicultural perspective: a strong link exists between gender and depression, women are more likely to be diagnosed with depression
cognitive-behavioral view of causes of unipolar depression
- depression results from problematic behaviors and dysfunctional thinking
- theoretical perspectives:
- behavioral dimension
- negative thinking
- learned helplessness
behavioral dimension
when there is no sufficient reward, people might lose interest to taking part in activities, contributing to depressed feelings
negative thinking
some people develop negative attitudes, leading to three types of maladaptive thought patterns (cognitive triad): experiences, self-view, and ideas about the future are interpreted in negative ways. depressed people also suffer from automatic thoughts = ongoing thought-chain that keeps suggesting pessimistic things
learned helplessness
depression occurs when people think that they do not have control over rewards and punishments in their life and that they are responsible for this helplessness
- attribution helplessness theory: attribution to some internal and stable cause results in depression
biological view of treatments of unipolar depression
- electroconvulsive therapy (ECT): sending electric signals through the brain, which activate different brain areas, creating a mini seizure, relieving depression
- antidepressant drugs
- brain stimulation
MAO inhibitors
slow production of enzyme MAO, enzyme breaks down norepinephrine, so MAO blocks this which relieves depressive symptoms
tricyclics
block re-uptake of norepinephrine and serotonin, stay longer in the synaptic cleft, stimulating neighbor cells
selective serotonin re-uptake inhibitors (SSRIs)
block re-uptake of serotonin
psychodynamic view of treatments of unipolar depression
- psychodynamic therapy: seeking unconscious causes and using psychodynamic procedures to work through them - not supported
cognitive behavioral view of treatments of unipolar depression
- cognitive behavioral therapy: behavioral activation, recognize and change negative cognitive processes
sociocultural view of treatments of unipolar depression
family social perspective:
- interpersonal psychotherapy (IPT): identify and resolve four types of problems that can lead to depression; loss, role dispute, role transition and deficits
- couple therapy: solving depression related to malfunctioning relationships by improving communication and problem-solving skills
multi-cultural perspective:
- helping someone recognize the consequences of their culture on their mental state and combining that with other sorts of treatment
bipolar disorder
disorder marked by alternating or intermixing periods of mania and depression. two types in DSM-5:
- bipolar diorder I
- bipolar disorder II
- cyclothymic disorder
bipolar disorder I
alternation between full manic and major depressive episodes
- full manic episode: high or irritable mood and heightened energy or activity for. most of every day for at least 1 week, and experiencing at least three of the following symptoms: grandiosity or overblown self-esteem, reduced sleep need, increased talkativeness, thoughts moving very fast, attention pulled in many direction, heightened activity, excessive pursuit of risky activities
bipolar disorder II
alternation between hypomanic episodes (very mild manic episode) and major depressive episodes
cyclothymic disorder
alternation between hypomanic and mild depressive symptoms, may evolve into bipolar I or bipolar II
biological view of causes of bipolar disorder
- neurotransmitters: higher norepinephrine and lower serotonin
- ion activity: irregularities in transport
- brain structures: les gray matter, small cerebellum and basal ganglia
- genetic factors: genetic predisposition to develop disorder
treatments for bipolar disorder
- mood stabilizing (anitbipolar) drugs: lithium (affects neurons’s second messengers, and may alter ion activity)
- adjunctive psychotherapy
- psychotherapy or mood stabilizing alone is rarely helpful, so they combine them
parasuicide
a suicide attempt does not result in death
suicide
self-inflicted death in which one makes an intentional, direct and conscious effort to end one’s life. 4 types of people who intentionally end their lives:
- death seekers
- death initiators
- death ignorers
- death darers
death seekers
people who intend to take their life at the time of suicide
death initiators
people who believe that they are going to die soon and want to speed up the process
death ignorers
people who believe that they will live on after their death
death darers
people who hesitate to end their life, even at the point of suicide
sub-intentional death
a death in which the victim plays an indirect, partial, covert or unconscious role. example: drug, alcohol, or tobacco use, recurrent physical fighting, medication mismanagement
non-suicidal self-injury
when someone inflicts damage on themselves without the intention of dying by suicide
studying suicide
- retrospective analysis: psychological autopsy in which clinicians piece together information about a person’s suicide from the person’s past
- studying people who survived their suicide attempts
suicide triggers
- stressful events: 4 long term stressors; social isolation, illness, repressive or abusive environment and occupational stress
- alcohol and drug use
- mental disorders
- modeling: people who have family members, friends or co-workers who die by suicide may come to see this as a possible solution
- social contagion effect: increased risk of someone dying by suicide when a family member or friend dies by suicide
- mood and thought changes
- hopelessness: pessimistic belief that one’s present circumstances, problems or mood will never change
- dichotomous thinking: viewing problems and solutions in rigid either/or terms (black-and-white thinking)
psychodynamic view of causes of suicide
suicide results from depression and negative feelings towards others that are redirected towards the self - not supported
durkheim’s sociocultural view of causes of suicide
suicide occurs when people do not have the feelings of belonging to a social group. three types of suicide:
- egotistic suicide: not being concerned about norms of society
- altruistic suicide: sacrificing one’s own life for the greater good of society
- anomic suicide: environment does not provide stable structures to give meaning to life
interpersonal view of causes of suicide
- interpersonal psychological theory: people with perceived burdensomeness, thwarted belongingness, and psychological capability to carry out suicide are most likely to attempt suicide
- perceived burdensomeness: people believe that their existence is a burden to their family, friends and even their social environment
- thwarted belongingness: people feel isolated and alienated from others
biological view of causes of suicide
- genetics
- brain development: low serotonin and abnormalities in depression-related brain circuits contribute to suicide
age as a cause of suicide
- the probability of dying by suicide increases until middle age, drops during early stages of old age, and increases beginning at age 75
- uncommon among children
- in adolescents:
- suicide linked to clinical depression, anger, impulsiveness, major stress and adolescent life itself
- there are more many suicide attempts than suicide deaths
- elderly suicide is linked to loss of health, friends, control and statues, which produces feelings of hopelessness, loneliness, depression or inevitability
treatments after suicide attempt
- medical care followed by psychotherapy or drug therapy
- cognitive behavioral therapy focuses on changing thoughts and new ways of coping
suicide prevention program
program that tries to identify suicidal people and prevent them from taking their own lives
- offer crisis intervention: helping people to look at their situation accurately and constructively in order to overcome their crisis
treatment of suicide focuses on:
- establishing a trusting and positive relationships with the suicidal person
- understand the suicidal person’s full problems
- assess the likelihood that the person will die by suicide
- try to recognize the suicidal person’s strengths and resources
- come up with a plan of action on what the person should do
