PSYB32: Mood disorders
Misconceptions of suicide
- You need a reason to be suicidal.
--You could have one, but it could be genetic and the reason could literally just be that youre mentally ill.
- There are always warnings
- Medications are not helpful
- Psychiatric institutions are scary
Loneliness and depression
Loneliness does not cause depression, depression causes loneliness.
Psychologist
People that tries to help you out by talking, therapy, diagnoses and referrals.
Psychiatrist
Medical doctor that might help with conversations, but will mostly give you medication.
Mood disorders
Disabling disturbances in emotions
Depression
Emotional state marked by great sadness, feelings of worthlessness and guilt.
Prevelance of MDD in general population, gender and age.
1/2 of population will experience it in their life, more common in women and the youth
Diagnosis of MDD
5 symptoms for at least 2 weeks:
- Sad mood every day
- Change is activity
- Change in appetite
- Sleeping difficulties
- Bad self-concepts
- Suicide thoughts
- Loss of interest and pleasure in activities
- Difficulties concentrating, slowed thinking, etc.
- Fatigue
Mania
Emotional state of elevated mood or irritability and increase in goal-oriented behaviour for no reason.
Bipolar I
Primarily mania with or without depressive episodes.
Manic episodes diagnoses
3-4 symptoms that severely impacts functioning.
- Increase in acitvity
- Talkativeness
- Distractability
- Inflated ego
- Increase in pleasures that might get you in trouble.
- Less sleep.
If they are not impaired, they're probably just having a great week.
Prevelance of Bipolar
Lifetime prevelance: 4.4%, women have more depressive episodes while men have more mania episodes. Depressive and mania episodes will not happen at the same time.
Why does bipolar have a high reoccurance rate?
They might stop treatment because they like the feeling to being high and productive.
Bipolar II
Episodes of depression with smaller periods of hypomania
Hypomania
Smaller/less version of mania.
Mood specifiers
Psychotic features, melanchoic, post/prepartum, seasonal
Psychotic features and difference between mania.
Mood specifier where the disorder also has symptoms of psychosis.
Manic episodes will say shit that is not impossible but unlikely but psychotic episodes will say shit that is impossible.
Melancholia
Mood specifier with symptoms that define a depressive episode like ahedonia, worse depression in the morning, waking up earlier, appetite/weight loss, etc.
Postpartum
Mood specifier with during 4 weeks of childbirth
Seasonal
Mood specifier where it appears at a particular time.
Ex: affective seasonal disorder where they are sad during winter due to lack of sunlight.
Chronic mood disorders
Mood disorders that are stable and last long
Dysthymic disorders
Chronic depressed symptoms but cant meet criteria for MDD.
Persistent depressive disorder
MDD episodes with episodes of dysthymia lasting more than 2 years.
Other term for persistent depressive disorder
Double depression
Cyclothymic disorder
Chronic bipolar I not high levels of depressive and mania for full diagnosis.
What type of depression does ECT work on?
Severe, used as a last resort.
What type of depression do antidepressants work on?
Moderate-severe.
What are mood stabilizers for?
Bipolar disorders
Other names for depression
Major depression disorder, unipolar depression
Length of depression
Most depression dissipates with time, but it could last for months. If it becomes chronic, they can't snap back to normal between episodes.
Manic episode time
Days to months
What happens when you try to curb mania behaviour
Pisses them off.
Why is depression more common in women
Do more ruminative coping and brooding
Ruminative coping
Tendency to focud on causes of depression and feelings instead of distracting yourself.
Co-rumination
Friends discuss and brood over eachother's problems that is good for depression.
Brooding
Moody contemplation of depressive symptoms.
Age of onset for bipolar I
20
What therapies will psychotic mood specifier people respond to?
Not depression drug therapies unless combined with psychotic feature drug therapies.
Ahedonia
Inability to feel good even with pleasureable things.
Time needed for diagnosis of cyclothymic disorder
half the time for 2 years.
Fruedian theory for depression
Created in early childhood where their needs are overly for insufficiently satisfied, they becomes dependant on that stage and their gratifications and others, they lose others they rely on, introjection, and emotional bonds during mourning work are not loosened.
Introjection
Identifying with those they lost and hating themsleves
Mourning work
recalling memories of introjection and deperating themselves from them, depression if this does not work.
Personality styles of depression
Sociotrophy: high levels of need to please others.
Autonomy: need to work towards goals free from contraints from others.
Dependency: depends on others.
Self-criticism: excessive levels of criticism towards yourself.
Congruency hypothesis
Depression happens in people with personality vulnerabilities and bad life events for those personalities.
Mech's schema theory
Depression because their thinking is bias towars negative interpretations.
3 levels of cognitive activities:
- Negative schema's and beliefs
- Negative triad: pessimistic views of the self, world and future
- Cognitive biases
Dysfunctional attitude
Cignitive bias negative cognitive attitude that confer risk for depression.
Arbitrary inference
Cognitive bias of making inferences with no evidence
Selective abstraction
Conclusion drawn on only one out of many elements
Overgeneralization
Conclusion applied to all situations.
Magnification and minimization
Cognitive bias of exaggertions in evaluations.
What happens when negative schemas are repeatedly activited
Negative modes that takes over cognitive information processing.
Difference between depression victims and normal person's cognitive processing
Schemas involve both positive and negative content, but negative content is more accessible.
Emotional stroop test
Test for cognitive processing for depression where participants try to identifu the colour of the world while ignoring its meaning, and those with depression will take longer to answer if the word has a negative meaning because they pay more attention to it.
Biggest issue with Beck's theory
It is bidirectional. Depression can make yoru cognitive processing more negative and vice versa.
Learned helplessness theory
Depression because they learn to be passive because they were in situations where they learn that their actions will not help them escape a bad situations and they have no control over their fates.
Depressive paradox
Tendency in depressed people to accept responsibility for bad events despite feeling like a lack of control. Depression happens with the internal, stable and global attributional style to bad events as the diathesis.
Depressive attributional style
tendency to attribute bad outcomes to personal, global and stable faults of character.
Hopelessness theory/ hopelessness depression
Depression caused by hopelessness
Hopelessness
Expectations that desirable outcomes won't occur or undesirable outcomes will and there is no way to change this.
Social lives of those with depression
Less social support, reducing ability to cope and making them more vulnerable.
Elicits negative reactions from others.
Have more hostile interactions with higher percieved criticisms
Low in social skills which could be bidirectional
Try to seek reassurance continuously, which could piss them off.
Behavioural activation systems of dysregulation theory
Bipolar/mania is due to hyper responsiveness to rewards from the BAS which makes people do more goal-directed behaviour.
Which disorder is most genetic and genes and what it can predict
Bipolar, with the dominent gene on the 11th chromosome.
Can not predict when manic symptoms occur.
What gene in depression
We don't know because it is polygenic.
Genes interact with childhood trauma
Most likely 5-HTTLPR gene that modulates serotonin levels
Antidepressants
Trycyclic drugs
Monoamine oxidase inhibitors
Selective serotonin reuptake inhibitors
Tricyclic drugs
Antidepressants with colecular structures characterised by 3 fused rings stopping serotonin, dopamine and norepinephrine reuptake
MAO inhibitors
Keeps MAO that are increased during depression from deactivitng nerons and mtabolising derotonin, norepinephrine and dopamine
SSRIs
Stops reuptake on serotonin.
Issues with neurotransmitter explanation for depression
- Timing is not correct
- Measure methods not only measures neurotransmitters in the brain.
- Alters chemical messangers
Brain structures for mood disorders
Amygdala (hyperactivity means sensitivity to negative stimuli)
Hippocampus (Smaller after symptom onset)
Prefrontal cortez (reduced functioning in depression)
Anterior cingulate
Hpothalamic pituitary adrenocortical (HPA) and depression
Overactive in depression, produced cortisol.
Neuroendocrine system and depression
Stress means distorted appraisals, HPA axis engagement, cortisal, depressive symptoms.
Psychoanalytic treatment
Uncover latent motivations for depressions and brings insight and releases hostility.
Flerman and Weissman's interpersonal therapy (IPT)
Helping people examine their interpersonal relationships and why they might not be able to gain satsfaction from them focusing on current life.
Cogitive therapy (CT)
Therapy aimed at altering maladaptive thought patterns to change opinions of events and self.
Methods:
- Moniter thoughts about self.
- Counterexamples for bad overgeneralisations
- Identify bad thought patterns.
- Think through bad beliefs and make them more realistic.
CT and behaviour
CT has behavioural components to act better but it is to enduce cognitive change.
Problem-solving therapy:
training adaptive problem-solving attitudes and skills.
Mindfulness-based cognitive therapy (MBCT)
Increasing awareness to changes in the self and mind with mindfulness meditation and developes metacognitive awareness
Metacognitive awareness
Ability to step back from one's thoughts and just see them simply as thoughts and feelings.
Cognitive behaviour interventions for bipolar
target thoughts and interpersonal behaviours that go wrong during moon swings
Electroconvulsive therapy (ECT)
Electrical shocks used to deliver seizures used for severe depression as a last measure attempt.
Bilateral: electrodes passed through both hemispheres of the brain.
Unilateral ECT: Passed trough only one side of the brain, probably the right side.
Problems with ECT
Inhumane, risky, confusion, memory loss, relapse rates.
Deep brain stimulation
Plants battery-operated electrodes in the brain to deliver electrical impulses.
What type of depression DBS is for
Treatment resistent depression
Repetitive transcranial magnetic stimulation (rTMS)
Stimulating the brain with magnets that produces electric impulses that is non-invasive.
Most common treatment for mood disorders
Drugs
Lithium carbonate
Drug for mania and depression that cuts out both the highs and lows of the thing.
Downsides of lithium carbonate
Possibly fatal side effects
First mood stabilizer
Lithium carbonate
Phototherapy
Exposure to intense white light for seasonal affective disorder
Gender paradox of suicide behaviour
Women have lower suicide mortality rates but more attempts.
Suicide ideation
Thoughts/intentions of killing yourself.
Suicide attempts
Self-injury behaviours meant to cause death.
Suicide gestures
self-injury when there's no intent to die just to communicate with others.
Mental illness associated with suicide other than depression
Borderline personality disorder, substance abuse, schizophrenia
3 types of suicide
Egoistic suicide: suicide because you have no connections to society and no one cares about you.
Altruistic suicide: suicide because you your connections to society and you think it would benefit others.
Anomic suice: suicide due to changes in a person's relationship to society and disorientation because they think theyve lost their former lives.
Risk factor model for suicide causes
Predisposing factors, precipitating factors, contributing factors, protective factors.
Baumeister's escape theory
Suicide arises from trying to avoid sversive self-awareness
Aversive self-awarness
Awareness of shortcomings/failuares someone attributes to themseles with unrealistic high standars and the possibility of failing them.
Perfectionism social disconnection model (PSDM)
interpersonal perfectionism creates an alienation and isolation that amplifies hopelessness and self-loathing sometimes in extreme forms of perfection.
They want to self-present as perfect and this is violated when they are humiliated they are particularily sensitive to bullying.
Joiner's interperonal theory of suicide
Suicide due to twarted need to belong and feeling like a burden
Will and way and suicide
Suicide happens to those with both the will and the way. Just because one has a will, it doesn not mean they have the way.
Snieldman's approach
Suicide is a concious effort to seek a soluation causing psyache
Psychache
intense psychological pain in those with suicide ideation
Reasons for living inventory
Survival and coping beliefs.
Responsibility to family.
Concerns about children.
Fear of social disapproval.
Fear of suicide.
Moral objections.
Hvae reasons to live means less suicidal.
Canada and suicide
No national stragety
What many believe need to happen to stip suicide
understanidnf underlying psychological disorder
Shnieldman's threefold strategy of suiicde prevention
Resduce psychache
Lfiting the blinders to help them see options other than intense suffering even if other options have pain, it is not as intense.
Getting them to stop self-destructive behaviour.
Therapists and suicide
Must report even if it break confidentiality
Assisted suicide
Legall in Canada
Need death to be forseeable, be very sick, mentally competent
Taking care of someone with suicide
Takes lots of energy, they become whole reliant on you and youre the most important person in their lives and they might even become hostile.