Mood Disorders And Suicide

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Major Depressive Episode

Back 1

depressed mood and/or loss of interest or enjoyment - 2 weeks. significant distress or impairment.

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Manic Episode

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period of one week or longer in which prevailing mood abnormally and persistently elevated, expansive, irritable. increase goal directed activity or psychomotor agitation, flight of ideas, decreased need for sleep

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Hypomanic Episode

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persistent eleveated, expansive, irritalbe mood at least four days. clear change in mood, but not severly impaired to casue disruption in functiong. marked increase in efficiency and accomplishments or creativity

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mixed episode

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one week rapidly alternating symptmos of manic or major depressive episodes. sever to casue marked impairment.

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Major Depressive Disorder

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one or more depressive episode no manic, hypomanic, or mixed in history.

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Major Depressive Disorder subtypes

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Psychotic features
Catatonic Features
Melancholic features
Postpartum onset - 10-20% of women expereince symptoms

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Gender/Age/Culture - Depression

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twice the rate for females. 20's average onset. irritablilty, somatic complaints children and adlolescents - memory issues for elderly. somatic complaints in diffirent cultures - nerves for hispanics.

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Course/Prognosis - depression

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untreated 6 months remit with full return to premorbid functiong. In 20-30% symptoms remain for momths to years.

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Catecholamine and Indolamine Hypothesis of depression

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Catacholamine - some forms of depression are due to a deficiency in norepinephrine.
Indolamine - low levels of serotonin.

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Depression and lack of new cell growth

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most recent theory - hippocampus is smaller-than normal in chronically depressed people

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Learned Helplessness Model - Seligman of depression

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result of prior exposure to uncontrolleable negative events coupled with a tendency to atribute negative events to internal, stable, and global factors. - sense of hopelessness

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Rehms Self Control MOdel of depression

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dpression is related to a combination of self-monitoring, selfevaluation, and self-reinforcement. depressed peole attend more to negative events and immediate outcomes...low rates of self-reinforcment

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Depressive Cognitive Triad - Beck

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netative, illogical self-statements about oneself, the world, and the future.

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Treatment of depression

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antideprssants and psychotherapy

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3 classes of antidepressants are most commonly prescribed

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Tricyclics (TCA) - most effective for classic depression hat involve vegetative symptoms, morning symptoms, moderate severity
Selective Serotonin Reuptake Inhibitors (SSRI) - more beneficial for melancholic dperssions and are associated with fewr side effects than TCA
Monoamine Oxidase Inhibitors (MAOI) - for patiesn that do not respond to TCA or SSRI and whose depressions ar atypical include phobic features, panic attakcs, increased appetiee,

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ECT

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used for deprssion with sucideal or delusions. anterograde and retrograde amneisa, confusion are side effects.

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Seasonal Affective Disorder

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usually display hypersomina, increased appetite and weight gain, craving for carbohydrates and other atypical sympomts.. some evidance suggests relarted to seasonal incraeses in melatonin levels. use of phototherapy exposure to bright light

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Dysthymic Disorder

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chronically deprssed mood that is present most of the time. two years adults one in children and adlolescents. never more then two months symptoms free.

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Bipolar I Disorder

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one or more manic or mixed episodes with or without a history of one or more major depression.

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Bipolar II Disorder

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at least one major depressive disorder and one hypomanic episode. never had a manic or mixed episode

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Gender/Age - bipolar

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equally common bipolar I - bipolar II more in females. average age for first manic episode is in early 20's

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bipolar - etiology

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genetic factors consistant. 65% for identical twins, while 14% for non. there is also evidence of stressful life events precipitating first few episodes

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Bipoloar - Treatment

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Lithium is the treatment of choice- effective 60-90% of cases of "classic" bipolar. reduces manic episodes and reduces mood swings. medication compliance low - start feelings better and stop or unwilling to give up highs. for people who do not respond to lithium - anti-seziure medication is used. treatment enhanced with psychotherapy.

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Cyclothymic Disorder

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fluctuating hypomanic symptoms and numerous periods of depressive symptoms. depressive symptoms don't meet criteria for MDepisode.

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Suicide
History
Age
Gender
Race
marital Status

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eighth leading casue of death in U.S.
80% give definite sign
over 65 highest completed, attempts 24-44. highest increase 10-14
4-5x more males commit suicide
higher amont whites except adolessence the rates for some native american tribes are higher than those of whites
Divorced, seperated, and widowed highter rates. lowest among married.

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Suicide and Cogntive Correlates
Self Oriented Perfectionism and Socially persecribed Perectionism

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Hopelessness most predictive of suicide then intensity of deprssive symptoms. socially perscribed perfectionism have been linked to elevated risk for depressin and sucide.

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Suicide - Early signs for adolescents

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talking about death, reunion with a deceased person, giving away pried possessions

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Sucide and Psychiatric Disorder

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Major Depression and Bipolar are most common with 50-80% of suicidal individual having a history of sever depression.
It is most likely to occur within three months after depressive symptoms begin to improve. Suicide risk incrases for adolescents when it co-occurs with
ADHD, conduct disorder, or substance abuse

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Sucide and biological correlates

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low levels of serotonin and 5HIAA

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Preventative measures for suicidal patient

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1 - no-suicide contract
2 - providing client with 24-hour clinical back-up
3- using strategies to increase compliance with continued treatment - involving family
4 - making sure firearms have been emoved from client's home