Test 4: Mood Disorders and Suicide Flashcards
What is depression?
- feeling of sadness/dejection
- resulting in increasingly pessimistic outlook on life
- including mental dullness
- seen in poor concentration & breakdown in reasoning
- accompanied by social withdrawal, decreased motivation, decreased drive for intimacy, sleep disturbances, increased anxiety, edginess, and critical thoughts
What are examples of people in the Scriptures of depression?
- David lost hope
- Jonah wanted to die
- Peter wept bitterly
- Elijah felt fear and despair
- Judas hanged himself
Self-focus
What are examples of feelings associated with being depressed in scripture?
- Having a fallen countenance
- Having a broken spirit
- Being sad
- Experiencing despair
- Being brokenhearted
- Being burdened by the weight of sin
- Mourning
- Losing heart
What are the factors that may lead to depression?
- Biological (chemical imbalance, illness, loss of sleep)
- Cognitive (unbiblical thought patterns, focus on self)
- Emotional (stress, guilt, regret, loss, loneliness)
- Spiritual (pride, self-pity, worry anger, bitterness)
What are bible verses about dealing with disappointment?
- Everyone has to deal with disappointment. If we don’t deal with disappointment properly, disappointment can lead to depression
- Philippians 3:13,14 - forgetting what is behind and pressing ahead
- Isaiah 42:9, 43:2 - look ahead for the new
- Romans 8:28,29 - what I perceive as “bad” God can use for my good
- Lamentation 3:22, 23 - His mercies are new every morning
What are bible verses about hope?
- Hope changes everything
- Romans 5:5, 15:13 - Hope = Joy & peace
- Psalm 42:5, 43:2 - Hope in the LORD
- Proverbs 3:5-6 - Don’t lean on myself-acknowledge Him-He directs
- Philippians 4:4-8 - Pray = peace
- I Peter 5:6-7 - Cast my cares on Him
- II Corinthians 4:8-9, 16-18 - He renews me
- Isaiah 40:31- Strength like an eagle
What are the D’s of the downward spiral?
- Disappointment: to fail to satisfy a hope or expectation
- Discouragement: focusing on the frustration caused by disappointment
- Depression: Dwelling on the negative
- Despondency: Unreactive to people, missing God’s blessings, and totally consumed with me
- Despair: Hopelessness, helplessness, selfishness, bitterness
- Death: Suicidal
What are tools for dealing with depression?
- Confess sin, turn away from old destructive patterns
- Cultivate a growing relationship with Christ
- Write Bible verses on 3x5 cards, sticky nots, screensavers
- Positive self-talk, claim God’s promises
- Journal as a prayer to the Lord
- Memorize/meditate on Scripture
- Turn away from self-focus by serving others
- Set goals with plans to reach those goals
- Focus ahead, don’t look back
- J.O.Y
- Utilize social support
- Pray…pray…pray, placing my dependence on God
- Identify and reframe negative, harmful thoughts
- Whatsoever things are…think on these things
- Fill idle time with activity not center on myself
- Count my blessings… name them one by one
What are two things depressed Christians need to think about?
- what I may perceive to be “bad circumstances” may be just the tool God uses to refine me and cause me to grow- and may result in something very good. Even through hard times, God is always up to something good
- God’s faithfulness is not proven by the absence of struggle, but by His sustaining grace, strength, and sweet fellowship through the trial
What about God’s truth and depression?
When there is a debate between what I am feeling and what Scripture says, Scripture always wins
What are Bible verses about believing God will do what His Word says He will Do?
- The JOY of the Lord is my strength (Neh 8:10)
- God’s GRACE truly is sufficient! (II Cor. 12:9-10)
- God’s MERCIES are new every morning! (Lam 3:22-23)
- Those who place their HOPE in God will never be disappointed (Rom. 5:5)
- God CARES about the things that concern me (I Pet. 5:7)
- REJOICE in the Lord always; again I say rejoice! (Phil 4:4)
- JOY comes in the morning (Ps 30:5)
- You, oh Lord, are my HIDING PLACE (Ps 32:7)
- My HOPE is in the Lord (Ps 42:5)
What is the heart of the matter of depression for the believer?
Depression, anxiety, or other emotional problems
- not always unrepentant heart / sin
- some issues biologically based
- any source is an occasion for spiritual work to be done
What are mood disorders? What composes them?
- Definition: Gross deviations in mood
- Composed: different types of mood “episodes” which are periods of depressed or elevated mood lasting days or weeks
– major depressive: episodes period of depressive mood
– maniac episodes: period of severely elevated mood
– hypomanic episodes: period of less severely elevated mood
What is a major depressive episode?
- Extremely depressed mood and/or loss of pleasure (anhedonia)
- Duration: most of the day, nearly every day, for at least two weeks
- At least four additional physical or cognitive symptoms (indecisiveness, feelings of worthlessness, fatigue, appetite change, restlessness or feeling slowed down, sleep disturbance)
What is a maniac episode?
- Elevated, expansive mood for at least one week
- (Symptoms ie inflated self-esteem, decreased need for sleep, excessive talkativeness, flight of ideas or sense that thoughts are racing, easy distractibility, increased in goal-directed activity or psychomotor agitation, excessive involvement in pleasurable but risky behavior)
What is a hypomanic episode?
- Shorter, less severe version of maniac episode
- Last at least four days
- Symptoms: fewer & milder
- Less interfering & impairment
- May not be problematic in and of itself, but usually occurs in the context of a more problematic mood disorder
What are mixed features?
Term for a mood episode with some elements reflecting the opposite valence of mood
(Depressive episode with some maniac)
What is the difference between unipolar and bipolar disorders? Types?
- Unipolar: only one extreme of mood is expressed (depression alone is much more common)
– Major depressive disorder, persistent depressive disorder, premenstrual dysphoric disorder, disruptive mood dysregulation disorder - Bipolar: both depressed and elevated moods are experienced
What are the clinical features of major depressive disorder?
- 1+ major depressive episodes separated by periods of remission
- single episode highly unusual while recurrent episodes more common
What are the clinical features of persistent depressive disorder?
- At lease two years of depressive symptoms
- Most of the day more than 50% days
- No more than 2 months symptom free
- Symptoms can persist long periods (>20yrs)
- May include periods of more severe major depressive symptoms (intermitent, majority, entirety)
What are the types of persistent depressive disorder?
- Mild depressive symptoms w/o any major depressive episodes (with pure dysthymic syndrome)
- Mild depressive symptoms with additional major depressive episodes occurring intermittently (previously “double depression)
- Major depressive episodes lasting 2+ yrs (with persistent major depressive episode)
What are specifiers?
Additional diagnostic label used by clinicians to convey extra information about symptoms
- not mandatory only assigned if appropriate
What is the psychotic features specifier of depressive disorders?
includes psychotic features
- hallucinations: sensory experiences in absence of sensory input
- delusions: strongly held but inaccurate beliefs
What is the anxious features specifier of depressive disorders?
- several significant symptoms of anxiety
- predicts poorer outcome
What is the mixed features specifier of depressive disorders?
- several episodes include several (at least 3) manic symptoms
What is the melancholic features specifier of depressive disorders?
additional severe symptoms ie early morning awakenings, lack of reactivity to positive stimuli
What is the catatonic features specifier of depressive disorders?
- extremely rare muscular symptoms
- remaining in a still stupor
- semi-rigid limbs remaining in place when manipulated
- repetitive/purposeless movement
(catatonia more common in schizophrenia)
What is the atypical features specifier of depressive disorders?
Presence of several symptoms less common in depression including oversleeping and overeating
What is the peripartum onset specifier of depressive disorders?
depression occurring surrounding time giving birth (pregnancy –> 6 mo. post-birth)
What is the seasonal pattern specifier of depressive disorders?
Depression occurring primarily in certain seasons (usually winter)
- sometimes “seasonal affective disorder”
- may be related seasonal changes in melatonin
- may be treated with light therapy
What is the onset and duration of depressive disorders?
- Rare in childhood
- Risk increased in adolescence and young adulthood
- Mean age 30
- Earlier onset persistent depression associated with worse outcome
- Episode length varies (usually several months, may be years)
How does the DSM recognize grief? What are the types of grief?
- Major depression may be occur as part of the grieving process
- Acute grief: occurs immediately after loss
- Integrated grief: eventual coming to terms with meaning of the loss
- Complicated grief: persistent acute grief and inability to come to terms with loss
What are Elisabeth Kubler-Ross’ Five Stages of Grief?
DABDA
- Denial
- Anger
- Bargaining
- Depression
- Acceptance
What are the clinical features premenstrual dysphoric disorder? The controversy?
Significant depressive symptoms occurring prior to menses during the majority of cycles, leading to distress or impairment
- Symptoms: numerous, persistent, interfering, distressing
- Controversial:
– Advantage: legitimizes the difficulties some face w/ severe symptoms
– Disadvantage: pathologizes an experience many consider to be normal
What are the clinical features of disruptive mood dysregulation disorder?
- severe temper outbursts occurring frequently, against a backdrop of angry or irritable mood
- Diagnosed only in children 6-12
- criteria for manic/hypomanic episode are not met
- To combat overdiagnosis of bipolar
What are the three bipolar disorders?
- Bipolar I disorder: alternate between major depressive episodes and manic episodes
- Bipolar II disorder: alternate between major depressive episodes and hypomanic episodes
- Cyclothymic disorder: alternate between less severe depressive and hypomanic periods
What are the clinical features of cyclothymic disorder?
- chronic version of bipolar
- alternate between mild depressive & mild hypomanic symptoms
- Not meet criteria for full major depressive/manic/hypomanic episodes
- Mood states may persist for long periods
- Lasts 2+ years (1 yr children/adolescents)
What are the diagnostic specifiers for bipolar disorders?
- all specifiers for depressive disorders
- rapid cycling specifier:
– rapid in and out of mania and depression
– 4+ manic or depressive episodes w/i a year
– 20-50% cases
– associated with greater severity
What is the word wide and sex difference prevalence of mood disorders?
- Worldwide lifetime prevalence 16%, 6% experienced in last year
- Sex difference:
– Females 2x likely major depression and in bipolar more likely rapid cycling and in depressive period
– Bipolar: affect men and women equally
What is the prevalence of mood disorders by age?
- occurs less often in prepubertal children
- rapid rise in adolescents
- 65+ ~50% less than general population
- Bipolar: same childhood/adolescence/adults
- Depression similar across subcultures
How does life span development influence mood disorders?
- 3 mo olds can show depressive symptoms
- young children: typically not show classic mania/bipolar symptoms
- mood disorder may be misdiagnosed ADHD
- children diagnosed with bipolar at increasing rates
- elderly depression 14-42%:
– co-occurrence with anxiety disorders
– less gender imbalance 65+
What is the prevalence of mood disorders across cultures?
- similar prevalence among U.S. subcultures, symptom experience may vary (cultures express somatic concern)
- higher prevalence among Native Americans (4x)
What are the familial influences of mood disorders?
- risk higher when relative has mood disorder
- relative with bipolar means greater risk of unipolar depression
- twin study: mood disorders greater risk if identical twin has depression than fraternal
- severe mood disorder strong genetic contribution
- heritability rate greater females
- some genetic factors confer risk both anxiety and depression
What are the neurotransmitter neurobiological influences for mood disorders?
- serotonin and regulation of other neurotransmitters: regulate norepinephrine and dopamine
- mood disorders related to low serotonin
- permissible hypothesis: low serotonin “permits” other neurotransmitters to vary more widely, increasing vulnerability to depression
What are the endocrine system neurobiological influences for mood disorders?
- elevated cortisol
- stress hormones decrease neurogenesis in the hippocampus so it is less able to make new neurons
What are the sleep disturbance neurobiological influences on mood disorders?
- Hallmark of most mood disorders
- depressed patients have quicker and more intense REM sleep (not get to deep sleep)
- sleep deprivation may temporarily improve depressive symptoms in bipolar patients
What is the psychological dimension of stress on mood disorders?
- strongly related to mood disorder
- poorer response to treatment
- longer remission time
- gene-environment correlation: more vulnerable to depression may be more likely to enter situations that will lead to stress
- strong relationship to bipolar
What is the psychological dimension of learned helplessness on mood disorders?
- lack of perceived control over life events leads to decreased attempts to improve own situation
- Martin Seligman research
- Negative cognitive styles are risk for depression
What are the depressive attributional style of the psychological factors affecting mood disorder?
- internal attributions: Negative outcomes are one’s own fault
- stable attributions: Believing future negative outcomes will be consistently one’s fault
- global attribution: believing negative events will disrupt many different context in my life
all contribute to hopelessness
What is the cognitive theory of the psychological dimensions of mood disorders?
- negative coping styles:
– depressed engage in cognitive errors
– tendency interpret life events negatively - types of cognitive errors:
– arbitrary inference: overemphasize the negative aspects of a mixed situation
– overgeneralization: negatives apply to all situations
What is Beck’s cognitive triad of depression?
Think negatively about
- oneself
- the world
- the future
What are the social and cultural dimensions of mood disorders?
Marital relations:
- marital dissatisfaction strongly related to depression
- relation particularly strong in males
Social support:
- level of social support is related to depression
- lack of social support predicts late onset depression
- substantial social support predicts recovery from depression
What are the gender differences of mood disorders? The potential reason?
- women: 7/10 cases of major depressive disorder
- women have greater rates of anxiety disorders
Causes? - women socialized to greater perception of uncontrollability
- parenting styles make girls less independent
- women more sensitive to relationship disruptions (breakups/tension)
- women ruminate more
What are the medication treatment options for mood disorders?
- Antidepressants: SSRIs, Tricyclic antidepressants, monoamine oxidase inhibitors, mixed reuptake inhibitors
- ~ equally effective: ~ 50% benefit, 25% normal functioning
What are the facts of SSRIs?
- Specifically block serotonin reuptake
- Most popular: fluoxetine (Prozac)
- Pose some risk of suicide, particularly in teens
- negative side effects common
What are the facts of tricyclic antidepressants?
- Tofranil, Elavil
- Mechanism not well understood: block reuptake norepinephrine & other neurotransmitters
- Negative side effects common (drowsiness, weight gain): discontinuation common
- Lethal in excessive dosage
- Sudden death in children under 14
What are the facts of mixed reuptake inhibitors?
- block reuptake of norepinephrine as well as serotonin
- best known: venlafaxine (Effexor)
- Fewer side effects than SSRIs
What are the facts of monoamine oxidase (MAO) inhibitors?
- Block monoamine oxidase that breaks down serotonin/norepinephrine
- Effective as tricyclics with fewer side effects
- Dangerous in combinations
– beer, red wine, cheese, cold meds
What are the facts of lithium?
- Lithium carbonate - common salt
- treatment of choice for bipolar disorder
- mood stabilizer (treats both poles)
- toxic on large amounts: careful dosage monitoring
- effective for 50% patients
- unclear why works
What are the facts of electroconvulsive therapy?
- for medication-resistant depression
- brief electrical current to brain
- temporary seizure
- 6-10 outpatient treatments
- side effects: short-term memory loss, some long-term memory loss,
- unclear mechanism
What are the facts of transcranial magnetic stimulation?
- magnets to generate precise localized electromagnetic pulse
- few side effects (headaches)
- less effective than ECT for medication-resistant
- may be combines with meds
What are the psychosocial treatments for depression?
- CBT: address cognitive errors and includes behavioral activation (scheduling valued activities)
- Interpersonal psychotherapy: focuses improving problematic relationships
- prevention: preemptive psychosocial care for people at risk
longer lasting effectiveness than meds - better at preventing relapse
What are the psychosocial treatments for bipolar disorders?
- Medication (usually Lithium) first line of defense
- Psychotherapy helpful in managing problems that accompany bipolar disorder
- Family therapy can be helpful
What are the general facts and statistics of suicide?
- 11th leading cause of death in USA (may be 2-3x higher)
- most common white & native Americans
- 3rd leading cause of death in teens
- 2nd leading cause of death in college students
- 12% college students consider suicide in a given year
What are the facts and statistics about gender and suicide?
- Males complete more (b/c more lethal means)
- Females attempt more
- Exception: more common among women in China - culture acceptance
What are the risk factors of suicide?
- suicide in the family
- low serotonin levels
- preexisting psychological disorder
- alcohol use and abuse
- stressful life event, especially humiliation
- past suicidal behavior
- plan and access to lethal methods
What is suicide contagion?
- some research indicated those already contemplating suicide more likely to commit after hearing about someone else committing suicide
- media accounts may worsen problem: sensationalizing/romanticizing suicide, describing methods
What are options for suicide prevention?
- Professionals: risk assessment (ideation, plans, intent, means), develop safety plan with client (contract)
- Programs: for at risk (CBT)
- Remove lethal methods
- Think at risk: talk to them and ensure getting support
