ABNORMAL PSYCH.docx

ABNORMAL PSYCH - CHAPTER 6 What are the symptoms of bipolar I and bipolar II disorders? What is the difference between the two? the symptoms of bipolar I disorder include the presence (or history) of one or more manic episodes, which are characterized by elevated or irritable mood, increased energy,...

ABNORMAL PSYCH - CHAPTER 6 What are the symptoms of bipolar I and bipolar II disorders? What is the difference between the two? the symptoms of bipolar I disorder include the presence (or history) of one or more manic episodes, which are characterized by elevated or irritable mood, increased energy, decreased need for sleep, grandiosity, racing thoughts, distractibility, and excessive involvement in pleasurable activities that have a high potential for painful consequences. The symptoms of bipolar II disorder include the presence (or history) of one or more major depressive episodes and at least one hypomanic episode, which is a less severe form of mania. During hypomania, the individual may experience increased energy, decreased need for sleep, grandiosity, racing thoughts, distractibility, and excessive involvement in pleasurable activities that have a high potential for painful consequences, but to a lesser degree than in a full manic episode. The main difference between bipolar I and bipolar II disorders is the presence of full manic episodes in bipolar I disorder, whereas bipolar II disorder is characterized by hypomanic episodes rather than full manic episodes. What is used to treat bipolar disorder and how does it work? there are several medications used to treat bipolar disorder, including mood stabilizers such as lithium and valproate, antipsychotics, and antidepressants. Lithium is a naturally occurring element that is effective in preventing and treating pathological shifts in mood. Valproate is another mood stabilizer that has recently overtaken lithium as the most commonly prescribed mood stabilizer for bipolar disorder. Antipsychotics are used to treat manic and mixed episodes, and some are also effective in treating depressive symptoms. Antidepressants are sometimes used in combination with mood stabilizers or antipsychotics to treat depressive episodes, but they must be used with caution as they can trigger manic episodes in some individuals The exact mechanisms by which these medications work to treat bipolar disorder are not fully understood, but they are thought to affect the levels of neurotransmitters in the brain, such as serotonin, dopamine, and norepinephrine, which are involved in regulating mood, energy, and motivation. Mood stabilizers such as lithium and valproate are thought to work by modulating the activity of these neurotransmitters, as well as by affecting intracellular signaling pathways and gene expression. Antipsychotics are thought to work by blocking the activity of dopamine receptors in the brain, which can help to reduce manic symptoms. Antidepressants are thought to work by increasing the levels of serotonin and/or norepinephrine in the brain, which can help to alleviate depressive symptoms What are some issues related to the treatment of bipolar disorder? there are several issues related to the treatment of bipolar disorder. One issue is that many individuals with bipolar disorder do not receive appropriate treatment, either because they are not diagnosed correctly or because they do not have access to adequate mental health care. Another issue is that medication adherence can be a challenge, as some individuals may not want to take medication due to side effects or because they enjoy the "high" of manic episodes. Additionally, some individuals may not respond well to medication or may experience a relapse despite treatment. Another issue is that the use of antidepressants in the treatment of bipolar disorder is controversial, as they can trigger manic episodes in some individuals. There is also debate over the use of long-term maintenance treatment with mood stabilizers, as some individuals may experience side effects or may not want to take medication for an extended period of time. Finally, there is a need for more research on the effectiveness of psychological interventions for bipolar disorder, as these interventions have been shown to be effective in managing interpersonal and practical problems associated with the disorder, but their long-term efficacy is not well established. Describe persistent depressive disorder, major depressive disorder, and double depression, and explain how they differ. persistent depressive disorder (dysthymia) is a type of depression that is characterized by a chronic, low-grade depressed mood that lasts for at least two years. The symptoms of persistent depressive disorder are often milder than those of major depressive disorder, but they remain relatively unchanged over long periods. In some cases, fewer symptoms are observed than in a major depressive episode, but they persist for at least two years. Major depressive disorder, on the other hand, may be a single episode or recurrent, but it is always time-limited. The symptoms of major depressive disorder are more severe than those of persistent depressive disorder and include a depressed mood, loss of interest or pleasure in activities, changes in appetite or weight, sleep disturbances, fatigue, feelings of worthlessness or guilt, difficulty concentrating, and recurrent thoughts of death or suicide. Double depression is a form of persistent depressive disorder in which an individual experiences both major depressive episodes and persistent depressive disorder. In other words, an individual with double depression has a chronic, low-grade depressed mood that persists for at least two years, as well as episodes of more severe depression that meet the criteria for major depressive disorder. In summary, persistent depressive disorder is a chronic, low-grade depressed mood that lasts for at least two years, major depressive disorder is a more severe form of depression that is time-limited, and double depression is a combination of both persistent depressive disorder and major depressive disorder. What are the psychological risk factors for suicide? there are several psychological risk factors for suicide. One of the most important risk factors is a history of mental illness, particularly mood disorders such as depression and bipolar disorder. Other psychological risk factors include hopelessness, feelings of worthlessness or guilt, impulsivity, aggression, and a history of trauma or abuse. Substance abuse and dependence are also significant risk factors for suicide, as they can exacerbate underlying mental health problems and impair judgment and impulse control. In addition, certain personality traits, such as perfectionism, pessimism, and low self-esteem, have been associated with an increased risk of suicide. Finally, social isolation and lack of social support can also increase the risk of suicide, as individuals who feel disconnected from others may be more likely to experience feelings of hopelessness and despair. It is important to note that these risk factors do not necessarily predict suicide, but rather increase the likelihood that an individual may experience suicidal thoughts or behaviors. It is also important to recognize that suicide is a complex phenomenon that is influenced by a wide range of factors, including biological, social, and environmental factors. What are the protective factors? there are several protective factors that can help to reduce the risk of suicide. These include: 1. Strong social support: Having a network of supportive friends and family members can help to reduce feelings of isolation and provide a sense of belonging and purpose. 2. Access to mental health care: Individuals who have access to mental health care and receive appropriate treatment for mental health problems are less likely to experience suicidal thoughts and behaviors. 3. Effective coping skills: Individuals who have effective coping skills, such as problem-solving and emotion regulation strategies, are better able to manage stress and reduce the risk of suicide. 4. Positive self-esteem: Individuals who have a positive self-image and a sense of self-worth are less likely to experience feelings of hopelessness and despair. 5. Sense of purpose: Having a sense of purpose and meaning in life can help to provide a sense of direction and reduce the risk of suicide. 6. Cultural and religious beliefs: Cultural and religious beliefs that discourage suicide can provide a protective factor against suicidal thoughts and behaviors. It is important to note that these protective factors do not guarantee that an individual will not experience suicidal thoughts or behaviors, but rather can help to reduce the risk of suicide and promote resilience in the face of adversity. What is the prevalence of suicide across age and ethnic groups, and in the general population? suicide rates vary across age and ethnic groups. In the United States, suicide is most common among middle-aged and older adults, with the highest rates observed among individuals aged 45-54 and 85 years and older. Suicide rates are also higher among men than women, although women are more likely to attempt suicide. Ethnic differences in suicide rates are also observed. Suicide is overwhelmingly a white phenomenon, with most minority groups, including African Americans and Hispanics, seldom resorting to this desperate alternative. However, Native Americans have extremely high suicide rates, far outstripping the rates in other ethnic groups. Even more alarming is the dramatic increase in death by suicide beginning in adolescence. In 2012 in the United States, the number of deaths by suicide per 100,000 people rose from 1.73 in the 10 to 14 age group to 14.26 in the 20 to 24 age group. In the general population, suicide is a significant public health concern. According to the Centers for Disease Control and Prevention (CDC), suicide is the 10th leading cause of death in the United States, with over 47,000 deaths by suicide reported in 2019. Suicide rates have been increasing in recent years, with a 35% increase in suicide rates between 1999 and 2018. It is important to note that suicide is a complex phenomenon that is influenced by a wide range of factors, including biological, social, and environmental factors. Understanding these factors and developing effective prevention and intervention strategies is critical to reducing the incidence of suicide. What steps are taken to reduce a client’s risk of suicide? there are several steps that mental health professionals can take to reduce a client's risk of suicide. These include: 1. Conducting a thorough assessment: Mental health professionals should conduct a thorough assessment of the client's mental health status, including any history of suicidal thoughts or behaviors, current symptoms, and risk factors for suicide. 2. Developing a safety plan: Mental health professionals should work with the client to develop a safety plan that outlines specific steps the client can take to stay safe in the event of a suicidal crisis. This may include identifying supportive individuals, developing coping strategies, and creating a plan for accessing emergency services if needed. 3. Providing education and support: Mental health professionals should provide education and support to the client and their family members or support system. This may include information on the warning signs of suicide, coping strategies, and available resources for support and treatment. 4. Monitoring and follow-up: Mental health professionals should monitor the client's mental health status and suicide risk over time, and provide ongoing support and follow-up care as needed. 5. Limiting access to lethal means: Mental health professionals should work with the client and their family members or support system to limit access to lethal means, such as firearms or medications, that could be used in a suicide attempt. It is important to note that suicide prevention is a complex process that requires a collaborative effort between mental health professionals, clients, and their support systems. Effective suicide prevention requires ongoing monitoring, support, and intervention to help individuals stay safe and manage their mental health concerns. DEFINITIONS Mood Disorders Mood Disorders, it refers to a group of mental health conditions characterized by significant changes in mood, emotion, and energy levels. The two most common types of mood disorders are depression and bipolar disorder. Depression is characterized by persistent feelings of sadness, hopelessness, and loss of interest or pleasure in activities that were once enjoyable. Bipolar disorder is characterized by episodes of mania (a state of elevated or irritable mood, increased energy, and impulsive behavior) alternating with episodes of depression. Other types of mood disorders include cyclothymic disorder, dysthymia, and seasonal affective disorder (SAD). Major Depressive Disorder Major Depressive Disorder, it is a type of mood disorder characterized by one or more major depressive episodes. A major depressive episode is defined as a period of at least two weeks during which an individual experiences persistent feelings of sadness, hopelessness, or loss of interest or pleasure in activities that were once enjoyable. Other symptoms may include changes in appetite or sleep patterns, fatigue, difficulty concentrating, feelings of worthlessness or guilt, and thoughts of death or suicide. Major Depressive Disorder may be a single episode or recurrent, but it is always time-limited. Hypomanic Episode Hypomanic Episode, it is a less severe version of a manic episode that does not cause marked impairment in social or occupational functioning and need last only four days rather than a full week. A hypomanic episode is not in itself necessarily problematic, but its presence does contribute to the definition of several mood disorders. Depressive Cognitive Triad the Depressive Cognitive Triad, it is a key concept in cognitive theories of depression. It refers to the three types of negative thoughts that are characteristic of depressed individuals: negative thoughts about the self, negative thoughts about the world, and negative thoughts about the future. According to this theory, individuals who are depressed tend to interpret events in a negative way, which reinforces their negative beliefs and leads to a cycle of negative thinking and mood. Bipolar I Disorder Bipolar I Disorder, it is a mood disorder characterized by the occurrence of one or more manic episodes, which may be preceded or followed by hypomanic or major depressive episodes. A manic episode is a distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least one week (or any duration if hospitalization is necessary). The episode is accompanied by symptoms such as inflated self-esteem, decreased need for sleep, talkativeness, racing thoughts, distractibility, and excessive involvement in pleasurable activities that have a high potential for painful consequences. The symptoms must cause marked impairment in social or occupational functioning or require hospitalization to prevent harm to self or others. Transcranial Magnetic Stimulation Transcranial Magnetic Stimulation (TMS), it is a non-invasive procedure that uses magnetic fields to stimulate nerve cells in the brain. The procedure involves placing a magnetic coil over the individual's head to generate a precisely localized electromagnetic pulse. This pulse is thought to alter the electrical activity in the brain, which can help to alleviate symptoms of depression. TMS is typically used when other treatments, such as medication and psychotherapy, have not been effective. Anesthesia is not required, and side effects are usually limited to headaches. Initial reports showed promise in treating depression, and recent observations and reviews have confirmed that TMS can be effective. Persistent Depressive Disorder Persistent Depressive Disorder, it is a type of mood disorder characterized by long-term, unchanging symptoms of mild depression, sometimes lasting 20 to 30 years if untreated. Daily functioning is not as severely affected, but over time impairment is cumulative. Persistent depressive disorder differs from major depressive disorder in the number of symptoms required, but mostly it is in the chronicity. It is considered more severe, since patients with persistent depression present with higher rates of comorbidity with other mental disorders, are less responsive to treatment, and show a slower rate of improvement over time. About 20% of patients with a major depressive episode report chronicity of this episode for at least two years, thereby meeting criteria for persistent depressive disorder. Also, 22% of people suffering from persistent depression with fewer symptoms eventually experienced a major depressive episode. These individuals who suffer from both major depressive episodes and persistent depression with fewer symptoms are said to have double depression. Disruptive Mood Dysregulation Disorder Disruptive Mood Dysregulation Disorder, it is a relatively new diagnosis that was introduced in the DSM-5. It is a childhood-onset disorder characterized by severe and recurrent temper outbursts that are grossly out of proportion in intensity or duration to the situation or provocation. These outbursts are manifested verbally and/or behaviorally and occur three or more times per week for at least 12 months. The mood between temper outbursts is persistently irritable or angry most of the day, nearly every day, and is observable by others in at least two of three settings (i.e., at home, at school) and is severe in at least one of these. The diagnosis is intended to address concerns about overdiagnosis of bipolar disorder in children and adolescents who do not meet the full criteria for the disorder but who have chronic, severe, and impairing irritability. Premenstrual Dysphoric Disorder Premenstrual Dysphoric Disorder (PMDD), it is a condition that affects some women during the premenstrual phase of their menstrual cycle. It is characterized by severe emotional and physical symptoms that can significantly impact a woman's quality of life. Symptoms include mood swings, irritability, depression, anxiety, fatigue, bloating, breast tenderness, and headaches. To be diagnosed with PMDD, a woman must experience at least five of these symptoms, including one of the first four, in the week before her period starts. These symptoms must improve within a few days after the onset of menses and become minimal or absent in the week post-menses. PMDD affects between 2% to 5% of women, and it is different from premenstrual syndrome (PMS), which is a milder form of premenstrual symptoms that does not significantly affect daily functioning. Criteria defining PMDD are presented in the DSM Disorder Criteria Summary. Mood Stabilizing Drug mood stabilizing drugs, they are a class of medications used to treat mood disorders, particularly bipolar disorder. These drugs are effective in preventing and treating pathological shifts in mood. Lithium is the most commonly used mood stabilizer, and it has been shown to be effective in preventing manic and depressive episodes in patients with bipolar disorder. Other mood stabilizers include valproate, carbamazepine, and lamotrigine. Antipsychotic medications are also sometimes used as mood stabilizers in the treatment of bipolar disorder. For patients who respond to lithium, maintenance on lithium or a related drug is recommended to prevent relapse. Bipolar II Disorder Bipolar II Disorder, it is a type of bipolar disorder in which a person experiences one or more major depressive episodes and at least one hypomanic episode. Hypomanic episodes are less severe than full manic episodes and are characterized by symptoms such as elevated mood, increased energy, decreased need for sleep, racing thoughts, and impulsivity. Unlike in bipolar I disorder, individuals with bipolar II disorder do not experience full manic episodes. The criteria for bipolar II disorder are presented in the DSM Disorder Criteria Summary. Double Depression Double Depression, it is a severe mood disorder that is characterized by major depressive episodes superimposed over a background of dysthymic disorder. Dysthymic disorder is a type of persistent depressive disorder that involves a chronically depressed mood, low self-esteem, withdrawal, pessimism, or despair, present for at least two years, with no absence of symptoms for more than two months. Double depression is a particularly challenging condition to treat, and it often requires a combination of psychotherapy and medication. The symptoms of double depression can be severe and can significantly impact a person's quality of life, making it important to seek professional help if you suspect you or someone you know may be experiencing this condition. The definition and description of Double Depression are presented in the DSM Disorder Criteria Summary. Mania mania, it is a period of abnormally excessive elation or euphoria associated with some mood disorders. Mania is a defining feature of bipolar I disorder, where it is accompanied by at least one major depressive episode. Mania is also a symptom of other conditions, such as schizoaffective disorder and substance-induced mood disorder. During a manic episode, a person may experience symptoms such as elevated mood, increased energy, decreased need for sleep, racing thoughts, grandiosity, and impulsivity. The criteria for a manic episode are presented in the DSM Disorder Criteria Summary. Cyclothymic Disorder Cyclothymic Disorder, it is a chronic (at least 2 years) mood disorder characterized by alternating mood elevation and depression levels that are not as severe as manic or major depressive episodes. The symptoms of cyclothymic disorder are similar to those of bipolar disorder but are less severe and do not meet the criteria for a full manic or major depressive episode. People with cyclothymic disorder may experience periods of hypomanic symptoms, such as elevated mood, increased energy, and decreased need for sleep, as well as periods of depressive symptoms, such as low mood, decreased energy, and feelings of hopelessness. The criteria for cyclothymic disorder are presented in the DSM Disorder Criteria Summary. Cognitive Therapy Cognitive Therapy, it is a type of psychotherapy that focuses on identifying and changing negative thought patterns and beliefs that contribute to mood disorders such as depression and anxiety. Cognitive therapy is based on the idea that our thoughts, feelings, and behaviors are interconnected and that changing our thoughts can lead to changes in our emotions and behaviors. Cognitive therapy is often used in combination with other treatments, such as medication, and has been shown to be effective in treating a range of mood disorders. Beck's cognitive therapy is one of the most well-known and widely used forms of cognitive therapy, and it grew directly out of his observations of the role of deep-seated negative thinking in generating depression. The implications of this theory are important, and by recognizing cognitive errors and the underlying schemas, we can correct them and alleviate depression and related emotional disorders. Electroconvulsive Therapy Electroconvulsive Therapy (ECT), it is a biological treatment for severe, chronic depression that involves the application of electrical impulses through the brain to produce seizures. In current administrations, patients are anesthetized to reduce discomfort and given muscle-relaxing drugs to prevent bone breakage from convulsions during seizures. Electric shock is administered directly through the brain for less than a second, producing a seizure and a series of brief convulsions that usually lasts for several minutes. In current practice, treatments are administered once every other day for a total of six to 10 treatments (fewer if the patient’s mood returns to normal). Side effects are generally limited to short-term memory loss and confusion that disappear after a week or two, although some patients may have long-term memory problems. For severely depressed inpatients with psychotic features, controlled studies indicate that approximately 50% of those not responding to medication will benefit. Continued treatment with medication or psychotherapy is then necessary because the relapse rate approaches 60% or higher.