Mood Disorders and Suicide Flashcards
What disorder is the most frequent and common?
Mood disorders
What are some of the common terminology associated with mood disorders?
Emotion, affect, mood, depression (Mood), versus clinical depression (syndrome), mania, euphoria and dysphoria
What is emotion?
State of arousal defined by subjective states of feeling. Felt in body, interpreted by the mind. Labelling happens in inner and outer environment
What is affect?
Pattern of observable behaviour to demonstrate emotion
What types of affect are seen in in some mood disorders?
Hunched shoulders, slow walk, crying, looking sad
What is a mood?
The pervasive and sustained emotional response that colours the perception of the world
What is mania?
Elated feeling, so happy you can’t control things, fluctuations between happy, sad, and angry
What is euphoria?
ELated mood-less intense than mania (Happens with success, good grades, etc)
What is dysphoria?
Exaggerated despondency (gloomy, low, down)
What is a unipolar mood disorder?
When you only have episodes of depression or mania (but unipolar mania is rare). Standard major depressive disorder is also known as unipolar depression
What is bipolar mood disorder?
When there are episodes of depression and mania (BP`1) or hypomania (BP2)
What is Bipolar 1 disorder?
Very light depression with severe, out of control mania-have to go to the psych ward for how bad your manic episodes get
What is Bipolar 2 disorder?
Depression and hypomania-get excitable, happy, possible irritation, violent, lots of ideas and productivity, no sleeping or eating, eventual crash. Severe depression poles with enormous difficulties- constant crying, no eating or sleeping, isolation for weeks or months
Which type of Bipolar disorder do lots of celebrities have?
Bipolar 2
What is the difference between normal sadness and depression?
Sadness: Temporary (usually a few days)
Depression: Unrelenting for period of weeks or months, can occur without precipitating events, often out of proportion with person circumstances. Impairs functioning in life, a wide variety of symptoms (eating and sleep issues, irritability), can be scary.
What are the Symptom categories for bipolar and unipolar mood disorders?
1) Emotional
2) Cognitive
3) Somatic
4) Behavioural
What are the emotional symptoms of unipolar depression?
- dysphoric mood
- despondency
- despair
- 1/3-2/3 of patients experience anxiety
What are the emotional symptoms of mania?
- elation
- euphoria
- irritability
- mood lability
What are the cognitive symptoms of unipolar depression?
- slowed thinking and poor concentration
- guilt, worthlessness
- Beck’s depressive triad
- suicidal ideation, behaviour
What is Beck’s depressive triad?
Focusing on negative aspects of the self, environment, and future
What are the cognitive symptoms of mania?
- racing thoughts (faster than you can handle)
- high distractibility
- grandiosity
- inflated self-esteem
- 2/3 of patients get perceptual disturbances and psychotic episodes.
What are the somatic symptoms of unipolar depression?
- fatigue, lethargy, aches and pains
- anhedonia (inability to experience pleasure)
- loss of interest in activities
- loss of interest in sex
- loss of appetite or overeating
- insomnia or hypersomnia
What are the somatic symptoms of mania?
- excessive, intense energy
- pressured speech
- psychomotor agitation
- decreased need for sleep
What are the behavioural symptoms of unipolar depression?
- agitation
- psychomotor retardation
What are the behavioural symptoms of mania?
- gregariousness
- impulsivity
- hypersexuality, excessive spending, and other extravagant behaviours
- irritability, aggressive stance, violence (some patients)
What type of disorder do lots of men who are abusive have?
Bipolar 2 (aggression, violence etc)
How does bipolar 2 usually progress?
As a slow descent into depression over a period of time, then person realizes they’re too sad and climbs back to hypomania. Rapid cycling type makes it more difficult.
What other types of disorders are typically comorbid with bipolar disorders?
Addiction and self-harm
When do people typically realize they might have bipolar disorder?
During the depressive phase when everything comes crashing down
What is the classification of Major depressive disorder?
The experience of at least one major depressive episode (often multiple discrete episodes), of at least 2 week duration without manic episodes
What are the symptoms that must be included in major depressive disorder?
EITHER
-depressed mood
-markedly diminished interest or pleasure
5/9 total symptoms needed to diagnose.
What is characteristic of Persistent Depressive Disorder (Dysthymia)?
Chronic low mood for at least 2 years with at least 2 associated symptoms. Can be accompanied by recurrent episodes of MDD.
What is characteristic of PDD according to research?
- Higher levels of impairment
- Younger onset age (17 or younger)
- higher comorbidity
- stronger family history
- lower social support
- higher levels of stress
- higher levels of dysfunctional personality traits
Why is the diagnosis of PDD criticised?
People see it as a sneaky way of getting more depressed people into the system (For insurance reasons)
What is the classification of BP1 disorder?
At least one manic episode (more severe than hypomanic) preceded or followed by depression- episode of depression is not necessary to diagnose BP1
What is the classification of BP2 disorder?
One or more hypomanic episodes with one or more major depressive episodes. No full blown manic episodes
What is the classification of cyclothymia?
Chronic mood swings over at least 2 years, numerous hypomanic and depressive episodes that do not meet criteria for MDD.
What is the specifier for the difference between cyclothymia and BP2?
Rapid cycling- 4+ manic and depressive episodes in 1 year. 2 months between each episode.
What is seasonal affective disorder?
Depression that occurs during specific seasons (winter). Issue with melatonin processing in brain (can’t sleep)-tendency to overeat and sleep more/less than usual
What other disorder do you have to be diagnosed with to have SAD?
MDD
What are some of the components of Post-Partum Depression?
Mood disorder with peri or post-partum onset. 10-15% of mothers get it-includes panc attacks, sleep disruptions, intrusive thoughts about harm to self or baby, inability to bond with baby, persistent disgust with baby
What percentage of women commit suicide and infanticide with PPD?
5% suicide, 4% infanticide.
When is the usual onset of unipolar depression?
Early-normally early to mid twenties
How long is the average depressive episode with unipolar depression?
6-9 months
Who is at an increased risk of relapse and what happens as relapses occur with unipolar depression?
People who have had 2-3 depressive episodes. If relapses continue, the “wellness” period in between becomes shorter.
What is the mean age of onset for bipolar disorder and when do a lot of people report onset?
20 is the mean, many report onset before 17
How long do the hypomanic/manic episodes last and how long do the depressive episodes last?
Hypomanic/Manic: 2 weeks to 4 months
Depressive: 6-9 months
What is the percentage of patients that have sustained recovery (with treatments)?
40-50%
Which type of bipolar disorder has the poorest prognosis?
Rapid cycling
What is key to treating unipolar and bipolar disorder?
Early intervention
What percentage of the population meets the criteria for mood disorders (last 12 months)
5-10%
What is the ratio of unipolar to bipolar?
5:1
What gender is 2-3 times more likely to experience unipolar depression?
Women
What are some of the psychosocial factors that cause mood disorders?
Attachment and loss (can be job, relationships, health)
Stressful live events
Aversive emotional expression within family
Self-verification theory: negative feedback-seeking
Interpersonal dependency and excessive reassurance-seeking
History of stressful life events
What are some of the psychological factors associated with mood disorders?
Cognitive distortions (ex: black and white thinking)
Depressive schemas
Helplessness and hopelessness (despair leads to suicidal ideation)
Reduced activity, less positive reinforcement
Rumination (more common in women)
Personality factors
What are depressive schemas?
Core beliefs about the self, the world, and the future (ex: unloveable, can’t do anything right etc)
What is an example of “Depressed” behaviour?
Watching daytime TV (lack of rewarding activity)
What is behavioural activation therapy?
When you log activities that you do, find out what is important to you, and then have a better time doing those activities
What is the most important personality trait to watch for with mood disorders?
Neuroticism-tendency towards negative thoughts and thinking.
Wha are some of the biological factors associated with mood disorders?
Genetics
Interaction of life stress and genetics
Sleep and circadian functioning
Neurotransmitters (serotonin and norepinephrine)
Density and sensitivity of post-synaptic receptors
Neuroendocrine system
Structural and functional brain abnormalities
What is the heritability of BP disorders coefficent?
.75
How much more likely are you to get MDD and BP when you have a 1st degree relative with it?
2-5X more with MDD. 7-15X more with BP
What happens when you have less serotonin and norepinephrine?
Serotonin-Poor dopamine processing, lack ability to block negative thoughts
Norepinephrine-More severe unipolar depression
What area of the brain shows higher activity in mood disorders?
Amygdala-more activation makes it harder to disambiguate from negative thinking.
What are some of the treatments for unipolar depression?
Cognitive therapy Interpersonal therapy Medications Transcranial magnetic stimulation Vagus nerve stimulation Phototherapy (for SAD)
What is cognitive therapy?
Most common treatment approach in mild/moderate depression. Identification and pattern of automatic thoughts
What is interpersonal therapy?
Focuses on the idea that depression comes from mismanaged relationships and loss-look at pattern of losses from childhood onwards and help people recognize problems, grieve losses, and change behaviour
When did the Tricyclics come out and how effective are they?
End of 50s-60s. Super effective, nothing is more effective HOWEVER has more side effects
What do the SSRI’s and SNRIs do and are they effective?
Slow down serotonin and norepinephrine reuptake-fewer side effects, have more energy. Effective, but can also make you numb to the world
Are the MAOIs effective?
Yes, but interact weirdly with foods. Prescribed after other forms of meds don’t work.
What are some of the treatments for bipolar disorder?
Lithium Carbonate
Anticonvulsant Medication
Psychotherapy
Electroconvulsive shock treatment (For severe bipolar and unipolar disorders)
Is Lithium Carbonate effective?
Yes, but is poisonous to brain in the wrong dose.
What does psychotherapy help with?
Social and self-management
What is one of the side effects of ECT?
Retrograde amnesia of 3-4 months BUT depression also causes this.
What percentage of suicides are related to mood disorders?
50
What percentage of all patients with mood disorders eventually commit suicide?
15-20
What is suicidal ideation?
The idea that one could commit suicide.
What are suicidal gestures?
Indications of level of distress (ex: someone who takes a bunch of non dangerous meds in an attempt to end life)
What is a suicide attempt?
When someone uses a method that could be lethal, but fails
How many suicide attempts are there in Canada each year?
10-20 million
How many people (for every 100 000) complete suicide each year?
11.3
Which gender is more likely to complete suicide?
Men
Who has the highest risk of successful suicide?
Men aged 40-54 and older men above the age of 75.
How much can a suicide cost?
850 000 dollars
What is the interpersonal model (Joiner)?
Having a high level of burdonsomeness, feelings of alienation, hopelessness about future, lead to ideation and intent-repeated self harm and suicide attempts lead to a decreased fear of death and increased tolerance of pain
What is the motivational volitional model (O’Conner)?
Stress is accompanied by thoughts of defeat, humiliation, entrapement. Sense of burden increases, acquire capabilities such as fearlessness and the copy cat syndrome (increased suicidal thoughts when someone close commits suicide).
What are some exceptional situations for suicide?
Saving someone elses life at the cost of your own.
Do countries with better gun control have fewer suicides?
YES
What are some ways we can treat suicide?
Primary prevention, psychotherapy, treating underlying problem, voluntary or involuntary hospitalization
