Chapter 7 Mood Disorders and Suicide

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Chapter 7Mood Disorders and Suicide
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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

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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

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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

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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

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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

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Depression Treatment
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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

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Mary
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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

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Barbara
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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

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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

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

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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

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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

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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

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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

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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

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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

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Beck Triad

• Figure 7.5 Becks cognitive triad for depression.

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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

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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

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• Figure 7.7 An integrative model of mood disorders.

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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

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Treatment of Mood DisordersMonoamine 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)

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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

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Table 7.7 Efficacy of Various Antidepressant
Drugs for Major Depressive Disorder
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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

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Treatment of Mood DisordersElectroconvulsive
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

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Electroconvulsive Therapy
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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

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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

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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

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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

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Exploring Mood Disorders
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Exploring Mood Disorders
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Exploring Mood Disorders
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Exploring Mood Disorders
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Exploring Mood Disorders (cont.)
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Exploring Mood Disorders (cont.)
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Exploring Mood Disorders (cont.)
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Exploring Mood Disorders (cont.)