Lecture 5: Everyday life

Question 1

What are the two main types of affective/mood disorder?

Answer 1

Unipolar depression and bipolar depression. It’s when severe dejection alters daily functioning

Question 2

Describe the prevalence of unipolar depression

Answer 2

15% of people have a severe episode at some point. Twice as many women have it but they tend to have it in a milder form. There is no sex differences in children. It’s dramatically increased in younger people. At ages 30-65, white people are more at risk than afro-american. Two thirds recover in 6 months but most have recurrent episodes.

Question 3

List the symptoms of unipolar depression

Answer 3

Intense sadness, dejection, feeling empty, crying, angry, anxious, little pleasure, loss of humour, motivation, sex drive and energy. Paralysis of will, lethargic, self blame, hopelessness, poor memory, headaches, indigestion, constipation, dizziness pain, appetite and sleep disturbance. They perform as well as everyone else but they think they have done worse. Up to 15% commit suicide.

Question 4

How is unipolar depression diagnosed?

Answer 4

Severely disabling, lasts at least 2 weeks, must have at least 5 of the symptoms. Drugs, medicine and grief must be ruled out as a cause. Some people have psychotic symptoms like hallucinations. Single episode means it’s the first episode they’ve had with no mania. After that it’s considered recurrent.

Question 5

What is SAD?
What is catatonic?
Postpartum?
Melancholic?
Dysthymia?
NOS?

Answer 5

Seasonal affective disorder, it means you’re depressed in the winter.
It can mean either motor disability or excessive motor activity
Unipolar depression 4 weeks after birth
When someone is unaffected by pleasurable events, suffers motor disturbances, feels guilt and has a loss of appetite and sleep
It’s when someone has less than five symptoms for more than 2 years, the recovery rate is 40%
Not otherwise specified is when someone has unipolar depression that doesn’t fully meet the previous criteria

Question 6

What is SAD?
What is catatonic?
Postpartum?
Melancholic?
Dysthymia?
NOS?

Answer 6

Seasonal affective disorder, it means you’re depressed in the winter.
It can mean either motor disability or excessive motor activity
Unipolar depression 4 weeks after birth
When someone is unaffected by pleasurable events, suffers motor disturbances, feels guilt and has a loss of appetite and sleep
It’s when someone has less than five symptoms for more than 2 years, the recovery rate is 40%
Not otherwise specified is when someone has unipolar depression that doesn’t fully meet the previous criteria

Question 7

Describe the life events of most people with unipolar depression

Answer 7

They’ve had a greater number of traumatic life events prior to an episode
If they’re isolated and there are multiple stressors then they’re more likely to become depressed
30% don’t report a traumatic event before the onset of depression
Internal and situational components interact with each other

Question 8

Describe the different hypotheses for the etiology of unipolar depression

Answer 8

Psychodynamic: Hostility turned inward, oral fixation, anal and phallic problems and loss of self esteem
Harlow: His monkeys showed that isolation and separation causes it, it’s a despair reaction.
Loss of a parent before age 6 can increase your chances
Lewinsohn: lower performance of positive behaviours which results in decreased reward, as the rate of reinforcement rises, the depression improves.
Beck: Negative cognitions like maladaptive attitudes or errors in thinking (arbitrary inference, selective abstraction, overgeneralisation, magnification/minification and personalisation) are the true cause of unipolar depression. Emotional, motivational, behavioural and somatic aspects of depression are caused by cognitive processes. Well supported.
Cognitive triad: Negative interpretations of experiences, oneself and one’s future.
Ruminative responses during a depressed mood is linked to a longer depressed mood
Seligman: Learned helplessness
Genetics: 20% of relatives are depressed compared to 5% of general population. Monozygotic= 43% concordance, dizygotic= 20%. Deficiency of norepinephrine, serotonin or both.

Question 9

Describe the different hypotheses for the etiology of unipolar depression

Answer 9

Psychodynamic: Hostility turned inward, oral fixation, anal and phallic problems and loss of self esteem
Harlow: His monkeys showed that isolation and separation causes it, it’s a despair reaction.
Loss of a parent before age 6 can increase your chances
Lewinsohn: lower performance of positive behaviours which results in decreased reward, as the rate of reinforcement rises, the depression improves.
Beck: Negative cognitions like maladaptive attitudes or errors in thinking (arbitrary inference, selective abstraction, overgeneralisation, magnification/minification and personalisation) are the true cause of unipolar depression. Emotional, motivational, behavioural and somatic aspects of depression are caused by cognitive processes. Well supported.
Cognitive triad: Negative interpretations of experiences, oneself and one’s future.
Ruminative responses during a depressed mood is linked to a longer depressed mood
Seligman: Learned helplessness
Genetics: 20% of relatives are depressed compared to 5% of general population. Monozygotic= 43% concordance, dizygotic= 20%. Deficiency of norepinephrine, serotonin or both.
Genes and the environment interact, 4+ stressful life events and a short/short allele at highest risk

Question 10

Describe the different hypotheses for the etiology of unipolar depression

Answer 10

Psychodynamic: Hostility turned inward, oral fixation, anal and phallic problems and loss of self esteem
Harlow: His monkeys showed that isolation and separation causes it, it’s a despair reaction.
Loss of a parent before age 6 can increase your chances
Lewinsohn: lower performance of positive behaviours which results in decreased reward, as the rate of reinforcement rises, the depression improves.
Beck: Negative cognitions like maladaptive attitudes or errors in thinking (arbitrary inference, selective abstraction, overgeneralisation, magnification/minification and personalisation) are the true cause of unipolar depression. Emotional, motivational, behavioural and somatic aspects of depression are caused by cognitive processes. Well supported.
Cognitive triad: Negative interpretations of experiences, oneself and one’s future.
Ruminative responses during a depressed mood is linked to a longer depressed mood
Seligman: Learned helplessness
Genetics: 20% of relatives are depressed compared to 5% of general population. Monozygotic= 43% concordance, dizygotic= 20%. Deficiency of norepinephrine, serotonin or both.
Genes and the environment interact, 4+ stressful life events and a short/short allele at highest risk

Question 11

Describe antidepressant treatments

Answer 11

Before 1950s: Amphetamines increased activity but didn’t help depression itself.
MAO inhibitors and tricyclics: Monoamine oxidase inhibitors like phenelzine prevents the destruction of norepinephrine and serotonin. However, MAO is an essential enzyme, for example it controls blood pressure. It stops its production in the liver and instestine, allowing tyramine to accumulate. Patients must watch their tyramine consumption (bananas, cheese). Tricyclics like imipramine, are more common and help unipolar patterns. Up to 50% chance of relapse within 6 months without drug but 20% chance with it if the drugs are taken for several months after there are no depressive symptoms. They act on reuptake mechanisms and alter the sensitivity of norepinephrine and serotonin receptors. Less dangerous and more effective than MAO but can cause dizziness, blurred vision and dry mouth.

Question 12

Describe antidepressant treatments

Answer 12

Before 1950s: Amphetamines increased activity but didn’t help depression itself.
MAO inhibitors and tricyclics: Monoamine oxidase inhibitors like phenelzine prevents the destruction of norepinephrine and serotonin. However, MAO is an essential enzyme, for example it controls blood pressure. It stops its production in the liver and instestine, allowing tyramine to accumulate. Patients must watch their tyramine consumption (bananas, cheese). Tricyclics like imipramine, are more common and help unipolar patterns. Up to 50% chance of relapse within 6 months without drug but 20% chance with it if the drugs are taken for several months after there are no depressive symptoms. They act on reuptake mechanisms and alter the sensitivity of norepinephrine and serotonin receptors. Less dangerous and more effective than MAO but can cause dizziness, blurred vision and dry mouth.
Second generation antidepressants: For example, maprotiline, they alter the sensitivity of norepinephrine and serotonin receptors. SSRI’s, selective serotonin reuptake inhibitors, fluoxetine, alter serotonin activity. Equally as effective as tricyclics but less side effects. Most research focuses on the synaptic site.

Question 13

When are MAO inhibitors most effective?

What about tricyclics?

Answer 13

Overeating, oversleeping, intense anxiety

Slow movement, insomnia, loss of appetite

Question 14

When are MAO inhibitors most effective?

What about tricyclics?

Answer 14

Overeating, oversleeping, intense anxiety

Slow movement, insomnia, loss of appetite

Question 15

Is electro-convulsive therapy more effective than tricyclics and MAO inhibitors?
When is ECT used?

Answer 15

Yes but without medication relapse is very likely

When someone has severe depression and doesn’t respond to other treatments, they must also be at high suicide risk

Question 16

Other than antidepressants, what treatments are there for unipolar depression?

Answer 16

Cognitive, interpersonal, behavioural and biological treatments are most effective. Behaviour is the least effective of these 4. Up to 60% of people have no depressive symptoms after 16 weeks. Drug therapy is fastest but they’re equally effective in the end. Fluoxetine/ prozac became popular in 1988/9. Behavioural is less effective and psychodynamic is even worse. CBT and drug is most effective. There is a lot of debate over the prescription of SSRI.

Question 17

Other than antidepressants, what treatments are there for unipolar depression?

Answer 17

Cognitive, interpersonal, behavioural and biological treatments are most effective. Behaviour is the least effective of these 4. Up to 60% of people have no depressive symptoms after 16 weeks. Drug therapy is fastest but they’re equally effective in the end. Fluoxetine/ prozac became popular in 1988/9. Behavioural is less effective and psychodynamic is even worse. CBT and drug is most effective. There is a lot of debate over the prescription of SSRI.

Question 18

Describe a manic episode of bipolar disorder

Answer 18

Exaggerated feelings of joy, immoderate activity, expansive emotions as well as irritability, anger and annoyance. They seek constant excitement, involvement and companionship. They’re hyperactive, loud, fast and flamboyant. Poor judgement, poor planning, incoherent due to thoughts wandering, grandiose self esteem. Easily distracted, little sleep, wide awake and energetic.

Question 19

Describe the diagnosis of bipolar disorder

Answer 19

Abnormally elevated, expansive and irritable. At least 3 other symptoms for at least a week. Hypomanic episodes; less severe, shorter duration and less symptoms. There are two types; bipolar I and bipolar II

Question 20

Describe bipolar I

Answer 20

Depressive and manic episodes alternate but some people have mixed episodes (both in the same). But manic episodes always alternate with major depressive episodes.

Question 21

Describe bipolar I

Answer 21

Depressive and manic episodes alternate but some people have mixed episodes (both in the same). But manic episodes always alternate with major depressive episodes.

Question 22

Describe bipolar II

Answer 22

Hypomanic episodes alternate with major depressive ones. If there are 4+ episodes in a year then the disorder is classified as rapid cycling. If it changes with the seasons then it’s seasonal.

Question 23

Describe the incidence of bipolar disorder

Answer 23

Up to 1.3% of adults have it. Bipolar I is more common. No sex differences. It usually occurs between age 15 and 44. No socioeconomic or ethnic differences. 60% start with a manic/hypomanic episode. If untreated, the cycles occur for several months before being dormant for 2+ years. 0.4% of the population have cyclothymic disorder which is periods of hypomanic and mild depressive symptoms.

Question 24

Describe the explanations aka etiology of bipolar disorder

Answer 24

The study of this disorder had little progress in the first half of this century.
Psychodynamic: The introjection of a loss object, manic reactions flow from the denial of the loss of a loved one. This view is unsupported.
Mania is related to the oversupply of norepinephrine which is supported by research as lithium is effective as it reduces norepinephrine activity. Mania is associated with a low level of serotonin, show through spinal fluid levels (5-HIAA-serotonin metabolite) and that lithium increases brain serotonin activity.
Permissive theory: Low serotonin activity sets the stage of a mood disorder and norepinephrine activity defines the type.
Defective transportation of sodium ions at certain neuron membranes- this is derived from the effectiveness of lithium.
Genes: 25% chance of relatives having it if you do compared to 1% of the population. 70% concordance with monozygotic, 20% with dizygotic.
Bipolar/red-green colour blindness has been linked to G6PD deficiency (cause by an X chromosome). Also found a link on chromosome 11 near insulin. However these findings have failed when replicated.

Question 25

Describe the explanations aka etiology of bipolar disorder

Answer 25

The study of this disorder had little progress in the first half of this century.
Psychodynamic: The introjection of a loss object, manic reactions flow from the denial of the loss of a loved one. This view is unsupported.
Mania is related to the oversupply of norepinephrine which is supported by research as lithium is effective as it reduces norepinephrine activity. Mania is associated with a low level of serotonin, show through spinal fluid levels (5-HIAA-serotonin metabolite) and that lithium increases brain serotonin activity.
Permissive theory: Low serotonin activity sets the stage of a mood disorder and norepinephrine activity defines the type.
Defective transportation of sodium ions at certain neuron membranes- this is derived from the effectiveness of lithium.
Genes: 25% chance of relatives having it if you do compared to 1% of the population. 70% concordance with monozygotic, 20% with dizygotic.
Bipolar/red-green colour blindness has been linked to G6PD deficiency (cause by an X chromosome). Also found a link on chromosome 11 near insulin. However these findings have failed when replicated.

Question 26

What is one of the top ten causes of death in Western societies?
Describe this

Answer 26

Suicide
Some suicides are probably classified as accidents as they’re stigmatizing (regarded with disgrace). For example, a car driving off a bridge. Half of all suicides are associated with mental disorders, especially mood, alcohol and schizophrenia.

Question 27

What is suicide?

How is it researched?

Answer 27

An intentional, direct and conscious effort to end your life.
To research it, you can do retrospective analysis (psychological autopsy). However, this is difficult as less than 25% have been to counselling and less than 15% leave a note. You can also study suicide survivors.

Question 28

What characteristics do suicide notes have?

Answer 28

Specific, concrete, information with names, places and things, instructions. Simulated notes are much less specific.

Question 29

What causes people to commit suicide?

Answer 29

Suicide attempters have had more negative events in their recent lives.
Loss of loved ones, divorce, rejection, job loss.
Long term stressors: Serious illness, abusive environment, occupational stress and role conflict
Serious illness can lead to suicide attempts because their ability to sustain life overrides the quality of it, in this case people believe you should bee allowed to commit suicide.
Rates are higher among psychiatrists, psychologists, physicians, dentists, lawyers etc. Women in professional positions who experience role conflict display the highest suicide rates of women in the workforce.
Mood and thought changes, 20% of suicides are legally intoxicated at time of death.
Mental disorders, modelling (copying celebrities, friends etc.).

Question 30

What causes people to commit suicide?

Answer 30

Suicide attempters have had more negative events in their recent lives.
Loss of loved ones, divorce, rejection, job loss.
Long term stressors: Serious illness, abusive environment, occupational stress and role conflict
Serious illness can lead to suicide attempts because their ability to sustain life overrides the quality of it, in this case people believe you should bee allowed to commit suicide.
Rates are higher among psychiatrists, psychologists, physicians, dentists, lawyers etc. Women in professional positions who experience role conflict display the highest suicide rates of women in the workforce.
Mood and thought changes, 20% of suicides are legally intoxicated at time of death.
Mental disorders, modelling (copying celebrities, friends etc.).

Question 31

Who is most likely to commit suicide?

Answer 31

Males are 3 times more likely
Older white men are more likely but young people are on the increase
No cultural diversity, it’s universal but there are patterns; Japan vs USA.
Most failed suicide attempters don’t go to professionals. Young females with a psychiatric condition are most likely to.
Most suiciders have not previously tried to commit suicide. 10% of attempters eventually succeed. 70-80% tell someone beforehand.

Question 32

Who is most likely to commit suicide?

Answer 32

Males are 3 times more likely
Older white men are more likely but young people are on the increase
No cultural diversity, it’s universal but there are patterns; Japan vs USA.
Most failed suicide attempters don’t go to professionals. Young females with a psychiatric condition are most likely to.
Most suiciders have not previously tried to commit suicide. 10% of attempters eventually succeed. 70-80% tell someone beforehand.

Question 33

Describe suicides in children

Answer 33

This is relatively rare but it’s increasing.
Boys are three times more likely, usually drug overdose.
50% live with one parent, 25% have previously attempted. It’s preceded by running away, loneliness, self-deprecation etc.

Question 34

Describe suicides in adolescents

Answer 34

It’s the third leading cause of death in the USA. 83% are boys. One third of all adolescents have considered suicide. Most common is drug overdose but shooting is more effective.
Most attempts occur at home or school, half are linked to clinical depression. More incomplete attempts but 40% reattempt and 14% eventually succeed. 93% of adolescents know someone who was attempted suicide.
They react more sensitively, angrily, dramatically and impulsively to events.

Question 35

Describe suicide in the elderly

Answer 35

In western cultures this is the age group that is most likely. Some say it’s the leading cause of death.
Precipitating factors: Illness, loss of friends and family, loss of control, loss of societal status, increased hopelessness, depression and loneliness.

Question 36

How can you treat people who have attempted suicide?

Answer 36

Medical care
Many survivors don’t become involved in therapy. Most therapy is outpatient as hospital admission can increase suicide risk. Schizophrenics and people with mood disorders respond best to extended inpatient treatment.