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Chapter 7 Mood Disorders and Suicide

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Abnormal Psychology: An Integrative Approach, 4th Edition, David H. Barlow ... Mood Disorders: Familial and Genetic Influences ... – PowerPoint PPT presentation

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Title: Chapter 7 Mood Disorders and Suicide


1
Chapter 7 Mood Disorders and Suicide
2
An Overview of Mood Disorders
  • Mood Disorders
  • Gross deviations in mood
  • Major depressive episodes
  • Manic and hypomanic episodes
  • Types of DSM-IV-TR Depressive Disorders
  • Major depressive disorder
  • Dysthymic disorder
  • Double depression
  • Types of DSM-IV-TR Bipolar Disorders
  • Bipolar I disorder
  • Bipolar II disorder
  • Cyclothymic disorder

3
Major Depression An Overview
  • Major Depressive Episode Overview and Defining
    Features
  • Extremely depressed mood Lasting at least 2
    weeks
  • Cognitive symptoms (e.g., feeling worthless or
    indecisive)
  • Disturbed physical functioning
  • Anhedonia Loss of pleasure/interest in usual
    activities
  • Major Depressive Disorder
  • Single episode Highly unusual
  • Recurrent episodes More common

4
Dysthymia An Overview
  • Overview and Defining Features
  • Milder symptoms of depression than major
    depression
  • Persists for at least 2 years
  • Can persist unchanged over long periods gt 20
    years
  • Facts and Statistics
  • Late onset Typically in the early 20s
  • Early onset Before age 21
  • Greater chronicity, poorer prognosis

5
Double Depression An Overview
  • Overview and Defining Features
  • Major depressive episodes and dysthymic disorder
  • Dysthymic disorder often develops first
  • Facts and Statistics
  • Associated with severe psychopathology
  • Associated with a problematic future course
  • High recurrence rates when dysthymia is left
    untreated

6
Bipolar I Disorder An Overview
  • Overview and Defining Features
  • Alternating full major depressive and manic
    episodes
  • Facts and Statistics
  • Average age on onset is 18 years
  • Can begin in childhood
  • Tends to be chronic
  • Suicide is a common consequence

7
Depression Treatment
8
Bipolar II Disorder An Overview
  • Overview and Defining Features
  • Alternating major depressive and hypomanic
    episodes
  • Facts and Statistics
  • Average age of onset is 22 years
  • Can begin in childhood
  • 10 to 13 of cases progress to full Bipolar I
    disorder
  • Tends to be chronic

9
Mary
10
Cyclothymic Disorder An Overview
  • Overview and Defining Features
  • More chronic version of bipolar disorder
  • Manic and major depressive episodes are less
    severe
  • Manic or depressive mood states persist for long
    periods
  • Pattern must last for at least 2 years for adults
  • Must last at least 1 year for children and
    adolescents
  • Facts and Statistics
  • Average age of onset is about 12 or 14 years
  • Cyclothymia tends to be chronic and lifelong
  • Most are female
  • High risk for developing Bipolar I or II disorder

11
Barbara
12
Additional Defining Criteria for Mood Disorders
Symptom Specifiers
  • Symptom Specifiers
  • Atypical Oversleep, overeat, weight gain,
    anxiety
  • Melancholic Severe depressive and somatic
    symptoms
  • Chronic Major depression only, lasting 2 years
  • Catatonic Absence of movement, very serious
  • Psychotic Mood congruent hallucinations/delusion
    s
  • Mood incongruent features possible, but rare
  • Postpartum Manic or depressive episodes after
    childbirth

13
Additional Defining Criteria for Mood Disorders
Course Specifiers
  • Course Specifiers
  • Longitudinal course
  • Past history of mood disturbance
  • History of recovery from depression and/or mania
  • Rapid cycling pattern For Bipolar I and II
    disorder only
  • Seasonal pattern
  • Depressive symptoms likely during a certain
    seasons

14
  • Figure 7.2 Mood disorders and specifiers for the
    most recent episode of the disorder.

15
Mood Disorders Additional Facts and Statistics
  • Worldwide Lifetime Prevalence
  • 16.1 for Major Depression
  • 3.6 for Dysthymia
  • 1.3 for Bipolar
  • Sex Differences
  • Females are more likely to suffer from major
    depression
  • Difference in depression disappear at age 65
  • Bipolar disorders equally affect males and
    females
  • Fundamentally Similar in Children and Adults
  • Prevalence of Depression Does not Vary Across
    Subcultures
  • Relation Between Anxiety and Depression
  • Most depressed persons are anxious
  • Not all anxious persons are depressed

16
Mood Disorders Familial and Genetic Influences
  • Family Studies
  • Rate is high in relatives of probands
  • Relatives of bipolar probands Risk for unipolar
    depression
  • Adoption Studies
  • Data are mixed
  • Twin Studies
  • Concordance rates are high in identical twins
  • Severe cases have a stronger genetic contribution
  • Heritability rates are higher for females
  • Vulnerability for unipolar or bipolar disorder
  • Appear to be inherited separately

17
Mood Disorders Neurobiological Influences
  • Neurotransmitters
  • Serotonin and its relation with other
    neurotransmitters
  • Mood disorders are related to low levels of
    serotonin
  • The permissive hypothesis
  • Endocrine System
  • Elevated cortisol
  • Dexamethasone suppression test (DST)
  • Dexamethasone depresses cortisol secretion
  • Persons with mood disorders show less suppression
  • Sleep Disturbance
  • Hallmark of most mood disorders
  • Relation between depression and sleep

18
Mood Disorders Psychological Influences (Stress)
  • The Role of Stress in Mood Disorders
  • Stress is strongly related to mood disorders
  • Poorer response to treatment
  • Longer time before remission
  • The relation between context of life events and
    mood
  • Whats good for you may not be good for others
  • Reciprocal-gene environment model

19
Mood Disorders Psychological Influences (Learned
Helplessness)
  • The Learned Helplessness Theory of Depression
  • Related to lack of perceived control over life
    events
  • 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 disrupt many life
    activities
  • All three domains contribute to a sense of
    hopelessness

20
Mood Disorders Psychological Influences (Cogniti
ve Theory)
  • Aaron T. Becks Cognitive Theory of Depression
  • Depressed persons engage in cognitive errors
  • A tendency to interpret life events negatively
  • Types of Cognitive Errors
  • Arbitrary inference Overemphasize the negative
  • Overgeneralization Negatives apply to all
    situations
  • Cognitive Errors and the Depressive Cognitive
    Triad
  • Think negatively about oneself
  • Think negatively about the world
  • Think negatively about the future

21
Beck Triad
  • Figure 7.5 Becks cognitive triad for depression.

22
Mood Disorders Social and Cultural Dimensions
  • Marriage and Interpersonal Relationships
  • Marital dissatisfaction is strongly related to
    depression
  • This link is particularly strong in males
  • Gender Imbalances
  • Females over males
  • Found in all mood disorders, except bipolar
    disorders
  • Gender imbalance likely due to socialization
  • Social Support
  • Related to depression
  • Lack of support predicts late onset depression
  • Substantial support predicts recovery from
    depression

23
Integrative Model of Mood Disorders
  • Shared Biological Vulnerability
  • Overactive neurobiological response to stress
  • Exposure to Stress
  • Activates hormones that affect neurotransmitter
    systems
  • Turns on certain genes
  • Affects circadian rhythms
  • Activates dormant psychological vulnerabilities
  • Contributes to sense of uncontrollability
  • Fosters a sense of helplessness and hopelessness
  • Social and Interpersonal Relationships are
    Moderators

24
  • Figure 7.7 An integrative model of mood disorders.

25
Treatment of Mood Disorders Tricyclic
Medications
  • Widely Used Examples include Tofranil, Elavil
  • Block Reuptake
  • Norepinephrine and Other Neurotransmitters
  • Takes 2 to 8 Weeks for the Effects to be Known
  • Negative Side Effects Are Common
  • May be Lethal in Excessive Doses

26
Treatment of Mood Disorders Monoamine Oxidase
(MAO) Inhibitors
  • Monoamine Oxidase (MAO)
  • Enzyme that breaks down serotonin/norepinephrine
  • MAO Inhibitors Block Monoamine Oxidase
  • MAO Inhibitors Are Slightly More Effective Than
    Tricyclics
  • Must Avoid Foods
  • Containing Tyramine (e.g., beer, red wine, cheese)

27
Treatment of Mood Disorders Selective
Serotonergic Re-uptake Inhibitors (SSRIs)
  • Specifically Block Reuptake of Serotonin
  • Fluoxetine (Prozac) is the most popular SSRI
  • SSRIs Pose No Unique Risk of Suicide or Violence
  • Negative Side Effects Are Common

28
Table 7.7 Efficacy of Various Antidepressant
Drugs for Major Depressive Disorder
29
Treatment of Mood Disorders Lithium
  • Lithium Is a Common Salt
  • Primary drug of choice for bipolar disorders
  • Side Effects May Be Severe
  • Dosage must be carefully monitored
  • How Lithium Works Remains Unclear

30
Treatment of Mood Disorders Electroconvulsive
Therapy (ECT)
  • ECT
  • Involves applying brief electrical current to the
    brain
  • Results in temporary seizures
  • Usually 6 to 10 treatments are required
  • ECT Is Effective for Cases of Severe Depression
  • Side Effects Are Few and Include Short-Term
    Memory Loss
  • Unclear Why ECT Works
  • Relapse Following ECT Is Common

31
Electroconvulsive Therapy
32
Psychological Treatment of Mood Disorders
  • Cognitive Therapy
  • Addresses cognitive errors in thinking
  • Also includes behavioral components
  • Behavioral Activation
  • Involves increased contact with reinforcing
    events
  • Interpersonal Psychotherapy
  • Focuses on problematic interpersonal
    relationships
  • Outcomes with Psychological Treatments
  • Are comparable to medications

33
The Nature of Suicide Facts and Statistics
  • Eighth Leading Cause of Death in the United
    States
  • Overwhelmingly a White and Native American
    Phenomenon
  • Suicide Rates Are Increasing, Particularly in the
    Young
  • Gender Differences
  • Males are more likely to commit suicide
  • Females are more likely to attempt suicide
  • Indices of Suicidal Behavior
  • Suicidal attempts
  • Suicidal ideations

34
The Nature of Suicide Risk Factors
  • Suicide in the Family
  • Low Serotonin Levels
  • Evidence of a Preexisting Psychological Disorder
  • Alcohol Use and Abuse
  • Past Suicidal Behavior
  • Experiencing of a Shameful/Humiliating Stressor
  • Publicity About Suicide and Media Coverage

35
Summary of Mood Disorders
  • All Mood Disorders Share
  • Gross deviations in mood
  • Unipolar or bipolar 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
  • Suicide Is an Increasing Problem
  • Not Unique to Mood Disorders
  • Medications and Psychotherapy Produce Similar
    Results
  • Relapse Rates for Mood Disorders Are High

36
Exploring Mood Disorders
37
Exploring Mood Disorders
38
Exploring Mood Disorders
39
Exploring Mood Disorders
40
Exploring Mood Disorders (cont.)
41
Exploring Mood Disorders (cont.)
42
Exploring Mood Disorders (cont.)
43
Exploring Mood Disorders (cont.)
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