Mood Disorders And Suicide PDF

Northern Luzon Adventist College Artacho, Sison, Pangasinan Department of Psychology Abnormal Psychology MOOD DISORDERS AND SUICIDE Integration of Faith and Learning/Value...

Northern Luzon Adventist College Artacho, Sison, Pangasinan Department of Psychology Abnormal Psychology MOOD DISORDERS AND SUICIDE Integration of Faith and Learning/Values For whatever was written in former days was written for our instruction, that through endurance and through the encouragement of the Scriptures we might have hope. Romans 15:4 Learning objectives Describe the essential features of the different diagnosis under Depressive and Bipolar Disorders Compare and contrast the different diagnosis under Depressive and Bipolar Disorders Identify and discuss the etiological factors that contribute to the development and perpetuation of different disorders in this classification An Overview of Depression and Mania (structure of each episode) Major Depressive Episode (MDE) → Extreme depressed mood state that last at least 2 weeks [fortnight] that includes cognitive symptoms and disturbed physical functions → The most central indicators of full major depressive episode are physical changes (sometimes called somatic or vegetative symptoms), along with the behavioral and emotional “shutdown” as reflected by low behavioral activation Anhedonia → loss of energy and inability to engage in pleasurable activities or have any “fun” → is more characteristic of severe episodes of depression than are, for example, reports of sadness or distress (Pizzagalli, 2014) → reflects that these episodes represent a state of low positive affect and not just high negative affect Mania (Elation, Euphoria, Extreme joy) individuals find extreme pleasure in every activity; some patients compare their daily experience of mania with a continuous sexual orgasm they become extraordinarily active (hyperactive), require little sleep, and may develop grandiose plans, believing they can accomplish anything they desire DSM-5 highlights this feature by adding criteria “persistently increased goal-directed activity or energy” to the “A” criteria speech is typically rapid and may become incoherent, because the individual is attempting to express so many exciting ideas at once; this feature is typically referred to as flight of ideas Prepared by: A. Fiaroque | Depressive Disorders | Bipolar & Related Disorders| 2024  DSM-5 criteria for a manic episode require a duration of at least 1 week, less if the episode is severe enough to require hospitalization. Irritability is often part of a manic episode, usually near the end paradoxically, being anxious or depressed is also commonly part of mania Hypomania Hypo means “below”; thus, the episode is below the level of a manic episode a less severe version of a manic episode that does not cause marked impairment in social or occupational functioning and need last only 4 days rather than a full week is not in itself necessarily problematic, but its presence does contribute to the definition of several mood disorders Types of Depressive Disorders MAJOR DEPRESSIVE DISORDER (MDD) ✓ There is a presence of depression (at least one MDE episode) and the absence of manic, or hypomanic episode before or during the disorder ✓ Very rare to have one isolated depressive episode in a lifetime ✓ If 2 or more MDE occurred and were separated by at least 2 months during which the individual was not depressed, the MDD is noted as being recurrent ✓ Unipolar depression is often a chronic condition that waxes and wanes over time but seldom disappears Symptoms: Begin suddenly, often triggered by a crisis, change, or loss Are extremely severe, interfering with normal functioning Can be long term, lasting months or years if untreated Treatment MDD is often treated with medication and psychotherapy. Some lifestyle adjustments can also help ease certain symptoms. People who have severe MDD or who have thoughts of harming themselves may need to stay in a hospital during treatment. Some might also need to take part in an outpatient treatment program until symptoms improve. PERSISTENT DEPRESSIVE DISORDER (PDD/DYSTHYMIA) ✓ Previously diagnosed as dysthymic disorder and other depressive disorders ✓ long-term unchanging symptoms of mild depression, sometimes lasting 20 to 30 years if untreated ✓ daily functioning not as severely affected, but over time impairment is cumulative ✓ The symptoms of PDD are similar to those of depression. However, the key difference is that PDD is chronic, with symptoms fewer than MDE occurring on most days for at least two years. Diagnostic Criteria: A. A depressed mood almost every day for most of the day 2 or more of the following: B. Having a poor appetite or overeating C. Difficulty falling asleep or staying asleep | Insomnia or hypersomnia Prepared by: A. Fiaroque | Depressive Disorders | Bipolar & Related Disorders| 2024  D. Low energy or fatigue E. Low self-esteem F. Poor concentration or difficulty making decisions G. Feelings of hopelessness For adults to be diagnosed with the disorder, they must experience a depressed mood most of the day, nearly every day, for two or more years. For children or teens to be diagnosed with the disorder, they must experience a depressed mood or irritability most of the day, nearly every day, for at least one year. A. DOUBLE DEPRESSION ✓ alternating periods of major depression/MDE and dysthymia with fewer symptoms Treatment Treatment for PDD consists of medication and talk therapy. Medication is believed to be a more effective form of treatment than talk therapy when used alone. However, a combination of medication and talk therapy is often the best course of treatment. Making certain lifestyle adjustments can complement medical treatments and help ease symptoms. PREMENSTRUAL DYSPHORIC DISORDER Premenstrual dysphoric disorder (PMDD) is a health problem that is similar to premenstrual syndrome (PMS) but is more serious. PMDD causes severe irritability, depression, or anxiety in the week or two before your period starts. Symptoms usually go away two to three days after your period starts. Diagnostic criteria: DSM-5 require that the symptoms of PMDD be present for a minimum of two consecutive menstrual cycles before making a diagnosis of PMDD. According to the guidelines, symptoms must: ✓ be present a week before the onset of menses ✓ resolve after the start and within the first few days of flow ✓ interfere with normal daily living For a PMDD diagnosis to be made, a patient must experience at least five symptoms, including at least one of the following: ✓ feelings of sadness or hopelessness ✓ feelings of anxiety or tension ✓ mood changes or increased sensitivity ✓ feelings of anger or irritability Other symptoms of PMDD can include: apathy to routine activities, which may be associated with social withdrawal difficulty concentrating fatigue changes in appetite sleeping problems, whether excessive sleeping (hypersomnia) or insomnia feeling overwhelmed or having a sense of a lack of control Prepared by: A. Fiaroque | Depressive Disorders | Bipolar & Related Disorders| 2024 Other physical symptoms of PMDD can include breast tenderness or swelling, headaches, joint or muscle pain, bloating, and weight gain. Treatment Two types of medication may help with PMDD: those that affect ovulation and those that impact the central nervous system (CMS). Examples include the use of: SSRI antidepressants such as fluoxetine (Prozac, Sarafem), sertraline (Zoloft), paroxetine (Paxil), and citalopram (Celexa) oral contraceptives that contain drospirenone and ethinyl estradiol gonadotropin-releasing hormone analogs such as leuprolide (Lupron), nafarelin (Synarel) and goserelin (Zoladex) danazol (Danocrine) Cognitive therapy (CT) has been shown to help those with PMS. Combined with medication, CT may also help those with PMDD. DISRUPTIVE MOOD DYSREGULATION DISORDER Diagnostic Criteria: A. Severe recurrent temper outbursts manifested verbally (e.g., verbal rages) and/or behaviorally (e.g., physical aggression toward people or property) that are grossly out of proportion in intensity or duration to the situation or provocation. B. The temper outbursts are inconsistent with developmental level. C. The temper outbursts occur, on average, three or more times per week. D. The mood between temper outbursts is persistently irritable or angry most of the day, nearly every day, and is observable by others (e.g., parents, teachers, peers). E. Criteria A-D has been present for 12 or more months. Throughout that time, the individual has not had a period lasting 3 or more consecutive months without all of the symptoms in Criteria A-D. *The diagnosis should NOT be made for the first time before age 6 years or after age 18 years. *By history or observation, the age at onset of Criteria A-E is before 10 years. Causes The exact causes of DMDD are not clear, although there are a number of factors that are believed to play a role. Such factors may include genetics, temperament, co-occurring mental conditions, and childhood experiences. The disorder appears to be more common during early childhood and is likely to co-occur with other psychiatric conditions, most commonly depressive disorders and oppositional defiant disorder. Treatment and Therapies DMDD is a new diagnosis. Therefore, treatment is often based on what has been helpful for other disorders that share the symptoms of irritability and temper tantrums. These disorders include attention deficit hyperactivity disorder (ADHD), anxiety disorders, oppositional defiant disorder, and major depressive disorder. Prepared by: A. Fiaroque | Depressive Disorders | Bipolar & Related Disorders| 2024 While researchers are still determining which treatments work best, two major types of treatment are currently used to treat DMDD symptoms: Medication Psychological treatments → Psychotherapy → Parent training → Computer based training Psychological treatments should be considered first, with medication added later if necessary, or psychological treatments can be provided along with medication from the beginning. It is important for parents or caregivers to work closely with the doctor to make a treatment decision that is best for their child. BIPOLAR DISORDERS Overview Bipolar disorder, formerly called manic depression, is a mental health condition that causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). When you become depressed, you may feel sad or hopeless and lose interest or pleasure in most activities. When your mood shifts to mania or hypomania (less extreme than mania), you may feel euphoric, full of energy or unusually irritable. These mood swings can affect sleep, energy, activity, judgment, behavior and the ability to think clearly. Episodes of mood swings may occur rarely or multiple times a year. While most people will experience some emotional symptoms between episodes, some may not experience any. Although bipolar disorder is a lifelong condition, you can manage your mood swings and other symptoms by following a treatment plan. In most cases, bipolar disorder is treated with medications and psychological counseling (psychotherapy). Defining Mania/Hypomania Mania and hypomania are two distinct types of episodes, but they have the same symptoms. Mania is more severe than hypomania and causes more noticeable problems at work, school and social activities, as well as relationship difficulties. Mania may also trigger a break from reality (psychosis) and require hospitalization. Both a manic and a hypomanic episode include three or more of these symptoms: Abnormally upbeat, jumpy or wired (euphoria) Exaggerated sense of well-being and self-confidence (grandiosity) Decreased need for sleep Unusual talkativeness Racing thoughts Distractibility Increased activity, energy or agitation Poor decision-making — for example, going on buying sprees, taking sexual risks or making foolish investments Prepared by: A. Fiaroque | Depressive Disorders | Bipolar & Related Disorders| 2024 Defining Major Depressive Episode A major depressive episode includes symptoms that are severe enough to cause noticeable difficulty in day-to-day activities, such as work, school, social activities or relationships. An episode includes five or more of these symptoms:  Depressed mood, such as feeling sad, empty, hopeless or tearful (in children and teens, depressed mood can appear as irritability)  Marked loss of interest or feeling no pleasure in all — or almost all — activities Significant weight loss when not dieting, weight gain, or decrease or increase in appetite (in children, failure to gain weight as expected can be a sign of depression) Either insomnia or sleeping too much Either restlessness or slowed behavior Fatigue or loss of energy Feelings of worthlessness or excessive or inappropriate guilt Decreased ability to think or concentrate, or indecisiveness Thinking about, planning or attempting suicide BIPOLAR I To be considered mania, the elevated, expansive, or irritable mood must last for at least one week and be present most of the day, nearly every day. To be considered hypomania, the mood must last at least four consecutive days and be present most of the day, almost every day. Bipolar 1 may be preceded by a major depressive episode. During this period, three or more of the following symptoms must be present and represent a significant change from usual behavior: 1. Inflated self-esteem or grandiosity 2. Decreased need for sleep 3. Increased talkativeness 4. Racing thoughts 5. Distracted easily 6. Increase in goal-directed activity or psychomotor agitation 7. Engaging in activities that hold the potential for painful consequences, e.g., unrestrained buying sprees BIPOLAR II The depressive side of bipolar II disorder is characterized by a major depressive episode resulting in depressed mood or loss of interest or pleasure in life. This may be preceded by a hypomanic episode, but never a manic one. The hypomanic episode has a minimum duration of 4 days; Although the episode represents a definite change in functioning, it is not enough to cause marked social or occupational impairment or hospitalization. There are no psychotic features Rapid-Cycling Specifier ✓ Unique to bipolar I and II disorders ✓ Individuals with this move quickly in and out of depressive or manic episode ✓ They experience at least 4 manic or depressive episodes within a year ✓ It is a severe variety of bipolar disorder that does not respond well to standard treatments Prepared by: A. Fiaroque | Depressive Disorders | Bipolar & Related Disorders| 2024 CYCLOTHYMIC DISORDER Cyclothymic disorder is a milder but chronic [longer] form of bipolar disorder involving many mood swings, with hypomania and depressive symptoms that occur often and fairly constantly yet not reaching the duration criteria for either bipolar 1 or 2. In short, the swings are short-lived and rapid. It is also important to note that cyclothymia does not have a manic episode. Cyclothymic disorder symptoms include the following: ✓ For at least two years, many periods of hypomanic and depressive symptoms (see above), but the symptoms do not meet the criteria for hypomanic or depressive episode. ✓ During the two-year period, the symptoms (mood swings) have lasted for at least half the time and have never stopped for more than two months Symptoms in Children and Teens Symptoms of bipolar disorder can be difficult to identify in children and teens. It's often hard to tell whether these are normal ups and downs, the results of stress or trauma, or signs of a mental health problem other than bipolar disorder. Children and teens may have distinct major depressive or manic or hypomanic episodes, but the pattern can vary from that of adults with bipolar disorder. And moods can rapidly shift during episodes. Some children may have periods without mood symptoms between episodes. The most prominent signs of bipolar disorder in children and teenagers may include severe mood swings that are different from their usual mood swings. ETIOLOGY OF MOOD DISORDERS Familial and Genetic Influences Family studies High rates on first-degree relatives of probands (2-3X greater) compare to relatives of control group with no mood disorders Relatives of bipolar probands tend to have unipolar depression Twin studies Concordance rates are high in identical twins (2-3X) than fraternal twins Severe mood disorders have strong genetic influence Heritability rates are higher for females compared to males; 40% women and 20% men for depression but may have many different patterns from different groups of genes Some genetic factors are common for depression, anxiety disorders, and panic (not mania though) 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 and contribute to mood irregularities Endocrine system ✓ Elevated cortisol damages the hippocampus and prevents neurogenesis Sleep disturbance ✓ Hallmark of most mood disorders ✓ REM and depression Prepared by: A. Fiaroque | Depressive Disorders | Bipolar & Related Disorders| 2024  ✓ Insomnia and depression linked Psychological Influences Stress and Stressful life events Stress is strongly related to mood disorders o Poorer response to treatment o Longer time before remission The relation between context (interpretation) of life events and mood Reciprocal-gene environment model – more common for depression Relationship between stress and bipolar is also strong Learned Helplessness Proposed by Martin Seligman Learned helplessness (LH) – lack of perceived control over life events LH and a depressive attributional style Internal attributions: negative outcomes are one’s own fault Stable attributions: believing future negative outcomes will be one’s fault Global attribution: believing negative events will disrupt many life activities Cognitive Theory by Aaron Beck, later on improved by his daughter Judith Beck Negative coping styles o Depressed persons engage in cognitive errors o Tendency to interpret negative life events negatively Types of cognitive errors o Arbitrary inference – overemphasize the negative o Overgeneralization – negatives apply to all situations Cognitive triad o Negative cognitions about: the self, the world, and the future o Negative schema – mental representations are always negative or not good Social and Cultural Influences ❖ Marital relations o Marital dissatisfaction is strongly related to depression especially in males ❖ Mood disorders in women o Females over males (70:30) except bipolar disorders (50:50) o Gender imbalance likely due to socialization (perceptions of uncontrollability) ❖ Social support ❖ Extent of social support is related to depression and predicts recovery from depression TREATMENT FOR MOOD DISORDERS For Depressive Disorders – Antidepressants 1. Selective-Serotonin Reuptake Inhibitors (SSRIs) a. Specifically block reuptake of serotonin ❖ Fluoxetine (Prozac) is the most popular SSRI b. SSRIs pose some risk of suicide particularly in teenagers c. Negative side effects 2. Mixed reuptake inhibitors Prepared by: A. Fiaroque | Depressive Disorders | Bipolar & Related Disorders| 2024  ❖ Venlafaxine (Effexor) – blocks norepinephrine as well as serotonin ❖ Nefazodone (Serzone) – improves sleep efficiency ❖ Both have fewer side effects than SSRIs 3. Tricyclic antidepressants a. Previously used medication but is less common today (e.g., Tofranil, Elavil) b. Block reuptake of norepinephrine and other neurotransmitters c. The therapeutic effects can take 2 to 8 weeks d. Negative side effects are common e. May be lethal in excessive doses so not good for suicidal tendencies 4. Monoamine oxidase (MAO) inhibitors a. Block the enzyme MAO that breaks down such neurotransmitters as norepinephrine and serotonin b. Slightly more effective than tricyclics c. Must avoid foods containing tyramine Examples include beer, red wine, and cheese Many patients do not like the dietary restrictions 5. Electroconvulsive Therapy (ECT) – last resort if patient does not respond to medication → Involves applying brief electrical current to the brain → Results in temporary seizures → Administered once every other day for a total of 6-10 treatments → Side effects of short-term memory loss and confusion that later disappear → Continued medication or psychotherapy is necessary because relapse rate approaches 60% or higher → Unknown how and why ECT works For Bipolar Disorders – Lithium 6. Lithium carbonate ✓ Mood-stabilizing drug – effective in preventing and treating manic episodes ✓ Gold standard for treatment of bipolar disorder ✓ Accounted for 50% initial reduction of manic symptoms ✓ Dosage has to be carefully regulated to prevent toxicity & lowered thyroid functioning ✓ Weight gain is common Psychological Treatment for Bipolar Disorders A combination of psychotherapy such as Cognitive-behavioral therapy (CBT) and Family- focused therapy to name a few Medications such as mood stabilizers are aimed to treat the swings. Although it is a life-long prognosis, management of symptoms is the closest to recovery. Psychological Treatments for Depressive Disorder Cognitive-behavioral therapy (CBT) Addresses cognitive errors in thinking Uses Socratic approach (teaching by asking questions) Also includes behavioral components Interpersonal psychotherapy (IPT) Resolving problems in existing relationships and learning to form new ones Identifies stressors and focuses on problematic interpersonal relationships Prepared by: A. Fiaroque | Depressive Disorders | Bipolar & Related Disorders| 2024 SUICIDE 11th leading cause of death in US Alarming increasing in death by suicide among adolescents At risk adolescents have access to firearm Dramatic increase in suicide rates among the elderly due to medical illness and loss of social support Suicide is the 5th leading cause of death from ages 5-14 In China, more women commit suicide than men, particularly in rural settings. Suicide, particularly among women, is often portrayed in classic Chinese literature as a reasonable solution to problems. A rural Chinese women’s family is her entire world, and suicide is an honorable solution if the family collapses. Furthermore, high toxic farm pesticides are readily available, and it is possible that many women who did not necessarily intend to kill themselves die after accidentally swallowing a poison. Suicidal gestures – giving away prized possessions as initial way of saying goodbye; this also suggest self-injuries who intend not to die but to influence somebody or communicate a cry for help Suicidal ideation – thinking seriously about suicide Suicidal plans – the formulation of specific method for killing oneself Suicidal attempts – the person survives after trying to oneself Prepared by: A. Fiaroque | Depressive Disorders | Bipolar & Related Disorders| 2024