PSY110P-Chapter-7-Mood-Disorders-and-Suicide.pptx

MOOD DISORDERS AND SUICIDE Understanding and Defining Mood Disorders  Mood disorders “Depressive disorders” “Affective disorders” “Depressive neuroses” Gross deviations in mood ○ Depression ○ Mania Mood Disorders   Disorders, such as depressive disorders or mania, in which there are di...

MOOD DISORDERS AND SUICIDE Understanding and Defining Mood Disorders  Mood disorders “Depressive disorders” “Affective disorders” “Depressive neuroses” Gross deviations in mood ○ Depression ○ Mania Mood Disorders   Disorders, such as depressive disorders or mania, in which there are disabling disturbances in emotion. Mood – Long and sustained feeling tone.  Emotion – A psychological and physiological reaction to a stimulus  Affect – An outward manifestation of emotion. Mood Episodes  Major Depressive Episode  Manic Episode  Mixed Episode  Hypomanic Episode Major Depressive Episode  Major depressive episode  Extreme depression  2 weeks  Cognitive symptoms  Physical dysfunction  Anhedonia  Duration—4 to 9 months, untreated Manic Episode  Manic episode  Exaggerated elation, joy, euphoria  1 week, or less  Cognitive symptoms  Duration—3 to 4 months, untreated  Hypomanic episode Mixed Episode and Hypomanic Episode Mixed Episode  Presence of Manic Episode and Major Depressive Episode nearly every day during at least a 1–week period. Hypomanic Episode  4 days symptoms similar to manic episode but not does not require hospitalization Depressive Disorders Structure of Mood Disorders  Unipolar disorders Depression or mania alone Typically depression  Bipolar disorders Depression and mania Dysphoric manic episode Mixed manic episode Depressive Disorders  Major depressive disorder, single episode  No mania/hypomania  Single episode ○ Rare  Major depressive disorder, recurrent  4 – 7 episodes (lifetime)  Duration—4 to 5 months Persistent Depressive Disorder (Dysthymia)  Milder symptoms  2+ years  Chronic  Persistent  Double Depression  Major depressive episodes and dysthymic disorder  Dysthymia first  Severe psychopathology  Poor course Additional Defining Criteria for Depressive Disorders - Symptom Specifiers Psychotic features ○ Hallucinations ○ Delusions Anxious distress ○ Comorbid disorders or anxiety symptoms Mixed features ○ At least 3 symptoms of mania Melancholic ○ Severe somatic symptoms  Atypical features ○ Oversleeping and overeating  Catatonic features ○ Catalepsy  Peripartum onset ○ 13 -19% meet criteria for depression  Seasonal pattern ○ Seasonal affective disorder (SAD) ○ 2.7% of population ○ Melatonin Phototherapy ○ CBT  Onset and duration Onset average 30 years old for depression ○ 5-12 years 5% ○ 13-17 years 19% ○ 18-23 years 24% ○ 24-30 years 16% Duration 2 weeks to several years for depression Early onset has poor prognosis in dysthymic disorder Dysthymic disorder may last 20 to 30 years New DSM 5 Depressive Disorder  2- 5% of women meet criteria  Disruptive Mood Dysregulation Disorder  Children have increased diagnosis for bipolar 40% between 1995 and 2005 ○ Severe recurrent temper outbursts, at least three times per week, in response to common stressors ○ Persistent negative mood between temper outbursts most days, and the negative mood is observable to others. ○ Age 6 or higher (or equivalent developmental level). Onset before age 10 ○ Temper outbursts or negative mood are present in at least two settings (at home, at school, or with peers) and are severe in at least one setting. From Grief to Depression  Depression frequently follows loss  Integrated grief - Grief that evolves from acute grief into a condition in which the individual accepts the finality of a death and adjusts to the loss.  Complicated grief - Grief characterized by debilitating feelings of loss and emotions so painful that a person has trouble resuming a normal life; designated for further study as a disorder by DSM-5. develops into a full-blown mood disorder.  Pathological or impacted grief reaction  Extreme reaction to the death of a loved one that involves psychotic features, suicidal ideation, or severe loss of weight or energy or that persists more than 2 months. ○ Note: DSM IV- TR does not qualify individuals under bereavement as clinically depressed. DSM 5 does. DSM 5 TR Prolonged Grief Disorder    happen when someone close to the bereaved person has died within at least 6 months for children and adolescents, or within at least 12 months for adults. In prolonged grief disorder, the bereaved individual may experience intense longings for the deceased or preoccupation with thoughts of the deceased, or in children and adolescents, with the circumstances around the death. These grief reactions occur most of the day, nearly every day for at least a month. The individual experiences clinically significant distress or impairment in social, occupational, or other important areas of functioning.  • • • • • • • • Some of the symptoms of prolonged grief disorder are: Identity disruption (e.g., feeling as though part of oneself has died). Marked sense of disbelief about the death. Avoidance of reminders that the person is dead. Intense emotional pain (e.g., anger, bitterness, sorrow) related to the death. Difficulty moving on with life (e.g., problems engaging with friends, pursuing interests, planning for the future). Emotional numbness. Feeling that life is meaningless. Intense loneliness (i.e., feeling alone or detached from others). Bipolar Disorder  Bipolar I  Bipolar II  Alternating major  Alternating major depressive and manic episodes depressive and hypomanic episodes  Single manic episode  Recurrent ○ Symptom-free for 2 months Cyclothymic Disorder  Alternating manic and depressive episodes  Less severe  Persists longer  Chronic symptoms  Adults = symptoms more than 2 years  Children and adolescents = symptoms more than 1 year  Statistics  Chronic  Risks for Bipolar I/II Etiology of Mood Disorders  Neurobiological Factors  Social Factors  Psychological Factors Neurobiological Factors Genetics  37 percent for MDD based on the comparison of MZ and DZ.  93 percent for bipolar disorders.  Higher heritability for females Neurotransmitters  Depression – Low norepinephrine, dopamine, serotonin levels Dopamine plays a major role in the sensitivity of the reward system in the brain, which is believed to guide pleasure, motivation, and energy in the context of opportunities to obtain rewards. Some research suggests that diminished function of the dopamine system could help explain the deficits in pleasure, motivation, and energy in major depressive disorder. Mania is also linked to hypersensitive dopamine receptors. Brain-Imaging Studies  Amygdala - The amygdala helps a person to assess how emotionally important a stimulus is. Functional brain activation studies show elevated activity of the amygdala among people with MDD.  Subgenual Anterior cingulate – greater activation for MDD  Hippocampus – MDD has diminished activity of the hippocampus.  Dorsolateral prefrontal cortex – diminished activity  Striatum – responsible for reactions to reward, is overly active for Mania Neuroendocrine System: Cortisol Dysregulation   there is evidence that the amygdala is overly reactive among people with MDD, and the amygdala sends signals that activate the HPA axis. The HPA axis triggers the release of cortisol, the main stress hormone. Cortisol is secreted at times of stress and increases activity of the immune system to help the body prepare for threats. Cushing’s syndrome - which causes oversecretion of cortisol, frequently experience depressive symptoms. Psychological Factors in Depression  Neuroticism - a personality trait that involves the tendency to react to events with greater-than-average negative affect, predicts the onset of depression.  As you would expect, neuroticism is associated with anxiety as well as dysthymia. Cognitive Theories  Beck’s Theory Cognitive Bias - tendencies to process information in certain negative ways. Negative/Cognitive Triad – negative views about: ○ Self ○ World ○ Future  Hopelessness Theory - an expectation that (1) desirable outcomes will not occur and that (2) the person has no responses available to change this situation.  Rumination Theory - Rumination is defined as a tendency to repetitively dwell on sad experiences and thoughts, or to chew on material again and again. The most detrimental form of rumination may be a tendency to brood or to regretfully ponder why an episode happened. Predictors of Mania  Reward Sensitivity - Researchers have demonstrated that people with bipolar disorder describe themselves as highly responsive to rewards on a self-report measure.  Sleep Disruption - Experimental studies indicate that sleep deprivation can precede the onset of manic episodes. Social and Cultural Dimensions  Marriage and Interpersonal Relationships Relationship disruption precedes depression ○ Strongest effects for males Martial conflict vs. marital support Gender differences in causal direction Social and Cultural Dimensions  Mood Disorders in Women Prevalence: Females > males True for all mood disorders ○ Except bipolar Social and Cultural Dimensions  Mood Disorders in Women Gender roles ○ Perceptions of uncontrollability ○ Socialization Access to resources Social and Cultural Dimensions Social and Cultural Dimensions  Social Support Related to depression Lack of support ○ predicts late onset depression Substantial support ○ predicts recovery for depression (not mania) Treatment of Mood Disorders  Changing the chemistry of the brain Medications ECT Psychological treatment Antidepressant Medications  Tricyclics (Tofranil, Elavil) Frequently used for severe depression Block reuptake/down regulate ○ Norepinephrine ○ Serotonin 2 to 8 weeks to work Many negative side effects Lethality Antidepressant Medications  Monoamine Oxidase (MAO) Inhibitors Block MAO Higher efficacy Fewer side effects Interactions ○ Foods ○ Medicines Selective MAO-Is Antidepressant Medications  Selective Serotonin Reuptake Inhibitors (SSRI) Fluoxetine (Prozac) First treatment choice Block presynaptic reuptake No unique risks ○ Suicide or violence Many negative side effects  Mixed reuptake inhibitors Blocking reuptake of norepinephrine as well as serotonin Lithium  Mood-stabilizing drug Common salt Primary treatment for bipolar disorders Unsure of mechanism of action Narrow therapeutic window ○ Too little—ineffective ○ Too much—toxic, lethal Electroconvulsive Therapy  Electroconvulsive Therapy (ECT) Brief electrical current Temporary seizures 6 to 10 treatments High efficacy ○ Severe depression Few side effects Relapse is common Transcranial Magnetic Stimulation  Transcranial magnetic stimulation (TMS) Localized electromagnetic pulse Fewer side effects Efficacy is likely good More studies needed  Vagus nerve stimulation Psychological Treatments for Depression  Cognitive Therapy Identify errors in thinking Correct cognitive errors Substitute more adaptive thoughts Correct negative cognitive schemas  Behavioral therapy Increased positive events Exercise Psychological Treatments for Depression  Interpersonal Psychotherapy (IPT) Address interpersonal issues in relationships ○ Role disputes ○ Loss ○ New relationships ○ Social skill deficits Stage of dispute ○ Negotiation stage ○ Impasse stage. ○ Resolution stage Psychological Treatments for Depression  CBT and IPT Outcomes Comparable to medications More effective than: ○ Placebo ○ Brief psychodynamic treatment Combined Treatments for Depression  Possible benefits above individual treatments 48% benefit from meds or CBT 73% benefit from combined Suicide Terms      Suicidal ideation - thinking seriously about suicide Suicidal plans - the formulation of a specific method for killing oneself Suicidal attempts - the person survives Attempters - self-injurers with the intent to die Gesturers - self-injurers who intend not to die but to influence or manipulate somebody or communicate a cry for help. Statistics in Suicide  Caucasians High incidence  Rapid increase among teenagers 16 – 30% of suidical ideation results to attempts 3rd leading cause of death 2nd leading cause of death among college students  Gender Men are 4 times likely to commit suicide in all ages (except in China) Men uses violent methods Women are 3 times more likely to attempt Types of suicide (Durkheim, a sociologist)     Altruistic - an individual who brought dishonor to himself ought to commit suicide; individual’s death is perceived as a means of helping others Egoistic – loss of social support Anomic – loss of social prestige such a job Fatalistic – loss of control over one’s destiny Psychological autopsy  Extensive assessment of an individual after death Risk Factors     Family history – incidence of suicide in the family Neurobiology – low levels of serotonin Preexisting disorder - More than 80% of people who kill themselves suffer from a psychological disorder, usually mood, substance use, or impulse control disorders Alcohol and drug use and abuse - 25% to 50% of suicides and are particularly evident in suicide among college students  Stressful life event  Shameful/humiliating stressor  Suicide publicity and media coverage