mood disorders + suicide (week 3)

Question 1

what are the requirements for a major depressive EPISODE? list some symptoms

Answer 1

-Five (or more) of the following within a two week period
and MUDT have either (1) or (2):
1. Depressed mood*
2. Diminished interest or pleasure*

3. Change in weight or appetite
4. Insomnia or hypersomnia
5. Psychomotor agitation or retardation
6. Fatigue or loss of energy
7. Worthlessness or guilt
8. Difficulties concentrating/indecisiveness
9. Thoughts of death, suicidal ideation or attempt

-These need to have a clinically significant impairment and not due to the direct physiological influence of a substance

Question 2

what are the requirements of a manic EPISODE? list some symptoms

Answer 2

A. Abnormally and persistently elevated, expansive, or irritable
mood AND increased energy or goal-directed activity (min
1 week)

B. 3 or more of:
1. Inflated self-esteem or grandiosity
2. Decreased need for sleep
3. More talkative than usual or pressure to keep talking
4. Flight of ideas
5. Distractibility
6. Increase in goal-directed activity or psychomotor agitation
7. Excessive involvement in risky pleasurable activities

Question 3

what are the requirements of hypomanic EPISODE? how does it differ from a manic episode?

Answer 3

Same list of seven symptoms as manic episode
BUT
-Minimum duration is shorter 4 days vs. one week, AND
- the episode is NOT severe enough to cause
marked impairment in social or occupational
functioning, or to necessitate hospitalization + there are NO psychotic features

-Not due to the direct physiological effects of a
substance

Question 4

what are the requirements for diagnosis of major depressive disorder?

Answer 4

major depressive episode only

Question 5

what are the requirements for diagnosis of bipolar I? bipolar II?

Answer 5

-Bipolar I: 1(+) manic episodes with OR without major depressive episode

-Bipolar II: 1(+) hypomanic episodes WITH 1(+) major depressive episode

Question 6

what are the requirements for persistent depressive disorder? list some symptoms

Answer 6

depressed mood most of the day, more days than not
-while depressed, 2(+) of:
-poor appetite/overeating
-insomnia/hypersomnia
-lower energy/fatigue
-low self-esteem
-poor concentration/indecisiveness
-hopelessness

-duration at least 2 years (1 for children/adolescents)
-significant impairment + not due to the direct physiological effects of a substance

Question 7

what is cyclothymia? what are requirements for diagnosis?

Answer 7

-chronic, but less severe, form of bipolar disorder; for at least 2yrs (1 for children/adolescents), numerous periods w hypomanic symptoms + periods w depressive symptoms that don’t meet criteria for Major Depressive Episode

-during 2 years, NOT without symptoms for more than 2 months at a time
-significant impairment + not due to the direct physiological effects of a substance

Question 8

what are the unipolar and bipolar mood disorders?

Answer 8

-unipolar: MDD, Persistent depressive disorder
-bipolar (includes mania/hypomania): bipolar I/II, cyclothymia

Question 9

what are the requirements for premenstrual dysphoric disorder? list some symptoms

Answer 9

-majority of menstrual cycles 5+ symptoms present in the week before the menses + improve within a few days of onset of menses; symptoms significantly interfere w fnxining (clinically significant distress/impairment)

-one or more of the following: marked affective instability, irritability, depressed mood, anxiety AND
-one or more of the following: decreased interest in usual activities, difficulty concentrating, fatigue, changes in sleep/appetite, physical symptoms (breast tenderness, joint/muscle pain, bloating)

-mood disturbance symptoms must be determined by PROSPECTIVE daily ratings for at least 2 cycles

Question 10

what are 2 reasons for criticism of adding PMDD to the DSM-5?

Answer 10

-most diagnoses req you to think backwards, PMDD asks people to assess looking forward, then report
-may be gender bias - in a study, w a sex-neutral form, 4.1% of men and 8.0% of women met criteria

Question 11

what is seasonal affective disorder characterized by?

Answer 11

-current depressive episodes that are tied to winter months

Question 12

what is postpartum depression characterized by?

Answer 12

-mood swings/feelings of depression up to 2 weeks after childbirth

Question 13

according to cognitive theory, what are explanations for depression? what are the results of a study that support this?

Answer 13

-how individuals think abt/interpret their world impacts feelings/behaviors ; emotional rxns in a situation are determined, at least partly, by one’s thoughts abt it
-depressed indivs’ schemas have a rigid negative quality
-cognitive triad: Negative core
beliefs/schemas about the self, the world,
and the future (eg “I’m a failure”, “No one loves me”, “My future is helpless”)

-study: indivs w a more negative cog style were more likely to dev depression

Question 14

what is Beck’s Diathesis-Stress model of depression?

Answer 14

-Negative cognitive schemas (diathesis)
are inactive until individuals face a life
stressor that matches the theme of the
schema.

-eg: schema: “I’m a failure”
stressor: Failing a course

Question 15

what is the goal of CBT for depression? what are 3 methods for this?

Answer 15

-to teach people to become aware of the meanings/attributions to events in their lives; examine how these cognitions contribute to the emotional rxns that follow

1. Behavioral activation - used for patients really ‘retreated’ from life; not engaging in daily activities
2. identify accuracy of automatic thoughts: common cognitive distortions of depressed individuals that contribute to negative mood (eg all or nothing thinking, jumping to concls, overgeneralizing, catastrophizing)
3. challenging patient’s core beliefs + schemas

Question 16

name and describe a behavioral activation techniques

Answer 16

-Activity scheduling: list pleasurable activities patients used to engage in; collaboratively w therapist schedule activities (eg getting out of bed, calling a friend)

Question 17

what is a strategy for challenging a patient’s core beliefs and schemas? how might this be done?

Answer 17

-behavioral experiments: view thoughts as hypotheses that can be tested; collect evidence for/against thoughts

-thought record: includes
situation
thoughts
moods 0-100
evidence supporting thought
evidence against
cognitive distortion
alt/more balanced thought
new mood 0-100

Question 18

what have studies supporting CBT for depression found?

Answer 18

-CBT significantly better than no treatment/psychodynamic therapy; comparable to medication
-lower relapse rates (compared to meds alone)

Question 19

what does the interpersonal model of depression say about traits of depressed individuals? what are risk factors of depression?

Answer 19

-compared to non-depressed indivs, depressed indivs show:
-deficits in social skills
-more negative intnxns (exchanges of depressed/angry feelings)
-less eye contact, less facial animation, less modulation in tone of voice
-(research does NOT suggest that deficits in social skills cause/predate depression)

-risk factors:
-negative feedback seeking (seek out criticism consistent w their self-schemas)
-excessive reassurance seeking (abt one’s worth/lovability)

Question 20

what does interpersonal pyschotherapy suggest? what 4 domains does it target and how?

Answer 20

-that depression occurs in an interpersonal context, ∴ addressing current problems in relationships should help relieve depression
-designed to be done in 12-16 sessions

-targets one source of Interpersonal Dysfunction within 4 domains:
1. Interpersonal disputes: frequent conflict
-Help identify why misunderstandings occur, build better communication/problem solving skills
2. Role transition: when people transition between diff roles in life, see ↑ risk
-Develop new roles, problem solve in adapting to new role; might use cognitive restructuring
3. Grief - commonly assoc w depression
4. Interpersonal deficits
-helps dev further social confidence/social skills, improve how they intxt in relationships

Question 21

how do tricyclics work? what are pros and cons?

Answer 21

-block reuptake from the synapse of catecholamine norepinephrine (NE) and/or indoleamine serotonin (5-HT), ∴ more of these neurotransmitters are available in the synapse to bind to postsynaptic receptors + trigger new action potentials

-pros: effective
-cons: many side effects, lethal in overdose

Question 22

how do Monoamine Oxidase Inhibitors (MAOIs) work? what are pros and cons?

Answer 22

-inhibit monoamine oxidase (an enzyme) that breaks down monoaminergic neurotransmitters in the presynaptic cell, ∴ more monoamines released into synapse to bind to postsynaptic receptors and to trigger new action potentials

-cons: potentially dangerous side effects

Question 23

how do Selective Serotonin Reuptake Inhibitors (SSRIs) work? what are pros and cons?

Answer 23

-block the reuptake of serotonin into the presynaptic cell. More serotonin in the synapse to bind to postsynaptic receptors + trigger new action potentials

-pros: first line treatment due to relatively mild side effects + once a day dosage which is easy to follow

Question 24

what are pros and cons of pharmacotherapy in general?

Answer 24

-pros: 50-70% of patients respond to antidepressants
-cons: high relapse rates

Question 25

what are 6 factors to keep in mind when deciding antidepressants?

Answer 25

-side effects
-ease of administration
-history of response (personal, family)
-medical issues
-depressive subtype
-cost

Question 26

when might it be helpful to combine CBT, IPT, and medication? what about otherwise?

Answer 26

-may be more effective for severe depression and for depressed adolescents.

-For mild to moderate depression no additive benefits

Question 27

what are some causes for bipolar disorders?

Answer 27

-Heritability: estimates for bipolar
disorder are ~ .75 (vs. .36
for major depressive disorder)
-Sleep deprivation trigger mania in
approximately 77% of bipolar patients

Question 28

describe 4 medication options for bipolar disorders. what are the pros and cons of using medication?

Answer 28

-lithium: don’t actually know how it works; requires regular monitoring – therapeutic dosage only slightly below the toxic dose
-anticonvulsants
-antipsychotics: short term treatment, risk of tardive dyskinesia (condition that does not reverse once stop taking meds, involves involuntary repetitive body movements)
-antidepressants: risk for triggering mania; typically used in conjunction w one of the mood stabilizers above

-pros: medication is the most effective treatment for bipolar disorder
-cons: high rates of relapse

Question 29

describe CBT for bipolar disorder

Answer 29

-CBT: similar to treatment for depression
-in addition, add a few components: problem solving around sleep difficulties; mood monitoring to identify triggers for relapse (mania); support medication adherence

Question 30

describe interpersonal and social rhythm therapy (IPSRT) for bipolar disorders, and a strength of it

Answer 30

focuses on regulating daily routines + teaching methods of coping w stressful events

-RCT comparing IPSRT and clinical management found that IPRST resulted in fewer relapses

Question 31

describe electroconvulsive therapy. under what situation would it be used? what is a risk?

Answer 31

-under general anesthesia, small electric currents are passed through the brain, intentionally triggering a brief seizure – seems to cause changes in brain chemistry that can quickly reverse symptoms of certain mental health conditions

-for people w severe mood disorders that have not responded to pharmacological / psychological treatments
-risks incl memory loss

Question 32

compare suicidal ideation / attempt, and completed suicide

Answer 32

-suicidal ideation: thoughts of death + suicidal plans
-suicide attempt: a nonfatal attempt, but the person did have an intent to die
-completed suicide: death by suicide

Question 33

how many people worldwide die by suicide a year? compare rates of completed suicide in men and women, as well as attempt rates for men and women.

Answer 33

-almost 1million worldwide

-3x higher in men

-3x higher in women

Question 34

suicide is the __ most common cause of death among Canadian youth ages 10-24

Answer 34

2nd (first is traffic accidents)

Question 35

suicide is the ________ cause of death among Cadn males between 15-19

Answer 35

leading

Question 36

what are high risk groups for suicide?

Answer 36

-males 19-24 and 70+
-first nations indivs living on reserves

Question 37

___% of people w untreated depression will complete suicide. what other disorders are associated with suicide?

Answer 37

-untreated mental disorder: ~15% of depressed people will complete suicide

-other disorders assoc w suicide: alc/substance abuse, schizophrenia, eating disorders (particularly anorexia nervosa)

Question 38

what is the primary focus of suicide prevention? how is this done?

Answer 38

-population based, [ ] on changing situations, attitudes, or conditions that predispose indivs toward suicide

-broad public education – limited success
-restricting access to suicide means – some success

Question 39

what are second/tertiary prevention methods for suicide?

Answer 39

-select for/target indivs at high risk (high in suicidal ideation/behaviors)
-eg suicide hotlines: most helpful for ↓ suicidal ideation

Question 40

what are the warning signs for suicide? (IS PATH WARM)

Answer 40

-I - ideation
-S - substance abuse
-P - purposeless
-A - anxiety
-T - trapped
-H - hopelessness/helplessness
-W - withdrawal
-A - anger
-R - recklessness
-M - mood changes