Week 6 - Mood Disorders and Suicide Flashcards
(23 cards)
Major depressive episode
A. Depressed mood and/or anhedonia most of the day most days for 2+ weeks, plus 4+:
- Weight/appetite change, sleep disturbance, restlessness/slowed down, fatigue, worthlessness/guilt, difficulty concentrating/ indecisiveness, suicidal thoughts
B. Clinically sig. distress, C. not due to something else
Manic episode
A. Elevated or irritable mood + increased goal-directed activity for 1+ week
B. 3+ (4 if mood is only irritable) symptoms:
- Grandiosity, less sleep, talkative, racing thoughts, distractibility, risky/pleasurable activities
C. Impaired functioning or hospitalisation
D. Not due to something else
Hypomanic episode
Less severe than manic - 3 or 4 (irritable only) symptoms but milder
Lasts 4 days, less impairment
Must rule out other things
Major depressive disorder
A. At least one depressive episode
B. Not better explained by psychotic
C. Never been a manic/hypomanic episode
Specifiers
- Single episode vs recurrent
- Mild, moderate, severe OR psychotic OR partial/full remission
- Anxious, mixed features (hypomanic), melancholic, atypical (mood reactivity, rejection sensitive), mood congruent/incongruent psychotic, catatonia, peripartum onset, seasonal
Persistent depressive disorder (Dysthymia)
A. Depressed mood (irritable - kids), 2+ years (1 for kids)
B. Two+:
- Low appetite/overeating, insomnia/hypersomnia, fatigue, low SE, difficulty concentrating/ indecisiveness, hopelessness
C. <2 months no symptoms, D. May have MDD, E. No mania/hypomania, F. No psychotic, G. Not due to something else, H. Clinically sig. distress
Specifiers
- Early onset (<21), late onset (>21)
- Mild, moderate, severe OR psychotic OR partial/full remission
- Anxious, mixed, melancholic, atypical, mood congruent/incongruent psychotic, peripertum onset
MDD & PDD prevalence
MDD - 9% (life), 4% (year)
PDD - 6% (life), 3% (year)
Chronic depression common in clinical settings
2F:1M, rapid rise in adolescence
Days out of role - PDD (9.7), MDD (6.4), Bipolar (5.3), any mood D (6.2)
MDD & PDD predictive factors
Interpersonal - childhood adversity. neg. life events, lack of support
- depressed people also contribute to stressful life events (marry people with interpersonal difficulties etc.)
Psychological - neuroticism, learned helplessness, hopelessness, Beck’s cog. triad, rumination
Behavioural Activation Theory
A lack of reinforcement for healthy behaviours, slight reinforcement for depressed behaviours contributes to an increased depressed mood > less behavioural activation and more avoidance and depressed behaviour (which leads back to reinforcement) > increased depressive symptoms
Psychological treatment for depression
Interpersonal psychotherapy - expressing feelings
Cognitive therapy - targeting cognitive triad
Third-wave therapies - being more present
Behavioural activation - reverse the BAT flowchart (less sessions)
All therapies equally effective (cognitive therapy worked via behavioural activation however)
Medication for depression
Antidepressants - SSRIs, tricyclics, MAOIs, SNRIs (equally effective - 50% benefit, 25% achieve normal function)
Medication-resistant depression
ECT - gives temporary seizures (short-term memory loss, some LTM loss)
TMS - localised magnetic pulse, maybe combined with meds (occasional headaches)
Premenstrual dysphoric disorder
A. 5+ sxs (one B and one C at least) week before menses, improves with menses, disappears after
B. 1+:
- Affective lability, anger, depressed mood/hopelessness, tension/anxiety
C. 1+:
- Decreased interest, poor concentration, lethargy, appetite change, insomnia/hypersomnia, overwhelm, physical symptoms
D. Clinically sig. impairment, E. not due to something else, F. Criterion A confirmed from daily ratings (woman must keep diary for 2 months)
PMDD prevalence, aetiology, treatment
Prevalence - 2% (13-18% subclinical though)
Aetiology - ovarian steroid hormones and metabolites may produce
Treatment - SSRIs in 2 weeks preceding menses, combined oral contraceptives, hysterectomy (severe)
Bipolar I disorder
A. At least one manic episode (doesn’t technically require depression but it almost always exists)
B. Not better explained by schizophrenia or psychotic disorder
Specifiers:
- Severity of recent episode OR in remission
- Anxious, mixed, mood-congruent/incongruent psychotic features, catatonia, peripartum, seasonal, rapid cycling
What it’s like - anxiety, anger, agitation, irritability
Bipolar II disorder
A. At least one hypomanic episode and one depressive episode
B. Never been a manic episode
C. Not better explained by schizophrenia or psychotic disorder
D. Clinically sig. distress
Specifiers:
- Severity of recent episode OR in remission
- Anxious, mixed, mood-congruent/incongruent psychotic features, catatonia, peripartum, seasonal, rapid cycling
Cyclothymic disorder
A. 2+ years (1- kids) numerous sub-threshold hypomanic and depressive episodes
B. <2 months without symptoms, and periods present more than half the time
C. Never met criteria for depressive, manic or hypomanic episode
D. Not better explained by schizophrenia/psychotic disorder
E. Not due to something else
F. Clinically sig. distress
Specify - with anxious distress
Bipolar disorders prevalence
Bipolar I (0.6%), Bipolar II (0.4-2%), Cyclothymia (4%) - poor research however
1F:1M, onset before 25
Associated with 10-20 years less life
Bipolar disorders predictive factors
Genes - MDD (35% genes), BD (60-80%)
Psychological - childhood maltreatment, reward sensitivity, sleep deprivation
Bipolar disorders treatment
Medication
- Mood stabilisers - lithium (mania), anticonvulsants (divalproex - mania, carbamazepine - mania), antipsychotics (olanzepine - dep & mania, quetiapine - dep & mania, aripripazole - mania)
- SSRIs contraindicated
- 40-60% relapse within 1-2 years of first episode
Psychological
- Cognitive therapy, family focused therapy, physical health priority (inactivity, eating, smoking, weight gain, some find meds intolerable)
Suicide
15th leading death cause (13th Aus), higher in high-income countries
Leading cause for women 15-19, second leading cause all people 15-29
30 attempts for every success
Males 3x more likely for suicide
Men - increase until 45-50, then dip
Women - stable, highest at 45-50
90% suicide have mental disorders
High-income countries - BD, PTSD, MDD predictive
Low-income countries - PTSD, conduct disorder, drug use predictive
Youth suicide in Australia
Indigenous people at elevated risk
Increase from 10 > 15 > 25
Males higher than females all ages
Risk factors - male, rural, aboriginal, mood disorder, substances, stressful life events, school disengagement
Suicide motivations
Most people report internal motivations - hopelessness, pain, escape (desire to die)
Less people report external motivations - communication, influence, help seek (may be protective - lower intent to die and more likely to be interrupted, signifies continued connection to people)
Three-step theory of suicide
- Are you in pain/hopeless?
- Does your pain exceed your connectedness?
- Do you have the capacity to attempt suicide?
- If yes to all three, attempt is then likely
Suicide prevention
Do a risk assessment (ideation, plan, means)
Develop a safety plan (sign safety contract, remove means access)
Talking to someone does not increase risk
