Chapter 8 - Mood Disorders and Suicide Flashcards Preview

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Flashcards in Chapter 8 - Mood Disorders and Suicide Deck (102):
1

imagined loss

the individual unconsciously interprets other types of events as severe loss events ex. argument with friend

2

why is clinical depression different

longer duration and more severe

3

Types of mood disorders

unipolar and bipolar

4

what is unipolar?

depression

5

what is bipolar?

depressive and manic symptoms

6

how long must the symptoms for major depressive disorder be present

for at least two weeks

7

how much more time do individuals that meet the criteria for symptoms of major depressive disorder require to sleep?

more than an hour to fall asleep every night

8

depressive disorders

involve a change in mood in the direction of depression

9

bipolar and related disorders

involve periods of depression cycling with periods of mania

10

symptoms of major depressive disorder

1) persistent low mood and/or lack of enjoyment in activities
2) changes in weight
3) changes in mood
4) agitation/retardation
5) tired/low energy
6) feeling worthless/ excessive guilt
7) trouble concentrating/indecisive
8) trouble concentrating/indecisive
9) suicidal thoughts

11

how many symptoms must be present for MDD?

5

12

symptoms of MDD classification

must show persistent sad mood and/or lack of pleasure or enjoyment in activities for at least two weeks and must be accompanied by 4 other symptoms

13

how much of the population does MDD affect

5%

14

gender differences in MDD

twice as common in women

15

average time episodes last

6-9 months, can last for years though

16

average age onset for MDD

early twenties to mid-twenties (early adulthood/teenage years)

17

gender differences data study showed

equal rates of depression for both sexes throughout childhood then begin to diverge at about age 10

18

do most individuals with MDD suffer from one or more additional mental disorders?

yes - most common is anxiety disorders

19

persistent depressive disorder/ dysthymia

chronic low mood, lasting for at least two years along with three associated symptoms (full criteria of MDD has been met)

20

what are some symptoms for PDD

1) changes in eating
2) changes in sleep
3) tired/low energy
4) low self-esteem
5) trouble concentrating/indecisive
6) feeling hopeless

21

prevalence of PDD

3%

22

differences between PDD and MDD

PDD has the following: higher levels of impairment, younger age of onset, higher rates of comorbidity, a stronger family history of psychiatric disorder, lower levels of social support, higher levels of stress, and higher levels of dysfunctional personality traits, and treatment response

23

Mania

distinct period of elevated, expansive, or irritable mood that lasts at least one week and is accompanied by at least 2 symptoms

24

symptoms of mania

1) grandiosity
2) decreased need for sleep
3) talkative
4) racing thoughts
5) distractable
6) increased goal-directed behaviour or psychomotor agitation
7) involvement in activities with high change of negative consequences
8) increased energy

25

Hypomania

less severe form of mania that involves a similar number of symptoms, but those symptoms need to be present for only four days

26

can you have depressive and manic/hypomanic symptoms at the same time?

yes - called a "mixed state"

27

Bipolar I disorder

- history of one or more manic episodes
- may or may not have had a depressive episode

28

Bipolar II disorder

- history of one or more hypomanic episodes
- history of one or more depressive episodes

29

prevalence of bipolar I

0.8%

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prevalence of bipolar II

0.5%

31

gender differences for bipolar disorder

equally in men and women

32

age onset in bipolar disorder

20 years is mean onset, some adult patines can experience it before age 17

33

cyclothymia

chronic, less sever form of bipolar disorder

34

how long must symptoms show for cyclothymia

at least 2 years in duration of altering between hypomania and subthreshold depression (depression that does not meet full criteria for major depression)

35

prevalence for cyclothymia

0.4%-1%

36

seasonal affective disorder (SAD)

can occur in both unipolar depression and bipolar disorder that are tied to changing seasons

37

prevalence of SAD

general population - 3%
MDD patients - 11%

38

melatonin theory SAD

melatonin - secreted at night by pineal gland, as sunlight increases, melatonin decreases - causes body temperature to rise, triggering body processes to their awake state. during winter months, more darkness so melatonin remains high and nothing switches body from sleep state to wake state

39

peri - or postpartum depression

last month of gestation (peri-partum) up to a couple months post-birth

40

theory about peri- and postpartum depression

hormones decrease, especially progesterone

41

psychodynamic theories

relationships between parents and children are important in shaping a child's temperament and that neglectful/abusive parenting confers a strong risk for later depression. individuals that have experienced this interpret life events as having a greater impact

42

cognitive theories

one's emotional response to a situation is determined by the manner in which that situation is appraised or evaluated

43

what are the 4 cognitive theories

1) all-or-nothing thinking
2) overgeneralization
3) magnification (catastrophizing)
4) jumping to conclusions

44

all-or-nothing thinking

it's one side or the other ex. C on math exam = I'm a failure I'll never get into med school

45

overgeneralization

single negative event is a never-ending patter ex. late for doctors appointment = I'm always screwing up

46

magnification (catastrophizing)

exaggerate the importance of your errors or problems ex. forget someone's name while introducing them = thinking this is horrible

47

jumping to conclusions

interpret things negatively when there are no definite facts to support your conclusion ex. boyfriend doesn't return call = thinking they don't care about you anymore

48

schemas

hypothetical structures in the mind that contain core beliefs about the self, world, and the future

49

cognitive triad

self, world, future

50

negative feedback seeking

tendency to actively seek out criticism and other negative interpersonal feedback from others

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excessive reassurance seeking

tendency to repeatedly seek assurance about one's worth and lovability from others, regardless of whether such assurances have already been provided

52

stress generation hypothesis

depressed individuals have been found to generate stressful life events in the interpersonal domain, including fights, arguments, and interpersonal rejection - depressed individuals contribute to the occurrence of these events due to their maladaptive interpersonal behaviours

53

adoption study

32% for bipolar disorder in the biological parents of affectively ill adoptees as compared to 12% in the adoptive parents

54

twin studies

genetic cause for mood disorders - twins both diagnosed with disorder are said to be concordant - consistent with genetic contribution to mood disorders, high concordance rates for unipolar major depression in identical twins. Concordance rates for bipolar disorder are 65% in identical twins and 14% in non-identical

55

low levels of neurotransmitters is equal to what

mood disorders

56

what are norepinephrine and serotonin related to

semantic and cognitive development (also linked to depression)

57

what do high levels of dopamine cause

psychosis

58

hypothalamic-pituitary-adrenal (HPA) axis

depressed people with chronic stress have elected levels of cortisol

59

Sleep neurophysiology

depressive people spend more time in REM sleep than average, and bipolar disorder - sleep deprivation is a risk factor

60

what are both bipolar and unipolar depression associated with in neuroimaging

decreased blood flow and glucose metabolism in the frontal cortex - particularly left side

61

what happens in neuroimaging when patients shift from depression into mania

decreased blood flow and glucose metabolism in the frontal cortex - particularly right side

62

when does increased glucose metabolism occur

depression (occurs in several subcortical regions)

63

CBT techniques

activity scheduling, thought records, behavioural experiments

64

activity scheduling

clients make a list of activities they used to engage in - found pleasurable and will eventually schedule these

65

thought record

challenge negative thinking patterns - break down problem - situation, how you feel about it, what your mood was, evidence supporting your thought, evidence against though, alternatives, new mood after thinking about situation

66

behavioural experiments

challenge negative and pessimistic beliefs - pick problem and then work out different solutions and try them out

67

CBT vs. medication

CBT has better long-term outcomes vs. medication

68

Behavioural components

as effective as full CBT, as effective as medication in short-term, more effective that medication in long-term

69

mindfulness-based cognitive theory

more effective at preventing depression relapses vs. visiting family doctor/medication

70

interpersonal theory (IPT)

presumes depression that occurs in an interpersonal context and that addressing current problems that depressed clients face in the interpersonal realm is key to relieving symptoms (12-16 sessions)

71

what are the four areas IPT works on

1) interpersonal disputes
2) role transitions
3) grief
4) interpersonal deficits

72

interpersonal disputes

conflicts in marital, family, or other social relationships - identifying sources of misunderstanding and using communication and problem-solving training to empower the client to change the situation

73

role transitions

situations in which client has difficulty adapting to a life change - intervened by helping the client to reappraise the old and new roles, identify problems in adapting to the new role and use cognitive restructuring to alter his or her dysfunctional appraisals of the new role

74

grief

IPT therapist uses empathic listening to help the client work through the mourning process, and encourages the client to form new relationships

75

interpersonal deficits

main problem for a client who reports either a low number or poor quality of interpersonal relationships - identify personality issues in the client that may be interfering with formation of close relationships

76

Tricyclic antidepressants

block reuptake of norepinephrine and sometimes serotonin - effective but poor side effects and lethal in overdose

77

monoamine oxidase inhibitors

break down enzymes that break down neurotransmitters - dangerous side effect profile, require dietary restrictions, can raise blood pressure

78

selective serotonin reuptake inhibitors

block serotonin reuptake - mild side effect, sage - first line treatment for unipolar depression

79

other antidepressants

serotonin-norepinephrine reputake inhibitors
- some increase dopamine, others affect GABA levels

80

antidepressants vs. placebo

antidepressant was no more effective than placebo in unipolar depression

81

lithium

effective treatment for mania, requires physician monitoring, high risk of relapse, interferes with regulation of sodium and water levels

82

anticonvulsants

increase GABA levels or decrease glutamate levels, often used alone or with lithium (glutamate has excitatory effect on brain)

83

antipsychotics

may be used as short-term treatment or can have a mood-stabilizing effect

84

antidepressants

treat depressive episodes, can trigger manic episodes, often used along with a mood stabilizer

85

combining psychotherapy and medication for depression

no benefit seen

86

what are the four exceptions to combing psychotherapy and medication for depression

1) severe depression: IPT + meds better than either on their own
2) persistent depression: CBT + meds better than either on their own
3) non-response to medication: add CBT
4) adolescents: CBT + meds better than either on their own

87

combining psychotherapy and medication for bipolar disorder

most effective treatment is medication but in some cases high risk of relapse, substantial impairment

88

three effective adjunctive treatments

family focused therapy, IPSRT, cognitive therapy

89

family focused therapy

education for both patient and family members about disorder and effect on the patient's functioning as well as communication and problem-solving training

90

IPSRT

based on theory that disruptions in daily routines and conflicts in interpersonal relationships can cause relapses of bipolar episodes - patients are taught to regulate their routines and cope more effectively with stressful events

91

cognitive therapy

how to regularize their sleep and daily routines, how to regularly monitor their mood to help identify early triggers, for manic episode relapses, importance of medication compliance

92

SAD psychotherapy

phototherapy:
40% remission in severe depression
60% in mild depression
can trigger manic episodes in bipolar patients

93

ECT

- creates seizure in brain that lasts approximately 25 seconds, used for treatment-resisitant depression or depression with life-threathening consequences and need for immediate results

94

TMS

currents from magnetic pulse stimulate nerve cells in the region of the cortex under the coil - helps because patients with depression have low levels of brain activity so this increases blood flow and nerve stimulation as well as glucose metabolism

95

Vagus nerve stimulation

information on this nerve travels from major organs to it, device is planted and stipulations are delivered every 30 seconds for 5 minutes

96

deep brain stimulation

surgically implanting wires into brain

97

self-harm rates

general population: 1-4%
teenagers: 14-39%
college students: 15%

98

gender differences in suicide

men are 3x more likely to complete suicide while women are 3x more likely to attempt

99

biological factors for suicide

identical twins are 5-10x more likely to commit suicide, and in adoption studies it is shown that the rate of suicide in biological relatives of adoptees was more than 6x higher than for the group of adoptees who had committed suicide

100

what neurotransmitter is involved with suicide

low levels of serotonin

101

psychache

feeling of unendurable psychological pain and frustration

102

treatment for suicide

CBT = identify and modify thoughts, images and core beliefs