Mood Disorders & Suicide

Question 1

Major depressive episode Diagnostic criteria

Answer 1

Almost every day for at least two weeks

Must have at least one

• Loss of interest/inability to experience pleasure
• depressed mood

Four of the following

• Decreased interest in activities they once enjoyed
• Fatigue
• Feelings of worthlessness/guilt
• Poor concentration
• thoughts of death or suicide
• Moving too much or too little
• Decrease or increase in appetite or weight

Cannot be explained by another condition

Causes significant distress or impairement

Question 2

Manic Episode (hypomanic)

Answer 2

Manic

Abnormally elevated mood that lasts for more than a week (or any duration if hospitalization is necessary)

3 or more of the following symptoms

• Sense of grandiosity
• Flight of ideas
• increased speed of talking
• distractability
• Increase in risky behavior
• less sleep

Impairment in functioning or hospitalization

not due to substance abuse

Hypomanic

At least four days of elevated mood

3 or more of symptoms

Less severe

does not require hospitalization or impairment of functioning

Question 3

Major depressive Disorder

Answer 3

• At least one major depressive episode: episodes repeated by periods of remission
• No manic/hypomanic episode (unless induced by a substance/other medical condition)
• Specify clinical status of the most recent depressive episode
  
  • Single or recurrent (two or more episodes separated by two months of remission)
  • mild-moderate, severe; in partial remission; in full remission

Question 4

Grief vs depression

Answer 4

• After loss, grief is natural
  
  • Acute grief: immediately after loss
  • Integrated grief: eventually coming to terms with loss
• Distinguishing between grief & depression
  
  • Grief sometimes has positive memories depression is constant negative mood
  • Grief has preserved self-esteem depression brings feelings of worthlessness
    *

Question 5

Unipolar vs Bipolar

Answer 5

Unipolar: only one extreme of the mood experienced e.g. only depression or mania

• Major Depressive disorder
• Persistent depressive disorder
• Premenstrual dysphoric
• Disruptive mood dysregulation disorder

Bipolar: both depressed & elevated moods experienced e.g. some depressive and some hypomanic or manic

• Bipolar I
• Bipolar II
• Cyclomanic

Question 6

Mixed features

Answer 6

Experience full diagnosis of one mood and part of the other pole

• at least three criteria
• Experiencing 3 symptoms of depression while in a manic episode
• Shows that moods can be independent of each other

Question 7

Persistent depressive disorder Diagnostic

Answer 7

• Milder symptoms than major depression
• Occurs most days for nearly 2 years (never more than 2 months without symptoms, though they can change)
• 2 or more symptoms
  
  • poor appetite or overeating
  • insomnia or hypersomnia
  • fatigue
  • feelings of worthlessness
  • low self-esteem
  • concentration difficulties

Question 8

Types of Persistent Depressive Disorder

Answer 8

• Mild depressive symptoms without any major depressive episodes (“with pure dysthymic syndrome”)
• Mild depressive symptoms w additional major depressive episodes occurring intermittently
• Major depressive episodes lasting 2+ years (with persistent major depressive episode)

Question 9

Premenstrual Dysphoric Disorder Diagnostic

Answer 9

• Reserved for severed and persistent symptoms
• Must meet at least 5 of the following
• Must have 1 of the following
  
  • mood swings
  • irritability
  • anxiety or tension
  • depression
• Must have at least one of the following
  
  • Decreased interest in activity
  • fatigue
  • hypersomnia/insomnia
  • appetite loss/increased appetite
  • feeling of overwhelmed
  • Physical symptoms such as breast tenderness or swelling
• Must cause significant impairment
• At least 2 menstrual cycles

Question 10

Premenstrual Dysphoric disorder controversy and percentage

Answer 10

only 20% meet criteria

advantage: legitimizes relief for those who might be suffering from severe symptoms
disadvantage: pathologizes something many consider “normal”

Question 11

Disruptive Mood Dysregulation Disorder

Answer 11

• Severe temper outburst at least 3 times a week against backdrop of a generally angry mood
• lasts 1 year
• only in children 6-18
• Criteria for mania/hypomania not met
  
  • created partially to combat overdiagnosis of bipolar disorder especially when elevated mood absent

Question 12

Bipolar Disorders overview

Answer 12

• Bipolar I: alterations between major depressive and manic episodes
• Bipolar II: alternations between major depressive and hypomanic episodes
• Cyclothymic
  
  • Alternations between less severe depressive and hypomanic episodes
  • never had full depressive or manic episodes

Question 13

Cyclothymic

Answer 13

• Alternations between less severe depressive and hypomanic episodes
• never had full depressive or manic episodes
• mood states may persist for a long time
• must persist for at least two years (one year in children)

Question 14

Prevalence of Mood disorders (Gender and cultural)

Answer 14

• Sex differences
  
  • Women twice as likely to have major depression
  • Bipolar affects men and women equally
    
    • Woman have more rapid cycling and more likely to be in depressive period
• Higher prevalence in native Americans
• Cross-cultural but different cultures may experience symptoms differently (somatic concerns(

Question 15

Onset and duration of depressive disorders

differences in age

Answer 15

• rare in childhood
• Onset increases in adolescence decrease in middle adulthood and increases in old age (U shaped curve)
  
  • Median age = 30
• May manifest differently depending on stage of life
  
  • children/adolescence: misbehavior, trouble sleeping loss of appetite
  • old age: physical complaints, isolation
• Episodes can last months or years untreated

Question 16

Onset and Duration of Bipolar Disorders

Answer 16

• Similar in children adults and adolescents
• Tend to be chronic
• Bipolar I: average age 15-18
• Bipolar II:
  
  • 19-22
  • 5-15% cases progress to bipolar I
  • Higher risk of suicide than bipolar I
• Cyclothymic
  
  • Age: 12-14
  • 33-50% cases progress to Bipolar I or II

Question 17

Causes of Mood Disorders: Family and Genetic

Answer 17

• Family studies
  
  • High risk if the mother has bipolar disorder
  • The closer you are in relation, the more likely you are to share bipolar disorder
• Twin Studies
  
  • Concordance rates high in identical twins: depression two to three times higher than fraternal twins
  • Severe mood disorders have a strong genetic contribution
  • Heritability rates higher for females than males

Question 18

Neurobiological Influences

Answer 18

• Neurotransmitters
  
  • Depressive disorders low levels of seratonin
    
    • Seratonin regulates norepinephrine and dopamine
    • Permissive hypothesis: low serotonin “permits” other NT to vary more widely increasing vulnerability to depression
  • Bipolar neurobiology unclear

Question 19

Psychological dimensions: stress

Depression & bipolar

Answer 19

• Stress strongly related to (but doesn’t guarantee) mood disorders
  
  • Poorer response to treatment
  • Longer time before remission
• What’s considered stressful is subjective
  
  • e.g. divorce can be life crushing for some, liberating for others
• Gene-environment correlation: people vulnerable to depression might be more likely to enter situations of stress
  
  • e.g. low self-esteem seek out partners who talk you down
• Relationship between stress and bipolar also strong
• Some stress might lead to depression (job loss social rejction) vs mania (achievements, new opportunities)

Question 20

Psychological: Learned helplessness and attributional style

Answer 20

• Attribution
  
  • Internal: “I’m not smart”
  • External: “the test was hard
• Stability
  
  • Stable “I’m not smart”
  • Unstable “Next time I’ll do better”
• Permanence
  
  • Global: “This shows I’m not good at anything I do”
  • Local: “It was just one test I can do better in the future

Question 21

Identifying negative cog thoughts

Cognitive theory

Answer 21

• Cognitive error: tendency to interpret life events negatively
  
  • Overgeneralization: Negatives apply to all situations
    
    • “Because I felt uncomfortable at a party I can’t make friends”
  • All or nothing thinking: view the situation in only two categories
    
    • If I’m not a total success I’m a failure
  • Mind reading: believe you know what others think
    
    • “He thinks I don’t know the first thing about this subject”
• Aaron beck’s negative cognitive triad model
  
  • Think negatively of oneself: “I’m too shy”
  • Think negatively of the world: “people only like extroverts
  • Think negatively of the future“I’ll never find a life partner”

Question 22

Social Cultural Dimensions

Answer 22

• Marital probelms strongest related to depression
  
  • Stronger in men: divorce for man much more likely to result in depression
• Social support
  
  • Lack of social support predicts late-onset depression
  • Substantial social support predicts recovery from depression

Question 23

Explanations for gender differences in Mood Disorders

Answer 23

• Women socialised to have stronger sense of uncontrollability
• Women more likely to experience sexual violence
• Parenting styles make girls less independent than boys
• Women generally more sensitive to relationship disruptions bc of greater emotional attunement
  
  • e.g. breakups tensions in friendships
• Tend to ruminate more than men

Question 24

Stress diathesis model

Answer 24

• Biological and psychological vulnerabilities interact with stressful life events to cause depression
  
  • Biological vulnerability: overactive neurobiological response to stress
  • Psychological vulnerability: e.g. depressive cognitive style

Question 25

SSRI, Tri, Mono, Mixed Reuptake

Depression disorders treatment: Medication

Answer 25

• Antidepressants
  
  • Selective Sertaonin reuptake inhibitors (SSRIs): Block reuptake of serotonin so more is available in the brain (Prozac)
    
    • Negative side effects common: sexual dysfunction, agitation, insomnia
  • Tricyclics
    
    • Block reuptake of NE and other NTs
    • Negative side effects: drowsiness weight gain, lethal in high doses; used if SSRI not effective
  • Monoamine oxidase inhibitors:
    
    • Block monoamine oxidase (enzyme that breaks down Seratonin and Norepinephrine)
      
      • Leads to more SE and NE in synapse
    • Fewer side effects than tricyclics but not used bc dangerous to use with cold meds or foods containing tyramine (beer cheese)
  • Mixed reuptake inhibitors (Effexor)
    
    • Block reuptake of NE and SE
    • Less side effects than SSRIs
  • All medications are only about 50% effective only 25% achieve normal function and takes 1-2 months to be effective

Question 26

• Bipolar medication

Answer 26

• Mood stabilizers for bipolar (lithium)
  
  • Stabilizer bc treats depression and mania
  • Toxic in large amounts can lead to kidney damage
  • negative side effects: hand tremor thirst vomitting diarrhea weight gain, drowsiness, muscle weakness
  • 50% effective
  • Patients often benefit from psychosocial therapy:
    
    • Focus on emotional self-awareness and medication compliance
  • medication used as baseline to help them become functional

Question 27

Electroconvulsive therapy

Answer 27

• Last resort
• 50% effective
• Nature of ECT
  
  • Brief electrical current applied to the brain
  • results in temporary seizures
  • every other day for a few weeks
• Lead to short term and sometimes long-term memory loss
• Mechanism unclear may disrupt stress hormones

Question 28

Psychosocial treatments Depression

Answer 28

• CBT
  
  • Cognitive restructuring/reframing: address maladaptive thought patterns or core beliefs that affect how we feel and what we do
  • Behavioral activation: scheduling and committing to valued activities to see if it improves your mood (no pressure to enjoy just try)
• ​Interpersonal therapy:
  
  • Focuses on addressing interpersonal issues like losing or gaining skills, handling disagreements, social skills deficits

Question 29

Preventing Depression Relapse

Answer 29

• Research on relapse prevention is relatively less common
• Talk therapy and pharmacological treatments are both used
• Psychosocial interventions generally better at preventing relapse
• Mindfulness-based CBT: developed to prevent relapse in depression
  
  • Mindfulness: intentional & nonjudgemental awareness of inner feelings and thoughts

Question 30

Effectiveness of treatments of Depression

Answer 30

• CBT IPT and medication all have an efficacy of 50-60%
• Psychosocial therapy more effective long term
• Combination of the two is better than either alone

Question 31

Effectiveness of Treatments for Bipolar disorder

Answer 31

• Medication (usually lithium) used as a baseline to stablise
  
  • Pleasures of manic state can make it difficult to make patients stay on track
• Psychotherapy helpful in managing problems (e.g. interpersonal, occupational) that accompany bipolar disorder
• Family therapy can help too

Question 32

Mood disorders and Suicide

Answer 32

• Depression big risk factor for suicide
• 11th biggest cause of death in US (underreported probably 2-3x higher)
• Whites and American indians 2-3x higher than hispanics and blacks
• Females have more attempted suicide (pills)
• males have more completed suicides (more lethal methods e.g. guns)

Question 33

Risk factors and protective factors of suicide

Answer 33

• Risk
  
  • Suicide in family
  • Low serotonin levels
  • Preexisting psychological condition
  • suicide contagion
  • low self-esteem
  • Hopelessness
  • Stressful life event
  • drug use/abuse
  • terminal illness
• Protective factors
  
  • social support
  • coping skills
  • cognitive flexibility (things aren’t black and white)
  • hope
  • relationships w small children
  • spirituality
  • no loss

Question 34

suicide prevention

Answer 34

• Clinician does risk assessment
  
  • Ideation, plan, intent, means (if planning on shooting self: have access to gun?), protective measures (what’s stopping you)
• Clinician and patient do safety plan
  
  • Identify warning signs internal + external coping strategies
    
    • internal: can do themselves: go on a walk, read a book
    • external: talk to someone
      
      • anyone to distract & doesn’t know about suicide
      • someone close about suicide
      • medical professional
      • emergency room
• In everyday life
  
  • if you think someone is at risk, talk to them and make sure they’re getting support (Rogerian approach)
  • Talking to someone about suicide will not put them at greater risk
  • Not providing social support to someone who needs it is huge