Mood Disorder Specific Assessments & Suicide

somatic treatment of Bipolar Disorder

Lithium is best known treatment, rarely used due to side-effects, safer but less effective drugs (antidepressants and some antipsychotics) most often prescribed

psychosocial treatment of bipolar disorder

usually not like cognitive behavioral therapy. one method is family therapy… increasing medication compliance, educate family about symptoms, help family develop new coping skills and communication styles

trends in suicide rates by sex

males have higher suicide rates, but females are more likely to have suicidal ideation, and make non-lethal attempts

prevalence of suicide ideation, planning and attempt

ideation: by 18 about 17%

planning: by 18 about 5%

attempt: by 18 about 4%

suicidal ideation is a symptom of:

major depressive episodes NOT major depressive disorder

common test items for suicide

• Hopelessness

• Rage, anger, seeking revenge

• Social withdrawal

• Anxiety, agitation, unable to sleep

• No reason for living

• Increasing alcohol or drug use

• Family conflict

what types of questions should you ask about a patient and suicide

• Beyond ideation, assess the risk, to the extent possible, especially…

  • Does the patient state they intend to kill themselves?

  • Does the patient have a plan to kill themselves? How definite is it?

  • Have they ever tried to kill themself in the past? How serious was the attempt?

what to do in less imminent cases for possible suicide

• Form a plan/contract around the suicidal behavior

• Engage if possible with friends/family to monitor

• Remove easy means of death from household 

• Continue to engage in care

Bayes theorem equation

PPV = sensitivity x prevalence / (sensitivity x prevalence) + ((1-specificity) x (1-prevalence))

in the context of suicide, what do the values in Bayes equation mean?ex. 56% sensitivity, 80% specificity, base rate 1/7246:

56% chance the test correctly scores that one person from the base rate as positive. there is a 44% chance the test incorrectly scores that one person as negative.

of the people who will not complete suicide, aka 7245 people, 20% of them will have false positives, and 80% of them will have true negatives.

psychological treatment of depression

cognitive behavioral therapy - most common, and behavior activation

what does cognitive behavioral therapy do for depresion

focuses on changing dysfunctional associated with depression, challenges negative attributions, either verbally with therapist or experimentally, clients do homework

what does behavioral activation do for depression

creates a hierarchy of reinforcing activities. engage and track these activities and evaluate connection to mood (more effective than cbt)

what do antidepressants do

most increases levels of serotonin and/or norepinephrine

problems with antidepressants

questionable effectiveness for mild to moderate depression, questionable utility in standard clinical care (50% stop taking or never take the drug), lacks efficacious treatment of depression which is a public health issue

t/f: antidepressant medication works better than psychosocial therapies

false, they work about the same

how to determine burden of disease

look at cost per subject and total cost. things like brain tumor hav high cost per subject, but low total cost. anxiety disorders have lower cost per subject but higher total cost.

what is ECT and why does it exist

a way to induce seizures artificially, in the early 20th century there was a belief that schizophrenia and epilepsy were linked, and that seizures would provide relief

now what is ECT used for / how

treatment of resistant depression, receive treatments every other day for 6-10 treatments, some short term memory loss, confusion. not sure why it works