Mood Disorders and Suicide PDF

Mood Disorders and Suicide Disorders to discussed on this chapter: 1. Major Depressive Disorder 2. Persistent Depressive Disorder 3. Seven Subtypes of Depressive Episodes Anxious distress Mixed features Melancholic features Psychotic features Catatonic features Atypical...

Mood Disorders and Suicide Disorders to discussed on this chapter: 1. Major Depressive Disorder 2. Persistent Depressive Disorder 3. Seven Subtypes of Depressive Episodes Anxious distress Mixed features Melancholic features Psychotic features Catatonic features Atypical features Seasonal pattern Peripartum onset 4. Manic Episode 5. Bipolar I 6. Bipolar II 7. Cyclothymic Disorder 8. Disruptive mood dysregulation 9. Suicide  Characteristics of Depressive Episodes  Symptoms of Depression Anhedonia is a loss of interest or pleasure in once-enjoyed activities. Anhedonia symptoms can be classified into two categories: Physical anhedonia makes it difficult to enjoy sensory pleasures. Examples: (Foods, Sex) Social anhedonia find it difficult to enjoy social interactions. For example, someone who used to like getting together with their friends for breakfast is now uninterested in attending these gatherings or answering phone calls. Changes in appetite -overeating/decrease in appetite Sleep disturbance - hypersomnia/insomnia Behaviorally - psychomotor agitation/retardation Emotion - Feeling of sadness, guilt, worthlessness, hopelessness and suicide. Unexplainable pain in the body Some are experiencing hallucinations and delusions. Diagnosing Depressive Disorders Major Depressive Disorder (MDD) or (clinical depression) has intense or overwhelming symptoms that last longer than two weeks.  Persistent Depressive Disorder (formerly dysthymic disorder and chronic major depressive disorder) more chronic form of depression. Has it essential feature of depressed mood for most of the day, for more days than not for at least 2 years. In children and adolescents, PDD requires at least 1 year of irritable mood and 2 or more symptoms of depressive symptoms.  What is the difference of MDD to PDD? None. If one individual meets the diagnostic criteria for MDD for 2 years, he/she may is also given a diagnosis of PDD.  Subtypes of Major Depressive Episodes Anxious distress - Prominent anxiety symptom. Mixed features - Presence of at least three manic/hypomanic symptoms, but does not meet criteria for a manic episode. Melancholic features - inability to experience pleasure, distinct depressed mood, depression regularly worse in morning, dare, morning awakening, marked psychomotor retardation or agitation, significant anorexia or weight loss. excessive guilt. Psychotic features - Presence of mood-congruent or mood-incongruent delusions or hallucinations Catatonic features - catatonic behaviors: not actively relating to environment, mutism, posturing,, mimicking "another's speech or movements. Atypical features - Positive mood reactions to some events, significant weight gain or increase in appetite, hypersomnia, heavy or leaden feelings in arms or legs, long-standing pattern of sensitivity to interpersonal rejection. Seasonal pattern - History of at least two years in which major depressive episodes occur during one season of the year (usually the winter) and remit when the season is over. Peripartum Onset - Onset of major depressive episode during pregnancy or in the 4 weeks following delivery  Premenstrual Dysphoric Disorder Some women regularly experience significant increases in distress during the premenstrual phase of their menstrual cycle. Their symptoms are often a mixture of depression, anxiety and tension, and irritability and anger, which may occur in mood swings during the week before the onset of menses, improve once menses has begun, and become minimal or absent in the week postmenses. These women also often report physical symptoms such as: breast tenderness or swelling, bloating and weight gain, and joint and muscle pain. Only about 2 percent of women meet the diagnostic criteria for premenstrual dysphoric disorder. Prevalence and Course of Depressive Disorders Women are about twice likely as men to experience both mild and severe depressive symptoms. Close to 1 in 10 young adults (8.9%) in the Philippines experience moderate to severe depressive symptoms. Good news, people who undergo treatment tend to recover quickly that they would without treatment and reduce the risk of relapse. Bad news, people with depression either never seek help or wait years before they seek care. With most terrible symptoms of depression don't seek for these reasons: They don't have money or they expect get better on their own and that will pass with time that won't affect their life. Characteristics of Bipolar Episodes  Symptoms of Mania The mood of people who are manic can be elated, but that elation is often mixed with irritation and agitation. People with mania have unrealistically positive and grandiose (inflated) self-esteem. They experience racing thoughts and impulses. At times, these grandiose thoughts are delusional and may be accompanied by grandiose hallucinations. People experiencing a manic episode may speak rapidly and forcefully, trying to convey a rapid stream of fantastic thoughts. They may engage in a variety of impulsive behaviors such as sexual indiscretions or shopping sprees. Often, they will frenetically pursue grand plans and goals.  Bipolar I (Manic-Depressive Disorder) Meeting all the criteria of manic episode eventually these people will fall into a depressive episode. Mania without depression is rare. They have mixed episodes in which they experience full criteria for manic and atleast 3 key symptoms of MDD in the same day, everyday for at least 1 week.  Bipolar II Severe episodes of depression that meet the criteria for major depression, but the episodes of mania is milder known as hypomania. Hypomania involves same symptoms as mania. The major difference is in hypomania symptoms are not severe enough to interfere with daily functioning, no hallucinations and delusions and last at least 4 consecutive days.  Cyclothymic Disorder less severe but more chronic type of bipolar. alternates between hypomanic and period of depressive episodes chronically a 2-year period. Note: The length of an individual episode of bipolar disorder varies greatly from one person to the next. Some people are in a manic state for several weeks or months before moving into a depressed state. More rarely, people switch from mania to depression and back within a matter of days or, even in the same day. Rapid cycling bipolar I or bipolar II disorder. The number of lifetime episodes also varies tremendously from one person to the next. Four or more mood episodes that meet criteria for manic, hypomanic, or major depressive episode within 1 year.  Disruptive Mood Dysregulation Disorder more classic bipolar on children a young person must show severe temper outbursts that are grossly out of proportion in intensity and duration to a situation and inconsistent with developmental level. During an outburst, these children may rage at others verbally and become physically violent toward others. To receive the diagnosis, a child must have at least three temper outbursts per week for at least 12 months and in at least two settings (e.g., home and school).  Theories in Depression Depression is one the most researched of all psychological disorders.  Biological Theories Genetic Factors Family history studies find that the first-degree relatives of people with major depressive disorder are two to three times more likely to also have depression. Twin studies of major depression find higher concordance rates for identical twins than for fraternal twins, implicating genetic processes in the disorder. Depression that begins early in life appears to have a stronger genetic base than depression that begins in adulthood (Levinson, 2010). Neurotransmitters Theories The neurotransmitters that have been implicated most often in depression are the monoamines, specifically, norepinephrine, serotonin, and, to a lesser extent, dopamine. These neurotransmitters are found in large concentrations in the limbic system, a part of the brain associated with the regulation of sleep, appetite, and emotional processes. The early theory of the role of these neurotransmitters in mood disorders was that depression is caused by a reduction in the amount of norepinephrine or serotonin in the brain.  Psychological Theories Learned Helplessness Theory suggests that the type of stressful event most likely to lead to depression is an uncontrollable negative event. Such events, especially if they are frequent or chronic, can lead people to believe they are helpless to control important outcomes in their environment. In turn, this belief in helplessness leads people to lose their motivation and to reduce actions on their part that might control the environment as well as leaving them unable to learn how to control situations that are controllable. Example: Battered women may develop the be lief that they cannot control their beatings or other parts of their lives. This belief may explain their high rates of depression and their tendency to remain in abusive relationships. Cognitive Negative Triad Aaron Beck (1967) argued that people with depression look at the world through a negative cognitive triad: They have negative views of themselves, the world and the future. They ignoring good events and exaggerating negative events. Their negative thinking both causes and perpetuates their depression. Many studies have demonstrated that people with depression show these negative ways of thinking, and some longitudinal studies have shown that these thinking styles predict depression over time. Interpersonal Theories Depressed people are more likely than nondepressed people to have chronic conflict in their relationships with family, friends, and co-workers (Hammen, 2005). Some depressed people have a heightened need for approval and expressions of support from others but at the same time easily perceive rejection by others, a characteristic called rejection sensitivity. They engage in excessive reassurance seeking, constantly looking for assurances from others that they are accepted and loved. They never quite believe the affirmations other people give, however, and anxiously keep going back for more. Gender Differences women are about twice as likely as men to suffer from depression. men are more likely than women to turn to alcohol to cope and to deny that they are distressed, while women are more likely than men to ruminate about their feelings and problems Men therefore may be more likely to develop disorders such as alcohol abuse, while women's tendency to ruminate appears to make them more likely to develop depression. Treatment of Mood Disorders SUICIDE  Defining and Measuring Suicide Suicide Suicide is among the three leading causes of death worldwide among people ages 15 to 44 (World Health Organization [WHO], 2012). The Centers for Disease Control and Prevention (CDC), one of the federal agencies in the United States that tracks suicide rates, defines suicide as "death from injury, poisoning, or suffocation where there is evidence (either explicit or implicit) that the injury was self-inflicted and that the decedent intended to kill himself /herself." Suicide Attempts may or may not end. Suicide Ideation thoughts Nonsuicidal Self-Injury Some people, most of the time adolescent repeatedly cut, burn, puncture, otherwise significantly injure their skin with no intent to die. people who engage to NSSI are increased of suicidal attempts. people who engage to this reports that the experience of feeling the pain and seeing blood actually calms them and release tension. Historical Perspective on Suicide In the classic work of Emil Durkheim focused on the mindsets certain societal conditions can create that increase the risk for suicide. He proposed that there are 3 types of suicide. 1. Egoistic 2. Anomic 3. Altruistic Egoistic Suicide is committed by people who feel alienated from others, empty of social contacts, and alone in an unsupportive world. The patient with schizophrenia who kills herself because she is completely isolated from society may be committing egoistic suicide. Anomic Suicide is committed by people who experience severe disorientation because of a major change in their relationship to society. A man who loses his job after 20 years of service may feel anomie, a complete confusion of his role and his worth in society, and may commit anomic suicide. Altruistic suicide is committed by people who believe that taking their life will benefit society. It is the sacrifice of one's life in order to save or benefit others, for the good of the group, or to preserve the traditions and honor of a society. Psychological Disorders and Suicide More than 90 percent of people who commit suicide probably have been suffering from a diagnosable mental disorder Depression increases the odds of a suicide attempt by approximately 6 times, and bipolar disorder increases the odds of a suicide attempt by 7 times. By far the best predictor of future suicidal thoughts and behavior is past suicidal thoughts and behavior (Borges et al., 2008, 2010).  It is critically important that suicidal thoughts and behaviors be assessed and that intervention be made, regardless of what other psychological problem they may have. Stress life events and Suicide studies across cultures have shown that a variety of stressful life events increase the risk of suicide (Borges et al., 2010). A large cross-national study found that interpersonal violence, especially sexual abuse, is the traumatic event most strongly linked to suicidal thoughts and attempts Loss of a loved one through death, divorce, or separation is also consistently related to suicide attempts or completions (Tacobson & Gould, 2009). People feel they cannot go on without the lost relationship. Another stressful event consistently linked to increased vulnerability to suicide is economic hardship (Borges et al., 2010; Fanous, Prescott, & Kendler, 2004). Loss of a job, for example, can precipitate suicidal tendencies. Finally, a large international study found that physical illness, especially if it occurred early in lifé, was a risk factor for suicidal ideation, plans, and attempts even in people who did not have mental disorder (Scott et al., 2010). The illness most strongly related to suicidal thoughts and behavior was epilepsy. Can suicide be contagious? Suicide Cluster Scientist refer to when two or more suicides or attempted suicides are non-randomly bunched together in space or time, such as a series of suicide attempts in the same high school or a series of completed suicides in response to the suicide of a celebrity or someone they believe. Suicide clusters occur not among close friends but among people who are linked by media exposure to the suicide of a stranger, often a celebrity. Some studies have suggested that suicide rates at least among adolescents, increase after publicized suicide. Personality and Cognitive Factors Impulsivity is the best characteristics that seems predict suicide best. Hopelessness is the cognitive variable that has most predicted suicide, the feeling that the future is bleak and there is no way to make it more positive. Biological Factor to Suicide Suicide runs in families. For example, one study found that the children of parents who had attempted suicide were 6 times more likely to also attempt suicide than were the children of parents who had a mood disorder but had not attempted suicide. Many studies have found a link between suicide and low levels of the neurotransmitter serotonin. For example, postmortem studies of the brains of people who committed suicide find low levels of serotonin. Also, people with a family history of suicide or who have attempted suicide are more likely to have abnormalities on genes that regulate serotonin Treatment and Prevention Crisis Intervention Lithium Dialectal Behavior Therapy What should you do if you suspect that a friend or family member is suicidal? The Depression and Bipolar Support Alliance (2008), a patient-run advocacy group, makes the following suggestions in Suicide and Depressive Illness: 1. Take the person seriously. Although most people who express suicidal thoughts do not go on to attempt suicide, most people who do commit suicide have communicated their suicidal intentions to friends or family members beforehand. 2. Get help. Call the person's therapist or any other source of professional mental health care. 3. Express concern. Tell the person concretely why you think he or she is suicidal. 4. Pay attention. Listen closely, maintain eye con-tact, and use body language to indicate that you are attending to everything the person says. 5. Ask direct questions about whether the person has a plan for suicide and, if so, what that plan is. 6. Acknowledge the person's feelings in a nonjudgmental way. For example, you might say something like 'I know you are feeling really horrible right now, but I want to help you get through this" or 'I can't begin to completely understand how you feel, but I want to help you." 7. Reassure the person that things can be better. Emphasize that suicide is not a permanent solution to a temporary problem. 8. Don't promise confidentiality. You need the freedom to contact mental health professionals and tell them precisely what is going on. 9. Make sure guns, old medications, and other means of self-harm are not available. 10. If possible, don't leave the person alone until he or she is in the hands of professionals. Go with him or her to the emergency room if need be. Then, once he or she has been hospitalized or has received other treatment, follow up to show you care. 11. Take care of yourself. Interacting with a person who is suicidal can be extremely stressful and disturbing. Talk with someone you trust about it perhaps a friend, family member, or counselor particularly if you worry about how you handled the situation or that you will find yourself in that situation again. END!