Which medical condition may exist when a patient displays mild symptoms of mania Quizlet

The person shows markedly elevated, euphoric, or expansive mood, often interrupted by occasional outbursts of intense irritability or even violence - particularly when others refuse to go along with the manic person's wishes and schemes.

These extreme moods must persist for at least a week for this diagnosis to be made.

In addition, three or four additional symptoms must occur in the same time period, ranging from behavioural
such as a:

* notable increase in goal-directed activity
* pleasure seeking and loosening of personal and cultural inhibitions such as in multiple sexual, political, or religious activities
* Mental symptoms where self-esteem becomes grossly inflated and mental activity may speed up ( such as lights of ideas, or racing thoughts, more talkative, distractibility),
*physical symptoms such as decreased need for sleep or psychomotor agitation.

Features must be significant enough to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalisation to prevent harm to self or others.

This is when a person experiences abnormally elevated, expansive, irritable mood for at least 4 days.

In addition, the individual must also have at least three other symptoms similar to those involved in mania but to a lesser degree ( inflated sense of self-esteem, the decreased need for sleep, flights of ideas, pressured speech etc.).

Although the symptoms listed are the same for manic and hypomanic episodes, there is much less impairment in social and occupational functioning in hypomania, and hospitalization is not required.

Research suggests that mild mood disorders are on the same continuum as the more severe disorders. The differences, however, come chiefly in the form of degree, not in kind.

Happens after the birth of a child and can have an adverse effect on child outcomes. In the past, it was thought that postpartum major depression was relatively common, but recent studies have shown that only postpartum blues is very common.

Symptoms of postpartum blues usually comprise of changeable mood, crying easily, sadness, and irritability, often liberally intermixed with happy feelings. Symptoms occur as many as 50 to 70 % of women within ten days of the birth of their child. And usually, subside on their own.

Hypomanic symptoms, intermixed with depression-like symptoms, have also been implicated in postpartum blues.

major depression in women occurs no more frequently in the postpartum period that would be expected in women of the same age and socioeconomic status who have not just given birth.

There is a greater likelihood of developing major depression after the postpartum blues - especially if it is severe.

Hormonal readjustment & alternations may play a role in postpartum blues and depression, although evidence is mixed. Psychological components and social components may also contribute, especially if the mother had a lack of social support or difficult adjusting to the new responsibilities.

Depressive disorders are usually time-limited. The average duration of an untreated episode is about 6 to 9 months

Certain predictors such as financial difficulties and severe stressful life events, as well as a genetic risk, point to a longer time before spontaneous remission of Symptoms.

Symptoms that do not remit for over two years diagnose as chronic major depressive disorder. This is been associated the serious childhood family problems and anxious personality in children.

Although most depressive episode remit, usually after two months, depressive episodes often reoccur at some future point.

In recent years, recurrence has been distinguished from relapse.

Relapse: referring to the return of symptoms within a fairly short time. This situation probably reflects the fact that the underlying episode a depression has not yet run its course.

Relapse can occur when pharmacotherapy is terminated prematurely - after symptoms have remitted but before the underlying episode is really over.

Recurrence: Recently reoccurrence of major depression was estimated at 40%-50%, Although the time period before a recurrence is highly variable.

In addition to these obvious emotional symptoms, for a recurrent diagnosis, he or she must show the presence of two or more major depressive episodes as indicated above, with least 2 consecutive months between.

The probability of recurrence increases with the number of prior episodes, and when the person has comorbid disorders.

Symptoms still presented themselves between episodes. Moreover, people with some residual symptoms, or with significant psychological impairment, following an episode, are even more likely to have recurrences and those whose symptoms remit company.

Genetic influences: family studies have shown that the surveillance of mood disorders is approximately 2 to 3 times higher among blood relatives of persons with clinically diagnosed unipolar depression than in the population at large. Twin studies also suggest a moderate genetic contribution to unipolar depression. One study found that's identical co-twins of a twin with unipolar major depression are about twice as likely to develop major depression as are fraternal co-twins. About 31 to 42% of the variance in liability to major depression is due to genetic influence. The estimate is substantially higher for more severe, early-onset and recurrent depression. Non-shared environmental influence contribute even more variance in the liability to most forms of major depression over genetic factors. Taken together, the resultsFrom family and twin studies make a strong case for moderate genetic contributions to the causal patterns unipolar major depression, although not as large as genetic contributions for bipolar disorder.

Genetic contributions to Milder but chronic forms of unipolar depression, such as dysthymia, is very slim. This is due to lack of research. However, it seems probable that no genetic contribution because of it strong link to elevated levels of the personality traits neuroticism, which is moderately hereditable.

Attempt to identify specific genes have not been successful, however, the serotonin transporter gene involved in transmission and reuptake serotonin - when key Nero transmitter in depression - is a candidate. There are two different kinds of versions or alleles involved - the short allele and the long allele, and people have two short alleles, too long alleles, or one of each. Having too short alleles make predisposes a person to depression relative to a person two long alleles. But work on this issue has provided mixed results. Studies testing of its genotype-environment interaction involving these two alleles of the serotonin transporter gene reported that individual who possessed genotype with the two short alleles were twice as likely to develop a major depressive episode following for or more stressful life events in the past five years as those who possess the genotype with the two long alleles and had experienced four or more stressful event. They also found that those found with the short alleles and had more severe maltreatment as children were also twice as likely to develop a major depressive episode than those with two long alleles who also has severe mistreatment and those with two short alleles who had not been mistreated.

These findings strongly support a diathesis-stress model . Other qualitative reviews have demonstrated that the Gene-environment is robust if the steady use sensitive interview base measures of Life stress. Such results suggest that the Search for candidate genes that are likely to be involved in major depression is likely to be much more fruitful if researchers also test for genotype-environment interactions

A large body of evidence suggests the various biological therapies that are often used to treat severe mood disorders - such as electroconvulsive therapy and antidepressant medications - affect the concentration for the activity of neurotransmitters at the synapse. These early findings encourage the development of neurochemical theories.

Early attention in the 1960s and 70s focused primarily on two neurotransmitters of the monoamine class, norepinephrine and serotonin, because researchers observe that antidepressant medications Seem to have the effect of increasing these Nero transmitters availability at synaptic junctions. This observation lead to the once influential monoamine theory of depression that believed depression was at least sometimes due to an absolute or relative depletion of one or both of these neurotransmitters at important receptor sites in the brain.

Collectively, senior transmitters are now known to be involved in the regulation of behavioral activity, Stress, emotional expression, and vegetative functions including appetite sleep and arousal - all of which are disturbed in mood disorders.

However by 1980 it was clear no such straightforward mechanism could possibly be responsible for causing depression. Some studies found The opposite of what is predicted in the monoamine hypothesis, showing a net increase in norepinephrine activity. Moreover, only a minority of patients with depression have lower serotonin activitiy, and these tend to be patient with high levels of suicidal ideation and behavior. Finally, even though short-term and immediate effects of antidepressant drugs increase the availability of norepinephrine and serotonin Thomas long-term clinical effects do not emerge until 2 to 4 weeks later when neurotransmitter levels may have normalized.

More recent research also suggests that dopamine dysfunction plays a significant role in at least some form of depression, including depression with atypical features and bipolar depression. Because dopamine is so prominently involved in the experience of pleasure and reward, such findings are keeping with the prominence of anhedonia, the ability to experience pleasure, which is such an important symptom of depression.

Unfortunately, the Early monoamine theory has not been replaced by a compelling alternative. Research for the past 20 to 25 years has focused on complex interactions and neurotransmitters and how they affect Cellular functioning. Other integrated theories have been proposed including a role for neurotransmitters as they interact with others disturbed hormonal and neurophysiological patterns and biological rhythms. One interesting focusIs and how these different neurobiological systems can promote resilience in the face of major stress, which may help explain why only a subset of people undergoing major stressors developed depression.

Neuropsychological research has followed up on earlier findings that damage to the left but not the right anterior prefrontal cortex often leads to depression. This leads to the idea that depression in people without brain damage may nonetheless be linked to lower levels of brain activity in the same region. Electroencephalographic (EEG) activity supports this idea showing asymmetry inactivity of the two sides of the prefrontal regions of the brain. People with depression shows relatively low activity in the left hemisphere in these regions and relatively high activity in the right hemisphere. PET Neuroimaging techniques have shown similar reports. Patients in remission show the same pattern, as do children at the risk for depression. These findings have seemed to hold promise as a way of identifying a person's risk for both an and initial episode and recurrent episodes.

A recent study found that left frontal asymmetry in never-depressed individuals predicted the onset of major and minor depressive episodes over a three-year period. The relatively lower activity on the left side of the prefrontal cortex and depression is thought to be related to symptoms of reduced positive affect and approach behaviors to rewarding stimuli, and increase right side activity is thought to underlie increased anxiety symptoms and increase negative affect associated with increased vigilance for threatening information.

Abnormalities have also been detected and several other Brain areas. Regions of the prefrontal cortex, Including the orbital prefrontal cortex, which is involved in responsivity to reward, Shows decreased volume in individuals with recurrent depression relative to normal controls. lower levels of activity in the dorsolateral prefrontal cortex, which are associated with decreased cognitive control have also been observed in individuals with depression compared to controls. Another area involved is the hippocampus, which is critical to learning and memory and regulation of adrenocorticotropic hormone.

Prolonged depression often leads to decreased hippocampal volume, At least an older people with depression, which could be due to cell atrophy or death. Evidence of hippocampal decrease involved in a never-depressed individual who is high risk for depression suggests that reductions in hippocampal volume may proceed the onset of depression.

Another area is the anterior cingulate cortex, which shows decrease volume and abnormally low levels of activation in patients with depression. This area is involved in selective attention, which is important in prioritizing the most important information available, and therefore in self-regulation and adaptability.

Finally, the amygdala, which is involved in the perception of threats and direct attention, tends to show increased activation in individuals with depression, which may be related to other biased attention to negative emotional information.

Stressful life events in psychological services involved in the onset of psychological stressors are known to be involved in the onset variety of disorders, but nowhere has the role been more carefully studied in the case of Unipolar major depression.

Most episodic stressful life events involved in precipitating depression involved loss of a loved one, serious threats to import close relationships or occupation, or severe economical for serious health problems.

Separation through death or divorce is highly associated depression. This is also the case with anxiety disorder. Losses involving humiliation Force stress of being a caregiver it's also associated with Major depression and anxiety disorder.

I'm important distinction has been made between stressful life events that are independent of the person's behavior and personality, and events that have been at least partly generated by the depressed person's behavior or personality. For example, people with depression sometimes generate stressful life events through their poor interpersonal problem-solving which is often associated with depression. Support problem-solving in turn leads to higher levels of interpersonal stress, which in turn leads to further symptoms of depression. Failing to keep up with routine tasks such as paying bills is another example wich may lead to a variety of troubles.

Dependent life events play an even stronger role in the onset of major depression. Research on stress and the onset of depression is complicated by the fact that people with depression have a distinctly negative view of himself and the world around. Thus, their perceptions of stress may result from the cognitive symptoms of their disorder rather than cause their disorder. That is, their pessimistic outlook may lead them to evaluate events as stressful that an independent evaluator would not. Researchers have therefore developed more sophisticated interview-based measures of life stress that do not rely on the depressed person's self-report how stressful an event is and that take into account the biographical context of a person's life.

Trained independent raters evaluate what the impact of a particular event would be expected to be for an average person, and the person subjective evaluations of stress are not reported or taken into Account in the rating of impact.

Conclusions derived from studies using peace sophisticated interview techniques are more reliable and valid in predicting depressive episode. Several recent studies using these measures show that several stressful life events play a causal role in about 20 - 50% of cases. Moreover, people with depression who have experienced a stressful life event tend to show more severe depressive symptoms and those who have not experienced a stressful life event. This is a much stronger relationship with people who are having their first onset been those undergoing recurrent episodes. 70% of people with the first onset of depression had a recent major stressful life event.

Personality and cognitive diathesis. Neuroticism is the primary personality variable that serves as a vulnerability factor for depression. Neuroticism, or negative affectivity, involves temperamental sensitivity to negative stimulus. People with high levels of the trait are prone to experiencing a broad range of negative moods. neuroticism also predicts the occurrence of more stressful life events, and is associated with a worse diagnosis for complete recovery from depression. Some researchers also attribute sex differences in depression to sex differences in neuroticism. High levels of introversion may also serve as vulnerability factors for depression. PositiveAffectivity involves a disposition to feel joy, energetic, proud, enthusiastic and confident. People low on this disposition feel the opposite. The cognitive diathesis that have been studied for depression generally focus on particular negative patterns of thinking semi people who are prone to depression more likely to become depressed when faced one or a more stressful life events. For example, people who attribute negative events to internal, stable, and global causes may be more prone to becoming depressed than people who viewed the same event with external, unstable and specific causes.

Beck hypothesized that the cognitive symptoms of depression often precedes and cause the effective or mood symptoms rather than vice versa. For example, if you think that you are a failure, it would not be surprising for those thoughts to lead to a depressive mood. Beck's theory, a Diathesis-stress theory in which negative cognitions are central, has become more elaborate over the years.

First, there are the underlying dysfunctional beliefs, known as depressogenic schemas, which are rigid, Extreme, and counterproductive. An example of this is "if everyone doesn't love me, then my life Is worthless". According to cognitive theory, such a Belief would predispose a person holding it to develop depression if he or she perceived social rejection. Alternatively, A person with the dysfunctional belif, "if I'm not perfectly successful, and I am nobody" would be vulnerable to developing negative thoughts and depressed affect if she or he felt like a failure. Beck did not maintain that simply having beliefs was sufficient to make someone depressed, he's dysfunctional beliefs needed to be activated by the occurrence as some form of stress. These depression producing Believes Are thought to develop during childhood and adolesce as a function of one's negative experiences with their parents and significant others, and thought to serve as the underlying diathesis to developing depression.

Although they may lie dormant for years, when dysfunctional beliefs are activated by current stressors they tend to fuel the current thinking pattern creating a pattern of negative automatic thoughts. These pessimistic predictions tend to center on three themes call the negative cognitive triad.

1) negative thoughts about the self ( I'm worthless)
2) negative thoughts about one's experiences and the surrounding world ( no one loves me)
3) negative thoughts about one's future ( things will always be this way)

He also postulated that's a negative cognitive triad tends to be maintained by a variety of negative cognitive biases or errors. Each of these involves the biased processing of negative self-relevant information. these include: 1) all or nothing reasoning with The tendency to think in extremes, 2) selective abstraction the tendency to focus On one negative detail of the situation while ignoring other elements, and 3) arbitrary inference I'm jumping to conclusions based on minimal or no evidence. He defines the act of making an arbitrary inference as the process of drawing a conclusion without sufficient evidence, or without any evidence at all.

If the content of your thoughts regarding your views of yourself, Your world, and your future it's already negative, and you tend to minimalize the good things that happen, those negative thoughts are not likely to disappear. Each of these components the Cognitive theory serves to reinforce the others and can produce other symptoms of depression.

Over the past 35 years and enormous amount of research has been conducted to test this theory. It has been well supported as a descriptive theory. However, More recent research has shown that stressors are not necessary to activate the latent depressive schemas between episodes. Simply inducing a depressive mood ( sad music) in an individual who was previously depressed is generally sufficient to activate latent depressogenic schemas.

There is also considerable evidence for certain cognitive biases for negative self relevance information and depression. People with depression show better recall of negative information and negative autobiographical memory. In addition people with depression more likely to draw negative a conclusion, it'll be on the information presented in the scenario and underestimate the positive feedback you receive. It is easy to see how if one is already depressed call remembering primarily the death thing that happened is likely to maintain the depression.

Research confirming the causal hypothesis is mixed only some studies have found that dysfunctional beliefs in Interaction with stressful life events predict deppression. Little evidence supports that interaction has predictive value Beyond that afforded by knowing a prior history of a person's depressive episode. Because of the inconsistencies in results across studies, more research is still needed to fully assess the causal effects cognitive theory of depression.

Martin Seligman fist proposed that the laboratory phenomenon of learned helplessness might provide useful animal model for depression.

In 1960 he noted that Laboratory dog who were first exposed to uncontrollable shocks later in a passive and helpless manner when in a situation where they could control the shocks. In contrast, animals first expose to equal amount of controllable shock had no trouble learning to control the shocks.

Learned helplessness hypotheses were developed to explain these effects. It states that when animals or humans find that they have no control over aversive events, they may learn they are helpless, which makes them unmotivated to try to respond in the future. Instead the exhibits passivity and even depressive symptoms. Subsequent research demonstrated that helpless animals also show other depressive symptoms as lower level of aggression, Loss of appetite and weight, and changes in monoamine neurotransmitter levels.

After demonstrating that this also occurs in humans, he went on to propose that learned helplessness may underlie some types of depression. People undergoing stressful life event over which they have little or no control my develop a syndrome like the helplessness seen in animals.

Major reforms in helplessness theory address some of the complexities of what humans do when faced with uncontrollable events. In particular, Abramson proposed that when people are exposed to uncontrollable negative events, they ask themselves why, and the kinds of attributes are in turn, central to whether they become depressed. Investigators proposed three critical dimensions on which attributions are made: internal and external, Global and specific, and stable and unstable. Pessimistic Attribution for a negative event is an internal stable and global one. People who have a relatively stable and consistent pessimistic Attributional style have a vulnerability for depression when faced with an uncontrollable negative my event. This seems to develop through social Learning.

This led to a great deal of new research. Many studies demonstrated that depressed people do indeed have this kind of pessimistic attributional style, but that of course does not mean that pessimistic attribution style plays a causal role. The helplessness theory has been used to explain sex differences in depression. By virtue of their roles in society, Women are more prone to experiencing a sense of lack of control over negative life events. These feelings might stem from poverty, Discrimination leading to employment or underemployment, imbalance of power, high rates sexual and physical abuse, Roll overload, and less perceived control over traits that men value when choosing a long-term mate. There is at least some evidence that each of these conditions is associated with higher than expected rate of depression, but whether the effects involve a sense of helplessness has not yet been established.

Combining the neuroticism theory With helplessness theory, it is important to note that there is evidence that People who are high on neuroticism I'm more sensitive to the effect of adversity relative to those low on the scale of neuroticism. Given that women maintain higher levels of neuroticism and the experiencing more uncontrollable stress, the increased prevalence of depression in women becomes less surprising.

Factors include:

1) Lack of social support and social skills deficits. Women without a close relationship we're more likely than those with at least one close confidant to become depressed after one serious severely stressful event.

2) Behavior of an individual who is often depressed places others in the position of providing sympathy, Support, and care. However, such positive reinforcement does not necessarily follow. Depressive behavior can elicit negative feelings and rejectionIn other people. Ultimately a downward spiraling relationship usually results, making the person with depression feel worse. Social rejection may be especially unlikely if the person with depression engages in excessive reassurance seeking.

3) A significant proportion of couples experiencing marital distress have at least one partner with clinical depression, And there is a high correlation between marital dissatisfaction and depression for both women and men. Additionally, A person whose depression has cleared up is likely to relapse it's she has had an unsatisfying marriage. Criticism is highly linked to relapse. Findings suggest that criticism might be associated with relapse and depression because it is capable of activating some of the neural circuits better thought to be involved in depression. People who are vulnerable to depression may be especially sensitive to criticism even after they have made a full recovery.

4) Parental depression also puts children at high risk for many problems but especially for depression, and maternal depression is somewhat larger. Children the parents who are depressed and become depressed themselves tend to become depressed earlier and to show a more severe and persistent course than control children. Some of these effects probably occur because these children inherit a variety of traits such as Temperament, low levels of positive emotion, and poor ability to regulate emotions. Many studies have documented the damaging effects of negative interaction patterns between a mother's with depression and their children. Also genetically determined that vulnerability is clearly involved, psychosocial influences clearly also play an important role, and the evidence is accumulating that inadequate parenting is what mediates the association between parental depression and the children's Depression.

Some people are subject to cyclical changes less severe than the mood swings bipolar disorder. If such symptomsPersist for at least two years, The person may receive a diagnosis of cyclothymic Disorder. This is defined as a less serious version of full-blown bipolar disorder because it lacks certain extreme symptoms and psychotic features such as delusions and the marked impairment caused by full-blown manic or major depressive episodes.

In the depressed phase of this disorder, a persons mood is dejected, he Or she experiences a distinct loss of interest or pleasure in customary activities and pastimes.

In addition, the person may show other symptoms such as low energy, feelings of inadequacy, Social withdrawal, And pessimistic attitude. Essentially, the symptoms are similar to those in someone with dysthymia except without the duration criterion.

Symptoms of the hypomanic phase are essentially the offices of the symptoms of dysthymia. In this phase of the disorder, the person may become especially creative and productive because of increased physical and mental energy. There Maybe significant periods between episodes in which the person with cyclothymia functions in a relatively adaptive manner.

For a diagnosis of cyclothymia, there must be at least a 2-year span during which there are numerous hypomanic and depressive symptoms, and the symptoms must cause clinically significant distress or impairment in functioning. Symptoms cannot meet criteria for major depressive episode. During the above two-year period, the person has not been without symptoms for more than two months at a time. The symptoms cannot better be accounted for by schizoaffective disorder, and are not superimposed on schizophrenia, schizofrineform disorder, delusional disorder, Or psychotic disorder not otherwise specified. Because individuals with cyclothymia are at increase risk of later developing full-blown bipolar one or two disorder, the DSM-TR-IV recommends they be treated.

Although recurring cycles of mania and melancholy were recognized as early as six century, Kraeplin in 1899 first introduced the term manic-depressive insanity and clarified the clinical picture. Today the DSM-TR-IV call this illness bipolar disorder, Although the term manic depressive illness is still common.

Bipolar I disorder: is distinguished from major depressive disorder by at least one manic episode or one mixed episode. A mixed episode is characterized by symptoms of both full-blown manic in major depressive episodes for at least one week, whether the symptoms are intermixed or alternate rapidly every few days.

The cases are increasingly being recognized as relatively common. Studies report that the average of 28% bipolar patients at least occasionally experience mixed states. Moreover, many patients in a manic episode has some symptoms of depressed mood, Anxiety, guilt, and suicidal thoughts, even if these are not severe enough to qualify as a mixed episode. A recent follow-up of people presenting with a full blown mixed episode or even a subthreshold mixed episode has shown that these individuals have a worse long-term outcome than those originally presenting with a depressive or a manic episode.

Even though a Client may be exhibiting only manic symptoms,It is assumed that a bipolar disorder exists and that a depressive episode Will eventually occur. Therefore there are no officially recognized unipolar manic or hypomanic counterparts to dysthymia or major depression.

Although some researchers have noted the probable existence of a unipolar type of manic disorder, critic at this diagnosis are you that such patients usually have bipolar relatives and may well have had a mild depression that went unrecognized.

Bipolar II Disorder, is when the person does not experience full blown manic episode, or mixed episodes, but that has experience clear-cut hypomanic episodes as well as major depressive episodes as in bipolar I disorder. Bipolar II disorder is equally or somewhat more common than bipolar I disorder, And, when combined, estimate I got about 2 to 3% of the US population will suffer from one or the other disorder.

Bipolar II disorder evolves into bipolar I disorder in only 5 to 15% S, suggesting that they are distinct forms of this disorder. Recently a subthreshold form of bipolar II disorder has also been recognized as careful study has shown that as many as 40% of individuals diagnosed with unipolar and MDD have a similar number of hypomanic symptoms, although not with a sufficient number or duration to qualify for a full-blown hypomanic episode.

Results in these studies are leading researchers and clinicians to recognize that unipolar MDD is a far more heterogeneous category than previously recognized.

Bipolar disorder occurs equally in males and females, and usually start in adolescence and young adulthood with an average age of onset of 18 to 22 years. Bipolar II disorder has an average age of onset approximately 5 years later than bipolar I disorder. both Bipolar I and II are typically recurrence disorders, With people experiencing single episodes extremely rarely. In about two-thirds of cases, the manic episode either immediately preceded or immediately following depressive episode. In other cases, the manic and depressive episodes are separated by intervals of relatively normal functioning. Most patients with bipolar disorder experience Times remission, during which they are relatively symptom-free; although this may occur on only about 50% of days. As many as 20 to 30% continued to experience significant impairment and mood liability most of the time. As many as 60% have chronic occupational or interpersonal problems between episodes. As with unipolar major depression, the recurrences can be seasonally nature, which is called bipolar disorder with a seasonal pattern.

The duration of manic and hypomanic episodes tends to be shorter than the duration of depressive episodes, with typically about three times as many days spent depressed as manic or hypomanic.

Although there is a higher degree of overlapping symptoms, comprehensive reviews of the literature reports some significant differences between symptoms of depressive episodes of bipolar disorder and unipolar major depressive episodes.

The most widely replicated differences are that, relative to people with unipolar depressive episodes, people with bipolar depressive episode tend on average, to show more mood liability, psychotic features, psychomotor retardation, and substance abuse. Individuals with unipolar depression, in contrast, show more anxiety, agitation, insomnia, physical complaints, and weight loss. Despite the similarity in symptoms, major depressive episodes in people with bipolar disorder are more severe than those seen in the unipolar depressive disorder, and can cause more role impairment.

Because the person who is depressed cannot be diagnosed with bipolar one disorder unless he or she exhibited at least one manic or mixed episode in the past, many people with bipolar disorder whose initial episode or episodes are depressive (about 50%) I misdiagnosed at first and possibly for the rest of their lives. Estimate between 10 and 50% of people who have an initial major depressive episode will later have a manic or hypomanic episode and will be diagnosed at that time as having bipolar one or two disorder. The younger the person is at the time of the first diagnosis, And the greater the number of recurrent episodes, the more likely he or she is to be diagnosed with bipolar I or II disorder.

Misdiagnoses are unfortunate because there are somewhat different treatment of choice for unipolar and bipolar depression moreover, there is evidence that some antidepressant drugs used to treat what is thought to be for depression may actually precipitate manic episodes in patients with an undetected bipolar disorder, worsening the course of illness.

The probability of full recovery from bipolar disorder is discouraging even with the widespread use of mood stabilizing medication, such as lithium, with one review estimating that patients with bipolar disorder spend about 20% of their lives in episodes. relapse rates are high, and depressive episodes that follow are three times more common than manic symptoms. The long-term course of bipolar disorder is even more severe for patient to have comorbid substance abuse, or dependence disorders.

With PET scans, it has proved possible to visualize variation in brain glucose metabolic rates in depressed and manic state. Far less is found in manic patients due to the difficulty in studying manic behaviour.

Several summaries of the evidence using PET and other Nero imaging techniques, shobaleader flow to the left prefrontal cortex is reduce during depression, and during mania it is increased In certain other products of the prefrontal cortex. Therefore there are shifting patterns of brain activity during mania and during depressed and normal moods.

Others studies show evidence that there are deficits in activity in the prefrontal cortex in bipolar disorder, which seems related to neuropsychological deficits that People with bipolar disorder in problem-solving, Planning, working memory,Shifting attention on set, and sustained attention on cognitive tasks. This is similar to what is seen in unipolar depression, are our deficits in the anterior Cingular cortex. However, structural imaging studies suggest that certain subcortical structures, Including the basal ganglia and an amygdala, Are enlarged in bipolar disorder but reduced in size in unipolar depression.

The decreases in hippocampal volume that are often observed in unipolar depression are generally not found in bipolar depression. Some studies also find increased activation in bipolar patients in subcortical brain regions involved in emotional processing, Such as the thalamus and amygdala, relative to unipolar patients and normals.

Depression occurs in all cultures but the form they take differs widely. In some non-western cultures such as China and Japan for depression rates are relatively low, many of the psychological symptoms of depression are often not present. Instead of people tend to exhibit somatic and vegetative manifestacion such as sleep disturbance, Loss of appetite, weight loss, and loss of sexual interest the psychological component of depression often seeming to be messing are the feelings of guilt, suicidal Ideation, worthlessness and self recrimination, Which are also commonly seen and developed countries.

Even when the psychological symptoms are present, in many cases the effected individuals may think that physical symptoms have more legitimacy and it is more appropriate to review and discuss physical rather than psychological symptoms.

Several possible reasons for the symptom differences stem Front Asian beliefs in the unity of the mind and body, a lack of expressive about emotions more generally, and the stigma attached to mental illness.

Western cultures view the individual as independent and autonomous, so when failure occurs, internal attributions are made. On contrast, individuals in Asian cultures are viewed as inherently independent with others. As countries such as china have embodied certain western values, rates of depression have risen.

Most recent national comorbidity survey replication found that the prevailing rates among African-Americans were slightly lower than White Americans and Hispanics, which were comparable. Lifetime surveillance of major depression was higher in European white Americans Than in African-Americans. Native Americans, by contrast, have significantly elevated rates compared to white Americans, and there are no significant differences among groups for bipolar disorder.

Rates of unipolar depression are inversely related to socioeconomic status; that is higher rates occur in lower socioeconomic groups. This may well be because low SES leads to adversity and life stress. Recent studies have not found bipolar disorder to be related to socioeconomic class. Individuals with a high level of accomplishment in the arts show an elevated risk of mood disorder.

Unipolar and bipolar disorder, but Especially bipolar disorder, occur with alarming frequency in poets, writers, composers, and artists.

One possible hypothesis to explain this relationship is that mania facilitates the creative process, and the intense negative emotional experience of Depression provides material for creative activity.

Many patients who suffer from the disorders never seek treatment, and Even without formal treatment, the great majority of individuals with mania and depression will recover within the year. However, due to the rapid increase in personal suffering identified and a large amount of treatment available, many are seeking treatment for than ever.

Treatments Include Pharmacotherapies such as cognitive behavioral therapy, behavioral activation treatment, interpersonal therapy, and Family and marital therapy.

With the modern methods of treatment, the general outlook for an episode if treatment is obtained, has been increasingly favorable for many, But by no means all. At least half never received even minimally adequate treatment. Although relapse and recurrences often occur, these can now often be prevented or at least reduced in frequency by maintaining therapy.

The mortality rate for individuals with depression is significantly higher than that for the general population. This is in part due to the higher incidence of suicide but also because there is an excess of deaths due to natural causes including coronary heart disease. Patients with mania also have a higher risk of death because of such circumstances as accidents, Neglect of proper health precautions, Or physical exhaustion. There is still a need for more effective treatment methods, both immediate and long-term.

__________________________ (CBT) also known as cognitive therapy, it's one of the two best-known psychotherapies for unipolar depression. It is relatively brief using 10 to 20 sessions, which focused on here and now problems rather than the more remote causal issues that psychodynamic psychotherapy often addresses. Cognitive therapy consists of highly structured, Systematic attempt to teach people with unipolar depression to evaluate systemically their dysfunctional beliefs and negative automatic thoughts.
They are also taught to identify and correct their biases or distortions in information processing and to uncover And challenge their underlying depressogenic assumptions and beliefs. Cognitive therapy relies heavily On an empirical approach in that patients are taught to treat their beliefs as hypotheses that can be tested through the use of behavioral experiments.

The usefulness of cognitive therapy has been well documented. When compared with pharmacotherapy, It is at least as effective when delivered by well-trained cognitive therapists. It also seems to have a special advantage in preventing relapse, Similar to that obtained by staying on medication. Evidence is beginning to accumulate showing that we can prevent recurrence several years following the episode when treatment occurred.

Some recent interesting brain imaging studies have shown that biological changes in certain brain areas that occurred following effective treatment with cognitive therapy versus medications are somewhat different, Suggesting that the mechanism through which they work are also different. One possibility is that medication targets the limbic system, where as cognitive therapy may have greater effect on cortical functions.

Recent evidence suggests that Cognitive behavioral therapy and medications are equally effective in the treatment of severe depression. However, by the end of the two-year follow-up, when all cognitive therapy and medications have been discontinued for one year, only 25% of patients treated with cognitive therapy had a relapse, versus 50% in the medication groups.

until recently, suicide attempts are most common in people that people between 25 and 44 years of age. But now people between 18 and 24 years old have the highest rates.

Women are about three times as likely than men, and about three or four times higher in people who are separated or divorced in attempting suicide. Most attempts occur in the context of interpersonal discourse or other severe life stress.

Completed suicide are far less frequent then attempts. Reports indicate that suicide was the seventh leading cause of death for men and the 15th in women. The only exception to these patterns of gender differences seems to be in people who have bipolar disorder, among whom as many, or more, are women.

The highest rate of suicide is in the elderly age 65 and over. Among elderly victims, a high proportion is divorced or widowed or suffer from a chronic physical illness that can lead to increased risk for suicide often becauseThe person is depressed. Full-blown mental disorders are relatively rare in those elderly persons who commit suicide compared to their prevailing among people in younger age groups.

For women, the method most commonly used is drug indigestion, where men tend to use lethal means that is a gunshot to the head. This may be why completed suicides or higher among men.

People with fairly severe and recurrent mood disorders have the highest risk of suicide at some point in their lives. And those with less severe forms of mood disorders so only as a somewhat elevated risk.

With schizophrenia and alcohol dependence have a slightly higher risk compared to the general population. Rates of attempt and completion are also elevated in an individual with borderline personality disorder and antisocial personality disorder. History of conduct disorder has also been found as a strong predictor in suicide attempts.

The risk for different suicide behaviors may differ as a function of psychopathology. For example, major depression was found to be the strongest risk factor for suicide ideation but not for suicide plans or attempts. In contrast, anxiety, impulse control, and substance use disorders were the strongest predictors of suicide plans and attempts.

Finally, people living alone or with low levels of perceived social support and people from socially disorganized areas are also at a heightened risk. Certain highly creative or successful scientists, Health Professionals, Business people, composers, writers, and Artists are also at a higher than average risk.

Completed suicide among children, while still very low, happened increasing. Hello 10 years of age is very rare, between age 10 to 14 are also rare but the fourth leading cause of death in the United States for that age group. Children are at increased risk for suicide if they have lost a parent or have been abused. Several forms of psychopathology are also known to be risk factors in children.

Mood disorders, Conduct disorder and substance abuse are relatively more and substance abuse are relatively more common in both completers and non-fatal attempter's. Among those with two or more of these disorders, risk for completion increases. Treatment of adolescent disorders with antidepressant medication Also seems to produce a very slightly increased risk for suicidal ideation And behavior in children and adolescents. Why is there such as surge in suicide attempts and completed suicide in adolescents? This is a period during which depression, Anxiety, alcohol and drug use, and conduct disorder problems also show increasing prevalence. These are all factors associated with increased risk for suicide. Increased availability of firearms and exposure to suicide in celebrity media, as they are often portrayed in dramatic terms and adolescents are highly susceptible to suggestions and imitation, may also contribute to prevalence.

College students also seemed very vulnerable to development of suicidal ideation. Academic demands, social interaction problems, and career choices, make it impossible for students to continue making the adjustments their life situations demand.

Impulsivity aggression pessimism and negative affectivity are the most frequently discussed personality traits associated with suicide. Suicide is often associated with negative events such as severe financial reversal, imprisonment, and interpersonal crisis of various sorts. Some believe the common denominator may be that these events lead either to the loss of a sense of meaning in life or to hopelessness about the future coma both of which can produce an mental state that looks to suicide as a possible way out. However, hopelessness about the future maybe a better long term predictor of suicide then it is for short-term. There is also an additional evidence that people who have a strong implicit association between the self and death or suicide is predictive of future suicide attempt, even over and above that affects of other known risk factors.

Other symptoms that seem to protect suicide more reliably in the short term in patients with major depression include severe psychic anxiety, panic attack, severe inability to experience pleasure Global Global insomnia, delusions,And alcohol abuse

Research indicates that suicide is the end product of a long sequence of events that begins in childhood. People who become suicidal often come from backgrounds in which there was some combination of a good deal of family psychopathology, Child maltreatment, family instability. These early experiences are intern associated with the child, and later the adults, having low self-esteem, hopelessness, and poor problem-solving skills. Such experiences may affect the person's cognitive functioning in a very negative way, these cognitive deficits may in turn mediate the link with suicidal behavior.

Substantial differences in suicide rates occur among different ethnic or racial groups in the USA. For example, White have significantly higher rates of suicide that African American, except among young male, where rates are similar between white and African-American men. Only young native American men Show is suicide rates similar to that of white males. Rates also appear to vary considerably from one society to another the USA has a rateAt approximately 11 per hundred thousand. Countries with low rates, less than nine per 100,000, include grease, italy, Spain, and the United Kingdom. Hungry with annual incidents of more than 40 per hundred thousand has the worlds highest rate. Other western countries with high suicide rates include Switzerland, Finland, Austria, Sweden, Denmark, and Germany. These are 20 per 100,000 or higher. Rate in Japan and China are also high and in China the estimated rate is three times the global average. 30% of suicide worldwide are estimated to occur in China and India. The estimate should, however, he considered in light of the fact that there are wide differences across countries in the criteria used for determining whether a death was due to suicide, sex differences may well contribute to the apparent differences in suicide rates. Religious taboos concerning suicide and the attitudes of society towards death are also apparently important determinants of suicidal rate. Both Catholicism and Islam strongly condemns suicide, leading to correspondingly low rates. Japan is one of a few societies in which suicide has been socially approved under certain circumstances - such as conditions that bring disgrace to an individual or group.

There are also interesting cross-cultural gender differences in whether men or women are more likely to attempt and complete suicide. Although women are more likely to attempt and Men to complete in the USA, in India, Poland, Finland men are more likely than women to engage in Nonfatal suicide attempt. In China, India, and Papua New Guinea, Women are more likely to complete suicide.

Ambivalence often accompanies thoughts of suicide. Some people, most often women, do not really rest to die but instead want to communicate a dramatic message to others concerning their distress. They're a tentatively involved nonlethal methodsSuch as minimal drug indigestion or minor wrist slashing. Usually arranged mattersSo that intervention by others is almost inevitable. In stark contrast, a small minority of suicidal people are seemingly intent on dying. They give little or no warning of their intent, and they generally rely on the more violent and certain means of suicide.

I thirds subset of people are ambivalent about dying and tend to leave the question of death to fate. A person in the group may entertain and tend to use methods that are often dangerous but moderately slow acting . After an unsuccessful attempt, A marked reduction in emotional turmoil usually occurs. This reduction in turmoil is usually not stable, however, and subsequent suicidal behavior may follow.

In the year after a suicide attempt, repetition of the behavior occurs in 15 to 25% of cases, and there is an increased risk that the second or third attempt will be fatal, Especially if the first attempt was serious.

If People wished to take their lives, what obligation, or right, to others have to intervene. Not all societies take the position that suicide should be prevented. Greeks believed in the dignity of death. Assisted suicide for terminally il persons is also common in many European countries. The state or Oregon also recently passed the Oregon Death with Dignity Act allowing physician-assisted suicide. Arguments against these positions fear the abuse of this assistance. Those terminally ill may feel pressured to end their lives rather than burden their families, for example. However, this has yet to be seen. Other options are always advocated for first.

But what about the rights of those that are not terminally ill? The right to suicide in these cases is not obvious, and physicians will not likely provide assistance in these cases. The right to death is even less clear when we understand all the possible interventions that people can take use of for the help with their distress.

Suicide intervention over prevention has been focused on in some circles as a more appropriate term for prevention. This embodies a more neutral moral stance.

The prevention argument becomes even harder when the individual required hospitalization. Sometimes considerable rejection is required to calm a patient down. Is this ethical? Moreover, these preventative measures may be fruitless.

This the vexing ethical problems of whether and to what extent one should intervene in cases of threatened suicide have now been complicated by legal problems as a result of preventative measures. As in other areas of professional practice, clinical judgement is no longer the only consideration in interventions decisions. This is a societal problem, and the solutions, if any, will have to be societal ones.

Which medical condition may exist when a patient displays mild symptoms of mania?

What medical condition is associated with mania?

What is a mild level of mania called?

What is mild manic?