Exam 2: Suicide + Mood

Mood disorders:

involve severe alternations in mood which are intense and persistent enough to be clearly maladaptive and often lead to serious problems.

Mood disorders must be…

clinically significant and significantly deviate from the individual’s base line or ordinary emotional state.

The two key moods involved in mood disorders are:

Euphoria and Dysphoria

Euphoric mood (mania):

characterized by intense and unrealistic feelings of excitement and euphoria.

Dysphoria: (depression):

feelings of extraordinary sadness and dejection

Mixed features (mixed episode):

characterized by symptoms of both mania or hypomania with depressive features.

Depressive disorder:

involves periods of symptoms in which an individual experiences an unusually intense sad mood. The disorder’s essential element is an unusually elevated sad
mood, known as dysphoria.

Major depressive disorder:

a disorder in which the individual experiences intense but time limited episodes of depressive symptoms.

Major depressive episodes:

a period in which the individual experiences intense psychological and physical symptoms accompanying feelings of overwhelming sadness.

Major depressive episodes:

a period in which the individual experiences intense psychological and physical symptoms accompanying feelings of overwhelming sadness.

Recurrent major depressive disorder:

with two or more episodes within an interval of at least 2 consecutive months.

An affected person must experience the following:

Dysphoria for most of the day, nearly every day for at least 2
consecutive weeks.

• Symptoms include: sleep and appetite disturbances, low energy/fatigue,
  low self-esteem, difficulty concentrating or making decisions, poor
  hygiene, feelings of hopelessness.

If untreated, a major depressive episode usually lasts….

6 to 9 months and often recur as some future point.

Persistent depressive disorder (dysthymia):

chronic but less severe mood disturbance in which the individual does not
experience a major depressive episode but a blue mood for a minimum of two years (1 year for children and adolescents).

• Average duration is 4 to 5 years but can last for 20 or more.

As compared to MDD, symptoms of PDD are…

mild to moderate but last much longer (are chronic).

• Periods of normal moods occur briefly but only last for a few days to a
  few weeks with a maximum of 2 months. These intermittent normal
  mood swings are the most important characteristic distinguishing PDD
  from major depressive disorder.

Unspecified Mood Disorder:

applies to symptoms characteristic of a depressive disorder and cause clinically
significant distress or impairment in social, occupational, or other important areas of functioning, however, symptoms do not meet the criteria for a depressive or bipolar disorder diagnosis.

Disruptive mood dysregulation disorder:

a depressive disorder in children who exhibit chronic and severe irritability and have frequent temper outbursts.

• Occur on average 3 or more times/week over at least 1 year and in at
  least 2 settings.
  

• Diagnosis for children between ages 6 to 18. Onset must be before age
  10.

  
  
  

Premenstrual dysphoric disorder (PMDD):

disorder that involves depressed mood or changes in mood, irritability,
dysphoria and anxiety during the premenstrual phase that
subside after the menstrual period begins for most of the
cycles of the preceding year.

Casual factors of PMDD:

Biological: genetic influences are prevalent.
Neurochemical factors: major depression is associated with altered
neurotransmitter activity, but newer research focuses more on the
complex interactions of neurotransmitters and how they affect cellular
functioning.

• So, it’s not how much, rather it’s how they interact with other
  hormonal and neurophysiological patterns.

Psychological causes:

stressful life events (ex: loss of a loved one, serious threats to important close relationships or to one’s occupation, economic or health problems), chronic stress, early adversity (ex: family turmoil, abuse, harsh or intrusive parenting), neuroticism, and learned helplessness

Neuroticism is the primary personality variable that serves as a….

vulnerability factor for depression (and anxiety). Involves
temperamental sensitivity to negative stimuli and are prone to
experiencing a broad range of negative moods.

The learned helplessness model of depression:

when perceived lack of control is present, helplessness may result in depression.

The result: people make attributions that are central to whether they become depressed.
3 critical dimensions:

1. Internal/external (blame themselves vs outside factors)

2. Global/specific (happens in every situation vs only part of our life)

3. Stable/unstable (no end to suffering vs temporary)
   

   -Those with a pessimistic attribution style have a vulnerability for
   depression.

Bipolar disorder:

mood disorder involving euphoric episodes, intense and very disruptive experiences of heightened mood referred to as a euphoric mood, possibly alternating with a major depressive episode.

Two main categories of Bipolar disorder:

Bipolar I and Bipolar II

Bipolar I:

distinguished from major depressive disorder by at least one
or more euphoric episodes or mixed features for at least 1 week.

Bipolar II:

person had one or major depressive episodes and at least one mixed with clear-cut hypomanic episodes.

Hypomanic episodes:

involves milder versions of euphoria but must last at least 4 days. Same symptoms but less impairment and never need hospitalization.

Cyclothymic disorder:

defined as more chronic but less severe version of bipolar disorder. (Lacks certain extreme symptoms and psychotic features).

• In the depressed phase, similar to persistent depressive disorder
  (dysthymia). In the hypomanic phase, involves creative and productive
  physical and mental energy.

• Must be at least 2 years of numerous periods with hypomanic and
  depressed symptoms (1 for children and adolescents) and symptoms
  must cause significant distress or impairment in functioning.
  Never symptom free for more than 2 months.

Bipolar is….

equal in men and women

Bipolar I onset in….

adolescence or young adulthood.

Bipolar II: on average 5 years later.

Cannot be diagnosed with bipolar disorder unless exhibited at least one
manic or mixed episode.

Rapid cycling:

experience at least 4 significant episodes in a year.

Of all the psychological disorders, bipolar disorder is the most likely to
occur in people who also have problems with…

substance abuse

With both:
-earlier onset
-more frequent episodes
-greater chance for anxiety and stress related disorders
-aggressive behavior
-problems with the law
-risk of suicide

Bipolar specifics:

Biological causal factors: genetic influences

Neurochemical factors: excesses of norepinephrine during manic
episodes, less serotonin in both depressive and manic phases.

Abnormalities of hormonal regulatory systems: some evidence of abnormalities of thyroid function are frequently accompanied by changes in mood.

Psychological factors: stressful life events as in depressive disorders

Mood disorder diagnosis where there is a prominent and persistent period of depressed mood or markedly diminished interest/pleasure thought to be related to the…

direct physiological effects of another medical condition.

Some well-known illnesses that can lead to a diagnosis of mood
disorder caused by a general medical condition can include:

Neurological disorders (Huntington's disease, Parkinson's disease, Alzheimer's disease), multiple sclerosis, hypothyroidism, traumatic brain injury, strokes, and heart attacks.

A prominent and persistent period of depressed mood or markedly
diminished interest or pleasure in all, or almost all, activities that
predominates in the clinical picture.

The disturbance is not better explained by another mental disorder
(e.g. - adjustment disorder with depressed mood, in which the stressor
is a serious medical condition).

• The disturbance causes clinically significant distress or impairment in
  social, occupational, or other important areas of functioning

Substance-induced mood disorder:

Symptoms of depression that are due to the effects of medicine, drug abuse,
alcoholism, exposure to toxins, or other forms of treatment.

• Substance-induced mood disorder is a change in the way you think, feel, or act, caused by taking or stopping a drug. These changes in your mood can last days or weeks.

• The brain makes chemicals that affect thoughts, emotions, and actions. Without the right balance of these chemicals, there may be problems with the way you think, feel, or act.

• Many drugs change the amounts of these chemicals.

Some drugs can cause mood problems while you are taking
them. Other drugs can cause mood problems for several weeks
after you stop taking them. Drugs and medicines that can cause
mood problems include:

• Alcohol, marijuana, and illegal drugs such as cocaine and LSD.
• Nonprescription medicines such as some decongestants.
• Prescription medicines such as those to treat heart problems,
high blood pressure, antianxiety medicines, antidepressants,
pain medicines, and others.

Adjustment disorder with depressed mood:

Depression is the result of what you are going through

Depression symptoms:

• Feel sad and uninterested in things you usually enjoy
• Have trouble falling asleep, wake up very early, or sleep too
much
• Have changes in your appetite and weight, either up or
down
• Have low energy
• Lose sexual desire
• Feel worthless and guilty
• Not be able to concentrate or remember things
• Feel hopeless or just not care about anything
• Have physical symptoms, such as headaches and joint pain
• Think often about death or suicide

Euphoria symptoms:

• Have a very high sense of self-worth and a feeling of being “on
top of the world”
• Be very talkative and talk so fast that others have trouble
following what you are saying
• Have racing thoughts and trouble concentrating
• Be very restless
• Have more feelings of anxiety and panic
• Go for days with little or no sleep and not feel tired
• Be very irritable and get into fights with others
• Be extremely active and act recklessly, such as going on
spending sprees or having unsafe sex

Substance-induced mood disorder can be treated with either:

group or individual therapy. Therapy in a group with other people
who have substance abuse problems is often very helpful. In
some cases, medicines for depression or anxiety may help you to
stop substance abuse.

• Self-help groups such as Narcotics Anonymous, support groups,
  and therapy may be helpful.

• Learning ways to relax may help. Yoga and meditation may also
  be helpful.

Claims have been made that certain herbal and dietary products
help control cravings or withdrawal symptoms.

Supplements are not tested or standardized and may vary in strengths and effects.
They may have side effects and are not always safe. Before you
take any supplement, talk with your healthcare provider

Suicide:

Fatal self-inflicted destructive act w/ explicit or inferred intent to die

Suicidal Continuum:

1. Suicidal ideation: thinking about ending one’s life
2. Developing a plan
3. Suicide attempt: nonfatal suicidal behavior
4. Suicide: actual ending of one’s life

The DSM-5-TR has added self-harm without the presence of
suicidality to its list of diagnoses:

• Because not everyone who has engaged in self-harm may do
so with the intent of ending their life, lumping it into suicidality
could blur assessments made by clinicians.
• The intent of the injury is the focus, which makes it easier to
track harmful behaviors and assess risk.
• In addition, diagnostic codes for suicidal behavior without the
presence of other mental health disorders have been included
in the new updates.

Positive psychology:

Resilience

• Risk for suicide but unlikely when high in resilience.
  Resilience is a psychological construct: a belief you can
  overcome diversity, good coping skills.

Antidepressant drugs:

Monoamine oxidase inhibitors (MAOIs) (1950’s, intense side effects
lethal, interactions with certain foods, significant withdrawal effects)

Tricyclic antidepressants (intense side effects, increase suicidal
thoughts particularly in children and adolescents) Elavil, Anafranil.
Selective serotonin reuptake inhibitors (SSRIs).
3 to 5 weeks to take effect

Mood stabilizing drugs:

For both depressive and euphoric episodes of
bipolar disorder. Most common, Lithium

Electroconvulsive therapy (ECT):

Treatments induce seizures, used with
severely depressed patients who may present serious suicidal risk.

Transcranial Magnetic Stimulation (TMS):

focal stimulation of the brain.
Stimulates nerve cells in the brain to improve symptoms of major
depression (OCD, anxiety, and PTSD). Noninvasive as there is no surgery
involved

Deep Brain Stimulation (DBS) (neuromodulation):

implanting an electrode in the brain (via tiny holes) and stimulating that area with
electric current. Controlled by a pacemaker type device placed under
the skin in the upper chest. A wire travels under the skin connecting
the device with the electrodes

Behavioral Activation Treatment:

focuses intently on getting patients
to become more active and engaged with their environment and with
interpersonal relationships

Interpersonal Therapy (IPT):

Focuses on current relationship issues and understanding and change of maladaptive interaction patterns

Dissociative Disorders:

conditions that involve disruptions or breakdowns of memory, awareness,
identity, or perceptions.

Dissociative Identity Disorder:

a dissociative disorder, formerly called MPD, in which an individual develops more than one-self or personality.

• Must have 2 distinct identities and when inhabiting identity one, are
  not aware that they also inhabit the other identity.
  

• As a result, will have large gaps in memory.

Individuals with dissociative identity disorder have learned to…

cope with extremely stressful life circumstances by creating
“alter” personalities that unconsciously control their thinking
and behavior when they are experiencing stress.

Oftentimes Dissociative disorders involve…

mood, anxiety, and PTSD.

Dissociative Amnesia:

inability to remember important personal details
and experiences, usually associated with traumatic or very stressful
events.

Fugue State:

: travel or wander without knowing their identity.
(Dissociative Amnesia with Dissociative Fugue)

Depersonalization:

condition in which people feel they are detached from their own body

Derealization:

condition in which people feel a sense of unreality or
detachment from their surroundings.

Depersonalization/derealization disorder:

condition in which the
individual experiences recurrent and persistent episodes of
depersonalization/derealization.

Somatic symptoms:

symptoms involving physical problems and/or
concerns about medical symptoms

“somatic” comes from the Greek word “soma” meaning…

body

Somatic symptom disorder:

somatic disorder involving actual physical symptoms that may or may not be
accountable by a medical condition, accompanied by maladaptive thoughts, feelings, and behaviors

• Manifests as physical symptoms that suggest illness or
  injury but cannot be explained fully by a general medical condition or by the direct effect of a substance and are not attributable to another mental disorder

• For those with this disorder, medical test results either normal or do not explain their sysmptoms. or a known medical condition. For a diagnosis, their must also be excessive worry about their symptoms, and
  this worry must be judged to be out of proportion to the severity of the physical complaints.
  

• - A diagnosis of somatic symptom disorder requires
  that the subject have recurring somatic complaints
  for at least six months.For those with this disorder, medical test results are either normal or do not explain the person’s
  symptoms, and do not indicate the presence of a
  known medical condition.

Symptoms are sometimes similar in various illnesses and may last for
years. Usually, the symptoms begin appearing during adolescence, and
patients are diagnosed before the age of 30 years.
Symptoms may occur across cultures and gender.
Other common symptoms include anxiety and depression. However, since
anxiety and depression are also common in those with confirmed medical
illnesses, it remains possible that such symptoms are a consequence of the
physical impairment, rather than a cause.

Somatic symptom disorders are not the result of conscious
malingering (fabricating or exaggerating symptoms for
secondary motives) or factitious disorders (deliberately
producing, feigning, or exaggerating symptoms).
Somatic symptom disorder is difficult to diagnose and treat.

Illness anxiety disorder:

a somatic symptom disorder characterized by the misinterpretation of normal bodily functions as signs of serious illness. Does not involve actual physical symptoms.
Known as hypochondriasis in DSM-4.

• Individuals do not experience any specific physical ailment, but
  instead, they are preoccupied with concern about developing a
  severe medical condition.
  

• Easily alarmed about their health and seek unnecessary medical tests
  and procedures to rule out or treat exaggerated or imagined illnesses.
  They remain unsatisfied with the reassurance of the physicians
  and can cause a huge burden on the resources of health care
  facilities and on health care providers.

  
  

Functional Neurological Symptom Disorder (Conversion disorder):

a
somatic symptom disorder involving the translation of unacceptable
drives or troubling conflicts into physical symptoms.

• Once known as “hysteria”.

• “Conversion” refers to the presumed transformation of psychological
  conflict to physical symptoms.
  Physical ailments include: “pseudoseizures”, disorders of movement,
  paralysis, weakness, disturbances of speech, blindness, and other
  sensory disorders and cognitive impairment.

  
  

Malingering:

involves deliberately fabricating physical or psychological
symptoms for some ulterior motive.

Fictitious disorder imposed on self:

fake symptoms or disorders not for
the purpose of any particular gain, but because of an inner need to
maintain a sick role. (Munchausen’s syndrome)

Fictitious disorder imposed on another:

inducing physical symptoms in another person who is under their care. (Munchausen’s syndrome by proxy)

Malingering:

Want direct benefit or reward

Primary gain:

the relief from anxiety or responsibility due to the
development of physical or psychological symptoms. Direct benefits
occupying the sick role. (disability, lawsuit, insurance benefits, time off
from work)

Factitious disorder:

faking or exaggerating symptoms for secondary
gains.

Secondary gain:

sympathy and attention that a sick person receives
from other people. Motives are internally driven, not externally.

Dissociative and Conversion disorders are nearly always precipitated by..

some prior trauma

Cognitive Behavioral Therapy (CBT):

help clients identify and change
their thoughts linked to their physical symptoms and change their
maladaptive behavior that accompanies those irrational thoughts.
Focus is on the unusually high level of health anxiety: worry about
physical symptoms and illness.
Hypnotherapy and Medication

Psychological factors affecting other medical conditions:

disorder in which clients have a medical disease or symptom that appears to be
exacerbated by psychological or behavioral factor.

Psychological factors affecting medical conditions include…

mental disorders, stress, emotional states, personality traits, and poor coping
skills.
All interact with physiological conditions.

Stress:

the unpleasant emotional reaction that a person has when an
event is perceived as threatening.

Stressful life event:

an event that disrupts the individual’s life.

Coping:

the process through which people reduce stress in a healthy
manor.

Daily Hassles:

relatively minor events that can add up and cause
significant stress that can impair mental health.

Problem focused coping:

coping in which the individual takes action to
reduce stress by changing whatever it is about the situation that makes
it stressful.

Emotion focused coping:

coping in which a person does not change
anything about the situation itself, but instead tries to improve feelings
about the situation.

Type A-behavior pattern:

a pattern of behaviors that include being
hard-driving, competitive, impatient, cynical and suspicious, easily
irritated, and hostile toward others.

Type D Personality:

people who experience emotions that include
anxiety, irritation, and depressed mood.

Eating disorders:

persistent disturbances of eating or eating related
behavior that result in changes in consumption or absorption of food.

• Eating behavior significantly impair the individual’s physical and
  psychosocial functioning.

  
  

Feeding disorders:

characterized by extreme food selectivity (beyond
pickiness)

• While eating disorders are not really about issues with the food, but
  rather a coping mechanism gone wrong, feeding disorders actually are
  more often the direct result of food preferences or perceived
  intolerances.

Body dysmorphia and related behaviors, such as negative body talk,
body-checking, or frequent weighing, are common with eating disorders,
though not…

associated with feeding disorders

Anorexia Nervosa (NA):

an eating disorder characterized by an inability
to maintain normal weight, an intense fear of gaining weight and
distorted body perception.

• Results in serious health changes.
  Weak and brittle bones, muscles, hair and nails, low blood pressure,
  slowed breathing and pulse, lethargic, sluggish, and fatigued.
  

• Eventually organ failure.

Bulimia Nervosa:

eating disorder involving alternation between the
extremes of eating large amounts of food in a short time and then
compensating for the added calories either by vomiting or other
extreme actions to avoid gaining weight. Must binge and purge once
per week.

Binge-eating:

Eat execessive amount of food during a short period

Purging:

inappropriate methods of compensating for added calories
such as vomiting, laxatives, diuretics, or other medications, fasting or
excessive exercise.

Binge-Eating Disorder;

the ingestion of large amounts of food during a
short period of time, even when full and a lack of control over what or
how much is eaten.

• Must engage in binges at least twice a week for 6 months. Must involve
  large food intake, past the point of full, eating while alone, feeling guilt
  or self-disgust after.
  - Usually significantly overweight.
  - No purging.

According to the DSM-5, the category of other specified feeding
or eating disorder (OSFED) is applicable to…

individuals who are
experiencing significant distress due to symptoms that are similar
to disorders such as anorexia, bulimia, and binge-eating disorder,
but who do not meet the full criteria for a diagnosis.