Mood disorders suicide Axis 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 activity 3 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 o Dysthymia Depression facts Major depressive disorder presence of major depressive episode not better accounted for by other disorder and no history of manic mixed hypomanic episode 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 16 lifetime prevalence long lasting recurrent 2 X more common in woman than men Ages 15 29 depression peaks then declines and then peaks again at age 85 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 link o Neurotransmitter problem with production regulation of serotonin dopamine norepinephrine decreased synthesis abnormalities in transport impaired release reuptake receptor abnormalities Brain abnormalities high cortisol levels prefrontal cortex anterior cingulate hippocampus amygdala issue o o Neuroendocrine factors issue with HPA hypothalamic pituitary adrenal axis for fight or flight responses Psychological theories of depression Behavioral stress reduces positive reinforcement learned helplessness theory belief of no control 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 Rejection sensitivity easily perceive rejection by others Excessive reassurance seeking from others that they are accepted loved Sociocultural theories of depression Cohort effect risk based on age era person lives in o o Higher depression rates for Hispanics o 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 o o o o o Tricyclic antidepressant drug many side effects can be fatal if slight OD no longer common SSRI selective serotonin reuptake inhibitor most common quick relief less severe side effects dangers SSNRI selective serotonin norepinephrine reuptake inhibitor similar to SSRI but more stimulant effect ECT electroconvulsive therapy for patients that don t respond to meds effective but 85 relapse rate VNS vagus nerve stimulation 30 40 relief rTMS magnetic stimulation to brain usually prefrontal cortex few side effects patients remain awake Psychological treatment for depression o o o o o o o Behavior therapy increasing positive reinforcers decreasing aversive life experiences Cognitive behavioral therapy change negative thinking increase positive reinforcement Interpersonal therapy identify address 1 4 interpersonal sources of depression Bipolar Disorder Bipolar I Disorder full manic episode and possible major depressive hypomanic episodes Bipolar II Disorder major depressive episode hypomanic episode no manic episode 4 1 6 lifetime prevalence 5 lifetime prevalence Cyclothymic disorder less severe more chronic form at least 2 years cycles between hypomanic and moderate depressive episodes o o o o o o o o Equally common in men and women more biological factors responsible 1 to 2 in 100 lifetime prevalence Bipolar facts Biological theories of bipolar disorder o Genetic factors highly genetic o o Neurotransmitter dopamine irregularities Psychosocial theories of bipolar disorder Brain abnormalities in prefrontal cortex striatum and structure function of amygdala o Greater sensitivity to reward o o Stressful life events may be trigger for new episodes Changes in bodily rhythms unusual routines Biological treatment for bipolar disorder same as depression plus o Mood stabilizers Lithium effective o o Anticonvulsants atypical antipsychotics Treated as chronic condition patients remain on medication throughout life Psychological treatment for bipolar disorder Interpersonal social rhythm therapy combine interpersonal behavioral techniques to help maintain routine Family focused therapy focus on interpersonal stress within context of family Cognitive behavior therapy address problematic cognitions to reduce vulnerability to depression mania o o o o Drug therapy and CBT are effective when combined Suicidal 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 o o o Impulsivity impulsive tendencies Cognitive theories hopelessness Biological theories genetics or neurotransmitters Interpersonal mix between thwarted belongingness perceived burdensome and capability for suicide Treatment o Decrease burdensome and increase belongingness through interpersonal coping skills challenging distorted beliefs activities that foster connectedness feeling of self efficiency Crisis intervention hospitalization suicide hotlines medication o o
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