Abnormal Psychology
ABPSY - 1st Sem (p.211-p.261)
Chapter 7: MOOD DISORDERS AND SUICIDE
Note: Feelings of depression (and joy) are universal, which
makes it all the more difficult to understand disorders of mood
—disorders that canbe so incapacitating that violent suicide
may seem by far a better option than living.
> The duration of manic episode, if untreated, is
approximatelly 3-4 months.
HYPOMANIC EPISODE - a less severe version of a
manic episode that does not cause marked
impairment in social or occupational functioning and
need last only 4 days rather than a full week.
> (Hypo means “below”; thus the episode is below the
level of a manic episode.)
Note: A hypomanic episode is not in itself necessarily
problematic, but its presence does contribute
to the definition of several mood disorders.
7.1: UNDERSTANDING AND DEFINING MOOD DISORDERS
The disorders described in this chapter used to be
categorized under several general labels, such as
“depressive disorders,” “affective disorders,” or even
“depressive neuroses.”
These problems have been grouped under the heading
mood disorders - because they are characterized by
gross deviations in mood.
MAJOR DEPRESSIVE EPISODE - most commonly
diagnosed and most severe depression.
> an extremely depressed mood state that lasts at least
2 weeks and includes cognitive symptoms (such as
feeling or worthlessness and indeciveness) and
disturbed physical functions (such as altered sleeping
patterns, significant changes in appetite and weight, or a
notable loss of energy) to the point that even the
slightest activity or movement requires an overwhelming
effort.
> Most central indicators of a full major depressive
episode are the physical changes (sometimes called
somatic or vegetative symptoms) along with the
behavioral and emotional “shutdown,” as reflected by
low behavioral activation.
> The duration of a major depressive episode, if
untreated, is approximatelly 4-9 months.
People with depression show dysfunctional reward
processsing and anhedonia.
ANHEDONIA - loss of energy and inability to engage
in pleasurable activities or have any “fun.”
second fundamental state of mood disorders:
abnormally exaggerated elation, joy, or euphoria.
MANIA - individuals find extreme pleasure in every
activity; some patients compare their daily
experience of mania with a continuous sexual
orgasm.
Speech is typically rapid and may become incoherent,
because the individual is attempting to express so many
exciting ideas at once; this feature is typically referred to
as flight of ideas.
> for a manic episode require a duration of only 1 week,
less if the episode is severe enough to require
hospitalization.
THE STRUCTURES OF MOOD DISORDERS
UNIPOLAR MOOD DISORDERS - individuals who
experience either depression or mania. Their mood
remains at one “pole” of the usual depression–mania
continuum.
> Most people with a unipolar mood disorder eventually
develop depression.
BIPOLAR MOOD DISORDER - someone who alternates
between depression and mania. Traveling from one
“pole” of the depression-elation continuum to the
other and back again.
MIXED FEATURES - An individual can experience
manic symptoms but feel somewhat depressed or
anxious at the same time or be depressed with a few
symptoms of mania.
requires specifying whether a predominantly manic
or predominantly depressive episode is present and
then noting if enough symptoms of the opposite
polarity are present to meet the mixed features
criteria.
> DYSPHORIC - anxious or depressive features more
commonly than was thought, and dysphoria can be
severe.
> FLIGHT OF IDEAS - racing thougts
PREDOMINANT POLARITY - exists if one polarity occurs
during at least two-thirds of the person’s lifetime.
It is important to determine the course or temporal
patterning of the depressive or manic episodes. For
example, do they tend to recur? If they do, does the
patient recover fully for at least 2 months between
episodes (termed full remission) or only partially recover
retaining some depressive symptoms (“partial
remission”)? Do the depressive episodes alternate with
manic or hypomanic episodes or not? All these patterns
for mood disorders are important to note, since they
contribute to decisions on which diagnosis is
appropriate.
The importance of temporal course (patterns of
recurrence and remittance) makes the goals of treating
mood disorders somewhat different from those for other
psychological disorders.
> chronic - almost continuous or nonchronic.
> the two most important factors describe mood
disorders are severity and chronicity.
CLINICAL DESCRIPTION
RECURRENT - If two or more major depressive
episodes occurred and were separated by at least 2
months during which the individual was not
depressed.
> Recurrence is important in predicting the future course
of the disorder, as well as in choosing appropriate
treatments.
UNIPOLAR DEPRESSION - is often a chronic condition
that waxes and wanes over time but seldom
disappears.
> The median lifetime number of major depressive
episodes is four to seven.
> The median duration of recurrent major depressive
episodes is 4 to 5 months.
PERSISTENT DEPRESSIVE DISORDER (DYSTHYMIA)
- shares many of the symptoms of major depressive
disorder but differs in its course, but depression remains
relatively unchanged over long periods, sometimes 20 or
30 years or more.
> defined as depressed mood that continues at least 2
years, during which the patient cannot be symptom free
for more than 2 months at a time even though they may
not experience all of the symptoms of a major depressive
episode.
> more severe, higher rates of comorbidity, less
responsive to treatment, and show slower rate of
improvement over time.
Chronicity is the most important distinction in diagnosing
depression independent whether the symptom
presentation meets criteria for a major depressive
disorder.
PURE DYSTHYMIC SYNDROME - people suffering from
persistent depression with fewer symptoms;
eventually experienced a major depressive episode.
> meaning one has not met criteria for a major
depressive episode in at least the preceding 2 years,
“with persistent major depressive episode,”
DOUBLE DEPRESSiON - Individuals who have major
depressive episodes and persistent depression with
fewer symptoms. (major depressive episode)
SPECIFIERS - may or may not accompany a
depressive disorder, but when they do, they are often
helpful in determining the most effective treatment or
likely course.
Clinicians use eight basic specifiers to describe
depressive disorders.
These are (1) with psychotic features (mood-congruent
or mood-incongruent), (2) with anxious distress (mild to
severe), (3) with mixed features, (4) with melancholic
features, (5) with atypical features, (6) with catatonic
features, (7) with peripartum onset, and (8) with
seasonal pattern.
1. PSYCHOTIC FEATURES SPECIFIER - Some individuals in
the midst of a major depressive (or manic) episode may
experience psychotic symptoms, specifically
hallucinations (seeing or hearing things that aren’t
there) and delusions (strongly held but inaccurate
beliefs). Somatic (physical) delusions, believing, for
example, that their bodies are rotting internally and
deteriorating into nothingness. Some may hear voices
telling them how evil and sinful they are (auditory
hallucinations).
MOOD CONGRUENT - hallucinations and delusions are
called mood congruent because they seem directly
related to the depression.
MOOD-INCONGRUENT HALLUCINATION OR DELUSION
- depressed indivuals might have other types of
hallucinations/delusions such delusions of grandeur that
do not seem consistent with the depressed mood; may
progress to schizoprenia.
DELUSIONS OF GRANDEUR - believing that they are
supernatural or supremely gifted.
Note: Delusions of grandeur accompanying a manic
episode are mood congruent.
> Psychotic features in general are associated with a
poor response to treatment, greater impairment, and
fewer weeks with minimal symptoms, compared with
nonpsychotic depressed patients over a 10-year period.
2. ANXIOUS DISTRESS SPECIFIER - The presence and
severity of accompanying anxiety, whether in the form of
comorbid anxiety disorders (anxiety symptoms meeting
the full criteria for an anxiety disorder) or anxiety
symptoms that do not meet all the criteria for disorders.
> makes suicidal thoughts and fatal suicide attempts
more likely, and predicts a less effective outcome from
treatment.
3. MIXED FEATURES SPECIFIER - Predominantly
depressive episodes that have several (at least three)
symptoms of mania, which applies to major depressive
episodes both within major depressive disorder and
persistent depressive disorder.
4. MELANCHOLIC FEATURES SPECIFIER - applies only if the
full criteria for a major depressive episode have been
met, whether in the context of a persistent depressive
disorder or not.
> Melancholic specifiers include some of the more
severe somatic (physical) symptoms,
5. CATATONIC FEATURES SPECIFIER - can be applied to
major depressive episodes whether they occur in the
context of a persistent depressive order or not, and even
to manic episodes, although it is rare—and rarer still in
mania.
CATALEPSY - This serious condition involves an
absence of movement (a stuporous state) in which
the muscles are waxy and semirigid, so a patient’s
arms or legs remain in any position in which they are
placed.
> may also involve excessive but random or
purposeless movement.
> this response may be a common “end state”
reaction to feelings of imminent doom and is found in
many animals about to be attacked by a predator.
6. ATYPICAL FEATURES SPECIFIER - This specifier applies
to both depressive episodes, whether in the context of
persistent depressive disorder or not.
> individuals with this specifier consistently oversleep
and overeat during their depression and therefore gain
weight, leading to a higher incidence of diabetes.
> although they also have considerable anxiety, they
can react with interest or pleasure to some things, unlike
most depressed individuals.
> the atypical group also has more symptoms, more
severe symptoms, more suicide attempts, and higher
rates of comorbid disorders including alcohol use
disorder.
7. PERIPARTUM ONSET SPECIFIER - Peri means
“surrounding”—in this case, the period of time just before
and just after the birth.
> peripartum depression - giving birth
> peripartum period - pregnancy and the 6-month
period immediately following childbirth)
> postpartum depression - after childbirth
Note: The father and mother can try psychological
interventions for paternal peripaturm depression.
In general, guidelines for treating and preventing
peripartum depression include CBT and interpersonal
therapy.
BABY BLUES - minor reactions in adjustment to
childbirth, typically last a few days and occur in 40%
to 80% of women between 1 and 5 days after delivery.
> mothers may have an elevated corticotrophinreleasing hormone.
8. SEASONAL PATTERN SPECIFIER - This temporal
specifier applies to recurrent major depressive disorder
(and also to bipolar disorders). It accompanies episodes
that occur during certain seasons (e.g., winter
depression).
SEASONAL AFFECTIVE DISORDER (SAD) - These
episodes must have occurred for at least 2 years with
no evidence of nonseasonal major depressive
episodes occurring during that period of time.
Emerging evidence suggests that SAD may be related to
daily and seasonal changes in the production of
melatonin, a hormone secreted by the pineal gland.
PHASE SHIFT HYPOTHESIS - SAD is a result of phasedelayed circadian misalignment, meaning that the
patient’s circadian rhythm is misaligned with the
environmental day–night cycle. (according to this
theory yung circadian rhythm though to have
relationship with our mood.)
PHOTOTHERAPY - a current treatment, most patients
are exposed to 2 hours of bright light (2,500 lux)
immediately on awakening. If the light exposure is
effective, the patient begins to notice a lifting of mood
within 3 to 4 days and a remission of winter
depression in 1 to 2 weeks.
U-SHAPED PATTERN - such that symptoms of
depression were highest in young adults, decreased
across middle adulthood, and then increased again
in older age, with older people also experiencing an
increase in distress associated with these symptoms.
ACUTE GRIEF - the natural grieving process.
After your initial reaction to the trauma, haveexperienced
a number of depressive symptoms as well as anxiety,
emotional numbness, and denial.
> Usually, the natural grieving process has peaked
within the first 6 months, although some people grieve
for a year or longer.
INTEGRATED GRIEF - The acute grief most of us would
feel eventually evolves in which the finality of death
and its consequences are acknowledged and the
individual adjusts to the loss.
For example, the very strong yearning in complicated
grief seems to be associated with the activation of the
dopamine neurotransmitter system.
Brain-imaging studies indicate that areas of the brain
associated with close relationships and attachment are
active in grieving people, in addition to areas of the brain
associated with more general emotional responding.
OTHER DEPRESSIVE DISORDERS
Premenstrual dysphoric disorder (PMDD) and
disruptive mood dysregulation disorder, both
depressive disorders, were added to DSM-5.
PREMENSTRUAL DYSPHORIC DISORDER (PMDD)
- As one can see, a combination of physical
symptoms, severe mood swings, and anxiety are
associated with incapacitation during this period
of time.
DISRUPTIVE MOOD DYSREGULATION DISORDER
- A child’s mood is persistently negative between
severe temper outbursts.
EMIL KRAEPLIN - manic-depressive illness
BIPOLAR DISORDERS - The key identifying feature of
bipolar disorders is the tendency of manic episodes
to alternate with major depressive episodes in an
unending roller-coaster ride from the peaks of elation
to the depths of despair.
ONSET AND DURATION
BIPOLAR II DISORDER - in which major depressive
episodes alternate with hypomanic episodes rather
than full manic episodes.
> bipolar disorders begin more acutely; that is, they
develop more suddenly.
BIPOLAR I DISORDER - are the same, except the
individual experiences a full manic episode.
The high during a manic state is so pleasurable that
people may stop taking their medication during periods
of distress or discouragement in an attempt to bring on a
manic state again; this is a serious challenge to
professionals.
CYCLOTHYMIC DISORDER - A milder but more
chronic version of bipolar disorder; chronic
alternation of mood elevation and depression that
does not reach the severity of manic or major
depressive episodes.
> Individuals with cyclothymic disorder tend to be in
one mood state or the other for years with relatively few
periods of neutral (or euthymic) mood.
> This pattern must last for at least 2 years (1 year for
children and adolescents) to meet criteria for the
disorder. People with cyclothymia should be treated
because of their increased risk to develop the more sever
bipolar I or bipolar II disorder.
CHRONICALLY FLUCTUATING MOOD STATES - by
definition, substantial enough to interfere with
functioning.
There is one specifier that is unique to bipolar I and II
disorders:
RAPID-CYCLING SPECIFIER - Some people move
quickly in and out of depressive or manic episodes.
> An individual with bipolar disorder who experiences at
least four manic or depressive episodes within a year is
considered to have a rapid-cycling pattern, which
appears to be a severe variety of bipolar disorder that
does not respond well to standard treatments.
RAPID SWITCHING OR RAPID MOOD SWITCHING
- When this direct transition from one mood state to
another happens, and is particularly treatment-resistant
form of the disorder.’
ULTRA-RAPID CYCLE - lengths that only last for days
to weeks.
ULTRA-ULTRA-RAPID CYCLING - in cases where cycle
lengths are less than 24 hours.
> switches into depression occurred at night, and
switches into mania occurred at daytime, suggesting
that for patients with mood cycles of 48 hours or less, the
switch process is closely linked to circadian aspects.
> The average age of onset for bipolar I disorder is from
15 to 18 years and for bipolar II disorder from 19 and 22
years, although cases of both can begin in childhood.
> people with bipolar II disorder will progress to full
bipolar I disorder.
> found that as many as 67.5% of patients with unipolar
depression experienced some manic symptoms.
SPECTRUM - These studies raise questions about the
true distinction between unipolar depression and
bipolar disorder and suggest they may be on a
continuum.
> cyclothymia is chronic and lifelong.
> In one sample of cyclothymic patients, 60% were
female, and the age of onset was often during the
teenage years or before, with some data suggesting the
most common age of onset to be 12 to 14 years.
> disruptive mood dysregulation disorder - which can be
diagnosed only up to 12 years of age.
> As far as mania is concerned, children under the age of
9 seem to present with more irritability and emotional
swings as compared with classic manic states,
particularly irritability.
EMOTIONAL SWING - oscillating manic states that are
less distinct than in adults, may also be characteristic
of children, as are brief or rapid-cycling manic
episodes lasting only part of a day.
EQUIFINALITY - same product resulting from possibly
different causes.
FAMILIAL AND GENETIC INFLUENCES
> In family studies, we look at the prevalence of a given
disorder in the first-degree relatives of an individual
known to have the disorder (the proband).
> Twin studies, in which we examine the frequency with
which identical twins (with identical genes) have the
disorder, compared with fraternal twins, who share only
50% of their genes (as do all first-degree relatives).
“PERMISSIVE” HYPOTHESIS - when serotonin levels
are low, other neurotransmitters are “permitted” to
range more widely, become dysregulated, and
contribute to mood irregularities, including
depression.
DOPAMINE - dopamine, particularly in relationship to
manic episodes, atypical depression, or depression
with psychotic features.
DOPAMINE AGONIST L-DOPA - to produce hypomania
in bipolar patients.
HYPOTHALAMIC-PITUITARY-ADRENOCOTIRCAL AXIS
(HPA) - produces stress hormones.
> beginning in the hypothalamus and running through
the pituitary gland, which coordinates the endocrine
system.
NEUROHORMONES - are an increasingly important
focus of study in psychopathology.
CORTICOL SECTION OF THE ADRENAL GLAND - which
produces the stress hormone cortisol that completes
the HPA axis.
CORTISOL - called a stress hormone because it is
elevated during stressful life events.
DEXAMETHASONE SUPPRESSION TEST (DST) - is a
glucocorticoid that suppresses cortisol secretion in
normal participants.
ADRENAL CORTEX - secreted enough cortisol to
overwhelm the suppressive effects of
dexamethasone.
> This theory was heralded as important because it
promised the first biological laboratory test for a
psychological disorder.
HIPPOCAMPUS - individuals experiencing heightened
levels of stress hormones over a long period undergo
some shrinkage of a brain structure.
> individuals experiencing heightened levels of stress
hormones over a long period undergo some shrinkage of
a brain structure.
NEUROGENESIS - organisms ability to develop new
neurons.
GUT MICROBIOTA - which are the bacteria and other
microorganisms residing in the human intestines.
REM SLEEP - when the brain arouses, and we begin to
dream.
SLOW-WAVE SLEEP - REM activity that is more intense,
and the stages of deepest sleep.
> Most mammals are exquisitely sensitive to day
length at the latitudes at which they live, and this
“biological clock” controls eating, sleeping, and weight
changes.
ALPHA WAVES - indicate calm, positive feelings.
> depressed individuals exhibit greater right-sided
anterior activation of their brains, particularly in the
prefrontal cortex (and less left-sided activation and,
correspondingly, less alpha wave activity) than
nondepressed individuals.
BIPOLAR SPECTRUM PATIENTS - (individuals with
subthreshold swings in mood) show elevated rather
than diminished relative left-frontal EEG activity and
that this brain activity predicts the onset of a full
bipolar I disorder.
> endocrine system, sleep and circadian rhythms, and
relative activity in certain areas of the brain associated
with depression.
DIATHESIS-STESS MODEL - which describes possible
genetic and psychological vulnerabilities.
PROSPECTIVELY - to determine more accurately the
precise nature of events and their relation to
subsequent psychopathology.
RECURRENT DEPRESSION - the clear occurrence of a
severe life stress before or early in the latest episode
predicts a poorer response to treatment and a longer
time before remission.
GENE-ENVIRONMENT CORRELATION MODEL - our
genetic endowment might increase the probability
that we will experience stressful life events.
STRESS AND BIPOLAR DISORDER
> First, typically negative stressful life events trigger
depression, but a somewhat different, more positive, set
of stressful life events seems to trigger mania.
> Second, stress seems to initially trigger mania and
depression, but as the disorder progresses, these
episodes seem to develop a life of their own.
> Third, some precipitants of manic episodes seem
related to loss of sleep, as in the postpartum period.
JET LAG - disturbed circadian rhythms.
> Finally, although almost everyone who develops a
mood disorder has experienced a significant stressful
event, most people who experience such events do not
develop mood disorders.
LEARNED HELPLESSNESS THEORY OF DEPRESSION
> (1) internal, in that the individual attributes negative
events to personal failings (“it is all my fault”); (2) stable,
in that, even after a particular negative event passes, the
attribution that “additional bad things will always be my
fault” remains; and (3) global, in that the attributions
extend across a variety of issues.
> people with depression make the worst of everything;
for them, the smallest setbacks are major catastrophes.
ARBITRARY INFERENCE - is evident when a depressed
individual emphasizes the negative rather than the
positive aspects of a situation.
OVERGENERALIZATION - You are overgeneralizing
from one small remark.
DEPRESSIVE COGNITIVE TRIAD - They make cognitive
errors in thinking negatively about themselves, their
immediate world, and their future, three areas that
together.
NEGATIVE SCHEMA - an enduring negative cognitive
belief system about some aspect of life.
SELF-BLAME SCHEMA - individuals feel personally
responsible for every bad thing that happens.
NEGATIVE SELF-EVALUTION SCHEMA - they believe
they can never do anything correctly.
COGNITIVE TRIAD - the self, the world, and the future.
NEGATIVE OUTLOOK - dysfunctional attributes.
DOMAINS OF RACISIM - (structural racism, cultural
racism, and individual-level discrimination)
ACTIVATING - getting them (patient/participants)
busy doing something.
PSYCHOLOGICAL VULNERABILITY - experienced as
feelings of inadequacy for coping with the difficulties
confronting them as well as depressive cognitive
styles.
ACUTE TRYPTOPHAN DEPLETION (ATD) - had the
effect of temporarily lowering levels of serotonin.
ELECTROCONVULSIVE THERAPY (ECT) - dramatically
affect brain chemistry.
MEDICATIONS
> selective-serotonin reuptake inhibitors (SSRIs), mixed
reuptake inhibitors, tricyclic antidepressants, and
monoamine oxidase (MAO) inhibitors.
SELECTIVE-SEROTONIN REUPTAKE INHIBITORS (SSRIs)
- specifically block the presynaptic reuptake of
serotonin.
> This temporarily increases levels of serotonin at the
receptor site, but again the precise long-term
mechanism of action is unknown, although levels of
serotonin are eventually increased.
MIXED REUPTAKE INHIBITORS - seem to have
somewhat different mechanisms of neurobiological
action.
VENLAFAXINE (EFFEXOR) - blocking reuptake of
norepinephrine as well as serotonin.
> side effects remain, including nausea and sexual
dysfunction.
MONOMINE OXIDASE (MAO) INHIBITOR - they block
the enzyme MAO that breaks down such
neurotransmitters as norepinephrine and serotonin.
> MAO inhibitors are usually prescribed only when other
antidepressants are not effective.
TRYCYCLIC ANTIDEPRESSANTS - were the most widely
used treatments for depression before the
introduction of SSRIs but are now used less
commonly.
> seem to have their greatest effect by down-regulating
norepinephrine, although other neurotransmitter
systems, particularly serotonin, are also affected.
SELF-BLAME SCHEMA - individuals feel personally re
systems, particularly serotonin, are also affected.
> Side effects include blurred vision, dry mouth,
constipation, difficulty urinating, drowsiness, weight
gain (at least 13 pounds on average), and sometimes
sexual dysfunction. Trycyclics are lethal if taken in
excessive doses.
ST. JOHN’S WORT - produces few side effects and is
relatively easy to produce.
REMISSION - Because the SSRIs and other drugs
relieve symptoms of depression to some extent in
about 50% of all patients treated but eliminate
depression or come close to it in only 25% to 30% of all
patients treated.
TREATMENT-RESISTANT DEPRESSION - when
depression does not respond adequately to drug
treatment.
SEQUENCES TREATMENT ALTERNATIVE DEPRESSION
- examined whether it is useful to offer those
individuals who did notachieve remission the alternatives
of either adding a second drug or switching to a second
drug.
DEPRESSION CARE MANAGER - office of their primary
medical care doctor including encouraging
compliance with drug taking, monitoring side effects
unique to older adults, and delivering a bit of
psychotherapy was more effective than usual care
> it is recommended that drug treatment go well beyond
the termination of a depressive episode, continuing
perhaps 6 to 12 months after the episode is over, or even
longer.
APGAR SCORE - (a measure of infant health
immediately after birth that predicts IQ scores,
performance in school, as well as neurological
disability including cerebral palsy, epilepsy, and
cognitive impairment lasting for many years after
birth).
LITHUIM CARBONATE (MOOD STABILIZING DRUG) - is a
common salt widely available in the natural
environment; It is also often effective in preventing
and treating manic episodes.
> anyone with recurrent manic episodes, maintenance
on lithium or a related drug is recommended to prevent
relapse.
TRANSCRANIAL MAGNETIC STIMULATION (TMS)
- it works by placing a magnetic coil over the
individual’s head to generate a precisely localized
electromagnetic pulse.
VAGUS NERVE STIMULATION - pulses to the vagus
nerve in the neck, which, in turn, is thought to
influence neurotransmitter production in the brain
stem and limbic system.
DEEP BRAIN STIMULATION - has been used with a few
severely depressed patients. In this procedure,
electrodes are surgically implanted in the limbic
system (the emotional brain). These electrodes are
also connected to a pacemaker-like device.
COGNITIVE BEHAVIORAL APPROACH
Aaron T. Beck - founder of cognitive therapy
Myrna Weissman and Gerald Klerman - interpersonal
psychotherapy.
COGNITVE-BEHAVIORAL ANALYSIS SYSTEM OF
PSYCHOTHERAPY (CBASP) - which integrates
cognitive, behavioral, and interpersonal strategies
and focuses on problem-solving skills, particularly in
the context of important relationships.
MINDFULNESS-BASED THERAPY - therapy has been
found to be effective for treating depression and
preventing future depressive relapse and recurrence.
NEUROGENESIS - in the hippocampus, which is known
to be associated with resilience to depression.
INTERPERSONAL PSYCHOTHERAPY (IPT) - focuses on
resolving problems in existing relationships and
learning to form important new interpersonal
relationships.
INTERPERSONAL ISSUES - dealing with interpersonal
role disputes, such as marital conflict; adjusting to
the loss of a relationship, such as grief over the death
of a loved one; acquiring new relationships, such as
getting married or establishing professional
relationships; and identifying and correcting deficits
in social skills that prevent the person from initiating
or maintaining important relationships.
Therapist first job is to identify and define an
interpersonal dispute.
After helping identify the dispute, the next step is to bring
it to a resolution. First, the therapist helps the patient
determine the stage of the dispute.
1. Negotiation stage. Both partners are aware it is a
dispute, and they are trying to renegotiate it.
2. Impasse stage. The dispute smolders beneath the
surface and results in low-level resentment, but no
attempts are made to resolve it.
3. Resolution stage. The partners are taking some action,
such as divorce, separation, or recommitting to the
marriage.
INSTITUTE OF MEDICINE (IOM) delineated three types of
programs:
universal programs, which are applied to everyone;
selected interventions, which target individuals at risk
for depression because of factors such as divorce, a
family history of alcohol use disorder, and so on; and
indicated interventions, in which the individual is
already showing mild symptoms of depression
ACUTE PHASE - has an enduring effect that protects
some patients against relapse and others from
recurrence following treatment termination.
SEQUENTIAL STRATEGY - in which you start with one
treatment (maybe the one the patient prefers or the
one that’s most convenient) and then switch to the
other only if the first choice is not entirely satisfactory.
MAINTENANCE TREATMENT - to prevent relapse or
recurrence over the long term.
PERFECT ADHERENCE - should have received
maximum benefit from the drugs.
INTERPERSONAL AND SOCIAL RHYTHM THERAPY
(IPSRT) - patients receiving IPSRT survived longer
without a new manic or depressive episode
compared with patients undergoing standard,
intensive clinical management.
SUICIDE
SUICIDAL IDEATION - thinking seriously about suicide.
SUICIDAL PLANS - the formulation of a specific
method for killing oneself,
(NONFATAL) SUICIDAL ATTEMPTS - the person
survives.
THOUGHTS - a serious contemplation of the act. The
first step down the dangerous road to suicide is
thinking about it.
FORMALIZED SUICIDES - suicides that were approved
of, such as the ancient custom in Japan of hara-kiri
(lit. stomach-cut), in which individuals slit open their
stomach and another person beheaded them. The
purpose of hara-kiri, or seppuku, was to preserve
one’s honor.
> ALTRUISTIC SUICIDE - Durkheim referred to this as
altruistic suicide. Durkheim also recognized the loss of
social supports as an important provocation for suicide;
he called this egoistic suicide.
ANOMIC SUICIDES - are the result of marked
disruptions, such as the sudden loss of a highprestige job.
FATALISTIC SUICIDES - result from a loss of control
over one’s own destiny.
Sigmund Freud believed that suicide (and
depression, to some extent) indicated unconscious
hostility directed inward to the self rather than outward to
the person or situation causing the anger.
PSYCHOLOGICAL AUTOSPY - The psychological profile
of the person who died by suicide is reconstructed
through extensive interviews with friends and family
members who are likely to know what the individual
was thinking and doing in the period before death.
low levels of serotonin are associated with impulsivity,
instability, and the tendency to over-react to situations.
HOPELESSNESS - predicts suicide among individuals
whose primary mental health problem is not
depression.
INTERPERSONAL THEORY OF SUICIDE - cites a
perception of oneself as a burden on others and a
diminished sense of belonging as powerful predictors
of hopelessness and subsequently suicide.
SENSATION-SEEKING - predicts teenage suicidal
behavior as well, above and beyond its relationship
with depression and substance use.
BORDERLINE PERSOALITY DISORDER
- Individuals with this disorder, known for making
manipulative and impulsive suicidal gestures without
necessarily wanting to destroy themselves, sometimes
kill themselves by mistake in as many as 10% of the
cases.
WERTHER EFFECT - Suicides as imitations of other
suicides.
PAPAGENO EFFECT - However, other media content
can be associated with a decrease in suicide.
STROOP TEST - people who demonstrated an implicit
association between the words death/suicide and
self, even if they weren’t aware of it, were six times
more likely to make a suicide attempt in the next 6
months than those without this specific association.
The clinician must assess for:
(1) suicidal desire (ideation, hopelessness,
burdensomeness, feeling trapped); (2) suicidal
capability (past attempts, high anxiety and/or rage,
available means); and (3) suicidal intent (available
plan,expressed intent to die, preparatory behavior).
NO SUICIDE CONTRACT - includes a promise not to do
anything remotely connected with suicide without
contacting the mental health professional first.