Suicide & Bipolar Disorders (Lesson 16) PDF

**[Lesson 16]** **[Bipolar and Related Disorders II]** **[Topic 77-81]** **[Topic 77: Suicide]** **Suicide is defined as an intentioned death, a self-inflicted death in which one makes an intentional, direct, and conscious effort to end one's life. Suicide is a very negative outcome of any menta...

**[Lesson 16]** **[Bipolar and Related Disorders II]** **[Topic 77-81]** **[Topic 77: Suicide]** **Suicide is defined as an intentioned death, a self-inflicted death in which one makes an intentional, direct, and conscious effort to end one's life. Suicide is a very negative outcome of any mental disorder, particularly depression. It is the act of killing oneself, most often as a result of depression or other mental illness. Suicide is a step taken to deal with intolerable mental anguish and pain, fear or despair that overwhelms an individual. Suicide is not officially classified as a mental disorder, although DSM-5's framers have proposed that a category called suicidal behavior disorder be studied for possible inclusion in future revisions of DSM-5.** **There could be multiple causes of suicide and it should not be attributed to any one single cause. It is not necessary that all who die by suicide have been diagnosed with a mental illness or all having a mental illness end their lives by suicide. People who experience suicidal thoughts experience tremendous emotional pain and overwhelming feelings of hopelessness, despair, and helplessness.** **Regardless of whether suicidal acts themselves represent a distinct disorder, psychological dysfunction, a breakdown of coping skills, emotional turmoil, a distorted view of life, usually plays a role in such acts. Suicidal acts may be connected to recent events or current conditions in a person's life. Although such factors may not be the basic motivation for the suicide, they can precipitate it. Common triggering factors include stressful events, mood and thought changes, alcohol and other drug use, mental disorders, and modeling.** **Suicide is not about a moral weakness or a character flaw. People who considering suicide feel as if their pain will never end and that suicide is the only way to stop their suffering. Several Factors can contribute to suicide such as:** - **Loss** - **Addictions** - **Childhood trauma or other forms of trauma** - **Depression** - **Psychotic disorder** - **Serious physical illness** - **Major life changes** **All of the above mentioned can make one feel overwhelmed and unable to cope. It is important to remember that it isn't necessarily the nature of the loss or stressor that is as important as the individual's experience of these things feeling unbearable. Any intentions, no matter how small, must not be ignored.** **[Topic 78: Etiological Factors of Bipolar and Related disorders]** **There are multiple etiological factors that are attributed to development of bipolar and related disorders. We will discuss the following in this regard:** **Neurobiological and Genetic or Chromosomal Factors:** **Bipolar disorder is among the most heritable of disorders. Much of the evidence for this comes from studies of twins.** **Adoption studies also confirm the importance of heritability in bipolar disorder. Bipolar II disorder is also highly heritable. Genetic models, however, do not explain the timing of manic symptoms. Other factors likely serve as the immediate triggers of symptoms.** **There is a huge amount of interest in finding the specific genes involved in mood disorders through molecular genetics research. Molecular biologists have identified genes associated with unipolar depression. Unipolar depression may be tied to chromosomes 1,4,9-14, 17,18,20,21,22 and X. Gene 5-HTTs located at chromosome 17 is associated with unipolar depression as 5-HTTs is responsible for production of serotonin.** **Depression is also associated with low levels of norepinephrine. Mania is associated with high levels of norepinephrine and dopamine levels. Mania and depression both are associated with low serotonin levels. Reward system in brain is believed to guide pleasure, motivation, and energy. Dopamine plays a major role in the sensitivity of the reward system in the brain, which is believed to guide pleasure, motivation, and energy in the context of opportunities to obtain rewards. Some research suggests that diminished function of the dopamine system could help explain the deficits in pleasure, motivation, and energy in major depressive disorder. Among people with bipolar disorder, several different drugs that increase dopamine levels have been found to trigger manic symptoms. One possibility is that dopamine receptors may be overly sensitive in bipolar disorder.** **Endocrinal System is also very important in this regard. Unipolar depression is also associated with high level of cortisol, released in stress by adrenal gland. Cortisol dysregulation also predicts a more severe course of mood symptoms over time. Melatonin, also called Dracula hormone as it gets released only in dark, is also associated with depression. If we talk about seasonal depression, it is usually seen in areas where there is less sunny and they see dark weather quite often. One cause may be this; they develop more melatonin which causes depression.** **[Topic 79: Psychological Factors]** **Many different psychological factors may play a role in depressive disorders. The triggers of depressive episodes in bipolar disorder appear similar to the triggers of major depressive episodes such as:** - **Losses in earlier life** - **Negative life events** - **Neuroticism** - **Negative cognitive styles etc.** - **Number of rewards received during life time** - **Social rewards (social support)** **Cognitive View** **In cognitive theories, negative thoughts and beliefs are seen as major causes of depression. Pessimistic and self-critical thoughts can torture the person with depression. If you always think negative, it causes the same emotions in your personality.** **Cognitive Triade: (Aaron Beck)** **As discussed in etiology of depressive disorder, Aron Beck talks of cognitive Triad. It consists of three forms of negative thinking towards self, towards others and towards future.** **There are also errors in thinking/ logic which cause depression. For instance, some people have an inclination to develop arbitrary inferences i.e. negative conclusion based on insufficient evidence. Selectively negative things are filtered from situation ignoring the positive one. In studies of how people process information, depression is associated with a tendency to stay focused on negative information once it is initially noticed. For example, if shown pictures of negative and positive facial expressions, those with depression tend to look at the negative pictures for longer than they look at the positive pictures. People with depression also tend to remember more negative than positive information.** **Automatic thoughts refer to images or mental activity that occurs as a response to a trigger. They are automatic and \'pop up\' or \'flash\' in your mind without conscious thought. People who develop depression usually experience these negative automatic thoughts.** **[Topic 80: Psychological Factors]** **Cognitive View** **Irrational Thinking (Albert Ellis):** **Ellis believed that a large number of psychological problems are due to patterns of irrational thought. He proposed that people interpret what is happening around them, that sometimes these interpretations can cause emotional turmoil. Ellis used to list a number of irrational beliefs that people can harbor. He later shifted from a cataloguing of specific beliefs to the more general concept of "demandingness," that is, the musts or should that people impose on themselves and on others. Thus, instead of wanting something to be a certain way, feeling disappointed, and then perhaps engaging in some behavior that might bring about the desired outcome, the person** **demands that it be so. Ellis hypothesized that it is this unrealistic, unproductive demand that creates the kind of emotional distress and behavioral dysfunction that bring people to therapists.** **Learned Helplessness (Seligman)** **Postulated by Seligman, learned helplessness refers to the perception, based on past experiences, that one has no control over one's reinforcements. People in this state typically accept that bad things will happen and that they have little control over them. They are unsuccessful in resolving issues even when there is a potential solution. This thinking leads to negative thinking, eventually causing depression.** **Attribution-Learned helplessness:** **Attributions refer to the explanations a person forms about why a stressor has occurred. The model places emphasis on two key dimensions of attributions.** 1. **Stable (permanent) versus unstable (temporary) causes** 2. **Global (relevant to many life domains) versus specific (limited to one area) causes** **Following is an example of attribution style:** ***Event: I failed my test today*** **Internal** **External** -------------- ---------------------------------------- ---------------------------------------------------------------------- -------------------------------------------------------- ------------------------------------------------------------------------------ **Stable** **Unstable** **Stable** **Unstable** **Global** **I have a problem with test anxiety** **Having argument with my sister spoiled my whole day** **Written tests are not good way to assess knowledge** **If the tests are given after vacation no one does better** **Specific** **I just have no grasp over subject** **I got confused and forgot as I could not do first question right** **The professor gives difficult tests** **The professor did not prepare test properly due to his other engagements** **People with depression attribute present loss of control to some internal cause which is both global and stable. People whose attributional style leads them to believe that negative life events are due to stable and global causes are likely to become hopeless and this hopelessness will set the stage for depression. They may feel helpless to prevent future negative outcomes.** **[Topic 81: Environmental Causes]** **Socio-environmental models focus on the role of negative life events, lack of social support, and family criticism as triggers for episodes but also consider ways in which a person with depression may elicit negative responses from others. People with less social skill and those who tend to seek excessive reassurance are at elevated risk for the development of depression. Few of the environmental factors which play a role in bipolar disorder are as follows:** - **Abuse** - **Mental stress** - **A significant loss** - **Some other traumatic event may contribute to or trigger bipolar disorder.** **It is always important to see that many people experience such bad socio-environmental challenges but not all of them develop mental disorders. There is a possibility that those with a genetic predisposition for bipolar disorder may not have noticeable symptoms until an environmental factor triggers it.** **Easy Notes for Remembering Topics 77-81** **Topic 77: Suicide** - **Definition**: Suicide is an intentional act of ending one\'s own life due to mental anguish, pain, or despair. - **Key Points**: - **Not a Mental Disorder**: Proposed for future inclusion in DSM-5 as \"Suicidal Behavior Disorder.\" - **Causes**: Depression, trauma, addiction, physical illness, life changes, and loss. - **Emotions Involved**: Hopelessness, despair, and helplessness. - **Triggering Factors**: - Stressful events - Mood and thought changes - Substance abuse - Mental disorders - Modeling (copying others\' behavior) - **Important Note**: Suicide is not due to weakness or character flaws but overwhelming pain. - **Prevention Tip**: Always take suicidal intentions seriously. **Topic 78: Etiological Factors of Bipolar Disorders** 1. **Neurobiological and Genetic Factors**: - Bipolar disorder is highly heritable (e.g., twin and adoption studies). - Genes linked to **serotonin** and **norepinephrine** imbalance: - Depression: Low norepinephrine and serotonin. - Mania: High norepinephrine and dopamine, low serotonin. - **Dopamine system sensitivity**: Explains energy and pleasure changes in mania and depression. - High **cortisol** (stress hormone) and **melatonin** (darkness hormone) linked to depression. 2. **Environmental Triggers**: - Seasonal changes (less sunlight can increase melatonin). - Life events or conditions that initiate symptoms. **Topic 79: Psychological Factors in Depression** 1. **Triggers**: - Early life losses - Negative life events - Neuroticism (emotional instability) - Negative cognitive styles - Lack of rewards and social support 2. **Cognitive View (Aaron Beck)**: - **Cognitive Triad**: - Negative views about self, others, and future. - **Thinking Errors**: - Arbitrary conclusions: Negative thoughts without evidence. - Selective attention to negative details. - **Automatic Thoughts**: Flash negative thoughts triggered automatically. **Topic 80: Psychological Theories** 1. **Irrational Thinking (Albert Ellis)**: - Emotional turmoil comes from **unrealistic demands** on oneself or others. - Example: \"I must succeed, or I am a failure.\" 2. **Learned Helplessness (Seligman)**: - **Belief**: No control over bad outcomes. - **Attributions**: - Stable (permanent) vs. Unstable (temporary) - Global (affects life broadly) vs. Specific (one area only) - Example: \"I failed the test because I\'m always bad at tests (global, stable).\" **Topic 81: Environmental Causes** 1. **Key Factors**: - Abuse, mental stress, significant loss, or trauma. - Lack of social support and family criticism. 2. **Interplay of Genetics and Environment**: - Genetic predisposition might need environmental triggers to activate bipolar disorder. 3. **Social Risk**: - Poor social skills or seeking constant reassurance can increase depression risk. **Key Reminders:** - Depression and bipolar disorder arise from a mix of biological, psychological, and environmental factors. - Early intervention, support systems, and treatment can significantly help manage these conditions.