Abnormal Physchology Chapter 6

Depressive Disorders

Depressive Disorders

covering Major Depressive Episode, Major Depressive Disorder, Persistent Depressive Disorder, Premenstrual Dysphoric Disorder, & Disruptive Mood Dysregulation Disorder

Bipolar & Related Disorders

covering Bipolar I Disorder, Bipolar II Disorder, & Cyclothymic Disorder

Mood Disorders

are “one of a group of disorders involving severe and enduring disturbances in emotionality ranging from elation to severe depression

Depression

is “a negative affective state, ranging from unhappiness and discontent to an extreme feeling of sadness, pessimism, and despondency, that interferes with daily life. Various physical, cognitive, and social changes also tend to co-occur, including altered eating or sleeping habits, lack of energy or motivation, difficulty concentrating or making decisions, and withdrawal from social activities.”

Mania

is “generally, a state of excitement, overactivity, and psychomotor agitation, often accompanied by overoptimism, grandiosity, or impaired judgment.”

Hypomania

is “generally, a state of enhanced mood and increased energy and activity that resembles mania but is milder.”

Recurrent

“occurring repeatedly or reappearing after an interval of time or a period of remission. It is often applied to disorders marked by chronicity, relapse, or repeated episodes (e.g., recurrent depressive symptoms).”

Remission

is “a reduction or significant abatement in symptoms of a disease or disorder, or the period during which this occurs. Remission of symptoms does not necessarily indicate that a disease or disorder is cured.

Major Depressive Episode

is the “most common and severe experience of depression, including feelings of worthlessness, disturbances in bodily activities such as sleep, loss of interest, and inability to experience pleasure, persisting at least 2 weeks.”

Major Depressive Disorder (MDD)

is a mood disorder that is “defined by the presence of at least one major depressive episode occurring in the absence of a history of manic or hypomanic episodes.”

Persistent Depressive Disorder (aka Dysthymia)

is a “mood disorder involving persistently depressed mood, with low self-esteem, withdrawal, pessimism, or despair, present for at least 2 years, with no absence of symptoms for more than 2 months.”

Frequently, people with this disorder will report being able to identify with the Disney animated character Eeyore.

Double Depression

is “a condition in which a person with [Persistent Depressive Disorder] (e.g., chronically low or irritable mood) experiences a concurrent major depressive episode. Symptoms commonly include hopelessness, low internal locus of control, low self-esteem, difficulty sleeping, and anhedonia. Severe hopelessness in particular has been implicated as the key distinguishing feature of double depression.”

Premenstrual Dysphoric Disorder (PMDD)

is “a mood disorder in women that begins in the week prior to the onset of menstruation and subsides within the first few days of menstruation. Women experience mood swings, including markedly depressed mood, anxiety, feelings of helplessness, and decreased interest in activities.

Disruptive Mood Dysregulation Disorder (DMDD)

is “a diagnosis in children age 6-18 years with persistent irritability and an average of at least three episodes per week of severe recurrent temper outbursts or extreme behavioral dyscontrol (e.g., severe rages).”

Electroconvulsive Therapy (ECT)

It is “a controversial treatment in which a seizure is induced by passing a controlled, low-dose electric current (an electroconvulsive shock; ECS) through one or both temples... It is most often used to treat patients with severe endogenous depression who fail to respond to antidepressant drugs. Benefits are temporary, and the mechanisms of therapeutic action are unknown.”

Transcranial Magnetic Stimulation (TMS)

is a “localized electrical stimulation of the brain caused by changes in the magnetic field in coils of wire placed around the head… It is approved for treatment of depression and is being investigated as a possible therapy for other psychological conditions, such as obsessive-compulsive disorder and Tourette’s disorder, and for some types of movement disorders

Bipolar Disorders

are “any of a group of mood disorders in which symptoms of mania and depression alternate.”

Bipolar I Disorder

is “characterized by a clinical course of recurring mood episodes (manic, depressive, and hypomanic), but the occurrence of at least one manic episode is necessary for the diagnosis of Bipolar I disorder.”

manic episode

is a distinct period during which there is an abnormally, persistently elevated, expansive, or irritable mood and persistently increased activity or energy that is present for most of the day, nearly every day, for a period of at least 1 week… Mood in a manic episode is often described as euphoric, excessively cheerful, high, or “feeling on top of the world

Bipolar II Disorder

is “characterized by a clinical course of recurring mood episodes consisting of one or more major depressive episodes and at least one hypomanic episode

¡Remember that if a person has ever experienced a manic episode, they would not be diagnosed with Bipolar II, and instead they would be diagnosed with Bipolar I Disorder.

hypomanic episode

requires that there be a distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally increased activity or energy for most of the day, nearly every day, for at least 4 consecutive days…” (Note: these symptoms are noticeable, but not at a level to meet the diagnostic criteria for a manic episode.)

Note: with both Bipolar I & Bipolar II, the following specifiers are used if applicable:

Specify if: a) with anxious distress; b) with mixed features; c) with rapid cycling; d) with melancholic features; e) with atypical features; f) with mood-congruent psychotic features; g) with mood-incongruent psychotic features; h) with catatonia; i) with peripartum onset; j) with seasonal pattern.

Note 2: with Bipolar I & Bipolar II, the following severity specifiers are also utilized:

Specify if: a) Mild, b) Moderate, or c) Severe

Note 3: with Bipolar I & Bipolar II, the following is specified if applicable:

Specify if: a) In partial remission; b) In full remission

Cyclothymic Disorder

is “a mood disorder characterized by periods of hypomanic symptoms and periods of depressive symptoms that occur over the course of at least 2 years. The number, duration, and severity of these symptoms do not meet the full criteria for a major depressive episode or a hypomanic episode. It often is considered to be a mild bipolar disorder. Also called cyclothymia

mood stabilizers

(e.g., lithium, atypical antipsychotics) are the most commonly prescribed type of medications for bipolar disorder.”

¡Medication is the cornerstone of bipolar disorder treatment, though talk therapy (psychotherapy)

can help many patients learn about their illness and adhere to medications, helping prevent future mood episodes.”

“Since bipolar disorder can cause serious disruptions in a person’s daily life and create

stressful family situations, family members may also benefit from professional resources, particularly mental health advocacy and support groups

Suicide

is “defined as death caused by self-directed injurious behavior with intent to die as a result of the behavior.”

Suicide Attempt

is “a non-fatal, self-directed, potentially injurious behavior with intent to die as a result of the behavior. A suicide attempt might not result in injury.”

Suicidal Ideation

“refers to thinking about, considering, or planning suicide.” 

Suicide Facts

¡Per the Center for Disease Control and Prevention (CDC) as reported by the NIMH, “Suicide is a leading cause of death in the United States.” 

¡CDC statistics regarding 2020:

•Suicide was the 12^th leading cause of death overall in the United States, claiming the lives of over 45,900 people.

•Suicide was the 2^nd leading cause of death among individuals between the ages of 10-14 and 25-34 , the 3^rd leading cause of death among individuals between the ages of 15-24, and the 4^th leading cause of death among individuals between the ages of 35 and 44.

•There were nearly 2x as many suicides (45,979) in the United States as there were homicides (24,576).

¡The Age-adjusted suicide rates in the US for each year from 2000 through 2020 were reported as follows by the CDC. 

•The total age-adjusted suicide rate in the United States increased 35.2% from 10.4 per 100,000 in 2000 to 14.2 per 100,000 in 2018, before declining to 13.9 per 100,000 in 2019 and declining again to 13.5 per 100,000 in 2020.

•In 2020, the suicide rate among males was 4x higher (22.0 per 100,000) than among females (5.5 per 100,000).

men tend to

chose more lethal means

Family history risk factors

¡“Among depressed patients, the strongest predictor of suicidal behavior was having a family history of suicide.”

¡“If a family member committed suicide, there is an increased risk that someone else in the family will also.”

¡“Offspring of family members who had attempted suicide had a six time the risk of suicide attempts compared with offspring of non-attempters. If a sibling was also a suicide attempter, the risk increased even more.”

¡Neurobiology risk factors:

“A variety of evidence suggests that low levels of serotonin may be associated with suicide and with violent suicide attempts… Extremely low levels of serotonin are associated with impulsivity, instability, and the tendency to overreact to situations.”

“Studies… suggest that transmission of vulnerabilities for a mood disorder, including the trait of impulsivity, may mediate family transmission of suicide attempts.”

¡Psychological disorder & other Psychological risk factors:

¡“More than 80% of people who kill themselves suffer from a psychological disorder, usually mood, substance use, or impulse control disorders.”

¡“As many as 60% of suicides (75% of adolescent suicides) are associated with an existing mood disorder.”

¡“Some investigators have isolated hopelessness… as strongly predicting suicide.”

¡“Alcohol use and abuse are associated with approximately 25% to 50% of suicides and are particularly evident in suicide among college students.”

“Sensation-seeking predicts teenage suicidal behavior as well.”

¡Other risk factors:

“Perhaps the most important risk factor for suicide is a severe, stressful event experienced as shameful or humiliating, such as a failure (real or imagined) in school or at work, an unexpected arrest, or rejection by a loved one.”

“Evidence confirms that the stress and disruption of natural disasters increase the likelihood of suicide, particularly in the case of extreme catastrophes like massive earthquakes.”