Quiz 2: Depression & Bipolar Flashcards
2 key symptoms of Depression
- depressed mood
- Anhedonia
Criteria for Major Depressive Disorder
one major depression episode that is not explained by other factors
experience 5 symptoms during the same 2 week period: must experience 1 out of the first 2 key symptoms (depressed mood or anhedonia)
*depressed mood
*anhedonia
-appetite
-sleep
-psychomotor
-energy
-self-esteem
-concentration
-suicidality or thoughts of death
-symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
-not physiological/substance-induced
What is the definition of anhedonia?
=the inability to feel happiness/ pleasure
What is a Research Domain Criteria document (RDoC)?
A research framework for new approaches to understanding and treating mental disorders
Prevalence of Depressive Disorder
Lifetime= 16%
male- 12%
female- 20%
Subsyndromal depression very common (20% of adults w/ some symptoms over 6 months
Risk factors for depressive disorder
people who experience early life stress are more at risk
childhood emotional abuse and neglect
older people at risk (existential thoughts of dying, losing a loved one, losing role of work, moving into a nursing home)
diathesis= biological predisposition (genetic risk)
- stress + biological predisposition = increase risk of depression
What is the gender distribution in the general population and in school aged children?
school age children prevalence: same for Male and Female
general population: Higher in Females (20%) than Males (12%)
How may depression present in children, adolescents and in the elderly population?
Children:
-school phobia, clinging to parents
Adolescents:
-behavioral acting out, poor academic performance
-mood is more irritable
Elderly:
-underdiagnosed
-presents with somatic complaints (physical complaints)
-may predispose to dementia and CAD
-demonstrable, significant cog. impairments usually represents comorbid or -developing dementing process
-high completed suicide among elderly males
What are the consequences of Depressive Disorders in terms of work, social dysfunction, leisure, ADLs/IADLs, cognitive functioning, psychomotor functioning, coping, problem-solving skills, suicidality and other medical conditions?
-inability manage financial: spending money you don’t have
-hard to keep a job
-losing relationships/ social aspect
-lack of self care (especially for depression, can’t get out of bed)
-lack of sleep (especially for mania)
Mixed feature depression
=have both symptoms of depression and symptoms of mania
-3 or more manic/hypomanic symptoms present nearly everyday during the majority days of a depressive episode
Effective treatment for Depressive Disorder
Medication- antidepressants
Psychotherapy- CBT, interpersonal therapy
Ahoy serious is the threat of suicide in US
-⅔ individuals who die by suicide suffer from some form of depression
use “die by suicide” not “commit suicide”; “commit” associated with stigma
-estimates from recent epidemiological data and meta-analyses (3.4-6% lifetime risk of suicide)
-high suicide in elderly men
Why is suicide assessment an essential part of a psychiatric assessment by the psychiatrist and the occupational therapist?
-determines passive vs active suicidal idealation
-determine if client has access to means
-protective factors
What is the basis of people’s fears of discussing suicide with a suicidal client?
People think discussing suicide, increases the chance their client commit suicide (this is not true)
Passive suicidal ideation
PSI= wishing you were dead, not going to do anything but “wouldn’t mind if they got cancer”, but not thinking of taking my life, does NOT include a plan
Active suicidal ideation
ASI= thoughts of taking one’s life, actively planning to take life
What are 3 questions that you could ask to assess the nature, frequency, depth, timing, and/or persistence of suicidal thinking?
- Have you ever had thoughts that life was not worth living?
- Have you ever had thoughts about hurting yourself or taking your life?
- How close have you come from acting on this?
What are reasons to explain the denial and stigma associated with suicide?
usually use the word “commit” with suicide, which associates suicide with “commiting a crime”
What are 6 risk factors for suicide?
- previous suicide attemp
- history of depression and other mental illnesses
- serious illness such as chronic pain
- criminal/legal problems
- job/financial problems
- substance misuse
- adverse childhood experiences
What are 3 protective factors for suicide?
- effective coping and problem-solving
- reasons for living (family, friends, pets)
- strong sense of cultural identity
What steps should an OT student take if they hear a client express suicidal ideation?
get help or contact psychiatrist immediately
What is dysthymia?
=Persistent Depressive Disorder
-chronic depression (can be MDD or lower grade depression)
-depressed mood most days for 2 or more years
Bipolar 1 vs Bipolar 2
Bipolar 1- criteria have been met for at least one manic episode
mania lasts 1 week
assumed you are going to have depressive episode after manic episode but not technically part of criteria
Bipolar 2- milder form
hypomania lasts 4 days
Criteria for mania
=distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting 1 week and present most of the day
3 or more
-inflated self-esteem/grandiosity (ex: I thought I was masia)
-decreased need for sleep (go days and days with much less sleep and still have high energy)
-pressured speech (keeps talking and talking)
-flight of ideas/racing thoughts (hard to follow their ideas)
-distractibility
-increase in goal-directed activity or psychomotor agitation (ex: up all night cleaning apartment, making unrealistic plans)
-high potential for painful consequences activities (risky impulsive activities, ex: unprotected sexual activity, spending more money than one can afford)
Marked impairment in social/occupational functioning or hospitalization or psychotic features
-dramatic presentation it is not subtle
What is hypomania
same features of mania but not as severe and does not last as long as mania
What is Cyclothymic Disorder?
multiple episodes of some degree of manic and depressive episodes but not severe enough to be diagnosed with bipolar
What is the prevalence of Bipolar disorders (BD) compared to Unipolar depression?
Bipolar 1- 1%
Bipolar 2- 1.1%
Depression is much more prevalent than bipolar
What is the typical age range of onset for BD?
Age 25 (mid 20s)
Typical course in BD I’m terms of times spent depressed vs manic
Spend most time depressed, manic episodes only last a few days
-so it can be hard to see if they were manic
-if we can treat mania, likely to stop the depressive episode that usually follows after (we have effective treatment for mania)
What is the most common medication prescribed to treat Bipolar Disorder?
Lithium
What are the consequences of BD in terms of work, social dysfunction, leisure, ADLs/IADLs, cognitive functioning, psychomotor functioning, coping, problem-solving skills, and suicidality?
-inability manage financial: spending money you don’t have
-hard to keep a job
-losing relationships/ social aspect
-lack of self care (especially for depression, can’t get out of bed)
-lack of sleep (especially for mania)
