UNIT 6: MOOD DISORDERS AND SUICIDE PDF

1|Page UNIT 6: MOOD DISORDERS AND SUICIDE Understanding and Defining Mood Disorders Disorders of mood can be so incapacitating that violent suicide may seem by far a better option than living. The DSM-5 recognizes two broad types of mood diso...

1|Page UNIT 6: MOOD DISORDERS AND SUICIDE Understanding and Defining Mood Disorders Disorders of mood can be so incapacitating that violent suicide may seem by far a better option than living. The DSM-5 recognizes two broad types of mood disorders: those that involve only depressive symptoms and those that involve manic symptoms (bipolar disorders). Mood disorders –characterized by gross deviations in mood. The most commonly diagnosed and most severe depression is called a major depressive disorder. The episode is typically accompanied by general loss of interest in things and an inability to experience ant pleasure from life. Evidence suggests that the most central indicators of a full major depressive episode are the physical changes (somatic or vegetative symptoms), along with the behavioral and emotional “shutdown” Anhedonia –loss of energy and inability to engage in pleasurable activities or have any “fun”. Anhedonia reflects that these episodes represent a state of low positive affect and not just high negative affect. Duration if untreated: approximately 4 to 9 months. Diagnostic Criteria for Major Depressive Disorders A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. 1. Depressed mood most of the day, nearly every day as indicated by subjective report or observations made by others. 2. Markedly diminished interest or pleasure in all or almost all activities, most of the day, nearly every day. 3. Significant weight loss or change in appetite 4. Sleeping too much or too little 5. Psychomotor retardation or agitation 6. Loss of energy (fatigue) 7. Feelings of worthlessness or excessive guilt 8. Difficulty concentrating, thinking, or making decisions 9. Recurrent thoughts of death or suicide B. The symptoms caused clinically significant distress or impairment in social, occupational, or other important areas of functioning. Compiled by: Ms. Laarni D. Muzones, MSPsy, RPsy ABNPSY330 Abnormal Psychology 2|Page C. The symptoms are not due to the direct physiological effects of a substance or a general medical condition. The second fundamental state in mood disorders is abnormally exaggerated elation, joy, or euphoria. In mania, individuals find extreme pleasure in every activity. 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 “persistently increased goal-directed activity or energy” to the “A” criteria. Flight ideas –typically rapid and incoherent speech because the individual is attempting to express so many exciting ideas at once. Duration if untreated: typically 3 to 4 months Hypomanic episode –a less severe form of a manic episode. Does not caused a marked impairment in social or occupational functioning & need Last only for 4 days rather than a full week. Hypomanic episode is not in itself necessarily problematic, but its presence does contribute to the definition of several mood disorders. Diagnostic Criteria for Manic Episode A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day, nearly every day. B. During the period of mood disturbance and increased energy activity, 3 (or more) of the following symptoms (4 if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior: 1. Inflated self-esteem or grandiosity 2. Decrease needs for sleep 3. More talkative than usual or pressure to keep talking 4. Flight of ideas or subjective experience that thoughts are racing 5. Distractibility 6. Increased in goal-directed behavior or psychomotor agitation 7. Excessive involvement in activities that have a high potential for painful consequences C. The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization Compiled by: Ms. Laarni D. Muzones, MSPsy, RPsy ABNPSY330 Abnormal Psychology 3|Page D. The episode is not attributable to the physiological effects of a substance or to another general medical condition. The Structure of Mood Disorders Individuals who experience either depression or mania are said to suffer from a unipolar mood disorder, because their mood remains at one “pole” of the usual depression-mania continuum. Someone who alternates between depression and mania is said to have a bipolar mood disorder traveling from one “pole” of the depression-elation continuum to the other back again. Depressive Disorders A. Major Depressive Disorder (Clinical Depression) The most easily recognized mood disorder. Absence of manic or hypomanic episodes before or during the disorder. If two or more major depressive episodes occurred and were separated by at least 2 months during which the individual was not depressed, the major depressive disorder is noted as recurrent. Diagnostic Criteria for Major Depressive Disorder A. At least one major depressive episode 1. Depressed mood most of the day, nearly every day as indicated by subjective report or observations made by others. 2. Markedly diminished interest or pleasure in all or almost all activities, most of the day, nearly every day. 3. Significant weight loss or change in appetite 4. Sleeping too much or too little 5. Psychomotor retardation or agitation 6. Loss of energy (fatigue) 7. Feelings of worthlessness or excessive guilt 8. Difficulty concentrating, thinking, or making decisions 9. Recurrent thoughts of death or suicide B. The occurrence is not better explained by other mental disorders. C. There has never been a manic episode or hypomanic episode. Specifiers: ▪ Single episode or recurrent episode (Mild, Moderate, Severe) ▪ With anxious distress ▪ With mixed features ▪ With melancholic features ▪ With atypical features Compiled by: Ms. Laarni D. Muzones, MSPsy, RPsy ABNPSY330 Abnormal Psychology 4|Page ▪ With mood-congruent psychotic features ▪ With mood-incongruent psychotic features ▪ With catatonia ▪ With peripartum onset ▪ With seasonal pattern (recurrent episode only) ▪ In partial remission, in full remission B. Persistent Depressive Disorder (Dysthymia) Shares many of the symptoms of major depressive disorder but differs in its course. Defined as depressed mood that continues at least 2 years, during which the patient cannot be symptom free for more than 2 months at a time even though they may not experience all the symptoms of a major depressive episode. Differ from a major depression disorder in the number of symptoms required, but mostly in the chronicity It is considered more severe, since patients with persistent depression present with higher rates of comorbidity with other mental health disorders, are less responsive to treatment, and show slower rate of improvement over time. Diagnostic Criteria for Persistent Depressive Disorder (Dysthymia) A. Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years. B. Presence, while depressed, of two (or more) of the following: 1. Poor appetite or overeating 2. Insomnia or hypersomnia 3. Low energy or fatigue 4. Low self-esteem 5. Poor concentration or difficulty making decisions 6. Feelings of hopelessness C. During the 2-year period of the disturbance, the person has never been without the symptoms in Criterion A and B for more than 2 months at a time. D. Criteria for major depressive disorder may be continuously present for 2 years. E. There has never been a manic episode or a hypomanic episode. F. The disturbance is not better explained by other mental disorders. G. The symptoms are not attributable to the physiological effects of a substance or another medical condition. Compiled by: Ms. Laarni D. Muzones, MSPsy, RPsy ABNPSY330 Abnormal Psychology 5|Page H. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Specifiers: ▪ Current severity: Mild, Moderate, Severe ▪ With anxious distress ▪ With mixed features ▪ With melancholic features ▪ With atypical features ▪ With mood-congruent psychotic features ▪ With mood-incongruent psychotic features ▪ With peripartum onset ▪ Early onset: If onset is before age 21 years old ▪ Late onset: If onset is at the age of 21 years or older Additional Defining Criteria for Depressive Disorders 1. Psychotic features specifiers -experience of: Hallucinations & delusions (mood congruent) Somatic (physical) delusions On rare occasions, might have other types of hallucinations or delusions such as delusions of grandeur that do not seem consistent with the depressed mood (mood incongruent) Mood congruent –directly related to depression Mood incongruent signifies a serious type of depressive episode that may progress to schizophrenia 2. Anxious distress specifier –the presence and severity of accompanying anxiety, whether in the form of comorbid anxiety disorders. For all depressive and bipolar disorders, the presence of anxiety indicates a more severe condition, makes suicidal thoughts, and completed suicide more likely and predicts a poorer outcome from treatment. 3. Mixed features specifiers –predominantly depressive episodes that have several (at least three) symptoms of mania. 4. Melancholic features specifiers –include some of the more severe somatic symptoms, such as early morning awakenings, weight loss, loss of libido, excessive or inappropriate guilt, and anhedonia 5. Catatonic features specifier –involves an absence of movement (a stuporous state) or catalepsy. Catatonic symptoms may also involve excessive but random or purposeless movement. 6. Atypical features specifier –consistent oversleeping and overeating during the depression and therefore, the individual gains weight, leading to a higher incident of diabetes. Compiled by: Ms. Laarni D. Muzones, MSPsy, RPsy ABNPSY330 Abnormal Psychology 6|Page 7. Peripartum features specifier: Peri means “surrounding”, in this case the period of time just before and just after birth. 8. Seasonal pattern specifier: Accompanies episodes that occur during certain seasons. These episodes must have occurred for at least two years with no evidence of non-seasonal major depressive episodes occurring during that period of time. This condition is called Seasonal Affective Disorder (SAD) From Grief to Depression Unexpected death of a significant person in one’s life could cause initial reactions to the trauma, a number of depressive symptoms as well as anxiety, emotional numbness, and denial. The natural grieving process has peaked within the first 6 months. Acute grief evolves into integrated grief in which the finality of death and its consequences are acknowledge and the individual adjusts to the loss. The concern of most mental health professionals is when a person does not grieve after death. Grieving is our natural way of confronting and handling loss. When grief lasts beyond typical time, mental health professionals again become concerned At this stage, suicidal thoughts increase substantially and focus mostly on joining the beloved deceased. Many of the psychological and social factors related to mood disorders in general, including a history of past depressive episodes, also predict the development of the syndrome of complicated grief. Complicated grief is now included as a diagnosis requiring further study in section III of DSM-5 NORMAL and COMPLICATED GRIEF Common symptoms of acute grief that are within normal limits within the first 6-12 months after: 1. Recurrent, strong feelings of yearning, wanting very much to be reunited with the person who died; possibly even a wish to die to be with deceased loved one. 2. Pangs of deep sadness or remorse, episodes of crying or sobbing, typically interspersed with periods of respite and even positive emotions 3. Steady of stream thoughts or images of deceased, may be vivid or even entail hallucinatory experiences of seeing or hearing deceased person. 4. Struggle to accept the reality of the death, wishing to protest it; there may be some feelings of bitterness or anger about the death 5. Somatic distress 6. Feeling disconnected from the world or other people, indifferent, not interested, or irritable with others. Compiled by: Ms. Laarni D. Muzones, MSPsy, RPsy ABNPSY330 Abnormal Psychology 7|Page Symptoms of integrated grief that are within normal limits: 1. Sense of having adjusted to the loss. 2. Interest and sense of purpose, the ability to function, and capacity for joy and satisfaction are restored. 3. Feelings of emotional loneliness may persist 4. Feelings of sadness and longing tend to be in the background but still present 5. Thoughts and memories of the deceased person accessible and bittersweet but not longer dominate the mind 6. Occasional hallucinatory experiences of the deceased may occur 7. Surges of grief in response to calendar days or other periodic reminders of the loss may occur Complicated Grief 1. Persistent intense symptoms of acute grief 2. The presence of thoughts, feelings, or behaviors reflecting excessive or distracting concerns about the circumstances or consequences of the death C. Diagnostic Criteria for Premenstrual Dysphoric Disorder A. In most menstrual cycles during the past year, at least five of the following symptoms from sections B and C were present in the final week before menses, improved within a few days of menses onset, and became minimal in the week after menses. B. At least 1 of the following symptoms: 1. Affective lability 2. Irritability 3. Depressed mood, hopelessness, or self-deprecating thoughts 4. Anxiety C. At least 1 of the following symptoms: 1. Diminished interest in usual activities 2. Difficulty concentrating 3. Lack of energy 4. Changes in appetite, overeating, or food craving 5. Sleeping too much or too little 6. Subjective sense of being overwhelmed or out of control 7. Physical symptoms such as breast tenderness or swelling, joint or muscle pain, bloating, or weight gain Compiled by: Ms. Laarni D. Muzones, MSPsy, RPsy ABNPSY330 Abnormal Psychology 8|Page D. Symptoms lead to significant distress or functional impairment. E. Symptoms are not an exacerbation of another mood or anxiety disorder or personality disorder. F. Symptoms are confirmed with prospective daily ratings over two cycles. G. Symptoms are present when oral contraceptives are not being taken. D. Disruptive Mood Dysregulation Disorder A. Severe recurrent temper outbursts, including verbal or behavioral expressions of temper that are out of proportion in intensity or duration to the provocation. B. Temper outbursts are inconsistent with developmental level. C. The temper outbursts tend to occur at least three times per week. D. Negative mood between temper outbursts is observable to others on most days. E. These symptoms have been present for at least 12 months and do not clear for more than 3 months at a time. F. Temper outbursts and negative mood are present in at least two settings (at home, at school, or with peers) and are severe in at least one setting. G. Diagnosis should not be made before age 6 or after age 18 years. H. Age of onset for Criteria A-E is before age 10. I. There has never been a distinct period lasting more than 1 day during which elevated mood and at least three other manic symptoms were present J. The behaviors do not occur exclusively during the course of major depressive disorder and are not better accounted for by another mental disorder. K. This diagnosis can not coexist with oppositional defiant disorder, intermittent explosive disorder, or bipolar disorders. Bipolar Disorders Key identifying feature: tendency of manic episodes to alternate with major depressive episodes in an unending roller-coaster ride from peaks of elation to depths of despair. Three forms: Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder The bipolar disorders are differentiated by how severe and long-lasting the manic symptoms are. These disorders are labeled “bipolar” because most people who experience mania will also experience depression during their lifetime (mania and depression are considered opposite poles). Compiled by: Ms. Laarni D. Muzones, MSPsy, RPsy ABNPSY330 Abnormal Psychology 9|Page An episode of depression is not required for a diagnosis of bipolar I, but it is required for a diagnosis of bipolar II disorder. Mania is a state of intense elation or irritability accompanied by other symptoms. Hypomania is “under”—less extreme than—mania. Mania involves significant impairment, hypomania does not. During manic episodes, people will act and think in ways that are highly unusual compared to their typical selves. They may be difficult to interrupt and may shift rapidly from topic to topic, reflecting an underlying flight of ideas. During mania, people may become sociable to the point of intrusiveness. They can also become excessively self-confident. Unfortunately, they can be oblivious to the potentially disastrous consequences of their behavior, which can include imprudent sexual activities, overspending, and reckless driving. Hypomania involves a change in functioning that does not cause serious problems. The person with hypomania may feel more social, flirtatious, energized, and productive. A. Bipolar Disorder I The criteria for diagnosis of bipolar I disorder (formerly known as manic-depressive disorder) include a single episode of mania during the course of a person’s life. NOTE: A person who is diagnosed with bipolar I disorder may or may not be experiencing current symptoms of mania. More than half of people with bipolar I disorder experience four or more episodes. (See criteria for manic episode) In fact, even someone who experienced only 1 week of manic symptoms years ago is still diagnosed with bipolar I disorder B. Bipolar Disorder II To be diagnosed with bipolar II disorder, a person must have experienced at least one major depressive episode and at least one episode of hypomania. Diagnostic Criteria for Bipolar Disorder II A. Criteria have been met for at least one hypomanic episode and at least one major depressive episode. Criteria for a hypomanic episode are identical to those for manic episode with the following distinctions: (1) Minimum duration is 4 days; (2) Although the episode represents a definite change in functioning, it is not severe enough to cause marked social or occupational impairment or hospitalization; (3) There are no psychotic features. Compiled by: Ms. Laarni D. Muzones, MSPsy, RPsy ABNPSY330 Abnormal Psychology 10 | P a g e B. There has never been a manic episode C. The occurrence of the hypomanic episode(s) and major depressive episode(s) is not better explained by other psychotic disorders D. The symptoms of depression or the unpredictability caused by frequent alterations between periods of depression and hypomania causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. Specify current or most recent episode: Hypomanic: If currently (or most recently) in a hypomanic episode Depressed: If currently (or most recently) in a major depressive episode Specify if: with anxious distress with mood-congruent psychotic features with mixed features with mood-incongruent psychotic features with rapid cycling with peripartum onset with catatonia with seasonal pattern C. Cyclothymia A milder but more chronic version of bipolar disorder. Similar in many ways to persistent depressive disorder Chronic alternation of mood elevation and depression that does not reach the severity of manic or major depressive episodes. Diagnostic Criteria for Cyclothymia A. For at least 2 years (at least 1 year in children and adolescents) there have been numerous periods with hypomanic symptoms that do not meet the criteria for a hypomanic episode and numerous periods with depressive symptoms that do not meet criteria for a major depressive episode. B. During the above 2-year period, the hypomanic and depressive periods have been present for at least half the time and the individual has not been without the symptoms for more than 2 months at a time. C. Criteria for a major depressive, manic, or hypomanic episode have never been met. D. The symptoms in criterion A are not better explained by psychotic disorders E. The symptoms are not attributable to physiological effects of a substance or another medical condition F. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Compiled by: Ms. Laarni D. Muzones, MSPsy, RPsy ABNPSY330 Abnormal Psychology 11 | P a g e Specify if: with anxious distress Rapid-Cycling Specifier A specifier that is unique to bipolar I and II disorders. Some people move quickly in and out of depressive or manic episodes. In most cases, rapid cycling tends to increase in frequency over time and can reach severe states in which patients cycle between mania and depression without any break (rapid switching or rapid mood switching) An individual with bipolar disorder who experiences at least four manic or depressive episodes within a year is considered to have a rapid-cycling pattern Learned Helplessness According to the learned helplessness theory of depression, people become depressed when they believe they have no control over the stress in their lives. The depressive attributional style is: Internal -the individual attributes negative events to personal failings Stable -even after a particular negative event passes, the attribution that “additional bad things will always be my fault” remains Global -attributions extend across a variety of issues. Suicide Suicide involves behaviors that are intended to cause death and actually do so. Suicide does not just occur in high-income countries but is a global phenomenon in all regions of the world. In fact, over 77% of global suicides occurred in low- and middle-income countries in 2019 (Who, 2019). The Mental Health Act of the Philippines was passed in 2018, and by 2020, there was a 149-percent increase in the average monthly calls for urgent help received by the National Center for Mental Health. In 2021, the Philippine Statistics Authority nonetheless reported that deaths caused by suicide rose by 57.3 percent from 2020. Indices of Suicidal Behavior Suicidal ideations -thinking seriously about suicide Suicidal plans-the formulation of a specific method for killing oneself Suicidal attempts -the person survives Nonsuicidal self-injury -intents to injure oneself without the intent to kill oneself Compiled by: Ms. Laarni D. Muzones, MSPsy, RPsy ABNPSY330 Abnormal Psychology 12 | P a g e Types of Suicide Altruistic suicide -an individual who brought dishonor to himself or his family is expected to impale himself. Egoistic suicide -individuals kill themselves after losing touch with their friends or family. Anomic suicide -the result of marked disruptions (e.g., sudden loss of high-prestige job) Fatalistic suicide -results from a loss of control over one’s own identity. Risk Factors Family History Neurobiology Existing Psychological Disorders and other Psychological Risk Factors Stressful Life Events References: Durand, V. & Barlow, D. (2016). Essentials of Abnormal Psychology. 7th Edition. Boston, MA 02210 USA. Hoeksema, S. (2014). Abnormal Psychology. 6th Edition. McGraw-Hill International Edition. New York. (2013). Diagnostic and Statistical Manual of Mental Disorders. 5th Edition. American Psychiatric Association. Washington, DC. London, England Compiled by: Ms. Laarni D. Muzones, MSPsy, RPsy ABNPSY330 Abnormal Psychology