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Mood Disorders and Suicide

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Chapter 6 Mood Disorders and Suicide * Stressful life events 20-50% of people develop a mood disorder Context of the life event single mother loses job and ... – PowerPoint PPT presentation

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Title: Mood Disorders and Suicide


1
Chapter 6
  • Mood Disorders and Suicide

2
Range of Emotions
  • A person with a mood disorder experiences
    emotions that are extreme and, therefore,
    abnormal.

3
Types of depressive disorders
  • Major depressive disorder
  • Dysthymic disorder
  • Double depression

4
Major Depression An Overview
  • Major depressive episode Overview and defining
    features
  • Extremely depressed mood lasting at least two
    weeks
  • Cognitive symptoms feelings of worthlessness,
    indecisiveness
  • Disturbed physical functioning (sleep and eating)
  • Anhedonia loss of pleasure/interest in usual
    activities

5
Major Depression An Overview
  • Major depressive disorder
  • Single episode highly unusual
  • Recurrent episodes (2 or more major depressive
    episodes separated by at least 2 months of no
    depression) more common
  • From grief to depression
  • Pathological or impacted grief reaction

6
Major Depression An Overview
  • Major depressive disorder
  • Mean age is 30
  • Typical first episode is 4-9 months if untreated

7
Dysthymia An Overview
  • Overview and defining features
  • Symptoms are milder than major depression
  • Persists for at least two years in adults, one
    year in children and adolescents
  • No more than two months symptom free
  • Symptoms can persist unchanged over long periods
    ( 20 years)
  • Facts and statistics
  • Late onset typically in the early 20s

8
Double Depression An Overview
  • Overview and defining features
  • Major depressive episodes and dysthymic disorder
  • Dysthymic disorder often develops first
  • Associated with severe psychopathology and
    problematic future course
  • High relates of relapse

9
Types of bipolar disorders
  • Bipolar I disorder
  • Bipolar II disorder
  • Cyclothymic disorder

10
The Structure of Mood Disorders
  • Mania
  • Hypomanic episode less severe than manic
    episode that lasts at least 4 days

11
The Structure of Mood Disorders
  • Features of a manic episode
  • Elevated, expansive mood for at least one week
  • At least 3 of the following
  • Inflated self-esteem, decreased need for sleep,
    excessive talkativeness, flight of ideas or sense
    that thoughts are racing, easy distractibility,
    increase in goal-directed activity or psychomotor
    agitation, excessive involvement in pleasurable
    but risky behaviors
  • Impairment in normal functioning

12
Bipolar I Disorder An Overview
  • Overview and defining features
  • Alternations between full manic or mixed episodes
    and (but not necessarily) depressive episodes
    and/or hypomania
  • Facts and statistics
  • Average age of onset is 15-18 years
  • Can begin in childhood
  • Tends to be chronic and acute
  • Suicide is a common consequence as high as 48
    (usually during depressive episodes)

13
Bipolar II Disorder An Overview
  • Overview and defining features
  • Alternations between major depressive and
    hypomanic episodes
  • Facts and statistics
  • Average age of onset is 19-22 years
  • Can begin in childhood
  • 10 to 25 of cases progress to full bipolar I
    disorder
  • Tends to be chronic

14
Cyclothymic Disorder An Overview
  • Overview and defining features
  • Milder but more chronic version of bipolar
    disorder
  • hypomanic and dysthymic episodes that last a long
    time
  • Must last for at least two years (one year for
    children and adolescents)

15
Cyclothymic Disorder An Overview
  • Facts and statistics
  • Average age of onset is 12 to 14 years
  • 60 are female
  • chronic and lifelong
  • 1/3 to 1/2 develop bipolar

16
Prevalence of Mood Disorders
  • Worldwide lifetime prevalence
  • 16 for major depression
  • Sex differences
  • Females are twice as likely to have major
    depression
  • Bipolar disorders equally affect males and
    females
  • 1 for bipolar disorder

17
Prevalence of Mood Disorders
  • Occurs less often in prepubertal children
  • Rapid rise in adolescence
  • Adults over 65 have about 50 less than adults
  • Three-month-olds can show depression
  • Children below nine do not show classic mania or
    bipolar symptoms
  • Mood disorders are often misdiagnosed as ADHD
  • Children are being diagnosed with bipolar at
    increasingly high rates

18
Life Span Developmental Influences on Mood
Disorders
  • Depression in elderly between 14 and 42
  • Comorbidity with anxiety disorders
  • Less gender imbalance after 65 years of age
  • Cultural differences exist
  • Hopi Native Americans - Heartbroken
  • Native American population - 4 X the rate

19
Mood Disorders Familial and Genetic Influences
  • Family studies
  • Rate is high in first-degree relatives of
    probands (2-3 x greater)
  • Relatives of bipolar probands tend to have
    unipolar depression
  • Twin studies
  • Concordance rates are high in identical twins
    (2-3 x)
  • Severe mood disorders have strong genetic
    influence
  • Heritability rates are higher for females
    compared to males 40 women and 20 men for
    depression

20
Mood Disorders Familial and Genetic Influences
  • Twin studies
  • Vulnerability for unipolar or bipolar disorder
  • Appears to be inherited separately
  • Some genetic factors are common for mood and
    anxiety disorders (not mania though)

21
Mood Disorders Neurobiological Influences
  • Neurotransmitter systems
  • Low Serotonin and its relation to other
    neurotransmitters causes mood disorders
  • Permissive hypothesis when serotonin is low,
    other neurotransmitters are permitted to become
    dysregulated

22
Mood Disorders Neurobiological Influences
  • The endocrine system
  • Elevated cortisol damages the hippocampus and
    prevents neurogenesis
  • Sleep disturbance
  • Hallmark of most mood disorders
  • REM and depression
  • Insomnia and depression linked

23
Mood Disorders Psychological Dimensions (Stress)
  • Stressful life events
  • Stress is strongly related to mood disorders
  • Poorer response to treatment
  • Longer time before remission
  • The relation between context (interpretation) of
    life events and mood
  • Reciprocal-gene environment model
  • Relationship between stress and bipolar is also
    strong

24
Mood Disorders Psychological Dimensions (Learned
Helplessness)
  • Learned helplessness (LH)- Lack of perceived
    control over life events
  • LH and a depressive attributional style
  • Internal attributions
  • Negative outcomes are ones own fault
  • Stable attributions
  • Believing future negative outcomes will be ones
    fault
  • Global attribution
  • Believing negative events will disrupt many life
    activities

25
Mood Disorders Psychological Dimensions
(Becks Cognitive Theory)
  • Negative coping styles
  • Depressed persons engage in cognitive errors
  • Tendency to interpret life events negatively
  • Types of cognitive errors
  • Arbitrary inference overemphasize the negative
  • Overgeneralization negatives apply to all
    situations

26
Mood Disorders Psychological Dimensions
(Cognitive Theory)
  • Cognitive errors and the depressive cognitive
    triad
  • Think negatively about oneself, the world and the
    future
  • Negative schema

27
Mood Disorders Social and Cultural Dimensions
  • Marital relations
  • Marital dissatisfaction is strongly related to
    depression especially in males
  • Mood disorders in women
  • Females over males (7030) except bipolar
    disorders (5050)
  • Gender imbalance likely due to socialization
    (perceptions of uncontrollability)
  • Social support
  • Extent of social support is related to depression
    and predicts recovery from depression

28
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29
An Integrative Theory
  • Shared biological vulnerability
  • Overactive neurobiological response to stress
  • Inadequate coping and depressive cognitive style
  • Diathesis-stress model
  • Biological, psychological and social factors all
    influence the development of mood disorders
  • Exposure to stress

30
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31
Treatment of Mood Disorders Selective
Serotonergic Reuptake Inhibitors (SSRIs)
  • Specifically block reuptake of serotonin
  • Fluoxetine (Prozac) is the most popular SSRI
  • SSRIs pose some risk of suicide particularly in
    teenagers
  • Negative side effects

32
Treatment of Mood Disorders Mixed Reuptake
Inhibitors
  • Venlafaxine (Effexor)- blocks norepinephrine as
    well as serotonin
  • Nefazodone (Serzone) improves sleep efficiency
  • Both have fewer side effects than SSRIs

33
Treatment of Mood Disorders Monoamine Oxidase
(MAO) Inhibitors
  • Monoamine oxidase (MAO)
  • Block monoamine oxidase enzyme that breaks down
    serotonin and norepinephrine
  • Slightly more effective than tricyclics
  • Must avoid foods containing tyramine
  • Examples include beer, red wine, cheese
  • Many patients do not like the dietary
    restrictions

34
Treatment of Mood Disorders Tricyclic
Antidepressants
  • Used to be widely used (e.g., Tofranil, Elavil)
  • Block reuptake
  • Norepinephrine and other neurotransmitters
  • Therapeutic effects
  • Can take two to eight weeks
  • Negative side effects are common
  • May be lethal in excessive doses so not good for
    suicidal tendencies

35
Treatment of Mood Disorders Lithium
  • Lithium carbonate is a common salt
  • Primary drug of choice for bipolar disorders (50
    reduction in symptoms)
  • Can be toxic
  • Side effects may be severe
  • Dosage must be carefully monitored
  • Lithium is a mood-stabilizing drug
  • Why lithium works remains unclear

36
Treatment of Mood Disorders Electroconvulsive
Therapy (ECT)
  • ECT is effective for cases of severe depression
  • The nature of ECT
  • Involves applying brief electrical current to the
    brain
  • Results in temporary seizures
  • Usually six to 10 outpatient treatments are
    required
  • Side effects are few and include short-term
    memory loss
  • Uncertain why ECT works
  • Relapse is common (60)

37
Psychosocial Treatments
  • Cognitive-behavioral therapy
  • Addresses cognitive errors in thinking
  • Also includes behavioral components
  • Interpersonal psychotherapy
  • Identifies stressors and focuses on problematic
    interpersonal relationships
  • Prevention
  • Combined treatments for depression more effective
    (73 versus 48)
  • Prevention relapse of depression
  • Psychosocial treatments for bipolar

38
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39
The Nature of Suicide Facts and Statistics
  • 11th leading cause of death in the United States-
    maybe two to three times higher
  • Overwhelmingly a white and Native American
    phenomenon
  • China and suicide rates (more females)
  • Suicidal ideation - thinking seriously about
    suicide
  • Suicidal plan formulation of a specific method
  • Suicidal attempt person survives

40
The Nature of Suicide Facts and Statistics
  • Gender differences
  • Males are more successful at committing suicide
    than females
  • Females attempt suicide more often than males

41
The Nature of Suicide Risk Factors
  • Risk factors
  • Suicide in the family
  • Low serotonin levels
  • Preexisting psychological disorder
  • Alcohol use and abuse
  • Stressful life event
  • Past suicidal behavior
  • Suicide contagion
  • Treatment

42
Summary of Mood Disorders
  • All mood disorders share
  • Gross deviations in mood
  • Common biological and psychological vulnerability
  • Occur in children, adults, and the elderly
  • Onset, maintenance, and treatment are affected by
  • Stress
  • Social support

43
Summary
  • Suicide is an increasing problem
  • Not unique to mood disorders
  • Medications and psychotherapy produce comparable
    results
  • High rates of relapse

44
DSM-5 Proposed Changes
  • http//www.dsm5.org/ProposedRevisions/Pages/MoodDi
    sorders.aspx
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