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Bipolar I Disorder
requires at least one manic episode, the episode must last for at least 1 week, be present most of the day nearly every day, and include at least three characteristic symptoms (inflated self-esteem or grandiosity, decreased need for sleep, excessive talkativeness, flight of ideas)
Must also require symptoms to cause marked impairment in social or occupational functioning, require hospitalization to avoid harm to self or others, or include psychotic features.
May include one or more episodes of hypomania or major depression.
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Bipolar - associated features
anxiety and substance use
lifetime risk for completed suicide is about 15 times the risk of the general population
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Bipolar - What is the average age for first episode?
18
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Bipolar II Disorder
requires at least one hypomanic episode lasting at least 4 consecutive days and one major depressive episode
The elevated, expansive, or irritable mood (hypomania) must involve at least three characteristic symptoms that are also associated with a manic episode but are not severe enough to cause marked impairment in social or occupational functioning or require hospitalization
A major depressive episode last for at least 2 weeks and involves five or more characteristic symptoms, at least of which must be a depressed mood or a loss of interest or pleasure in all or almost all activities
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Cyclothymic Disorder
characterized by numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic episode and numerous periods with depressive symptoms that do not meet criteria for a major depressive episode and that cause significant distress or impaired functioning.
Symptoms last for at least 2 years in adults and 1 year in children and adolescents and are present for at least half the time with individual not being symptoms free for more than 2 months at a time.
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A diagnosis of Bipolar I Disorder requires the presence of at least one manic episode that last for at least ________, while the diagnosis of Bipolar II Disorder requires at least one major depressive episode and one _________ episode
one week
hypomanic
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Of the psychiatric disorders, Bipolar Disorder has most consistently been linked to ________ factors.
genetic
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Treatment for Bipolar Disorder often includes ________, which not only reduces manic symptoms but also levels out mood swings; or. for those who do not respond to this drug, an ___________ drug such as carbamazepine or divalpoex sodium may be effective
lithium
anti-seizure
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A diagnosis of Cyclothymic Disorder requires a duration of symptoms of at least _______ in adults and ________ in children and adolescents.
2 years
1 year
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Disruptive Mood Dysregulation Disorder
Diagnosed when:
a) severe recurrent temper outbursts manifested verbally and/or behaviorally that are grossly out of proportion in intensity or duration to the situation or provocation
b) a chronic, persistently irritable or angry mood between temper outbursts on most days.
Symptoms persist for 12 months and are exhibited in at least two or three settings, and temper outbursts are inconsistent with the developmental level and occur, on average, at least 3 times each week.
must be at least 6 and before 18 years old, and the age of onset must be before 10
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Major Depressive Disorder
requires the presence of at least 5 symptoms nearly every day for at least 2 weeks, with at least one symptom being depressed mood or a loss of interest or pleasure.
Symptoms are: depressed mood (depressed or irritable mood for children); markedly diminished interest or pleasure in most or all activities; significant weight loss when not dieting, weight gain, or a decrease or increase in appetite; insomnia or hypersomnia; psychomotor agitation or retardation; fatigue or loss of energy; feelings of worthlessness or excessive guilt; diminished ability to think or concentrate; recurrent thoughts of death, recurrent suicidal ideation, or suicide attempt.
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What is the Peripartum specifier for MDD, BPI, and BPII?
when the onset of symptoms is during pregnancy or within four weeks of post partum.
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Major Depressive Disorder - Associated Features
Sleep abnormalities including continuity disturbances (early morning waking), reduced stage 3 and 4 (slow wave) sleep, decreased REM latency (earlier onset of REM sleep), and an increased duration of REM sleep early in night.
60% experience anxiety - linked to more severe depression and less favorable outcomes
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Major Depressive Disorder - peak age of onset
mid 20's
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Major Depressive Disorder - concordance rates for monozygotic and dizygotic twins
.50
.20
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Major Depressive Disorder - behavioral theory of depression
based on the principles of operant conditioning.
attributes the disorder to a low rate of response-contingent reinforcement for social and other behaviors, which results in extinction of those behaviors as well as in pessimism, low self-esteem, social isolation, and other features of depression that tend to reduce the likelihood of positive reinforcement in the future.
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Major Depressive Disorder - learned helplessness model
the result of prior exposure to uncontrollable negative events couples with a tendency to attribute those events to internal, stable, and global factors.
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Major Depressive Disorder - depressive cognitive triad
From Beck, views depression as being related to negative, illogical self-statements about onself, the world, and future
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Persistent Depressive Disorder (dysthymia)
characterized by a depressed mood (or in children and adolescents, a depressed or irritable mood) on most days for at least 2 years is adults and 1 year in children as indicated by the presence of at least two of the following: low self-esteem; poor concentration or difficulty making decisions; feelings of hopelessness.
cannot be symptoms free for more than 2 months
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Premenstrual Dysphoric Disorder
For more menstrual cycles, the presence of at least 5 characteristic symptoms during the week before the onset of menses with an improvement in symptoms within a few days after the onset of menses and the absence or presence of minimal symptoms during the week postmenses.
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A diagnosis of Major Depressive Disorder requires the presence of at least _______ symptoms of a major depressive episode with at least one symptom being either a depressed mood or _________.
5
loss of interest or pleasure
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The peripartum onset specifier applies when the onset of symptoms is during pregnancy or with ______ weeks postpartum; and the ________ specifier applies when there is a temporal relationship between the onset of symptoms and a particular time of year. Symptoms of the latter include hypersomnia, increased appetite and weight gain, and a craving for __________.
4
seasonal pattern
carbohydrates
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In children, the rates of MDD are qual for boys and girls; but, in adults the rate for women is about ________ the rate for men
twice
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Symptoms vary somewhat with age. In children, ___________ complaints and irritability are common; among older adults, cognitive impairments may resemble those seen in _________
somatic
Major or Mild Neurocognitive Disorder
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Evidence for a genetic contribution to MDD is provided by studies showing that the disorder is ________ times more common among first-degree biological relatives of people with the disorder than among people in the general population
1.5 - 3
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According to the ________ hypothesis, depression is due to a deficiency of norepinephrine. Lewinson's behavioral theory links depression to a low rate of __________, while a recent version of the learned helplessness model identifies ________ as the proximal and sufficient cause. Beck's cognitive theory describes depression involving a "cognitive triad" characterized by negative beliefs about __________.
catecholamine
response-contingent reinforcement
hopelessness
self, world, future
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Treatment for MDD often includes antidepressants. The TCAs are most effective for "classic" depression that include _______symptoms and more sever symptoms in the morning; while the _________ are considered the first-line drug treatment and produce fewer undesirable side effects than the TCAs.
vegetative
SSRI
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A diagnosis of Persistent Depressive Disorder (Dysthymia) requires the presence of a depressed mood for at least 2 years in adults or ______ in children and adolscents.
1 year
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Risk factors for suicide - Age - combined male and female and separate male and female
combined: 45-54
male: 75+
female: 45-54
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Risk factors for suicide - gender
4x as many males than females complete suicide
females attempt 2-3 times more than males
males are more successful because they use more lethal methods
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Risk factors for suicide - race/ethinicity
whites are the highest for most age groups
exception for American Indians/Alaskan Natives 15-34 with 2.5 times higher than national average
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Risk factors for suicide - marital status
divorced, separated, and widowed people have the highest rates
lowest rates among married people
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Risk factors for suicide - previous attempts as a risk factor
60-80% of people who complete suicide have at least one previous attempt and 80% give a definite warning of intentions
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Risk factors for suicide - early warning signs
threatening self-harm or suicide
writing or talking about death or suicide
seeking means to commit suicide
making preparations for dying such as preparing a will, giving away possessions, or saying goodbye to loved ones
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Risk factors for suicide - Life stress risk factors
failure at work or school
rejection by a loved one
living alone
absence of social support and social ties
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Risk factors for suicide - Most common psychiatric disorders
MDD and Bipolar
In adolescents risk dramatically increases with depression co-occurs with conduct disorder, substance use disorder, or ADHD
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Until recently, the highest suicide rate has been for individuals ages 65 and older but in 2004, the rates for individuals ages ________ began to surpass the rates of the older age group. In terms of gender, _________ are more likely to commit suicide while ________ are more likely to attempt suicide. With regard to race/ethnicity, Whites have the highest rate of suicide with the exception that American Indians/Alaskan Natives ages _________ have the highest rate
45-54
males
females
15-34
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Of the psychiatric disorders, MDD and ________ are most often linked to suicide; and when suicide is associated with depression, it is most likely to occur within ______ months after depressive symptoms start to improve.
Bipolar
3
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Beck found __________ to be a better predictor of suicide than the intensity of depressive symptoms
hopelessness
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In terms of biological predictors, a low level of the neurotransmitter ________ has been linked to suicide and violent suicide attempts
serotonin
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The choice of intervention for a client who is at risk for suicide depends on several factors including the client's level of risk and preferences. _________ is appropriate for a client who has just attempted suicide or is believed to be at imminent risk, while ______ may be the best approach when the client is at moderate risk as evidenced by a lack of access to lethal means, the presence of adequate social support and fair to good problem-solving skills, and willingness to comply with treatment recommendations.
hospitalization
Outpatient crisis intervention
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Lewinsohn's (1974) behavioral model attributes depression to a low rate of response-contingent reinforcement for adaptive behaviors, which causes:
A.an increase in those behaviors.
B.a decrease in those behaviors.
C.extinction of those behaviors.
D.behavioral inhibition.
C
According to Lewinsohn's behavioral theory, depression is the result of a low rate of response-contingent reinforcement for adaptive behaviors, which causes extinction of those behaviors as well as pessimism, low self-esteem, social isolation, and dysphoria that, in turn, are reinforced by the sympathy and concern of others.
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Anita A., age 16, is brought to therapy by her mother, who says the girl has recently become "another person." She says that Anita used to be friendly and cooperative and popular at school. However, for the last few weeks, Anita has been constantly irritable, is not doing her homework, has failed several tests, and has been getting very little sleep. When the therapist interviews Anita, her speech is loud and rapid, and she is easily distracted. He learns that she has started drinking alcohol nearly every day and has engaged in high-risk sexual behavior. The most likely diagnosis for Anita is:
A.Conduct Disorder.
B.ADHD.
C.Bipolar II Disorder.
D.Bipolar I Disorder.
D
The nature and sudden onset of Anita's symptoms (e.g., irritability, substance use, school truancy and failure, and loud, rapid speech) are consistent with a manic episode. Therefore, the most likely diagnosis for Anita is Bipolar I Disorder.
Answer A: The diagnosis of Conduct Disorder requires a persistent pattern of behavior that violates the basic rights of others and/or age-appropriate social norms and involves at least three characteristic symptoms from four categories: aggression to people and animals; destruction of property; deceitfulness or theft; and serious violation of rules.
Answer B: The sudden onset of Anita's symptoms and the presence of mood symptoms are more suggestive of Bipolar Disorder than ADHD.
Answer C: The diagnosis of Bipolar II Disorder requires at least one major depressive episode and one hypomanic episode. Anita's symptoms are more consistent with a manic episode.
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Which of the following is true about the prevalence of Major Depressive Disorder in adolescents and adults?
A.The rates for males and females are about equal.
B.The rate for females is one and one-half to three times the rate for males.
C.The rate for males is about one and one-half to three times the rate for females.
D.The rate for females is four to five times the rate for males.
B
Prior to puberty, the rates of Major Depressive Disorder are about equal for males and females; but, beginning in adolescence, the rate for females becomes one and one-half to three times the rate for males.
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Researchers have linked abnormal levels of melatonin to which of the following?
A.Bipolar I Disorder
B.Major Depressive Disorder with seasonal pattern
C.Major Depressive Disorder with peripartum onset
D.Cyclothymic Disorder
B
Melatonin is a hormone released by the pineal gland and is involved in the regulation of circadian rhythms. One explanation for the symptoms of Major Depressive Disorder with seasonal pattern (also known as seasonal affective disorder) is that it is related to elevated levels of melatonin.
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According to the DSM-5, the 12-month prevalence rate for Bipolar I Disorder in the United States is _____ percent.
A.0.6
B.1.8
C.3.2
D.5
A
The DSM-5 reports the 12-month prevalence rate for Bipolar I Disorder in the United States as 0.6% and the prevalence rate across 11 countries as ranging from 0.0% to 0.6%.
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A 63-year-old college professor exhibits impairments in memory and other cognitive functions and a depressed mood. Which of the following would suggest that his symptoms are more likely due to "pseudodementia" than to a Major or Mild Neurocognitive Disorder?
A.The onset of the man's symptoms was insidious.
B.The man exaggerates his cognitive deficits and seems overly concerned about them.
C.The man has marked deficits in both recognition and recall memory.
D.The man exhibits greater impairment in declarative memory than in procedural memory.
B
The term pseudodementia is sometimes used to describe Major Depressive Disorder when it involves apathy and prominent cognitive symptoms (e.g., memory loss, impaired concentration, distractibility). A distinguishing feature is that people with pseudodementia are likely to exaggerate their cognitive problems, while those with a Major or Mild Neurocognitive Disorder tend to deny or minimize them.
Answers A and C: An insidious onset of symptoms and deficits in both recognition and recall are characteristic of Neurocognitive Disorder.
Answer D: In contrast, people with pseudodementia tend to have greater impairment in procedural than declarative memory.
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Which of the following is not a symptom of Persistent Depressive Disorder?
A.Poor appetite
B.Overeating
C.Insomnia
D.Psychomotor agitation
D
A diagnosis of Persistent Depressive Disorder involves a depressed mood on most days for at least two years in adults or one year in children and adolescents. The diagnosis requires the presence of at least two of the following symptoms: poor appetite or overeating; insomnia or hypersomnia; low energy or fatigue; low self-esteem; impaired concentration or decision making; and feelings of hopelessness. Psychomotor agitation is a symptom of Major Depressive Disorder, but not of Persistent Depressive Disorder.
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