1. dysphoria
2. anhedonia
3. lack of drive
4. changes in appetite, sleep, and activity levels
5. thoughts of hopelessness, guilty, and worthlessness 

1. recurrent
2. with melancholic features
3. with catatonic features
4. with postpartum onset
5. with seasonal pattern
6. with psychotic features

1. reinstate reinforcing activities
2. contingency management
3. training in social skills 

1. Negative views of the self.
2. Negative views of experiences.
3. Negative views of the future.  

(Lewinsohn et al., 2001)

Adolescents with dysfunctional attitudes who experienced high stress were more likely to develop major depression.

Global vs. Specific

Stable vs. Unstable

Internal vs. External

Alloy, Abramson, & Francis, 1999

Prospective study of college students and attributional styles.

Hopeless attributional style

• 17% first onset
• 27% with history relapsed

Optimistic attributional style

• 1% first onset
• 6% with history relapsed

1. interpersonal loss
2. interpersonal disuptes
3. role transitions
4. interpersonal deficits

Caspi et al., 2003

Stressful life events and depression diagnoses.

1. prefrontal cortex
2. Brodmann area 25
3. hippocampus
4. amygdala 

1. Monoamine (MAO) inhibitors
2. tricyclic antidpressants
3. selective serotonin reuptake inhibitors (SSRIs) 

1. mood
2. thoughts
3. increased self-estseem
4. activity 

1. delusions
2. schizoaffective diagnosis
3. rapid cycling
4. mixed states
5. noncomliance with meds 

1. Neurotransitter abnormalities (serotonin and norepinephrine)
2. Second messengers (ion activity; lithium)
3. Brain structure (enlarged ventricles) 

1. Sodium lactate infusion
2. CO2 inhalation
3. Placebo infusion
4. Hyperventilation 

1. Norepinephrine
2. Locus ceruleus 

1. past history of violence.
2. substance abuse.
3. medication noncompliance (lack of insight).
4. paranoid symptoms or command hallucinations. 

Kendra was killed in 1999, at age 32, when she was pushed under the subway. 

Goldstein had attacked 8 people prior to her and had been hospitalized 15 times. He reported having an uncontrollable urge to push a blonde woman under the subway.

Assisted Outpatient Treatment

(Outpatient Commitment)

1. Much cheaper to treat than to put in jail.
2. Improves public saftey by preventing crimes by untreated mentally ill.
3. Recidivism rate for first 6 years was 14% (as opposed to 67% overall). 

Self-murder.

Death from ijury, poisoning, or suffocation where there is evidence that the injury was self-inflicted and that the decendent intended to kill himself.

A suicide is a self-injurious act with a fatal outcome.

Simulated notes gave more details about the circumstances and thoughts leading up to the imagined suicide.

Authentic notes had more hoplessness without description of why as well as practical advice.

• will to live
• risk taking beahvior
• suicidal ideation
• suicide attempts and suicide

1. Death Seeker
2. Death Initiator
3. Death Ignorer
4. Daeth Darer 

1. Egoistic Suicide
2. Altruistic Suicide
3. Anomic Suicide
4. Fatalistic Suicide 

Severe depression is far more prdictive of suicide than just mild depression. If coupled with agitation or substance abuse is the worst combination.

None: 8.3 per 100,000

Mild: 0 per 100,000

Moderate: 220 per 100,000

Severe: 3,900 per 100,000

Egeland and Sussex, 1985

Family pedigree study of Amish families.

of 26 confirmed suicies, 25 had mood disorders. Mood disorders tended to run in families.

Only 4 families accounted for 73% of all of the suicides.

Roy, 1992

Follow-up study of 92 people who had been hospitalized following suicide attempt.

High Serotonin: In the next year, 3 committed suicide.

Low Serotonin: In the next year, 8 committed suicide.

Schneidman

Goals and Techniques at Suicide Prevention Center

1. establish a positive relationship.
2. understand and clarify the problem.
3. assess and mobilize client's resources.
4. formulate a plan.