KHA 305 Lecture Notes - Lecture 4: Hypothalamus, Basal Ganglia, Suicide Attempt
30 Jun 2018
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Clinical Psychology week 4: Mood disorders
- Changes between mood disorder criterions in DSM
oMood disorder section:
oUnipolar depressive disorder:
One pole
Depressive, negative mood
oBipolar: both ends of pole
oNow:
oUnipolar depressive disorders = depressive disorders
oBipolar disorders = bipolar and related disorders section
Major depressive disorder: MDD
- Clinically significant sadness with associated cognitive and somatic changes
oSome sort of impairment to the way they functioning due to this mood
oChanges in thinking: eg. Speed of processing
oInsomnia eg.
- Episodic disorder:
oPeriods of normal mood in between periods of depressed mood
oTypically not the case to have a constant long mood
oPeriods of depression, then when not feeling so bad, and then repeated
- If you have one depressive episode you are likely to have another
oNot everyone experiences this however
oTend to be this way however
- Criteria has changed very little over the DSM’s
oFive or more of the following within the same 2 week period
o1. Depressed mood most of the day, nearly every day
sad, depressed, down, hopeless, discouraged
o2. Markedly diminished interest or pleasure in all, or almost all,
activities most of the day, nearly every day
no longer get any enjoyment out of previously enjoyed
activities
Anhedonia: no sensation of getting pleasure form normally
pleasurable activities
o3. Significant weight loos or gain or increase/decrease in appetite
o4. Insomnia or hypersomnia nearly everyday
Middle and terminal insomnia are more common
Time during middle of sleep pattern
Terminal: wake up early and cant get back to sleep for
rest of time
Hypersomnia may also occur: excessive sleepiness
o5. Psychomotor agitation or retardation nearly everyday
Agitation: increased activity
Retardation: decreased activity
o6. Fatigue or loss of energy nearly every day
Constant tiredness, often without physical exertion
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o7. Feelings of worthlessness or excessive or inappropriate guilt nearly
every day
inadequacy
o8. Diminished ability to think, concentrate, indecisiveness, nearly
every day
o9. Recurrent thoughts of death, recurrent suicidal ideation, suicide
attempt or plan
oB. C. D. and E.
E. there has never been a manic or hypomanic episode
Past history
Even if there has only been one then this is likely to be bipolar
which needs different treatment
- Prevalence:
o14.4%
oin 12 month period: 6.6%
oOnset mean age is 30.5, but looks to be decreasing
oWomen more likely
Men lack of reporting?
Also men statistics are growing
oRelapse:
Risk of relapse is high, but lowered when successfully
complete CBT compared with medication
Lost work days = 27.2 years
Most people don’t access treatment
Suicide is distinct from depression
oSuicide is prevalent in many different disorders
oSuicide ideation: thoughts about ending life
Common in depression
And other mental health disorders
oSuicide attempt: attempt is made on life but is unsuccessful
Women attempt suicide more than men
Men often use more serious methods
oSuicide: death from a suicide attempt
Completed suicides more likely in men
More lethal means
Also many disguised as accidents: car accidents
oNon-suicidal self injury: aim is to cause harm, but not to die
Cutting is common
Very traumatic and difficult to live with and high levels of
distress
- Responsibilities of clinicians:
oAUSTRALIAN PSYCHOLOGICAL SOCIETY provides guidelines
for clinicians and researchers
oThis includes specific guidelines relating to working with clients who
are suicidal
oConfidentiality:
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Psychologists disclose confidential information obtained in the
course of their provision
There is an immediate and specified risk of harm to an
identifiable person or persons that can be averted only by
disclosing information
Responsibility to do everything you can to prevent this
oClient safety: broader
Be aware of current and ongoing signs of risks of suicide
Monitor this
If signs are present: need to assure they’re safe
Take steps to attend to immediate safety
Thorough assessment
oSafety of others:
Where suicide may harm others
- Emergency services, lifeline, beyond blue, kids helpline, present to local
emergency department
Differential diagnosis: MDD
- Bipolar 1 / Bipolar 2:
oWhen you have someone with a major depressive episode its important
to always assess for a history of mania and or hypomania
oIf the patient has had a manic/hypomanic episode it will exclude them
from a diagnosis of MDD
Persistent Depressive Disorder: dysthymia
- Depressive symptoms that last > 2 years with no period of remission
- Similar in terms of presentation, but a chronic time with no remission
- Prevalence:
oLifetime 2.5%
oNot as common but this is still considerable
- Criterion:
oDepressed mood for most of the day for more days than not, as
indicated by either subjective account or observation by others, for at
least years
oPresence while depressed of 2 or more of the following:
Poor appetite or over eating
Insomnia or hypersomnia
Low energy or fatigue
Low self esteem
Poor concentration or difficulty making decisions
Feelings of hopelessness
oDuring the period not without symptoms for more than2 months
oContinuously present for more than 2 years
oNo manic episodes ever
oCant be explained by…
oNot due to substance abuse
oDistress and impairment
- Comorbidity
oMDD and PDD often experience comorbid disorders
Anxiety
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Document Summary
Changes between mood disorder criterions in dsm: mood disorder section, unipolar depressive disorder: Depressive, negative mood: bipolar: both ends of pole, now, unipolar depressive disorders = depressive disorders, bipolar disorders = bipolar and related disorders section. If you have one depressive episode you are likely to have another: not everyone experiences this however, tend to be this way however. Criteria has changed very little over the dsm"s: five or more of the following within the same 2 week period, 1. Depressed mood most of the day, nearly every day sad, depressed, down, hopeless, discouraged: 2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day no longer get any enjoyment out of previously enjoyed activities. Anhedonia: no sensation of getting pleasure form normally pleasurable activities: 3. Significant weight loos or gain or increase/decrease in appetite: 4. Middle and terminal insomnia are more common.
