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Abnormal Psych > Mood Disorders & Suicide > Flashcards

Mood Disorders & Suicide Flashcards

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1
Q

Major depressive episode Diagnostic criteria

A

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

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2
Q

Manic Episode (hypomanic)

A

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

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3
Q

Major depressive Disorder

A
  • 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
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4
Q

Grief vs depression

A
  • 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
      *
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5
Q

Unipolar vs Bipolar

A

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
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6
Q

Mixed features

A

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
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7
Q

Persistent depressive disorder Diagnostic

A
  • 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
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8
Q

Types of Persistent Depressive Disorder

A
  • 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)
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9
Q

Premenstrual Dysphoric Disorder Diagnostic

A
  • 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
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10
Q

Premenstrual Dysphoric disorder controversy and percentage

A

only 20% meet criteria

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

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11
Q

Disruptive Mood Dysregulation Disorder

A
  • 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
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12
Q

Bipolar Disorders overview

A
  • 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
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13
Q

Cyclothymic

A
  • 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)
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14
Q

Prevalence of Mood disorders (Gender and cultural)

A
  • 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(
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15
Q

Onset and duration of depressive disorders

differences in age

A
  • 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
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16
Q

Onset and Duration of Bipolar Disorders

A
  • 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
17
Q

Causes of Mood Disorders: Family and Genetic

A
  • 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
18
Q

Neurobiological Influences

A
  • 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
19
Q

Psychological dimensions: stress

Depression & bipolar

A
  • 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)
20
Q

Psychological: Learned helplessness and attributional style

A
  • 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
21
Q

Identifying negative cog thoughts

Cognitive theory

A
  • 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”
22
Q

Social Cultural Dimensions

A
  • 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
23
Q

Explanations for gender differences in Mood Disorders

A
  • 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
24
Q

Stress diathesis model

A
  • 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
25
Q

SSRI, Tri, Mono, Mixed Reuptake

Depression disorders treatment: Medication

A
  • 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
26
Q
  • Bipolar medication
A
  • 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
27
Q

Electroconvulsive therapy

A
  • 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
28
Q

Psychosocial treatments Depression

A
  • 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
29
Q

Preventing Depression Relapse

A
  • 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
30
Q

Effectiveness of treatments of Depression

A
  • 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
31
Q

Effectiveness of Treatments for Bipolar disorder

A
  • 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
32
Q

Mood disorders and Suicide

A
  • 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)
33
Q

Risk factors and protective factors of suicide

A
  • 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
34
Q

suicide prevention

A
  • 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

Abnormal Psych (12 decks)

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