Exam 2 Psychopathology Mood Disorders and Suicide

Mood Disorders

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

In order to diagnose Mood Disorder they must be…

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

Two key moods involved in mood disorders

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) are 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

dysphoria (depressive disorder)

essential element is an unusually elevated sad mood

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

in order to diagnose major depressive disorder…

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

A person affected by major depressive disorder must experience

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

Major depressive disorder symptoms

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

If untreated major depressive disorder…

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

persistant 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 for persistent depressive disorder

4 to 5 years but can last for 20 or more

Persistant depressive disorder symptoms are…

mild but last longer are chronic

Important characteristic of PDD

Periods of normal moods occur briefly but only last for a few days to a few weeks with a maximum of 2 months

Seasonal affective disorder (SAD)

mood disorder with episodes of depression typically occur during the fall and winter and subside during the spring.

Seasonal affective disorder is more common among

women and those who live in northern latitudes

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.

Disruptive mood dysregulation disorder duration

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

disruptive mood dysregulation age diagnosis

children ages 6 to 18 and 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.

PMDD casual factors: Biological

Genetic influences are prevalent

PMDD casual factor (Neurochemical)

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. 

PMDD 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… (temperamental sensivity to negative stimuli)

primary personality variable that serves as a vulnerability factor for depression (and anxiety). prone to a range of negative moods

Learned helplessness model of depression

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

Learned helplessness model of depression (result)

people make attributions that are central to whether they become depressed.

1. Criticism of learned helplessness model of depression

Internal/external

2. Criticism of learned helplessness model of depression

Global/specific

3. Criticism of learned helplessness model of depression

Stable/unstable

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.

Bipolar 1

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

Bipolar 2

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

Hypomanic episode

: 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).

cyclothymic disorder (depressive phase)

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

Cyclothymic disorder in order to be diagnosed

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 1 onset in

adolescence or young adulthood

Bipolar 2 on average

5 years later

Can’t be diagnosed with bipolar disorder unless

exhibited at least one manic or mixed episode.

rapid cycling

experience at least 4 episodes in a year. 

people who have problems with substance abuse are most likely to have

bipolar disorder

substance abuse and bipolar disorder symptoms

earlier onset

-more frequent episodes

-greater chance for anxiety and stress related disorders

-aggressive behavior

-problems with the law

-risk of suicide

Bipolar disorder (biological)

genetic influences

Bipolar disorder (Neurochemical)

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

Abnormalities of hormonal regulatory system (bipolar)

some evidence of abnormalities of thyroid function are frequently accompanied by changes in mood.

psychological factors (bipolar)

: stressful life events as in depressive disorders

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

depressive disorder due to medical condition

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.

criteria for depressive disorder due to another medical condition

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

criteria 2 for depressive disorder due to another medical condition

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).

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.

changes caused by substance induced mood disorder

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.

drugs affect on the brain

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

some drug 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

•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

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. yoga and meditation

self help groups for substance induced mood disorder

Narcotics Anonymous, support groups, and therapy may be helpful.

substance induced mood disorder (other treatments)

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.

suicide

“fatal self-inflicted destructive act with explicit or inferred intent to die”.

suicide continuum 1.

Suicidal ideation: thinking about ending one’s life

suicide continuum 2.

developing a plan

suicide continuum 3.

suicide attempt: nonfatal suicidal behavior

suicide continuum 4.

suicide: actual ending of one’s life

Self-harm without suicidality (DSM-5-TR)

Self-harm NOT meant to cause death
→ Added because not all self-harm = suicide
→ Helps clinicians focus on intent of behavior and assess risk better

positive psychology

resilience

risk of suicide with high resilience

unlikely

Resilience is a psychological construct

: a belief you can overcome diversity, good coping skills.

Mood-stabilizing drugs:

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

Antidepressant drugs (types + key facts)

• MAOIs (1950s): severe side effects, dangerous food interactions, withdrawal

• Tricyclics: strong side effects, ↑ suicidal thoughts (esp. kids/teens)

• SSRIs: most commonly used, safer

• All take ~3–5 weeks to work

Electroconvulsive therapy (ECT) (biological treatment for Suicide)

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

Transcranial Magnetic Stimulation (TMS) (biological treatment for Suicide)

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) (biological treatment for Suicide)

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

psychotherapy: treatment using talk + psychological methods (not medication)

Family and Marital therapy