Mood disorders & suicideAxis I (mood disorders): requires presence (or absence) of mood episodes such as 1. Major depressive episode: has at least 5 of the following symptoms- depressed mood, anhedonia, appetite/weight change, sleep issue, psychomotor changes, energy loss, inappropriate guilt/worthlessness, concentration problems, suicidality 2. Manic episode: distinct period of elevated or irritable mood, plus at least 3 of the following symptoms- inflated self-esteem,decreased sleep, more talkative, flight of ideas, distractibility, increase goal directed activity, excessive pleasurable activity3. Hypomanic episode: distinct period of elevated mood or irritability for at least 4 days, plus at least 3 of the following- inflated self-esteem, decreased sleep, more talkative, flight of ideas, distractibility, increase goal directed activity, excessive pleasurable activity- Unipolar:o Major depression: Major depressive disorder: presence of major depressive episode, not better accounted for by other disorder, and no history of manic/mixed/hypomanic episodeo Dysthymia: Less severe/more chronic At least 2 of the following for at least 2 years: appetite problem, sleep problem, low energy/self-esteem, poor concentration, feeling of hopelessness - Depression facts:o 16% lifetime prevalence, long lasting/recurrent, 2 X more common in woman than meno Ages 15-29 depression peaks, then declines, and then peaks again at age 85o Lowest rates in people around 60 due to difficulties in diagnoses and adaptive coping skills- Biological theories of depression: o Genetic: abnormalities in serotonin transporter gene, strong genetic linko Neurotransmitter: problem with production/regulation of serotonin/dopamine/norepinephrine (decreased synthesis, abnormalities in transport, impaired release/reuptake, receptor abnormalities)o Brain abnormalities: high cortisol levels, prefrontal cortex/anterior cingulate/hippocampus/amygdala issueo Neuroendocrine factors: issue with HPA (hypothalamic pituitary adrenal axis) for fight or flight responses- Psychological theories of depression: o Behavioral: stress reduces positive reinforcement, learned helplessness theory (belief of no control) o Cognitive: Negative Cognitive Triad by Beck (negative thinking about self/world/future) & Reformulated Learned Helplessness Theory (causal attribution error- blame self for negative events that are stable, internal, & global)- Interpersonal theories of depression:o Rejection sensitivity: easily perceive rejection by otherso Excessive reassurance seeking from others that they are accepted/loved- Sociocultural theories of depression: o Cohort effect: risk based on age/era person lives ino Higher depression rates for Hispanicso Higher depression in more modern/industrialized countries- Biological treatments for depression:o MAOI’s drug: can be fatal if slight OD or mix, can cause liver damage (no longer common)o Tricyclic antidepressant drug: many side effects, can be fatal if slight OD (no longer common)o SSRI (selective serotonin reuptake inhibitor): most common, quick relief, less severe side effects/dangerso SSNRI (selective serotonin & norepinephrine reuptake inhibitor): similar to SSRI but more stimulant effecto ECT (electroconvulsive therapy): for patients that don’t respond to meds, effective but 85% relapse rateo VNS (vagus nerve stimulation): 30/40% reliefo rTMS: magnetic stimulation to brain (usually prefrontal cortex)few side effects, patients remain awake- Psychological treatment for depression:o Behavior therapy: increasing positive reinforcers/decreasing aversive life experienceso Cognitive behavioral therapy: change negative thinking/increase positive reinforcement o Interpersonal therapy: identify & address 1-4 interpersonal sources of depression- Bipolar Disorder: o Bipolar I Disorder: full manic episode, and possible major depressive/hypomanic episodes .4-1.6% lifetime prevalence o Bipolar II Disorder: major depressive episode, hypomanic episode, no manic episode .5% lifetime prevalence o Cyclothymic disorder: less severe, more chronic form (at least 2 years), cycles between hypomanic and moderate depressive episodes- Bipolar facts:o Equally common in men and women (more biological factors responsible)o 1 to 2 in 100 lifetime prevalence- Biological theories of bipolar disorder: o Genetic factors- highly genetico Brain abnormalities in prefrontal cortex, striatum, and structure/function of amygdalao Neurotransmitter: dopamine irregularities- Psychosocial theories of bipolar disorder:o Greater sensitivity to rewardo Stressful life events (may be trigger for new episodes)o Changes in bodily rhythms/unusual routines- Biological treatment for bipolar disorder: (same as depression plus:)o Mood stabilizers: Lithium (effective)o Anticonvulsants/atypical antipsychotics o Treated as chronic condition: patients remain on medication throughout life - Psychological treatment for bipolar disorder: o Interpersonal & social rhythm therapy: combine interpersonal & behavioral techniques to help maintain routine o Family-focused therapy: focus on interpersonal stress (within context of family)o Cognitive behavior therapy: address problematic cognitions to reduce vulnerability to depression/maniao Drug therapy and CBT are effective when combinedSuicidal behavior:- Based on 2 dimensions: outcome vs. intent- 1,000,000 lives are lost to suicide each year (33,000 Americans)- Males are 4 times more likely to die from attempted suicide, but females are 3 times more likely to attempt suicide- Suicide is most common in euro-americans- Common myths: suicide is by “whim”, people wanting to commit suicide can’t be stopped, it is cry for help (empathy helps)- Difficult to study/understand cause of suicide because it is rare, relies on family for information, and most don’t leave note- Durkheim’s theory: 3 types of suicide- egoistic (related to alienation), anomic (disorientation due to major change), or altruistic (belief that world is better without them)- Risk factors: hopelessness, impulsivity, elderly, male, social isolation, family history of suicide, divorce, aggression, etc.- Perspectives on suicide: o Mental disorder: depression, bipolar, substance abuse, etc.o Impulsivity: impulsive tendencieso Cognitive theories: hopelessnesso Biological theories: genetics or neurotransmitterso Interpersonal: mix between thwarted belongingness, perceived burdensome, and capability for suicide- Treatment: o Decrease
View Full Document
Unlocking...